1. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Program Emphasis on Spirituality and Adoption of Evidence-based Practices J. Aaron Johnson, Ph.D. Center for Research on Behavioral Health and Human Services Delivery The University of Georgia

2. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Background Substantial resources devoted to identifying both barriers to and facilitators of adoption of evidence- based practices in addiction treatment –NIDA CTN –SAMHSA ATTC’s –RWJF Advancing Recovery Initiative Previous research found negative relationship between counselor’s belief in 12-step model and attitudes toward EBPs, particularly pharmacotherapies Present study examines relationship between other measures of spirituality and adoption of EBPs

3. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Research Question To what extent are various aspects of spirituality present in addiction treatment programs affiliated with the NIDA Clinical Trials Network? What impact do different measures of spirituality have on the likelihood of using evidence-based practices including medications and behavioral therapies?

4. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation The National Treatment Center Study Monitoring the organization, management, delivery, and content of addiction treatment in the U.S. Includes Nationally Representative Samples of: –Privately-funded treatment programs (N=401) –Publicly-funded treatment programs (N=362) –Therapeutic Communities (N=380) Includes all programs affiliated with NIDA Clinical Trials Network (N=227)

5. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation NTCS Instrument Design Multiple data collection methods used: –Detailed on-site interviews with program administrator Focus - organizational characteristics, services offered, and use of innovations –Mail questionnaire from program administrator Focus - leadership and management practices –Mail questionnaire from counselors Focus - services received by clients and attitudes toward innovations –Brief telephone follow-ups w/ program administrator at six month intervals Focus - changes within the center including adoption of new EBPs Current analyses – data from on-site interviews with programs in NIDA Clinical Trials Network (N=227)

6. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Provision of Spiritual Content in Addiction Treatment Programs (% Offering) Content Type Percentage Required 12-step meeting attendance39.6 Psycho-educational Groups/Lectures on Spirituality 68.3 Instruction in or group practice of prayer17.2 Instruction in or group practice of meditation49.3 On-site religious worship services15.0 Individual spiritual direction/guidance36.1 Spiritual or religious reading material48.0

7. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Use of Selected EBPs (On-site interviews – October 2003 – Jan. 2005) PHARMACOTHERAPIES Methadone33.5% Buprenorphine15.8% Naltrexone16.7% BEHAVIORAL THERAPIES MET53.5% Motivational Incentives37.4% Matrix Model17.5%

8. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Results of Multivariate Logistic Regression Models Evidence-based Practices (Pharmacotherapies) MethadoneNaltrexoneBuprenorphine Spiritual Services Offered + Client Participation in Spiritual Services - Program Size (log of FTES) +- Physician on Staff ++ Program offers IP Detox + JCAHO Accredited ++

9. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Results of Multivariate Logistic Regression Models Evidence-based Practices (Behavioral Therapies) METIncentivesMatrix Spiritual Services Offered Client Participation in Spiritual Services - Program Size (log of FTES) - % Counselors Masters or Higher +

10. N T C S at UGA * Funded by National Institute on Drug Abuse and Robert Wood Johnson Foundation Conclusions Two measures of spirituality within addiction treatment programs were created – the number of spiritual-based services offered by the program and the extent of client participation in spiritual-based services. The level or emphasis on spirituality in addiction treatment programs was expected to have a negative effect on the adoption and use of EBPs. Among pharmacotherapies, methadone was the only EBP impacted in the expected direction by spirituality measures. Among behavioral therapies, the Matrix model was the only EBP impacted by the spirituality measures. Program emphasis on spirituality is not a significant deterrent to the adoption of EBPs.