Substance Use Disorder (SUD) treatment services for youth and adults can be improved by the implementation of appropriate Evidence Based Practices. Although efficacious practices for the treatment of substance use disorders exist, implementation of treatments that employ empirically validated practices has been slow to occur. Estimates of the use of empirically based treatments in the field of substance abuse across the United States are as low as 10% (McGlynn et al., 2003). Though a majority of social workers are involved with diagnosis and treatment of substance use disorders (Smith, Whitaker and Weismiller, 2006), estimates of social work training in substance abuse practice is approximately 50% (Smith et al.).
The study examines factors related to implementation of three widely-used Best Practices by social workers in the field of SUD treatment. Although researchers have identified contextual and personal/cognitive factors that affect the adoption of empirically based practices into substance use treatment services (e.g., Aarons, 2004; Eccles, Grimshaw, Walker, Johnston, & Pitts, 2005), implementation remains low. The investigation of factors related to implementation in this study allows a more complete understanding of contextual and personal factors which are specifically related to implementation.
A sample of 644 social work practitioners, randomly selected from the list of social workers who subscribe to the Alcohol, Tobacco, and Other Drug specialty section of the National Association of Social Workers (NASW), was surveyed to generate the data used in the study. The relationship of personal/cognitive and social contextual factors to social work clinicians' implementation of Best Practices was estimated by analytical methods used to model the data.
The study found that the social workers implemented Best Practices with 75% of their clients with SUDs. Of the seven Best Practices surveyed, Cognitive Behavioral Therapy, Self-Help Interventions, and Motivational Interviewing were the most widely-used. The social cognitive factors of confidence and motivation were found to explain between 51% and 71% of the variance in implementation. Social contextual variables of leadership attitude and social network implementation were found to moderate the relationships between social cognitive variables and implementation. The combination of social cognitive and social contextual variables explained between 58% and 75% of the variance in implementation in the final models for the three examined Best Practices. Study hypotheses were supported by the results.
The results of this study suggest that social cognitive factors of confidence and motivation are good predictors of implementation. Clinical management or educators can utilize this information to improve clinicians' implementation of Best Practices in this field. The findings of this study suggest that leadership attitude and social network implementation of Best Practices do moderate the relationship of social cognitive factors and implementation. This finding suggests that social contextual factors facilitate or inhibit implementation of Best Practices. Social context must be considered in improving implementation of Beset Practices in clinical or educational settings.