title: What is usual about "treatment-as-usual"? Data from two multisite effectiveness trials.
abstract: Despite increased emphasis on broadening the implementation of empirically supported therapies (ESTs) to improve standard clinical practice and patient outcomes, objective descriptions of what actually constitutes standard practice in community-based drug abuse treatment do not exist. We present data from independent ratings of 379 audiotapes drawn from the "treatment-as-usual" arm of two multisite randomized effectiveness trials in the National Institute on Drug Abuse Clinical Trials Network. As expected, the most frequently occurring strategies involved assessing the participant's substance use and social functioning, asking open-ended questions, discussing problems and feedback, and giving advice and direction. However, a number of interventions associated with ESTs were very rarely implemented in these early sessions. These data suggest missed opportunities for optimally engaging patients in the early stages of treatment and enhancing substance use outcomes and only moderate success to date of efforts to bridge the gap between research and practice.
authors.affiliation: Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT 06516, USA. elizabeth.santaana@yale.edu
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Santa Ana
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Ball
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.forename: Tami L
authors.initials: TL
authors.lastname: Frankforter
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000379:methods* / Q000592:standards; D037001:Directive Counseling / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D013637:Tape Recording; D016896:Treatment Outcome