title: Advancing recovery: implementing evidence-based treatment for substance use disorders at the systems level.
abstract: OBJECTIVE
  A multisite evaluation examined the process and outcomes of Advancing Recovery, a Robert Wood Johnson Foundation initiative to overcome barriers to implementing evidence-based treatments within alcohol and drug treatment systems.
  
  
  METHODS
  We report findings from a 3-year, mixed-method study of how treatment systems promoted two evidence-based practices: medication-assisted treatment and continuing care management. We compared outcomes and implementation strategies across 12 state/county agencies responsible for alcohol and drug treatment and their selected treatment centers. Each partnership received 2 years of financial and technical support to increase adoption of evidence-based treatments.
  
  
  RESULTS
  Partnerships flexibly applied the Advancing Recovery model to promote the adoption of evidence-based treatments. Most sites achieved a measurable increase in the numbers of patients served with evidence-based practices, up from a baseline of virtually no use. Rates of adopting medication-based treatments were higher than those for continuing care management. Partnerships used a menu of top-down and bottom-up strategies that varied in specifics across sites but shared a general process of incremental testing and piecemeal adaptation.
  
  
  CONCLUSIONS
  Supported partnerships between providers and policymakers can achieve wider adoption of evidence-based treatment practices. Systems change unfolds through a trial-and-error process of adaptation and political learning that is unique to each treatment system. This leads to considerable state and local variation in implementation strategies and outcomes.
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA. laura.schmidt@ucsf.edu
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schmidt
authors.forename: Traci
authors.initials: T
authors.lastname: Rieckmann
authors.forename: Amanda
authors.initials: A
authors.lastname: Abraham
authors.forename: Todd
authors.initials: T
authors.lastname: Molfenter
authors.forename: Victor
authors.initials: V
authors.lastname: Capoccia
authors.forename: Paul
authors.initials: P
authors.lastname: Roman
authors.forename: David H
authors.initials: DH
authors.lastname: Gustafson
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
mesh_terms: D000437:Alcoholism / Q000534:rehabilitation; D003266:Continuity of Patient Care / Q000458:organization & administration; D003299:Cooperative Behavior; D055317:Evidence-Based Practice / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D017063:Outcome Assessment, Health Care; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000534:rehabilitation*