Author: Amy Shanahan, MS, CADC 

Evidence-based practices (EBPs) are critical in addiction treatment, using scientific research to guide clinical decisions and improve patient outcomes. Despite their effectiveness, widespread adoption of EBPs is hindered by challenges such as limited resources, lack of training, provider resistance, and systemic barriers¹. To address these issues, targeted strategies like increased funding for training, organizational support, and ongoing evaluation are essential.

The Exploration, Preparation, Implementation, Sustainment (EPIS) model provides a structured approach for adopting EBPs within organizations². The model divides the process into four phases: Exploration, Preparation, Implementation, and Sustainment.

1. Exploration Phase: Assessing Needs and Readiness

The Exploration phase focuses on evaluating the organization’s readiness for change and selecting the appropriate EBPs. Key actions include:

• Needs Assessment: Evaluate current services, identify gaps, and prioritize needs.
• EBP Selection: Research and select EBPs that align with organizational goals and the needs of the target population.
• Organizational Readiness: Assess the organization’s capacity, infrastructure, and staff skills, and identify barriers to implementation.

Case Study: A leadership team from outpatient, perinatal, and methadone clinics conducted a needs assessment, finding poor attendance as a major barrier to treatment success. Contingency Management (CM), an evidence-based strategy to improve engagement, was chosen to address this challenge.

2. Preparation Phase: Building Capacity

The Preparation phase focuses on preparing the organization for successful implementation. Key actions include:

• Developing an Implementation Team: Assemble a team of stakeholders, including clinicians and administrators, to oversee the process.
• Gap Analysis: Identify resource needs such as training, staffing, and funding, and create plans to address them.
• Cultural and Equity Evaluation: Assess the cultural and social factors influencing the target population, ensuring the EBP is suitable for diverse groups.
• Implementation Planning: Set clear goals, create timelines, and plan for ongoing support.
• Securing Resources: Identify funding sources and allocate budgets for training and technical assistance.

Case Study: Each clinic director facilitated planning sessions to identify target populations for CM. They developed a CM protocol, which included targeting specific behaviors, establishing a reinforcement schedule, and selecting motivating incentives. Comprehensive training was scheduled, funding was secured, and materials were developed.

3. Implementation Phase: Integrating EBPs into Practice

The Implementation phase is when the EBP is integrated into practice. Key steps include:

• Pilot Testing: Implement the EBP with a small group to test feasibility and gather feedback.
• Training and Supervision: Provide staff training and ongoing supervision to ensure fidelity to the EBP.
• Monitoring: Collect data on client outcomes and track implementation progress, adjusting strategies as needed.

Case Study: After securing funding, the clinics’ directors provided standardized training and technical assistance. CM implementation became a regular topic in clinic meetings to track progress, address challenges, share feedback, and monitor costs.

4. Sustainment Phase: Ensuring Long-Term Success

The Sustainment phase focuses on embedding EBPs into routine practices for long-term success. Key activities include:

• Continuous Quality Improvement: Regularly assess the implementation process and make adjustments as needed.
• Staff Retention: Develop strategies to reduce turnover and support professional development.
• Sustainability Planning: Ensure ongoing funding, staffing, and leadership support for continued EBP use.
• Knowledge Sharing: Share lessons learned with other organizations and participate in professional networks.

Case Study: The clinics implemented a system for data collection to monitor program effectiveness, including attendance rates, patient satisfaction, and changes in substance use. Feedback from staff and patients helped identify successes and areas for improvement. Sustainability planning included:

• General Outpatient and Methadone Clinics: These clinics saw significant improvements in attendance and decided to continue using CM. They developed strategies to secure ongoing funding, refine the program, and integrate it into routine care.
• Perinatal Clinic: This clinic did not observe significant improvements in attendance. After analyzing factors like targeting a broader population, the decision was made to discontinue CM due to limited effectiveness.

Conclusion

The EPIS model provides a structured, phased approach to implementing EBPs in addiction treatment. By following the phases of Exploration, Preparation, Implementation, and Sustainment, organizations can overcome barriers to adoption and integrate EBPs into routine practice. With careful planning, resource allocation, and continuous evaluation, organizations can enhance treatment outcomes and provide more effective, equitable care for diverse populations.

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Amy Shanahan, MS, CADC is an implementation specialist, trainer, coach and owner of Compass Consulting & Training.  With more than 3 decades of experience as a leader in addiction medicine care, she is currently a consultant with the Opioid Response Network, and other organizations, universities and treatment providers. She is dedicated to creating learning environments that foster skill growth for individuals and groups.

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References and Resources

• 1. Kelly, J. F., Wandrei, K. E., & Evans, A. C. (2005). Barriers to implementation of evidence-based addiction treatment: A national study. Journal of Substance Abuse Treatment, 29(2), 139-149.
• 2. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. National Implementation Research Network (NIRN).
• Center for Addiction Treatment Studies (CATS). (2021). Advancing Evidence-Based Practices in Addiction Treatment: A Guide for Policymakers and Practitioners.
• National Institute on Drug Abuse (NIDA). (2018). Principles of Drug Addiction Treatment: A Research-Based Guide for Clinicians.
• Substance Abuse and Mental Health Services Administration (SAMHSA). (2016). Framework for Effective Treatment: A Guide for Clinicians and Policymakers.

A new study of nearly 10,000 adolescents has identified distinct differences in the brain structures of those who used substances before age 15 compared to those who did not. The journal JAMA Network Open  published the National Institutes of Health-funded study on December 30, 2024. Learn more.

The National Institute on Drug Abuse (NIDA) is launching a working group to the National Advisory Council on Drug Abuse (NACDA) consisting of people with lived or living experience (PWLLE) with drug use.

Primary purpose of the group: to advise on strategies for enhancing and increasing meaningful engagement of PWLLE with drug use in NIDA-funded research.

NIDA is seeking workgroup members who identify as having current or former experience with substance use or substance use disorder, or as a family member or caregiver of someone who does.

If you are interested in participating, please send a brief personal statement in any format (written, audio, or video recorded) to [email protected] by January 10th, 2025. Learn more.

Addiction and behavioral health professionals who have repeated contact with trauma survivors can themselves experience vicarious trauma. Vicarious trauma is “second hand” trauma that is passed on to workers when they interact with individuals who experienced trauma “firsthand” or encounter information about the trauma¹. The VOTE Index is an instrument developed to identify:

• What part of a worker’s job expose them to vicarious trauma
• How often they are exposed to vicarious trauma
• How strong the vicarious trauma exposure is

Although measuring symptoms — that include having memory gaps about client/patient interactions or disturbing dreams about these persons — are important, having a tool to adequately measure vicarious trauma ensures determining what caused the symptoms to appear.

Download a copy of the VOTE Index: Narrative format   Table format

¹ Stelson, E., Sabbath, E.L., Chen, L., Sorensen, G., Berkman, L., & Kubzansky, L.D. (2024). The Vicarious Occupational Trauma Exposure (VOTE) Index: Instrument development and validity and reliability assessment with the substance use disorder workforce. Available at https://centerforworkhealth.sph.harvard.edu/resources.