Computer Based Training for Contingency Management: Phase I
DESCRIPTION (provided by applicant): Bridging the gap between science and practice remains a significant concern in the effective delivery of treatments for drug abuse. Contingency management (CM) treatments, an empirically supported therapy, is well positioned to bridge this gap. Recent studies demonstrate the efficacy of CM in improving outcomes of substance abusers in community-based clinical settings, yet few substance abuse counselors are familiar with CM or how to design and implement CM interventions. We are one of the few groups in the country that have been investigating how best to train clinicians to implement empirically-based interventions. In a randomized study, we demonstrated that intensive didactic training by ABR staff (Drs. Nuro and Carroll) dramatically increases real world substance abuse counselors' ability to implement therapies effectively, compared to simply reading a therapist training manual. However, standard training models, regardless of their effectiveness, are not feasible to train large numbers of clinicians. Computer-assisted training models offer greater flexibility in the location and timing of training, as well as a high level of interaction and the opportunity to view effective implementation of the treatment. Computer-assisted training models, nevertheless, have rarely been explored as a strategy to train clinicians. In this Phase I project, we plan to develop a single introductory module of computer-based training in CM (CBT for CM), as we have done for other empirically based therapies including cognitive-behavioral and 12-step therapies. We will also conduct a randomized pilot study of 30 substance abuse counselors to evaluate the efficacy of this training module compared with reading a CM training manual and watching a CM video alone. If the prototype 'CBT for CM' program is associated with statistically significant improvements in counselors' ability to understand and design CM protocols, we will proceed with a Phase II study. We have noted large effect sizes in terms of training therapists in other therapy techniques, and primary outcome measures will include independent ratings of adherence as well as knowledge of CM. If Phase I is successful in training CM, a Phase II project will be developed to provide further computerized training and evaluate the efficacy of this approach in a much larger sample of clinicians. Thus, we expect that this computerized program may make a major impact on bridging the gap between science and practice with respect to training therapists in this important, empirically-supported therapy. Contingency management interventions in many ways embody the gap between research and practice in substance abuse treatment, as they have among the highest levels of empirical support from rigorously conducted randomized trials in a range of settings and populations but at the same time are almost nonexistent in clinical practice. Thus, this project, a stand alone computer-assisted training program for CM, represents a unique opportunity to train clinicians and programs on a broad, even national scale, in these important approaches. Our goal for Phase II will be a stand-alone program encompassing all elements of training clinicians in CM and effectively administering a CM program in a wide range of settings and applications, including initiating abstinence, fostering treatment retention, and even enhancing compliance with pharmacotherapy. Furthermore, the data to be gathered in Phases I and II on the impact of this program on fostering understanding and effective implementation of CM will be invaluable in furthering knowledge regarding dissemination of empirically supported approaches.
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