Cognitive behavioral therapy (CBT) has strong empirical support from randomized clinical trials in a variety of substance-using populations, but effective implementation of CBT remains rare in clinical practice. A recent randomized dissemination trial conducted by Drs. Sholomskas, Carroll & Rounsaville demonstrated that a comprehensive CBT training program significantly improves 'real world' clinicians' knowledge and ability to implement CBT effectively relative to merely reading a CBT manual. However, these training methods, however effective, are not likely to be feasible to train large numbers of clinicians. Thus, more efficient and less costly methods of training large numbers of 'real world' clinicians to use scientifically validated treatments such as CBT are needed. Interactive, multimedia computer-assisted training may be an effective and less costly approach than traditional face-to-face training methods in this context. In this Stage I behavioral therapies development project, 90 substance abuse counselors, drawn from community based drug abuse treatment clinics, will be randomized to one of three training conditions: (1) Exposure to the NIDA CBT manual only, (2) the standard clinical trials training model (e.g., 3 days of intensive small group didactic training followed by individual supervision with feedback on performance) or (3) access to a computer-based training program in CBT (""""""""CBT for CBT"""""""") followed by individualized supervision via the internet. Outcome measures will include clinicians': (1) knowledge of CBT, assessed by a multiple choice test of CBT principles and concepts, (2) ability to implement CBT effectively, as assessed by independent, 'blind' ratings of the clinicians' adherence and competence in delivering key CBT skills based on three videotaped structured roleplays and a sample tape drawn from the clinician's caseload, and (3) satisfaction with training and level of implementation of CBT in the clinician's actual clinical practice, assessed via self-report. Outcome measures will be collected at baseline, at one month (after face-to-face or computer-assisted training), and at 3 months after randomization (following completion of supervised practice and feedback)
