In the research field, we have little understanding of how alcoholism treatment strategies, shown to be efficacious through controlled clinical trials, operate and function in """"""""real world"""""""" conditions. The gap between research and practice in addictions treatment has recently drawn considerable attention (e.g., Institute of Medicine, 1998). For example, as has been the case with many techniques and therapeutic strategies, widespread translation of motivational interviewing (MI) techniques from clinical trials to use in community-based treatment clinics has not occurred. Clinical trials have demonstrated that a single, MI-based preparatory session at the onset of alcoholism treatment reduces premature termination from treatment. The present application seeks to study the dissemination and """"""""real world"""""""" effectiveness of a MI-based preparatory procedure designed to reduce early attrition from alcoholism outpatient treatment. ? ? In order to study dissemination and adoption, 150 New York State Office of Alcoholism and Substance Abuse Services (OASAS) alcoholism outpatient clinics will be randomly assigned to one of three dissemination conditions: (1) on-site delivery of the training manuals with a one-hour introductory presentation, (2) the manuals with a four-hour basic workshop, or (3) the manuals with the four-hour workshop and a four-hour MI-technique specific training. Measures of adoption will focus on both clinician and programmatic adoption, will be multifaceted, and will include assessment of partial adoption and modified adoption. ? ? In order to study the effectiveness of the MI-based preparatory procedure, we propose to examine clinic sites' rates of early treatment attrition and client treatment outcome prior to dissemination and following dissemination. Specifically, two cohorts of OASAS admissions will be followed for 12 months, one cohort prior to dissemination, the second cohort after dissemination. These are collected from standard OASAS admission and discharge reports on all clients treated in OASAS-licensed clinics and will be available to the research team. ? ? The monetary costs associated with delivery of each of the three dissemination strategies will be determined. Cost-effectiveness indices will then be calculated by associating dissemination costs with outcome variables and then compared and contrasted between the three dissemination strategies. These data will provide valuable information to governmental bodies and health care organizations interested in disseminating the MI preparatory technique. ? ?
