There are significant barriers to implementing empirically-supported treatments, such as cognitive-behavioral relapse prevention (CB/RP), in community-based substance abuse treatment settings. Our team has devel- oped and begun to evaluate a user-friendly multimedia group counseling curriculum (RoadMAP Toolkit) as a low-cost strategy to introduce addictions counselors to the use of CB/RP. In a one-arm pilot trial, we found that a brief training on the RoadMAP Toolkit was sufficient to achieve very large improvements in counselor CB/RP adherence which were durable over 6 months with no additional training or supervision. In addition to these improvements, Toolkit (TK) counselors and their clients reported significantly improved satisfaction with their TK sessions. Furthermore, in our recently completed randomized controlled trial, we found preliminary support for a similarly designed 12-step facilitation Toolkit to decrease alcohol use. The purpose of this appli- cation is to evaluate the RoadMAP Toolkit?s clinical effectiveness with clients diagnosed with an alcohol use disorder (AUD) and to assess the amount of exposure to CB/RP content (i.e., homework completion) as a function of treatment condition. Design: Fifty group counselors from 4 drug-free intensive outpatient treatment programs will participate in a randomized controlled trial. They will be randomly assigned within sites to one of two training conditions. Counselors assigned to the CB/RP Toolkit condition (TK) will receive a brief training in the use of the Toolkit and 2 key RP activities and will then conduct a complete series of 6 Toolkit groups with enrolled clients (ntotal=100). Counselors assigned to the Attention Control condition (AC) will receive training of the same length and intensity on group counseling management practices. Similar to the TK condition, counse- lors will conduct a complete series of counseling groups with enrolled clients (ntotal=100). All counselors will re- ceive three 30-minute coaching sessions (tailored to condition) during the intervention. Client participants with an AUD, alcohol use in the past 30 days, and < 4 weeks of attendance at the program will be enrolled. They will be assessed prior to beginning the intervention, weekly during the intervention, at the end of the interven- tion (8-weeks), and again at 16- and 24-week follow-ups. To address our primary hypothesis, we will compare urinalysis-verified self-reported alcohol use of clients in the TK and AC conditions at the end of the intervention (8-weeks) and at 16- and 24-week follow-ups. For our secondary hypothesis, we will compare differences in the amount of homework completed during the intervention by TK versus AC clients. Exploratory hypotheses will compare TK and AC clients on treatment attendance, coping skills, and abstinence confidence at the 8-, 16-, and 24-week timepoints. If successful, this project will provide support for a cost-effective, efficient, and sustainable strategy to equip community-based addictions counselors to deliver CB/RP using a group counsel- ing curriculum which will positively impact client alcohol use and other relevant outcomes.
Incorporating empirically-supported interventions practices into community-based substance abuse treatment programs is critically needed but requires substantial resources (time, staff and financial) that are often limited in such settings. This project investigates the clinical effectiveness of a user-friendly, cost-effective, multimedia relapse prevention group counseling ?toolkit? in improving clinical outcomes of adults with alcohol use disorders in community treatment programs. If successful, this method of disseminating scientifically-validated practices will advance a critical component in NIAAA?s mission to bring feasible and desirable ways to incorporate scientifically proven, best practices into the 13,000 treatment programs throughout the US.
