What is usual about “treatment-as-usual”? Data from two multisite effectiveness trials.

Despite increased emphasis on broadening the implementation of empirically supported therapies (ESTs) to improve standard clinical practice and patient outcomes, objective descriptions of what actually constitutes standard practice in community-based drug abuse treatment do not exist. In this article, the authors present data from independent ratings of 379 audiotapes drawn from the “treatment-as-usual” arm of two multisite effectiveness trials in the National Drug Abuse Treatment Clinical Trials Network (protocols NIDA-CTN-0004, “Motivational Enhancement Treatment to Improve Treatment Engagement and Outcome in Subjects Seeking Treatment for Substance Abuse,” and NIDA-CTN-0005, “Motivational Interviewing (MI) to Improve Treatment Engagement and Outcome in Subjects Seeking Treatment for Substance Abuse”).

As expected, the most frequently occurring strategies involved assessing the participant’s substance use and social functioning, asking open-ended questions, discussing problems and feedback, and giving advice and direction. However, a number of interventions associated with ESTs were very rarely implemented in these early sessions. These data suggest missed opportunities for optimally engaging patients in the early stages of treatment and enhancing substance use outcomes and only moderate success to date of efforts to bridge the gap between research and practice.

Related protocols: CTN-0004, CTN-0005