Methodological innovation to increase the utility and efficiency of psychotherapy research for patients with co-occurring mental health and substance use disorders.

Psychotherapy research with chronic and difficult-to-treat populations, such as those with co-occurring mental health and addictive disorders, can employ flexible research designs, which allow for a systematic yet nonlinear relationship between efficacy and effectiveness designs. Outcomes research can bypass the efficacy-effectiveness dichotomy through use of a hybrid model (Carroll & Rounsaville, 2003) conducted in the context of community treatment settings in collaboration with community providers.

This article presents the case for using this methodological approach as a means of advancing psychotherapy research and practice, while translating and disseminating empirically supported treatments with more efficiency. A hybrid model study conducted within the National Drug Abuse Treatment Clinical Trials Network, protocol CTN-0015, illustrates the application while also illuminating the inefficiency of the traditional linear stage model of behavioral therapy given the diversity of population, predictably irregular treatment participation, and the relevance of training and supervision implementation issues. Hybrid model designs can maximize external validity (while maintaining internal validity controls) and yield many meaningful findings, while also maximizing cost-effectiveness. These findings inform new directions for future research.

Related protocols: CTN-0015