Efficacy of Centervention-ATOD: An Implementation Tool for Dissemination of Evidence-based Programs for Substance Abuse

Alcohol, tobacco, and other drug (ATOD) use among adolescents is a major public health
problem with devastating personal, familial, and societal costs. Substance use in youth is
associated with increased accidental injuries (including overdoses), psychiatric
comorbidities, suicidality, school problems, juvenile delinquency, social and family
problems, sexual impulsivity, and health consequences.A burgeoning neuroscience literature
demonstrates ATOD use in youth is associated with a host of negative and potentially
long-term sequelae, including alterations in brain structure, function, and neurocognition.
Moreover, drug use in adolescence is the best predictor of abuse in adulthood; data published
by the National Center on Addiction and Substance Abuse reveal that 90% of adults who meet
substance dependence criteria began using alcohol and drugs during adolescence. In the U.S.,
the economic impact of substance abuse is staggering: in 2005, federal, state, and local
governments spent a combined $467 billion on the direct and indirect costs associated with
addiction, rendering substance dependence the largest, costliest, and most preventable public
health problem in the U.S. today.

Over the past few decades, significant progress has been made in the field of ATOD research
in developing evidence-based practices (EBPs), with research demonstrating ATOD users who
receive research-proven treatments are nearly 2.5 times more likely to achieve clinically
significant post-treatment abstinence compared to those receiving non-evidence-based
treatment. However, despite availability, EBPs are rarely adopted for use in everyday service
settings. Further, even when adopted, considerable variation exists both in the quality with
which EBPs are implemented and their long-term sustainability. Furthering our understanding
of how efficacious treatment programs can be successfully introduced into real-world
treatment settings is key to bridging this research-to-practice gap.

The pilot test of Centervention-ATOD, a customizable suite of online tools specifically
designed to support quality implementation and sustainability of any ATOD-EBP within
real-world service settings, will evaluate whether the product awards additive benefits in
provider implementation proficiency and efficacy, quality of implementation delivery, and EBP
(i.e., Free Talk or CHOICE) outcomes compared to traditional implementation methods.
Additionally, a cost-effectiveness study will be conducted to assess whether the
implementation support strategy (i.e., Centervention-ATOD) is more cost-effective than
traditional implementation methods.

The pilot test will employ a Hybrid Type II study design[14] to simultaneously test the
clinical evidence-based program as well as the implementation strategy. Regardless of the EBP
implemented, 110 mental health (MH) providers will be randomly assigned to one of two
conditions: (1) Enhanced implementation (EI) or (2) Implementation as Usual (IAU). Providers
will either implement (a) Free Talk, a motivational interviewing group intervention with 5-8
youth per group over a six-week period or (b) CHOICE, a motivational interviewing group
prevention program with 5-8 youth per group over a five-week period. Participating youth
between ages 14-17 who may have experimented with alcohol or other drugs (AOD) will
participate in the Free Talk intervention while youth between ages 11-15 who may or may not
have used any substances will participate in the CHOICE prevention program. At the conclusion
of the pilot test, a study of cost-effectiveness of the implementation support strategy
(i.e., Centervention-ATOD) will be conducted with agency administrators of participating
providers.

Inclusion Criteria: Community Mental Health (CMH) Providers

- Licensed CMH Provider to youth between ages 14 -17 for Free Talk EI/TAU

- Students enrolled in local University Clinical Programs for CHOICE EI/TAU

Inclusion Criteria: Youth

- Between ages 14 -17 for Free Talk EI/TAU, Between ages 11 -14 for CHOICE EI/TAU

- For Free Talk EI/TAU, youth may have experimented with or currently use alcohol or
other drugs.

- For CHOICE EI/TAU, youth may, or may not, have considered ATOD experimentation.