Matrix of Interventions
Evidence-Based Practices for Treatment of Adults with Substance Use Disorder
Adapted from University of Washington Alcohol and Drug Abuse Institute*
Behavioral Couples $
Therapy
3.
Behavioral SelfControl Training
4.



N

N


No


Brief Cognitive
Behavioral
Intervention for
Amphetamine
D


5.
Brief Marijuana
Dependence
Counseling
D

N

N
6.
Cognitive
Behavioral Coping
Skills Therapy
D



7.
Community
Reinforcement
Approach (CRA)
with Vouchers
D



Contingency
Management
without CRA
No


9. (Lower Cost)
Contingency
Management
No

No

8.
10. Day Tx with
Contingencies &
Vouchers




Opiate substitution
clients
Offenders
Low income
IV drug user
Homeless
Co-occurring patients

N






Housing, employment

N
Women and/or pregnant
women
Poly-substance
Marijuana
Heroin/opiates


N

Reduced depression


Cocaine/crack

N
Meth/amphetamine

N
Adverse consequences
from drinking (N)
Fewer arrests and
hospitalizations, improved
relationships (N)
Adverse consequences
from drinking; reduced
partner violence
Mild/moderate problem
drinking

N
Alcohol problems

N
Hispanic/Latino
2.
D
Other (e.g., legal, family,
interpersonal, medical)
Population
African Americans
Twelve-Step
Facilitation
Abstinence from
substances
1.
Reduced substance use
Outcomes/substance:
N=Listed in NREPP 1
Treatment completion
**Manual availability:
D= Free download
$ = Purchase copy
No = No manual
Retention
Manual availability**
See Appendix 1 for
references
Not specific to one drug
Problematic substance
Positive outcomes
Engagement
Practice
























ASI drug use composite
score (when used with
#12)
12. Individual Drug
Counseling for
Cocaine Addiction:
CCTS Model
D


ASI drug use composite
score (when used with
#11)
13. Matrix Intensive
Outpatient
Program for the Tx
of Stimulant Abuse
$/D

N

N

N

HIV risk
14. Motivational
Enhancement
Therapy (MET)
D



N

N
Motivation, social
functioning

N

N
Commitment to treatment,
HIV risk, illegal activity

N

N

N

N
Reduced PTSD symptoms

N

N
Lower methadone dose,
reduced depression

N

N
Reduced mental health
symptoms, HIV risk
15. Mapping Enhanced
D
Counseling

N
16. Relapse Prevention D
Therapy
17. Seeking Safety: A
Psychotherapy for
Trauma/PTSD and
Substance Abuse
$
18. SupportiveExpressive
Psychotherapy
$
19. Boston Consortium
Model: TraumaD
Informed SUD TX
for Women

N


N

N
Marital adjustment (N)

N



N



N

N

N

N

N

N

N

N

N


N

Opiate substitution
clients
IV drug user
Homeless





Co-occurring patients
Women and/or pregnant
women
Hispanic/Latino
African Americans
Poly-substance



N
Marijuana
Heroin/opiates
Cocaine/crack
Meth/amphetamine


Offenders
D
Population
Low income
11. Group Drug
Counseling for
Cocaine Addiction:
CCTS Model
Mild/moderate problem
drinking
Other (e.g., legal, family,
interpersonal, medical)
Alcohol problems
Abstinence from
substances
Reduced substance use
Outcomes/substance:
N=Listed in NREPP 1
Treatment completion
**Manual availability:
D= Free download
$ = Purchase copy
No = No manual
Retention
Manual availability**
See Appendix 1 for
references
Not specific to one drug
Problematic substance
Positive outcomes
Engagement
Practice




N
*Adapted from the University of Washington Alcohol and Drug Abuse Institute (ADAI). Evidence-Based Practices for Treating Substance Use Disorders:
Matrix of Interventions, August 2006. URL: http://adai.washington.edu/ebp/matrix.pdf
1
NREPP= SAMHSA National Registry of Evidence-based Programs and Practices, http://nrepp.samhsa.gov/
APPENDIX I
Information on Evidence-Based Practices
The following list of evidence-based practices (EBPs) corresponding to the matrix (see previous
page) describes each EBP, provides references that support the link between the practice and
client outcomes, and, if available, research on fidelity to the practice. This list also includes links to
downloadable manuals, if available.
1. Twelve-Step Facilitation Therapy (TSF). TSF is a strategy designed to increase the likelihood
of a substance abuser becoming actively involved in 12-step self-help groups, thereby
promoting abstinence. This EBP is a brief, structured, manual-driven approach to facilitate
early recovery from alcohol abuse, alcoholism, and other drug abuse and addiction problems.
Research from Project MATCH indicates that compared with participants who received
treatment as usual, TSF participants had a higher percentage of days abstinent in the prior 3
months at 6 months and 12 months posttreatment (Project MATCH Research Group, 1998a).
Kaskutas and colleagues (2009) developed a related approach, “Making AA Easier” (MAAEZ),
a six-session manual-guided intervention designed to help clients connect with individuals
encountered in AA.
Fidelity
Over 80 therapists from diverse backgrounds received careful training and supervision using
Project MATCH structured manuals and were able to implement the TSF therapy successfully
and with fidelity (Project MATCH Research Group, 1998b). In addition, Sholomskas and Carroll
(2006) developed a feasible and effective computer-assisted training program to impart skills
associated with the delivery of TSF. A study by Guydish and others (2013) found that higher
competence and empathy in the delivery of TSF was associated with fewer days of drug use
and better employment outcomes at 3 months post-baseline; greater adherence to the protocol
was associated with better employment outcomes only (TSF was adapted for groups and
stimulant users).
References reporting improved client outcomes:
Kaskutas LA, Subbaraman MS, Witbrodt J, & Zemore SE. (2009). Effectiveness of making
Alcoholics Anonymous easier: A group format 12-step facilitation approach. Journal of
Substance Abuse Treatment, 37, 228-239.
Project MATCH Research Group. (1998a). Matching patients with alcohol disorders to
treatments: Clinical implications from Project MATCH. Journal of Mental Health, 7, 589-602.
Project MATCH Research Group. (1998b). Matching alcoholism treatments to client
heterogeneity: Project MATCH three-year drinking outcomes. Alcoholism: Clinical and
Experimental Research, 22, 1300-1311.
Treatment manual:
Nowinski J, Baker S, Carroll K. (1995). Twelve Step Facilitation Therapy Manual: A Clinical
Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence.
National Institute on Alcohol Abuse and Alcoholism Project MATCH Monograph Series vol. 1.
Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
http://lib.adai.washington.edu/pubs/match1/match1.pdf
2. Behavioral Couples Therapy for Alcoholism and Drug Abuse (BCT): In BCT, the therapist
works with both the person who is abusing substances and his or her partner to build a
relationship that supports abstinence. Program components include a recovery contract
between the partners and therapist; activities and assignments designed to increase positive
feelings, shared activities, and constructive communication; and relapse prevention planning.
Partners generally attend 15–20 hour-long sessions over 5–6 months. During the 1-year
posttreatment follow-up, participants who received BCT reported fewer days of drinking, fewer
drinking-related negative consequences, higher dyadic adjustment, and reduced partner
violence, compared with participants who received individual or educational support (FalsStewart et al., 2006).
Fidelity
In an effectiveness study of BCT by Fals-Stewart et al. (2006), all sessions were audiotaped,
and three of the sessions for each participant were randomly selected and rated for adherence
and compliance by an experienced clinical psychologist who had extensive knowledge of BCT.
Adherence and competence scores for all rated sessions in all the conditions were acceptable.
Fidelity requirement for improved outcomes not found (i.e., a literature search was conducted
for information on the extent that BCT treatment fidelity might be associated with better
outcomes; however, information could not be found.
References reporting improved client outcomes:
Fals-Stewart W, Birchler GR, & Kelley ML. (2006). Learning sobriety together: A randomized
clinical trial examining behavioral couples therapy with alcoholic female patients. Journal of
Consulting and Clinical Psychology, 74, 579-591.
Schumm JA, O'Farrell TJ, & Andreas JB. (2012). Behavioral couples therapy when both
partners have a current alcohol use disorder. Alcoholism Treatment Quarterly, 30, 407-421.
Treatment manual:
The following guidebook is available:
O'Farrell TJ, & Fals-Stewart W. (2006). Behavioral couples therapy for alcoholism and drug
abuse. New York: Guilford Press.
Slides describing BCT and information to order the book are available at:
http://uwf.edu/cap/DeploymentMentalHealth/materials/Dr.%20Timothy%20O'Farrell%20%20Behavioral%20Couples%20Therapy%20for%20Alcoholism%20and%20Drug%20Abuse.pd
f
3. Behavioral Self-Control Training for Alcohol Use (BSCT): BSCT is an approach used with
individuals who have a treatment goal of either controlled/non-problematic drinking or
abstinence. BSCT includes six elements: specific goal-setting, self-monitoring of drinking or
urges to drink, strategies to reduce or avoid consumption, self-reinforcement for achievement
of goals, identification of high-risk situations, and alternatives to drinking as a coping response.
A review of treatments for mild to moderate problem drinking indicates several studies
demonstrate the robust efficacy of behavioral self-control strategies in reducing alcohol
consumption among problem drinkers with low levels of physical dependence on alcohol
(Walitzer & Connors, 1999).
Fidelity:
No formal treatment manual has been developed for BSCT. Walitzer and Connors (1999)
reported that studies of the effectiveness of this approach found numerous variations in how
BSCT was implemented. Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Walters GD. (2001). Behavioral self-control training for problem drinkers: A meta-analysis of
randomized control studies. Behavior Therapy, 31, 135-149.
Walitzer KS, & Connors GJ. (1999). Treating problem drinking. Alcohol Research & Health, 23,
138-143.
Treatment manual:
Not applicable. Information about BSCT is available in:
Miller WR, & Muñoz RF. (2013). Controlling Your Drinking, 2nd Edition, Tools to Make
Moderation Work for You. New York: Guilford Press.
Miller WR, & Muñoz RF. (1982). How to control your drinking. Albuquerque: University of New
Mexico Press.
4. Brief Cognitive Behavioral Intervention for Amphetamine Users. This intervention consists
of four weekly individual sessions lasting 45–60 minutes that are focused on developing skills
to reduce amphetamine use. The sessions involve motivational interviewing, coping with
cravings and lapses, controlling thoughts about amphetamine use, developing skills to refuse
amphetamine use, and preparation for future high-risk situations. A pilot study (Baker et al.,
2001) and a full-scale trial (Baker et al., 2005) were conducted in Australia; both studies
showed an overall decrease in amphetamine use across the control and treatment groups and
a significant increase in abstinence in the treatment groups compared to the control groups.
Fidelity:
Therapists received a week-long training session prior to delivering the manualized intervention
that covered research procedures and role-plays of treatment sessions. Videotaped feedback
was used to enhance training. Session checklists were employed to guide weekly supervision.
Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Baker A, Boggs TG, Lewin TJ. (2001). Randomized controlled trial of brief cognitive –
behavioural interventions among regular users of amphetamine. Addiction, 96, 1279 – 87.
Baker A, Lee NK, Claire M, Lewin TJ, Grant T, Pohlman S, et al. (2005). Brief cognitive
behavioural interventions for regular amphetamine users: a step in the right direction.
Addiction, 100, 367-378.
Treatment manual:
Baker A, Kay-Lambkin F, Lee N, Claire M & Jenner L. (2003) A Brief Cognitive-Behavioural
Intervention for Regular Amphetamine Users. Canberra: Australian Government Department of
Health and Aging.
http://www.health.gov.au/internet/main/publishing.nsf/content/1DEA7F68576F8F16CA257BF00
01F3E5C/$File/cognitive-intervention.pdf
5. Brief Marijuana Dependence Counseling (BMDC). BMDC combines elements from
motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), and case
management. It consists of an assessment session followed by nine weekly one-on-one
sessions: Enhancing Motivation (sessions 1 and 2); and Changing Marijuana Use through Skill
Building (sessions 3 through 9). Participants in nine sessions significantly reduced the
percentage of days in which they used marijuana by an averaged of 58.8%, compared with a
35.7% reduction among participants in a two-session program and a 15.9% reduction among
clients awaiting services (Marijuana Treatment Project [MTP] Research Group, 2004).
Fidelity:
Independent evaluators reviewed sample treatment sessions to assess therapists’ adherence
to the manuals throughout treatment (MTP Research Group, 2004; Litt et al., 2005). In a
subsequent study, BMDC was delivered as specified in the MTP (9 sessions, each lasting 60–
minutes) and was based on the therapy manual developed for MTP (Kadden et al., 2007).
Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Kadden RM, Litt MD, Kabela-Cormier E, & Petry NM. (2007). Abstinence rates following
behavioral treatments for marijuana dependence. Addictive Behaviors, 32, 1220-1236.
Litt MD, Kadden RM, Stephens RS. (2005). Coping and self-efficacy in marijuana treatment:
results from the Marijuana Treatment Project. Journal of Consulting and Clinical Psychology
73, 1015-25.
Marijuana Treatment Project (MTP) Research Group. (2004). Brief treatments for cannabis
dependence: findings from a randomized multisite trial. Journal of Consulting and Clinical
Psychology, 72, 455-66.
Treatment manual:
Steinberg KL, Roffman, RA, Carroll, KM, McRee B, Babor, TF, Miller, M, Kadden, R, Duresky
D, and Stephens, R. (2005). Brief Counseling for Marijuana Dependence: A Manual for
Treating Adults. DHHS Publication No (SMA) 05-4022.Rockville, MD: Center for Substance
Abuse Treatment, Substance Abuse and Mental Health Services Administration.
http://www.integration.samhsa.gov/clinicalpractice/sbirt/brief_counseling_for_marijuana_dependence.pdf
6. Cognitive Behavioral Coping Skills Therapy (CBT)
Cognitive behavioral approaches, such as relapse prevention, are grounded in social learning
theories and principles of operant conditioning. The defining features of these approaches
emphasize functional analysis of drug use and skills training (Carroll & Onken, 2005). A specific
12-session CBT individual intervention used in Project MATCH aimed to improve patients’
cognitive and behavioral skills for changing problematic alcohol behavior. Later, CBT was
adapted for cocaine-addicted individuals and is listed in NIDA’s Principles of Drug Addiction
Treatment (2012) as effective with individuals who use methamphetamine, marijuana, and
nicotine, in addition to alcohol and cocaine. Participants in all Project MATCH conditions,
including CBT, showed significant reductions in drinking in the first year after treatment, and
these reductions were sustained over the 3-year follow-up period; almost 30% were totally
abstinent in months 37 to 39 (Project MATCH Research Group, 1998). A meta-analysis
suggests that CBT may be more effective for treating alcohol than cocaine problems (Irvin et
al., 1999). However, among cocaine users, those who received CBT reduced their cocaine use
significantly more than those who received interpersonal psychotherapy (Carroll et al., 2004).
Fidelity:
Over 80 therapists from diverse backgrounds received careful training and supervision using
Project MATCH structured manuals and were able to implement the CBT therapy successfully
and with fidelity (Project MATCH Research Group, 1998). A study of treatment providers
assigned to either review the CBT manual only (manual only); review the manual and access
the CBT training website (website); or review the manual and participate in a didactic seminar
followed by supervised casework (supervision) found significant differences in protocol
adherence and skill ratings favoring the seminar plus supervision over the manual-only
condition, with intermediate scores for the website condition (Sholomskas et al., 2005).
However, this study did not address the extent to which the type of training affected actual
patient outcomes. A study by Hogue (2008) found that better adherence to a cognitive
behavioral intervention targeting adolescent substance use and other problems predicted better
drug use outcomes when the therapeutic alliance was controlled. Overall, cognitive behavioral
approaches may be comparatively complex, and training clinicians to implement these
approaches effectively can be challenging (Carroll & Onken, 2005).
References reporting improved client outcomes:
Carroll KM, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, & Rounsaville BJ. (2004).
Efficacy of Disulfiram and Cognitive Behavior Therapy in Cocaine-Dependent Outpatients:
A Randomized Placebo-Controlled Trial. Archives of General Psychiatry, 61, 264-272.
Carroll KM, and Onken LS. (2005). Behavioral therapies for drug abuse. The American Journal
of Psychiatry, 168, 1452–1460.
Carroll KM, Rounsaville BJ, Gawin FH. (1991). A comparative trial of psychotherapies for
ambulatory cocaine abusers: Relapse prevention and interpersonal therapy. American
Journal of Drug and Alcohol Dependence, 17, 229-247.
Irvin JE, Bowers CA, Dunn ME, & Wang MC. (1999). Efficacy of relapse prevention, a metaanalytic review. Journal of Consulting and Clinical Psychology, 67, 563-570.
National Institute on Drug Abuse (NIDA). (2012). Principles of Drug Addiction Treatment, 3rd
edition. (NIH Publication No. 12-4180) NIDA, Bethesda, MD.
Project MATCH Research Group. (1997). Matching alcoholism treatments to client
heterogeneity: Project MATCH post treatment drinking outcomes. Journal of Studies on
Alcohol and Drugs, 58, 7-29.
Treatment manual:
The CBT manual from Project MATCH (addressing alcohol problems) is:
Kadden R, Carroll K, Donovan D, Cooney N, Monti P, Abrams D, Litt M, Hester R (1992).
Cognitive-behavioral Coping Skills Therapy Manual, A Clinical Research Guide for Therapists
Treating Individuals with Alcohol Abuse and Dependence. (NIAAA Project MATCH Monograph,
Vol. 3, DHHS Publication No. ADM 92-1895). Washington, DC: U.S. Government Printing
Office. http://pubs.niaaa.nih.gov/publications/MATCHSeries3/Project%20MATCH%20Vol_3.pdf
The CBT manual for cocaine addiction is:
Carroll KM. (2000). A Cognitive-behavioral Approach: Treating Cocaine Addiction. US Dept. of
Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.
http://archives.drugabuse.gov/pdf/CBT.pdf
7. Community Reinforcement Approach (CRA) with Vouchers. CRA with Vouchers uses a
range of recreational, familial, social, and vocational reinforcements, as well as material
incentives to make a non-drug-using lifestyle more rewarding than substance use. The
treatment goals among cocaine users are to maintain drug abstinence long enough to learn
new life skills, and to reduce alcohol consumption among individuals whose drinking is
associated with cocaine use. Individuals treated with CRA with vouchers were more likely to be
retained in treatment, used cocaine at a lower frequency during treatment, and reported a lower
frequency of drinking to intoxication during treatment and follow-up compared with patients
treated with vouchers only. Those treated with CRA with vouchers also reported a higher
frequency of days of paid employment during treatment and the initial 6-month follow-up,
decreased depressive symptoms during treatment, and had fewer hospitalizations and legal
problems during follow-up (Higgins et al., 2003).
Fidelity
No information could be found regarding fidelity, or if/how CRA with vouchers was delivered as
intended. A study conducted in Spain reported CRA was implemented according to the manual
but with one difference: instead of delivering all sessions individually, Secades-Villa et al.
(2008) reported sessions were delivered both individually and in groups due to the need to
adapt the program to the characteristics of the research site’s Institutional Review Board.
Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Brooks AC, Ryder D, Carise D, Kirby KC. (2010). Feasibility and effectiveness of computerbased therapy in community treatment. Journal of Substance Abuse Treatment, 39, 227235.
Higgins ST, Sigmon SC, Wong CJ, Heil SH, BadgerM GJ, Donham R, et al. (2003). Community
reinforcement therapy for cocaine-dependent outpatients. Archives of General Psychiatry,
60, 1043-1052.
Roozen HG, Boulogne JJ, van Tulder MW, van den Brink W, De Jong CAJ, and
Kerhof JFM. (2004). A systemic review of the effectiveness of the community reinforcement
approach in alcohol, cocaine and opioid addiction. Drug and Alcohol Dependence 74, 1–13.
Secades-Villa R, García-Rodríguez O, Higgins ST, Fernández-Hermida JR, & Carballo, JL.
(2008). Community reinforcement approach plus vouchers for cocaine dependence in a
community setting in Spain: Six-month outcomes. Journal of Substance Abuse Treatment,
34, 202-207.
Treatment manual:
Budney AJ, Higgins ST, Mercer DE, Carpenter G. (1998). A Community Reinforcement Plus
Vouchers Approach: Treating Cocaine Addiction. NIDA Therapy Manuals for Drug Addiction
No. 2; NIH publication no. 98-4309. Rockville: National Institute on Drug Abuse.
http://archives.drugabuse.gov/pdf/CRA.pdf
8. Contingency Management (CM). CM is defined as procedures that aim to alter drug use by
systematically arranging consequences that are designed to weaken drug use and strengthen
abstinence. The time interval for monitoring for incidences of substance use should be short
(e.g., three urine tests per week). Different types of incentives (e.g., cash, vouchers, prizes, or
the privilege of taking home doses of methadone) are used in CM to prepare drug users for an
abstinent lifestyle (Higgins et al., 2004). Silverman et al., (1996) reported that participants in an
abstinent-contingent voucher group gave cocaine-positive urines approximately 40% less often
than a random voucher group, suggesting this approach is efficacious for treating cocaine use
in a methadone-maintained population.
Fidelity
Numerous variations in voucher schedules are possible, and some studies report individuals
with negative urine tests are eligible to participate in drawings for prizes, rather than receive
specific amounts in vouchers. The value of a voucher may escalate with each successive
negative urine and can be reset to a lower value following a positive urine test, or a bonus is
provided after a certain number of negative urine tests are produced (Prendergast et al., 2006).
Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Higgins ST, Heil SH, Lussier JP. (2004). Clinical implications of reinforcement as a determinant
of substance use disorders. Annual Review of Psychology, 55, 431–61.
Prendergast M, Podus D, Finney J, Greenwell L, & Roll J. (2006). Contingency management
for treatment of substance use disorders: A meta‐ analysis. Addiction, 101, 1546-1560.
Silverman K, Wong CJ, Higgins ST, Brooner RK, Montoya ID, Contoreggi C, et al. (1996).
Increasing opiate abstinence through voucher-based reinforcement therapy. Drug and
Alcohol Dependence, 41, 157-165.
No manual available.
9. Lower-Cost Contingency Management (LCCM). LCCM approaches that use prizes with
monetary values of $1–$100 appear to reduce drug use as indicated in studies by Petry et al.
(2001; 2002; 2005). Cocaine- and heroin-dependent participants were randomly assigned to a
group that was eligible to receive abstinent-contingent prizes or a standard care group (Petry et
al., 2002). In the abstinent-contingent prize group, participants who submitted urine samples
negative for cocaine and opioids were eligible to draw for prizes of various values. Patients in
the prize group condition achieved longer durations of continuous abstinence than patients in
the standard treatment condition, and these effects were maintained throughout a 6-month
follow-up period. Conversely, LCCM approaches that use reinforcers without monetary value
and/or reinforce behaviors other than provision of drug-free urine samples may be promising
strategies, but there are no cost-effectiveness data that might persuade policy makers and
third-party payers to support these approaches in clinical practice (Carroll & Onken 2005).
Fidelity
As stated above, numerous variations in voucher schedules and implementation of CM/LCCM
are possible, depending on program resources. Fidelity requirement for improved outcomes not
found.
References reporting improved client outcomes:
Carroll KM, & Onken LS. (2005). Behavioral therapies for drug abuse. American Journal of
Psychiatry, 162, 1452-1460.
Petry NM, Peirce JM, Stitzer ML, Blaine J, Roll JM., Cohen A, et al. (2005). Effect of prizebased incentives on outcomes in stimulant abusers in outpatient psychosocial treatment
programs. Archives of General Psychiatry, 62, 1148-1156.
Petry NM, Martin B, Cooney JL, Kranzler HR. (2000). Give them prizes, and they will come:
contingency management for treatment of alcohol dependence. Journal of Consulting and
Clinical Psychology, 68, 250-257.
Petry NM, Martin B. (2002). Low-cost contingency management for treating cocaine- and
opioid-abusing methadone patients. Journal of Consulting and Clinical Psychology, 70, 398405.
No manual available, for more info see: http://ctndisseminationlibrary.org/display/291.htm
10. Day Treatment with Abstinence Contingencies and Vouchers. This intervention was
developed to treat homeless individuals dependent on crack/cocaine. Lunch and transportation
were provided, as were individual and group counseling, and multiple psycho-educational and
relapse prevention groups. After at least two weeks of abstinence, participants graduated to a
4-month work component that paid wages that could be used to rent inexpensive, drug-free
housing. A voucher system also rewarded drug-free related social and recreational activities.
Compared to usual care, intervention participants had 36% fewer positive tests for cocaine at 2
months and 18% fewer at 6 months; they were also more likely to be employed and had fewer
days of homelessness at follow-up.
Fidelity
Each component of day treatment was described in a brief program guide, which provided
structure for counselors. The guide described the goals of the activities, procedures, and
groups. Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Milby JB, Schumacher JE, Raczynski JM, Caldwell E, Engle M, Michael M, Carr J. (1996).
Sufficient conditions for effective treatment of substance abusing homeless. Drug & Alcohol
Dependence, 43, 39-47
Schumacher JE, Milby JB, Caldwell E, Raczynski J, Engle M, Michael M, & Carr J. (1995).
Treatment outcome as a function of treatment attendance with homeless persons abusing
cocaine. Journal of Addictive Diseases, 14, 73-85.
No manual available.
11. Group Drug Counseling (GDC) for Cocaine Addiction: The Collaborative Cocaine
Treatment Study Model (CCTS). GDC involves 24 group therapy sessions during a 6-month
period in two phases. Phase 1 is structured and psycho-educational in nature, and provides an
overview of the key issues in early recovery related to addiction, the recovery process, and
relapse prevention. In Phase II, a more “open” problem-solving approach is used to discuss
current concerns and problems, and clients set the agenda for discussion during each group
session. Although the CCTS study found that individual drug counseling (IDC), cognitive
therapy, and other treatments helped patients improve, the combination of IDC and GDC
produced the best results in terms of reductions in cocaine and other drug use (Crits-Christoph
et al., 1999).
Fidelity
Extensive attention was paid to selection, training, and competence of each counselor
delivering the intervention. Assessments of treatment fidelity and discrimination were obtained
during the training phase and the main trial using independent audiotape ratings. Training
phase data indicated that the treatments were implemented as intended and that the treatment
conditions could be readily differentiated (Crits-Christoph et al., 1999). Fidelity requirement for
improved outcomes not found.
References reporting improved client outcomes:
Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken LS, et al. (1999).
Psychosocial treatments for cocaine dependence: Results from the NIDA collaborative
cocaine treatment Study. Archives of General Psychiatry, 56, 493-502.
Crits-Christoph P, Siqueland L, McCalmont E, Gastriend DR, Frank A, Moras K, et al. (2001).
Impact of psychosocial treatments on associated problems of cocaine-dependent patients.
Journal of Consulting and Clinical Psychology, 69, 825-830.
Treatment manual:
Daley DC, Mercer DE, & Carpenter G. (2002). Drug Counseling for Cocaine Addiction: The
Collaborative Cocaine Treatment Study Model. US Department of Health and Human Services,
National Institutes of Health, National Institute of Drug Abuse.
http://archives.drugabuse.gov/pdf/Manual4.pdf
12. Individual Drug Counseling Approach to Treat Cocaine Addiction (IDC): The
Collaborative Cocaine Treatment Study Model (CCTS). IDC is a drug counseling approach
that focuses on the symptoms of drug addiction and related areas of impairment, and the
content and structure of the patient's ongoing recovery program. It gives the patient coping
strategies and tools for recovery and promotes 12-step ideology and participation. The goals
are to assist patients in achieving and maintaining abstinence from addictive chemicals and
behaviors, and to help them recover from the damage the addiction has caused in their life.
IDC consists of 36 sessions over 6 months (approximately 45 minutes each) during the active
treatment phase and then once-a-month follow-up sessions for 3 months. As noted with GDC,
the researchers with the CCTS study reported IDC and other treatments helped patients
significantly reduce cocaine and other drug use; however, the combination of IDC and GDC
produced the best results (Crits-Christoph et al, 1999)
Fidelity:
Barber et al. (1996) developed a seven-point fidelity scale for IDC. Three raters assessed 43
items based on the main components described in the treatment manual. These measures
were used to assess both adherence (i.e., extent to which intervention components are
delivered as prescribed in the treatment manual), and competence (i.e., qualitative measure of
the skillfulness in which intervention components are delivered). Rater training included a
practice period during which raters met weekly to rate 72 tapes, followed by discussion about
how they were using the scale. Raters then rated 62 new tapes in order to assess interrater
reliability. Overall, intraclass correlation coefficients for adherence and competence ratings
were acceptable. Adherence to IDC was associated with better drug use outcomes only when
the therapeutic alliance was low (Barber et al., 2006).
References reporting improved client outcomes:
(See references under #11, GDC)
Treatment manual:
Mercer DE, & Woody GE. (1999). An Individual Drug Counseling Approach to Treat Cocaine
Addiction: The Collaborative Cocaine Treatment Study Model. US Department of Health and
Human Services, National Institutes of Health, National Institute of Drug Abuse.
http://archives.drugabuse.gov/pdf/Manual3.pdf
13. Matrix Intensive Outpatient Program for Treatment of Stimulant Abuse The Matrix Model
is a treatment approach for stimulant use disorders that was developed through 20 years of
experience in real-world treatment settings. This approach consists of relapse-prevention
groups, education groups, social-support groups, individual counseling, and urine and breath
testing delivered over a 16-week period. Participants also become familiar with self-help
programs. Matrix participants were 38% more likely to stay in treatment and 27% more likely to
complete treatment compared with participants receiving treatment as usual; stimulant use in
the past 30 days declined from an average of 11 days at the beginning of treatment to 4 days
at treatment discharge (Rawson et al., 1995, 2004).
Fidelity
Staff trained to deliver the Matrix Model received an initial 40 hours of didactic and experiential
training. Clinical supervisors conducted booster training sessions at each site, led mandatory
weekly teleconferences with Matrix clinicians, monitored clinician performance via a weekly
activity checklist, reviewed a sample of tape-recorded sessions and provided feedback
regularly to ensure that the Matrix Model was implemented as designed. Two fidelity scales
were developed to assess adherence to the treatment protocol. Data from Year 2 of the study
found that sites adhered to the Matrix Model protocol in implementation of critical elements
(Rawson et al., 2004). Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Rawson RA, Marinelli-Casey P, Anglin MD, Dickow A, Frazier Y, Gallagher C, et al. (2004). A
multi-site comparison of psychosocial approaches for the treatment of methamphetamine
dependence. Addiction, 99, 708-717.
Rawson RA, Shoptaw SJ, Obert JL, McCann MJ, Hasson AL, Marinelli-Casey PJ, et al. (1995).
An intensive outpatient approach for cocaine abuse treatment: The Matrix model. Journal of
Substance Abuse Treatment, 12, 117-127.
Treatment manual:
The Matrix Institute, Obert JL, Rawson, R, McCann MJ, Ling W. (2005). The Matrix Model
Therapist's Manual, A 16-week Individualized Program. Center City, MN: Hazelden Publishing.
Some manuals and materials are available free of charge; others may be purchased at
www.hazelden.org. For more information about treatment manuals:
http://www.matrixinstitute.org/training/manuals.html
14. Motivational Enhancement Therapy (MET). MET is an adaptation of motivational interviewing
(MI) that includes normative assessment feedback to clients that is presented and discussed in
a non-confrontational manner. This approach is a goal-oriented, client-centered counseling
style for facilitating behavior change by helping clients resolve ambivalence across a range of
problematic behaviors. MET uses an empathic and strategic approach in which the therapist
provides feedback that is intended to strengthen and consolidate the client's commitment to
change and promote a sense of self-efficacy. As noted under TSF and CBT, participants in all
Project MATCH conditions, including MET showed significant reductions in drinking (Project
MATCH Research Group, 1998). Further study shows this approach is associated with
reductions in alcohol and drug use during treatment and 12 weeks after treatment, as well as
improvements in social functioning (Ball et al., 2007).
Fidelity:
Over 80 therapists from diverse backgrounds received careful training and supervision using
Project MATCH structured manuals and were able to implement these treatments successfully
and with fidelity (Project MATCH Research Group, 1998). However, more recently, Madsen et
al. (2005) found variability in studies employing motivational interviewing (MI) approaches with
regard to the training, supervision, and monitoring of therapists delivering the intervention. This
finding is problematic given the concerns of some researchers that MI is sometimes
implemented in a fashion that violates the spirit of the approach; consequently, instruments that
assess adherence to MI approaches are being developed (Madsen et al., 2006). Martino et al.
(2008) found that greater adherence to MET was associated with significant, although modest,
client process and outcome variables, and a higher rate of negative drug screens during
treatment was found for clients whose counselor demonstrated better adherence to the MET
protocol.
References reporting improved client outcomes:
Ball SA, Martino S, Nich C, Frankforter TL, van Horn D, Crits-Christoph P, et al. (2007). Site
matters: Multisite randomized trial of motivational enhancement therapy in community drug
abuse clinics. Journal of Consulting and Clinical Psychology, 75, 556-567.
Project MATCH Research Group. (1997). Matching alcoholism treatments to client
heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on
Alcohol, 58, 7-29.
Treatment manual:
Miller WR, Zweben A, DiClemente CC, Rychtarik RG. (1994). Motivational Enhancement
Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol
Abuse and Dependence. Project MATCH Monograph Series, Vol. 2; DHHS Publication No. 943723. Rockville, MD: NIAAA, 1994. http://lib.adai.washington.edu/pubs/match2/match2.pdf
15. Mapping-Enhanced Counseling (formerly “Node-Link Mapping”). This strategy involves the
counselor and client developing visual representations, or maps, of issues that emerge in SUD
treatment. Drawing a map or diagram can help clients see and understand relationships
between their actions and consequences and can help them express complex relationships
and parallel ideas that are difficult to verbalize. As a therapeutic tool, it helps address problems
more clearly than when relying strictly on verbal skills. Clients who received this approach
significantly decreased their opiate and cocaine use and had fewer positive urine samples
overall than clients receiving standard counseling; they also were less likely to have used a
dirty needle at 6-month follow-up (Dansereau et al., 1996). In addition, clients assigned to
mapping-enhanced counseling missed fewer scheduled sessions than standard counseling
clients in the first 6 months of treatment (Newbern et al., 2005).
Fidelity:
The training included a series of workshops during which counselors practiced using mapping
and received training in the use of the manual. Mapping procedures were monitored and
observed periodically by the training staff to assure that mapping was implemented adequately
(Dansereau, et al., 1996). Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Dansereau DF, Joe GW, Dees SM, & Simpson DD. (1996). Ethnicity and the effects of
mapping-enhanced drug abuse counseling. Addictive Behaviors, 21(3), 363-376.
Joe GW, Dansereau DF, Pitre U, & Simpson DD. (1997). Effectiveness of node-link mapping
enhanced counseling for opiate addicts: A 12-month post treatment follow-up. Journal of
Nervous and Mental Disease, 185, 306-313.
Newbern D, Dansereau DF, Czuchry M, & Simpson DD. (2005). Node-link mapping in
individual counseling: Treatment impact on clients with ADHD-related behaviors. Journal of
Psychoactive Drugs, 37, 93-103.
Treatment manual:
Dansereau DF, Dees SM, Chatham LR, Boatler JF, & Simpson DD. (August 1993) Mapping
New Roads to Recovery. Texas Institute of Behavioral Research at Texas Christian University
(TCU). http://ibr.tcu.edu/wp-content/uploads/sites/2/2013/09/mappingall.pdf
16. Relapse Prevention Therapy (RPT). RPT is a behavioral self-control program that teaches
individuals with substance addiction how to anticipate and cope with the potential for relapse.
RPT can be used as a stand-alone SUD treatment or as an aftercare program to sustain gains
achieved during initial SUD treatment. Coping skills training is the cornerstone of RPT. A metaanalysis found RPT was most effective when applied to alcohol or polysubstance use
disorders, and combined with the adjunctive use of medication (Irvin et al., 1999). Overall,
many basic tenets of the RPT model have received support, and findings regarding its clinical
effectiveness have generally been supportive (Hendershot et al., 2011). Effectiveness of RPT
in reducing the frequency of relapse episodes as well as the intensity of lapse and/or relapse
episodes among people who resumed alcohol use after treatment has been reported (Larimer
et al., 1999).
Fidelity
In a study of RTP for cocaine dependence, all therapists received extensive training in RTP
that included a 2-day didactic seminar and successful completion of at least one closely
supervised training case. To promote adherence to manual guidelines and prevent drift through
the main phase of the study, therapists met weekly with study investigators to discuss case
material and review session videotapes (Carroll et al., 1999). Fidelity requirement for improved
outcomes not found.
References reporting improved client outcomes:
Carroll KM, Rounsaville BJ, Nich C, Gordon LT, Wirtz PW, & Gawin F. (1994). One-year followup of psychotherapy and pharmacotherapy for cocaine dependence: delayed emergence of
psychotherapy effects. Archives of General Psychiatry, 51, 989-997.
Hendershot CS, Witkiewitz K, George WH, Marlatt GA. (2011). Relapse prevention for
addictive behaviors. Substance Abuse Treatment Prevention and Policy, 6, 17.
Larimer ME, Palmer RS, Marlatt GA. (1999). Relapse prevention: An overview of Marlatt’s
cognitive-behavioral model. Alcohol Research and Health, 23, 151-160.
Treatment manual:
Marlatt GA, Parks GA, and Witkiewitz K. (December 2002). Clinical Guidelines for
Implementing Relapse Prevention Therapy: A Guideline Developed for the Behavioral Health
Recovery Management Project. Addictive Behaviors Research Center, University of
Washington, Seattle. http://www.bhrm.org/guidelines/RPT%20guideline.pdf
17. Seeking Safety. Seeking Safety is a present-focused treatment for clients with a history of
trauma and substance abuse for use in groups or individual treatment, with male and female
clients, and in a variety of settings. This approach focuses on safety as the overarching goal
(helping clients attain safety in their relationships, thinking, behavior, and emotions) and
integrated SUD/PTSD treatment. Compared with women in a treatment-as-usual condition,
women who participated in Seeking Safety significantly reduced their substance use at the end
of treatment and at the 6-month follow-up (Hien et al., 2004). Another study found that
substance use outcomes were improved but were not significantly different over time for
women receiving the Seeking Safety intervention compared to those who received a treatmentas-usual intervention called "Women's Health Education" (Hien et al, 2009).
Fidelity
All counselors and supervisors attended a comparable centralized 3-day workshop, and
supervisors received another half day of training focused on how to carry out supervision. An
expert from the lead training team rated the videotaped certification sessions for adherence to
the manual and competency in the delivery of the interventions. The supervisors used the
certification sessions to obtain interrater reliability with the lead expert trainers on the
adherence measures (Hien et al., 2009). Fidelity requirement for improved outcomes not found.
References reporting improved client outcomes:
Hien D, Wells EA, Jiang H, Suarez-Morales L, Campbell AN, Cohen LR, et al. (2009). Multisite
Randomized Trial of Behavioral Interventions for Women with Co-Occurring PTSD and
Substance Use Disorders. Journal of Consulting and Clinical Psychology, 77, 607-619.
Hien DA, Cohen LR, Miele GM, Litt LC, & Capstick C. (2004). Promising treatments for women
with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161,
1426-1432.
Holdcraft LC, & Comtois KA. (2002). Description of and preliminary data from a women's
dual diagnosis community mental health program. Canadian Journal of Community Mental
Health, 21, 91-109.
Treatment manual:
Najavits LM. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. New
York: Guilford Press. http://www.seekingsafety.org/
18. Supportive-Expressive Psychotherapy (SE). SE is an analytically oriented, time-limited
psychotherapy that has been adapted for use with individuals with heroin and cocaine
addiction. Particular emphasis is given to themes related to drug dependence, the role of drugs
in relation to problem feelings and behaviors, and alternative, drug-free means of resolving
problems. Relative to individuals who received drug counseling, those who received SE
reported fewer days of opiate and sedative use and were able to take a lower dose of
methadone at follow-up (Luborsky et al., 1985).
Fidelity
The SE treatment manual was used in both the initial training and in the continuing supervision
of all psychotherapists. The SE therapists were supervised weekly in a group by Dr. Luborsky
for the first two thirds of the study and then biweekly. Fidelity requirement for improved
outcomes not found.
References reporting improved client outcomes:
Luborsky L, McLellan, AT, Woody GE, O'Brien CP, & Auerbach A. (1985). Therapist success
and its determinants. Archives of General Psychiatry, 42, 602-611.
Woody GE, Luborsky L, McLellan AT, O'Brien CP, Beck AT, Blaine J, et al. (1983).
Psychotherapy for opiate addicts: Does it help? Archives of General Psychiatry, 40, 639645.
Treatment manual:
Luborsky L. (2000). Principles of Psychoanalytic Psychotherapy: A Manual for SupportiveExpressive (SE) Treatment. New York: Basic Books.
19. Boston Consortium Model (BCM): Trauma-Informed Substance Abuse Treatment for
Women. This program provides a fully integrated set of substance abuse treatment and
trauma-informed mental health services to low-income, minority women with co-occurring
alcohol/drug addiction, mental disorders, and trauma histories. The treatment provider
develops an integrated, trauma-informed treatment plan for the client, links her to the
appropriate mental health services, and works collaboratively as the primary point of contact
with the client's mental health and SUD treatment service teams. Additionally, BCM uses five
manual-driven, skills-building group modules. Women in the BCM condition reported
significantly lower illicit drug use, mental health symptoms, and HIV risk behaviors than a
treatment-as-usual group (Amaro et al., 2007).
Fidelity
Staff who participated received in-depth staff training on trauma informed care, links between
trauma, mental illness and SUDs, and trauma specific intervention. Fidelity requirement for
improved outcomes not found.
References reporting improved client outcomes:
Amaro H, Dai J, Arevalo S, Acevedo A, Matsumoto A, Nieves R, et al. (2007). Effects of
integrated trauma treatment on outcomes in a racially/ethnically diverse sample of women
in urban community-based substance abuse treatment. Journal of Urban Health, 84, 508522.
Amaro H, Larson MJ, Zhang A, Acevedo A, Dai J, & Matsumoto A. (2007). Effects of
trauma intervention on HIV sexual risk behaviors among women with co-occurring disorders
in substance abuse treatment. Journal of Community Psychology, 35, 895-908.
Amaro H, Chernoff M, Brown V, Arévalo S, & Gatz M. (2007). Does integrated trauma-informed
substance abuse treatment increase treatment retention? Journal of Community
Psychology, 35, 845-862.
Amaro H, McGraw S, Larson MJ, Lopez L, Nieves R, Marshall B. (2004). Boston Consortium of
Services for Families in Recovery: a trauma-informed intervention model for women’s
alcohol and drug addiction treatment. Alcoholism Treatment Quarterly, 22, 95–119.
Treatment manual:
Amaro, H, Melendez, MP, Melnick, S, and Nieves, RL. (2005). Integrated Substance Abuse,
Mental Health and Trauma Treatment with Women: A case study workbook for staff training.
Boston Consortium of Services for Families in Recovery, Public Health Commission, Boston,
MA. http://www.bphc.org/whatwedo/AddictionServices/Documents/Curricula/Intergrated%20Substance%20Abuse%20EN.pdf
APPENDIX II
About the Evidence-Based Practice Matrix
The matrix is a modified version of the Evidence-Based Practices for Treating Substance Use
Disorders: Matrix of Interventions, which was developed as a joint project of the University of the
Washington Alcohol & Drug Abuse Institute (ADAI) and the Northwest Frontier Addiction
Technology Transfer Center. The ADAI matrix can be accessed from:
Institute http://adai.washington.edu/ebp/matrix.pdf
Links to the developers, summaries, intervention details, training/technical assistance, supporting
references, and treatment manuals (when available) are embedded within this matrix. The
following sources were used to determine which practices to include in the ADAI matrix.

Knowledge Application Program (KAP) of the Center for Substance Abuse Treatment. This
program produces, markets, and distributes knowledge about best treatment practices by
putting it in the hands of providers who help individuals seeking substance abuse treatment.

Miller WR, Wilbourne PL, Hettem JE. "What Works? A Summary of Alcohol Treatment
Outcome Research." In: Hester, Reid K; Miller, William R (eds.) Handbook of Alcoholism
Treatment Approaches: Effective Alternatives (3rd ed.). Boston : Allyn and Bacon, 2003.
pp.13-63.

National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A ResearchBased Guide (1999). This guide was developed after NIDA's National Conference on Drug
Addiction Treatment: From Research to Practice in April 1998. It is designed to help foster
more widespread use of scientifically based treatment components.

Onken, Lisa. Effective Behavior Therapies for Treatment of Drug Abuse. (Unpublished
document). Bethesda, MD: Behavioral Treatment Development Branch National Institute on
Drug Abuse (NIDA).

SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP). A
searchable database of interventions for the prevention and treatment of mental and
substance use disorders. http://nrepp.samhsa.gov/
APPENDIX III
Evidence-based practices as adjunctive treatments (for issues/concerns other than SUD)
Although the following EBPs were not developed to treat SUD, these treatments address concerns
relevant to many individuals with SUD. For more information about these treatments, go to
http://adai.washington.edu/ebp/matrix.pdf and click on the specific treatment. Updated links to
manuals are provided below.
Time Out! for Me: An Assertiveness and Sexuality Workshop Designed for Women
This intervention, which was developed for the TCU/DATAR project, was designed to help
counselors work with sexually active women to improve their self-esteem, interpersonal
communication skills, and comfort with sexuality. These are important issues for increasing
women’s acceptance of safer sex choices and healthier sexual life-styles, and may help reduce
their risk of HIV infection from sexual behaviors.
Treatment manual: http://www.ibr.tcu.edu/pubs/trtmanual/tofm.html
Time Out! for Men: A Communication Skills and Sexuality Workshop Designed for Men.
This intervention provides guidelines for leading an 8-session workshop for men who are interested
in improving their intimate relationships. Communication skills, self-esteem, sexual health, and
conflict resolution skills are presented as a foundation for helping men find solutions to relationship
difficulties.
Treatment manual: http://www.ibr.tcu.edu/pubs/trtmanual/tofmen.html
Anger Management for Substance Abuse and Mental Health Clients: Cognitive-Behavioral
Therapy
Anger Management is based on social learning theory; it may be useful for counselors who work
with substance abuse and mental health clients with concurrent anger problems.
Treatment manual: http://store.samhsa.gov/shin/content//SMA13-4213/SMA13-4213.pdf
Moral Reconation Therapy [Reconation meaning “the conscious process of decision-making”]
This is a systematic treatment strategy that seeks to decrease recidivism among criminal offenders
by increasing moral reasoning. Its cognitive-behavioral approach combines elements from a variety
of psychological traditions to progressively address ego, social, moral, and positive behavioral
growth.
Treatment manual: http://www.moral-reconation-therapy.com/
Holistic Health Recovery Program (HHRP, formerly Holistic Harm Reduction Program)
HHRP is an HIV prevention and management intervention dedicated to harm reduction, health
promotion, and improved quality of life for individuals addicted to illicit drugs. It utilizes cognitive
remediation strategies (e.g., multimodal presentation of material) to facilitate acquisition and
retention of new harm reduction skills. The group treatment manual, handouts, and client workbook
are all available free of charge at the link below; slides are available for a fee. This program
provides separate HHRP manuals for individuals of negative or unknown HIV serostatus and
individuals who know their serostatus is HIV positive.
Treatment manual: http://medicine.yale.edu/spiritualselfschema/training/hhrp/hhrpgroup.aspx
APPENDIX IV
Articles Reporting Fidelity Research on Evidence-Based Practices
Barber JP, Gallop R, Crits-Christoph P, Frank A, Thase M, Weiss RD, et al. (2006). The role of
therapist adherence, therapist competence, and alliance in predicting outcome of individual drug
counseling: results from the National Institute on Drug Abuse Collaborative Cocaine Treatment
Study. Psychotherapy Research, 16, 229–240.
Barber JP, Mercer D, Krakauer I, Calvo N. (1996). Development of an adherence/competence
rating scale for individual drug counseling. Drug and Alcohol Dependence, 43, 125–132.
Barber JP, Sharpless BA, Klosterman S, McCarthy KS. (2007). Assessing intervention competence
and its relation to therapy outcome: a selected review derived from the outcome literature.
Professional Psychology: Research and Practice, 38, 493–500.
Carroll KM, & Onken LS. (2005). Behavioral therapies for drug abuse. American Journal of
Psychiatry, 162, 1452-1460.
Guydish J, Campbell BK, Manuel JK, Delucchi KL, Le T, Peavy KM, & McCarty D. (2014). Does
treatment fidelity predict client outcomes in 12-Step Facilitation for stimulant abuse? Drug and
Alcohol Dependence, 134, 330-336.
Hogue A, Henderson CE, Dauber S, Barajas PC, Fried A, Liddle HA. (2008). Treatment
adherence, competence, and outcome in individual and family therapy for adolescent behavior
problems. Journal of Consulting and Clinical Psychology, 76, 544–555.
Madson MB, & Campbell TC. (2006). Measures of fidelity in motivational enhancement: A
systematic review. Journal of Substance Abuse Treatment, 31, 67-73.
Martino S, Ball SA, Nich C, Frankforter TL, Carroll KM, (2008). Community program therapist
adherence and competence in motivational enhancement therapy. Drug and Alcohol Dependence,
97, 37–48.
Sholomskas, DE, & Carroll, KM. (2006). One small step for manuals: Computer-assisted training in
twelve-step facilitation. Journal of Studies on Alcohol, 67, 939-947.
Sholomskas DE, Syracuse-Siewert G, Rounsaville BJ, Ball SA, Nuro KF, & Carroll KM. (2005). We
don't train in vain: a dissemination trial of three strategies of training clinicians in cognitivebehavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106-112.