There are well documented problems in adapting evidence-based treatments to fit the real world of addiction treatment programs. Most are too complex, requiring too much training and ongoing clinical supervision to be practical for community-based programs. Confronted with a similar problem in the teaching profession, educational researchers have divided new and complex topics into key elements that could be teachable within individual class sessions. The material for these sessions is typically enhanced with easy-to-use video and audio information to engage the class as well as bulleted teacher points to stimulate class discussion, and pre-packaged class exercises to provide practice with the material. This project uses that same approach, developing and pilot-testing conceptual fidelity, practical utility, and the effectiveness of a curriculum of six toolkits designed to help drug counselors deliver Relapse Prevention (RP) group therapy sessions. This study will enroll 20 counselors from 4 community-based substance abuse treatment programs. We will develop the Toolkit curriculum during the first six months of the grant. We will conduct a study of observed counselor group therapy techniques and content employed, using a single group of counselors (N = 20) (directly observed and rated using a standardized measure) conducting four groups across a four-week period (T1). Three months later, (two-six weeks after being oriented and provided the Toolkit curriculum), the same counselors will be observed conducting four groups across a four week period a second time (T2), and again at a six-month follow-up (T3). Therefore, we will follow the same clinicians across a span of ten months (three months for T1, a one-month bridge for orientation, and six months for T2 and T3). We will also collect measures of Clinician Satisfaction and Clinician RP Knowledge, at each of these time periods, and will track clinician report of frequency and content of groups they conduct on a weekly basis throughout the nine month period. At T1 and at T2, but not at T3, we will also recruit 200 patients at each time point who will take a pre-post RP Knowledge questionnaire, complete a Satisfaction measure, and will provide consent for research staff to review their charts to record attendance, discharge status and UDS results (N = 400). We expect pre-post improvements in counselor skillfulness and content adherence when conducting RP treatment groups. We also expect improvements in pre-post counselor RP knowledge and satisfaction with group content, and we expect improvements in degree of RP-based content employed in treatment groups during the follow-up period. We also expect differences in pre-post patient RP knowledge and group satisfaction. We also expect increased patient treatment attendance, fewer positive urine drug screens, and improved case disposition (discharge type) in the patient group exposed to the RP Toolkit curriculum (T2) when compared to patients not exposed to the Toolkits curriculum (T1).

Project Narrative This project will develop user-friendly, cost effective curriculum of "toolkits" to assist counselors in delivering evidence-based treatments in community treatment programs. If successful, this method of disseminating scientifically-validated practices will advance a critical component in NIDA's mission to bring feasible and desirable ways to incorporate scientifically proven, best practices into the 13,000 treatment programs throughout the US.