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Individual Oral Paper

Dissemination & Implementation Science

Biopsychosocial Predictors of Substance Use

7 - (IOP 29) Minimal Progress Toward Sustainment: 10-year Replication of Substance Use EBP Sustainment Trajectories and Associations with Implementation Characteristics

Sunday, November 23, 2025
11:30 AM - 11:45 AM CST
Location: Imperial 12, Level 4
Keywords: Implementation, Substance Abuse, Adolescents
Recommended Readings: Hunter, S.B., et al. Associations between implementation characteristics and evidence-based practice sustainment: a study of the Adolescent Community Reinforcement Approach. Implementation Sci 10, 173 (2015). https://doi.org/10.1186/s13012-015-0364-4,   Dopp, A.R., et al. Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders: protocol for a mixed-method study. Implement Sci Commun 3, 51 (2022). https://doi.org/10.1186/s43058-022-00298-y,   Chinman, M., et al. “What We Have Here, Is a Failure to [Replicate]”: Ways to Solve a Replication Crisis in Implementation Science. Prev Sci 23, 739–750 (2022). https://doi.org/10.1007/s11121-021-01286-9,   ,  
Background. Over the past decade, implementation researchers have empirically identified factors influencing long-term sustainment of evidence-based practices (EBPs) that can be targeted in EBP implementation efforts. We conducted a conceptual replication of a prior study (Hunter et al., 2015) by examining sustainment of a cognitive-behavioral exemplar EBP for adolescent substance use, the Adolescent Community Reinforcement Approach (A-CRA), using the same methods and a unique, but comparable, sample.

Method. Our sample included 66 service organizations that implemented A-CRA through federal grants awarded to state substance use agencies (previously, Hunter et al. studied 68 organizations that had directly received federal grants). Data were collected 1-5 years after grant end (M=3.3 years) through interviews and surveys with clinicians and supervisors. We assessed A-CRA sustainment status, date of A-CRA discontinuation (when relevant), and factors related to sustainment across multilevel domains in the Consolidated Framework for Implementation Research (CFIR). Using survival analysis, we calculated the probability of A-CRA sustainment over time and examined whether CFIR factors predicted sustainment status. We compared our findings with Hunter et al., using combined data from both studies to test if grant type (state vs. organization) predicted sustainment status or interacted with CFIR factors. We used rapid qualitative analysis of interviews to further explore patterns in the quantitative findings.

Results. Our findings closely replicated those of Hunter et al. A-CRA sustainment was strongly related to time since grant end; 71% of organizations were sustaining A-CRA when funding ended, whereas 50% sustained after 2 years and only 33% by 5 years. In the combined survival analysis, grant type did not predict sustainment probability. Sustainment was significantly associated with factors across the CFIR domains: we replicated associations with funding stability, focus on substance use services, available clinicians, and intervention complexity from Hunter et al., and found unique associations with program evaluation and strategic planning capacities, available supervisors, and perceived advantages and success of A-CRA. Three other associations from the prior sample did not fully replicate (p < .10), but there were no significant interactions between CFIR factors and grant type. Qualitative findings help contextualize these results with in-depth description of service organization perspectives on CFIR factors.

Discussion. This replication study found remarkably consistent ACRA sustainment trajectories and predictors in two samples, 10 years apart. Our findings suggest that implementation strategies and system-level supports for EBPs addressing youth substance use have not made significant advancements toward promoting sustainment. Future work needs to carefully incorporate the growing knowledge base on sustainment predictors into development and testing of robust, multilevel implementation strategies. This study also provides a useful illustration of a replication study in implementation science, which are important but remain rare.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Identify sustainment trajectories and predictors for evidence-based practices, and describe how those findings have replicated over time.