Panel Discussion 37 - When Good Treatments Meet Bad Policy: defending the Integrity of Evidence-based Services

Consistent with the convention theme of Promoting Rigorous Science, our panel highlights challenges in moving effective evidence-based therapies from research to clinical practice. Four panelists will discuss experiences implementing substance use disorder (SUD) interventions with a focus on policy barriers, consumer-driven adaptations to interventions that negatively impact patient outcomes, and obstacles to fidelity monitoring. Our efforts have involved state and federal governments, legal systems, community agencies, and medical and mental health treatment organizations, as well as complexities of navigating state- and federal- policies and the highly variable limitations associated with different funding sources. Dr. Carla Rash will present on deviations from data-driven contingency management protocols, focusing on several examples with national scope and impact and the ethical implications of offering ‘evidence-based treatments’ that no longer align with effective science-backed protocols. Dr. Jeremiah Weinstock will discuss the top-down and bottom-up challenges of implementing contingency management in two different State systems while navigating the federally imposed limits on patient incentives and implementation within a community-based participatory context. Dr. Zachary Adams will highlight barriers to the uptake of effective treatments for SUD and co-occurring mental health concerns in community mental health and primary care settings with a focus on services for adolescents. He will also share challenges to fidelity monitoring in these settings. Last, Dr. Noah Emery will present on a possible model for promoting truly evidence-based practice with a discussion of the practice provisions for addiction treatment in Colorado state law, as well as associated licensure requirements and enforcement mechanisms. Our collective experience of working to bridge the science-to-practice gap while maintaining effectiveness of treatments highlights multiple bottlenecks slowing widespread availability of treatments for clients in need. However, challenges beget opportunities. The panelists will discuss problem-solving steps and solutions, as well as recommendations for future implementation efforts.