Dissemination and Implementation of Cognitive Behavioral Therapy for Stimulant Dependence: A Randomized Trial Comparison of 3 Approaches

Background: This study evaluated the effectiveness of 3 approaches to transferring cognitive behavioral therapy (CBT) to addiction clinicians in the Republic of South Africa (RSA). Methods: Clinicians (N = 143) were assigned to 3 training conditions: (1) an in vivo (IV) approach in which clinicians received in-person training and coaching; (2) a distance learning (DL) approach providing training via videoconference and coaching through teleconferencing; and (3) a control condition (C) providing a manual and 2-hour orientation. Results: Frequency of use of CBT skills increased significantly with the IV and DL approaches compared with the C approach, and the IV approach facilitated greater use of CBT skills than the DL approach. During the active phase of the study, skill quality declined significantly for clinicians trained in the C condition, whereas those in the DL approach maintained skill quality and those in the IV approach improved skill quality. After coaching was discontinued, clinicians in the IV and DL approaches declined in skill quality. However, those in the IV approach maintained a higher level of skill quality compared with the other approaches. Cost of the IV condition was double that of the DL condition and 10times greater than the C condition. Conclusions: In vivo supervision and distance learning methods appear to be effective dissemination and implementation strategies, and distance learning has significant potential to be less costly.