Improving Substance Abuse Treatment: An Introduction to the Evidence-Based Practice Movement

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Michele J. Eliason

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  • SAGE SOURCEBOOKS FOR THE HUMAN SERVICES SERIES

    Series Editors: ARMAND LAUFFER and CHARLES GARVIN

    Recent Volumes in This Series

    HEALTH PROMOTION AT THE COMMUNITY LEVEL edited by NEIL BRACHT

    FAMILY POLICIES AND FAMILY WELL-BEING: The Role of Political Culture by SHIRLEY L. ZIMMERMAN

    FAMILY THERAPY WITH THE ELDERLY by ELIZABETH R. NEIDHARDT & JO ANN ALLEN SINGLE-PARENT FAMILIES by KRIS KISSMAN & JO ANN ALLEN

    SUBSTANCE ABUSE TREATMENT: A Family Systems Perspective edited by EDITH M. FREEMAN

    SOCIAL COGNITION AND INDIVIDUAL CHANGE: Current Theory and Counseling Guidelines by AARON M. BROWER & PAULA S. NURIUS

    UNDERSTANDING AND TREATING ADOLESCENT SUBSTANCE ABUSE by PHILIP P. MUISENER

    EFFECTIVE EMPLOYEE ASSISTANCE PROGRAMS: A Guide for EAP Counselors and Managers by GLORIA CUNNINGHAM

    COUNSELING THE ADOLESCENT SUBSTANCE ABUSER: School-Based Intervention and Prevention by MARLENE MIZIKER GONET

    TASK GROUPS IN THE SOCIAL SERVICES by MARIAN FATOUT & STEVEN R. ROSE

    NEW APPROACHES TO FAMILY PRACTICE: Confronting Economic Stress by NANCY R. VOSLER

    WHAT ABOUT AMERICA'S HOMELESS CHILDREN? Hide and Seek by PAUL G. SHANE

    SOCIAL WORK IN HEALTH CARE IN THE 21st CENTURY by SURJIT SINGH DHOOPER

    SELF-HELP AND SUPPORT GROUPS: A Handbook for Practitioners by LINDA FARRIS KURTZ

    UNDERSTANDING DISABILITY: A Lifespan Approach by PEGGY QUINN

    QUALITATIVE METHODS IN SOCIAL WORK RESEARCH: Challenges and Rewards by DEBORAH K. PADGETT

    LEGAL ISSUES IN SOCIAL WORK COUNSELING, AND MENTAL HEALTH: Guidelines for Clinical Practice in Psychotherapy by ROBERT G. MADDEN

    GROUPWORK WITH CHILDREN AND ADOLESCENTS: Prevention and Intervention in School and Community Systems by STEVEN R. ROSE

    SOCIAL WORK PRACTICE WITH AFRICAN AMERICAN MEN: The Invisible Presence by JANICE M. RASHEED & MIKAL N. RASHEED

    DESIGNING AND MANAGING PROGRAMS: An Effectiveness-Based Approach (2nd edition) by PETER M. KETTNER, ROBERT M. MORONEY, & LAWRENCE L. MARTIN

    PROMOTING SUCCESSFUL ADOPTIONS: Practice With Troubled Families by SUSAN LIVINGSTON SMITH & JEANNE A. HOWARD

    CREATING AND MAINTAINING STRATEGIC ALLIANCES: From Affiliations to Consolidations by DARLYNE BAILEY & KELLY McNALLY KONEY

    STOPPING CHILD MALTREATMENT BEFORE IT STARTS by NEIL B. GUTERMAN

    ORGANIZATIONAL CHANGE IN THE HUMAN SERVICES by REBECCA ANN PROEHL

    FAMILY DIVERSITY: Continuity and Change in the Contemporary Family by PAULINE IRIT ERERA

    EFFECTIVELY MANAGING HUMAN SERVICE ORGANIZATIONS (3rd edition) by RALPH BRODY

    SOCIAL WORK SUPERVISION: Contexts and Concepts by MING-SUM TSUI

    IMPROVING SUBSTANCE ABUSE TREATMENT: An Introduction to the Evidence-Based Practice Movement by MICHELE J. ELIASON

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    Acknowledgments

    This project was initiated with funding from the Center for Substance Abuse Treatment, Practice Improvement Collaborative, Grant # 5 UDI TI12632-02. Much of this book was conceived and written while the author was still in residence at the Iowa Consortium for Substance Abuse Research and Evaluation. Consortium Director Stephan Arndt reviewed the first draft and assisted with writing the content on statistics and research designs. Anne Wallis of the University of Iowa College of Public Health contributed content to the chapter on evaluation. Kristina Barber and Kris White provided considerable support for the project as it progressed from pamphlet to book. The book was completed while the author was on sabbatical with generous support from the Institute for Health and Aging at the University of California, San Francisco. Finally, much thanks to Diana Amodia and Marty Jessup for inspiration and support.

    Sage Publications would like to thank the following reviewers:

    • John T. Franklin, University of Detroit Mercy
    • Larry Ashley, University of Nevada, Las Vegas
    • Paul Force-Emery Mackie, Minnesota State University, Mankato
    • Susan L. Schoppelrey, University of Illinois at Urbana-Champaign
    • Steve Shoptaw, University of California, Los Angeles
    • Michael A. Bozarth, State University of New York at Buffalo
    • S. Lala Straussner, NYU School of Social Work
  • Glossary of Key Terms

    Clinical practice guidelines: These are sets of statements or principles that are used to guide the clinical care of clients. Most specialty areas have clinical practice guidelines that were developed for and sponsored by professional associations. For example, the American Society of Addiction Medicine produces the guidelines for patient placement in substance abuse treatment.

    Descriptive statistics: These statistical tools are used to characterize the sample or findings of a research study. They address questions such as: How many participants were there? How old were the participants? How many were women? What kinds of drug patterns were identified? What was the average score on a depression scale, and what was the range of scores? Common descriptive statistics include frequencies, percentages, ranges, means, and standard deviations.

    Evidence-based practice (EBP): As used in this book, an EBP is a treatment approach or skill set that has been tested in several research studies, preferably with randomized clinical trials, and has found to be effective in impacting important client outcomes. It is in a form that is ready to implement in the field, such as a treatment manual or highly specific training materials.

    Fidelity: This is the degree to which clinicians use an EBP in the same way that it was taught to them or presented in a manual.

    Generalizability: The degree to which the findings of a research study might apply to clients or settings not included in the research study. To know if the findings of a study might generalize, one would need to look at the sample characteristics and how individuals were selected for the research study. If a program director is looking for an approach to use with women with anxiety disorders, but all the research on the approach has been done on antisocial men, the research may not generalize.

    Hypothesis: Sometimes called a research question, the hypothesis sets out the expected outcome of the study (“Motivational interviewing will be better than treatment as usual in retaining adolescents in outpatient treatment”) or specifies the question to be answered (“Does naltrexone reduce craving for gambling and tobacco along with reductions in craving for alcohol?”).

    Inferential statistics: These types of statistics are used to determine if the result of the study might be due to chance or sampling errors. They are used to compare the characteristics of a sample to the larger population to test representativeness, to compare the results from two groups to each other, or to compare some measure from baseline to posttest. Common inferential statistics include the t-test, ANOVA, chi square, and multiple regression analyses.

    Logic model: An evaluation tool to facilitate program planning, intervention, and evaluation, a logic model is a visual way of showing the relationships among program resources, activities, and outcomes (results). These relationships can be depicted in tables, graphs, flow charts, or other forms. For a guide to developing logic models, see the W. K. Kellogg Foundation (2004): http://www.wkkf.org/default.aspx?tabid=101&CID=281&CatID=281&ItemID=2813669&NID=20&LanguageID=0

    Meta-analysis: When several randomized clinical trials of one approach are available, those studies can be pooled together and studied for effect size. This method uses each study as the unit of analysis instead of pooling all the individual participants. Effect sizes can be nonexistent, small, medium, or large. Meta-analysis indicating medium or large effects is considered one of the strongest forms of scientific evidence for a practice.

    p-value: Probability values indicate how likely that a result or outcome is due to chance or error. For exploratory studies, one might set the p-value fairly low, such as p = 0.01 (the chance of error is 1 in 100). For making decisions that involve risk or high cost, the p-value is often set at 0.001 (1 in 1,000 chance of being wrong).

    Practice improvement: Also called process improvement, this includes strategies for enhancing the business components of a treatment delivery system, such as methods of reducing waiting lists, ways of handling drop-ins, altering program hours to accommodate more clients, and so on. The Network for the Improvement of Addiction Treatment (NIATx) provides many examples of these procedures. See http://chess.chsra.wisc.edu/NIATx/Content/ContentPage.aspx?NID=171

    Process evaluation: This procedure evaluates program characteristics, such as policies and procedures, rather than client outcomes. It is useful in the study of implementation of new approaches. Was the process—the way the approach was identified, the training, the adoption, the implementing procedures—effective? Process evaluation often uses methods such as interviews with staff members, focus groups, or review of meeting minutes as the primary data collection tools.

    Randomized clinical trial (RCT): Often considered the gold standard of experimental studies used to determine the efficacy and/or effectiveness of some approach, an RCT has two components: random assignment of participants into groups; and at least two groups—an experimental and a control (no treatment) or comparison (treatment as usual) group.

    Sample: In a research study, not everyone in the population of interest can be studied, so a sample of the population must be drawn. The population may be cocaine users, but the sample may be cocaine users in one urban clinic in an eastern state. Statistics can be used to determine if the sample is similar to the larger population on demographic characteristics, increasing the likelihood that the findings will generalize to the larger population.

    Technology transfer: This term refers to the process of finding practical ways to apply scientific findings to the field. It includes tried and true methods such as workshop training, but broadens the idea to examine how and why people learn and how they can be taught or encouraged to apply the knowledge they are given consistently and maintain that knowledge base over time.

    Treatment effectiveness: This term refers to whether an approach has demonstrated that it can produce positive results (impact a desired outcome) in a real-world treatment setting.

    Treatment efficacy: This term refers to whether an approach has been demonstrated to work in controlled laboratory settings under ideal conditions.

    Variable: A characteristic that can take on different values. Variables are the units of study in a research study. For example, gender is a variable that can take on the values of male, female, or other. Age is a variable that can take on many values, from 0 to 100 or more. In an experimental research study, there are at least two kinds of variables:

    • Dependent variables are the outcomes of interest (such as treatment completion rate).
    • Independent variables are the ones that the researcher manipulates (whether the client gets a contingency management intervention or treatment as usual).

    References and Web Resources

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    Appendix A: Text of Oregon Law

    72nd OREGON LEGISLATIVE ASSEMBLY—2003 Regular Session

    Enrolled Senate Bill 267

    Sponsored by COMMITTEE ON JUDICIARY (at the request of AFSCME Council 75)

    CHAPTER

    AN ACT

    Relating to public safety; creating new provisions; amending ORS 181.620 and 181.637; and declaring an emergency.

    Be It Enacted by the People of the State of Oregon:

    SECTION 1. ORS 181.620 is amended to read:

    181.620. (1) The Governor shall appoint a Board on Public Safety Standards and Training consisting of [23] 24 members as follows:

    • Two members shall be chiefs of police recommended to the Governor by the Oregon Association of Chiefs of Police;
    • One member shall be a sheriff recommended to the Governor by the Oregon State Sheriffs' Association;
    • One member shall be a fire chief recommended to the Governor by the Oregon Fire Chiefs' Association;
    • One member shall be a representative of the fire service recommended to the Governor by the Oregon Fire District Directors' Association;
    • One member shall be a member of the Oregon State Fire Fighter's Council recommended to the Governor by the executive body of the council;
    • One member shall be a representative of corrections personnel recommended to the Governor by the Oregon State Sheriffs' Association;
    • One member shall be a representative of the fire service recommended to the Governor by the Oregon Volunteer Fire Fighters' Association;
    • One member shall be a representative of public safety telecommunicators;
    • One member shall be a district attorney recommended to the Governor by the Oregon District Attorneys Association;
    • One member shall be the Superintendent of State Police;
    • One member shall be the Chief of the Portland Police Bureau;
    • One member shall be the State Fire Marshal;
    • One member shall be the Chief of the Portland Fire Bureau;
    • One member shall be the Director of the Department of Corrections;
    • One member shall be the Special Agent in Charge of the Federal Bureau of Investigation for Oregon;
    • One member shall represent forest protection agencies recommended to the Governor by the State Forestry Department;
    • One member shall be an administrator of a municipality recommended to the Governor by the executive body of the League of Oregon Cities;
    • Two members shall be nonmanagement representatives of law enforcement;
    • One member shall be a public member. A person appointed as a public member under this section shall be a person:
      • Who has no personal interest or occupational responsibilities in the area of responsibility given to the board; and
      • Who represents the interests of the public in general; [and]
    • Two members shall be representatives of the private security industry recommended to the Governor by the Advisory Committee on Private Security Services; and
    • One member shall be a representative of the collective bargaining unit that represents the largest number of individual workers in the Department of Corrections.

    (2) The term of office of a member is three years, and no member may be removed from office except for cause. Before the expiration of the term of a member, the Governor shall appoint the member's successor to assume the member's duties on July 1 next following. In case of a vacancy for any cause, the Governor shall make an appointment, effective immediately, for the unexpired term.

    (3) Except for members who serve by virtue of office, no member shall serve more than two terms. For purposes of this subsection, a person appointed to fill a vacancy consisting of an unexpired term of at least one and one-half years has served a full term.

    (4) Appointments of members of the board by the Governor, except for those members who serve by virtue of office, are subject to confirmation by the Senate in the manner provided in ORS 171.562 and 171.565.

    (5) A member of the board is entitled to compensation and expenses as provided in ORS 292.495.

    SECTION 2. ORS 181.637 is amended to read:

    181.637. (1) The Board on Public Safety Standards and Training shall establish the following policy committees:

    • Corrections Policy Committee;
    • Fire Policy Committee;
    • Police Policy Committee; and
    • Telecommunications Policy Committee.

    (2) The members of each policy committee shall select a chairperson and vice chairperson for the policy committee. Only members of the policy committee who are also members of the board are eligible to serve as a chairperson or vice chairperson. The vice chairperson may act as chairperson in the absence of the chairperson.

    (3) The Corrections Policy Committee consists of:

    • All of the board members who represent the corrections discipline;
    • The chief administrative officer of the training division of the Department of Corrections;
    • A security manager from the Department of Corrections; and
    • The following, who may not be current board members, appointed by the chairperson of the board:
      • One person recommended by and representing the Oregon State Sheriffs' Association;
      • Two persons recommended by and representing the Oregon Jail Managers' Association;
      • One person recommended by and representing a statewide association of community corrections directors; [and]
      • One nonmanagement corrections officer employed by the Department of Corrections; and
      • One corrections officer who is a female, who is employed by the Department of Corrections at a women's correctional facility and who is a member of a bargaining unit.

    (4) The Fire Policy Committee consists of:

    • All of the board members who represent the fire service discipline; and
    • The following, who may not be current board members, appointed by the chairperson of the board:
      • One person recommended by and representing a statewide association of fire instructors;
      • One person recommended by and representing a statewide association of fire marshals;
      • One person recommended by and representing community college fire programs; and
      • One nonmanagement firefighter recommended by a statewide organization of firefighters.

    (5) The Police Policy Committee consists of:

    • All of the board members who represent the law enforcement discipline; and
    • The following, who may not be current board members, appointed by the chairperson of the board:
      • One person recommended by and representing the Oregon Association of Chiefs of Police;
      • Two persons recommended by and representing the Oregon State Sheriffs' Association;
      • One command officer recommended by and representing the Oregon State Police; and
      • One nonmanagement law enforcement officer.

    (6) The Telecommunications Policy Committee consists of:

    • All of the board members who represent the telecommunications discipline; and
    • The following, who may not be current board members, appointed by the chairperson of the board:
      • Two persons recommended by and representing a statewide association of public safety communications officers;
      • One person recommended by and representing the Oregon Association of Chiefs of Police;
      • One person recommended by and representing the Oregon State Police;
      • Two persons representing telecommunicators;
      • One person recommended by and representing the Oregon State Sheriffs' Association;
      • One person recommended by and representing the Oregon Fire Chiefs' Association;
      • One person recommended by and representing the Emergency Medical Services and Trauma Systems Program of the Department of Human Services; and
      • One person representing paramedics and recommended by a statewide association dealing with fire medical issues.

    (7) In making appointments to the policy committees under this section, the chairperson of the board shall seek to reflect the diversity of the state's population. An appointment made by the chairperson of the board must be ratified by the board before the appointment is effective. The chairperson of the board may remove an appointed member for just cause. An appointment to a policy committee that is based on the member's employment is automatically revoked if the member changes employment. The chairperson of the board shall fill a vacancy in the same manner as making an initial appointment. The term of an appointed member is two years. An appointed member may be appointed to a second term.

    (8) A policy committee may meet at such times and places as determined by the policy committee in consultation with the board. A majority of a policy committee constitutes a quorum to conduct business. A policy committee may create subcommittees if needed.

    (9)

    • Each policy committee shall develop policies, requirements, standards and rules relating to its specific discipline. A policy committee shall submit its policies, requirements, standards and rules to the board for the board's consideration. When a policy committee submits a policy, requirement, standard or rule to the board for the board's consideration, the board shall:
      • Approve the policy, requirement, standard or rule;
      • Disapprove the policy, requirement, standard or rule; or
      • Defer a decision and return the matter to the policy committee for revision or reconsideration.
    • The board may defer a decision and return a matter submitted by a policy committee under paragraph (a) of this subsection only once. If a policy, requirement, standard or rule that was returned to a policy committee is resubmitted to the board, the board shall take all actions necessary to implement the policy, requirement, standard or rule unless the board disapproves the policy, requirement, standard or rule.
    • Disapproval of a policy, requirement, standard or rule under paragraph (a) or (b) of this subsection requires a two-thirds vote by the members of the board.

    (10) At any time after submitting a matter to the board, the chairperson of the policy committee may withdraw the matter from the board's consideration.

    SECTION 3. As used in this section and section 7 of this 2003 Act:

    (1) “Agency” means:

    • The Department of Corrections;
    • The Oregon Youth Authority;
    • The State Commission on Children and Families;
    • That part of the Department of Human Services that deals with mental health and addiction issues; and
    • The Oregon Criminal Justice Commission.

    (2) “Cost effective” means that cost savings realized over a reasonable period of time are greater than costs.

    (3) “Evidence-based program” means a program that:

    • Incorporates significant and relevant practices based on scientifically based research; and
    • Is cost effective.

    (4)

    • “Program” means a treatment or intervention program or service that is intended to:
      • Reduce the propensity of a person to commit crimes;
      • Improve the mental health of a person with the result of reducing the likelihood that the person will commit a crime or need emergency mental health services; or
      • Reduce the propensity of a person who is less than 18 years of age to engage in antisocial behavior with the result of reducing the likelihood that the person will become a juvenile offender.
    • “Program” does not include:
      • An educational program or service that an agency is required to provide to meet educational requirements imposed by state law; or
      • A program that provides basic medical services.

    (5) “Scientifically based research” means research that obtains reliable and valid knowledge by:

    • Employing systematic, empirical methods that draw on observation or experiment;
    • Involving rigorous data analyses that are adequate to test the stated hypotheses and justify the general conclusions drawn; and
    • Relying on measurements or observational methods that provide reliable and valid data across evaluators and observers, across multiple measurements and observations and across studies by the same or different investigators.

    SECTION 4. As used in sections 5 and 6 of this 2003 Act, “agency,” “cost effective,” “evidence-based program” and “program” have the meanings given those terms in section 3 of this 2003 Act.

    SECTION 5. (1) For the biennium beginning July 1, 2005, the Department of Corrections, the Oregon Youth Authority, the State Commission on Children and Families, that part of the Department of Human Services that deals with mental health and addiction issues and the Oregon Criminal Justice Commission shall spend at least 25 percent of state moneys that each agency receives for programs on evidence-based programs.

    (2) Each agency shall submit a report containing:

    • An assessment of each program on which the agency expends funds, including but not limited to whether the program is an evidence-based program;
    • The percentage of state moneys the agency receives for programs that is being expended on evidence-based programs;
    • The percentage of federal and other moneys the agency receives for programs that is being expended on evidence-based programs; and
    • A description of the efforts the agency is making to meet the requirements of subsection (1) of this section and sections 6 (1) and 7 (1) of this 2003 Act.

    (3) The agencies shall submit the reports required by subsection (2) of this section no later than September 30, 2006, to the interim legislative committee dealing with judicial matters.

    (4) If an agency, during the biennium beginning July 1, 2005, spends more than 75 percent of the state moneys that the agency receives for programs on programs that are not evidence based, the Legislative Assembly shall consider the agency's failure to meet the requirement of subsection (1) of this section in making appropriations to the agency for the following biennium.

    (5) Each agency may adopt rules necessary to carry out the provisions of this section, including but not limited to rules defining a reasonable period of time for purposes of determining cost effectiveness.

    SECTION 6. (1) For the biennium beginning July 1, 2007, the Department of Corrections, the Oregon Youth Authority, the State Commission on Children and Families, that part of the Department of Human Services that deals with mental health and addiction issues and the Oregon Criminal Justice Commission shall spend at least 50 percent of state moneys that each agency receives for programs on evidence-based programs.

    (2) Each agency shall submit a report containing:

    • An assessment of each program on which the agency expends funds, including but not limited to whether the program is an evidence-based program;
    • The percentage of state moneys the agency receives for programs that is being expended on evidence-based programs;
    • The percentage of federal and other moneys the agency receives for programs that is being expended on evidence-based programs; and
    • A description of the efforts the agency is making to meet the requirements of subsection (1) of this section and section 7 (1) of this 2003 Act.

    (3) The agencies shall submit the reports required by subsection (2) of this section no later than September 30, 2008, to the interim legislative committee dealing with judicial matters.

    (4) If an agency, during the biennium beginning July 1, 2007, spends more than 50 percent of the state moneys that the agency receives for programs on programs that are not evidence based, the Legislative Assembly shall consider the agency's failure to meet the requirement of subsection (1) of this section in making appropriations to the agency for the following biennium.

    (5) Each agency may adopt rules necessary to carry out the provisions of this section, including but not limited to rules defining a reasonable period of time for purposes of determining cost effectiveness.

    SECTION 7. (1) The Department of Corrections, the Oregon Youth Authority, the State Commission on Children and Families, that part of the Department of Human Services that deals with mental health and addiction issues and the Oregon Criminal Justice Commission shall spend at least 75 percent of state moneys that each agency receives for programs on evidence-based programs.

    (2) Each agency shall submit a biennial report containing:

    • An assessment of each program on which the agency expends funds, including but not limited to whether the program is an evidence-based program;
    • The percentage of state moneys the agency receives for programs that is being expended on evidence-based programs;
    • The percentage of federal and other moneys the agency receives for programs that is being expended on evidence-based programs; and
    • A description of the efforts the agency is making to meet the requirement of subsection (1) of this section.

    (3) The agencies shall submit the reports required by subsection (2) of this section no later than September 30 of each even-numbered year to the interim legislative committee dealing with judicial matters.

    (4) If an agency, in any biennium, spends more than 25 percent of the state moneys that the agency receives for programs on programs that are not evidence based, the Legislative Assembly shall consider the agency's failure to meet the requirement of subsection (1) of this section in making appropriations to the agency for the following biennium.

    (5) Each agency may adopt rules necessary to carry out the provisions of this section, including but not limited to rules defining a reasonable period of time for purposes of determining cost effectiveness.

    SECTION 8. The provisions of section 7 of this 2003 Act apply to biennia beginning on or after July 1, 2009.

    SECTION 9. (1) As used in this section, “agency,” “evidence-based program” and “program” have the meanings given those terms in section 3 of this 2003 Act.

    (2) Each agency shall conduct an assessment of existing programs and establish goals that enable the agency to meet the requirements of sections 5 (1), 6 (1) and 7 (1) of this 2003 Act. Each agency shall work with interested persons to establish the goals and to develop a process for meeting the goals.

    (3) No later than September 30, 2004, each agency shall submit a report containing:

    • An assessment of each program on which the agency expends funds, including but not limited to whether the program is an evidence-based program;
    • The percentage of state moneys the agency receives for programs that is being expended on evidence-based programs;
    • The percentage of federal and other moneys the agency receives for programs that is being expended on evidence-based programs; and
    • A description of the efforts the agency is making to meet the requirements of sections 5 (1), 6 (1) and 7 (1) of this 2003 Act.

    SECTION 10. This 2003 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2003 Act takes effect on its passage.

    About the Author

    Michele (Mickey) J. Eliason, PhD, is an adjunct professor at the Institute for Health and Aging at the University of California, San Francisco. She also teaches courses about sexuality and gender at San Francisco State University. Formerly, she was a faculty member in the College of Nursing at the University of Iowa for nearly 20 years. Dr. Eliason has been an applied researcher in the substance abuse treatment field for more than 15 years, and is particularly interested in diverse populations, including women and sexual and gender minority clients. Her interest in the evidence-based practice movement grew out of a 4-year involvement with the Iowa Practice Improvement Collaborative, funded by the Center for Substance Abuse Treatment to develop a statewide practice-research collaboration. This highly rewarding experience highlighted the complex barriers to implementing evidence-based practices in the poorly funded and stigmatized settings of community-based treatment programs.


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