Developing the tools of implementation science in substance use disorders treatment: applications of the consolidated framework for implementation research

Abstract

The implementation of evidence-based treatments (EBTs) and practices (EBPs) depends on both top-down and bottom-up responsibilities. Many articles in this special section on Implementation Science in Substance Use Disorders address the interaction between these two approaches when implementing new substance use disorder (SUD) treatments. Generally the articles place this interaction within the Consolidated Framework for Implementation Research (CFIR), a relatively new and comprehensive synthesis of theories and conceptualizations of the components needed for successful implementation strategies. The range of SUD treatments covered includes well-established behavioral interventions, such as screening and brief interventions for alcohol, as well as new pharmacotherapies, such as buprenorphine for opiates. One contribution uses the CFIR to review continuing care interventions and self-help groups that can follow-up after more intensive clinical care. External and internal pressures for change drive implementation. The successful EBT/EBP implementations reviewed in these articles recognized these potential change drivers in designing their strategy for introducing the EBT/EBP, and they modified aspects of the EBT/EBP to satisfy many of these drivers. The CFIR model has limitations, as do the contributions to this special section. The implementation science field is new and developing rapidly, and many of the EBTs and EBPs were developed and tested through controlled studies evaluating the efficacy of interventions under controlled conditions, rather than examining their performance in the broader landscape of addiction treatment programs. These limitations may also be considered as boundary conditions to be explored in further research, implementation, and development of the next edition of the CFIR.