Abstract

Despite significant effort devoted to developing and testing treatments for substance use disorders (SUD), most individuals who receive treatment in the United States (USA) do not receive evidence-based care. In this article, we summarize the emerging body of descriptive research that focuses on the question of why SUD treatment programs in the USA do not use evidence-based treatments (EBT) more and highlight initiatives that have shown promise as ways to facilitate their use. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, we provide an overview of how various factors promote or inhibit the use of evidence-based treatments in SUD treatment settings in the USA. We then discuss how promising approaches to facilitate the use of EBT build upon many CFIR concepts and constructs. The article concludes with a discussion of the implications of the USA experience with EBT implementation for non-Western nations as they develop SUD services, highlighting three main lessons learned: (1) historical and cultural factors impact EBT implementation; (2) studies that test both clinical effectiveness and implementation outcomes can enhance implementation; and (3) multilevel implementation approaches may have greater impact than strategies that address just one level of change (e.g., individuals, organizations, systems).