Although manual-based treatments are widely available in mental health care, they are often not delivered according to protocol. Treatment-, therapist- and organizational-related determinants are known to affect therapist adherence to treatment protocols, and subsequently treatment success. This study examined which determinants are associated with therapist adherence to the Community Reinforcement Approach (CRA) manual, an evidence-based behavioural treatment programme commonly used in addiction care. Using a cross-sectional design, adherence to the CRA manual and potential contributing determinants were assessed through a self-report survey among therapists (N = 69) working in out-patient addiction care. Correlation analysis and backward stepwise regression analysis were used to examine which treatment-, therapist- and organizational-related determinants were associated with CRA adherence. Significant associations with self-reported CRA adherence were found for nine out of 16 determinants examined. Three independent determinants explained 43% of the variance in CRA manual adherence, namely compatibility with the working method therapists were used to, perceived outcome expectations, and perceived adoption of CRA procedures by colleagues. These determinants should be considered when implementing CRA in addiction care, for example by investing in training and taking into account therapists’ previous treatment experience. This also accounts for creating positive outcome expectations and the use of descriptive norms by making experiences explicit of therapists and teams that excel. Future research should investigate which other determinants contribute to therapists’ adherence and focus on clarifying causality between determinants and adherence.

1. (1) To understand the importance of treatment, therapist and organizational determinants influencing therapist adherence to the CRA manual.

2. (2) To explain the three determinants that make the largest contribution to self-reported therapists’ adherence to the CRA manual, namely: compatibility with the working method, perceived outcome expectations, and perceived adoption of CRA procedures by colleagues.

3. (3) To reflect on the clinical implications regarding therapist training, implementation of manual-based treatments and future research.

Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized.

We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs.

NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system.

Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.