clinicians from the 11 participating sites were surveyed as to their usual theoretical orientation and techniques when working with clients at that site. Multiple orientations were endorsed, including 12-Step/disease concept, reality therapy, MI/MET, client centered, psychodynamic, and experiential; however, the most commonly endorsed orientation was relapse prevention/CBT (Ball et al., 2002). Nevertheless, review of taped TAU sessions by independent raters blind to treatment assignment indicated CBT techniques and strategies were among the most infrequently used in practice. Specifically, any clinician mention of cognitions or thoughts about substance use was identified in 14 of the 379 sessions rated and mention of skills training was detected only 13 times (Santa Ana et al., 2008). That these basic CBT components were detectable in less than 6% of all sessions rated suggests very limited success in disseminating CBT to the clinical community, at least in the settings included in those studies.
