As is the case for other evidence-based approaches, it has been challenging to move CBT into widespread clinical practice (Emmelkamp et al., 2014; Harvey & Gumport, 2015; Institute of Medicine, 2001; Kazdin & Blase, 2011). General barriers to moving evidence-based behavioral treatments into clinical practice include lack of training and certification programs for clinicians, the cost of training and high rate of clinician turnover in many settings, lack of feasible means of evaluating and supporting fidelity in delivering evidence based therapies, different views on standards of evidence between researchers and practitioners, limited focus on sustainability, and several others (Addis & Krasnow, 2000; Crits-Christoph, Frank, Chambless, Brody, & Karp, 1995; Harvey & Gumport, 2015; Hoffman & McCarty, 2013; Institute of Medicine, 1998; McHugh & Barlow, 2010; McLellan, Carise, & Kleber, 2003; Olmstead, Abraham, Martino, & Roman, 2012; Weissman et al., 2006). Moreover, given the lack of a mandate for the substance use treatment system to track or report on meaningful treatment outcomes measures (Humphreys & McLellan, 2011) and weak, inconsistent efforts to require that providers demonstrate that they utilize evidence-based practice, there are few incentives for adopting evidence based treatments that might improve those outcomes (Carroll, 2014).
