Adoption is the proportion of those eligible to deliver the intervention who actually do so. We could not identify any implementation initiatives reporting the adoption of CBT-OUD in real-world settings. In the Department of Veterans Affairs CBT-SUD initiative, therapists were eligible to implement CBT-SUD if they were licensed staff members who delivered psychotherapy to Veterans diagnosed with a substance use disorder and functioned as a psychiatrist, psychologist, social worker, advanced practice mental health nurse, licensed professional mental health counselor, or marriage and family therapist; rates of adoption were not reported.

Reach is the number or proportion of patients eligible to receive the intervention who actually do so. Prior trials of CBT-OUD generally find that the majority of patients randomly assigned to 12-week protocols receive at least 50% of their sessions. In the Department of Veterans Affairs CBT-SUD initiative, 458 Veterans received CBT-SUD; the proportion of those receiving it relative to those eligible was not reported.

Fidelity refers to the extent to which CBT-OUD was implemented as intended. Fidelity can be used both to evaluate implementation and as a part of the implementation strategy. Trials of CBT-OUD have generally required therapists to demonstrate fidelity before they deliver the intervention, but then did not monitor fidelity over time. In the Department of Veterans Affairs CBT-SUD initiative, therapists submitted audio recordings to a consultant who rated their sessions using the CBT-SUD Rating Scale, which was adapted from the Yale Adherence and Competency Scale. This feedback was used to help improve their CBT-SUD delivery over time.