NIDA’S CLINICAL TRIALS NETWORK: A SOURCE OF SOCIAL

WORK PRACTICE-RELEVANT KNOWLEDGE

Elizabeth Wells Dennis DaleySchool of Social Work Western Psychiatric Institute University of Washington University of Pittsburgh

Supported by Grants # U10 DA020036 and U10 DA013714 from the National Institute on Drug

Abuse

“…serious gaps of communication exist between the research community and community-based drug treatment programs.”*

*IOM, 1998 – Executive Summary

CTN Mission

Study behavioral and pharmacological treatments that have high potential for success in community treatment settings

Get research findings into the hands of clinicians who can make the best use of them – as fast as possible

Regional Research and Training Center (RRTC)

State with Community Treatment Program (CTP)

CTN Across the Nation

University of WA (D. Donovan)

WA State University(J. Roll)

Providence Behavioral

Health

Evergreen Manor

Recovery Centers of King

County

Seattle Counseling

Services

Evergreen TreatmentServices

Node Structure

Triumph Treatment

Services

Residence XII

Puget Sound VA

Parent-Child Assistance Program

Group Health

Cooperative

Daybreak Youth

Services

S.E. AlaskaRegional Health

Consortium

WA Physicians

Health Prog.

C.H.A.M.M. P.

Regional Research and Training Center (RRTC)

Initiates and Develops ProtocolsArranges Community Treatment

Program (CTP) ParticipationConducts TrainingConducts StudiesDisseminates Regionally RRT

C

Community Treatment Program (CTP)

Equal representation on national CTN Steering Committee

Participates fully in CTN committeesGenerates clinically relevant conceptsProvides setting and staffing for CTN

studiesCollects dataPotential early adopters CTP

Assumptions Underlying CTN*

Research findings that would benefit patients are not being used.

Research will be aided by 2-way communication & long-term collaboration between CTPs & researchers.

CTPs will benefit from participating in research.

* Also from IOM, 1998

Multi-Site Hybrid Efficacy – Effectiveness* Trials

External Validity Internal Validity

Community-based clinics Heterogeneity of

participants Community clinicians, Comparison to “treatment-

as-usual” Cost-effectiveness

evaluation Patient & clinician

satisfaction Interest in sustainability

Random assignment Study protocol &

operations manual Manual-based treatment Fidelity monitoring Standard measures Quality assurance

* Carroll, K.M. & Rounsaville, B.J. (2003) Psychiatric Services, 54.

Increasing Role for Social Work in Addiction

Treatment Integration of substance use and mental

health treatment (behavioral health)

With health care reform, larger numbers of behavioral health clients served

With health care reform, integration of behavioral health into health care settings, e.g., primary care

Social Workers’ Multiple Roles in Behavioral Health

Managers in behavioral health settings

Providers in health care settings

Care managers in integrated care

Policy development and oversight

What does the CTN Offer Social Workers?

1. EBPs - What psychosocial or pharmacological interventions for treating substance use disorders (SUD) are effective?

2. EBPs for adolescents3. EBPs for HIV prevention in SUD treatment

settings4. Evidence-based for all populations (e.g.,

women, racial and ethnic minorities, sexual minorities)?

What does the CTN Offer Social Workers?

5. Sufficient benefit to warrant cost of training and implementing?

6. What is required to train community providers to deliver EBPs?

7. Characteristics of treatment sites that deliver EBPs successfully?

8. Sustainability of practices

1. EBPs for SUD

2. EBPs for Adolescents

3. HIV Prevention

4. Evidence-Based for Marginalized Populations?

5. Cost-Benefit

6. Training in EBPs

7. Treatment Sites

8. Sustainability of EBPs

Adoption of Buprenorphine over 4 year period in the CTN:

Cross-sectional data

Baseline 24-month FUP 48-month FUP0

10

20

30

40

50

60

70

15.5

31.8 34.5

% o

f pro

gram

s

Paul M. Roman & Amanda J. Abraham, University of Georgia

Adoption of Motivational Incentives over

4 year period in the CTN: Cross-sectional data

Baseline 24-month FUP 48-month FUP0

10

20

30

40

50

60

70

35.6 35.6 34

% o

f pro

gram

s

Paul M. Roman & Amanda J. Abraham, University of Georgia

http://ctndisseminationlibrary.org

http://www.ctndatashare.org/

Allows researchers to download de-identified data from completed CTN studies to conduct analyses that improve the quality of drug abuse treatment

Data available after primary outcome paper published

Data from 25 CTN studies currently available

The NIDA/SAMHSA Blending Initiative Three components:

Regional Blending ConferencesState Agency PartnershipsBlending Teams

Blending Teams Use NIDA research findings to design user-

friendly science-based tools for use in treatment settings soon after research results are published.

Teams include members from: SAMHSA-CSAT Addiction Technology Transfer

Center (ATTC) Network, NIDA researchers, and Community treatment providers participating in the

NIDA Drug Abuse Treatment Clinical Trials Network (CTN).

Blending ProcessSelected CTN protocols

or other NIDA Research

Hand-Off Meeting Create the charge for Blending Team

Blending Team Develop dissemination strategies and products.

Current Blending Packages

Blending Packages Available in Spanish

http://www.attcnetwork.org/explore/priorityareas/science/blendinginitiative/index.asp

Products Under Development

1. POATS (Prescription Opioid Addiction Treatment Study)

2. Onsite HIV Rapid Testing3. Buprenorphine for Young Adults

(Spanish version)