Gaps in Substance Use Treatment

Presented by:

Rhonda G. Patrick, LCSW, MPA

Evidence Based Practices

What is it?“The integration of best research evidence with clinical expertise

and patient values.”

Treatment based on the best available science Respect for the expertise of the clinician Acknowledgement and incorporation of patient values

Institute of Medicine, 2001

Evidence Based PracticesWhat is it?

“EBP is a process in which the practitioner combines well researched interventions with clinical experience, ethics, client preferences, and culture to guide and inform the delivery of treatments and services.”

National Association of Social Workers

Evidence Based PracticesWhy EBP?

Concerns related to cost and effectiveness of substance abuse treatment.

Delineation of a rational approach to allocation of scarce resources.

Mitigation against a system in which treatment practices are based solely on practice wisdom.

Finding the “best” available treatment or policy that reduces the harm and costs of substance abuse.

Research & Knowledge

What do we know?We have validated measurement toolsWe have replicable biopsychosocial predictors of substance

related events and outcomesWe have a number of efficacious treatments of varying

intensity and duration that produce benefits across a range of problem severity.

Research & Knowledge

What do we don’t know?Much treatment research has proceeded without the benefit

of theory, the mechanisms of action of many efficacious treatments are poorly understood.

Patterns of substance use, abuse, remission and relapse are highly variable over time between and across individuals in treated and untreated samples. We do not have an understanding of the influence of contextual factors.

Research & Knowledge

What do we don’t know?The reach and impact of efficacious treatments into the

affected population remains suboptimal. Most people with substance use disorder do not seek professional care, a subset recover on their own, and most available treatments target the majority with more serious problems.

Research & Knowledge

What do we know about Hispanic substance users? Younger users of alcohol and drug have more serious social problems as

they age. Consequences are greater the younger you start. Cultural dissonance is occurring, especially for immigrated families. The closer you are to the routes of trade the higher your risk. Most will not and do not seek assistance through formal networks of care. There are regional substance use differences, however across the board

alcohol and marijuana abuse impact a significant portion of the Latino community.

There are differences in subpopulations of the Latino group in substance use severity, retention and outcome.

Research & Knowledge

What do we don’t know about Hispanic substance users? What are the circumstances of Hispanics in their own communities (i.e.,

community context); What service delivery models are tailored to Hispanics’ circumstances and

special needs; What are the client, provider, and system barriers to utilization of substance

abuse services; How do we establish links between drug abuse services, social services, and

other service sectors to optimize treatment outcomes.

Bridging the Gap: CommunityCharacterize the local Hispanic community in terms of structure, cultural composition,

and relations with the larger non- Hispanic community. Consider the role of community unemployment, residential segregation, proximity to centers of drug trade, and numbers of retail alcohol outlets in communities were Hispanics live as risk factors.

Understand community factors that might prevent or promote use of alcohol or drugs.

Develop community research partnerships can help elucidate how services need to be adapted for a particular community group or segment (e.g., Hispanic gang-involved youth, outreach) and identify how feasible and acceptable are the planned community interventions.

Utilize a community participatory research framework: involve local community members and community-based organizations in community-based research. This research involves capacity building in intervention, services research for community leaders; learning about community needs and structure for researchers; and exploring the potential for alternative, community-based models of care to enhance service delivery by addressing local needs.

Bridging the Gap: Service DeliveryTest the effectiveness of community-based therapeutic

approaches that take advantage of natural supports (religious organizations) and of those that bring evidence-based treatments to non-clinical environments (e.g., academic community-partnerships).

Evaluate and test collaborative research partnerships with Hispanic community members that identify new and innovative approaches to drug abuse treatment services.

Test community-level interventions that facilitate recovery and reintegration of drug users within their Hispanic communities.

Bridging the Gaps: BarriersTest the effects of improved communication between caregivers

and Hispanic clientele and its impact on retention in pharmacologic and cognitive substance abuse treatments.

Assess programs on Latino’s health literacy for entry and engagement in care and decision-making in substance abuse treatments.

Evaluate the impact of insurance coverage on access to substance abuse services, sustained attendance in drug treatments and relapse recovery.

Test system interventions to redesign complicated admissions systems, improve patient engagement at intake, accommodate flexible scheduling, and reduced provider burden.

Bridging the Gap: LinkagesGenerate information that can be used to develop and

test a workable model of community-based delivery in Hispanic communities, including research that identifies untapped, informal Hispanic community-based resources.

Develop and evaluate best practices that focus on the integration of social, health and drug abuse services and that can optimize treatment outcomes for Hispanic service users.

Bridging the Gap: Other Issues

Speaking a Common Language How we define the problem How we define the outcome How we define the measurement

Documenting Effectiveness Informal Publications Formal Publications

Increasing Funding for Research and Services Making Addiction a Priority

Economic Costs Social Costs

Evidence Based Substance Use Treatment: Where do we find them?National Registry of Evidence-Based Programs and

Practices Created in 2007 List SAMSHA Model Treatment Programs Defines EBP as “approaches t prevention or treatment based in

theory and have undergone scientific evaluation.” Submissions are “reviewed” by experts with doctorial degrees,

evaluation research experience and clinical experience. Many more prevention/intervention programs. Searchable by target population needs

Evidence Based Substance Use Treatment: Where do we find them?

Agency for Healthcare Research and QualityNational Guidelines ClearinghouseSearch by topic area.Can compare multiple guidelines across variety of criteria

and classifications.Can download information to PDA’s.Rigorous selection and review process

Evidence Based Substance Use Treatment: Where do we find them?Co-Occurring Disorder Center for Excellence

Foster infusion and adoption of evidence and consensus based treatment and program innovation into clinical and organization practice.

Created in 2003 Intended for the co-occurring disorder service system Provides descriptions of interventions Describes intervention implementation References related to EBPs

Evidence Based Substance Use Treatment: Where do we find them?Technology Transfer Centers

14 Regionally based addiction technology transfer centersBridging the gap between science and practiceAddiction Science Made Easy Program Intended for addiction treatment professionals Provides descriptions of interventions Describes intervention implementation References related to EBPs

Evidence Based Substance Use Treatment: Where do we find them?National Drug Abuse Treatment Clinical Trials Network

The CTN provides an enterprise in which the National Institute on Drug Abuse, treatment researchers, and community-based service providers cooperatively develop, validate, refine, and deliver new treatment options to patients in community-level clinical practice. This unique partnership between community treatment providers and academic research leaders aims to achieve the following objectives:

Conducting studies of behavioral, pharmacological, and integrated behavioral and pharmacological treatment interventions of therapeutic effect in rigorous, multi-site clinical trials to determine effectiveness across a broad range of community-based treatment settings and diversified patient populations; and

Ensuring the transfer of research results to physicians, clinicians, providers, and patients. Regional “Nodes” Service providers attached to various regional nodes