NIDA’s clinical trials network: a source of social work practice-relevant knowledge
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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
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“…serious gaps of communication exist between the research community and community-based drug treatment programs.”*
*IOM, 1998 – Executive Summary
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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
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Regional Research and Training Center (RRTC)
State with Community Treatment Program (CTP)
CTN Across the Nation
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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.
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Regional Research and Training Center (RRTC)
Initiates and Develops ProtocolsArranges Community Treatment
Program (CTP) ParticipationConducts TrainingConducts StudiesDisseminates Regionally RRT
C
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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
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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
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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.
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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
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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
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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)?
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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
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1. EBPs for SUD
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2. EBPs for Adolescents
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3. HIV Prevention
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4. Evidence-Based for Marginalized Populations?
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5. Cost-Benefit
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6. Training in EBPs
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7. Treatment Sites
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8. Sustainability of EBPs
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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
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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
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http://ctndisseminationlibrary.org
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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
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The NIDA/SAMHSA Blending Initiative Three components:
Regional Blending ConferencesState Agency PartnershipsBlending Teams
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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).
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Blending ProcessSelected CTN protocols
or other NIDA Research
Hand-Off Meeting Create the charge for Blending Team
Blending Team Develop dissemination strategies and products.
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Current Blending Packages
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Blending Packages Available in Spanish
http://www.attcnetwork.org/explore/priorityareas/science/blendinginitiative/index.asp
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Products Under Development
1. POATS (Prescription Opioid Addiction Treatment Study)
2. Onsite HIV Rapid Testing3. Buprenorphine for Young Adults
(Spanish version)