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Blending Clinical Practice and Research: Forging Partnerships to Enhance Drug Addiction Treatment

Plenary Session & Workshop Descriptions, Day 1


Putting Drug Abuse Research to Use in Real-Life Settings
Glen R. Hanson, Ph.D., D.D.S., Acting Director, NIDA

Over the past two decades, scientific research has revolutionized our understanding of how drugs affect the brain. We now know that prolonged, repeated drug use can result in fundamental, long-lasting changes in brain structure and function. The ultimate task for treatment, therefore, is to reverse, or at least somehow compensate for, those brain changes. The establishment of the National Drug Abuse Clinical Trials Network provides an important research infrastructure for NIDA to develop and test new behavioral and medication treatments for drug addiction in real-life settings. The success of this network and the incorporation of its findings into clinical practice are grounded in our ability to successfully bridge the gap between research and practice. This presentation will highlight major advances in drug addiction research and show how these findings will help improve drug addiction treatment via a "blending" of practice and research.

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Building Bridges Between Practice and Research

There is a large gap between everyday practice in community-based drug addiction treatment programs and the knowledge gained from research. This disconnect is reflected in the often wide cultural and experiential separation between the professionals who conduct empirical investigations and those who apply research findings in treatment settings. The two panels in this session will:

  • Describe NIDA's National Drug Abuse Clinical Trials Network (CTN), a research infrastructure designed to develop and test the effectiveness of behavioral and medications treatment for drug addiction in real-life settings with diverse populations.

  • Discuss the New York Blending Project and its goal of setting an agenda for change and establishing a legacy to last long after the conference is over.

  • Address barriers to systems change and ways to motivate change within systems and organizations.

  • Review successful strategies in conducting clinical research in community treatment programs and illustrate how these strategies work in the real world.

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Taking Action Nationally and Locally

Taking Action: The NIDA National Drug Abuse Clinical Trials Network
Betty Tai, Ph.D., Director, Center for Clinical Trials Network, NIDA

As in other fields of medicine, a gap exists in the drug abuse treatment field between clinical practice and scientific research. One important response to this gap has been NIDA's Clinical Trials Network (CTN). The CTN is a research infrastructure currently consisting of 14 research "nodes" designed to test the effectiveness and usefulness of new and improved interventions in community-based treatment settings with diverse populations. The CTN is an important component of NIDA's overall goal to establish and maintain partnerships with drug abuse researchers and community treatment providers to ensure that research findings are applied in the community. This presentation will provide an overview of the establishment and current status of NIDA's CTN and the key components required to successfully blend research and practice.

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The Blending Project
John Rotrosen, M.D., New York University School of Medicine and New York Node
NIDA Clinical Trials Network

The overarching goal of the New York Blending Project is to ensure that the March 14 and 15, 2002, Blending Conference sets an agenda for change and leaves a lasting legacy. We hope to establish an affiliation of stakeholders interested in improving access to addiction treatment, expanding the range of available treatments, enhancing the quality of treatment, and improving outcome. Conference plenary sessions and workshops are organized around themes intended to initiate and motivate the long-term project. A roundtable session on March 15, immediately following the larger conference, will serve as the project kickoff. Invited participants include providers and representatives of the prevention community, student and employee assistance programs, the New York State Office of Alcoholism and Substance Abuse Services, managed behavioral health care organizations, funding organizations, law enforcement and prison communities, legislatures, the media, and Addiction Technology Transfer Centers; students; clinical professional educators; and researchers of the New York and Long Island Nodes of NIDA's Clinical Trials Network. Others are welcome to participate. We hope that the kickoff will establish a lasting forum for communication and for the development of a broad range of collaborative projects.

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Motivating Organizational Change
Richard N. Rosenthal, M.D., St. Luke's-Roosevelt Hospital Center

This presentation will focus on current research development and dissemination of state-of-the-art practice through NIDA's Clinical Trials Network. A parallel domain that must be addressed, above the informational level, is that of the barriers to systems change within the system itself, in the form of power structures, reinforced beliefs, daily routines, and payors.

Current Research Tells Us

  • Motivation may be mobilized by crisis, incentive, or alteration of beliefs.

  • Lessons from history and psychotherapy can inform which interventions might prove useful, once it is clarified which characteristics individuals and systems have in common and which they do not.

Considerations for Putting Research to Actual Use

  • What are the forces at work that keep things "the same"?

  • What are the appropriate "primers" for systems change?

Considerations for Future Research

  • Participants must be empowered to realize that they are part of what keeps systems from changing and that with rediscovery of core values, they have more power and intent to foster change than previously experienced.

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Real-Life Perspectives on Blending Practice and Research
Kathleen M. Carroll, Ph.D., Connecticut Veterans Affairs Medical Center and Yale University School of Medicine
Lawrence S. Brown, Jr., M.D., M.P.H., Addiction Research and Treatment Corporation

This presentation will review successful strategies in conducting clinical research in community treatment programs, based on the experiences of Yale investigators over the past 15 years. Strategies that are effective in building effective partnerships, including involving key personnel in all stages of the research, attending to hidden costs of research, and several more, will be reviewed. To illustrate how these strategies work in the real world, a pilot study done in a community treatment program that was developed collaboratively by Yale investigators, the State of Connecticut Department of Children and Families, the Genesis Center, and Advanced Behavioral Health, Inc., will be reviewed. Issues surrounding the implementation of research within a community-based treatment program will be discussed based on experiences at the Addiction Research and Treatment Corporation.

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Applying Research in Community Settings
Herbert D. Kleber, M.D., New York State Psychiatric Institute and Columbia University

Research suggests that certain interventions may be useful in treating substance abuse. However, as the current debate over mammograms shows, research is not always unambiguous. The overall challenge remains to figure out which interventions will be most useful for which patients in a particular community setting. There are, however, a number of landmark advances that have been made over the past decade in treating substance abuse. This talk will address both these advances and the obstacles that have kept them from being adequately and widely implemented. Examples include refusal by drug courts to refer clients to methadone maintenance treatment, unwillingness to use naltrexone in probation, and failure to implement cognitive-behavioral relapse prevention techniques or contingency programs in treating cocaine abuse.

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Innovations in the Treatment of Adolescent Substance Use Disorders: Blending Research and Practice
Paula Riggs, M.D., University of Colorado Health Sciences Center
Andrew R. Morral, Ph.D., RAND Corporation
Robert Savitt, M.S.W., CSW, North Shore University Hospital at Glen Cove
Ramon Solhkhah, M.D., New York University School of Medicine

The goals of this workshop are to:

  • Provide an overview of the multidimensional developmental context and state of the science in the assessment and treatment of adolescent substance use disorders (SUDs) and common comorbid conditions such as conduct disorder (CD), attention deficit-hyperactivity disorder (ADHD), and depression.

  • Identify the clinical priorities of community treatment programs.

  • Identify barriers to blending research and practice.

  • Discuss mechanisms to overcome barriers to blending research and practice.

  • "Marry" community treatment program priorities with the state of the science in adolescent substance treatment research.

Current Research Tells Us

  • Empirically supported treatment modalities for adolescents with SUDs include family-based interventions, behavioral therapies (including therapeutic community treatment models), cognitive behavioral therapy, and motivational enhancement.

  • Most adolescents with SUDs have a comorbid psychiatric disorder, including CD, depression, or ADHD, calling for more integrated treatment approaches.

  • Most adolescents in the juvenile justice system have CD, SUDs, or other comorbidity but limited access to comprehensive, integrated mental health and substance use treatment.

Considerations for Putting Research to Actual Use

  • Research-based treatments and training must be made more widely available, feasible to implement, cost-effective, transportable, and sustainable in real-world community treatment programs.

  • We must identify barriers to "blending" research and practice.

  • We must develop a true bidirectional dialog between university-based treatment researchers and real-world community treatment programs for authentic blending and sustainable dissemination.

Considerations for Future Research

  • Codevelop the research/clinical trial priorities and scientific/clinical agenda with community treatment providers by "marrying" the clinical priorities and problems faced by real-world community treatment programs to the state of the science in treatment research.

  • Conduct effectiveness trials in community treatment settings that have been codeveloped by university-based researchers and community treatment providers (CTN model).

  • Codevelop feasible models of providing integrated, multidimensional treatment of adolescent SUDs and comorbid disorders and include the family in treatment.

  • Codevelop mechanisms to improve the linkages in juvenile justice system adolescent substance treatment (e.g., drug courts).

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Early Intervention With At-Risk Children and Adolescents
Stephen J. Donovan, M.D., New York State Psychiatric Institute and Columbia University
John Fitzgerald, CPP, New York City Board of Education
Drew Humphries, Ph.D., Rutgers University
Laurie S. Miller, Ph.D., New York University School of Medicine
Ramon Solhkhah, M.D., New York University School of Medicine

Developmental processes are not linear. Early intervention in a developmental process means we recognize a tendency for something to change into something else, and we do things before that change happens. The focus here is on substance abuse. What is it that evolves into substance abuse in adolescence? Current research suggests that antisocial spectrum problems evolve into problem behaviors in adolescence, including substance use, abuse, and dependence. This workshop will focus on points of intervention in this process and include a presentation on a broad range of social and psychological approaches that address high-risk children, including early intervention, to help place our strategy within a larger context. Though based in the school system, the advantages and challenges of attempting to intervene in a process will be explored. Another presentation focusing on the social level will identify community-level factors that encourage predisposed youth to develop adolescent problem behaviors. Supervision is crucial to prevention and halting the progression of problem behaviors. Drawing on the resources of the community can mobilize prosocial factors on a communitywide basis. An additional presentation will focus on a particular institution, elementary school, and a particular target within that institution, teachers. Primary school is where antisocial attitudes are solidified in the classroom and in the schoolyard. The idea is to develop interventions primarily using health science and physical education classes, and the goal is to promote prosocial attitudes across the board in the expectation that this will benefit even those exposed to caregiver addiction. The final presentation will examine the biopsychological aspect of antisocial behavior in childhood and how it leads to coercive reciprocal social interactions, as well as placement in classes with other aggressive youth. The idea is that the social learning aspects of antisocial spectrum behaviors might be amenable to pharmacological treatment, and professions working with high-risk youth should have a conceptual framework for deciding which medications are used for a particular aspect of antisocial behavior.

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Substance Abuse and Infectious Diseases/Medical Consequences of Drug Abuse
Lawrence S. Brown, Jr., M.D., M.P.H., Addiction Research and Treatment Corporation
Don DesJarlais, Ph.D., National Development and Research Institutes, Inc.
Francis A. McCorry, Ph.D., New York State Office of Alcoholism and Substance Abuse Services
Susan Tross, Ph.D., New York State Psychiatric Institute and Columbia University

Infectious diseases pose serious health risks to drug users in treatment. These risks demand the integration of enhanced medical services for screening, assessment, referral, and, if possible, treatment. They also demand enhanced services for risk education and prevention (of infection, disease progression, and transmission). The health consequences and state of the art assessment and treatment options for the most prevalent of these, especially HIV, hepatitis and certain STDs, will be discussed. Effective strategies for injection risk reduction will be discussed. Effective strategies for prevention of sexual transmission - especially including gender-specific curriculum, active behavioral and negotiation skills building, focus on the drug use-sexual risk behavior connection, and use of female- and male-controlled methods of protection - will be discussed. The practical and policy challenges to and solutions for providing on-site resources or to establishing working linkages between drug treatment programs and health care facilities will be discussed.

Current Research Tells Us

  • Integration of medical services into drug treatment programs is an effective means of delivering medical services to drug users.

  • Practical education about sterile injection practices and resources can decrease injection risk behavior in drug users.

  • Gender-specific, active skills-building interventions, are more effective than informational interventions in increasing sexual risk reduction in drug users.

Considerations for Putting Research to Actual Use

  • Establishment of solid linkages to drug-user-friendly infectious disease facilities.

  • Inclusion of education about sterile injection resources and practices into an array of prevention strategies discussed in drug treatment programs.

  • Training of drug treatment staff to implement sexual behavior curriculum.

Considerations for Future Research

  • Comparison of integration of medical services versus linkage to medical services models of delivery.

  • Comparison of drug treatment programs receiving staff training in sexual risk reduction intervention versus programs that do not receive such training.

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Abuse of Prescription Drugs and Pain Management
Eric Collins, M.D., New York State Psychiatric Institute and Columbia University
Madeline A. Naegle, R.N., Ph.D., CS, FAAN, New York University
Sidney H. Schnoll, M.D., Ph.D., Purdue Pharma, LP

This workshop will focus on concerns about drug dependence as they arise in the treatment of pain. Pain is commonly undertreated, often as a result of fear about fostering and maintaining addiction in patients treated with opiates for chronic pain. Confusion typically arises about the meaning and significance of the physical dependence that chronic opiate therapy produces. Many physicians are reluctant to prescribe opiates because they fear that regulatory agencies may sanction them for improper prescribing practices. The popular press has recently focused increasing attention on the abuse of prescription opiates, which may lead to poorly informed policy decisions. Unfortunately, there are no solid data about the likelihood of developing addiction when being treated for pain. Furthermore, pain patients present special diagnostic difficulties for physicians attempting to evaluate whether a substance use disorder exists. The DSM-IV criteria for substance dependence can easily be misapplied to patients taking prescription medications.

Current Research Tells Us

  • Little is known about problems associated with the abuse of prescription drugs, because so little quality research has been done in this area.

Considerations for Putting Research to Actual Use

  • What can be done now with our limited knowledge?
Considerations for Future Research

  • We must delineate the severity and specific nature (including risk factors) of the problems of drug dependence in patients treated with prescription medications.

  • What models can be used to answer these questions?

  • How will research address the problem of distinguishing pseudoaddiction from addiction?

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Club Drugs and Methamphetamine
David McDowell, M.D., New York State Psychiatric Institute
Gregory Bunt, M.D., Daytop Village
Perry Halkitis, Ph.D., New York University
Richard Rawson, Ph.D., Integrated Substance Abuse Programs, University of California, Los Angeles

"Club drugs" - in particular, MDMA, ketamine, and GHB - are increasingly used, especially among young people. Contrary to public perception, club drugs cause real and substantial morbidity and even mortality. This is, and ought to be, alarming to clinicians, researchers, and public health officials.. These issues have far-reaching implications for substance abuse treatment and psychiatric treatment in the future.

Current Research Tells Us

  • GHB is increasing in use, is dependency inducing, and has been responsible for numerous deaths due to overdose.

  • Younger people who attend social events, such as "raves" (all-night dance marathon parties), often use multiple club drugs, as well as more "traditional substances."

  • There is increasing and substantial evidence that MDMA causes persistent serotonergic axonal death.

  • Club drugs may be used both for sensation seeking and self medication (pharmaceutical reasons).

  • Club drugs are also used in non-social venues such as people's homes.

  • Club drug use is related to sexual risk taking and pose a threat to the spread of HIV and/or other STD's.

  • There is evidence that methamphetamines cause structural brain changes.

Considerations for Putting Research to Actual Use

  • Given the increasingly extensive evidence of serotonergic damage, are there physiologic interventions that might prohibit or limit such damage?

  • What educational efforts are most effective in terms of reducing this damage?

  • Educational prevention efforts have been aimed primarily at MDMA. Might other strategies dealing with other club drugs be more effective?

  • How can educational campaigns be used to prevent the onset of use of club drugs?

Considerations for Future Research

  • Which treatment strategies are best employed for preventing these "gateway drugs" from leading to future, continued drug abuse?

  • For individuals who are dependent on any of these agents, what are the best strategies for managing withdrawal and maintaining abstinence?

  • What are the functional implications of MDMA neurotoxicity, and how is this best treated?

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Gender Issues
Gloria M. Miele, Ph.D., St. Luke's-Roosevelt Hospital Center
Alexis Gadsden, M.S.W., CASAC, Outreach Project, Inc.
S. Lala Ashenberg Straussner, D.S.W., CSW, CEAP, BCD, CAS, Shirley M. Ehrenkranz School of Social Work, New York University
Cora Lee Wetherington, Ph.D., NIDA

This workshop will focus on blending research and practice in treating women with addictions. The workshop will provide a research review of predictors of treatment outcome for women, as well as an overview of the special needs of ethnoculturally diverse substance-abusing women. The impact of these findings on clinical practice will be discussed, emphasizing the viewpoints and roles of clinicians who work with women in recovery.

Current Research Tells Us

  • Psychological variables, such as depression, anxiety, and hostility, need to be addressed in women's treatments.

  • Childhood trauma is a significant predictor of substance abuse in women.

  • Psychosocial and demographic factors are key elements of a woman's recovery.

Considerations for Putting Research to Actual Use

  • What types of resources and supports do treatment programs and clinicians need to address gender issues?

  • What are "best practices" for women in recovery?

Considerations for Future Research

  • How can we improve women's outcomes in both gender-specific and mixed-gender programs?

  • What other services do women need to enhance treatment effectiveness?

  • How can the cultural backgrounds of women with addictions be integrated into current treatment models?

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Alternatives to Incarceration
Eileen Pencer, M.S.W., M.Ed., CSW, ACSW, Lower Eastside Service Center, Inc.
Judge Alex M. Calabrese, J.D., Redhook Community Justice Center, New York State Court System
Jayme A. Delano, CSW, Brooklyn Treatment Court
Judge Sol Wachtler, Law and Psychiatry Institute, North Shore-Long Island Jewish Health System

Current Research Tells Us

  • Mentally ill persons who are arrested for less serious crimes are usually abusers of alcohol and other drugs.

  • Diversion of these persons from the criminal justice system to community-based mental health and drug treatment outcome results in better long-term programs and less chance of return to criminal behavior. This diversion takes the form of various policies and procedures, all of which are designed to provide therapeutic intervention instead of imprisonment.

  • With the support of drug treatment programs, mental health professionals, enlightened law enforcement personnel, and empathetic judges, various prearraignment, postarraignment. and drug and mental health courts are being established.

Considerations for Putting Research to Actual Use

  • Specialized criminal justice and monitoring services must be made available.

  • Provisions must be made to provide treatment to a population that is, in all probability, not currently accessing these services.

Considerations for Future Research

  • Tracking outcomes

  • Verifying the reduction in recidivism

  • Measuring the effectiveness of modalities of treatment

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School-Based Interventions
Cynthia Kuhn, Ph.D., Duke University Medical School
Nancy E. Jones, M.H.S.A., CEAP, CPP, Capital Region BOCES-CAPIT
Ellen Morehouse, Student Assistance Services Corporation

This workshop will provide an overview of effective prevention principles and proven prevention practices. Specific school-based strategies for applying these principles and practices will be discussed through examples of comprehensive school-based programs for adolescents and after-school programs that reach youth in their neighborhoods.

Current Research Tells Us

  • Effective programs are multicomponent. They (1) teach life skills, (2) use an effective leader, (3) increase the perception of risk of harm of substances, (4) enhance protective factors, and (5) reduce risk factors.

  • School environment also affects the effectiveness of programs. Policies, faculty training, administrative support, and parent involvement all contribute to a successful program.

Considerations for Putting Research to Actual Use

  • Effective programs are designed to influence specific risk and protective factors.

  • Effective programs may be limited to specific populations with regard to age, gender, and racial/ethnic characteristics and/or to settings such as middle school, alternative schools, and after-school programs.

  • Program implementers and staff members must be selected with specific skills, training, language, supervision, and personal characteristics.

  • The community in which the school is based must be considered in designing effective programs.

Considerations for Future Research

  • Which programs are most effective with children of substance-abusing parents?

  • How are outcomes affected when there are no program incentives?

  • How can we design effective and flexible (limited delivery) prevention programs in a school environment in which drug education competes with testing requirements and other academic goals?

  • What is the fidelity of adaptation of research-based programs?

  • What are the core elements for successful delivery?

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Therapeutic Communities
Robert L. Hubbard, Ph.D., M.B.A., Duke University Medical Center
Allen Bray, M.H.S., Self Help Addiction Rehabilitation, Inc.
George De Leon, Ph.D., National Development and Research Institutes, Inc.
Kevin McEneaney, Phoenix House Foundation, Inc.

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Acupuncture for Addiction Treatment
Herbert D. Kleber, M.D., New York Psychiatric Institute and Columbia University
Vincent Brewington, M.A., Lincoln Medical and Mental Health Center
Mindy Fullilove, M.D., New York State Psychiatric Institute and Columbia University
Paul McLaughlin, M.A., Hartford Dispensary

Mr. Brewington will provide an overview of controlled research on acupuncture for substance abuse problems; discuss implementation of a placebo-designed, NIDA-funded study on acupuncture detoxification for cocaine/crack use conducted at Lincoln Hospital; and theoretical concerns in evaluating acupuncture detoxification.

Dr. Fullilove will describe a collaboration with Lincoln Recovery Center to develop counseling manuals to accompany acupuncture treatment. Connecting and Coping has 24 structured sessions and can be led by a peer counselor. Bonding and Strengthening covers parenting skills as well as family strengthening skills for 12 sessions. The structured counseling reinforces motivation and supplies problem-solving strategies.

Mr. McLaughlin focuses on Acupuncture Services in a methadone maintenance treatment program from the perspective of a program manager. He reviews how an acupuncture program was implemented; barriers; patient response; cultural receptivity; and level of patient interest. A review of program outcomes will focus on patient satisfaction and how clinical information is enhanced using information gained through the acupuncture process.

  • Current Research Tells Us that acupuncture is widely used in substance abuse treatment but the empirical database for such use is slim.

  • Considerations for putting research into practice include that while acupuncture may have a role as an adjunct for intensive therapies, its use as a stand-alone treatment or with minimal other intervention does not seem appropriate at this time.

  • Considerations for Future Research include the need to examine the appropriate role of acupuncture in a variety of settings and in combination with a variety of psychosocial interventions.

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Pregnancy and Maternal and Child Health
Janet Lerner, D.S.W., Narco Freedom, Inc.
Loretta P. Finnegan, M.D., Office of Research on Women's Health, National Institutes of Health
Angela M. Seracini, Ph.D., Babies and Children's Hospital of New York and Columbia University

This workshop will review recent research findings on pregnancy and maternal drug abuse and the children of substance abusers, including:

  • Correlates to substance use and maternal and child health (e.g., barriers to treatment, poor prenatal care, comorbid psychiatric disorders, etc.)

  • General health care challenges, including risk for HIV/AIDS

  • Treatment needs of drug-dependent women (e.g., parenting skills; compassionate, persistent followup)

  • Research on children of substance abusers (e.g., risk and protective factors that can moderate or mediate the impact of maternal substance abuse)

Considerations for Putting Research to Actual Use

  • Developmental and treatment needs of the children of substance-abusing parents and how these might be delivered

  • Parent support and training

  • Integrating treatment for children into substance abuse treatment programs for their parents

Considerations for Future Research

  • Developing creative approaches to treatment that draw heavily on risk and protective factors and other empirical findings.

  • Developing new research models that study intermediate and long-term outcome goals.

  • Studying integrated service systems for this population.

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Guiding Treatment in the 21st Century
Susan Brandau, New York State Office of Alcoholism and Substance Abuse Services
Ira J. Marion, M.A., Albert Einstein College of Medicine and Montefiore Medical Center

The term "evidence-based practice" is both the buzz word within the addiction research community and the proposed solution for improved client outcomes once "technology transfer" occurs at the programmatic level. The catch seems to be the technology transfer part of the equation. This workshop will explore issues specific to treatment programs that are inherent to the integration process for new evidence-based practices within existing programs. Methodology and resources will be identified for the creation of a programmatic environment that is receptive to new techniques.

Current Research Tells Us

  • Addiction research must be relevant, timely, and fiscally viable for practitioners.

  • Addiction research published in research journals is not readily accessible either physically or psychologically to the treatment staff.

  • Interpersonal contact between addiction researchers and practitioners strengthens research and enhances the likelihood of actual application of research findings.

  • The program staff must be psychologically ready to accept a new initiative and the programmatic change it will entail.

Considerations for Putting Research to Actual Use

  • There are real-world impediments to the implementation of research at the programmatic level that must be successfully negotiated.

  • Program administrators are in a key position to set the tone for their agencies and create a receptive environment for subsequent staff integration of evidence -based practices.

  • Staff incentives should be clear and continuous to facilitate knowledge adoption.

  • Literature in other disciplines describes a diffusion of innovations process that may yield knowledge that can be applied to the addiction treatment field.

Considerations for Future Research

  • To what extent does a program's involvement in research enhance the integration of evidence-based practices?

  • How can we measure the impact on both clients and staff members of a program's adoption of an evidence-based practice?

  • Is there a need to individualize per program a set of knowledge adoption strategies, or is there a one-size-fits-all model?

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Employment Issues in Treatment Outcome
Eileen Wolkstein, Ph.D., Steinhardt School of Education, New York University
Susan James, Ph.D., National Center on Addiction and Substance Abuse at Columbia University
Timothy P. Janikowski, Ph.D., State University of New York, Buffalo
Alice Ostrowsky, M.A., The Educational Alliance, Inc.

This workshop will describe the most recent research on integrating employment-related services into treatment and employment as a treatment outcome. It also will describe the relationship between employment and employment-related services and treatment retention and relapse and the impact that welfare reform policies have had on treatment. Obstacles to the integration of employment services and factors that contribute to success in employment will be highlighted. Overcoming programmatic obstacles will be described as well as new approaches to the delivery of employment services. The correlation between employment appropriateness and coexisting conditions will be demonstrated in research and practice.

Current Research Tells Us

  • Coexisting conditions affect the delivery of employment services.

  • There is a correlation between the delivery of vocational services and treatment retention.

  • Employment as a treatment component and outcome is not well understood in the substance abuse community.

Considerations for Putting Research to Actual Use

  • What is necessary to adequately prepare individuals in treatment for success in employment?

  • What is necessary in treatment programming to facilitate employment outcomes?

  • What is important to understand about the obstacles to employment that exist in both the treatment setting and the business community?

Considerations for Future Research

  • How can we demonstrate to programs and staff members the importance of recognizing employment services as a part of treatment as well as a treatment outcome?

  • What are the most effective approaches to deliver employment services?

  • How can we overcome the stigma of alcohol and other drug use as it affects employment opportunities?

  • How do we best integrate what we have learned into new approaches to effect change in employment outcomes?

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Challenges of Blending Clinical Practice and Research Into Daily Program Operations
Robert E. Sage, Ph.D., Addiction Research and Treatment Corporation/Urban Resource Institute
Catherine A. Doherty, M.Ed., Albany Citizens Council on Alcoholism and Other Chemical Dependencies, Inc.
Anthony S. Benedetto, CSW, CASAC, Samaritan Village, Inc.

This workshop will describe the importance and necessity of implementing new research studies and research-based practices into clinical operations. It will describe the difficulties experienced in implementing research studies, evaluating new protocols and studies that have proven outcomes, and translating research protocols and treatment approaches into clinic operations so that staff members will willingly and eagerly implement them into daily practice. A close look will be given to facilitating staff input, as well as staff training methods in the value and efficacy of such research and training protocols and the implementation of this methodology. New ways to develop staff buy-in and ownership will be described and discussed. Identification of specific challenges unique to certain modalities, shared experiences with the staff (both positive and negative), and examples of practical designs will be given, with ample opportunity for workshop participants to share experiences and explore options.

Current Research Tells Us

  • Adequate and proper staff training and materials are necessary for successful implementation of new treatment approaches and research protocols.

  • Positive outcomes are produced when the staff accepts ownership of treatment and research protocols and actively participates in research and protocol implementation.

Considerations for Putting Research to Actual Use

  • Target populations, clinic size, staff makeup, and existing demands on staff time and energy must be considered before implementing new research-based practices and research studies.

  • Staff members' experience and academic backgrounds play key roles in the implementation of new research studies and research-based practices.

Considerations for Future Research

  • How can we train staff members to welcome and implement new research studies and research-based practices?

  • How can we empower staff members to develop new protocols and practices, based on their own experiences and knowledge?

  • How can we consistently monitor the efficacy of existing practices and incorporate changes and new practices in a timely manner?

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Motivational Enhancement Therapy
Jon Morgenstern, Ph.D., National Center on Addiction and Substance Abuse at Columbia University
Bruce J. Rounsaville, M.D., Connecticut Veterans Affairs Healthcare System, New England Mental Illness Research Education and Clinical Center, and Yale University School of Medicine
Larry Taub, M.A., CSW, Lower Eastside Service Center, Inc.

Lack of motivation to reduce or stop drug use is considered one of the primary obstacles in treating substance abuse disorders. Motivational interviewing (MI) and its related application, motivational enhancement therapy (MET), are directive, client-centered brief interventions designed to elicit behavior change by helping clients explore and resolve ambivalence. Clinical trials have supported the efficacy of MI approaches for treating substance abuse disorders. This workshop will feature three presentations. The first presentation will provide a broad overview of MI, including the conceptual underpinnings of the approach and a review of clinical trials findings. The second presentation will provide an indepth description of the MI techniques used to promote change and offer the audience a hands-on opportunity to learn and practice some of the key elements of MI. The third presentation will describe an ongoing study testing the effectiveness of adding MI or MET to community-based drug treatment. In addition to describing the study, the presentation will focus on the challenges and rewards of implementing MI in a clinical practice setting.

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Assessment of Addiction
Deborah Hasin, Ph.D., Columbia University
Thomas A. Coyne, M.S.W., National Training Services

This workshop will describe established and innovative methods to assess addiction, abuse, and dependence among individuals found in different types of clinical settings. This will include measures of substance use and its impact on functioning in different life areas as well as the assessment of abuse and dependence, physiological dependence, remission and relapse, denial, and issues when multiple substances are being used. Basic concepts and contrasting methods of assessment will be described, as well as the role of such measures in research and clinical practice.

Current Research Tells Us

  • When clinicians and researchers do not use standardized concepts and measures, they can use the same terms to mean very different things.

  • Measures of substance addiction and dependence can be used in reliable and valid ways in a wide variety of clinical settings.

  • Different types of measures (e.g., relapse represented by use vs. dependence symptoms) can produce different research results.

Considerations for Putting Research to Actual Use

  • Who should conduct assessments and when?

  • What types of measures are best for different purposes?

  • How can the consistency and validity of different measures be monitored?

Considerations for Future Research

  • Does assessment, monitoring, or self-monitoring affect behavior for the better?

  • Will technological developments improve assessment?

  • Can assessment be built into supervision or program management in a way that improves overall treatment outcomes?

What's New Contents

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Sponsored by
National Institute on Drug Abuse
National Institutes of Health
Department of Health and Human Services

In partnership with
The New York CTN Node/New York University School of Medicine
The Long Island CTN Node/Columbia University and New York State Psychiatric Institute
New York State Office of Alcoholism and Substance Abuse Services
Alcoholism and Substance Abuse Providers of NYS
Northeast Addiction Technology Transfer Center (ATTC)
New York State Practice Improvement Collaborative (PIC)

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