Addicted to discovery: Does the quest for new knowledge hinder practice improvement?

Despite the billions of dollars spent on health-focused research and the hundreds of billions spent on delivering health services each year, relatively little money and effort are directed toward investigating how best to connect the two. This results in missed opportunities to assure that research findings inform and improve quality across healthcare in general and for addiction prevention and treatment in particular. There is an asymmetrical focus that favors the identification of new interventions and neglects the implementation of science-based knowledge in actual practice. The consequences of that neglect are severe: significantly diminished progress in research on how to implement treatments that could improve the lives of persons with addiction problems, their families, and the rest of society. This commentary proposes three interrelated strategies for improving the implementation process. First, develop scientific tools to understand implementation better, by expanding investigations on the science of implementation and broadening approaches to the design and execution of research. Second, nurture and support a collaborative implementation workforce comprised of scientists and on-the-ground practitioners, with an explicit focus on enhancing appropriate incentives for both. This includes adding relevance to research right from the start, something protocol CTN-0033 (Methamphetamine and Other Drugs in American Indian and Alaska Native Communities) did by collaborating with partners in more than a dozen American Indian/Alaska Native communities. As the collaborations matured over time, other community-specific goals and activities were shaped by the expressed needs and desires of each local community. Third, pay closer attention to crafting research that seeks answers that are most relevant to clinicians’ actual needs, primarily by ensuring that the anticipated users of the evidence-based practice are full partners in developing the questions right from the start.

Related protocols: CTN-0033-Ot