Search the Library

Abstract: This 12-page brochure provides an overview of the first decade of research in the National Drug Abuse Treatment Clinical Trials Network. The CTN was started in 1999 to help bridge the gap between research and practice in the drug and alcohol abuse field, helping move evidence-based treatments into adoption in community treatment centers. The CTN’s innovative approach blends the skills and experience of community treatment providers and academic researchers in collaborative partnerships (“Nodes”) that offer patients better access to scientifically tested treatments. In the first 10 years, the CTN has fueled a cultural shift toward evidence-based care for substance abuse treatment, showing that rigorous and relevant clinical research can be carried out directly in CTPs and can address a broad range of addictive disorders. Some of the most effective protocols include those about buprenorphine, a pharmacotherapy for opiate addiction; contingency management/motivational incentives; and motivational interviewing. The brochure also describes several CTN-related projects, such as the NIDA/SAMHSA Blending Initiative, which has developed several products to assist in the dissemination and training for some of the CTN’s successful treatment protocols, and the CTN Dissemination Library, which is a digital repository of resources and downloadable materials by and about the CTN. The CTN will continue to evolve and is poised to examine a variety of innovative approaches in its next decade, all with the ultimate goal of getting the best treatments to those who need them.

Abstract:

This presentation provides an overview of the National Drug Abuse Treatment Clinical Trials Network’s first ten years. It begins with the premise for the CTN’s initiation: to improve addiction treatment using randomized, controlled clinical trials to generate evidence-based treatments that are then implemented in community treatment programs via engagement with providers participating in the research process. It then describes the infrastructure of the CTN, the research done thus far (including multiple secondary and platform studies), the overall utilization of that research (including dissemination strategies and the CTN Dissemination Library), and plans for the next decade of the CTN.

The future mission of the CTN is to continue to help bring drug abuse treatment into mainstream medical practice, maintain a flexible research strategy/portfolio, help facilitate research utilization through better training platforms for the clinical workforce, and address more research questions that directly impact clinical practice.

Abstract:

This presentation provides an overview of the CTN protocols that examined various pharmacotherapies for opiate dependence (buprenorphine/naloxone, e.g.), smoking cessation, and adolescents.

Each protocol is described, along with its aims and conclusions, and the presentation ends with a “to-do list” for future CTN pharmacotherapy research, in the hopes that protocols about cocaine, methamphetamine, marijuana, pharmacogenetics, combination therapies (medication plus behavioral treatments), and comorbidity will be explored down the line.

Related protocols: CTN-0001, CTN-0002, CTN-0003, CTN-0009, CTN-0010, CTN-0027, CTN-0028, CTN-0029, CTN-0030

Abstract:

This presentation explores organizational-level adoption, implementation, and discontinuation of evidence-based treatment practices (EBPs), comparing programs that participated in CTN research to programs that did not. It describes three University of Georgia platform studies that examined three specific EBPs: buprenorphine, motivational incentives, and alcohol pharmacotherapies.

Overall, the studies found that there is greater adoption of EBPs in CTN versus non-CTN treatment programs, and that participating in research networks is important when it comes to promoting evidence-based practices.

Abstract:

This presentation describes the growth and diverse characteristics of the CTN community treatment provider network (CTPs), a network that began with only 52 participants in 2000 is has now grown to 187 in 2010. CTPs in the CTN typically fall into one of two categories: those offering medication-assisted treatments (methadone/harm reduction) and those that do not (“drug free” clinics). To date, there have been ten medication-based trials in the CTN, 6 involving Suboxone, 2 involving methylphenidate, and 1 each using nicotine patches and bupropion.

The presentation describes many of these protocols, focusing in particular on the impact participation in medication-assisted treatment trials has had on CTP use of agonist replacement medications in general. The positive outcomes of such participation are described, as well as considerations for future research.

Abstract:

This presentation begins with an overview of tobacco addiction perspectives, focusing in particular on dependence and withdrawal and arguing that treatment is vital in tobacco control and could be greatly advanced by further CTN support. There have been several studies so far in the CTN about tobacco cessation, including CTN-0009 (“Smoking Cessation Treatment with Transdermal Nicotine Replacement Therapy in Substance Abuse Rehabilitation Programs”) and CTN-0029 (“A Pilot Study of Osmotic-Release Methylphenidate in Initiating and Maintaining Abstinence in Smokers with ADHD”), but more work could be done.

The presentation ends with an informal survey of other NIDA-supported tobacco research leaders, describing the major impact on public health that NIDA treatment support of tobacco research has had. The CTN provides a unique capability for further advances in tobacco addiction treatment; suggestions on major challenges and opportunities in the network are described.

Abstract:

This presentation begins with an update on the CTN-0014 platform study, “Mediators and Moderators of BSFT for Adolescent Drug Use.” Previous research on BSFT, a family therapy based on structural family systems theory, has focused mainly on outcomes, with little attention to how the treatment actually works or for whom it might be the most beneficial. Using protocol CTN-0014 as a platform, the authors tested hypotheses about mediators and moderators of BSFT. The study found within-treatment associations between BSFT fidelity and outcome, with minority participants accounting for most of these associations. Associations between BSFT fidelity and observed family change also varied by ethnicity, with significant correlations appearing for minority families, but not whites. Unfortunately, the study also found that the modal quality of BSFT was considerably less than ideal — most of the cases reviewed by the investigators featured BSFT that was considered less than adequate. As fidelity is at the heart of good psychosocial intervention trials, good treatment effectiveness research, and replicable dissemination, the fact that establishing and maintaining high fidelity was very difficult in this trial warrants further examination.

The presentation ends with reflections on future directions for the CTN, including ways to elevate the study of mechanisms, focus on moderators at both the case and organizational level, study therapist development to maximize fidelity, and have centrally organized but independently conducted trials across sites.

Related protocols: CTN-0014, CTN-0014-A-1

Abstract:

This presentation begins with an overview of the history of dissemination-focused committees in the CTN, beginning with the Dissemination Subcommittee, started in 2001, which over time has evolved into the present-day Research Utilization Committee (RUC). During the first decade of the CTN, several dissemination and implementation strategies have been employed, including the publication of numerous articles about technology transfer, platform dissemination/implementation studies, NIDA-SAMHSA Blending Team Products and Blending Conferences, and a variety of regional dissemination workshops, local trainings, and interactive websites.

Additionally, the CTN Dissemination Library was launched in 2003 to provide CTN members and the public with a single point of access to research findings and other materials approved for dissemination throughout the CTN and to the larger community of providers, researchers, and policy-makers. Use of the Blending Products, trainings and workshops, and the Library have grown steadily in the past several years. The presentation ends with suggestions for ways the RUC can continue to help “close the gap” between treatment and research.

Abstract:

The IOM Report from 1998 (“Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment”), published by the Institute of Medicine of the National Academies, used real-life experiences in addiction treatment to examine why research remains remote from treatment and made specific recommendations to community providers, federal and state agencies, and other decision-makers. One of those recommendations was that NIDA and other institutes in the field support the development of an infrastructure to facilitate research within a network of community-based treatment providers.

In this presentation, Oregon State Representative Mitch Greenlick, PhD, reviews those recommendations and describes elements of the CTN that create the perfect setting in which to move forward with community participation in research and the ability of that research to impact policy transformation in the long term.

Abstract:

This presentation begins with the history of contingency management (CM), an intervention that originally developed out of B.F. Skinner’s Operant Conditioning model. CM typically involves the use of positive reinforcements to change behavior and was first applied to problems with alcoholism in the late 1960’s. The New York Node joined the CTN in 2000 and participated in one of the two MIEDAR studies (“Motivational Incentives for Enhanced Drug Abuse Recovery: Methadone Clinics,” CTN-0007). This purpose and outcomes of this study are described in the presentation along with details about the specific involvement of two CTPs from the New York Node in the protocol (Lower Eastside Service Center and Greenwich House MMPT). In 2008, threatened changes in methadone maintenance policy led the New York City Health and Hospitals Corporation (HHC), the largest provider of addiction treatment in the U.S., to adopt new vocational rehabilitation programs. When patients refused to participate in the offered programs, the HHC adopted CM as a technique to increase involvement. The HHC eventually formed an alliance with the CTN to help develop a Vocational Incentives Program. Results from both the CM-related CTN protocols and the HHC’s VIP program are presented. The HHC has maintained its connection to the CTN via co-sponsored CM trainings and other workshops and conference, a perfect example of the CTN’s ability to help foster the dissemination of evidence-based practices in to real-world settings.

Abstract:

Protocol CTN-0032, “HIV Rapid Testing and Counseling,” seeks to evaluate the most effective strategy to ensure that persons in drug treatment programs are tested for HIV and receive their HIV test results.

This presentation describes the development and goals of the protocol, the “nuts and bolts” of its implementation, and conclusions about the utility of research experience in the CTN for community treatment providers.

Related protocols: CTN-0032

Abstract:

This study applies a latent variable approach to examine gender and racial/ethnic differences in cocaine dependence, to determine the presence of differential item functioning (DIF) or item-response bias to diagnostic questions of cocaine dependence, and to explore the effects of DIF on the predictor analysis of cocaine dependence. The analysis sample included 682 cocaine users enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN) (protocols CTN-0006 and CTN-0007, Motivational Incentives for Enhanced Drug Abuse Recovery in Drug Free/Methadone Clinics, respectively). Participants were recruited from 14 community-based substance abuse treatment programs associated with the CTN, including 6 methadone and 8 outpatient non-methadone programs. Factor and multiple indicators-multiple causes (MIMIC) procedures evaluated the latent continuum of cocaine dependence and is correlates. MIMIC analysis showed that men exhibited lower odds of cocaine dependence than women, controlling for the effects of DIF, years of cocaine use, addiction treatment history, comorbid drug dependence diagnoses, and treatment setting. There were no racial/ethnic differences in cocaine dependence; however, DIF by race/ethnicity was noted. Within the context of multiple community-based addiction treatment settings, women were more likely than men to exhibit cocaine dependence. Addiction treatment research needs to further evaluate gender-related differences in drug dependence in treatment entry and to investigate how these differences may affect study participation, retention, and treatment response to better serve this population.

Supported by the Duke Clinical Research Institute (CTN DSC 1).

Related protocols: CTN-0006, CTN-0007

Abstract:

Pain complaints are common among individuals with opioid dependence. However, few studies investigate pain during opioid detoxification or the impact this pain has on continued opioid use. This secondary analysis utilized data from two Clinical Trials Network randomized controlled trials of buprenorphine-naloxone for short-term opioid detoxification (protocols CTN-0001 and CTN-0002) to examine the extent to which pain was associated with continued opioid use during and immediately following a 13-day detoxification protocol. At follow-up, more severe pain was associated with a greater number of self-reported days of opioid use during the prior 30 days (p < .05) but was not associated with urine toxicology results collected at follow-up.

These results, although mixed, have potentially important clinical implications for assessing and addressing pain during opioid detoxification. Pain that is experienced during and immediately following medically monitored detoxification may be associated with continued opioid use. These findings lend further support for continued research on pain among patients with opioid dependence, and suggest potentially important clinical implications regarding pain management during the detoxification process.

Related protocols: CTN-0001, CTN-0002

Abstract:

This article examines variables that predicted outpatient treatment entry within six months of residential detoxification. Patient data were collected from 632 injection drug users enrolled in a randomized trial conducted at eight detoxification programs within the National Drug Abuse Treatment Clinical Trials Network (CTN) with follow-up assessments conducted at 2, 8, 16, and 24 weeks (protocol CTN-0017, “HIV and HCV Intervention in Drug Treatment Settings”). Detoxification program characteristics were collected during this study and from a survey of CTN treatment organizations. Survival analysis found that estimated proportions of reported outpatient treatment entry varied across sites from .06 to .72. A model-building approach determined variables significantly associated with outpatient treatment entry. The best predictive model contained five program-level variables: accreditation, fewer beds, longer stays, shorter distance between detoxification and outpatient unit, and the larger city population.

This study suggests that smaller detoxification units with longer lengths of stay and treatment services nearby may boost rates of continuing treatment beyond detoxification for injecting drug users. In addition, innovative research should combine what are typically separate areas of inquiry, for example, matching patients to program variations and examining multilevel interventions that target both patient-level change and programmatic quality improvement.

Related protocols: CTN-0017

Abstract:

Multisite effectiveness trials such as those carried out in the National Drug Abuse Treatment Clinical Trials Network (CTN) are a critical step in the development and dissemination of evidence-based treatments because they address how such treatments perform in real-world clinical settings. Several possible experimental designs may be chosen for such effectiveness trials. These include (a) a new treatment intervention (Tx) is compared to an existing mode of community based treatment as usual (TAU): Tx versus TAU; (b) a new intervention is added to TAU and compared to TAU alone: Tx + TAU versus TAU; or (c) a new intervention is added to TAU and compared to a control condition added to TAU: Tx + TAU versus control + TAU. Each of these designs addresses a different question and has different potential strengths and weaknesses. As of December 2009, the primary outcome paper had been published for 16 of the multisite randomized clinical trials conducted in the CTN, testing various treatments for drug abuse, HIV risk behavior, or related problems.

This paper systematically examines, for each of the completed trials, the experimental design type chosen and its original rationale, the main findings of the trial, and the strengths and weaknesses of the design in hindsight. Based on this review, recommendations are generated to inform the design of future effectiveness trials on treatments for substance abuse, HIV risk, and other behavioral health problems. Addressing the right questions, looking closely at effect size and power, as well as internal versus external validity, and more consideration for three-arm designs and cost-effectiveness will serve well the goals of effectiveness research.

Related protocols: CTN-0001, CTN-0002, CTN-0003, CTN-0004, CTN-0005, CTN-0006, CTN-0007, CTN-0009, CTN-0010, CTN-0011, CTN-0013, CTN-0015, CTN-0017, CTN-0018, CTN-0019, CTN-0021