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Abstract: A quarter century ago, research-to-practice gaps in addiction care gained national attention and prompted formation of the National Drug Abuse Treatment Clinical Trials Network (CTN) and formalization of the Addiction Technology Transfer Centers (ATTCs). Soon after, the RE-AIM explanatory framework was developed to enable examination of the public health impact of healthcare innovations—with its domain of adoption corresponding most directly to the CTN’s mission of transferring research results of its trials to the addiction workforce. A node-level CTN-ATTC collaboration, the Western States CTN Node Training and Dissemination Workgroup, seeks to contribute to this national mission. Our workgroup—currently comprising leadership of the Western States CTN Node, Northwest ATTC, Pacific Southwest ATTC, and CTN Dissemination Library—promotes workforce adoption of scientific advancements in addiction care via two long-running universal technical assistance activities: a semi-annual webinar series, and a monthly column in the ATTC Messenger newsletter. In this commentary, we provide historical context for the salience of bridging research-to-practice gaps, and then describe the origin of this workgroup, detail its pair of long-running universal technical assistance activities intended to increase adoption of healthcare advancements among addiction workforce members, and offer metrics concerning the audiences attracted over a recent five-year period. In celebration of the CTN’s 25th anniversary, we also reflect on the value of this multi-institutional partnership for the Western States CTN Node and propose a dissemination agenda to prompt future efforts whereby the CTN mission may be more fully and effectively achieved.

Abstract:

Timely and wide translation of NIDA’s science and research findings is necessary to educate health providers (HCPs) and to inform policy makers and youth and their families, and it ultimately improves adolescent and public health.

NIDA’s web portals, such as NIDAMED, CTN Dissemination Initiative, Research Studies/Translational Research Resources (Drug Topics), NIDA for Teens, and CTN Dissemination Library disseminate empirically based evidence regarding adolescent substance use.

Dissemination of scientific information involves active partnerships with researchers; professional organizations, youth and their families; and educators and policy makers, to ensure bidirectional exchange and to inform a constantly evolving process to make relevant information readily available in user-friendly and cost-free formats. This article provides an overview of all of thee approaches to dissemination and sets the stage for a call to HCPs to educate youth on the dangers of substance use and to treat youth who may have already developed a substance use disorder.

Abstract:

Clinical trials have been slow to incorporate e-technology (digital and electronic technology that utilizes mobile devices of the Internet) into the design and execution of studies. In the meantime, individuals and corporations/organizations are relying more on electronic platforms and most have incorporating such technology into their daily lives. This paper, written by five members of the NIDA Clinical Trials Network, provides a general overview of the use of e-technologies in clinical trials research, specifically within the last decade, marked by rapid growth of mobile and Internet-based tools. Benefits of and challenges to the use of e-technologies in data collection, recruitment and retention, delivery of interventions, and dissemination are provided, as well as a description of the current status of regulatory oversight of e-technologies in clinical trials research. As an example of ways in which e-technologies can be used for intervention delivery, a summary of e-technologies for the treatment of substance use disorders is presented, including the Therapeutic Education System studied in protocol CTN-0044 of the NIDA Clinical Trials Network, making trials more efficient while also reducing costs. However, researchers should be cautious when adopting these tools given the many challenges in uses new technologies, as well as threats to participant privacy/confidentiality.

Conclusions: Challenges of using e-technologies in each stage of a clinical trial can be overcome with careful planning, useful partnerships, and forethought. The role of web- and smartphone-based applications is expanding, and the increasing use of those platforms by scientists and the public alike make them tools that cannot be ignored.

Related protocols: CTN-0044

Abstract:

Large-scale dissemination efforts seek to expand opportunities for the addiction treatment community to receive training in empirically supported treatments (ESTs). Prospective consumers of such training are valuable sources of input about content of interest, preferences for how training events are structured, and obstacles that deter receipt of training. In this mixed-method study, data were collected in 64 semistructured individual interviews with personnel during site visits to 16 community opioid treatment programs (OTPs). At each OTP, interviews were completed with the executive director, a clinical supervisor, and 2 direct-service clinicians.

Topical interests were analyzed qualitatively in a cultural domain analysis. Likert ratings of training event preferences were analyzed via generalized linear mixed models (GLMMs), and unstructured interviewee comments were analyzed via narrative analysis. Obstacles to training receipt were analyzed qualitatively with both content coding and narrative analysis. Based on topics of reported interest, cultural domain analysis suggests as ESTs of note: Multidimentional Family Therapy, Motivational Enhancement Therapy, Relapse Prevention Therapy, “Seeking Safety,” and broad addiction-focused pharmacotherapy. Regarding training event preferences, GLMMs and narrative analysis revealed clear preferences for time-distributed trainings and use of participatory activities (e.g., trainer demonstrations, role plays, small group exercises). Content coding identified cost as the primary obstacle to receipt of EST trainings, followed by lack of time, logistical challenges, and disinterest, and narrative analysis elaborated on contextual issues underlying these obstacles.

Conclusions: As primary consumers of EST technologies, the treatment community has valuable input to offer. Dissemination efforts may be enhanced by greater consideration of their preferences for training content and event structure, as well as practical obstacles that challenge their receipt of training.

Abstract:

The Affordable Care Act calls for integration of substance abuse treatment into medical care via medical homes and continuing specialty care. For this integration to occur in the substance abuse treatment field, substantial sharing and dissemination of information by treatment providers is required. This study explored the determinants of organizational activities directed at disseminating evidence-based practices (EBPs) undertaken by 193 community treatment programs who are members of the National Institute on Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (CTN). Using factor analysis, the research identified two generic categories reflecting different motivations for dissemination activities and explored both treatment center leadership and organizational characteristics as determinants of these different types of dissemination activities. Organizational characteristics predicting treatment center dissemination activities included size, previous involvement in research protocols, linkages with other providers, and having non-profit status. The treatment center leader’s membership in professional organizations was also a significant determinant. Organization variables account for a larger portion of the variance in treatment center dissemination activities.

Conclusions: The results suggest that the willingness of treatment providers to help disseminate EBPs within the industry may be heavily influenced through shared network connections with other treatment organizations. Policy leaders’ efforts to increase EBP implementation and care integration targeted by the ACA may want to pay particular attention to the effects of network involvement found in this study.

Abstract:

To date, the National Drug Abuse Clinical Trials Network Starting Treatment with Agonist Replacement Treatment Study (START) includes the largest database of patients (n=1269) entering opioid agonist treatment programs at community methadone centers around the United States (U.S.). Participants in the study were randomized to either Methadone (MET) treatment or Buprenorphine/Naloxone (BUP/Nx) treatment, and closely monitored during induction as well as throughout active treatment and follow-up. Pharmacotherapy was provided for 24 weeks with taper or continuation possible through week 32. Primary outcomes showed low rates of liver injury and no differences in liver functions between MET and BUP/Nx groups. Secondary findings present a multitude of interesting and clinically relevant outcomes. This Blending Initiative workshop presented several of those secondary outcomes from both a U.S. and international perspective.

Session One: United States Perspective

This segment of the session presented several important secondary outcomes from the START study including: From a comparison of the impact of MET vs. BUP/Nx treatment on HIV risk behaviors; a description of six different BUP/Nx and three different MET induction trajectories and their outcomes; and an association between genotype and treatment outcome in African-American participants receiving BUP/Nx or MET.

Session Two: International Perspective

To complement the findings and dissemination strategies from the U.S. perspective, a panel of international collaborators presented findings from studies conducted abroad and implementation strategies that have been successful. Presentations included outcomes from a collaborative project between NIDA and treatment providers in Indonesia, data from epidemiological studies showing the association between the length of MET treatment and mortality rates and dissemination and implementation strategies, and the use of incentive-based interventions in reducing drug use and associated consequences. The session also described the N-ALIVE (NALoxone InVEstigation) study–a large, prison-based, trial that assesses the number of lives that could be saved by providing Naloxone-on-release to adult prisoners with a history of heroin injection. The discussion after session two focused on on how the knowledge gained from these analyses and findings can be translated for the implementation of relevant MET or BUP/Nx treatment in clinical settings treating opioid dependent patients in the U.S. as well as internationally

Related protocols: CTN-0027

Abstract:

Guided by a comprehensive implementation model, this CTN-platform study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a National Drug Abuse Treatment Clinical Trials Network-affiliated opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a history control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted design and the applied, skills-based focus of staff training processes.

Conclusions: Collective results offer preliminary support for the collaborative approach taken to design of the focal CM intervention and the applied, skills-based focus of the staff training processes. Given the disparity between voluminous empirical support for efficacy of CM methods and their limited community dissemination, the current work may offer a useful template for processes of planning and design, training and consultation, and trial implementation and evaluation that enabled this CM intervention to be effectively transported for use by this community-based substance abuse treatment setting. Additional implications for CM dissemination are discussed.

Abstract:

The use of social media has grown exponentially over the past decade. Social media is a potential mechanism to disseminate science-based information with the ability to reach patients, organizations, cities, states, and federal entities simultaneously. The Ohio Valley Node (OVN) of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) began using Facebook and Twitter in the fall of 2011 to disseminate science-based information regarding substance use disorders (SUD). Data from calendar year 2012 was captured and metrics were developed to evaluate the utility of using social media as a dissemination tool. Information was posted to Facebook 73% of days with a mean number of 1.4 posts per day (SD=1.6, range=0-11) and to Twitter 75% of days with a mean number of 1.2 posts per day (SD=1.5, range=0-12). For Facebook posts, the total mean reach of Facebook posts was 32 people (SD=11, range=0-85) and the mean total impressions was 118 people (SD=39, range=5-293). By the end of 2012, 95 people or pages liked the OVN Facebook page and the OVN liked 341 Facebook pages. By the end of 2012, the OVN twitter account had 504 followers and the OVN was following 1,063 Twitter accounts. Additional data will be presented describing target audience reach (persons or organizations interested in SUD) and content of posts, as well as social networking metrics. In summary, social media is a low-cost tool to disseminate information and additional research is needed to measure the impact of this form of dissemination.

Abstract:

Substance abusers who enter treatment require a combination of motivation, skills and opportunities to make the behavior changes needed that will advance their recovery. One technique that has been helpful in boosting and sustaining motivation for successful participation and behavior change during treatment involves the use of tangible incentives that are awarded to clients by clinic staff contingent upon objective evidence of goal attainment. Contingency Management and Motivational Incentives are synonymous names for this technique. A large body of research provides evidence that motivational incentives, when implemented appropriately, can increase length of treatment participation and promote sustained periods of drug abstinence. Further, the technique has been shown efficacious when applied to users of a variety of abused substances including cocaine, alcohol and marijuana.

A large multi-site clinical trial conducted within the National Drug Abuse Treatment Clinical Trials Network supported effectiveness for treatment of stimulant users when abstinence-contingent incentives were added to usual care in community treatment programs that provided either psychosocial counseling alone or opiate substitution therapy (methadone) as well. Data from this trial will be used to demonstrate the magnitude and generality of these effects. Motivational incentives have been well accepted and widely adopted by substance abuse treatment researchers including those in CTN, to support adequate participation and/or to promote abstinence among research volunteers. The technique can also improve substance abuse treatment outcomes but has been less well accepted and widely adopted within the realm of clinical practice, despite being one of the most effective known behavioral interventions available for use in these settings. Nevertheless, adoption is gradually increasing as more training and dissemination materials become available and as solutions to perceived adoption impediments are addressed. During this presentation, dissemination resources will be provided and lessons learned about adoption discussed.

Related protocols: CTN-0006, CTN-0007

Abstract:

This presentation begins with an overview of the growing prescription opioid abuse problem in Scioto County, Ohio, including data on increasing injury deaths, unintentional overdose deaths, and treatment admissions. In 2009, a “call to action” was announced in the community, with three town halls and petitions to the governor. Through grassroots community activities, Scioto County helped bring attention to the issue, and a governor’s task force was established in 2010.

The Ohio Valley Node has been participating in activities intended to increase access to evidence-based practices in Scioto County and the region, including buprenorphine trainings and study proposals aimed at, among other things, studying cross-system approaches to reduce drug overdoses. The Node has been actively involved in meeting with community groups, treatment providers, and regional/national partners. By August 2011, 4 physician licenses had been suspended for violating opioid prescription laws, 2 pharmacies were DEA suspended, 1 doctor was convicted, and 3 clinic owners were indicted. The presentation ends with a discussion on lessons learned collaborating across systems, from the state level down to the community.

Abstract:

In an effort to increase retention in a community-based multi-site clinical trial, protocol CTN-0044 (“Web-Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders”), three of the ten participating sites introduced social media tools to contact and locate participants enrolled in outpatient substance abuse treatment. Of 138 eligible participants, 68 (49%) agreed to be contacted via social media. Most who did not agree did not have a social media account or reliable access to a computer. Research staff found social media outlets to be useful, but only used them when other contact options were exhausted.

This poster describes technology issues, confidentiality concerns, and recommendations for establishing systematic guidelines for social media use.

Related protocols: CTN-0044

Abstract:

The role of social media tools is rapidly expanding and radically changing the way we communicate with one another. The purpose of this guide is to provide people within the NIDA CTN with a basic understanding of social media and tips for navigation.

While there are many social media tools, this guide is limited to Facebook, Twitter, LinkedIn, and blogs. Whether you choose to engage in social media or only to watch from the sidelines, it is important to be aware of what is already happening. This guide provides descriptions of each medium, as well as practical examples from the CTN and beyond.

Abstract:

The National Drug Abuse Treatment Clinical Trials Network (CTN) has faced many challenges over its first eleven years. This review explores some of these challenges and the paths the CTN took to meet these challenges, including: designing clinical trials that reflect the CTN’s mission and changing public health needs, finding the synergies in the varied expertise of clinical treatment providers and academic researchers, promoting evidence-based practices, and expanding the Network into mainstream medical practices to reach a broader patient population. Included in this exploration are specific examples from CTN clinical trials.

CTN studies have shown that quality clinical trials can be successfully implemented into practice settings unfamiliar with research logistics by taking clinicians’ practical needs and research knowledge level into account. The challenges yet to be faced in the CTN’s efforts to expand opportunities to offer existing treatments to the segment of the drug-abusing population that utilizes mainstream health care seem large, but not as large as the potential for improvements in public health.

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-0014, CTN-0015, CTN-0017, CTN-0018, CTN-0019, CTN-0020, CTN-0021, CTN-0027, CTN-0028, CTN-0029, CTN-0030, CTN-0031, CTN-0032, CTN-0037, CTCN-0044, CTN-0047, CTN-0048, CTN-0049

Abstract:

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

Abstract:

This workshop, the third dissemination workshop organized by the CTN Research Utilization Committee (RUC), highlighted different methods CTPs have used to disseminate evidence-based treatment into their practice settings. Speakers from a number of community treatment providers presented at the workshop, which focused primarily on smoking cessation and implementation of the Matrix Model.

Presentations included:

Nicotine Replacement Prescribing Trends in a Large Psychiatric Hospital, Before and After Implementation of a Hospital-Wide Smoking Ban by Antoine Douaihy, MD, University of Pittsburgh School of Medicine, Pennsylvania, ATS Node

Recovery Network of Programs, Inc. (RNP) Tobacco Dependence Treatment Pilot by John Hamilton, LMFT, LADC, Regional Network of Programs, Inc., Connecticut, NEC Node

We Still Haven’t Come a Long Way, Baby! Smoking Cessation Efforts in an Oregon CTP by Lucy Zammarelli, MA, Willamette Family, Inc., WS Node; and Barbara Tajima, Institute for Health Policy Studies, UCSF, WS Node

Matrix Intensive Outpatient Treatment with Adolescents by Martin Moskowitz, LCSW and Seamus McEntee, LMSW, Mineola Community Treatment Center, NSLIJ, New York

The Matrix Model of Intensive Outpatient Treatment by Jeanne Obert, MFT, MSM, Matrix Institute on Addictions, California