As many health professionals are painfully aware, it takes too long for clinical research results to be implemented in routine patient care—an average of 17 years according to the Institute of Medicine.1 This lag is costly for society and wasteful of knowledge and investments made to improve the health and quality of people's lives—including the millions of lives altered by drug abuse and addiction.
To help translate the results of our rich research portfolio and to systematically move science-based interventions and practices into community settings for use by those who need them, the National Institute on Drug Abuse (NIDA) relies on a dynamic and multifaceted approach, reflected in our Blending Initiative. Blending works by: (1) ensuring bidirectional communication and feedback from a distributed network of researchers, treatment providers, and mainstream public health officials; (2) testing research-based treatments in diverse real-world settings; (3) developing products to facilitate the implementation of treatments that work; and (4) eliciting buy-in from practitioners in the field who will use them. This approach helps to ensure that treatments showing positive results are also practical, are in alignment with community and provider values, and are accepted and used by practitioners in the field––for that is how innovations get adopted in the real world of community-based treatment programs.
To assess the practical effectiveness of proven treatments—crucial in bringing research to practice––NIDA uses as one of its tools the National Drug Abuse Treatment Clinical Trials Network. The CTN involves practitioners from community-based treatment programs in formulating research protocols, trains them to implement and assess the various research-based therapies under study, and elicits feedback on treatment success and feasibility. Training community providers to deliver research-based treatments is a driving force for their use with patients. It also facilitates a continuous improvement loop whereby practitioners identify products needed by the field, then participate in testing and adapting them as necessary.
Developing implementation tools for research-based practices and putting them into the hands of treatment professionals is, of course, a key component of creating the change NIDA is helping to bring about. Blending Teams, composed of NIDA researchers, community treatment practitioners, and representatives from SAMHSA's Addiction Technology Transfer Center (ATTC) program (which NIDA partially supports), create products designed to foster adoption of new research-based treatment strategies. The ATTCs, a network of 14 regional offices and a national office, monitor, translate, and disseminate advances in addiction research, and provide treatment professionals with assistance to enhance needed skills.
Reaching justice populations
Given the close relationship between substance abuse and crime, NIDA is leveraging our blending and translation efforts to integrate drug treatment in criminal justice settings. The primary goal is to stop the vicious cycle of drug abuse and criminal involvement.
Whereas the overriding mission of NIDA's CTN is to improve the quality of drug abuse treatment by moving innovative approaches into the larger community, research supported through our Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) initiative is designed to effect change by bringing new treatment models into the justice system and thereby improve outcomes for offenders with substance use disorders. It seeks to better integrate drug abuse treatment with public health and public safety systems, and represents a collaboration among NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC), Department of Justice agencies, and a host of drug treatment, criminal justice, and health and social service professionals.
A research-based tool recently developed for criminal justice system professionals summarizes the key tenets of what constitutes effective treatment for offenders. Titled Principles of Drug Abuse Treatment for Criminal Justice Populations, the guide, revised this year, highlights some of the proven components for successfully treating prisoners and parolees and thus helping to lower rates of criminal activity and recidivism. It is intended for use not just by the criminal justice community but by treatment professionals working with drug-abusing offenders. The guide describes 13 research-based treatment principles and answers frequently asked questions about drug abuse treatment for justice-involved individuals.
In time, the blending of clinical research and practice will enable the drug treatment field to identify interventions, or key aspects of them, that can be adopted consistently in diverse treatment settings, including criminal justice settings, and help bring about better outcomes for varied patient populations. Indeed, this is already starting to happen.
Findings from CTN studies
The Blending Initiative embraces the notion that hands-on experience with using new protocols and seeing them work influence their adoption by community-based treatment programs and underscore the value of promoting greater interaction among researchers, practitioners, and other stakeholders. To illustrate, the remainder of this article focuses on two protocols: buprenorphine detoxification and motivational incentives, whose adoption by community programs participating in the clinical trials illustrates the value of practitioner involvement in research networks.