Gaps in Substance Use Treatment

Presented by:

Rhonda G. Patrick, LCSW, MPA

Amy C. Traylor, MSW, Ph.D.

What is it?

What is it not?

Not only for clinical practice

Evidence based practice…

Steps of evidence based practiceConvert the need for information into an answerable question.

Track down the best clinical evidence to answer that question.

Critically appraise the evidence.

Integrate your appraisal with your expertise and the client’s values.

Evaluate the effectiveness of the process.

Integration is key…

What does the literature say?

What do I bring?

What about my client?

Evidence Based PracticesWhy EBP?

Concerns related to cost and effectiveness of substance abuse treatment.

Delineation of a rational approach to allocation of scarce resources.

Mitigation against a system in which treatment practices are based solely on practice wisdom.

Finding the “best” available treatment or policy that reduces the harm and costs of substance abuse.

Research & Knowledge

What do we know?

What don’t we know?

Bridging the Gap: Community

Characterize the local community

Understand community factors

Develop community research partners

Utilize a community participatory research framework

Bridging the Gap: Service DeliveryTest the effectiveness of community-based therapeutic

approaches that take advantage of natural supports (religious organizations) and of those that bring evidence-based treatments to non-clinical environments (e.g., academic community-partnerships).

Evaluate and test collaborative research partnerships with community members that identify new and innovative approaches to drug abuse treatment services.

Test community-level interventions that facilitate recovery and reintegration of drug users within their communities.

Bridging the Gap: LinkagesGenerate information that can be used to develop and

test a workable model of community-based delivery in communities, including research that identifies untapped, informal community-based resources.

Develop and evaluate best practices that focus on the integration of social, health and drug abuse services and that can optimize treatment outcomes for service users.

Bridging the Gap: Other Issues

Speaking a Common Language How we define the problem How we define the outcome How we define the measurement

Documenting Effectiveness Informal Publications Formal Publications

Increasing Funding for Research and Services Making Addiction a Priority

Economic Costs Social Costs

Evidence Based Substance Use Treatment: Where do we find them?National Registry of Evidence-Based Programs and

PracticesCreated in 2007Lists SAMSHA Model Treatment ProgramsDefines EBP as “approaches to prevention or treatment

based in theory and have undergone scientific evaluation.”Submissions are “reviewed” by experts with doctoral

degrees, evaluation research experience, and clinical experience.

Many more prevention/intervention programs. Searchable by target population needs

Evidence Based Substance Use Treatment: Where do we find them?

Agency for Healthcare Research and QualityNational Guidelines ClearinghouseSearch by topic area.Can compare multiple guidelines across variety of

criteria and classifications.Can download information to PDA’s.Rigorous selection and review process

Evidence Based Substance Use Treatment: Where do we find them?Co-Occurring Disorder Center for Excellence

Created in 2003 to foster infusion and adoption of evidence and consensus based treatment and program innovation into clinical and organization practice.

Intended for the co-occurring disorder service system Provides descriptions of interventions Describes intervention implementation References related to EBPs

Evidence Based Substance Use Treatment: Where do we find them?Technology Transfer Centers

14 regionally-based addiction technology transfer centers

Bridging the gap between science and practiceAddiction Science Made Easy ProgramIntended for addiction treatment professionals Provides descriptions of interventions Describes intervention implementation References related to EBPs

Evidence Based Substance Use Treatment: Where do we find them?National Drug Abuse Treatment Clinical Trials

NetworkConducting studies of behavioral, pharmacological, and

integrated behavioral and pharmacological treatment interventions of therapeutic effect in rigorous, multi-site clinical trials to determine effectiveness across a broad range of community-based treatment settings and diversified patient populations; and

Ensuring the transfer of research results to physicians, clinicians, providers, and patients.

Regional “Nodes” Service providers attached to various regional nodes