Psychotic illnesses. Questions remain about which antipsychotic medication should be the first line of therapy, what constitutes a sufficient period of time for a trial of a new medication to see if it is effective, and how to handle poor response to the initial prescribed medication (Kane et al., 2003). Moreover, the use of multiple antipsychotic medications takes place despite a lack of evidence about their combined efficacy and how to manage their dosing when increased symptoms or side effects occur (Miller and Craig, 2002).


Amphetamine or marijuana dependence. No medications have yet been found effective in treating these dependencies.


Cocaine dependence. No medications are currently approved by the U.S. Food and Drug Administration to treat this dependency.


Relative effectiveness of different treatments. Multiple therapies are used to treat the same illness. For example, more than 550 psychotherapies are currently in use for children and adolescents, with little helpful information for clinicians or consumers about their comparative effectiveness (Kazdin, 2000, 2004). As in other areas of health care, the federal government’s drug approval rules give little incentive for head-to-head clinical trials (Pincus, 2003), and there is a lack of substantial capital investment in developing and testing psychosocial interventions.


Therapies for other population subgroups. Ethnic and cultural minorities are largely missing from efficacy studies for many treatments (DHHS, 2001) in spite of growing evidence that drug dosages may vary by ethnic status (Lin et al., 1997). Few of these studies had the power necessary to examine the impact of care on specific minorities.

in general health care are less frequently utilized in M/SU health care. Research on M/SU health care needs to make greater use of these approaches to generating evidence on effective therapies.

Filling the Gaps in the Evidence Base

As is the case for general health care, federal agencies, philanthropic organizations, and other private-sector entities undertake many efforts to identify priority areas in M/SU health care in need of evidence, fund and conduct research, and support systematic reviews of research findings to identify evidence-based therapies. A strategy for coordinating these various efforts is articulated in Chapter 9. However, the large number of gaps in the evidence base for M/SU health care also requires that all sources of valid and reliable information be used to produce as much evidence as quickly, comprehensively, and accurately as possible. Three sources of information have been under-



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