Tensions between research and practice were evident in the testimony presented to the committee. Providers expressed concerns that managed care misused findings from controlled clinical trials to inappropriately justify reductions in the length and intensity of care. Policymakers hinted at discomfort with researcher-directed and -managed interventions. Both clinicians and investigators sought more value from the collaborative relationship. The folk wisdom found in the story above characterizes some of these tensions. Even readers who disagree with sentiments in the story should recognize the pragmatic, underlying attitudes. Practitioners and consumers want concrete results with clear applicability to clinical and personal needs. Investigators who seek to work closely and effectively with practitioners must be prepared to describe their research in straightforward language and must be able to explain the relevance for treatment and recovery. Similarly, because consumers and clinicians may not appreciate the need for experimental controls, researchers must be willing to teach practitioners and consumers about the importance of comparison groups. At the same time, investigators must learn to be sensitive to the treatment environment and to understand the culture of recovery. They should also respect the insights of experiential learning and be willing to explore non-experimental research opportunities.

This chapter examines the benefits and challenges to working in a clinical environment from the perspective of the research investigator. The chapter also examines approaches that have been used successfully to build research/practice partnerships, and the lessons to be learned from prior federally sponsored demonstrations that linked practice and research in the field of drug abuse treatment.

Rapid development of community-based drug abuse treatment programs requires partnerships among investigators trained in theory and methods, clinical practitioners schooled in working with clients, administrators oriented toward problem resolution, and policymakers who fund and regu-