Bridging the Gap Between Practice and Research Forging Partnerships with Community-Based Drug and Alcohol Treatment (1998) / Chapter Skim
Currently Skimming:
2 The Gaps Between Research, Treatment, and Policy
2 The Gaps Between Research, Treatment, and Policy
Pages 27-55
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 27... ...
Taking public funds, rather than relying on self-pay and other private sources, forces the program to accept more criminal justice referrals. The program's board of directors primarily comprises older, conservative AA members.
|
From page 28... ...
He feels that his Board wonI`1 oppose intro~lucing any more non-AA treatment as part of a research project. Information Sharing on Treatment Advances Regarding information dissemination, this director mentions "NIDA Notes" and says that a similar, brief publication focusing on treatment research would help him.
|
From page 29... ...
OVERVIEW 29 There are important gaps between the knowledge gained from research, everyday practice in community-based drug abuse treatment programs, and governmental policies about drug abuse treatment at the local, state, and national levels. Much has been learned about drug abuse treatment at each of these levels research, treatment, and policy.
|
From page 30... ...
For example, methadone maintenance treatment began as a research effort, and relapse-prevention techniques were honed by research investigations. Significant advances have been made in behavioral treatment of drug abusers (Stitzer and Higgins, 1995~.
|
From page 31... ...
However, the value of having the right information at the right time was illustrated by the workshop participant who reported that a timely costeffectiveness study resulted in the 600 substance abuse treatment programs in Ohio receiving a 30 percent funding increase for the biennium (Ohio Department of Alcohol and Drug Addiction Services, 1996~. A state agency director expressed the need for faster research turnaround this way: Much research now being published was conceived several years or a decade ago, when a much different system was in place when today's problems were just beginning.
|
From page 32... ...
Adequately designed clinical trials have consistently shown that methadone maintenance treatment is effective only when methadone is given in adequate doses (Ball and Ross, 1991; Caplehorn and Bell, 1991~. Despite this research finding, past surveys have found many treatment programs that prescribe inadequate methadone doses (Calsyn et al., 1991; D'Aunno and Vaughn, 1992)
|
From page 33... ...
Over the years, these principles have been applied to drug abuse treatment in several ways. In a study of cocaine users, Higgins and colleagues used a system of vouchers which could be traded for material goods which individuals received when the routine urine testing proved negative (Higgins et al., 1994~.
|
From page 34... ...
Service delivery methods, which involve bundling drug abuse treatment with other services that address the multiple disabilities of addicted individuals, have been shown to promote recovery and prevent relapse. Service delivery approaches include, for example, case management, rapid admission, programs geared to the special requirements of treating women with children, as well as so-called "wraparound services" such as medical care, job training, and social services.
|
From page 35... ...
Outcome studies of a wide variety of programs and service delivery methods demonstrate, when keeping patient characteristics, treatment intensity, and duration constant, some programs have much more success than others. In another study of subjects receiving methadone only, standard methadone treatment, and enhanced methadone services, the enhanced treatment group demonstrated the greatest improvement in the areas of personal adjustment and public health and safety risk (McLellan et al., 19931.
|
From page 37... ...
. The committee found little evidence of research that systematically examines the distribution of treatment research across different kinds of modalities of drug abuse treatment.
|
From page 38... ...
Patient factors have been much more widely studied than have treatment setting or modality, perhaps because there are few measures of treatment setting or treatment services. Treatment providers speaking to the committee recommended directing research attention to such challenging problems as community resistance to the placement of drug treatment facilities, the so-called "NIMBY" (not in my back yard)
|
From page 39... ...
While the authors acknowledge that the existing literature is disappointing with regard to informing practice at the level of the community treatment program, they identify findings from controlled clinical research that have been significantly and repeatedly related to favorable outcomes and do suggest important directions for treatment practice in the real world. Their findings also suggest that a reader will get substantially different views about the outcome of treatment, depending upon the perspective taken regarding what "outcome" is and when, how, and by whom it is measured.
|
From page 40... ...
Policies That Impede Treatment Further, there is a need to review the policies that may put barriers in the way of the utilization of proven treatments and the development of new ones. For example, state regulations can be a barrier to the integration of methadone treatment into comprehensive treatment facilities and laws in some states prohibit methadone maintenance entirely.
|
From page 41... ...
The number and mix of practitioners are sufficient to support a specific treatment program and achieve a sufficient revenue base. However, implementing new psychopharmacological therapies generally requires adding medical staff, and new behavioral interventions may require trained psychologists who are not a part of current staff (Stitzer and Higgins, 1995~.
|
From page 42... ...
By accepting block grant funding states accept provisions which affect how drug abuse treatment is delivered. Block grants require the states to ensure the provision ot prevention services, outreach tor Injection drug users, and early intervention for those at risk for HIV.
|
From page 43... ...
17. Since most drug abuse treatment facilities derive a portion of their funding locally, they must also be responsive to community priorities and community opinions.
|
From page 44... ...
of life-long learning and to be familiar with the processes of acquiring new formal knowledge to improve their treatment. Drug abuse treatment providers who gain knowledge primarily through experience and on-the-job training may not be as open or as able to participate in the adoption of new treatments that are outside their experience base.
|
From page 45... ...
C 45 Even when studies document that a treatment can be successfully implemented in a clinical setting, the challenge of the final stage of transfer to treatment programs is often daunting.
|
From page 46... ...
People who work in drug abuse treatment programs may face a very personal problem of stigma. In many places working in this field is considered a mark of failure.
|
From page 47... ...
This included physicians and nurses as well. Of all the health care treatment programs, drug abuse treatment may be the most frequent employer of its own graduates.
|
From page 48... ...
Addiction treatment training, as well as research training in community-based treatment facilities requires more opportunities for hands-on experience and continuing educa t~on. Inadequate Knowledge Base About Technology Transfer There is little information about spread of innovations in drug treatment and how treatment programs use research findings in their work.
|
From page 49... ...
Technology transfer in drug abuse treatment appears to be a fruitful field for further work. Policy Barriers In the environment described above, it is easy for society to ration drug treatment, or reject certain forms of treatment.
|
From page 50... ...
cn a) a, FIGURE 2.1 Federal drug abuse treatment spending, 1981-1997 (millions of dollars)
|
From page 51... ...
Other barriers include lack of advocacy efforts, and lack of training opportunities (and requirements) in substance abuse treatment and research for all health-related professions.
|
From page 52... ...
1994. A feminist approach to substance abuse treatment and service delivery.
|
From page 53... ...
1995. Treatmetnt services in two national studies of community-based drug abuse treatment programs.
|
From page 54... ...
1993. The effects of psychosocial services in substance abuse treatment.
|
From page 55... ...
1996. The impact of HIV infection on medical services in drug abuse treatment programs.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.