What the Heck is the CTN Anyway? The NIDA National Drug Abuse Treatment Clinical Trials Network

Principles of Drug Addiction Treatment Principles of Drug Addiction Treatment Counseling and Other Behavioral Therapies Are Critical Components of Effective Treatment For Addiction Counseling and Other Behavioral Therapies Are Critical Components of Effective Treatment For Addiction

Principles of Drug Addiction Treatment Principles of Drug Addiction Treatment Medications Are An Important Element of Treatment For Many Individuals, Especially When Combined With Behavioral Therapies Medications Are An Important Element of Treatment For Many Individuals, Especially When Combined With Behavioral Therapies

Institute of Medicine Report Bridging the Gap between Practice and Research : Forging Partnerships with Community-Based Treatment Lamb, Greenlick, McCarty, 1998

Science Practice & Policy We Need To Bring Practice and Policy In Line With the Science We Need To Bring Practice and Policy In Line With the Science

Bridging the Gap Research Practice Policy

How Can We Accomplish This?

CSAT’s Response to IOM Report: Practice Improvement Collaboratives Developed in 1999, with 7 statewide and 7 metropolitan area projects To support and promote effective and efficient community- based treatment Develop and sustain community involvement in and commitment to practice improvement in the delivery of substance abuse treatment services Improve the quality of substance abuse treatment through the adoption of evidence-based practices in community- based organizations

NIDA’s Response to the IOM Report The National Drug Abuse Treatment Clinical Trials Network (CTN)

NIDA’s Millennial Goal: To Improve Drug Abuse Treatment Throughout the Nation… Using SCIENCE as the Vehicle To Improve Drug Abuse Treatment Throughout the Nation… Using SCIENCE as the Vehicle

NIDA Treatment Initiative Improve Existing Treatment Components Incorporate Efficacious Treatments into Clinical Practice Develop New Treatment Components

NIDA’s Clinical Trials Network Established in NIDA’s largest initiative to blend research and clinical practice by bringing promising therapies to community treatment providers. Network of 17 University-based Nodes (RRTCs) involving 116 Community Treatment Programs (CTPs) in 24 states, Washington D.C. and Puerto Rico.

Important Precursors to CTN at the Local Level DASA Research Subcommittee ADAI Statewide Outcome Project Failed attempt for NIDA center grant Decision not to try for CTN the first time around DASA “Bridging the Gap” Group

Developed as an offshoot from the DASA Research Subcommittee Stimulated by Institute of Medicine’s 1998 report, “Bridging the Gap Between Practice and Research: Forging Partnerships with Community- Based Drug and Alcohol Treatment” Brought together individuals with interest in research and practice, and expanded to include “policy” as a component

Bridging the Gap Group Helped plan the November 1999 NIDA Town Meeting in Seattle, including a panel entitled “Bridging the Gaps: Policy – Practice – Research” Helped develop subsequent DASA Research Meetings Provided a sounding board in the development of the Washington grant proposal submitted for the CTN Provided clear evidence that there was a supportive atmosphere for researchers, community-based practitioners, and policy implementers to work together collaboratively

National Drug Abuse Treatment Clinical Trials Network

CTN Nodes Oregon Node OHSU Washington Node U. Washington Pacific Node UCLA Rocky Mountain Node U. Colorado Florida Node U. Miami Great Lakes Node Wayne State U. Ohio Valley Node U. Cincinnati South Carolina Node MUSC North Carolina Node Duke California/Arizona Node UCSF/U. Arizona Southwest Node U. New Mexico Northern NE Node McLean/Harvard New England Node Yale New York Node NYU Long Island Node NY State Psych. Inst. Delaware Valley Node U. Pennsylvania Mid-Atlantic Node JHU/MCV

National Drug Abuse Treatment Clinical Trials Network  Conduct multi-site clinical trials of interventions efficacious in small-scale studies, to test their effectiveness across a broad range of clinical settings and patient populations.  Develop models for integrating new medications and behavioral interventions into clinical practice. Goal: To establish a research infrastructure to improve the quality of drug abuse treatment in the nation

Purpose of the National Drug Abuse Clinical Trials Network “…do these treatments work when you embed them in diverse, ongoing treatment programs and do they work with diverse patients typically seen in community-based treatment programs? The second goal of the network is to diffuse those science-based treatment components that are in fact shown to be effective into ongoing practice throughout the country.” Alan Leshner, Ph.D. Director, National Institute on Drug Abuse National Drug Abuse Clinical Trials Network Kickoff Meeting (2/99)

Moving from Research to Community Based Treatment It’s as Much a Process as It Is an Outcome

Basic Operating Principle of the CTN Bidirectional Partnership Research Practice

A CTP View of the Research-to-Practice Process “Research to practice is like marriage; if you stick together with anything long enough you can get used to it and develop a unique affection.” Nancy Hamilton, M.P.A., CAP, CCJAP, Operation PAR, Florida Node

National Drug Abuse Treatment Clinical Trials Network Node CTP -- Community-Based Treatment Program RRTC -- Regional Research and Training Center CTP RRTC

Regional Research and Training Centers (RRTCs) A Center Core Research agenda, management plan, SOPs, policies, budget, training, performance measures A Data Management Center Statistical support, methods/design, data management Community Based Treatment Programs (CTPs) Operational plan, concept generation, protocol implementation, subject accrual, QA

Regional Research and Training Centers (RRTCs) Initiate and Develop Protocols Conduct Studies Arrange CTP Participation Design and Conduct Training Implement Local Data Management Plan

Additional Components of Washington Node RTC CTN Dissemination Library Dissemination Specialist / ATTC Liaison

Community Treatment Programs (CTPs) Provide Setting for CTN Studies Incorporate CTN Training Protocols Collect Protocol-Specific Data Generate Clinically Relevant Concepts Have equal representation on CTN Steering Committee Participate fully in CTN committees

National Drug Abuse Treatment Clinical Trials Network – Washington Node

Research Center CTP Providence CTP Evergreen Manor CTP RCKC CTP Kitsap Recovery CTP Evergreen Treatment The Washington Node CTP Residence XII Triumph University of Washington CTP Vancouver VAMC

The Washington Node of the NIDA Clinical Trials Network

The Route from Concept to Protocol Implementation Concept Development Concept Review Protocol Development Protocol Review Protocol Implementation in CTPs Community Clinicians and Researchers

Protocol Design & Implementation Training Data Management Regulatory Quality Assurance Publications Steering Committee Protocol Development Project Teams Design and Analysis

“NIDA Clinical Trials Network Begins First Multisite Tests of New Science-Based Drug Abuse Treatments” By Robert Mathias, NIDA NOTES Staff Writer NIDA Notes - Volume 15, Number 6

First CTN Protocols  Buprenorphine / Naloxone Detoxification  Motivational Enhancement Therapy (MET) to Improve Treatment Engagement  Motivational Incentive – Vouchers for Drug Free Urine Samples *

CTN Protocols A baseline assessment of the CTN for investigating diffusion of innovation * Smoking cessation Buprenorphine/naloxone-facilitated rehabilitation of heroin addicted adolescents Telephone-enhanced long-term engagement Infections and Substance abuse * MET for pregnant substance abusers Brief strategic family therapy for adolescent drug abusers Women's treatment for trauma and substance use disorders *

CTN Protocols Patient feedback improvement system HIV intervention in drug treatment settings * HIV/STD safer sex skills for men ** HIV/STD safer sex skills for women * Job seekers workshop MET – Spanish Family management skills for opiate addicted women 12-step facilitation ** Reducing HIV risk among adolescent drug abusers Community reinforcement and family training for increasing motivation Treatment of depressed adult substance abusers (Lexapro)

Local CTN Involvement Buprenorphine Detoxification Taper –Providence Behavioral Health –Andy Saxon, Anthony Floyd Women’s Treatment for Trauma and Substance Use Disorders –Residence XII –Betsy Wells, Mary Hatch Maillette HIV Intervention in Drug Treatment Settings –Recovery Centers of King County –Don Calsyn, Anthony Floyd

Local CTN Involvement HIV Safer Sex Skills for Men and Women –Evergreen Treatment Services –Don Calsyn, Sara Berns, Mary Hatch-Maillette Twelve Step Facilitation –Under Development –Dennis Donovan