1. Rev. 8-14-07 1 In the Diffusion of Innovations Everyone Changes: Linking Practice with Scientific Research James L. Sorensen, Ph.D. University of California, San Francisco and San Francisco General Hospital. American Psychological Association San Francisco, CA (August 2007) Support from NIDA (U10DA15815, R01DA14922, R01DA014470, P50DA09253) and Robert Wood Johnson Foundation..

2. 2 DISSEMINATION, DIFFUSION Dissemination… –To scatter seed, far and wide Diffusion is a two-way process… –An intermingling of molecules Everyone changes

3. 3 PREVIEW 1. Diffusion can be slow 2. Principles of successful diffusion 3.What are the needs in substance abuse? 4.Selected resources

4. 4 1. DIFFUSION CAN BE SLOW Why the long lag between knowledge and adoption? –Scurvy 194 years

5. 5 Illustration of Diffusion Barriers: The Dvorak Keyboard

6. 6 LIVING HISTORY OF DIFFUSION: The LCD Projector

7. 7 BRIEF HISTORY OF “PROJECTION” 2 nd Century Magic Lantern 1888 discovery of liquid crystalline structure 1950s Kodachrome…35 mm projectors 2004 Last Slide Projector made by Kodak 2010 LCD projector sales may top 7,000,000

8. 8 2. WHAT AFFECTS DIFFUSION OF INNOVATIONS? The nature of innovations –Complex? –Compatible? The organizations (the target of adoption) –Organizational slack –Fit with the clients –Organizational climate –Champions of change The dissemination process –Active and in-person techniques work better –Also are more costly

9. 9 3. DISSEMINATION NEEDS IN SUBSTANCE ABUSE: Effective Treatments Relapse Prevention Supportive-Expressive Psychotherapy Individualized Drug Counseling, Motivational Enhancement Therapy, Behavioral Therapy for Adolescents Multidimensional Family Therapy for Adolescents Multisystemic Therapy Combined Behavioral and Nicotine Replacement Therapy for Nicotine Dependence Addiction Community Reinforcement Approach Plus Vouchers Voucher-based Reinforcement Therapy for Patients in Methadone Maintenance Treatment Day Treatment with Abstinence Contingencies and Vouchers Matrix Model of Drug Abuse Treatment 1 Adapted from National Institute on Drug Abuse, 1999. Principles of Drug Addiction Treatmetn: A Research Based Guide. Availabile at: http://www.nida.nih.gov/PODAT/PODAT4.html

10. 10 EVIDENCE-BASED INTERVENTIONS

11. 11 RESEARCH-DEVELOPED INTERVENTIONS Behavioral Treatments –Motivational Interviewing –Contingency Management Pharmacotherapy: –Naltrexone –Buprenorphine

12. 12 Buprenorphine in Wired April 2005

13. 13 4. RESOURCES CTN Dissemination Library Implementation Science USF review

14. 14 Clinical Trials Network Dissemination Library Technology Transfer in Drug Abuse Treatment http://ctndisseminationlibrary.org

15. 15 Implementation Science (new journal) http:// www.implementation science.com

16. 16 USF Review http://nirn.fmhi.usf.edu

17. 17 IN SUMMARY Change is slow –And sometimes never happens (keyboard) Many innovations can be useful in our field Reasons for change are multifactorial Need more information

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20. 20 WHY LCD?  Flexible  Advances in technology  Trained workforce (compatible)  Dissemination methods?

21. 21 3. Needs in Substance Abuse Area: WHY THE GAP? Little overlap between common treatment methods and those with scientific evidence Due in part to history of isolation from mainstream health care Treatments came from an alternate system of care, compassionate peers Resulting polarization of science vs. practice

22. 22 TREATMENT-DEVELOPED INTERVENTIONS Self-Help Programs Drug Courts

23. 23 An Alternative to Incarceration Behavioral Health Court offers counseling to criminal defendants with psychological disorders. Cheaper than jail, it’s changing lives. San Francisco Chronicle 1-23-2006

24. 24 RESEARCH NEEDS RE. DISSEMINATION Not much research in addictions area Top-down versus partnership models Adopt or Adapt (fidelity or reinvention?) Measures of diffusion Effectiveness of training

25. 25 DISSEMINATION RESEARCH NEEDS What learning experiences are needed? How do treatments work? (vs. black box) What prevents “relapse?” (to old ways) Individual & organizational differences? What system factors matter?