NIDAs Blending Initiative

1
NIDAs Blending Initiative

• Timothy P. Condon, Ph.D.
• Deputy Director
• National Institute on Drug Abuse
• National Institutes of Health
• Department of Health and Human Services

Friends of NIDA Washington, D.C. February 22,
2007
2
Advances in Science Are Bringing Us
New Understanding of Drug Abuse Addiction
AND
This Knowledge Is Allowing Us To Develop More
Targeted Strategies for Its Prevention and
Treatment
The Problem Is
3
ROADBLOCK Although Treatments For Addiction
Are Available, They Are Not Being Widely Used By
Those Who Need Them
In 2004, An Estimated 22.5 Million
Americans Were Dependent On or Abused Any Illicit
Drugs or Alcohol ButOnly 3.8 Million (17)
of These Individuals Had Received Some Type
of Treatment In the Past Year
Community
Bedside
Bench
4
If a Tree Falls in the Forest, and No One Is
Around

• Does It Really Make a Sound?

5
If Research is Done and Only Published in Peer
Reviewed Journals
6
that Remain on the Shelves.
7
Does It Have An Impact on the Lives of
Individuals?
8
To Reap Any Benefits From Scientific Knowledge
It Needs To Be Useful
9
As we strengthen our knowledge on treatment of
addiction it becomes increasing urgent to
expand our research on strategies to optimize
their translation into clinical practice and the
community
10
Although We Have A Variety Of Research-Based
Treatment Options In The Clinical Toolbox
We Have a Variety of Barriers to Implementation
11
According to a 1998 Institute of Medicine report
noted that a 17-year gap exists between the
publication of research results and its impact on
treatment delivery
12
IMPLEMENTATION SCIENCE
Everett Rogers Diffusion of Innovations
(1962) Hybrid seed corn was released to farmers
in 1928 it took 12 years before it was adopted
by most Iowa corn growers Introduced
Adopted 1928 1940 Although
many farmers understood that the new hybrid seed
corn would increase the number of bushels per
acre, they were unwilling to try it until someone
who was part of their social network had both
tried and succeeded at planting and harvesting
with this new corn.
13
NIDA
What Are We Doing About All of This?
14
Our Strategy Involves BLENDING
Bringing Science-Based Technologies Into Ongoing
Community Practice
15
Clinical Trials Network

• Mission
• Conduct multi-site clinical trials to
  determine the
• effectiveness of drug abuse treatment
  interventions
• in diverse community-based treatment settings
  and
• diverse patient populations
• Transfer research results to treatment
  programs,
• clinicians, and their patients to improve the
  quality
• of drug abuse treatment throughout the nation

16
National Drug Abuse Treatment Clinical Trials
Network

• Infrastructure based on NIH model
• Test effectiveness in real-life settings
• Behavioral and medications treatment
• Diverse populations
• Partnership with community treatment programs

17
National Drug Abuse Treatment Clinical Trials
Network Node
RRTC -- Regional Research and Training Center
CTP -- Community-Based Treatment Program
18
Puerto Rico
Puerto Rico ATTC
As of February 20, 2007
19
First CTN Protocols

• CTN0001 Buprenorphine/Naloxone versus Clonidine
  for Inpatient Opiate Detoxification Lead
  Investigator Walter Ling, M.D.
• CTN0002 Buprenorphine/Naloxone versus Clonidine
  for Outpatient Opiate Detoxification Lead
  Investigator Walter Ling, M.D.
• CTN0003 Buprenorphine/Naloxone Comparison of
  Three Taper Schedules for Opiate Detoxification
  Lead Investigator Walter Ling, M.D.
• CTN0004 Motivational Enhancement Treatment To
  Improve Treatment Engagement and Outcome in
  Subjects Seeking Treatment for Substance Abuse
  Lead Investigator Kathleen Carroll, Ph.D.
• CTN0005 Motivational Interviewing To Improve
  Treatment Engagement and Outcome in Subjects
  Seeking Treatment for Substance Abuse Lead
  Investigator Kathleen Carroll, Ph.D.
• CTN0006 Motivational Incentives for Enhanced
  Drug Abuse Recovery Drug Free Clinics Lead
  Investigator Maxine Stitzer, Ph.D.
• CTN0007 Motivational Incentives for Enhanced
  Drug Abuse Recovery Methadone Clinics Lead
  Investigator Maxine Stitzer, Ph.D.

20
The CTN Trials (1999 now)
Medical Interventions 9 Behavior
Interventions 11 HIV/HCV Interventions
4 Others 3
21
First CTN Research Findings

• Short Term Bup/Nx Detoxification
• NNT ClonidineBup/Nx 5.44
• High acceptability many drug free clinics have
  already adopted
• Motivational Interviewing
• Improved retention for stimulant abusers entering
  treatment

Motivational Incentives for Enhanced Drug
Abuse Recovery (MIEDAR)

• Low cost incentives are effective in promoting
  treatment
• retention and abstinence, successfully
  introduced into
• community
• Positive reinforcement vs punishment

22
Research Utilization
An Example with Adoption of Buprenorphine
An Example with Adoption of Motivation Incentives
Source Roman et al Presented 2006
23
Developing an Evidence-Based-Practice is Only One
Piece of the Translation Puzzle
Organization Structure Climate
Access Engagement
External Environment (stigma, financing)
Provider Knowledge Behavior
24
To Reap Any Benefits From Scientific Knowledge
It Needs To Be Useful
25
To Reap Any Benefits From Scientific Knowledge
It Needs To Be Useful ...and Used
26
SoHow do we accomplish dissemination of research
findings for application in the
community?BLENDING RESEARCH AND PRACTICE
27
NIDA Blending Initiative
The Blending Initiative encompasses three
primary components

• Blending Conferences
• Blending Teams
• State Agency Partnerships

28
First Component NIDA Blending Conferences

• LA, CA
• New York, NY
• Denver, CO
• Detroit, MI
• Miami, FL
• Seattle, WA

29
NIDA SAMHSA have partnered to conduct and
disseminate research findings for application in
the community
30
ATTC Areas of Emphasis

• Enhancing Cultural Appropriateness
• Developing Disseminating Tools
• Building a Better Workforce
• Advancing Knowledge Adoption
• Ongoing Assessment Improvement
• Forging Partnerships

31
Puerto Rico
Puerto Rico ATTC
As of February 20, 2007
32
SAMHSA/CSAT
Addiction Technology Transfer Centers
Puerto Rico
Puerto Rico ATTC
As of February 20, 2007
33
Research Dissemination ApplicationA Recipe
for Success

• One part CSAT
• One part NIDA
• A pinch of
• Oka few more
• Some TLC
• A dash of luck
• Shake vigorously and.

34
CTN
Policy Makers
ATTCs
Researchers
Practioners
Community
NIDA Blending Initiative our latest blending
recipe
35
NIDA-SAMHSA Interagency Agreement to Expedited
Transfer of Findings from Treatment into Clinical
Practice

• 1.5 million collaborative effort
• NIDA is providing funding to support CSATs
  Addiction Technology Transfer Centers (ATTCs)
• Designed to enhance the efforts to disseminate
  and apply finding from NIDAs CTN and other
  NIDA-supported studies to practitioners served by
  the ATTCs

36
National Drug Abuse Treatment Clinical Trials
Network
and The Addiction Technology Transfer Centers
Puerto Rico
Puerto Rico ATTC
As of February 20, 2007
37
CTN Research Findings Blending Teams

• Short Term Bup/Nx Detoxification
• NNT ClonidineBup/Nx 5.44
• High acceptability many drug free clinics have
  already adopted
• Motivational Interviewing
• Improved retention for stimulant abusers entering
  treatment

Motivational Incentives for Enhanced Drug
Abuse Recovery (MIEDAR)

• Low cost incentives are effective in promoting
  treatment
• retention and abstinence, successfully
  introduced into
• community
• Positive reinforcement vs punishment

38
NIDA/SAMHSA Blending Teams Process
CTN Protocols
Other NIDA Research
Create the charge for the Blending Team,
based on research results and how it can
address critical needs in the
treatment field
Hand-Off Meeting
Goal is to develop dissemination strategies
products. Each Blending Team is composed of
3 ATTC members 3 NIDA members
Blending Team
Blending Products are Disseminated at Nearly the
Same Time Research is Published
39
Second Component Blending Teams
Current Status of Product Development
1) Buprenorphine Treatment 2) Buprenorphine
Detoxification 3) Addiction Severity Index
(ASI) 4) Motivational Interviewing (MI) 5)
Promoting Awareness of Motivational
Incentives (PAMI)
Expected completion date Early 2007
40
NIDA-SAMHSA Blending Teams
Motivational Interviewing Assessment
Supervisory Tools for Enhancing Proficiency
(MIA-STEP)
Promoting Awareness of Motivational
Incentives (PAMI)

• Buprenorphine Treatment A Training
  for Multidisciplinary Addiction Professionals

Short-Term Opioid Withdrawal Using
Buprenorphine

• SMART Treatment Planning Utilizing the
  Addiction Severity Index (ASI)

41
Third Component State
Partnerships

• GOALS
• To disseminate information about research-based
  practices and CTN results to SSA leadership
• To identify strategies for accelerating the
  adoption of Research-Based Practices State
  programs
• METHODS
• Annual Meeting at National Association of State
  Alcohol and Drug Abuse Directors (NASADAD)
• Regional Meeting in Conjunction with Blending
  Conferences

42
Future Directions
Key Research Questions

• What are the characteristics of interventions
  that can
• - Reach large numbers of people
• - Be broadly adopted by different settings
• - Be consistently implemented by staff with
  moderate training
• - Produce replicable and long-lasting effects
• - Implemented at a reasonable cost

43
New solution

• Working across agency boundaries promotes
  innovative activities that
• Enhance public health applications of research
• Improve quality of available services
• Reduce obstacles that contribute to time lags in
  adoption of evidence-based interventions
• Develop most user-friendly interventions possible

44
Partnerships Are Essential In Advancing the
Science of Addiction and in Translating
Promising Strategies into Practice
45
CTN
Policy Makers
ATTCs
Researchers
Practioners
Community
NIDA Blending Initiative our latest blending
recipe
46
Visit Our Website _at_
47
(No Transcript)
48
(No Transcript)