Several years ago, a NIDA-supported researcher in Vermont discovered that a new behavioral treatment could reduce cocaine abuse among mostly white rural patients. Later, when NIDA intramural and extramural researchers in Baltimore tested the same treatment with inner-city cocaine and heroin abusers, they found that it reduced their cocaine abuse, too. These researchers have shown that this behavioral treatment can reduce cocaine abuse among a variety of patients in controlled clinical research studies. However, they still have more to learn. For example, how well will the treatment work in a resource-starved neighborhood clinic? What training will treatment counselors need to use the new therapy effectively? Will the new treatment be cost-effective?
How to translate promising drug abuse treatments from research into practice is one of the many critical issues that will be addressed by a major Treatment Initiative NIDA has launched to improve the quality of drug abuse treatment.
The Initiative has both a research and a communications thrust. The research thrust will stimulate additional work to improve current treatments and to develop new treatments and transfer them to community-based drug abuse treatment clinics. The communications thrust will increase the exchange of useful information about drug addiction and its treatment among the research and treatment communities and the general public.
"We now have a variety of effective addiction treatments as a result of our research," says NIDA Director Dr. Alan I. Leshner. Both behavioral and pharmacological treatments have been shown to reduce drug abuse, crime and delinquency, and the spread of HIV/AIDS and other infectious diseases that are associated with drug abuse, he points out. "By spurring additional drug abuse treatment research and speeding the evaluation and application of research-tested treatments in the real world, NIDA's Treatment Initiative can have a significant impact on the Nation's public health," he says.
Under the research prong of the Initiative, NIDA will hold workshops to assess the current of scientific knowledge about behavioral therapies, treatment medications, HIV/AIDS risk behaviors, and comprehensive treatment services. The Institute also plans to solicit and support new research to meet needs identified in all of these areas throughout the course of the Initiative.
Advancing the role of behavioral therapies in drug abuse treatment is a priority of the Treatment Initiative, says Dr. Lisa Onken of NIDA's Division of Clinical and Services Research (DCSR). Dr. Onken is coordinating the Initiative with Dr. Stephen Zukin, who heads the Division. This fall, DCSR is holding workshops on translating the findings of basic behavioral science research into innovative behavioral therapies and on transferring clinically tested behavioral therapies to the community treatment setting. Two other workshops are examining adolescent treatment issues. One is focusing on the development of more effective treatment approaches to deal with the special needs of adolescents. The other workshop is addressing how to develop early treatment strategies for adolescents and preadolescents who are beginning to abuse drugs.
Advancing health services research also will be an important part of the Initiative. This year, the Initiative is holding health services workshops on:
- factors that influence patients' readiness for treatment and motivation to change. This workshop also is exploring alternative approaches to drug abuse treatment for patients unable or unwilling to seek help in traditional treatment programs
- drug abuse treatment for special populations such racial and ethnic minorities, the homeless, persons with disabilities, and pregnant women. Unique treatment needs, potential barriers to treatment, and culturally appropriate treatment models to set research priorities to improve treatment for these populations are among the issues on the agenda.
- integrating medical and mental health services and drug abuse treatment. This workshop aims to promote cross-system health services research by increasing communication and interaction between medical health services researchers and drug abuse treatment researchers.
- financing drug abuse treatment and services. An expert panel is convening at this workshop to develop research recommendations to address both the immediate and long-term funding needs of providers of treatment resources.
Other Treatment Initiative research workshops on this year's agenda are designed to:
- evaluate the validity and reliability of instruments that researchers are currently using to assess whether drug abuse treatment reduces AIDS risk behaviors; and
- look at ways to improve and expand the use of the heroin treatment medication naltrexone.
Under the communications thrust of the Initiative, NIDA will hold a major drug abuse treatment conference in April 1998. The conference will highlight the principles of effective drug abuse treatment; detail pharmacological and behavioral treatments that have been shown to be effective; and examine the state of current research on special populations. The audience for the conference will include treatment researchers, treatment providers and practitioners, representatives from State drug abuse agencies and managed care organizations, and public policymakers. "We want to invite anyone who has an impact on treatment," said Dr. G. Alan Marlatt of the University of Washington in Seattle at a recent meeting of NIDA's National Advisory Council on Drug Abuse. Dr. Marlatt serves on a Council subcommittee that is helping NIDA plan the treatment conference and focus the Treatment Initiative.
In addition to the treatment conference, NIDA plans a host of other communications activities for the Initiative. Several work-shops will identify and disseminate research-based behavioral therapies.
Additional conferences will update the drug abuse treatment community on the treatment of cocaine addiction, heroin treatment medications, and other effective drug abuse treatment and HIV prevention approaches. Treatment research symposia at major national meetings will inform professionals in related fields about drug abuse treatment research findings.
NIDA NOTES will provide further information about the Treatment Initiative's conferences, symposia, and workshops as details become available.