Gaps in Substance Use Treatment Presented by: Rhonda G. Patrick, LCSW, MPA Amy C. Traylor, MSW, Ph.D.

What is it? What is it not? Not only for clinical practice Evidence based practice…

Steps of evidence based practice Convert the need for information into an answerable question. Track down the best clinical evidence to answer that question. Critically appraise the evidence. Integrate your appraisal with your expertise and the client’s values. Evaluate the effectiveness of the process.

Integration is key… What does the literature say? What do I bring? What about my client?

Evidence Based Practices Why EBP? Concerns related to cost and effectiveness of substance abuse treatment. Delineation of a rational approach to allocation of scarce resources. Mitigation against a system in which treatment practices are based solely on practice wisdom. Finding the “best” available treatment or policy that reduces the harm and costs of substance abuse.

Research & Knowledge What do we know? What don’t we know?

Bridging the Gap: Community Characterize the local community Understand community factors Develop community research partners Utilize a community participatory research framework

Bridging the Gap: Service Delivery Test the effectiveness of community-based therapeutic approaches that take advantage of natural supports (religious organizations) and of those that bring evidence-based treatments to non-clinical environments (e.g., academic community-partnerships). Evaluate and test collaborative research partnerships with community members that identify new and innovative approaches to drug abuse treatment services. Test community-level interventions that facilitate recovery and reintegration of drug users within their communities.

Bridging the Gap: Linkages Generate information that can be used to develop and test a workable model of community-based delivery in communities, including research that identifies untapped, informal community-based resources. Develop and evaluate best practices that focus on the integration of social, health and drug abuse services and that can optimize treatment outcomes for service users.

Bridging the Gap: Other Issues Speaking a Common Language How we define the problem How we define the outcome How we define the measurement Documenting Effectiveness Informal Publications Formal Publications Increasing Funding for Research and Services Making Addiction a Priority Economic Costs Social Costs

Evidence Based Substance Use Treatment: Where do we find them? National Registry of Evidence-Based Programs and Practices Created in 2007 Lists SAMSHA Model Treatment Programs Defines EBP as “approaches to prevention or treatment based in theory and have undergone scientific evaluation.” Submissions are “reviewed” by experts with doctoral degrees, evaluation research experience, and clinical experience. Many more prevention/intervention programs. Searchable by target population needs

Evidence Based Substance Use Treatment: Where do we find them? Agency for Healthcare Research and Quality National Guidelines Clearinghouse Search by topic area. Can compare multiple guidelines across variety of criteria and classifications. Can download information to PDA’s. Rigorous selection and review process

Evidence Based Substance Use Treatment: Where do we find them? Co-Occurring Disorder Center for Excellence Created in 2003 to foster infusion and adoption of evidence and consensus based treatment and program innovation into clinical and organization practice. Intended for the co-occurring disorder service system Provides descriptions of interventions Describes intervention implementation References related to EBPs

Evidence Based Substance Use Treatment: Where do we find them? Technology Transfer Centers 14 regionally-based addiction technology transfer centers Bridging the gap between science and practice Addiction Science Made Easy Program Intended for addiction treatment professionals Provides descriptions of interventions Describes intervention implementation References related to EBPs

Evidence Based Substance Use Treatment: Where do we find them? National Drug Abuse Treatment Clinical Trials Network Conducting studies of behavioral, pharmacological, and integrated behavioral and pharmacological treatment interventions of therapeutic effect in rigorous, multi-site clinical trials to determine effectiveness across a broad range of community-based treatment settings and diversified patient populations; and Ensuring the transfer of research results to physicians, clinicians, providers, and patients. Regional “Nodes” Service providers attached to various regional nodes