Nida's Clinical Trials Network: A Source of Social Work Practice-Relevant Knowledge

Background and Purpose: There are long-standing gaps between research findings and practice in service provision to those dependent on drugs or alcohol. State and local policies increasingly advocate or require the use of evidence-based practices in publicly funded treatment programs. The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) began in 1999 with the goal of “improv[ing] the quality of drug abuse treatment throughout the country using science as the vehicle.” Its establishment responded to calls to align research and practice in the addictions, most notably the 1998 Institute of Medicine report, Bridging the Gap between Practice and Research (Lamb et al., 1998). The purpose of this presentation is to describe the CTN, provide an overview of its work, and highlight the applicability of its findings to social work research and practice.

Methods: Funded by NIDA through a set of cooperative agreements, the CTN is comprised of 13 regional nodes consisting of a university-based research center and community addiction programs, totaling 240 programs across 37 States. A Steering Committee, composed of an investigator and a treatment program representative from each node and NIDA staff, designs and monitors CTN studies. Social workers are involved as both university-based researchers and community program representatives. The network attempts to move efficacious treatments into practice through multi-site behavioral and pharmacological Stage III (effectiveness) studies. Efficacy and effectiveness trials lie along a continuum defined by the degree of emphasis on internal versus external validity. The CTN uses a “hybrid model” (Carroll & Rounsaville, 2003) of design incorporating both external (e.g., use of community clinicians to deliver interventions; broad inclusion of representative patients; comparison conditions that represent treatment-as-usual; cost-effectiveness evaluation; and assessment of patient and clinician satisfaction) and internal (e.g., random assignment, manualized treatments, monitoring of treatment fidelity, and use of objective outcome measures) validity.

Results: To date the CTN has launched 28 multi-site intervention trials: 14 psychosocial/behavioral interventions, 10 medication or combined psychosocial/medication interventions, and 4 focused on HIV risk. Of these, 24 have been completed, with 17 primary outcome papers (involving a total of 6,215 participants) in print (see http://ctndisseminationlibrary.org). Overall, the CTN has been successful at implementing science-based treatments with fidelity in clinical settings. Trial outcomes vary, with some treatments producing improvements in retention, HIV risk behavior, or during- or post-treatment substance use. Others have not out-performed standard community practice. Results also differ by sub-population and by treatment site. Community-based treatment programs that participate in the CTN have adopted CTN-tested interventions at a faster pace than programs outside the CTN, but not at the rate initially expected. The CTN has also attempted to influence practice more generally through numerous dissemination efforts.

Conclusions & Implications: The CTN represents a source of practice-relevant knowledge that can be utilized by social workers in a variety of settings. Interventions that hold up to testing in community settings have an increased likelihood of effectiveness when implemented in like settings. More information is needed about strategies that increase successful dissemination and implementation of evidence-based practices in service settings.