What the Heck is the CTN Anyway?

The NIDA National Drug Abuse Treatment Clinical Trials Network

Principles of Drug Addiction

Treatment

Principles of Drug Addiction

Treatment

Counseling and Other Behavioral Therapies

Are Critical Components of Effective Treatment

For Addiction

Counseling and Other Behavioral Therapies

Are Critical Components of Effective Treatment

For Addiction

Principles of Drug Addiction

Treatment

Principles of Drug Addiction

Treatment

Medications Are An Important Element of Treatment For

Many Individuals,

Especially When Combined With

Behavioral Therapies

Medications Are An Important Element of Treatment For

Many Individuals,

Especially When Combined With

Behavioral Therapies

Institute of Medicine ReportInstitute of Medicine Report

Bridging the Gap Bridging the Gap between between

Practice and ResearchPractice and Research: :

Forging Partnerships Forging Partnerships with with

Community-Based TreatmentCommunity-Based Treatment

Lamb, Greenlick, McCarty, 1998

Science

Practice & Policy

Practice & Policy

We Need To Bring Practice and Policy In Line

With the Science

We Need To Bring Practice and Policy In Line

With the Science

Bridging the Gap

Research Practice

Policy

How Can We Accomplish This?How Can We Accomplish This?

CSAT’s Response to IOM Report: Practice Improvement Collaboratives

• Developed in 1999, with 7 statewide and 7 metropolitan area projects

• To support and promote effective and efficient community-based treatment

• Develop and sustain community involvement in and commitment to practice improvement in the delivery of substance abuse treatment services

• Improve the quality of substance abuse treatment through the adoption of evidence-based practices in community-based organizations

NIDA’s Response to the IOM Report

The National Drug Abuse Treatment

Clinical Trials Network

(CTN)

NIDA’s Millennial Goal:

To Improve Drug Abuse TreatmentThroughout the Nation…

Using SCIENCE as the Vehicle

To Improve Drug Abuse TreatmentThroughout the Nation…

Using SCIENCE as the Vehicle

NIDA Treatment InitiativeNIDA Treatment Initiative

Improve Existing Treatment Components

Incorporate Efficacious Treatments into Clinical Practice

Develop New Treatment Components

NIDA’s Clinical Trials Network

• Established in 1999.

• NIDA’s largest initiative to blend research and clinical practice by bringing promising therapies to community treatment providers.

• Network of 17 University-based Nodes (RRTCs) involving 116 Community Treatment Programs (CTPs) in 24 states, Washington D.C. and Puerto Rico.

Important Precursors to CTN at the Local Level

• DASA Research Subcommittee

• ADAI Statewide Outcome Project

• Failed attempt for NIDA center grant

• Decision not to try for CTN the first time around

• DASA “Bridging the Gap” Group

DASA “Bridging the Gap” Group

• Developed as an offshoot from the DASA Research Subcommittee

• Stimulated by Institute of Medicine’s 1998 report, “Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment”

• Brought together individuals with interest in research and practice, and expanded to include “policy” as a component

Bridging the Gap Group

• Helped plan the November 1999 NIDA Town Meeting in Seattle, including a panel entitled “Bridging the Gaps: Policy – Practice – Research”

• Helped develop subsequent DASA Research Meetings

• Provided a sounding board in the development of the Washington grant proposal submitted for the CTN

• Provided clear evidence that there was a supportive atmosphere for researchers, community-based practitioners, and policy implementers to work together collaboratively

National Drug Abuse Treatment Clinical Trials Network

National Drug Abuse Treatment Clinical Trials Network

CTN Nodes

Oregon NodeOHSU

Washington NodeU. Washington

Pacific NodeUCLA

Rocky Mountain NodeU. Colorado

Florida NodeU. Miami

Great Lakes NodeWayne State U.

Ohio Valley NodeU. Cincinnati

South Carolina NodeMUSC

North Carolina NodeDuke

California/Arizona NodeUCSF/U. Arizona

Southwest NodeU. New Mexico

Northern NE NodeMcLean/Harvard

New England NodeYaleNew York Node

NYULong Island Node

NY State Psych. Inst.

Delaware Valley NodeU. Pennsylvania

Mid-Atlantic NodeJHU/MCV

National Drug Abuse Treatment National Drug Abuse Treatment Clinical Trials NetworkClinical Trials Network

Conduct multi-site clinical trials of interventions efficacious in small-scale studies, to test their effectiveness across a broad range of clinical settings and patient populations.

Develop models for integrating new medications and behavioral interventions into clinical practice.

Goal: To establish a research infrastructure to improve the quality of drug abuse treatment in the nation

Purpose of the National Drug Abuse Clinical Trials Network

“…do these treatments work when you embed them in diverse, ongoing treatment programs and do they work with diverse patients typically seen in community-based treatment programs? The second goal of the network is to diffuse those science-based treatment components that are in fact shown to be effective into ongoing practice throughout the country.”

Alan Leshner, Ph.D. Director, National Institute on Drug Abuse National Drug Abuse Clinical Trials Network

Kickoff Meeting (2/99)

Moving from Research to Community Based Treatment

It’s as Much a Process as It Is an Outcome

Basic Operating Principle of the CTN

Bidirectional Partnership

Research Practice

A CTP View of the Research-to-Practice Process

“Research to practice is like marriage; if you stick together with anything long enough you can get used to it and develop a unique affection.”

Nancy Hamilton, M.P.A., CAP, CCJAP, Operation PAR, Florida Node

National Drug Abuse Treatment Clinical Trials Network Node

National Drug Abuse Treatment Clinical Trials Network Node

CTP -- Community-Based Treatment Program CTP -- Community-Based Treatment Program

RRTC -- Regional Research and Training CenterRRTC -- Regional Research and Training Center

CTPCTP

CTP

CTP

CTP

CTP

CTP

CTP

CTP

CTP

RRTCRRTC

Regional Research and Training Centers (RRTCs)

A Center Core• Research agenda, management plan, SOPs,

policies, budget, training, performance measuresA Data Management Center

• Statistical support, methods/design, data management

Community Based Treatment Programs (CTPs)• Operational plan, concept generation, protocol

implementation, subject accrual, QA

Regional Research and Training Centers (RRTCs)

• Initiate and Develop Protocols

• Conduct Studies

• Arrange CTP Participation

• Design and Conduct Training

• Implement Local Data Management Plan

Additional Components of Washington Node RTC

• CTN Dissemination Library

• Dissemination Specialist / ATTC Liaison

Community Treatment Programs (CTPs)

• Provide Setting for CTN Studies

• Incorporate CTN Training Protocols

• Collect Protocol-Specific Data

• Generate Clinically Relevant Concepts

• Have equal representation on CTN Steering Committee

• Participate fully in CTN committees

National Drug Abuse Treatment

Clinical Trials Network – Washington Node

Research Center

CTPProvidence

CTPEvergreen Manor

CTP RCKC

CTP Kitsap Recovery

CTPEvergreen Treatment

The Washington NodeThe Washington Node

CTP

CTPResidence XII

Triumph

University of Washington CTP

Vancouver VAMC

The Washington Node of the NIDA Clinical Trials Network

The Route from Concept to The Route from Concept to Protocol ImplementationProtocol Implementation

ConceptDevelopment

ConceptReview

ProtocolDevelopment

Protocol Review

ProtocolImplementation

in CTPs

Community Clinicians and

Researchers

Protocol Design & Implementation

Training

Data Management

Regulatory

Quality Assurance

Publications

Steering Steering CommitteCommitte

ee

Protocol Development

ProjecProject t

TeamTeamss

Design and Analysis

“NIDA Clinical Trials Network Begins First Multisite Tests

of New Science-Based Drug Abuse

Treatments”

By Robert Mathias, NIDA NOTES Staff Writer NIDA Notes - Volume 15, Number 6

First CTN ProtocolsFirst CTN Protocols

Buprenorphine / Naloxone Detoxification

Motivational Enhancement Therapy (MET)

to Improve Treatment Engagement

Motivational Incentive – Vouchers for

Drug Free Urine Samples

*

CTN Protocols

• A baseline assessment of the CTN for investigating diffusion of innovation *

• Smoking cessation

• Buprenorphine/naloxone-facilitated rehabilitation of heroin addicted adolescents

• Telephone-enhanced long-term engagement

• Infections and Substance abuse *

• MET for pregnant substance abusers

• Brief strategic family therapy for adolescent drug abusers

• Women's treatment for trauma and substance use disorders *

CTN Protocols

• Patient feedback improvement system

• HIV intervention in drug treatment settings *

• HIV/STD safer sex skills for men **

• HIV/STD safer sex skills for women *

• Job seekers workshop

• MET – Spanish

• Family management skills for opiate addicted women

• 12-step facilitation **

• Reducing HIV risk among adolescent drug abusers

• Community reinforcement and family training for increasing motivation

• Treatment of depressed adult substance abusers (Lexapro)

Local CTN Involvement• Buprenorphine Detoxification Taper

– Providence Behavioral Health

– Andy Saxon, Anthony Floyd

• Women’s Treatment for Trauma and Substance Use Disorders – Residence XII

– Betsy Wells, Mary Hatch Maillette

• HIV Intervention in Drug Treatment Settings– Recovery Centers of King County– Don Calsyn, Anthony Floyd

Local CTN Involvement

• HIV Safer Sex Skills for Men and Women– Evergreen Treatment Services

– Don Calsyn, Sara Berns, Mary Hatch-Maillette

• Twelve Step Facilitation– Under Development– Dennis Donovan