Having built, over the past ten years, a capable and bi-directional infrastructure for conducting research that is relevant to community-based practice, the CTN is adapting to new challenges. The network’s continuing relevance and utility depends on its ability to address emerging public health issues and research opportunities in the field of substance abuse treatment. Areas for future study may include the integration of primary care and substance abuse treatment systems into effective chronic care models for addiction treatment (McLellan, 2009
) and the assessment of holistic approaches in treating patients with co-occurring substance use, mental health and somatic disorders. The use of health information technology (e.g., web-based interventions, SMS/text messaging, etc.) to improve treatment delivery efficiency and expand treatment capacity is another urgent and yet under-researched area that the CTN must address.
The next decade is likely to bring increasingly sophisticated pharmacotherapies and behavioral therapies to the research and addiction treatment arenas. The CTN’s alliance of treatment providers and investigators is well positioned to conduct rigorous tests of these innovations in practice environments throughout their development and to conduct economic evaluations to help guide potential adopters of these interventions. As the CTN completes research on interventions, the network reaches providers through research utilization efforts and engages stakeholders to disseminate therapeutic tools and improve substance abuse treatment.
The randomized controlled trial remains the gold standard for generating evidence-based therapies; however, randomized trials are both costly and time consuming. The CTN must consider adopting more innovative and practical strategies for developing evidence-based substance abuse treatment interventions. A recent Institute of Medicine (IOM) report suggested a meta-experimental approach for building a foundation for evidence-based medicine. It may include some or all of the following tactics:
- Utilization of existing patient databases (large survey databases, treatment reimbursement databases, etc.), registry databases, and electronic medical records;
- Development of statistical tools and techniques such as adaptive design, simulation and modeling and methods to analyze large databases;
- Attention to practical clinical trials and subgroup analysis; and
- Exploration of reasonable approaches to incorporate physiologic and genetic information into evidence-based medicine (Institute of Medicine, 2008).
The CTN has great potential to broaden its research portfolio to realize this meta-experimental approach in generating evidence-based addiction treatment interventions.
A flexible and comprehensive research strategy is critical for the CTN to better serve as the home for Comparative Effectiveness Research (CER) in substance abuse treatment. CER, a centerpiece of the current healthcare reform initiative, provides healthcare professionals with evidence-based treatment options (Institute of Medicine, 2007
; Institute of Medicine, 2009
). These options should minimize unnecessary and inappropriate health interventions and reduce the frequency of medical errors and adverse consequences, with the ultimate goal of improving care and containing costs (Garber & Tunis, 2009
). CER in substance abuse treatment is of particular importance, as the development of research information compatible with the broader goals of healthcare reform will further the integration of substance abuse treatment into the mainstream of medical practice. With its durable research infrastructure and experienced workforce, the CTN is well positioned to undertake CER projects that address substance abuse treatment within the context of the larger healthcare system. To do so, the CTN must expand to incorporate clinical settings that frequently see patients with co-morbid substance use disorders. These may include, but are not limited to, primary care clinics, dental clinics, pain management clinics, emergency care centers and HIV/STD clinics. With this broadened approach to addiction treatment research, the CTN will continue to serve as a forum for bi-directional communication and collaboration within its research and dissemination efforts.
In the next decade, expeditiously translating scientific advances into patient care is a top priority for the NIH (NIH Roadmap Initiative, 2008
). Conducting research directly within the community and involving community providers in research activities is critical to achieve this goal (Horowitz, Robinson, & Seifer, 2009
). The CTN has learned a number of important lessons, reflected in the foregoing descriptions, about how to practice bi-directionality and how to conduct research in real world treatment settings. This work needs to continue, while at the same time we hope the lessons learned may encourage similar efforts in other related fields.