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The appalachian tri-state node experiences


the advantages of researchers collaborating with community providers.We discuss our Appalachian Tri-State Node’s (ATS) experiences in the CTN as one of 13 Nodes working with NIDA and treatment providers throughout the United States to conduct clinical trials and disseminate information to sub- stance abusers, families, and treatment providers. We describe our long-term ‘‘bidirectional’’ relationship with our commu- nity partners in Western Pennsylvania, Eastern Ohio, and West Virginia and show many benefits of this unique collaboration. We also review our Node’s experience in research and dissemination activities with a focus on the importance of CTPs contributing to research and dissemination activities.


Finally, in order to provide a complete perspective on the


CTN and to synthesize knowledge of addiction treatment brought about by the CTN, we summarize the results of specific CTN studies that have not been reviewed elsewhere.22 The current review includes descriptive studies of the CTN, patient populations, cost-effectiveness studies, CTN research on adoption of evidence-based practices, and the most recent CTN clinical trials. We discuss the implications of these studies for implementing EBPs and guiding future addiction research.


Overview of the National Institute on Drug Abuse Clinical Trials Network


Origins The CTN was conceived in the late 1990s based on one of


the findings at the Institute of Medicine (IOM) that there is an unacceptable gap between research and practice in the addiction treatment field. The IOM recommended moving science to practice in ‘‘real-life’’ and the objective of the CTN was to build a clinical trial network throughout the United States that would permit testing of drug addiction treatment research in clinical practice settings.23


One important objective of the CTN is to reduce the time it


takes to disseminate the results of clinical trials so that evidence-based practices are available to the treatment community as quickly as possible. This CTN concept is unique because its foundation is that separate levels of effort, ie, the ‘‘research level’’ and ‘‘treatment level’’ no longer exist. The relationship between research and practice exists only on a time-oriented continuum. The continuum creates a same- level structure that allows for communication between treatment researchers and providers.


While speed is critical another important element of the


CTN is to maintain proper scientific method for validating treatment effectiveness. This is accomplished by researchers conducting oversight of effectiveness studies, and experts in the practice of evidence-based treatments conducting train- ings with treatment providers who are already working in established hospitals, residential facilities, ambulatory clinics, and other addiction services in their communities.


In a recent paper on the infrastructure of the CTN, Tai and colleagues describe the process as ‘‘bidirectionality’’ and discuss how it informs researchers about the issues con- fronted when implementing treatment in the ‘‘real world’’


www.slm-psychiatry.com 57


Mission of the CTN The CTN was developed to improve the quality of drug


abuse treatment throughout the country using science as the vehicle.23 This unique partnership between NIDA, research- ers, and community providers aims to achieve the following two objectives: (1) conduct studies of behavioral, pharmaco- logical, and integrated behavioral and pharmacological treat- ment 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 (2) ensure the transfer of research results to physicians, clinicians, providers, and patients.


Premises of CTN


The CTN is based on the belief that addiction treatment services will be improved as EBPs are broadly implemented in community treatment programs. Randomized, controlled clinical trials are the gold standard for generating these EBPs. Engaging providers in the research and dissemination processes will improve the acceptability, adoption, and sustainability of EBPs found to be effective in clinical trials.


Appalachian Tri-State Node The Regional Research Training Center (RRTC) of our ATS


Node is housed in Addiction Medicine Services (AMS) at the University of Pittsburgh, Western Psychiatric Institute and Clinic. The ATS includes 11 CTPs in addiction, medical and psychiatric settings serving tens of thousands of patients per year in all types of treatment settings in three states. The main aims of our Node are: (1) to maintain an effective collaborative bidirectional relationship with our CTPs in order to participate in clinical trials; (2) collaborate with the CTN to identify gaps in research, develop and implement research protocols; and (3) ensure that CTN findings and EBPs are disseminated to providers, patients, families, and the com- munity.


Our RRTC worked with CTPs for several years on pilot projects and the application to join the CTN prior to getting funded in 2005. This process enabled us to identify CTPs committed to research, as well as rule out CTPs that were not able devote the time and resources needed to develop an infrastructure to conduct clinical trials and engage in dissemination activities. All of our original CTPs spent


M&B 2011; 2:(1). July 2011


and helps providers understand how research can pose and answer questions that will improve the effectiveness of their treatments.24


This is a ‘‘perfect fit’’ when conducted efficiently because


the most important element of a rapid transfer of research to practice is the capability of recruiting large enough samples to conduct adequately powered studies in the shortest amount of time. Of course, recruitment is done most expeditiously in an environment where large numbers of patients are im- mediately accessible, such as are available in established community treatment programs. For a more complete description of the operations of the CTN please see Tai et al.24


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