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Mind & Brain, the Journal of Psychiatry

Administration (SAMHSA) ‘‘Blending Initiative’’ aimed at dissemination of research-based treatment findings into community practice. This initiative involves three compo- nents:26 (a) blending conferences throughout the country in which findings about drug abuse treatment are presented by CTN researchers and community providers; (b) state agency partnerships in which policy makers help identify strategies to accelerate the adoption of EBPs; and (c) blending teams, which design user-friendly tools or products for treatment providers to facilitate their adoption of science-based inter- ventions. These products are provided at no cost on CD-ROM sets that contain training manuals, PowerPoint presentations, and other resources need to adopt EBPs in community programs. Blending products are available on: buprenorphine treatment, short-term opioid withdrawal using buprenor- phone (detox), treatment planning, motivational interviewing assessment supervisory tools for enhancing proficiency (MIA- STEP), and promoting awareness of motivational incentives (PAMI).

SUMMARY OF THE CTN CLINICAL TRIALS There has been one comprehensive review of the outcomes

of CTN studies22 that includes a summary of 15 clinical trials. The current review is intended to supplement this effort and to review any additional CTN reports available since its publication. Therefore, none of the studies included in Wells et al22 are included herein. In summary, Wells and colleagues most important recommendations for future trials are: (a) select interventions with strong evidence for efficacy; (b) use motivational incentives whenever possible as a component of research design; (c) use longer-term studies in order to allow for collecting more information on maintenance of treatment effects; (d) include important variables related to patient, therapist, and treatment site; and (e) conduct more studies of comorbid conditions, especially conditions of substance and nonsubstance-related conditions such as bipolar disorder and posttraumatic stress disorder (PTSD).

Methods of Current Review Since the publication of Wells and colleagues,22 several

studies of the CTN network and analyses of the data from the original clinical trials have been published and provide important information about the success of the CTN and the effectiveness of particular interventions. The studies in the current review include these descriptive studies, ancillary data analyses of the original research and cost-effectiveness studies that have not been reviewed elsewhere. In addition to a recent NIDA publication on completed and current trials, PubMed and Medline were searched for any publication with the keywords ‘‘clinical trial,’’ ‘‘National Institute on Drug Abuse,’’ ‘‘NIDA,’’ ‘‘Clinical Trial Network,’’ and ‘‘CTN’’ to determine the studies for review. The findings for some trials that employ similar methods and/or populations are com- bined, eg, studies of opioid detoxification, cost effectiveness studies.

M&B 2011; 2:(1). July 2011 60

Results of CTN Studies Not Reviewed Elsewhere Clinical Trials

In late 2010, Hien and colleagues 27 reported on a secondary analysis of their study of Seeking Safety (SS) versus a course on health education for treating patients with PTSD. Seeking Safety focuses on avoiding the unsafe behaviors associated with substance abuse. Based on previous research28 Hien and colleagues27 hypothesized that reducing PTSD symptoms would result in reduced substance use but that reducing substance use would not result in reduced PTSD symptoms. In their original analyses of 353 women, they found no overall differences between the groups with regard to decreased substance use and there was little indication that reduced substance use resulted in reduced PTSD severity.29,30 In the most recent study of this sample, the investigators found a relationship between alcohol misuse and PTSD improvement such that women who were abusing alcohol who were treated with health education did not improve while their peers in SS were found to have clinically significant reductions in PTSD symptoms.27

Another ancillary study of these data involved documenting traumatic events among substance using women, as well as examining the potential for child abuse related to exposure to traumatic events, the symptoms related to traumatic events, and whether the patient used drugs intravenously.31 The investigators tested 44 female patients (19 intravenous [IV] drug users and 25 non-IV drug users) and found that participants who were drug users were at greater risk for abusing their children. Multivariate analyses revealed expo- sure to trauma, severity of trauma-related symptoms (includ- ing symptoms of affective dysregulation), and IV drug use status all made unique contributions to the risk for child abuse. A relationship between affective dysregulation, violence in relationships, and IV drug status was found and the investigators inferred that this is possibly related to the violent nature of the subculture associated with IV drug use.

Sonne and colleagues32 report on a study of 225 patients

who were treated for nicotine dependence and found that severity of depression was associated with higher levels of addiction, craving, withdrawal symptoms, and difficulty stopping use of cigarettes. Current depression was more highly associated with these findings and the investigators recommend that depressed patients be treated for their depression before initiating smoking cessation interventions.

Cost-Effectiveness Studies CTN 0007-A-2 involved an economic evaluation of the CTN

0007. The CM program was evaluated for cost-effectiveness and it was determined that CM to increase abstinence was less expensive to operate in methadone-maintenance clinics, compared to the operation conducted in drug-free clinics. Increasing the time for abstinence from stimulants and alcohol by 1 week in drug-free clinics cost $258 and the cost of obtaining one stimulant-free urine sample was $146. In the methadone clinic the respective costs for the outcomes were $141 and $70.33

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