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Mind & Brain, the Journal of Psychiatry

against addiction. It represents an unprecedented effort to integrate research with treatment and, thereby, mount the best approach for delivering treatment and rapidly disseminating EBPs to the field. We now know enough to be able to say that the CTN platform, consisting of the collaboration between training centers and CTPs, represents the best opportunity to date to offer education and training on a national scale. The bidirectional collaboration has led to significantly improved staff training in EBPs for substance use disorders within the CTN and beyond to include the entire field of addiction treatment.

Our own (ATS) experience within the CTN to date illustrates

that researchers and clinicians in community treatment programs can collaborate effectively in designing and im- plementing clinical trials. Providing patients and families the where-with-all for understanding addiction also represents an important aspect of dissemination and ATS has been among the most successful in the CTN for accomplishing this objective. Educated consumers result in a knowledgeable populace and it is vitally important to be highly responsive in challenging the multiple sources of misinformation about drugs that are continuously accessible on the Internet.

Of course, increasing the speed with which education and

addiction treatment is delivered is, ultimately, only as beneficial as the quality of the care provided. Improving the ‘‘state of the art’’ in any field is a continuing learning and relearning process. In this regard, the CTN also represents the best opportunity for responding to the need for the constant changes that are necessary to get it right.

Practice Pointers Several practice pointers stem from the collaboration of

researchers and clinicians and the findings in these CTN trials. These can be especially useful because they arise out of effectiveness research that approximates community-based treatment conditions.

. Community providers have much to offer researchers in terms of ideas on research and implementing trials in diverse clinical settings. They are aware of current challenges of patients in treatment for SUDs and the ‘‘gaps’’ in the research literature.

. When providers collaborate with researchers they increase the adoption and sustained use of evi- denced-based practices. Research findings are only as good as the ability of providers to sustain their use over time.

. One overarching conclusion from the research con- ducted thus far is that the more treatments are combined, the more effective treatment becomes. One specific conclusion is that CM should be used as often as is practical, especially with group therapies and in populations with high addiction severity, eg, opioid dependent and comorbid patients.

. A primary objective of treatment should be to keep patients in treatment as long as possible. The reviewed research shows that nonthreatening approaches such

M&B 2011; 2:(1). July 2011 64

as MI result in patients entering treatment sooner and retaining improvements longer after treatment stops, thereby increasing effectiveness.

. Therapies that focus on health education may be as effective for treatment of PTSD among substance abusers for less severe cases but specific treatments such as Seeking Safety should be used for more severe cases of drug abuse and PTSD.

. The findings on risk for STD transmission also suggests that group treatments that are equivalent in time and focus on health-related outcomes were equivalent during treatment but the effects of Real Men Are Safe (REMAS) treatment specific for reducing STD risk behavior are retained longer following treatment. This finding is especially true for men at risk for STD transmission behavior.

It follows from these findings that treatment programs should make program implementation decisions based on the severity of their population and the trade-off between increasing effectiveness and the demand on valuable health care resources. All things being equal, however, it appears that multiple therapies and therapies that have been devel- oped specifically for treating specific conditions, eg, Seeking Safety, should be employed compared to the nonspecific therapies they were tested against in the reviewed studies.

Disclosure: The authors declare no conflict of interest.

Funding: Supported by grant U10 DA020036 from the National Institute on Drug Abuse.

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3. Kessler RC, McGonagle KA, Zhao S. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:819.

4. Ross S. The mentally ill substance abuser. In: Galanter M, Kleber HD, eds. Substance Abuse Treatment. 4th ed. Washington, DC: American Psychiatric Publishing, Inc; 2008:537554.

5. Drake RE, Mueser KT, Clark RE, Wallach MA. The course, treatment, and outcome of substance disorder in persons with severe mental illness. Am J Orthopsychiatry. 1996;1:4151.

6. Reis RK, Goldsmith RJ, eds. Co-occurring addiction and psychiatric disorders. In: Reis RK, Fiellin DA, Miller SC, Saitz R Principles of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2009:11371274.

7. Horsfall J, Cleary M, Hunt GE, Walter G. Psychosocial treatments for people with co-occurring severe mental illness and substance use disorders (dual diagnosis): a review of empirical evidence. Harvard Rev Psychiatry. 2009;17(3):2434.

8. Drake RE, O’Neal EL, Wallach MA. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. J Subst Abuse Treat. 2008;34:123138.

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10. Nunes EV, Selzer J, Levounis P, Davies CA, eds. Substance Dependence and Co-Occurring Psychiatric Disorders: Best Practices for Diagnosis and Clinical Treatment. Kingston, NJ: Civic Research Institute; 2010.

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