Clinical Trials Network Research

Addressing Ethnic Disparities in Drug Abuse Treatment in the Clinical Trials Network

Ethnic minorities have significantly higher rates of unmet needs for treatment of substance use disorders and are often underrepresented in clinical trials and treatment research. The National Drug Abuse Treatment Clinical Trials Network (CTN) was established in 1999 to conduct research in a wide variety of community based treatment programs across the United States. Through its size and scope, the CTN provides a unique opportunity to address a variety of underserved populations, and in particular to evaluate access to and effectiveness of treatments for ethnic minorities. The CTN has continually sought to reduce barriers to all its studies and has attended carefully to recruitment and retention of women and ethnic minority groups. This article describes a symposium from the June 2006 CPDD annual meeting that included four presentations on ongoing CTN activities and strategies used to address the issues of ethnic disparities. Kathleen Carroll described a protocol developed specifically to address retention in treatment among Spanish-speaking substance users. Ray Daw described the special issues raised in clinical research among American Indian communities, including those encountered by a CTN protocol that was adapted on site so it could be implemented among American Indian communities. Kathryn Magruder summarized results of a secondary analysis of CTN data, evaluating rates of retention among ethnical minorities. And Lawrence Brown described a secondary analysis of a CTN survey study on national practices regarding the availability of specialized treatment for sexually transmitted diseases in drug abuse treatment, focusing specifically on services for ethnic minorities. Carroll, K.M., Rosa, C., Brown, Jr., L.S., Daw, R., Magruder, K.M., Beatty, L. Addressing Ethnic Disparities in Drug Abuse Treatment in the Clinical Trials Network. Drug Alcohol Depend. 90(1), pp. 101-106, 2007.

Improving the Transition from Residential to Outpatient Addiction Treatment: Gender Differences in Response to Supportive Telephone Calls

Substance use relapse rates are often high in the first months after discharge from inpatient substance abuse treatment, and patient adherence to aftercare plans is often low. Four residential addiction treatment centers participated in a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare. A total of 282 participants (100 women, 182 men) with substance use disorders were included in this secondary analysis. The findings revealed that women were more likely than men to attend aftercare. This "gender effect" persisted after adjustment for a number of potential mediators. Carter, R.E., Haynes, L.F., Back, S.E., Herrin, A.E., Brady, K.T., Leimberger, J.D., Sonne, S.C., Hubbard, R.L., and Liepman, M.R. Improving the Transition from Residential to Outpatient Addiction Treatment: Gender Differences in Response to Supportive Telephone Calls. Am. J. Drug Alcohol Abuse, 34(1), pp. 47-59, 2008.

No Smoking Allowed: Integrating Smoking Cessation with Treatment

Substance abuse counselors, programs, and treatment systems are considering how to address smoking and nicotine dependence in the populations they serve. This article reports on the results from a survey within the National Drug Abuse Treatment Clinical Trials Network (CTN) that assessed whether the surveyed treatment agency provided smoking cessation treatment as part of their regular services. The survey also assessed the attitudes of staff regarding the feasibility of offering smoking cessation treatment. Analyses explored those factors associated with whether or not smoking cessation services were provided, and factors that predict staff attitudes toward smoking cessation treatment in these drug treatment strategies. Overall, the study found that smoking cessation treatment was more likely to be available in units that offered other ancillary services, including detoxification. Additionally, clinics that provide smoking cessation care were more likely to have a staff with a supportive attitude toward such services. This was especially true in clinics with a high number of pregnant women, but the proportion of youth admissions was neither a predictor for staff attitudes nor for the provision of smoking cessation services. Overall, this study presents some challenges to the treatment field to focus on evidence-based services regarding smoking cessation treatment, and raises some ethical issues as well. Fuller, B.E., and Guydish, J. No Smoking Allowed: Integrating Smoking Cessation with Treatment. Counselor, 9(1), pp. 22-27, 2008.

Cost, Effectiveness, and Cost-Effectiveness of Contingency Management All Vary by Clinic

Results from cost effectiveness analyses are usually reported based on study averages, where results from all study sites are pooled into one sample. This study, in contrast, examined whether, and by how much, the effectiveness, costs, and cost-effectiveness of a prize-based contingency management intervention (CM) varied across the eight outpatient psychosocial community-based clinics with a total of 412 stimulant abusing clients involved in the NIDA CTN's Motivational Incentives for Enhanced Drug Treatment trial (MIEDAR). Results indicated that that the incremental cost of using CM compared to usual care varied by a factor of 1.9 across the clinics, ranging from an additional $306 to an additional $582 per patient. The effect of CM on the longest duration of continuous stimulant abstinence (LDA) varied by a factor of 8.0 across the clinics, ranging from an additional 0.5 to an additional 4.0 weeks. The ICER's for the LDA varied by a factor of 4.6 across the clinics, ranging from $145 to $666. These results show that the cost-effectiveness of CM varied widely among the clinics in the MIEDAR trial. Future research should focus on identifying the sources of this variation, perhaps by identifying clinic-level best practices and/or identifying those subgroups of patients that respond the most cost-effectively, with the ultimate goal of improving the cost-effectiveness of CM overall. Olmstead, T., Sindelar, J., and Petry, N. Clinic Variation in the Cost-Effectiveness of Contingency Management. Am. J. Addict., 16(6), pp. 457-460, 2007.