Clinical Trials Network Research

Health Services for HIV/AIDS, HCV, and Sexually Transmitted Infections in Substance Abuse Treatment Programs

The National Drug Abuse Treatment Clinical Trials Network conducted this study to determine the availability of and factors associated with infection-related health services in substance abuse treatment settings. In a cross-sectional descriptive design, state policies, reimbursement for providers, state level of priority, and treatment program characteristics were studied via written surveys of administrators of substance abuse treatment programs and of state health and substance abuse departments. Data from health departments and substance abuse agencies of 48 states and from 269 substance abuse treatment programs revealed that human immunodeficiency virus/acquired immunodeficiency syndrome-related services are more frequent than hepatitis C virus or sexually transmitted infection-related services, and that nonmedical services are more frequent than medical services. While the availability of infection-related health services is associated with medical staffing patterns, addiction pharmacotherapy services, and state priorities, reimbursement was the most significant determining factor. These findings suggest that greater funding of these health services in substance abuse treatment settings, facilitated by supportive state policies, represents an effective response to the excess morbidity and mortality of these substance use-related infections. Brown, Jr, L.S., Kritz, S., Goldsmith, R.J., Bini, E.J., Robinson, J., Alderson, D., and Rotrosen, J. Health Services for HIV/AIDS, HCV, and Sexually Transmitted Infections in Substance Abuse Treatment Programs. Public Health Reports, 122(4), pp. 441-451, July-August 2007.

AIDS Research in the NIDA Clinical Trials Network: Emerging Results

Prevention and treatment of HIV/AIDS among drug users continue to be vexing problems. Scientifically validated interventions have been developed to prevent and treat HIV/AIDS among substance users. The Clinical Trials Network (CTN) of the National Institute on Drug Abuse (NIDA) is conducting multi-site clinical trials, with emerging results that address both prevention and treatment of HIV/AIDS. This is a report of preliminary results from several of those trials, presented at a workshop of the College on Problems of Drug Dependence. Lawrence Brown surveyed over 120 CTN clinics and reports on the state of the clinics in treating HIV/AIDS and other infectious diseases. Robert Booth summarized preliminary data from over 600 participants in a multi-site trial of HIV and hepatitis C virus (HCV) interventions in drug detoxification settings. Donald Calsyn reported preliminary results from an effectiveness trial of a gender-specific, action-oriented, safer-sex group intervention for 575 men in drug treatment programs. Susan Tross reported on a similar study focusing on 515 women in 12 clinics. Yong Song presented the perspective of treatment programs in conducting clinical trials. Jacques Normand added comments from the perspective of the Director of the NIDA AIDS research program. Sorensen, J.L., Brown, L., Calsyn, D., Tross, S., Booth, R.E., Song, Y.,and Normand, J. AIDS Research in the NIDA Clinical Trials Network: Emerging Results. News & Views Section Drug Alcohol Depend. 89(2-3), pp. 310-313, 2007.

Issues in Designing and Implementing a Spanish-Language Multi-Site Clinical Trial

To address at least in part health disparities in Hispanic populations, the NIDA Clinical Trials Network implemented the first multi-site randomized clinical trial of substance abuse treatment conducted entirely in Spanish. This trial was intended to evaluate the effectiveness of Motivational Enhancement Therapy in a diverse population of Hispanics. In the conduct of this trial, several barriers to the successful implementation of a Spanish-language multi-site trial had to be addressed, including the appropriate translation of assessment instruments, shortage of appropriately trained Spanish-speaking clinical staff, and barriers to recruitment and retention of this population. To encourage similar research, strategies are described that were developed by the study team to meet these challenges. Suarez-Morales, L., Matthews, J., Martino, S., Ball, S.A., Rosa, C., Farentinos, C., Szapocznik, J., and Carroll. K.M. (the MET Spanish Team). Issues in Designing and Implementing a Spanish-Language Multi-Site Clinical Trial. Am J Addict. 16(3), pp. 206-215, 2007.

Organizational Readiness for Change and Opinions toward Treatment Innovations

Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network completed surveys to characterize participating programs and practitioners. A two-level random-effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission, and more organizational stress. Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC's utility in assessing agency strengths and needs during the implementation of evidence-based practices. Fuller, B.E., Rieckmann, T., Nunes, E.V., Miller, M., Arfken, C., Edmundson, E., and McCarty, D. Organizational Readiness for Change and Opinions Toward Treatment Innovations. Journal of Substance Abuse Treatment. 33(2), pp. 183-192, September 2007.

Site Matters: Multisite Randomized Trial of Motivational Enhancement Therapy in Community Drug Abuse Clinics

This study examined the effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites. Ball, S.A., Martino, S., Nich, C., Frankforter, T. L., Van Horn, D., Crits-Christoph, P., Woody, G.E., Obert, J.L., Farentinos, C., and Carroll, K.M. Site Matters: Multisite Randomized Trial of Motivational Enhancement Therapy in Community Drug Abuse Clinics. J Consult Clin Psychol. 75(4), pp. 556-567, 2007.