Blending Clinical Practice and Research: Forging Partnerships to Enhance Drug Addiction Treatment
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Blending Clinical Practice and Research: Forging Partnerships to Enhance Drug Addiction Treatment |
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Plenary Session & Workshop Descriptions, Day 2Contents
Science of Stress and Substance Abuse Coping in the Wake of Tragedy Assessment for Psychiatric Comorbidity in Addiction Treatment Psychiatric disorders such as depression and anxiety are prevalent among patients being treated for substance dependence and have been associated with poor treatment outcome. A series of studies among alcoholics and opiate addicts suggest that depression can be treated and that improvement in depression may result in improved outcome of substance abuse treatment. Over the past decade there has been an increasing awareness in the treatment community of the importance of co-occurring disorders and the wide variety of disorders, including bipolar disorder, schizophrenia, panic disorder, phobias, posttraumatic stress disorder, eating disorders, pathological gambling, attention deficit disorder, and learning disabilities. Many challenges remain, including the fundamental challenge of how to accurately but efficiently identify these disorders among substance-dependent patients. This workshop will present the state of the research on the diagnosis and treatment of comorbid disorders and overview the challenges treatment providers confront in managing these disorders. Audience members will be asked to draw from their experience and knowledge in a discussion of how current research findings may be used to improve treatment and what shape future research should take. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Buprenorphine/Naloxone Treatment of Opiate Dependence This workshop will present an overview of more than two decades of research that have brought us to the point of adding a new medication to the treatment of opiate dependence. Integration of buprenorphine/naloxone into treatment will likely result in fundamental changes in the practice of addiction medicine in the United States. Buprenorphine/naloxone is likely to be approved for use in nonnarcotic treatment settings and in private medical offices. This workshop will include presentations on background pivotal research studies, the application of research evaluations to private-office opiate treatment, current detoxification studies in community settings, and an overview and discussion of some of the issues related to the integration of research and new treatments into an abstinence-based model. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Innovations in Methadone and LAAM Treatment This workshop will describe important innovations in methadone and LAAM treatment and review the major successes, issues, and problems encountered over the 38 years of methadone maintenance treatment. Data will be presented from a 17-year experience of developing a novel model and treating approximately 300 patients in a medical maintenance program. To date, there have been no significant adverse events in this private, office-based pharmacotherapy model. The outcome data, medical comorbidity, and logistics of the program will be reviewed. The main issue encountered by the many successfully rehabilitated patients remains the widespread stigma and prejudice. Data also will be presented on the development of novel, office-based methadone treatment, including implementing methadone maintenance as part of primary care, as well as data related to the use of a mobile methadone treatment van to deliver care in diverse locations. Brief discussions may include different approaches to treatment outcome enhancement, including motivational enhancement and acupuncture intervention. An additional presentation will address the development and utilization of a computer model that automates the inventory of controlled substances, facilitates the accurate dispensing process for the delivery of methadone pharmacotherapy, and establishes a network for all the components of a methadone maintenance clinic. The computer model also collects and organizes data with efficiency, allowing examination of patient compliance and details of individual patient treatment. Another presentation will review issues, problems, and approaches to a community-based, urban methadone maintenance treatment program serving patients of cultural, ethnic, and economic diversity, including a brief discussion of the potential usefulness of LAAM in managing patients who have been less responsive to methadone maintenance treatment. A general discussion of these and other innovations will include the panelists and workshop participants. Smoking Cessation Treatment in Substance Abuse Rehabilitation Programs The problem of cigarette smoking among alcohol and other drug abusers has received increased attention in the past decade. Clinically important reasons for this include the high prevalence rate of smoking among substance abusers, markedly increased health risks and mortality rates, and evidence for greater alcohol or other drug addiction severity and health problems in substance abusers who smoke. Moreover, as social views about smoking in the United States have shifted toward viewing cigarette smoking as an addictive disease, substance abuse patients and their treatment providers have become more far more receptive to incorporating smoking cessation programs in their clinics. This workshop will review the pharmacological and behavioral treatment modalities for smoking cessation and examine the feasibility of smoking cessation treatment in substance abuse rehabilitation programs. The prevalence of cigarette smoking with other forms of substance abuse, nicotine neuropsychopharmacology, the relationship between nicotine dependence and other addictions, and the health consequences of smoking will be examined. Discussions will cover previous research on smoking cessation treatment in alcohol and other drug rehabilitation programs and its effects on alcohol and other drug abstinence and smoking quit rates and will address how to best integrate smoking cessation with substance abuse rehabilitation. The development of a smoking cessation program tailored to outpatient drug abuse treatment programs, designed in collaboration with treatment providers, will be presented. The challenges to implementing this and other smoking cessation programs, and investigating them across multiple modalities of substance abuse treatment, will be discussed. Family Network Therapy This workshop will describe a variety of approaches to family and network therapy, focusing especially on the network approach. It will address basic approaches that can be used by the therapist to move a substance abuser toward recovery, employing the support of family or close friends. Video examples will be used to illustrate these approaches. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Trauma and Addiction This workshop will focus on blending research and practice in treating comorbid trauma-related disorders and addiction. The workshop also will provide a research review of the epidemiology of trauma comorbidity and of new developments in the diagnosis of complex posttraumatic stress disorder and disorders of extreme stress. Included will be a review of empirically supported treatments that target trauma-related conditions among substance abusers, with a discussion of challenges to implementing such treatments in community-based addiction treatment programs. The complex pathways among trauma exposure, intimate partner violence, and risks for child maltreatment also will be explored in the context of discussing the challenges faced by clinicians working with substance abusers in recovery and their families. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Substance Abuse and Coexisting Disabilities This workshop will describe issues related to providing substance use disorder treatment for persons with coexisting disabilities. It also will overview what is known about the prevalence of persons with coexisting disabilities in treatment and the challenges confronting treatment providers and researchers. Areas for future research will be suggested. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
How Does the AOD Provider Prepare To Integrate the Use of Addiction Medicines and Clinical Behavioral Treatment? This workshop will be an interactive exercise with full audience participation. The purpose of the workshop is to extract from the audience potential barriers that they have experienced or foresee in using medications as an adjunct to clinical behavioral treatment of substance abuse. Of significant importance is ensuring that addiction medicines will work with and enhance clinical behavioral treatment. This requires that program administrators and medical and clinical staff members work together to develop integrated protocols and systems. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Treatment of Marijuana Abuse and Dependence This workshop is designed to focus on treatment issues for marijuana-dependent individuals. The workshop will examine the extent of the problem, the potential impact of marijuana withdrawal on retention and treatment response, and therapeutic strategies that are currently practiced in the community or being empirically tested. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Craving, Addiction, and the Brain: How Can We Apply This to Treatment? Accumulated evidence over the past 5 years shows that drug craving, particularly cue-induced drug craving, can be linked to activation of specific pathways in the brain, particularly those involved in reward and the anticipation of reward. The activation of this powerful "GO!" system may explain part of why patients struggle with craving and relapse. Another important piece of the puzzle is why some patients have so much more difficulty than others in "STOPPING," or managing, their craving. Recent brain findings show that some patients may have defects in the brain's "STOP!" circuitry, which is important in taking into account the future consequences of behavioral choice. These brain-based problems - plenty of GO! and not enough ability to STOP! - have important implications for how we view addiction and how we structure treatments to address craving and relapse. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Naltrexone Revisited This workshop will discuss the use of naltrexone in the treatment of opioid dependence and in the treatment of alcohol dependence. It will describe methods of integrating naltrexone into treatment programs and the effective use of this medication in the treatment of patients. Barriers to integration will be discussed in the context of treating both opioid- and alcohol-dependent patients. Current Research Tells Us
Considerations for Putting Research to Actual Use
Considerations for Future Research
Motivational Incentives/Contingency Management Dr. B.F. Skinner believed that the best way to change behavior was through positive reinforcement. The contingency management or motivational incentive approach, using a structured yet straightforward design, seeks to reward patients for successfully abstaining from substance use. Using clear criteria, rapid onsite urine testing, and immediate reinforcement in terms of vouchers or gifts when patients present drug-free urine samples, motivational incentive programs have a powerful impact on retention and reduced substance use in both methadone and drug-free treatment centers. The goal of this workshop is to familiarize clinicians with (1) the behavioral principles involved in contingency management, (2) the exciting and creative research that has been done in this area, and (3) the challenges and successes that both researchers and clinicians are experiencing as they attempt to implement this program in two clinics in New York City. Methadone and Beyond: Medication and Its Role in Treating Addiction Where Will We Be in 5 to 10 Years There is an assumption that research determines the direction in which practice moves. But funding and referral choices today are as likely to be influenced by policy and economic considerations as by what science has to say. Moreover, the influence of research in practice need not always be beneficial. Research tends to focus attention on what has most recently been illuminated, and this may not necessarily be what practitioners most need to address. Understanding how drug abuse changes brain chemistry, for example, has led to an understandable emphasis on -- and elevated expectations of -- pharmacological solutions to addiction. As a result, less attention has been paid to social and humanistic interventions, without which pharmacotherapies are of only limited utility. These two plenary presentations will explore what the future holds for the treatment of drug addiction. However, looking 5 or 10 years ahead, we should bear in mind that pharmacology is only a part of the picture. When dealing with most addictive disorders, the needs of the whole person must also be addressed. |
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