Integration of Research and Practice in Substance Use Disorder Treatment: Findings from Focus Groups of Clinicians, Researchers, Educators, Administrators, and Policy Makers

Article excerpt

Clinicians, researchers, educators, administrators, and policy makers, who represented stakeholders in the substance abuse treatment field, participated in 5 focus groups. Four general areas regarding integration of research and practice were investigated: definition of research, training/education, current integration, and future integration.

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The call for the integration of research and practice and the establishment of evidence-based practices continues to grow (Center for Substance Abuse Treatment [CSAT], 2000; Garland, Kruse, & Aarons, 2003; Lamb, Greenlick, & McCarty, 1998). One of the strongest calls has come from the Institute of Medicine (IOM) in Bridging the Gap Between Practice and Research (Lamb et al., 1998). In that report, "research to practice" referred to improving treatment practices by improving the training of counselors, administrators, and policy makers in the use of research findings and increasing the relevance of research to clinical practice. The IOM report also recommended strategies for (a) linking research to clinical practice, (b) linking research findings with policy development and treatment implementation, (c) the dissemination and knowledge transfer for consumer participation, and (d) training strategies for community-based research collaboration between researchers and community-based organizations. In addition to the call for research and practice integration from the IOM and CSAT, professionals who provide treatment for substance use disorders continue to receive more pressure and mandates to provide evidence of treatment effectiveness from funders and accrediting bodies, such as the Joint Commission on Accreditation of Healthcare Organizations (2002; Cesare-Murphy, McMahill, & Schyve, 1997).

Many impediments to the integration of research and practice still exist, however, including ambiguity regarding the terms research--practice integration and evidence-based practice, ambivalence about the utility of such ideas, and the pragmatics of implementation (Garland et al., 2003; Hall, Amodeo, Shaffer, & VanderBilt, 2000; Read, Kahler, & Stevenson, 2001). In addition, the burgeoning of research regarding substance use disorders across many different levels (e.g., basic neuroscience, intervention clinical trials, intervention effectiveness studies) and across many different disciplines (e.g., psychology, medicine, pharmacology) provides much new and useful information. At the same time, however, this plethora of information can lead to information overload and, for many, the task of sorting through the information for relevant information becomes daunting (Lamb et al., 1998). Some of the reasons suggested for the gap between research and practice in the area of substance use include (a) researchers' reliance on statistical significance versus clinical significance, (b) reliance on efficacy trials versus effectiveness studies, (c) lack of research training for clinicians, (d) a communication gap between researchers and clinicians, (e) time constraints that are primarily due to paperwork obligations, (f) supervisors' lack of training and experience, (g) lack of resources in treatment centers, and (h) lack of contact between researchers and clinicians (Campbell, Catlin, & Melchert, 2003; CSAT, 2000; Hayes, Barlow, & Nelson-Gray, 1999; Lamb et al., 1998; Thompson, 2002).

Potential strategies have been presented for overcoming such barriers in order to promote the integration of research and practice. These strategies include development of financial incentives for employees, sustained support from the U.S. federal government, and establishment of communication systems between researchers and clinicians (Alaszewski & Harrison, 1992; Brown & Flynn, 2002; Campbell et al., 2003; Hall et al., 2000; Lamb et al., 1998). With regard to communication systems, both the IOM report (Lamb et al., 1998) and CSAT (2000) stated that in order for effective integration of research and practice to occur, communication systems between researchers and clinicians must be relevant, timely, clear, credible, multifaceted, continuous, and bidirectional. …