Charting a Path between Research and Practice in Alcoholism Treatment

Article excerpt

The journey between research and practice in alcoholism treatment is worthwhile but can be difficult because of the inherent differences between the treatment and research disciplines. This article describes how the path between research and practice can be navigated successfully, discusses the factors that influence the journey, and offers specific pharmaceutical and behavioral interventions as examples of research-based treatment approaches that can be implemented more widely. KEY WORDS: health services research; alcohol dependence; research in practice; Researcher in Residence Program; treatment method; treatment research; treatment program; treatment provider; motivational interviewing

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The Hana Highway lures adventurers with a legendary combination of scenic splendor and driving danger. Drivers navigate countless hairpin turns and 56 one-lane bridges on the 52-mile stretch between Kahului and Hana along Maui's northern coast. There is little room for error. On the left, surf pounds a rugged shoreline far below the road; black basalt presses close on the right. Intermittent squalls and swirling mountain mist moisten the roadway, limit visibility, and increase risk. The trip is exhausting and exhilarating and doesn't get easier with practice.

The journey between research and practice in alcoholism treatment can resemble the Hana Highway--attractive yet treacherous, with unexpected hazards. Culture and language differ in the worlds of practice and research, and bidirectional translation is necessary. It helps to have guides pointing out signposts in each discipline, and the traveler must be receptive to the customs of each field. Researchers sensitive to clinical issues will learn that resources are limited in most practice settings and that simple interventions are more likely to be useful. Therapists, in turn, come to appreciate the value of standardized techniques and the benefits of data collection.

Researchers introducing "evidence-based" practices may face a host of objections from treatment providers. "Experience-based" treatment providers resent the implication that their treatments are not empirical; they point to the millions of men and women who have found stable recovery through these treatments. Clinicians are concerned that standardized practices inhibit individualized care. As a result, many researchers and clinicians who hope to travel between practice and research start but turn back, lose their way, or second-guess the destination. Success requires clearly defined objectives, constant negotiation with conflicting demands, and a willingness to enjoy the journey. With persistence, treatment programs can achieve the goal of providing research-guided services.

Applying science to policy and practice is both challenging and attractive, as is the use of clinical insights to guide research. Efficacy trials show that an effect is possible in controlled settings (e.g., that a particular alcoholism treatment approach is effective under specific conditions); effectiveness trials document that these effects are feasible in real practice settings. This article describes how the path between research and practice can be navigated successfully, discusses the factors that influence the journey, and offers specific pharmaceutical and behavioral interventions as examples of research-based treatment approaches that can be implemented more widely.

THE CHALLENGE

Health care services in the United States often are not based on the latest scientific research and fail to meet patient needs. The Institute of Medicine (IOM) has challenged health care systems to fundamentally restructure the organization and delivery of care (IOM 2000). The gap between practice and research seems to be especially pronounced in the delivery of treatments for alcohol and other drug (AOD) use disorders. The IOM's analysis Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment (Lamb et al. …