Connecting Substance Abuse Treatment and Research: "Let's Make a Deal"
Rawson, Richard A., Branch, Cheryl, Journal of Drug Issues
Partnerships between substance abuse researchers and practitioners are being encouraged by numerous initiatives developed in response to a 1998 Institute of Medicine Report (IOM, 1998). The need for the initiatives is clear; however, the structure of the partnerships and how each partner can benefit from them is less clear. There is evidence that each group appreciates the principle of moving research and practice closer together. It is less clear what each group wants from the partnership and what each group can contribute to it. Researchers want to conduct well-controlled studies, with access to clinical populations and adequate control over the study environment to ensure rigorous protocol compliance. Practitioners should be compensated for the time they spend on these projects, and they want to address questions that are of importance to their clinical populations and stay current with new knowledge and technology. No matter how interesting and important these efforts are, unless each group derives adequate and fairly shared benefits, the partnerships will flounder.
During the first years of the 211 century, few issues in the substance abuse field have captured as much attention as the efforts to link research and practice. The Institute of Medicine (IOM) Report: "Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment" (IOM, 1998), is the seminal substance abuse policy document that frames this important challenge. The reasons for the research-practice "gap" are numerous, and the proposed solutions are multilayered and will require considerable change in the priorities and activities of both researchers and practitioners (Brown, 2000; Marinelli-Casey, Domier, & Rawson, 2002).
There is a considerable literature concerning the different "cultures" of research and practice (empiricism vs. experience), the dissimilar training and backgrounds of researchers and practitioners (academia vs. life experience), and the clashes that occur in the priorities of researchers and practitioners (i.e., data collection vs. patient care; Brown, 2000; IOM, 1998; Marinelli-Casey, et al., 2002). However, one issue whose importance may be underestimated in the preparations for practice-research partnerships is a clear set of expectations about the benefits each partner will derive as the partnerships evolve.
CURRENT RESEARCH-PRACTICE INITIATIVES
As the efforts to join practitioners and researchers in long-term, mutually beneficial agreements progress, how do the "payoffs" of research-practice integration work? It seems reasonable to presume that the creation of successful partnerships must benefit both partners as well as the individuals seeking treatment and the taxpayers who pay the bills. This is particularly true when the economics of the substance abuse field are considered. The publicly funded system for treating people with substance use disorders has been traditionally seriously under-funded, and the needs of patients greatly exceed treatment resources. The research-practice initiatives currently in place by the National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), and Center for Substance Abuse Treatment (CSAT) represent major investments and resource allocations. NIDA has invested tens of millions of dollars in the largest of the research practice initiatives, the Clinical Trials Network (Hanson, Leshner, & Tai, in press). In addition, NIAAA has its own set of programs to improve the research-practice connection, CSAT has initiated the Practice Improvement Collaboratives (PIC), and much of the work ofthe CSAT Addiction Technology Transfer Centers (ATICs) is devoted to increasing the use of science-based techniques (Clark, this volume). There is little doubt that to make the major changes of the scope suggested by the IOM report, a substantial investment is needed. …