Post on 13-Jan-2016
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The NIDA/SAMHSA-ATTC Blending Initiative: New Tools for Bringing
Research into Clinical Settings
Beth Rutkowski, M.P.H., & Thomas Freese, Ph.D.
UCLA Integrated Substance Abuse Programs/Pacific Southwest Addiction Technology Transfer Center
www.uclaisap.org www.psattc.org
So who are the participants in this endeavor?
An Introduction to SAMHSA/CSAT
SAMHSA/CSAT
• To improve the lives of individuals and families affected by alcohol and drug abuse by ensuring access to clinically sound, cost-effective addiction treatment that reduces the health and social costs to our communities and the nation.
• CSAT's initiatives and programs are based on research findings and the general consensus of experts in the addiction field that, for most individuals, treatment and recovery work best in a community-based, coordinated system of comprehensive services.
• Because no single treatment approach is effective for all persons, CSAT supports the nation's effort to provide multiple treatment modalities, evaluate treatment effectiveness, and use evaluation results to enhance treatment and recovery approaches.
CSAT’s Mission:
The ATTC Network
The ATTC Network
ATTC ofNew England
NortheastATTC
PacificSouthwest
ATTC
NorthwestFrontier
ATTC
Prairielands ATTC
Mid-AmericaATTC
Great LakesATTC
Gulf Coast ATTC
MountainWestATTC
Mid-Atlantic ATTC
Southern CoastATTC
Southeast ATTC
Central EastATTC
Caribbean Basin, Hispanic/Latino & US Virgin Islands
ATTC
Central East ATTC
NorthwestFrontier
ATTC
ATTC National Office
An Introduction to NIDA
NIDA's mission is to lead the Nation in bringing the power of science to bear on drug abuse and addiction
So what is this thing called the CTN?
NIDA’s Clinical Trials Network
• Established in 1999• NIDA’s largest initiative to blend research and
clinical practice by bringing promising therapies to community treatment providers
• Network of 17 University-based Regional Research and Training Centers (RRTCs) involving 116 Community Treatment Programs (CTPs) in 24 states, Washington D.C., and Puerto Rico
CTN RRTC
States with CTP
CTN NodesCTN Nodes
Regional Research &
Training Center
Community Treatment Program
Community Treatment Program
Community Treatment Program Community
Treatment Program
Community Treatment Program
CTN Node
Community Treatment Program
Community Treatment Program
Community Treatment Program
Goals of the Agreement
• Take “what we know” from NIDA-funded research and produce products for use by addiction field:– Training materials– Pamphlets– Bibliographies/reading materials– On-line courses
Current Blending Teams
• Buprenorphine Awareness
• S.M.A.R.T. Treatment Planning
• Buprenorphine Detoxification
• Motivational Interviewing (MIA:STEP)
• Motivation Incentives (PAMI)
NIDA/SAMHSA-ATTC InitiativeBlending Team
Buprenorphine Treatment: A Training for Multidisciplinary
Addiction Professionals
Buprenorphine Awareness Blending Team Members
ATTC Members:• Thomas Freese, Pacific Southwest ATTC, Chair• Beth Finnerty, Pacific Southwest ATTC• Glenda Clare, Central East ATTC• Gail Dixon, Southern Coast ATTCNIDA Members:• Leslie Amass, Friends Research Institute, Inc.• Greg Brigham, CTN Ohio Valley Node• Eric Strain, Johns Hopkins University
Goals for the Bup Awareness Blending Team
• Creation of a package of materials to increase the awareness of the usefulness of buprenorphine for treating opiate addiction among non-physician practitioners.
• To provide information designed to increase motivation for bringing buprenorphine to local communities as a treatment option
• To provide information relevant to non-physician providers about what to expect when someone is treated with buprenorphine.
Bup Awareness Blending Team Products
• Standup Training Package– 5-6 hour awareness training– 20-minute stand alone introduction
• CEATTC On-line Course– Self-paced option
• Additional Materials– Brochures– National Office Annotated Bibliography
Blending Team Products
• Standup Training Package – 6 modules– Module I: Introduction to Opioid Treatment
• What leads to opiate addiction• History of opiate treatment• Receptor pharmacology• Use of agonists, partial agonists, and
antagonists in treatment
Blending Team Products
• Standup Training Package – 6 modules– Module II/III: Buprenorphine/Opiate 101
• Overview of the medication and how it works
• The role of buprenorphine in treatment– Induction– Maintenance– Medically-Assisted Withdrawal
Blending Team Products
• Standup Training Package – 6 modules– Module IV: Identification of Patients for
Buprenorphine Treatment• Where are opiate dependent patients seen?• Screening and identification of opiate dependent
individuals • Ways for providers to facilitate treatment• Understanding who is an optimal candidate for
buprenorphine treatment
Blending Team Products
• Standup Training Package – 6 modules– Module V: Coordinated Care
• How to find a physician who can prescribe Bup
• Roles of providers• Working within the scope of practices/using
linkages to other providers• No wrong door to treatment
Blending Team Products
• Standup Training Package – 6 modules– Module VI: Counseling Buprenorphine
Patients• Craving and Triggers • Working with Special Populations• Buprenorphine-Related Patient Management
Issues
Key Components of this Package
• Available through the 14 regional ATTCs and 17 Nodes of the CTN.
• Designed to be completely customizable to meet the needs of each state.
• An important new resource for your states to assist in integrating this important new treatment in local treatment environments.
NIDA/SAMHSA-ATTC InitiativeBlending Team
S.M.A.R.T. Treatment Planning: Utilizing the Addiction Severity Index
S.M.A.R.T. Treatment Planning Blending Team Members
ATTC Members:• Richard Spence, Gulf Coast ATTC, Chair• Nancy Roget, Mountain West ATTC• Pat Stilen, Mid-America ATTC
NIDA Members:• Deni Carise, Treatment Research Institute• Meghan Love, Treatment Research Institute• A. Thomas McLellan, Treatment Research
Institute
S.M.A.R.T Treatment Planning Utilizing the Addiction Severity Index
• S pecific
• M easurable
• A ttainable
• R ealistic
• T ime related
S.M.A.R.T. Treatment Planning
• Goal and Focus:– Transform required paperwork (e.g., ASI,
psychosocial assessment) into clinically useful information
– The focus of the training is on incorporating the assessment information in treatment planning and using the treatment plan to guide service delivery
S.M.A.R.T. Treatment Planning
• Information covered:– Addiction Severity Index (ASI) application in
treatment planning– Individualized treatment plans vs. program-
driven plans– Evaluation uses for program directors and
clinical supervisors– Role of treatment plan in clinical records– Experiential writing exercises
• Training manual including trainer notes and PowerPoint slides
• On-line training program
• Additional products– Quick guide– Lesson plans– Bibliography
S.M.A.R.T Treatment Planning Utilizing the Addiction Severity Index
• Module 1: Learn how the results from administering the ASI can make a counselor’s task easier and be able to discern differences between program-driven and individualized treatment plans
• Module 2: Identify and understand individualized treatment plans and how these plans can improve client retention/treatment outcomes
• Module 3: Practice formulating treatment plans using ASI information
• Module 4: Practice formulating documentation notes based on treatment plan progress.
S.M.A.R.T Treatment Planning Course Content
NIDA/SAMHSA-ATTC InitiativeBlending Team: Buprenorphine
for Opioid Detoxification
Based on Results from
CTN Protocols for Inpatient Detox (CTN0001) and Outpatient Detox (CTN0002)
Buprenorphine Detox Blending Team Members
ATTC Members:• Thomas Freese, Pacific Southwest ATTC, Chair• Beth Finnerty, Pacific Southwest ATTC• Kay Gresham Morrison, Southeast ATTC• Steven Gumbley, ATTC of New EnglandNIDA Members:• Greg Brigham, CTN Ohio Valley Node• Judy Harrer, CTN Ohio Valley Node• Dennis McCarty, CTN Oregon Node
Buprenorphine for Opioid Detoxification
Goals:
• Training for physicians to conduct the 13-day buprenorphine taper evaluated through the CTN studies.
• Information for other multidisciplinary treatment personnel to support patients who are receiving this treatment
Buprenorphine Detox Blending Team Products
• Four hour classroom training program providing instruction on using buprenorphine for opioid dependent patients. Including:– Rational for providing detoxification to opioid
dependent patients– Characterization of opiate withdrawal– Goals of detoxification– Results of the CTN studies– Implementation training– Patient and treatment staff perspectives– Overdose risk following detoxification
Present and Opioid Negative 0001 (Inpatient)
0
10
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80
90
Day 3-4 Day 7-8 Day 10-11 Day 13-14
Clonidine Bup/Nx
Present and Opioid Negative 0002 (Outpatient)
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10
20
30
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50
60
70
80
90
Day 3-4 Day 7-8 Day 10-11 Day 13-14
Clonidine Bup/Nx
NNT: Number Needed to Treat
NNT= Number of patients needed to treat
to achieve 1 treatment success
CTN 0001 (Inpatient)• NNT for Bup/Nx 77/59 = 1.31 • NNT for Clonidine 36/8 = 4.5
NNT Clonidine : BupNx = 3.44
CTN 0002 (Outpatient)• NNT for Bup/Nx: 157/46 = 3.4 • NNT for Clonidine: 74/4 = 18.5
NNT Clonidine : Bup/Nx = 5.44
Motivational Interviewing Assessment: Supervisory Tools for Enhancing
Proficiency (MIA:STEP)
NIDA/SAMHSA-ATTC InitiativeBlending Team
Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA:STEP)
Blending Team Members
ATTC Members:• Steven Gallon, Northwest Frontier ATTC, Chair• Sherry Ceperich, Mid-Atlantic ATTC• Maria del Mar Garcia, Caribbean Basin & Hispanic
ATTC• Denise Pyle, Mid-Atlantic ATTC• Edna Quinones, Caribbean Basin & Hispanic ATTCNIDA Members:• Samuel Ball, CTN New England Node• John Hamilton, CTN New England Node• Steve Martino, CTN New England Node
What is an MI Assessment?
• Use of client-centered MI style• MI strategies that can be integrated into the
agency’s existing intake assessment process• Methods that can be used with diverse substance
use problems• Skills for assisting clients in assessing their own
substance use• Understanding the client’s perception and
willingness to enter into a treatment process
Implementing MI may require:
• Focused clinical supervision
• Audio taped MI Assessment sessions
• Tape coding
• Feedback, coaching and instruction for improving skills
Benefits of MI Assessment
• It has a solid evidence-base
• MI improves client engagement and retention
• Using MIA:STEP: Enhances clinical supervision Builds counselor knowledge and
proficiency in MI
Why another application of MI?
• Positive outcomes depend on clients staying in treatment for adequate length of time
• Adding MI at beginning of treatment increases client retention
• The type of clinical supervision needed to maintain and improve MI skills is generally lacking
The costs of implementing MI Assessment
• Time to learn and implement the protocol
• Regular review and feedback on MI skills
• Ongoing clinical supervision, including:- Training - Mentoring
- Practice - Review of recorded interviews
- Feedback - Development of learning plans
• The cost of recorders and supplies
Why consider this approach when staff are already trained in MI?
• Most trained clinicians do not use MI appropriately, effectively or consistently
• MI is more difficult than clinicians expect
• The key to successful implementation of MI is supervisory feedback and coaching
Development of the protocol
• The NIDA Drug Abuse Treatment Clinical Trials Network designed the protocol
• Designed as something that all outpatient community treatment providers could use
• Researchers worked directly with MI experts and treatment providers on both development and implementation.
MI Assessment “Sandwich”
MI strategies during 1MI strategies during 1stst 20 min 20 min
MI strategies during last 20 minMI strategies during last 20 min
Agency Intake or Agency Intake or AssessmentAssessment
MIA:STEP Toolkit includes everything you need to:
• Introduce the idea of doing an MI assessment
• Train counselors and supervisors
• Provide ongoing supervision of MI
• Train supervisors to use a simple tape rating system
• Use an MI style of supervision
MIA:STEP Toolkit Overview
1. Briefing materials2. Summary of the MI Assessment
intervention3. Results of the NIDA CTN Research4. Teaching tools for enhancing and assessing
MI skills5. Tape rating guide and demonstration
materials6. Supervisor training curriculum
Promoting Awareness of Motivational Incentives (PAMI)
NIDA/SAMHSA-ATTC InitiativeBlending Team
Promoting Awareness of Motivational Incentives (PAMI)
Blending Team Members
ATTC Members:• Lonnetta Albright, Great Lakes ATTC, Chair• Joe Rosenfeld, Great Lakes ATTC• Amy Shanahan, Northeast ATTC• Anne Helene Skinstad, Prairielands ATTCNIDA Members:• John Hamilton, CTN New England Node• Scott Kellogg, CTN New York Node• Therese Killeen, CTN South Carolina Node
Rationale for Developing the PAMI Blending Package
•Research has shown that motivational incentive programs using low-cost reinforcement (prizes, vouchers, clinic privileges, etc.), delivered in conjunction with onsite urine screening promotes higher rates of treatment retention and abstinence from drug abuse. •This Blending Team is focusing its efforts on informing the field about successful approaches in the use of motivational incentives (also referred to as contingency management).
Motivational Incentives for Enhanced Drug Abuse
Recovery
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2 4 6 8 10 12
Control
Incentive
Study Week
Per
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Improved Retention in Counseling Treatment
50% vs. 35% retained in the 12-week study using low-cost incentives.
Motivational Incentives for Enhanced Drug Abuse
Recovery
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1 2 3 4 5 6 7 8 9 10 11 12
Treatment as Usual
Treatment as Usualplus Incentives
Week
Per
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sam
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Incentives Improve Outcomes in Methamphetamine Users
46% vs. 30% presented negative results when tested for Methamphetamines.
Motivational Incentives for Enhanced Drug Abuse
Recovery
0
10
20
30
40
50
60
70
1 5 9 13 17 21
Treatment as Usual
Treatment as Usualplus Incentives
Study Visit
Per
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Incentives Reduce Stimulant use in Methadone Maintenance Treatment
61% vs. 31% presented negative results when tested for stimulants.
Goals of the PAMI Blending Package
•Designed to acquaint the addiction treatment field with Motivational Incentives as a science-based therapeutic strategy.•Elements incorporate examples of successful MI principles and strategies including the Fishbowl method.•Illustrates positive outcomes and lessons learned from the NIDA Motivational Incentives Enhanced Drug Abuse Recovery (MEIDAR) CTN study.
PAMI Blending Team Products
Blending Team products are currently being developed and will include a:•Awareness video•PowerPoint presentation •Brochure•Resource CD•Tool Kit (supporting materials)
For more informationContact your Regional ATTC
ATTC ofNew England
NortheastATTC
PacificSouthwest
ATTC
NorthwestFrontier
ATTC
Prairielands ATTC
Mid-AmericaATTC
Great LakesATTC
Gulf Coast ATTC
MountainWestATTC
Mid-Atlantic ATTC
Southern CoastATTC
Southeast ATTC
Central EastATTC
Caribbean Basin, Hispanic/Latino & US Virgin Islands
ATTC
Central East ATTC
NorthwestFrontier
ATTC
ATTC National Office
More Information and Regional ATTC Web Pages Can Be Found
at:
ATTC National Office
www.nattc.org
The End
For more information, please contact:
• Beth Rutkowski, M.P.H., (310) 267-5376 finnerty@ucla.edu
• Thomas Freese, Ph.D., (310) 267-5397 tefreese@ix.netcom.com