Aims The study evaluated the effectiveness of an 8-week combined group plus individual 12-step facilitative intervention on stimulant drug use and 12-step meeting attendance and service. Design Multisite randomized controlled trial, with assessments at baseline, mid-treatment, end of treatment, and 3- and 6-month post-randomization follow-ups (FU). Setting Intensive outpatient substance treatment programs. Participants Individuals with stimulant use disorders (n = 471) randomly assigned to treatment as usual (TAU) or TAU into which the STAGE-12 intervention was integrated. Measurements Urinalysis and self-reports of substance use and 12-step attendance and activities. Intervention Group sessions focused on increasing acceptance of 12-step principles; individual sessions incorporated an intensive referral procedure connecting participants to 12-step volunteers. Findings Compared to TAU, STAGE-12 participants had significantly greater odds of self-reported stimulant abstinence during the active 8-week treatment phase; however, among those who had not achieved abstinence during this period, STAGE-12 participants had more days of use. STAGE-12 participants had lower ASI Drug Composite scores at and a significant reduction from baseline to the 3-month FU, attended 12-step meetings on a greater number of days during the early phase of active treatment, engaged in more other types of 12-step activities throughout the active treatment phase and the entire FU period, and had more days of self-reported service at meetings from mid-treatment through the 6-month FU. Conclusions The present findings are mixed with respect to the impact of integrating the STAGE-12 intervention into intensive outpatient drug treatment compared to TAU on stimulant drug use. However, the results more clearly indicate that individuals in STAGE-12 had higher rates of 12-step meeting attendance and were engaged in more related activities throughout both the active treatment phase and the entire 6-month follow-up period than did those in TAU.

The relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices. Programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts.

Objective-Individuals with direct care responsibilities in 348 drug abuse treatment units were surveyed to obtain a description of the workforce and to assess support for evidence-based therapies.Methods-Surveys were distributed to 112 programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN). Descriptive analyses characterized the workforce. Analyses of covariance tested the effects of job category (counselors, medical staff, managersupervisors, and support staff) on opinions about evidence-based practices and controlled for the effects of education, modality (outpatient or residential), race, and gender.Results-Women made up two-thirds of the CTN workforce. One-third of the workforce had a master's or doctoral degree. Responses from 1,757 counselors, 908 support staff, 522 managerssupervisors, and 511 medical staff (71% of eligible participants) suggested that the variables that most consistently influenced responses were job category (19 of 22 items) and education (20 of 22 items). Managers-supervisors were the most supportive of evidence-based therapies, and support staff were the least supportive. Generally, individuals with graduate degrees had more positive opinions about evidence-based therapies. Support for using medications and contingency management was modest across job categories. Conclusions-The relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices. Programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts.The National Drug Abuse Treatment Clinical Trials Network (CTN) began in 1999 with support from the National Institute on Drug Abuse. Research centers (currently 17) partner with five or more local alcohol and drug treatment centers (currently almost 150 distinct corporations) to conduct multisite clinical trials that test behavioral, pharmacological, and integrated behavioral and pharmacological treatment interventions in treatment programs with heterogeneous patient populations (1). Successful trials generate evidence of effectiveness and may promote the dissemination and adoption of science-based behavioral and pharmaceutical therapies. The first trials assessed buprenorphine detoxification (2,3), motivational interviewing and motivational enhancement therapy (4), and low-cost incentives for use with patients in methadone and outpatient programs (5,6). Initial results documented the feasibility of collaboration with community drug abuse treatment centers and provided a foundation for expansion and growth.Bridging the gap between practice and research, however, requires more than conducting clinical trials in community settings. Individuals who work in the treatment programs are essential to the introduction, adoption, and sustainability of science-based practices. Unfortunately, there is little current information on the workforce that provides treatment services for substance use disorders and on workers' opinions about the use of evidencebased therapies....

NCT0178830; Results.

Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed organizational (n = 106 of 112; 95% response rate) and treatment unit surveys (n = 348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not Conflict of Interest None of the authors report conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Medicine, 1998, p. 123). After receiving public testimony and evaluating potential strategies, the Committee proposed that NIDA support a research/ practice infrastructure where investigators and treatment programs collaborate to facilitate adoption of evidence-based practices (Recommendation 1, p. 6). NIH Public Access National Drug Abuse Treatment Clinical Trials NetworkIn 1999, the National Institute on Drug Abuse issued awards to support the National Drug Abuse Treatment Clinical Trials Network (CTN). The CTN uses multi-site clinical trials to test behavioral, pharmacological, and integrated behavioral and pharmacological treatment interventions in a broad range of treatment programs with heterogeneous patient populations. Each node includes community treatment programs in partnership with a research center. In January of 2003, there were 17 nodes and 112 treatment providers. Treatment PhilosophyClinics addressing alcohol and drug disorders vary in treatment philosophies, and that variation may influence the adoption and use of specific treatment strategies. The Institute of Medicine identified three program philosophies or orientations that guide treatment strategies: physiological (addiction is a progressive disease that requires medical intervention including the use of pharmacotherapy), psychological (addiction is a behavioral and emotional problem that responds to intensive group and individual therapy), and sociocultural (addiction is the result of socialization in environments that promote use of alcohol and other drugs and treatment requires environmental restructuring and new social relationships) (Institute of Medicine 1990). These models of care are not mutually exclusive but reflect service priorities.Social model programs, for example, articulate six core beli...

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Access to the opioid antidote naloxone is a critical component of addressing the opioid crisis. Naloxone is a population-level prevention intervention associated with substantial reductions in overdose mortality and reduction of nonfatal overdose. Pharmacies’ pivotal role in dispensing medications like buprenorphine for the treatment of opioid use disorder and selling nonprescription syringes places them at the crossroads of opioid access and risk mitigation methods like naloxone provision. Testing ways to optimize pharmacy-based naloxone provision will be key as the country expands the implementation of naloxone through the medical system. In the Respond to Prevent Study, we conducted a large, practical study of a pharmacy-focused intervention in a sample of Washington, Oregon, Massachusetts and New Hampshire community chain pharmacies to increase naloxone dispensing and improve opioid safety. The intervention integrated two evidence-based educational toolkits and streamlined materials to enhance the focus on naloxone policy, stigma reduction, and patient communications around naloxone, nonprescription syringes and buprenorphine access. The real-world study implemented a stepped wedge, clustered randomized trial design across 175 community chain pharmacies to evaluate the effectiveness of the Respond to Prevent intervention in increasing: (a) pharmacy based naloxone distribution rates, naloxone-related patient engagement, and pharmacist and technicians’ attitudes, knowledge, perceived behavioral control and self-efficacy toward naloxone; and (b) pharmacy nonprescription syringe sales, and pharmacist and technicians’ attitudes, knowledge, perceived behavioral control and self-efficacy toward dispensing buprenorphine for opioid use disorder (secondary outcomes). This commentary provides a brief narrative about the study and presents insights on the design and adaptations to our study protocol, including those adopted during the unprecedented COVID-19 pandemic further compounded by Western wildfires in 2020.