The Appalachian Tri-State Node Experiences with the National Institute on Drug Abuse Clinical Trials Network

Introduction

Substance use disorders (SUD) are highly prevalent in the United States and are associated with considerable adverse effects including psychiatric and medical comorbidity and mortality. The National Institute on Drug Abuse (NIDA) reports that drug-related deaths have more than doubled since the early 1980s and one in four deaths in the United States is attributable to alcohol, tobacco, and illicit drug use.1

Abstract

The National Institute on Drug Abuse (NIDA)-sponsored Clinical Trial Network (CTN) recently celebrated 10 years of conducting “real world” research into the treatment of addiction. This article reviews the history and results of the most recent CTN studies and describes the experiences of one of the 13 participating research affiliates, the Appalachian Tri-State (ATS) Node. We discuss our “bidirectional” collaboration with multiple community treatment programs (CTPs) on research and dissemination activities and include their experiences as a member of our ATS Node.

Results of CTN clinical trials have found unexpectedly that treatment as usual (TAU) is often almost as good as evidence-based interventions such as Motivational Interviewing (MI), possibly due to the difficulty in implementing evidence-based practices most effectively among divergent treatment sites and heterogeneous clinical populations. Some expected findings from the reviewed research are that severity of addiction and comorbidity moderate treatment outcomes and must be accounted for in future CTN-sponsored studies. Notwithstanding these results, much has been learned and recommendations are suggested for changes in CTN research designs that will address methodological limitations and increase treatment effectiveness in future CTN studies.

Keywords

clinical trial network, comorbidity, addiction, substance use disorder, treatment