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ARRA Investments in Comparative Effectiveness Research for the Prevention and Treatment of Addiction and Related Disorders

Public Health Burden
Both illicit and licit drugs impose an extraordinary public health burden, with an estimated 22.2 million persons (nearly 9 percent of the population) classified with substance dependence or abuse in the past year.  This translates into societal costs of over $600 billion dollars annually in increased health care costs, crime, and lost productivity.  Interventions to counter these dangerous and costly trends benefit from studies that compare emergent approaches demonstrating efficacy, and those already in use.  Comparative effectiveness research helps to optimize strategies for disseminating and implementing effective treatments across diverse settings and patient populations. 

Web-Based Interventions
Web-based technologies may have far-reaching potential to increase and improve the delivery of evidence-based substance abuse interventions.  Many allow users to access “real time” therapy from distant locations, or in physicians' offices, making treatments accessible to a broader patient population.  A variety of ARRA-funded grants are exploring web-based interventions.  A few include:
  • A competitive supplement to collect data on the effectiveness of a computer-delivered 5A’s (Ask, Advise, Assess, Assist, Arrange) intervention for cigarette smoking; the parent grant identifies primary care patients at risk for problem alcohol and drug use through a 15-minute computer-delivered health screen (Health Cheq) that asks about a variety of health behaviors.1
  • A first-ever study to compare the effectiveness of an accredited Internet-based videoconferencing platform for delivering routine drug counseling to patients in methadone treatment with traditional face-to-face counseling.2
  • New technology that would enhance the effectiveness of standard tobacco “quitlines” by improving their delivery and use through giving callers mobile access (via a web-enabled cellular phone) to a menu of evidence-based treatment components.3
  • A clinical trial to compare the effectiveness and cost-effectiveness of a web-based HIV prevention program to an educator-delivered one offered to youth in outpatient, community-based substance abuse treatment.4 This project may generate clinically and economically meaningful data for using technology to deliver new, science-based HIV prevention models.
  • A randomized controlled trial of a web-based medication adherence program for HIV-positive individuals, presented within the framework of a stress and mood management program—compared with standard treatment delivered by a nurse case manager who imparts medication adherence strategies.  This program could expand the reach of adherence programs and improve the mental health of those infected with HIV.5
Innovations in Chronic Disease Management
Similar to diseases such as hypertension and diabetes, addiction is a chronic disease that requires long-term treatment engagement and adherence to medications.  Several ARRA-funded grants are exploring ways to enhance treatment through bolstering long-term disease management and medications adherence strategies.  The following are just two examples.
  • A test of the Long-Term Recovery Management (LTRM) model based on initiating long-term addiction management at treatment onset, expanding time in treatment, adapting treatment intensity to patient response, and actively facilitating patient buy-in.  This model seeks to remove barriers to treatment re-engagement, and thereby prevent relapse and promote recovery.6
  • A comparison of methods for delivering buprenorphine, a medication used to treat opioid addiction.  Investigators will compare a subcutaneous (under the skin) implant, able to continuously deliver the medication for 6 months after a single treatment, with a daily sublingual tablet formulation, currently in use.  It is hoped that the implantable formulation will prove more effective by preventing poor treatment adherence and medication diversion.7
Comorbid Patient Populations
Many drug abusing populations also suffer from other conditions, including chronic pain, comorbid mental illness, and HIV; additionally, certain disadvantaged groups are at greater risk and require a more responsive treatment culture. These ARRA-funded grants represent efforts to this end.
  • A grant to evaluate a contingency management strategy (prizes awarded for abstinence) to improve use of psychiatric services and to reduce distress in opioid-dependent patients with other mental illness.8 Improving the care of drug-dependent patients with comorbid psychiatric disorders through an integrated approach is a high priority for the treatment field.
  • A study to establish two chronic pain data registries, retrospective and prospective, to identify specific pain management interventions that are most effective for distinct types of chronic pain patients.9 Chronic pain is a major public health problem, whose treatment can pose an addiction risk for some patients.
  • A study to evaluate the effect of providing routine counseling as part of HIV screening on (1) the incidence of sexually transmitted infections and (2) the receipt of HIV test results. Researchers will also measure reduction of sexual risk behaviors, substance use during sex, and cost and cost-effectiveness of counseling and testing. This study is an identified priority of the Institute of Medicine for comparative effectiveness research.10
  • A study to help reduce stigma and lower barriers to HIV testing by offering it in pharmacies—either on its own, or as part of routine comprehensive screening for a variety of health conditions.11

  1. 3R01DA026091-02S1 -- Computer vs Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care -- Svikis, Dace (VA)
  2. 1RC1DA028189-01 -- Improving Substance Abuse Counseling Adherence Using Web-Based Videoconferencing -- King, Van (MD)
  3. 1RC1DA028710-01 -- Comparative Effectiveness of Web-based Mobile Support for the DC Tobacco Quitline -- Kirchner, Thomas R. (DC)
  4. 1RC1DA028415-01 -- Comparative Effectiveness of Web-based vs. Traditional Adolescent HIV Prevention -- Marsch, Lisa A. (NY)
  5. 1RC1DA028505-01 -- Test of a Web-based Program to Improve Adherence to HIV/AIDS Medications -- Cook, Royer F. (VA)
  6. 1RC1DA028467-01 -- Comparing Acute and Continuous Drug Abuse Treatment: A Randomized Clinical Trial -- Carlson, Robert G. (OH)
  7. 1RC2DA028910-01 -- A Six-Month RCT of Probuphine Safety and Efficacy in Opioid Addiction -- Beebe, Kathrine L. (CA)
  8. 1RC1DA028154-01 -- Maximizing Effectiveness of Integrated Treatment Approaches -- Kidorf, Michael S. (MD)
  9. 1RC2DA028928-01 -- Comparative Effectiveness of Interventions for Chronic Pain Management -- Horn, Susan D.; Inturrisi, Charles E. (NY)
  10. 1RC2DA028973-01 -- HIV Testing and Counseling in STD Clinics: an Adaptation of CTN 0032 -- Colfax, Grant N and Metsch, Lisa R. (FL)
  11. 1RC1DA028284-01 -- Development of Behavioral and Social Interventions that Reduce Stigma and Improve -- Fuller, Crystal M. (NY)

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Page Last Updated on June 30, 2018 NIH...Turning Discovery Into Health®