By Paul Roman, Editor
The relatively new specialty of health services research focused on substance use disorders (SUD) has clearly demonstrated that the expansion of quality in the delivery of treatment services is far from simple. Among the many considerations for change and quality improvement, the use of pharmacotherapies in SUD treatment is in many ways critical to the total enterprise. It not only broadens treatment choices but also (through its use of conventional medical technology) opens avenues for integration of SUD treatment into other areas of medical practice. Greater use of pharmacotherapies can also shift the images and stereotypes of SUDs further toward the paradigms of medical care.
The slowness of this diffusion within SUD treatment, discouraging to many, cannot and should not be reduced to accusations of narrow or backward thinking on the parts of SUD treatment providers, as has frequently been the temptation. Research has made substantial progress on understanding some of these issues, such as the importance of using media for diffusion that have credibility among local-level decision-makers in the adoption process. Research has also shown the critical but not-so-simple role of physician involvement in the implementation of pharmacotherapies. At the same time, multiple studies have confirmed the embeddedness of treatment models based on 12-step models that seem in some (but certainly not all) instances to be barriers to consideration of pharmacotherapies at the provider level, or maybe beyond.
SUD-related health services research generally does not go beyond service providers in its primary data collections, and hence has neglected the first-line consumers of these services, a collection of people that includes current patients, prospective patients, and past patients, as well as the "personal stakeholders" that more or less surround each of these individuals. What is their role in the further diffusion and implementation of pharmacotherapies in SUD treatment? To that end, I asked members of the Editorial Board of The Bridge to respond to the following:
In the diffusion/adoption/implementation of evidence-based practices, the SUD specialty gives much lip service to the idea that it follows a "business model." Within a business model for service delivery organizations, the central issue is the marketing and consumption of services. SUD treatment's consumers are actual and potential patients, as well as the significant others who motivate people either toward or away from treatment. Instead of focusing on these consumers, much emphasis in the SUDs specialty is on various agencies that may provide funding for treatment, and these are frequently referred to as the key customers for service. The assumption here is that this singular emphasis, and the ignoring of the patient et al. as the consumers of services is a huge hole in the SUDs business model. There are many facets to this question, so let us first focus on pharmacotherapies. What is the relationship between the focus on the attitudes, desires, and orientations of patients (potential and actual) and their significant others, and their demand for or acceptance of pharmacotherapies?
Following are the responses to these questions of six members of the Editorial Board: Holly Hagle, Michael Boyle, Louise Haynes, Dennis McCarty, Hannah Knudsen and myself. Both Dennis and Hannah are joined by several colleagues in preparing their essays.
We are very pleased to welcome Louise Haynes, MSW, as a new member of the editorial group. Louise is the Director of Research for the Lexington-Richland (South Carolina) Alcohol and Drug Abuse Council and through this position has been very active in the Southern Consortium Node of the NIDA Clinical Trials Network. She has served as PI for several CTN trials in community settings and is an Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Science at the Medical University of South Carolina. Louise has made major research contributions to understanding the integration of identification and treatment for HIV/AIDS in SUD treatment, and has been an exemplar of the research-involved practitioner within the original "bidirectional" model of the CTN operational dialogue between researchers and direct service providers.
Several other new contributors have joined the editorial group, and they will be introduced in the next issues as they offer their debut essays in The Bridge.
Paul M. Roman
Editor in Chief
We invite readers to respond to these materials, including the workgroup report itself. To the extent they are appropriate, these reactions may be included in future issues of The Bridge. Please address your comments to Paul Roman at the University of Georgia (firstname.lastname@example.org).
The opinions expressed herein are the views of the authors and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA, CSAT or the ATTC Network. No official support or endorsement of DHHS, SAMHSA, or CSAT for the opinions of authors presented in this e-publication is intended or should be inferred.