The gap between the number of investigational addiction treatment drugs and the few actually available on the market--along with the relatively small number of physicians prescribing medications approved for patients with drug dependence--was the theme of several forums at the May 2006 American Society of Addiction Medicine (ASAM) conference in San Diego. Among these sessions was the pointedly titled symposium, "Breaking the Bottleneck of Research Adoption."
"There's a lot of concern about the amount of research that gets done that never finds its way into the field," declared the symposium moderator, Joan Zweben, PhD, of the University of California, San Francisco.
Jack Stein, PhD, deputy director of the Division of Epidemiology Services and Prevention Research at the National Institute on Drug Abuse (NIDA) indicated that NIDA is embarking on research into the adoption and implementation of new treatments, with the aim of improving dissemination of information and facilitating the provision of treatment. Stein has been disappointed with some previous efforts in this direction, such as mailings of guid-ance brochures and practice manuals that are later found discarded or unopened.
"We're faced with the paradox of non-evidenced-based implementation of evidence-based programs," Stein said.
From his initial review of the literature on diffusion of new technologies, Stein offered several factors that could favor treatment adoption: the treatment should present an advantage over existing options; its implementation should be relatively compatible with existing practice; it should be able to be tried in limited populations before full implementation; and it should produce observable, measurable outcomes.
Adoption is not just a function of practitioners embracing evidence-based methods, Stein observed; it is influenced by a host of other factors. "We need to look at some of those program-level elements," he said, "the organizational-cultural components and then, on another level, the system-level issues--the legal, the regulatory issues, the financial aspects."
Implementing use of drugs for alcoholism
The lack of research on implementation and adoption was also lamented at a symposium sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), with presenters discussing progress of medications for alcoholism moving from research bench to patient bedside. Mark Willenbring, MD, Director of Treatment and Recovery Research, NIAAA, noted that new treatments for alcoholism are slow to evolve and be adopted, not just because of the difficulties in drug development research, but also because of ideologic barriers and lack of funding for alcoholism treatments.
1. Anton RF, O'Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence. JAMA 2006;295:2003-2017.