Treatment Research Institute Annual Progress Report: 2010 Formula Grant Reporting Period July 1, 2011 June 30, 2012 Formula Grant Overview The Treatment Research Institute received $139,351 in formula funds for the grant award period January 1, 2011 through December 31, 2012. Accomplishments for the reporting period are described below. Research Project 1: Project Title and Purpose Medication Assisted Treatment for Opioid, Alcohol Dependence: Improving Knowledge, Attitudes & Referrals - There is strong evidence supporting the effectiveness of medication assisted treatment (MAT) at reducing substance use, criminal behaviors, and fatal overdose among people with substance dependence. However, the widespread utilization of MAT has been impeded by misperceptions, negative attitudes, and a general lack of awareness of MAT. The purpose of this project is to reduce these barriers among critical stakeholders by developing a brief training, delivering it to treatment referrers and policymakers situated in the criminal justice system, and assessing its effect on knowledge, attitudes, and willingness to refer to MAT. The training aims to improve the health and safety of all Pennsylvanians by promoting the utilization of treatment that reduces the negative consequences associated with substance use among a subpopulation where this problem is rampant. Anticipated Duration of Project 01/01/2011-12/31/2012 Project Overview In Phase I we will identify existing training programs developed by the Substance Abuse & Mental Health Services Administration (SAMHSA), National Institute on Drug Abuse (NIDA), Addiction Technology Transfer Center (ATTC) and other treatment specialists relating to medication assisted treatment of chemical dependence (MAT). We will conduct an in-house review of these products with training, treatment and criminal justice (CJ) experts at the Treatment Research Institute (TRI) to identify relevant components as well as material that will need to be developed in order to provide complete coverage of medications used to treat addiction as well as issues that pertain specifically to medication assisted treatment (MAT) with individuals involved in the CJ system. The goal of this review is to identify training matter that can serve as the basis for an intervention that will convey accurate and useful information about MAT in a way that is most acceptable and useful to CJ addiction treatment referrers and Treatment Research Institute 2010 Formula Grant Page 1
policymakers. Furthering progress towards this goal in Phase II, we will convene an expert panel of academic researchers, correctional-based treatment providers and referrers, and addictions policymakers to conduct an external evaluation of the material gathered in Phase I. This expert panel will meet in person at TRI in Philadelphia with the aim of gathering these stakeholders suggestions for improvement and consolidation of the training material. During Phase III, with careful coordination between TRI s investigators and data programmer, we will develop a beta version of an online training curriculum that incorporates the feedback from the internal and external consultants just identified. This pre-release version of the training will be distributed to consultants and will allow them the opportunity to comment on the product's content and usability. The training will be finalized once feedback has been received and appropriately incorporated into the training. Phase IV of the project consists of testing whether, and to what extent, the training impacts treatment referrers and policymakers knowledge, attitudes, and (as appropriate) willingness to refer to MAT. This will involve a randomized control trial comparing the outcomes of the MAT training to those of an attention control training with 50 treatment referrers (n = 25 for each training) serving a correctional population in Philadelphia county. We will also employ a pre-post design to assess the impact of the training with 25 decision-makers within the CJ system. Finally, in Phase V, based upon the training s effectiveness and trainee feedback, adjustments to improve the training may be made. The instrument and study results will then be used to develop funding proposals to support research and dissemination of the training outside the CJ system. Principal Investigator Jason C. Matejkowski, PhD Associate Research Scientist Treatment Research Institute 600 Public Ledger Building 150 S. Independence Mall West Philadelphia, PA 19106 Other Participating Researchers David S. Festinger, PhD, Karen Dugosh, PhD employed by Treatment Research Institute Expected Research Outcomes and Benefits Drug and alcohol dependence has a substantial and negative impact on the health of Pennsylvanians and their communities. Dependence can often lead to criminal justice (CJ) involvement, physical morbidity, and death. Medication assisted treatment (MAT) for addiction has been shown to result in substantial improvements in the lives of individuals and community health. A critical challenge for our field is to promote the uptake of these under-utilized treatments. A promising approach to doing so involves raising awareness and addressing misperceptions about MAT. This project will develop and evaluate a brief training designed to increase participants knowledge, attitudes, and (as appropriate) willingness to refer to medication assisted treatment. Expert consultants will generate specific recommendations for a training curriculum that will convey accurate and useful information about MAT to treatment Treatment Research Institute 2010 Formula Grant Page 2
referrers and policymakers within the CJ system. Although the current project may not be directly assessing CJ referrals to and initiation of MAT, the training to be developed addresses a necessary first step in promoting these behaviors by imparting the appropriate knowledge and positive perceptions warranted for these evidence-based treatments. As a result, this training will have significant benefits for the Commonwealth by addressing both issues of public health and public safety via an increase in the likelihood that referrals are provided, that MAT is initiated, and that clients substance use is reduced. Indeed, the information obtained from this investigation will serve as preliminary data to develop a NIDA research grant to assess whether the increased knowledge and positive attitudes imparted by the training will lead to increased referral to MAT and improvements in the health status of drug abusers. In addition, findings will result in presentations at treatment programs, professional conferences, as well as scholarly publications in peer-reviewed journals. Summary of Research Completed Since our last report, we have completed Phase I and Phase II of the study. We are nearing completion of Phase III and preparing to implement Phase IV. In-House Review As part of Phase I, we have concluded our in-house review of the MAT training that included a presentation to approximately thirty training, treatment and criminal justice (CJ) experts at a Treatment Research Institute (TRI) science meeting. Feedback received at the science meeting was incorporated into the training. We also met individually with Dr. George Woody, Board Member at TRI, to present the training and receive his feedback and comments for improvement. Dr. Woody is also Professor in the Department of Psychiatry at the University of Pennsylvania with 35 years of specialized research on treatment efficacy in substance abuse. Among his notable achievements are founding member of the Board of Addiction Psychiatry of the American Psychiatric Association, two-time member of the Board of Directors of the College on Problems of Drug Dependence, and Life Fellow of the American Psychiatric Association. He is currently Director of the Delaware Valley Node of the NIDA-funded Clinical Trials Network. Dr. Woody s suggestions for improvement were incorporated into the training. External Review Phase II consisted of consultation with experts that included academic researchers, correctionalbased treatment providers and referrers, and addictions policymakers. We presented the MAT training, refined from the results of the in-house review, to some of the top academic researchers and policymakers in the field of addictions during a presentation at the Center for Studies of Addiction at the University of Pennsylvania. Feedback was received from Charles P. O Brien, MD, PhD. Dr. O Brien is Chief of Psychiatry at the Philadelphia VA Medical Center, and Vice- Chair of Psychiatry at the University of Pennsylvania where he is also Director of the Center for Studies of Addiction. Dr. O Brien s research focus is on discovery of changes to the central nervous system involved in relapse, new medications, behavioral treatments, and instruments for measuring the severity of addictive disorders. He is past President of both the American College of Neuropsychopharmacology and the Association for Research in Nervous and Mental Disease. Treatment Research Institute 2010 Formula Grant Page 3
In addition to Dr. O Brien and other renowned experts in addiction at the Center for Studies of Addiction at the University of Pennsylvania, Dr. A. Thomas McLellan was in attendance for the presentation and provided feedback on the MAT training. At the time Dr. McLellan was transitioning from a position in the federal government back to TRI. Dr. McLellan is a 35-year career researcher in addiction who has published over 400 articles on the topic and has received numerous distinguished awards for his contributions to the field. Dr. McLellan co-founded the Treatment Research Institute in 1992 and served as its Director and Senior Scientist until 2009 when he was unanimously confirmed as Deputy Director of the White House Office of National Drug Control Policy. In that position he co-authored the President's National Drug Control Strategy and helped to integrate substance abuse prevention and treatment into the national healthcare reform legislation. Feedback from these experts was incorporated into the training. The training was presented to administrators at Community Education Centers (CEC) and Philadelphia s Public Health Management Corporation (PHMC). Steve Tomlin, Dr. Ralph Fretz and Dr. Robert Mackey of CEC joined us at TRI to view and provide feedback on the MAT training. Dr. Mackey is Senior Vice President for Clinical Services, Quality Assurance and Research at Community Education Centers. With more than 30 years of experience, Dr. Mackey has provided therapeutic services to adult and juvenile offenders in public and private sector operations. He is a Licensed Psychologist and Clinical Alcohol & Drug Counselor and has also served as a law enforcement officer. Dr. Ralph Fretz is the Director of Assessment and Research for Community Education Centers and Steve Tomlin is Eastern Regional Director for CEC overseeing the sites where the MAT training is to be implemented with CEC staff. In addition, we presented the training to Laurie Corbin, Program Director of Forensic Services, at PHMC. Ms. Corbin oversees the sites where the MAT training is to be implemented with PHMC staff. Feedback from these experts was incorporated into the training. Beta Testing of the Online Training Curriculum We are nearing completion of Phase III, beta testing of an online training curriculum that incorporates the work of both internal and external experts. The web-based training is modeled after interactive programs (e.g., http://phrp.nihtraining.com) in that it contains periodic quizzes to assess mastery of the topics and tracks completion of training components. The training also provides audio and animation similar to an online demonstration video developed by TRI (http://www.trirant.org/demo.htm). This Phase has involved careful coordination between the investigators and TRI s data programmer to develop a training that: will take less than 2 hours to complete due to competing demands on the time of trainees; is capable of self-administration by non-technically savvy individuals who may have limited computer experience; is capable of generating immediate corrective feedback on comprehension assessments; and can transfer deidentified data to TRI s secure server in a highly encrypted manner. In addition, we have identified an attention control training and prepared it for delivery as part of the randomized testing process described below. Testing of the online MAT Training We are preparing for Phase IV; to test whether, and to what extent, the training impacts treatment referrers and policymakers knowledge, attitudes, and (as appropriate) willingness to refer to MAT. The involvement of human subjects in this testing requires IRB approval of the testing protocol. In order to implement Phase IV, we have already submitted the testing protocol to Treatment Research Institute 2010 Formula Grant Page 4
TRI s IRB for review; the protocol was approved. Utilizing staff from PHMC in this testing also requires approval of the testing protocol by PHMC s IRB. The protocol has been approved by PHMC s IRB. Treatment Research Institute 2010 Formula Grant Page 5