Transcript Patterns of Medical Service Use of Substance Abusers with HIV/AIDS

In the Diffusion of Innovations
Everyone Changes:
Linking Practice with Scientific
Research
James L. Sorensen, Ph.D.
University of California, San Francisco and
San Francisco General Hospital.
American Psychological Association
San Francisco, CA (August 2007) Support from NIDA
(U10DA15815, R01DA14922, R01DA014470, P50DA09253)
and Robert Wood Johnson Foundation..
Rev. 8-14-07
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DISSEMINATION, DIFFUSION
• Dissemination…
– To scatter seed, far and wide
• Diffusion is a two-way process…
– An intermingling of molecules
Everyone
changes
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PREVIEW
1. Diffusion can be slow
2. Principles of successful diffusion
3. What are the needs in substance
abuse?
4. Selected resources
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1. DIFFUSION CAN BE SLOW
• Why the long lag between knowledge
and adoption?
– Scurvy 194 years
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Illustration of Diffusion Barriers:
The Dvorak Keyboard
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LIVING HISTORY OF DIFFUSION:
The LCD Projector
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BRIEF HISTORY OF
“PROJECTION”
• 2nd Century Magic Lantern
• 1888 discovery of liquid crystalline structure
• 1950s Kodachrome…35 mm projectors
• 2004 Last Slide Projector made by Kodak
• 2010 LCD projector sales may top 7,000,000
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2. WHAT AFFECTS DIFFUSION
OF INNOVATIONS?
• The nature of innovations
– Complex?
– Compatible?
• The organizations (the target of adoption)
– Organizational slack
– Fit with the clients
– Organizational climate
– Champions of change
• The dissemination process
– Active and in-person techniques work better
– Also are more costly
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3. DISSEMINATION NEEDS IN
SUBSTANCE ABUSE:
Effective Treatments
•
Relapse Prevention
•
Supportive-Expressive Psychotherapy
•
Individualized Drug Counseling,
•
Motivational Enhancement Therapy,
•
Behavioral Therapy for Adolescents
•
Multidimensional Family Therapy for Adolescents
•
Multisystemic Therapy
•
Combined Behavioral and Nicotine Replacement Therapy for Nicotine Dependence
Addiction
•
Community Reinforcement Approach Plus Vouchers
•
Voucher-based Reinforcement Therapy for Patients in Methadone Maintenance
Treatment
•
Day Treatment with Abstinence Contingencies and Vouchers
•
Matrix Model of Drug Abuse Treatment
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Adapted from National Institute on Drug Abuse, 1999. Principles of Drug Addiction Treatmetn: A Research
Based Guide. Availabile at: http://www.nida.nih.gov/PODAT/PODAT4.html
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EVIDENCE-BASED
INTERVENTIONS
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RESEARCH-DEVELOPED
INTERVENTIONS
• Behavioral Treatments
– Motivational Interviewing
– Contingency Management
• Pharmacotherapy:
– Naltrexone
– Buprenorphine
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Buprenorphine in Wired
April 2005
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4. RESOURCES
• CTN Dissemination Library
• Implementation Science
• USF review
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Clinical Trials Network
Dissemination Library
Technology Transfer in Drug Abuse Treatment
http://ctndisseminationlibrary.org
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Implementation Science
(new journal)
http:// www.implementation science.com
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USF Review
http://nirn.fmhi.usf.edu
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IN SUMMARY
• Change is slow
– And sometimes never happens (keyboard)
• Many innovations can be useful in our field
• Reasons for change are multifactorial
• Need more information
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Sir, the following
paradigm shifts
occurred while you
were out
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WHY LCD?
 Flexible
 Advances in technology
 Trained workforce (compatible)
 Dissemination methods?
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3. Needs in Substance Abuse
Area: WHY THE GAP?
• Little overlap between common treatment
methods and those with scientific evidence
• Due in part to history of isolation from
mainstream health care
• Treatments came from an alternate system
of care, compassionate peers
• Resulting polarization of science vs.
practice
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TREATMENT-DEVELOPED
INTERVENTIONS
• Self-Help Programs
• Drug Courts
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An Alternative to Incarceration
• Behavioral Health Court offers counseling to
criminal defendants with psychological
disorders. Cheaper than jail, it’s changing lives.
•San Francisco
Chronicle 1-23-2006
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RESEARCH NEEDS RE.
DISSEMINATION
• Not much research in addictions area
• Top-down versus partnership models
• Adopt or Adapt (fidelity or reinvention?)
• Measures of diffusion
• Effectiveness of training
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DISSEMINATION RESEARCH
NEEDS
• What learning experiences are needed?
• How do treatments work? (vs. black box)
• What prevents “relapse?” (to old ways)
• Individual & organizational differences?
• What system factors matter?
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