Calm the discord between researchers and practitioners

For at least 20 years many efforts have been made to ensure that the findings of the latest addiction research are reflected in what our addiction treatment system offers. We have made great progress, despite sometimes heated disagreements between researchers and practitioners on the nature of the problem and the best possible solution.

Those of us with a foot in each group often have had to defend one or the other from unfair stereotypes. The ugliest of these include the idea that researchers live in ivory towers, totally disconnected from reality, and the notion that practitioners are uneducated ex-users with no qualifications other than their own individual experience. Each group also has some legitimate concerns that it is not fully understood by the other.

The collaboration between researchers and practitioners works best when a common vision motivates both groups. When practitioners and researchers are united by a focus on their shared goal of positive client outcomes, implementing research findings goes very well. This column is designed to help each group understand the other better and to bring the two together in that common focus.

Practitioners' perspective

Practitioners want researchers to know that they are not resistant to change, and that they truly value what research has to offer. Once convinced that a major benefit to clients can ensue, practitioners can and do move quickly. Practitioners value the expertise of those conducting the research, but also want researchers to know that practitioners have expertise of their own that deserves respect.

Practitioners want researchers to know that practitioners are not willing to abandon the treatment system they have spent a lifetime building and to start from scratch each time there seems to be some credible evidence to support a small change. Practitioners work hard to identify major developments that might benefit their clients, and integrate these in their treatment offerings. Practitioners work equally hard to protect their clients from the harm that could result from their jumping aboard the latest unproven fad.

Practitioners want researchers to know that practitioners design their services to be research-informed, rather than exact replicas of laboratory conditions. Practitioners understand the concept of fidelity and its usefulness in the context of research. Practitioners want researchers to understand that this concept is not as useful in the operation of treatment programs, for several reasons.

In the context of research, a typical goal is to create an experiment with only one variable, making it easier to attribute client improvements to a specific medication or technique. Fidelity is important in studies that are designed to build on previous research. Yet in operating a treatment program there are other considerations. Fidelity to one particular research-based treatment protocol often shortchanges clients in another area. For example, treatment programs might integrate what seems like the active ingredient in two different research-based treatment options, each with its own very specific treatment protocols. To use either protocol exclusively would improve a program's fidelity rating, but not necessarily its treatment outcomes.

Practitioners want researchers to know that integrating the latest research constitutes a process and not an event. It takes time to identify and prioritize needed changes, to train staff and to measure performance. Because of the time lag from decision to full implementation, insisting on fidelity to a specific treatment protocol usually doesn't work. By the time the process is nearing completion, the specific protocol often will have been replaced by one found to be more effective.

Treatment programs use research to inform their choices and to set priorities. Practitioners try their best to catch the big waves of ideas that are most beneficial to their clients. Treatment programs can integrate the best that research has to offer by considering the implications of the research in supervision and evaluation of program staff, and by developing an individual development plan for each staff member.

Researchers' perspective

Researchers want practitioners to know that their main goal is to help each practitioner get better outcomes. Researchers understand the difference between the laboratory and the real world, and want practitioners to know that they respect the work done by the addiction treatment system. Feedback from practitioners is essential to refine research and to identify areas for further study.

Researchers want practitioners to know that many of them are practitioners as well. Researchers understand each treatment program's need to adapt the research to its own specific needs, and to make educated guesses about what is and is not helpful to its clients.

Researchers want practitioners to know that workshops and in-service trainings, in and of themselves, are not effective in transferring research to practice. No matter how well training is done, training alone does not lead to successful implementation.

Researchers want practitioners to know that researchers realize that integrating research is a process and not an event. Researchers know that funding a change or mandating a change is not an effective way to implement change unless it is accompanied by demonstrations, practice, feedback and ongoing supervision.

Researchers want practitioners to know that it is unethical to claim they are using a specific treatment protocol when they are not. Researchers deserve credit for their contributions to the body of knowledge on addiction treatment, and this includes accurate citations. Researchers want practitioners to realize that it is in the best interest of their clients to value the preponderance of evidence generated by the academic community.

Researchers want practitioners to know that every practitioner's experience is limited to the populations they have served and the services they have provided. This is too small of a universe to use as a basis to generalize their interpretations of what's helpful to the entire population of people with substance use problems. Researchers are in a far better position to attribute positive client outcomes to one specific variable, and to distinguish causal relationships from correlations.

Practitioners and researchers both should take full advantage of the Addiction Technology Transfer Centers (ATTCs) that are dedicated to identifying and advancing opportunities for improving addiction treatment. More information on their work is available at https://www.nattc.org. They are a great resource for the unification of science, education and practice, and they provide a wide range of helpful services.