NCAD: Where`s the logic in research, policy and practice?

Addiction researchers get stuck in a system that fails to generate impactful findings for the real world. Policymakers horse-trade much of the sense out of well-meaning initiatives. Care providers lack the skills to adapt evidence-based practices to the nuances of their clinical settings.

These realities add up to a need for closer communication and new approaches among the research, policy and practice communities, an academic leader said in the closing plenary at the National Conference on Alcohol & Addiction Disorders (NCAD) in Anaheim, Calif. And it could take a long time for this to happen.

“This is a long game, for most everything we do,” said John Clapp, PhD, interim dean at the Suzanne Dworak-Peck School of Social Work at the University of Southern California. “These problems are so complex, so ingrained, that it doesn't make sense to think that we can do this quickly.”

Clapp cited in his talk numerous examples from an area of research he has explored extensively: alcohol prevention initiatives for young adults. Problems appear intractable when the data show that 44% of adults ages 18 to 24 report a binge drinking episode in the past two weeks. These numbers have remained stable despite a boatload of money having been put into prevention initiatives targeting this age group, Clapp said.

He cited how research often provides crystal-clear solutions that nevertheless can't be widely replicated. A campus drunk-driving study of his ended up showing a significant drop in incidents after implementation of frequent checkpoints accompanied by a media blitz. However, the intervention was so expensive that no campus communities could afford it.

A more modest effort might have shown merit, Clapp said, but the pared-down version might never have had the appeal necessary to secure a research grant.

“Most of us want to make a real-world change, but the funding mechanisms and the publication mechanisms don't necessarily support that,” he said of his colleagues in the research community.

Clapp did point out that at USC, tenure decisions are beginning to be influenced by whether an academician's research produces changes in practice or policy.

Too few policy options

“A lot of it is not rational,” Clapp said of public policy initiatives in addiction.

Too many potentially useful policy options are summarily dismissed because of ideology, or on religious or moral grounds, or because some stakeholder group doesn't want it (maybe the alcohol industry), Clapp said.

“What ends up being passed doesn't really reflect science, or practice,” he said.

Think like an engineer

Many in the addiction field adopt the scientist's mentality of trying to understand everything about a problem, but Clapp says sometimes it's better to act like an engineer and just identify a solution. An engineer's approach likely would have recommended the more stripped-down version of the drunk driving prevention strategy for campuses, and achieved a more replicable result.

Clapp also pointed out that numerous “sacred cows” in treatment and prevention have slowed the field's progress. Too many communities hang on to approaches that have little to no research basis. The D.A.R.E. effort in schools serves as a prime example.

“If we don't get better at this, in some ways we'll have more problems with funding,” Clapp said.