Commentary: Research-Informed Solutions to Substance Use Problems

Substance abuse permeates nearly every aspect of our society, but it is not intractable nor is it inevitable.

Research has contributed much knowledge over the decades to smarter prevention of addiction, more efficient early interventions, better and more sustained treatment outcomes, and wiser policies. Now it’s time for research to transform all this knowledge into solutions to the many substance abuse issues confronting our society.

For example, parents want to learn how to prepare their children to turn away from drugs and how to get the best treatment when their adolescents need it. Doctors want to know how to detect and intervene when substance use is interfering with medical outcomes or to reduce early-onset alcohol and drug problems (both may be affecting the quality and costs of primary care). For schools and colleges, now (appropriately) focusing on improving student achievement and graduation, how can kids learn if they show up for class hung over or high? Courts and community corrections need research-derived solutions that can be more effective – and affordable – for managing drug-related offenders.

Science-backed tools are within our capabilities. Just from my group, there is a science-based tool for parents helping them, possibly, avoid the problems of a drug-involved child. In criminal justice, we have science-informed tools to help judges assign offenders based on the offenders’ risk and needs; or to evaluate “problem” courts to improve performance (ie, improve prospects for clients) and justify existence to higher-ups. 

For treatment providers, we have introduced a helping tool teaching principles of relapse prevention in group therapy (research has said much about relapse prevention in substance abuse, a chronically relapsing disease). We have another tool for integrating continuous recovery management into regular treatment practice. For doctors, researchers at TRI are investigating new practices for conducting screening and brief interventions in medical settings.   

There are other examples of science-based solutions, and not just from my group. But there need to be more. Science can point the way – for the many organizations, like schools, health care organizations, employers, parents, insurance companies – that need good, sensible and cost-effective tools helping them help people confronting substance use and abuse.  

Drugs and alcohol aren’t going away any time soon. There are many agencies at the federal, state and even local level that regularly, and helpfully, issue reports quantifying the problem. But we also need to develop solutions to the problem – in the form of tools that work, and work affordably. This may be another job that researchers can and should do.

In the meantime, substance abuse is hardly intractable. True, we need better awareness of the problem and all its impacts on society. But we also need more science-backed helping tools widely disseminated and put in the hands of the people and organizations that can use them.  

A. Thomas McLellan, PhD, is the CEO of the Treatment Research Institute, an independent, nonprofit research and development organization dedicated to developing and providing evidence-based solutions to the devastating problems of substance abuse that are affecting families, schools, businesses, courts and health care.

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    April 3, 2012 at 2:54 PM

    Boy, hate to be sarcastic here, but he sure is using that Science Base. He used the word way too many times, trying to convince me that all of these studies are flawless and really based on quantitative empirical scientific evidence. I have read a couple of claims of studies done by Dr. McLellan that gave me a lot of reason to wonder who peer reviewed his studies (if ever). I sorry that I sound negative and scrutinizing people’s studies, but scrutiny has given us more breakthroughs in science than pure confirmation after confirmation without doing studies that questions the truth of the hypothesis. The more
    I read some of the studies publish here, the more I question, how much this authors who
    claim “evidence base” really know about science, or did they just learned to use the words. Is he aware of “Confirmational Biases”, “Correlation Illusions” and other science concepts like empirical falsification, continuity. I have read a study by him supporting and being a proponent of a dominant theory that has the least evidence of safety and efficacy. I have follow his work for a year or so know.
    I also agree with Jane, “Substance Use Disorder” is a much more explicit term than Substance Abuse which had been over used some time to explain plain use (just because the substance is illegal does not automatically make the person an abuse of the substance.

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    Jane Pressly

    March 28, 2012 at 11:01 AM

    I too greatly admire Dr. McLellan and the work of TRI. As a recovery advocate and a person in long-term recovery, my request is that they discontiue using the word “abuse” in their writing and consider “substance use disorder” instead. William L. White says: “Abuse is one of the most ill-chosen and pernicious words in the addiction/treatment vocabulary. Abuse has long implied the willful commission of an abhorrent act” againt partners, children or animals. People do not abuse alcohol and other drugs. They “treat these potions with the greatest devotion and respect.” Research shows that patients in ERs are treated worse when referred to as “substance abusers” than as “people with substance use disorders.”

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    Susan Weinstock, M.D.

    March 23, 2012 at 9:47 PM

    Just wanted to express my gratitude to Dr.
    McLellan, and others like him, for working to
    inform treatment at the community level.
    As a San Diego based addictionologist, I am
    chagrined by the large number of treatment
    programs that have not yet embraced research-
    based treatment. Dr. McLellan’s work will ultimately decrease the current needless loss
    of life.

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    March 23, 2012 at 4:36 PM

    I agree, we need to bring this to the people, put it to practical use. USDA/Cooperative Extension could do that.

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    Steve Castleman

    March 23, 2012 at 1:16 PM

    Efforts to combat substance abuse should start with an understanding of the science of addiction — that addiction is a legitimate, treatable brain disease.

    For a website that discusses the science of addiction in accessible English(what parts of the brain are affected by drug use; how drug abuse alters the brain’s structure and function resulting in addict behavior; why some get addicted while others don’t; how treatment works; etc.), click on AddictScience.

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