Abstract
The transfer of treatment research findings to clinical practice begins with influential dissemination. Other factors, such as availability of resources, acceptance by clinicians, and relevant (i.e., pharmaceutical) company sponsorship can ultimately determine the clinical application of a new technology. Two examples related to the pharmacotherapy of substance abuse which were experienced during our work at the Addiction Research Foundation, as well as our proposal for a dissemination model, are discussed. Alcohol withdrawal (A W) and alcoholic liver disease (ALD) are common, potentially serious clinical problems associated with alcohol abuse. Clinical trials indicated that assessment and monitoring of AW can be simplified and standardized with a valid, reliable instrument, the CIWA-A. In severe AW (CIWA-A score >25), the benzodiazepine. loading dose technique was proven to be an affective, shortened, simplified pharmacotherapy. An attempt to improve treatment of AW in rural detox centers in Ontario, Canada, was thwarted by lack of resources to perform simple clinical assessments and make decisions regarding pharmacotherapy and by reluctance to change. The CIWA-A was not adopted because, according to its guidelines, most detox center patients would be diagnosed with severe AW and would require pharmacotherapy, but dedicated and accessible physicians were not available to administer it (i.e., the problem was denied). Furthermore detox center staff were not willing to change current treatment practices (supportive care) for most severe AW patients. In the other case, in a long-term (2-year) placebo-controlled clinical trial in 310 patients, mortality from ALD was reduced by 50% with propylthiouracil (PTU), an antihyperthyroid medication. Results were published in a prestigious medical journal but misconceptions about risk of hypothyroidism and other side effects (e.g., agranulocytosis), cancellation of a multicenter trial, and lack of endorsement by hospitals and pharmaceutical companies may have deterred physicians from prescribing it. Thus, due to an inadequate marketing strategy, clinical use of PTU for ALD did not extend significantly beyond the original research institute. These two examples show that scientists must collaborate with professionals trained in techniques of dissemination and marketing in order to facilitate the transfer of research results to clinical practice. To correct this situation partially the Pharmacotherapy Research Unit, Addiction Research Foundation Clinical Research and Treatment Institute, presented a model for disseminating research results. However, due to administrative changes within the Foundation, the model has not been implemented. Efforts at research dissemination at NIDA, in the United States, seem to be developing in a more secure footing because of consistent administrative support and clear objectives.
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