As an illness, addiction may present in many forms and levels of severity—from “harmful use” of alcohol or marijuana with few side effects, to chronic and severe addiction to alcohol, opiates, cocaine, or methamphetamine, accompanied by profound problems in health, self support and family relationships. Contemporary treatments have not been conceptualized,

want available treatments, many of those who do enter care find it does not meet their needs, and even those who complete treatment often relapse due to lack of appropriate continuing care.

At the provider, manager and regulatory level, agents have become conditioned to measuring progress (and demonstrating accountability) by assessing results at some point after patients leave treatment. The resulting information has no clinical value and often produces results disappointing to policy makers given the inherently relapsing nature of addictions, especially evident when outcomes are measured when patients are no longer managed. This evaluation model has been rejected for other chronically relapsing conditions such as diabetes and hypertension, where patient progress and symptom status are repeatedly evaluated while the patient is under medical management and the results used to modify treatment to maximize outcomes.

TRI investigators who are participating in the C3 Center are developing and evaluating practical, empirically suggested care options with corresponding tracking systems for individuals at all points in the severity continuum and at all points in the recovery process. C3 projects span the full continuum of care, from work designed to achieve earlier engagement of compromised but un-treated individuals, to extended low-level monitoring for patients who have received more intensive, initial treatment. Center investigators collaborate with other leading experts at the University of Pennsylvania, University of Michigan, and other top clinical research settings to develop and evaluate:

• Brief interventions for those still early in their substance abuse
• Clinical and administrative strategies to make care more engaging
• Strategies for the use of medications at each stage of care
• Adaptive, stepped care models that adjust treatment over time on the basis of changes in patients’ symptoms and status
• Affordable telephone and internet-based continuous monitoring and extended care models
• Automated data collection systems that produce clinically meaningful data, reduce provider burden and provide clinically and administratively useful reports.

Overcoming Regulatory Barriers to Continuous Monitoring and Recovery

The Center for Policy Analysis and Research at the Treatment Research Institute supports the work of TRI’s C3 scientists by analyzing government purchasing practices, contracting regulations, and other processes that may inhibit adoption of best clinical practices. Directed by former SAMHSA official Mady Chalk, Ph.D., the same rigorous standards of scientific inquiry are applied to develop, evaluate and disseminate exemplary government practices. Chalk works with C3 investigators to identify regulatory roadblocks to adoption of new addiction management and continuing care protocols. In her more than 25 years in the field of addictions, Dr. Chalk has worked with over 30 single state agencies and even more municipal governments to create financing policies, incentives, and support systems to improve access and retain patients in treatment.