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Thank you, John Imhof! The Journal of Substance Abuse Treatment enters its third decade
Journal of Substance Abuse Treatment 20 (2001) 107 ± 109
Editorial
Thank you, John Imhof ! The Journal of Substance Abuse Treatment enters its third decade 1. Introduction
The field of substance abuse treatment owes John Imhof a sincere and longstanding debt of thanks for his vision, tireless work, scholarship, and practicality. Before the founding of the Journal of Substance Abuse Treatment (JSAT ) by Dr. Imhof, there was no scholarly journal devoted to the systematic study, development, and dissemination of treatments for addiction to alcohol, nicotine, and other drugs. There were, of course, journals that published articles in this area, but none were devoted to the treatment field. Since its founding, JSAT and John have described, evaluated, and discussed many treatment-relevant issues, including
an emerging heroin epidemic AIDS, tuberculosis, and hepatitis C epidemics ``crack cocaine,'' ``ice,'' methamphetamine, and ``club drug'' epidemics CARF1 and Joint Commission2 accreditation standards managed care national outcome studies, such as TOPS,3 DATOS,4 NTIES,5 and Project MATCH6 ``culturally sensitive'' treatments ``harm reduction'' relapse prevention therapy, brief interventions, motivational enhancement therapy, cognitive behavioral therapy, 12-step facilitation therapy, and many other therapeutic approaches
1 The Rehabilitation Accreditation Commission (formerly Commission on Accreditation of Rehabilitation Facilities). 2
Joint Commission on Accreditation of Healthcare Organizations.
3
Treatment Outcome Prospective StudyÐfunded by the National Institute on Drug Abuse.
methadone, buprenorphine, naltrexone, acamprosate, andÐat this writingÐ an emerging heroin epidemic.
Throughout all, JSAT has contributed research-based empiricism mixed with clinical sensitivity and practicality to inform these issues. Indeed, one of the hallmarks of JSAT's contribution under John Imhof's leadership has been the opportunity for clinicians, researchers, and policy makers in the substance abuse treatment field to contribute to these debates in a spirit of mutual respectÐbut always with a singular focus on improved care for the patient. I believe JSAT has done this better than any other journal in our field. Without John, his vision, and his determination to develop this field, none of this could have happened.
2. Continuing the focus on practice and research So it is with gratitude for all of John's work, mixed with trepidation at the task of working in his shadow, that I have taken on the responsibility for carrying on the work that John has so capably begun. Like John, I am committed to having JSAT remain focused on combining the joint perspectives of practice and research. Thus, JSAT will continue to seek reviews, training and educational articles, and especially original research articles that are meaningful to the treatment of nicotine, alcohol, and other forms of drug dependence. JSAT will continue to serve treatment practitioners from all disciplines (medicine, nursing, social work, psychology, counseling) in both private and public sectors, including those involved in schools, health centers, community agencies, correctional facilities, and individual practices. As we move forward with John's legacy, JSAT articles will use the tools of science and research to examine and discuss treatment components, techniques, and approaches.
4
Drug Abuse Treatment Outcome StudyÐfunded by the National Institute on Drug Abuse. 5
National Treatment Improvement Evaluation StudyÐfunded by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. 6 Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH)Ðfunded by the National Institute on Alcohol Abuse and Alcoholism.
3. Treatment-relevant research topics This may be the most excitingÐif not challengingÐtime to be in the substance abuse treatment field. There is no shortage of clinical issues, policy matters, or research discoveries that will affect the manner in which addiction
0740-5472/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII: S 0 7 4 0 - 5 4 7 2 ( 0 1 ) 0 0 1 6 2 - 3
108
Editorial / Journal of Substance Abuse Treatment 20 (2001) 107 ± 109
treatments are delivered and the results of those treatments. Here I list only a few of the issues that JSAT will be focused upon in the coming years: The combining of pharmacological and therapeutic approaches in attractive and cost-effective ways. There are many well-tested medications for the treatment of alcohol, nicotine, and heroinÐbut not marijuana, cocaine, or methamphetamineÐdependence. There are also proven counseling techniques for opiate, alcohol, and cocaine addiction (cognitive behavioral treatment, motivational enhancement treatment, 12-step facilitation, and others). How do these proven medications and therapies fit together, especially in contemporary settings? What is the appropriate focus of counseling and therapy in the context of medicationÐadherence to the medication, development of complementary behavioral changes, or both? These are lessons that therapists and counselors in the mental health field have had to learn, and there may be important information from their experience. Maintenance of the gains from substance abuse treatment after the end of formal care. Traditionally, Alcoholics Anonymous/Narcotics Anonymous meetings have been virtually the only way for recovering persons to get the community support and encouragement they need to maintain behaviors that have been changed during treatment. In other areas of medicine, the treatment team performs telephone monitoring, home visits and/or outreach to maintain the reductions in symptoms and the behavioral changes that sustain recovery. Is simple monitoring of symptoms by telephone or visit adequate in substance-abusing populations, or is there a need for continuing therapy, community support, or both to maintain treatment-initiated changes? The effects of insurance parity on substance abuse treatment. The federal government has required health insurance companies to offer equal benefits and coverage for surgical, general medical, mental health, and substance abuse illnesses in all policies sold to federal employees. Will primary care physicians be interested in/able to screen, diagnose, and treat alcohol- and drug-dependent patients? Will traditional treatment programs get more referrals from primary care practitionersÐor will family medicine practitioners manage the care for substance-abusing patients as they have for diabetic and hypertensive patients? Will traditional medical management procedures be effective with substance-dependent patients? Studies of addiction treatment interventions in nontraditional sites (schools, office sites, shopping centers, physician offices, welfare offices, health clubs). There are many persons who drink too much or use drugs too frequently for their health and social lives. They may not meet criteria for ``abuse or dependence,'' but they may be on their way toward meeting those criteria. These people are typically not inclined to attend Alcoholics Anonymous meetings or to go to formal drug abuse treatment. What can be done to offer these individuals interventions that could forestall the development of dependence? For individuals who do meet
criteria for drug or alcohol dependence, what kinds of treatment-oriented interventions could be used effectively in other, nontraditional settings? The role of the office-based practitioner in substance abuse treatment. There is a large and very diverse group of professionals (clergy, counselors, psychiatrists, traditional healers, to name a few) who treat addiction from their private offices. Very little research has been performed on the office-based treatment of addiction. What types of substance-dependent patients are ``suitable'' for treatment in an office-based setting? Is group therapy used or just individual therapy? How often are the sessions held, and how long does the treatment last? Are spouses/family invited to take part? Are urinalyses performed and Breathalyzer readings taken? What criteria are used to decide that treatment is not working? What types of patients might do betterÐand worseÐin office-based settings? The role of genetic counseling in substance abuse treatment. There is clear evidence for genetic heritability of alcohol, cocaine, and opiate dependence, and there is work now investigating the genetic contribution in marijuana dependence. How is family history information used in addiction treatment and to what effect? Should treatment providers discuss the genetic vulnerability to addiction in the children of their adult patients? Could this be an opportunity for a combined treatment and prevention intervention? Developing effective ways of improving treatment practices. The substance abuse treatment field is flooded with new findings regarding improved methods and interventions in the treatment of addiction. I am not talking about arcane and remote laboratory findings. I mean proven methods that have been tested in ``real-world'' settings. Yet, as in so many other fields, few of these new findings ever get incorporated. JSAT is very interested in well-conceived ``translational research'' studies testing new methods of teaching, information dissemination, and technology transfer to bring about positive change in treatment practices.
4. Conclusion This is only a partial listing of the many issues facing contemporary substance abuse treatment providers and researchers. Thus, there is much we do not know. But thanks to the work of John Imhof and the many authors who have contributed to JSAT over the past years, there is much we have learned. Our responsibility to those affected by nicotine, alcohol, and other drug problems demands that we keep addressing these and other issues. As we move into the third decade of JSAT, readers will notice some changes in formatting, and authors should notice improvements in manuscript processing and reviewÐthanks to the capable work of our Managing Editor, Janice Jerrells. However, as we move into the future we will continue to do what John Imhof started: use clinical sensitivity and practicality to translate research findings into more effective care.
Editorial / Journal of Substance Abuse Treatment 20 (2001) 107 ± 109
Acknowledgments Supported by grants from the Department of Veterans Affairs, the National Institute on Drug Abuse, the Center for Substance Abuse Treatment, and the Robert Wood Johnson Foundation.
109
A. Thomas McLellan, Ph.D. The Treatment Research Institute at The Penn-VA Center for Studies of Addiction, Philadelphia, PA 19106-3475, USA
Editorial
Thank you, John Imhof ! The Journal of Substance Abuse Treatment enters its third decade 1. Introduction
The field of substance abuse treatment owes John Imhof a sincere and longstanding debt of thanks for his vision, tireless work, scholarship, and practicality. Before the founding of the Journal of Substance Abuse Treatment (JSAT ) by Dr. Imhof, there was no scholarly journal devoted to the systematic study, development, and dissemination of treatments for addiction to alcohol, nicotine, and other drugs. There were, of course, journals that published articles in this area, but none were devoted to the treatment field. Since its founding, JSAT and John have described, evaluated, and discussed many treatment-relevant issues, including
an emerging heroin epidemic AIDS, tuberculosis, and hepatitis C epidemics ``crack cocaine,'' ``ice,'' methamphetamine, and ``club drug'' epidemics CARF1 and Joint Commission2 accreditation standards managed care national outcome studies, such as TOPS,3 DATOS,4 NTIES,5 and Project MATCH6 ``culturally sensitive'' treatments ``harm reduction'' relapse prevention therapy, brief interventions, motivational enhancement therapy, cognitive behavioral therapy, 12-step facilitation therapy, and many other therapeutic approaches
1 The Rehabilitation Accreditation Commission (formerly Commission on Accreditation of Rehabilitation Facilities). 2
Joint Commission on Accreditation of Healthcare Organizations.
3
Treatment Outcome Prospective StudyÐfunded by the National Institute on Drug Abuse.
methadone, buprenorphine, naltrexone, acamprosate, andÐat this writingÐ an emerging heroin epidemic.
Throughout all, JSAT has contributed research-based empiricism mixed with clinical sensitivity and practicality to inform these issues. Indeed, one of the hallmarks of JSAT's contribution under John Imhof's leadership has been the opportunity for clinicians, researchers, and policy makers in the substance abuse treatment field to contribute to these debates in a spirit of mutual respectÐbut always with a singular focus on improved care for the patient. I believe JSAT has done this better than any other journal in our field. Without John, his vision, and his determination to develop this field, none of this could have happened.
2. Continuing the focus on practice and research So it is with gratitude for all of John's work, mixed with trepidation at the task of working in his shadow, that I have taken on the responsibility for carrying on the work that John has so capably begun. Like John, I am committed to having JSAT remain focused on combining the joint perspectives of practice and research. Thus, JSAT will continue to seek reviews, training and educational articles, and especially original research articles that are meaningful to the treatment of nicotine, alcohol, and other forms of drug dependence. JSAT will continue to serve treatment practitioners from all disciplines (medicine, nursing, social work, psychology, counseling) in both private and public sectors, including those involved in schools, health centers, community agencies, correctional facilities, and individual practices. As we move forward with John's legacy, JSAT articles will use the tools of science and research to examine and discuss treatment components, techniques, and approaches.
4
Drug Abuse Treatment Outcome StudyÐfunded by the National Institute on Drug Abuse. 5
National Treatment Improvement Evaluation StudyÐfunded by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. 6 Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH)Ðfunded by the National Institute on Alcohol Abuse and Alcoholism.
3. Treatment-relevant research topics This may be the most excitingÐif not challengingÐtime to be in the substance abuse treatment field. There is no shortage of clinical issues, policy matters, or research discoveries that will affect the manner in which addiction
0740-5472/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII: S 0 7 4 0 - 5 4 7 2 ( 0 1 ) 0 0 1 6 2 - 3
108
Editorial / Journal of Substance Abuse Treatment 20 (2001) 107 ± 109
treatments are delivered and the results of those treatments. Here I list only a few of the issues that JSAT will be focused upon in the coming years: The combining of pharmacological and therapeutic approaches in attractive and cost-effective ways. There are many well-tested medications for the treatment of alcohol, nicotine, and heroinÐbut not marijuana, cocaine, or methamphetamineÐdependence. There are also proven counseling techniques for opiate, alcohol, and cocaine addiction (cognitive behavioral treatment, motivational enhancement treatment, 12-step facilitation, and others). How do these proven medications and therapies fit together, especially in contemporary settings? What is the appropriate focus of counseling and therapy in the context of medicationÐadherence to the medication, development of complementary behavioral changes, or both? These are lessons that therapists and counselors in the mental health field have had to learn, and there may be important information from their experience. Maintenance of the gains from substance abuse treatment after the end of formal care. Traditionally, Alcoholics Anonymous/Narcotics Anonymous meetings have been virtually the only way for recovering persons to get the community support and encouragement they need to maintain behaviors that have been changed during treatment. In other areas of medicine, the treatment team performs telephone monitoring, home visits and/or outreach to maintain the reductions in symptoms and the behavioral changes that sustain recovery. Is simple monitoring of symptoms by telephone or visit adequate in substance-abusing populations, or is there a need for continuing therapy, community support, or both to maintain treatment-initiated changes? The effects of insurance parity on substance abuse treatment. The federal government has required health insurance companies to offer equal benefits and coverage for surgical, general medical, mental health, and substance abuse illnesses in all policies sold to federal employees. Will primary care physicians be interested in/able to screen, diagnose, and treat alcohol- and drug-dependent patients? Will traditional treatment programs get more referrals from primary care practitionersÐor will family medicine practitioners manage the care for substance-abusing patients as they have for diabetic and hypertensive patients? Will traditional medical management procedures be effective with substance-dependent patients? Studies of addiction treatment interventions in nontraditional sites (schools, office sites, shopping centers, physician offices, welfare offices, health clubs). There are many persons who drink too much or use drugs too frequently for their health and social lives. They may not meet criteria for ``abuse or dependence,'' but they may be on their way toward meeting those criteria. These people are typically not inclined to attend Alcoholics Anonymous meetings or to go to formal drug abuse treatment. What can be done to offer these individuals interventions that could forestall the development of dependence? For individuals who do meet
criteria for drug or alcohol dependence, what kinds of treatment-oriented interventions could be used effectively in other, nontraditional settings? The role of the office-based practitioner in substance abuse treatment. There is a large and very diverse group of professionals (clergy, counselors, psychiatrists, traditional healers, to name a few) who treat addiction from their private offices. Very little research has been performed on the office-based treatment of addiction. What types of substance-dependent patients are ``suitable'' for treatment in an office-based setting? Is group therapy used or just individual therapy? How often are the sessions held, and how long does the treatment last? Are spouses/family invited to take part? Are urinalyses performed and Breathalyzer readings taken? What criteria are used to decide that treatment is not working? What types of patients might do betterÐand worseÐin office-based settings? The role of genetic counseling in substance abuse treatment. There is clear evidence for genetic heritability of alcohol, cocaine, and opiate dependence, and there is work now investigating the genetic contribution in marijuana dependence. How is family history information used in addiction treatment and to what effect? Should treatment providers discuss the genetic vulnerability to addiction in the children of their adult patients? Could this be an opportunity for a combined treatment and prevention intervention? Developing effective ways of improving treatment practices. The substance abuse treatment field is flooded with new findings regarding improved methods and interventions in the treatment of addiction. I am not talking about arcane and remote laboratory findings. I mean proven methods that have been tested in ``real-world'' settings. Yet, as in so many other fields, few of these new findings ever get incorporated. JSAT is very interested in well-conceived ``translational research'' studies testing new methods of teaching, information dissemination, and technology transfer to bring about positive change in treatment practices.
4. Conclusion This is only a partial listing of the many issues facing contemporary substance abuse treatment providers and researchers. Thus, there is much we do not know. But thanks to the work of John Imhof and the many authors who have contributed to JSAT over the past years, there is much we have learned. Our responsibility to those affected by nicotine, alcohol, and other drug problems demands that we keep addressing these and other issues. As we move into the third decade of JSAT, readers will notice some changes in formatting, and authors should notice improvements in manuscript processing and reviewÐthanks to the capable work of our Managing Editor, Janice Jerrells. However, as we move into the future we will continue to do what John Imhof started: use clinical sensitivity and practicality to translate research findings into more effective care.
Editorial / Journal of Substance Abuse Treatment 20 (2001) 107 ± 109
Acknowledgments Supported by grants from the Department of Veterans Affairs, the National Institute on Drug Abuse, the Center for Substance Abuse Treatment, and the Robert Wood Johnson Foundation.
109
A. Thomas McLellan, Ph.D. The Treatment Research Institute at The Penn-VA Center for Studies of Addiction, Philadelphia, PA 19106-3475, USA