Morning Zen

Mr. President, Science Matters: Build Back NREPP NOW (the National Registry of Evidence-based Programs and Practices)

April 16, 2021

Dear Mr. President:

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Nation experienced the silencing of proven science to prevent, moderate, treat and recover from mental, emotional, behavioral disorders, including serious mental illnesses and addictions. The former Administration removed all traces of scientifically proven strategies that regular citizens, families, local leaders, schools, and communities could review and chose from to better the lives of loved ones, schools, communities, and more. It was an act of “cancel culture” of knowledge. The former Trump-appointed SAMSHA administration killed the National Registry for Evidence-Based Programs and Practices (NREPP)—used by tens of thousands of people and organizations every year to understand what strategies might be helpful.

It was as if every public library in the country banished Consumers’ Report, a staple that normal citizens use to spend their money wisely. Families, schools, clinics, clinicians, hospitals, and policymakers need usable info to make wise choices with local, state, and national funds for prevention and treatment.

Suppose you are a top-tier researcher, a grad student, clinician, or top policy leader. In that case, you know how to use the National Library of Medicine (pubmed.gov) or PsycInfo (the American Psychological Association) to find such strategies. But that can take a great deal of time searching, reading, and digesting all the advances. Many people want reliable information about practical, proven ways to prevent or improve upon mental, emotional, behavioral, and serious psychiatric or substance abuse disorders. Of course, you can read the Institute of Medicine or Surgeon General Reports—but those are not written for where the tires meet the road, let alone which directions to take on that road.

Most American individuals, organizations, and funders cannot hire a Ph.D. scientist like my colleagues and I to tell them about:

  • An evidence-based program proven to prevent child abuse at a population level for about $7 per child.
  • A proven therapy (about 300 published studies) that can successfully treat opiate addictions in any community in America, even if implemented by non-clinical local citizens—from released prisoners, to poor Black neighborhoods or among the hollows of West Virginia. 
  • A simple non-curricular approach that can dramatically improve reading and math scores, which was also part of the research team responsible for the famous Meaningful Differences study—so that inner-city kids test scores mirror white upper-middle-class families [1, 2].
  • A grade-school strategy proven to prevent virtually every addiction, mental health problem, and suicide was originally invented by a teacher 50+ years ago [3].
  • Or a change in the school lunch program for the Department of Defense PX food that could improve students’ behavior and mental health, or reduce suicide among active-duty military, based on nearly a hundred studies at the National Institute on Alcohol and Alcohol Abuse [4-12].

Yes, Mr. President, America has tested and proven strategies to reverse early DSM disorders in children, prevent youth suicide, and prevent virtually every addiction. Many of the same strategies reverse the effects of historic disparities—whether it’s poor kids in the hallows of West Virginia, inner-cities, or on tribal lands. The same science also helps all the middle-class and well-to-do families with their children’s mental health crises, from addictions to suicides. All that is the good news.

America’s intellectual greatness grew from the Enlightenment by inspired people who were experimentalists like Benjamin Franklin. As a country, we also grew more creative because the Indigenous Peoples of the Western Hemisphere were extraordinarily adept at solving environmental challenges across the vast arc of the continent. While forbidden to hold patents, many African American Slaves were also incredible inventors. In America, we have lots of intelligent minds. Let’s use them.

The National Registry of Evidence Programs and Practices (NREPP) held hundreds of reviewed practices that could better lives. Some of the strategies are truly lifesavers. Some prevented ACE’s for less than $10 [13]. Some practices prevent suicide in the first instance [14]. Some simple strategies promise long-lasting relief from psychosis [15, 16], without new medication. A simple behavioral strategy reduces adolescent tobacco use across states [17]. The NIDA-funded opiate/cocaine treatment strategy can be implemented well-meaning adults in the community, from church groups to recovery groups [18-23].

I cannot find rational, medical, scientific, or spiritual reasons to burn all the books, papers, manuals, and procedures that can prevent, reduce, or heal the terrible mental, behavioral, and psychiatric disorders ripping through America. I can intuit what, or who might benefit—if all that knowledge was kept from parents, families, spouses, lovers, schools, social workers, spiritual leaders, doctors, hospitals, the media, or policymakers. 

The bad news is that nobody can easily find those tested and well-proven strategies, except people like me. Turning OFF National Registry of Programs and Practices (NREPP) made it nearly impossible for good citizens, local officials, and advocates to find proven and tested strategies to prevent, intervene, and even treat serious addictions and serious mental health disorders. 

Mr. President, your appointees and you need to know the best scalable strategies have been tested their practicality in the real world, not just tightly controlled clinical studies. Some have been scaled up and tested in the real world with Federal, state, county/city, or private funds. None of these proven strategies are advertised on TV, Cable, in newspapers. None of these proven strategies, many once listed in NREPP, cost close to the price of a high-priced DC consultant briefing hard-working government servants and officials all over this country. We can do better.

You and your team, Mr. President, want their kids, their families, their neighbors, their schools, and businesses to be free from the epidemic scourge of mental health and addictions that afflicts at least half our children by age 18. More and more meds—as advertised on TV —are not going to fix it or end the nightmare for families, business owners, law enforcement, and community leaders.

Mr. President, there are proven, scientific strategies—with decades of science primarily funded by the US Government—that could reduce violent crime, addictions, mental illnesses, and historic disparities while improving educational attainment and meaningful employment. Those strategies are detailed in Institute of Medicine Reports and Surgeon General Reports. If people know what to look for, that research is largely indexed by the National Library of Medicine (www.pubmed.gov). American citizens and most users of practical science don’t have the time or experience to do those searches. That’s been part of my job to find and review such literature for almost 50 years.

Maybe, we could have a beer and talk about it. Oh, give the order to SAMSHA to put NREPP back up. That would be a damn good start to bringing back science and sane policy for the people and accessible by the people.


References

1. Greenwood, C.R., et al., Primary intervention: A means of preventing special education? Evidence-based reading practices for response to intervention., 2007: p. 73-103.

2. Kamps, D.M., et al., The efficacy of ClassWide peer tutoring in middle schools. Education & Treatment of Children, 2008. 31(2): p. 119-152.

3. Kellam, S.G., et al., The impact of the good behavior game, a universal classroom-based preventive intervention in first and second grades, on high-risk sexual behaviors and drug abuse and dependence disorders into young adulthood. Prevention Science, 2014. 15(Suppl 1): p. S6-S18.

4. Raine, A., et al., Omega-3 (ω-3) and social skills interventions for reactive aggression and childhood externalizing behavior problems: a randomized, stratified, double-blind, placebo-controlled, factorial trial. Psychol Med, 2019. 49(2): p. 335-344.

5. Raine, A., et al., Nutritional supplementation to reduce child aggression: a randomized, stratified, single-blind, factorial trial. J Child Psychol Psychiatry, 2016. 57(9): p. 1038-46.

6. Raine, A., et al., Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial. J Child Psychol Psychiatry, 2015. 56(5): p. 509-20.

7. Hibbeln, J.R. and R.V. Gow, The potential for military diets to reduce depression, suicide, and impulsive aggression: a review of current evidence for omega-3 and omega-6 fatty acids. Mil Med, 2014. 179(11 Suppl): p. 117-28.

8. Marriott, B.P., et al., Understanding diet and modeling changes in the omega-3 and omega-6 fatty acid composition of US garrison foods for active-duty personnel. Mil Med, 2014. 179(11 Suppl): p. 168-75.

9. Hamazaki, T., et al., The safety of fish oils for those whose risk of injury is high. Mil Med, 2014. 179(11 Suppl): p. 134-7.

10. Coulter, I.D., The response of an expert panel to Nutritional armor for the warfighter: can omega-3 fatty acids enhance stress resilience, wellness, and military performance? Mil Med, 2014. 179(11 Suppl): p. 192-8.

11. Lewis, M.D., et al., Suicide deaths of active-duty US military and omega-3 fatty-acid status: a case-control comparison. J Clin Psychiatry, 2011. 72(12): p. 1585-90.

12. Lewis, M.D. and J. Bailes, Neuroprotection for the warrior: dietary supplementation with omega-3 fatty acids. Mil Med, 2011. 176(10): p. 1120-7.

13. Prinz, R.J., et al., Population-based prevention of child maltreatment: The US Triple P system population trial. Prevention Science, 2009. 10(1): p. 1-12.

14. Wilcox, H.C., et al., The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 2008(Special Issue): p. 14.

15. Bach, P., S.C. Hayes, and R. Gallop, Long-Term Effects of Brief Acceptance and Commitment Therapy for Psychosis. Behav Modif, 2011.

16. Bach, P. and S.C. Hayes, The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting & Clinical Psychology, 2002. 70(5): p. 1129-1139.

17. Wilson, D.S., et al., Evolving the Future: Toward a Science of Intentional Change. Brain and Behavioral Sciences, 2014. 37(4): p. 395-416.

18. Petry, N.M., Contingency management for substance abuse treatment: A guide to implementing evidence-based practice. 2012: New York, NY, US: Routledge/Taylor & Francis Group. xiii, 320.

19. Petry, N.M., J. Weinstock, and S.M. Alessi, A randomized trial of contingency management delivered in the context of group counseling. J Consult Clin Psychol, 2011. 79(5): p. 686-96.

20. Petry, N.M. and J.M. Roll, Amount of earnings during prize contingency management treatment is associated with posttreatment abstinence outcomes. Exp Clin Psychopharmacol, 2011.

21. Petry, N.M., C.J. Rash, and C.J. Easton, Contingency management treatment in substance abusers with and without legal problems. J Am Acad Psychiatry Law, 2011. 39(3): p. 370-8.

22. Petry, N.M., J.D. Ford, and D. Barry, Contingency management is especially efficacious in engendering long durations of abstinence in patients with sexual abuse histories. Psychol Addict Behav, 2011. 25(2): p. 293-300.

23. Petry, N.M., S.M. Alessi, and D.M. Ledgerwood, Contingency management delivered by community therapists in outpatient settings. Drug Alcohol Depend, 2011.

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About the Author

Dennis Embry

Dennis Embry is a prominent prevention scientist in the United States and Canada, trained as a clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. Dr. Embry serves as a National Advisory Council member and Chief Science Advisor to the Children’s Mental Health Network.

The Child Welfare League of America has recognized Dr. Dennis Embry as one of the 100 Champions for Children. As part of CWLA’s 100th-anniversary celebration, they chose to recognize the exceptional commitment of individuals, organizations, and corporations who serve as champions for children and those who work on their behalf. Dennis Embry has devoted a lifetime of service on behalf of young children and their families.

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