Morning Zen

Whose Research is Better for Helping American People That SAMHSA Is Charged to Serve?

August 18, 2018

At my first combined National Advisory Council meeting, the Assistant Secretary, Dr. McCance-Katz was quite dismissive of any evidence-based practices on NREPP, both for prevention and treatment. I rather took scientific offense to her conclusion, as I hang out nationally and internationally with some of the smartest and most celebrated scientists doing this work. It’s even my guild, the Society for Prevention Research and the National Prevention Science Coalition for Saving Lives. The work of my colleagues and I in prevention science is cited in multiple Institute of Medicine and Surgeon General Reports, not to mention published in high-quality scientific journals.

During my very first meeting on the National Advisory Council, the Assistant Secretary opined that there were no evidence-based strategies on NREPP for serious addictions or serious mental illness. I knew that that was factually incorrect, and required correction. I spoke up, mentioning the contingency-management work of Nancy Petry on the “prize bowl” as NIDA single-most scientifically proven strategy to treat addictions and the work of Steven Hayes on Acceptance and Commitment Therapy (ACT), which significantly reduces rehospitalization from psychosis [1].

Dr. McCann-Katz tartly responded that people relapse as soon as Petry’s reinforcement system ends. I replied that that is factually incorrect based on high-quality experimental research, which contingency management is properly used [2]. For the life of me, I cannot understand why the Assistant Secretary would not be curious why or how a scientifically proven strategy contributes to better outcomes. Is contingency management or Acceptance and Commitment Therapy perfect? No, but they are much better than treatment as usual, using quite good science.

My scientific colleagues in the United States and I are increasingly concerned that the Assistant Secretary is blind to the incredible body of peer-reviewed research with high-quality randomized control studies funded by NICCHD, NIMH, NIAAA, CDC, IES, etc. This is not consistent with her stance on high-quality research.

Both Drs. McCance-Katz and Petry are powerful and productive women, with many publications on the National Library of Medicine (www.pubmed.gov). Both have histories of work in Connecticut. Dr. McCance-Katz has 102 pubmed.gov citations, and Dr. Nancy Petry has 332 publications on pubmed.gov. I feel completely dwarfed, having only 12 citations on pubmed.gov. I have only 3% of the citations that these incredible women combined. I should have citation envy.

At the advisory council, I sensed that Dr. McCance-Katz was dismissive when it came to learning about gold-standard research conducted outside her specialty. She may well have been burned by some touted strategy in her past. Unfortunately, Dr. McCance-Katz’s cursory review official statement about NREPP and lack of differentiation between the 2007 requirements and the 2015 change is harming treatment, intervention, and prevention in America. I hope the Assistant Secretary has the psychological flexibility to learn about the science she does not know, found in the legacy section of NREPP. The article by Dr. Sharon Hennessey brilliantly articulated the standards for those reviewers. The Assistant Secretary would be even more stunned to sit down with the new review panel convened by the Institute of Medicine to create a report on scaling up population-level prevention of mental, emotional, and behavioral disorders among young people, a sequel to the 2009 IOM Report [3].

Virtually every major scalable prevention, intervention, or treatment strategy highlighted by the CDC, Surgeon General Reports, IOM Reports, Blueprints, and European Union entities was scored high in 2007 criteria reviews in the original NREPP. Most have more potent studies to validate them since that time.

It’s inconsistent for the historic mission of SAMHSA to obliterate, by turning off a switch to the accumulated scientific treatment, intervention, and prevention treasures of NIDA, NIMH, NIAAA, NICHD, IES, CDC and foundations that are cataloged in 2007 (Legacy) NREPP. The legacy NREPP represents hundreds of millions of dollars and human hours of labor on the finest research in the world, funded mainly by the U.S. government. This is a motivational puzzle.

In human history, people ascending to power have sometimes destroyed or banned books, scourging those who created the scientific knowledge. Now, people in power only need only to erase hard drives and disconnect URL’s. Switching off NREPP destroyed knowledge for good people all over America who sought to use proven, scientific knowledge to better the lives of our children, adults, and their communities.

Thus, I’m left with a nagging, very uncomfortable question: Who benefits when proven, replicated scientific knowledge to prevent, intervene or treatment of mental, emotional, and behavioral disorders is less accessible?

References

  1. Bach P, Hayes SC, Gallop R: Long-term effects of brief acceptance and commitment therapy for psychosis. Behav Modif 2012, 36(2):165-181.
  2. Petry NM, Alessi SM, Rash CJ: Contingency management treatments decrease psychiatric symptoms. J Consult Clin Psychol 2013, 81(5):926-931.
  3. O’Connell ME, Boat T, Warner KE (eds.): Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: Institute of Medicine; National Research Council; 2009.
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About the Author

Dennis Embry

Dennis Embry is a prominent prevention scientist in the United States and Canada, trained as 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. His work and that of colleagues is cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America.

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