SCTR: Southern Consortium of the Clinical Trials Network
Guest: Dr. Kathleen Brady - Psychiatry & Behavioral Sciences, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: Dr. Kathleen Brady is Professor of Psychiatry and Director of the Southern Consortium of the Clinical Trials Network. Dr. Brady, tell us exactly what that position is and what the Clinical Trials Network is.
Dr. Kathleen Brady: The Clinical Trials Network is an initiative that’s funded by the National Institute on Drug Abuse with the main idea of bringing research and evidence-based treatment to frontline treatment settings. So, in order to do this, what NID, or the National Institute on Drug Abuse, has done is fund 17 centers, distributed throughout the country. And, in each of these centers, an academic setting; like me and my group at MUSC, partner with frontline treatment settings throughout the region in order to conduct clinical trials in those settings. And, it’s a two-way street in terms of communication. We get feedback from the frontline settings about the kind of research that we’re conducting and the kinds of treatments that we’re proposing.
Dr. Linda Austin: Can you give some examples of the kinds of projects that you’ll be partnering on?
Dr. Kathleen Brady: Well, one of my favorite projects that we partnered on very early in the Clinical Trials Network, I think, is a great example. It’s an example where the idea for the research trial came from the community. This was where the Betty Ford Clinic, out in California, had a certain protocol that ensured that what people got from an inpatient setting, they got in aftercare as well. In drug abuse treatment, this is one of the main places where people sort of fall off the map and relapse to use.
So, they suggested that we try to get the evidence to see if their protocol would work in other settings. So, one of the first trials that we conducted here in South Carolina involved a number of clinicians from Morris Village, and other treatment settings here, going to the Betty Ford Clinic to learn exactly how they did this introduction, or liaison, to aftercare and then implementing that in South Carolina.
Dr. Linda Austin: The philosophy behind the Clinical Trials Network strikes me as being part of a new way of conceptualizing research, generally. That is, in the old days, researchers were, you know, sort of mad scientists back in their laboratory with bubbling test tubes and so forth. Now, research is, really, very integrated with clinical practice, and this sounds like it’s part of that trend.
Dr. Kathleen Brady. That’s absolutely correct. That’s one of the main points of this initiative; to make sure that researchers don’t get so disconnected from what’s actually happening in treatment settings, that the questions they’re asking, or methods they’re pursuing, are really relevant to practice. So, in fact, there’s a lot of emphasis on bidirectionality and two-way communication in every single research project that we even think about doing. The first thing we do is bring it to the treatment providers and say, Does this sound like something that would work; what are your thoughts?
Dr. Linda Austin: Dr. Brady, who are some of your community partners at this time?
Dr. Kathleen Brady: Well, we’ve partnered with the state substance abuse treatment system, DAODAS (Department of Alcohol and Other Drug Abuse Services), and we’ve partnered with the commission in Dorchester and Charleston County, Morris Village. But we’ve also partnered with sites in Atlanta; via Emory, in Mississippi. And, our latest consortium actually includes Duke and a number of treatment sites in North Carolina. So, we are the southern consortium. We consider ourselves in the Deep South. We cover the states of North Carolina, South Carolina, Georgia, Mississippi, and Tennessee.
Dr. Linda Austin: That’s really quite a large area. And, this is one of 17 such centers nationally, correct?
Dr. Kathleen Brady: Correct, yes.
Dr. Linda Austin: And, you are the director of this?
Dr. Kathleen Brady: Yes. I’m the director of our southern consortium, yes.
Dr. Linda Austin: How large a budget is this?
Dr. Kathleen Brady: Well, it depends on how many trials you do. The infrastructure is one to two million a year just to maintain all these sites in a research-ready position, and then each trial that you have has its own budget. So, it makes sense. The more research you do; the more studies you’re conducting, the larger your budget would be that year.
Dr. Linda Austin: Do you personally have any ideas that you’re thinking about as future research directions?
Dr. Kathleen Brady: Well, I’m very interested in the area of post-traumatic stress disorder and substance use disorders. Our group has actually developed a treatment; an integrated treatment, that takes elements of effective treatment for substance use disorders and matches those with elements of what we know are effective treatments for post-traumatic stress disorder. And so, I’m proposing that we test that integrated treatment in the Clinical Trials Network.
Dr. Linda Austin: Describe some of the details of that. It sounds really interesting.
Dr. Kathleen Brady: Well, for substance use disorders, one of the most effective talk therapies is cognitive behavioral, where you actually have people analyze their high-risk situations, come up with alternative strategies to drug use, and really try to bring to the conscious level some of the unconscious behaviors and decisions that they make that lead them into drug abuse.
So, we start with several sessions of that. And then, one of the most effective treatments for post-traumatic stress disorder is actually having the person relive, in the safe therapeutic setting, that trauma that is causing so many problems for them. It’s often been thought that you should not do that sort of exposure-based therapy with people that have substance use disorders because it will precipitate relapse. But our thought is, if we teach them cognitive behavioral strategies to prevent relapse and keep them in the safe environment of substance abuse treatment, we can then implement this effective exposure-based treatment and have improved outcomes.
Dr. Linda Austin: Dr. Brady, thanks so much.
Dr. Kathleen Brady: Thank you.