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TRAILBLAZING ADDICTION RESEARCHER PLANS "CONSUMER REPORT" ON EFFECTIVENESS OF TREATMENT
A. Thomas McLellan, Ph.D. Named Robert Wood Johnson Foundation Innovator

(Princeton, NJ, July 23, 2003) - A. Thomas McLellan, Ph.D., has spent most of his career researching the effectiveness and quality of substance abuse treatment, while working to reduce the stigma attached to addiction. After his own frustrating search for an effective substance abuse treatment for his relative, McLellan founded a research center -- Philadelphia's Treatment Research Institute. Now, he hopes to use funds from a Robert Wood Johnson Foundation Innovators Combating Substance Abuse award to develop an easy-to-understand guide to addiction treatments and to publish that guide in a format similar to those published by Consumer Reports. The work will also be published in other formats, including a Web version, and refreshed annually with new research.

Among his many accomplishments, McLellan developed two of the most practical and widely used methods of assessing addiction severity and treatment success - measurement tools that have revolutionized how addiction treatment is delivered worldwide. He then set out to change how addiction is perceived, comparing it to such chronic illnesses as high blood pressure, diabetes, and asthma in a seminal article in the Journal of the American Medical Association (JAMA) in 2000.

"Addiction should be thought of as a chronic illness," McLellan says. "We found, for example, that 40% of hypertension is related to lifestyle choices and can't be attributed to genetics. The statistics for some forms of addiction are nearly identical, and alcoholism may be up to 100% genetically predetermined. So why don't we treat addiction as a disease?" McLellan's JAMA paper and other research in this area paved the way for mainstream medicine and policy-makers to re-think their views on addiction and how best to treat it.

In the 1970s, McLellan had his doctorate and was doing psychological research. But he abruptly changed direction after an exposure to the effects of substance abuse. "I got a job at a VA hospital and saw the terrible toll addiction was taking on Vietnam-era vets," he says. He dedicated himself to addiction research and continued working within the Veterans Administration for 25 years.

A Universal Standard for Measuring Addiction and its Treatment

During the 1970s through the 1990s McLellan and his colleagues developed, tested and disseminated the Addiction Severity Index (ASI) and the Treatment Services Review (TSR), now the most widely used addiction measurement instruments in the world. The tools are used universally to gauge a patient's condition and to provide insights into the nature of the treatment process.

McLellan's ASI and TSR tools are easy to learn and informative to treatment providers. To encourage their wide adoption in the field, McLellan committed to making the instruments available for free, although he could have easily charged for their use. The tools remain in the public domain and are utilized in a variety of patient care settings. They involve learning fundamental interviewing skills, including a step-by-step method for eliciting answers to questions. Several companies have created software and training packages for both clinical and research users. The tools, used internationally, have been translated into 20 languages.

Finding the Best Treatment When Addiction Strikes Home

In the early 1990s, McLellan's career took another turn. By then a professor of psychiatry at the University of Pennsylvania School and Medicine, "I had been growing increasingly frustrated with the lack of direct impact of research on treatment and policy," he says. "This general frustration turned to personal despair when addiction hit my own family." He tried with limited success to find the best treatment for a close relative. "At that point I resolved that the rest of my career would be devoted to finding and promoting real solutions to addiction - not just idealized forms of care."

McLellan and his Penn colleagues put together a research team, and in 1992 founded the Treatment Research Institute (TRI). TRI is an independent, not-for-profit institute that works in real-world settings to develop practical solutions to contemporary addiction problems. TRI now helps judges improve their decision-making in drug court cases and assists welfare programs in creating improved interventions for substance-dependent women. McLellan and the TRI team are also helping mainstream physicians integrate substance abuse interventions into the treatments of chronic hypertension, diabetes, asthma, pain and depression. Their most recent work begins development of performance monitoring systems to bring accountability and new sources of revenue into the substance abuse treatment system.

The Next Step: Helping Consumers Understand Addiction Treatment

Now, McLellan has come up with a novel idea with potentially important ramifications for substance abuse treatment: he plans to consolidate existing scientific reviews covering decades of research literature on addiction treatment and to distill those scientific findings into common, understandable language, using metrics popularized by Consumer Reports. "Consumer Reports has the most highly developed procedure for evaluating a range of services and products," says McLellan. "It is well-conceived, objective and understandable." He has spoken with the publication's editors, and they are anxious to see his results.

McLellan and two colleagues (Michael Prendergast from UCLA and John Finney from Stanford and the Palo Alto VA Medical Center) will translate the findings of more than 350 peer-reviewed research studies conducted over the past 15 years into everyday language, subjecting treatment components to a standardized scoring system that will communicate the strength of evidence for each treatment. He sees the publication of such a scoring system as a way to move shared knowledge forward. He also plans to publish his results in a peer-reviewed scientific journal, and in a Web document, giving visitors to the Journal of Substance Abuse Treatment Web site the ability to click on any of the scoring symbols in order to read citations that were used as a basis for the rating.

The Consumer Reports project will be accomplished under the auspices of The Robert Wood Johnson Foundation Innovators Combating Substance Abuse awards program. McLellan and four others were recently named "Innovators" as part of a program that recognizes leaders in the fields of substance abuse treatment, prevention, and policy development, and brings attention to their groundbreaking work. The program also provides an opportunity for awardees to undertake projects they might not otherwise be able to complete.

Innovators Combating Substance Abuse is a national program of The Robert Wood Johnson Foundation that recognizes and rewards those who have made substantial, innovative contributions of national significance in the field of substance abuse. Each award includes a grant of $300,000, which is used to conduct a project over a period of up to three years that advances the field. The program addresses problems related to alcohol, tobacco and illicit drugs, through education, advocacy, treatment and policy research and reform at the national, state and local levels. The Innovators program is run by a national program office at The Johns Hopkins University School of Medicine.

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NOTE TO LOCAL EDITORS: Thomas McLellan is a resident of Philadelphia.