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Richard A. Rawson chaired and Felipe Castro and Ewa Stamper served on the 15-member consensus panel that created SAMHSA’s TIP 33: Treatment for Stimulant Use Disorders.  Richard A. Rawson: The paper struck me first of all as a valuable personal account of a treatment program achieving positive outcomes with methamphetamine abusers. There has been a pervasive, unsubstantiated rumor that meth abusers do not respond to treatment. Recent studies (e.g., Hser, Evans, and Huang, 2005; Rawson et al., 2004; Roll et al., 2006) have begun to dispel that myth and prove that community treatment can produce results. The Prairie Ridge experience provides a clear instance of that.  I am pleased that Mr. Hansen felt that the TIP enhanced the tools and strategies they were using, and that it got a positive response from the staff.  Ewa Stamper: In my opinion, the program used the TIP extremely appropriately. They understood the most important thing, which was the client-centered, nonrigid approach. They also adopted the TIP’s way of looking at relapse as a normal phenomenon in early recovery rather than treatment failure, and the need for a rest period before starting treatment. They got the key concepts; the details aren’t so important.  Felipe Castro: Prairie Ridge seems to have done a good job of taking good science and modifying it as necessary to make it work in their circumstances. Unfortunately, other programs sometimes change things they don’t like, take things out that aren’t convenient, and end up with a watered-down rendition of the treatment that is unlikely to be effective. I call that mis-adaptation, as opposed to adaptation.  Rawson: We didn’t intend the document to be a treatment manual. Our idea was to introduce ideas and concepts and allow clinicians to employ those they found useful. In that light, Mr. Hansen’s struggles to apply TIP 33 with mixed groups of patients, not all of whom abused meth, were very instructive to read about. While there is good agreement that the patient-centered approach applies to all drug treatments, there have not been a lot of comparative studies on whether a particular set of protocols that was designed to treat one set of patients can also be used successfully with another. Without those data, I think clinicians logically should determine for themselves which strategies to apply widely and which only narrowly.  Castro: It is inevitable that clinical judgment will come into play in these situations, but it is important that these decisions aren’t made haphazardly. Ideally, we should be able to teach clinicians how to make adaptations based on their local situation without removing the treatment from the context of the original, evidence-based approach.  Stamper: I was especially impressed by the spirit of continuing education and openness to new ideas among the staff at Prairie Ridge. Unfortunately, I don’t think that’s typical of rural or smaller centers. At least here in Hawaii, treatment providers sometimes tend to distance themselves from the research community and to be entrenched in what they know and what works for them.

Response: Tipsters Weigh In: Putting Good Science to Work