NIDA

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NIDAs Public Health Division The Division of
Epidemiology, Services and Prevention Research

• Wilson M. Compton, M.D., M.P.E.
• Director, Division of Epidemiology, Services and
  Prevention Research
• National Institute on Drug Abuse
• Department of Health and Human Services

Penn State University 29 November 2006
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NIDA
National Institute on Drug Abuse
Office of the Director
Nora D. Volkow, MD
Director
Director, AIDS Research
Special Populations Office
Timothy P. Condon, Ph.D.
Deputy Director
Laura S. Rosenthal
EEO
Associate Director for Management
Office of Extramural Affairs
Office of Planning Resource Management
Office of Science Policy Communications
Center for the Clinical Trials Network
Intramural Research Program
Teresa Levitin, PhD
Laura Rosenthal
Timothy Condon, PhD
Betty Tai, PhD
Barry Hoffer, MD, PhD
Division of Epidemiology, Services Prevention
Research
Wilson Compton, MD, MPE
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DESPR Organization and Vision
DESPR seeks to improve the nations public
health by promoting integrated approaches to
understand and address interactions between
individuals and environments that contribute to
the continuum of problems related to drug use.
Our goal is to develop scientific knowledge
with clear application to practice and public
policy.
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First, a story exemplifying linkages of
Epidemiology, Prevention and Services
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Epidemiological Finding Childhood and Adult
Antisocial Behavior Strongly Associated with Drug
Use/Disorders
Odds Ratios for Lifetime Antisocial Personality
Disorder by Specific Drug Disorders, Reference
group is persons without the drug disorder
(NESARC Study, Compton 2004)
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From Longitudinal Epidemiology comes evidence
for a plausible pathway
Poor academic achievement
Early Aggression
Deviant peer association
Adolescent/Early Adult Antisocial Behavior and
Drug Abuse
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From Prevention comes tests of the theory and
tests of a plausible intervention strategy
Support for theory and development of practical
and useful interventions.
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From Prevention Reducing Early Aggressive
Behaviors Reduces Drug Use
Modified from Storr, et al., Drug and Alcohol
Dependence, 6651-60, 2002.
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From Prevention Enhancing Social Bonding Reduces
Violence
Hawkins, et al., Arch Pediatr Adolesc Med 1999
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From Services Early Interventions Can Be
Cost-Effective
Cost per Taxpayer Participant and
Crime Victims Net Benefit Nurse
Home Visiting Program 7,733 15,981 Seattle
Social Development Project
4,355 14,169 Big Brothers/Sisters Mentoring
1,054 4,524
Aos, et al., The Comparative Costs and Benefits
of Programs to Reduce Crime, Washington State
Institute for Public Policy, 2001
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Ongoing Problem To Reap Any Benefits From
Scientific Knowledge It Needs To Be Used In
Practice
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From Services Few Schools Use Effective
Prevention Programs
Ringwalt, et al. (2002), Prevention Science
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Thus, all three branches of DESPR contribute to a
unified story about pathways to drug use and how
to intervene in these pathways.
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And now A Few Key Findings
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Cigarette Smoking Declines Markedly Since
Mid-1990s
ERB
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Life Course View of Addiction Refines
Understanding of Recovery Benefit Cost
SRB
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Universal Family-based Prevention Interventions
Reduce Methamphetamine
PRB
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HIV Screening Can Be As Cost-Effective As
Screening for Hypertension and Other Medical
Conditions
DESPR
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DESPR provides a foundation for NIDAs Public
Health Mission.
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Priority Areas for NIDA
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Summary Drug Abuse Research Needs a Systems
Approach
social
DRUGS OF ABUSE
behavior
neuronal circuits
protein expression
genome
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DESPR 2006 Major Research Questions

1. What new theoretical approaches can inform our
   research?
2. What intrapersonal and environmental factors
   interact with each other and with genetic
   factors?
3. How can we blend science and services to
   measurably impact public health outcomes?

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Prevention 2006 Key Research Goal

• Develop and maximize use of high quality
  preventive interventions in real world settings
  through research on
• Individual factors
• Relationship of drug abuse prevention to HIV
  prevention
• Environmental strategies
• Community-based participatory research

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What are we doing to develop and promote these
themes?
Workgroups, Meetings, Publications, etc.
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Translational Research is NOT Unidirectional
There are Feedback Loops
Type 1
Type 2
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Bi-Directional Influences

• Basic science laboratories prevention
• Sensation Seeking
• Neurobehavioral disinhibition
• Early-onset antisocial behavior
• Psychiatric co-morbidity
• Stress reactivity
• Prevention basic neuroscience laboratories
• What are the biological mechanisms that explain
  the emergence of drug abuse during adolescence?
• What specific vulnerabilities are familial?
• What are the biological mediators of social
  interactions?

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Linking Public Health Research to Neuroscience
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Circuits Involved In Drug Abuse and Addiction
All Should Be Considered In Strategies to Prevent
and Treat Addiction
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(No Transcript)
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Promise of Translation HPA axis plasticity
Source Fisher P, OSLC
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Key Basic Epidemiology Finding Addiction is a
Developmental Disorder With Onset During
Adolescence
Source NESARC Study, 2001-2002
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Recent Studies Have Shown that Maturation of
the Brains Gray Matter Moves from Back to Front
Brain areas where volumes differ in adolescents
compared to young adults
Source Sowell, E.R. et al., Nature Neuroscience,
2(10), pp. 859-861, 1999
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During Adolescence the COGNITION-EMOTION
Connection is Still Undergoing Development
Amygdalo-cortical Sprouting Continues Into Early
Adulthood
Low-power light photomicrographs of
immunoperoxidase-labeled, biocytin-containing
amygdalofugal varicose fibers within the mPFC of
animals at 6 stages of development
Source Cunningham, M et al., J Comp Neurol 453,
pp 116-130, 2002.
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Implications

• Developmental differences must be considered in
  designing prevention strategies.
• Can frontal lobe functioning be strengthened?

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Translating Sensation Seeking Research into
Clinical Study Communications Research

• Sensation-Seeking Targeting
• (Palmgreen et al., 2001)
• Used Activation model of information exposure to
  design messages for target audiences
• RESULTS All 3 targeted television campaigns
  reversed upward trends in 30-day marijuana use
  among high SS

How will D2 receptor research inform this field?
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Community
Bedside
Bench
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Developing an intervention is only one part of
translating research into practice.
Access and Engagement
Organization Structure and Climate
Intervention
External Environment (stigma, financing)
Provider knowledge and behavior
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Interagency Collaborations are indispensable
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DHHS
SAMHSA
NIH
NIDA
NIDA
Collaborations to Translate Research Findings
Into Relevant Clinical Practice
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Testing the Communities That Care (CTC)
Prevention System
Research Centers
Coordinating Center
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Linking grant programs

• Braiding funding streams to enhance both
  research and services
• Each agency doing what it does best
• Examples
• Adolescent Services Including Brief Interventions
  (FY2003 with SAMHSA)
• Assessment and Brief Interventions in Primary
  Care (FY2004 with SAMHSA)
• NIDA Funding Research on CSAPs National SPF-SIG
  Program (FY2004)
• Service to Science Grants for State Substance
  Abuse Authorities (FY2005) and for CBOs (FY2006)

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Developing the Health Services Research Program
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NIDA Blue Ribbon Task Force on Health Services
Research
Co-Chairs Thomas McLellan, PhD,
Constance Weisner, DrPH, MSW Andrea
Barthwell, MD Caryn Blitz, PhD Rick
Catalano, PhD Mady Chalk, PhD
Linda Chinnia, MEd Lorraine Collins,
PhD Wilson Compton, MD, MPE
Michael Dennis, PhD Richard Frank, PhD
Warren Hewitt, MS James Inciardi, PhD
Marguerita Lightfoot, PhD Isaac Montoya,
PhD Claire Sterk, PhD Janet Wood,
MBA, MEd
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New Opportunities

• Science to Services
• Medical Settings
• Screening (especially SBIRTs)
• Prescription Drug Abuse (especially opioids)
• HIV
• Interactions
• Implementation Science
• New Theories
• Economics
• Organization/Management

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Division of Epidemiology, Services and Prevention
Research

• Providing a foundation for NIDAs public health
  mission.