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Confederation of Northwest Addiction Research Centers: Addiction: Mechanisms, Prevention, Treatment,

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Title: Confederation of Northwest Addiction Research Centers: Addiction: Mechanisms, Prevention, Treatment,


1
Confederation of Northwest Addiction Research
Centers Addiction Mechanisms, Prevention,
Treatment, Conjoint 556
  • Lecture 1
  • Creation of 21st Century Addiction Science
  • Rico Catalano
  • Professor
  • School of Social Work
  • 543-6382

2
Con federation of Addiction Research Centers 150
faculty Major grants from NIAAA, NIDA, and
NIMH UW Centers Addictive Behaviors Research
Center Alcohol and Drug Abuse Institute Center
for Drug Addiction Research Center for Functional
Genomics HCV-Related Liver Disease Center for
Healthcare Improvement for Addictions, Mental
Illness and Medically Vulnerable
Populations Center for the Study of Health Risk
Behaviors Fetal Alcohol and Drug Unit Fetal
Alcohol Syndrome Diagnostic Prevention
Network Innovative Programs Research
Group Reconnecting Youth Research Group Social
Development Research Group
3
Why is Addiction a Problem?
  • Rates of alcohol, tobacco and other drug use
    begin early and increase through the mid 20s
  • Early use increases the risk of addiction
  • Consequences of alcohol, tobacco and drug use are
    great.
  • Addiction affects all strata of society
  • Costs of addiction are high including death, lost
    productivity, costs to society and families

4
Prevalence of Binge Drinking, Tobacco Use,
Marijuana Use, and Other Drug Use
5
Why is Addiction a Problem?
  • Rates of alcohol, tobacco and other drug use by
    children and adolescents and young adults are
    high
  • Early adolescent use increases the risk of
    addiction
  • Alcohol, tobacco and drug use have negative
    consequences.
  • Addiction affects all strata of society
  • Costs of addiction are high including death, lost
    productivity, costs to society and families

6
Adolescent Binge Drinking Trajectories
7
Both Early Chronic Bingers and Increasers had
Problems at Age 21
  • Early Chronic Bingers fewer completed high
    school, more were obese, and more had
    hypertension
  • Increasers were more likely to have a diagnosis
    of alcohol abuse or dependence

Hill, et al. 2000
8
Why is Addiction a Problem?
  • Rates of alcohol, tobacco and other drug use by
    children and adolescents and young adults are
    high
  • Early use increases the risk of addiction
  • Consequences of alcohol, tobacco and drug use are
    great.
  • Addiction affects all strata of society
  • Costs of addiction are high including death, lost
    productivity, costs to society and families

9
Why a New Addiction Science
  • Research conducted over the last thirty years has
    identified reliable predictors of use and
    addiction in the social environment and the
    individual
  • New research over the last 20 years has begun to
    identify biological and genetic factors involved
    in addiction processes
  • Research over the last 20 years has identified
    effective prevention and treatment programs to
    reduce problem use and addiction

10
  • The health and behavior problems of concern to us
    are predicted by malleable risk and protective
    factors in social environments and individuals.

11
Community
Family
School
Individual/Peer
12
Protective Factors
  • Individual Characteristics
  • High Intelligence
  • Resilient Temperament
  • Competencies and Skills
  • In each social domain (family, school, peer group
    and neighborhood)
  • Prosocial Opportunities
  • Reinforcement for Prosocial Involvement
  • Bonding
  • Healthy Beliefs and Clear Standards

13
Prevalence of 30 Day Alcohol Use by Number of
Risk and Protective Factors
14
Prevalence of 30 Day Marijuana UseBy Number of
Risk and Protective Factors
15
Prevalence of Any Other Illicit Drug Use(Past 30
Days)By Number of Risk and Protective Factors
16
Prevalence of Attacked to HurtBy Number of
Risk and Protective Factors
17
Prevalence of Other Problemsby Number of Risk
Factors
Bond, Thomas, Toumbourou, Patton, and Catalano,
2000
18
Number of School Building Risk Factors and
Probability of Meeting WASL Standard (10th Grade
Students)
Arthur et al., 2006
19
Number of School Building Protective Factors and
Probability of Meeting WASL Standard (10th grade
students)
Arthur et al., 2006
20
Why a New Addiction Science
  • Research conducted over the last thirty years has
    identified reliable predictors of use and
    addiction in the social environment and the
    individual
  • Research over the last 20 years has begun to
    identify genetic and neurobiological factors
    involved in addiction processes
  • Research over the last 20 years has identified
    effective prevention and treatment programs to
    reduce problem use and addiction

21
  • Candidate genes have been identified

22
Table 1. Genes having one or more variants that
have been reported to be
associated with one or more addictions.
Kreek et al. (Nature, Dec 2005) provides a
reasonable list of candidate genes for substance
use.
23
Why a New Addiction Science
  • Research conducted over the last thirty years has
    identified reliable predictors of use and
    addiction in the social environment and the
    individual
  • New research over the last 20 years has begun to
    identify biological and genetic factors involved
    in addiction processes
  • Research over the last 20 years has identified
    effective prevention and treatment programs to
    reduce problem use and addiction

24
Ineffective Prevention Strategies
  • Universal Prevention
  • Peer counseling, mediation, positive peer culture
  • Non-promotion to succeeding grades
  • After school activities with limited supervision,
    programming
  • Drug information, fear arousal, moral appeal.
  • DARE
  • Selected, Indicated Prevention
  • Gun buyback programs
  • Firearm training
  • Mandatory gun ownership
  • Redirecting youth behavior
  • Shifting peer group norms
  • Neighborhood Watch

U.S. Surgeon General, U.S. Department of Health
and Human Services, 2001 National Institute of
Justice, 1998 Gottfredson, 1997.
25
Wide Ranging Approaches to Prevention Have Been
Found To Be Effective
  • Prenatal Infancy Programs
  • Early Childhood Education
  • Parent Training
  • After-school Recreation
  • Mentoring with Contingent Reinforcement
  • Youth Employment with Education
  • Organizational Change in Schools
  • Classroom Organization, Management, and
    Instructional Strategies
  • School Behavior Management Strategies
  • Classroom Curricula for Social Competence
    Promotion
  • Community School Policies
  • Community Mobilization

26
Why We Need a New Addiction Science
  • Although efficacious preventive and treatment
    interventions have been identified, many
    individuals do not respond to these interventions
  • It is likely that there are important
    neurobiological differences that contribute to
    this non-response
  • We need a better understanding of the
    neurobiological-environment interaction as well
    as the neurobiological-environment-development
    interaction in order to develop more effective
    preventive and treatment interventions

27
Twenty-first Century Addiction Science is Needed
to Identify the Role of Genetic, Individual and
Environmental influences
Persistent Problem Use Alcohol TobaccoMarijuana

Consistent FamilyManagement
Individual Differences e.g., BAS
28
Behavioral Activation Syndrome (BAS) may be
genetically influenced (Reuter, et al. 2005).
Individual Differences BAS
29
Does BAS predict Alcohol Dependence Symptoms in
Adulthood?
BAS
8th and 9th Grades (ages 14-15)
30
BAS is predictive of Alcohol Dependence Symptoms
at age 27
? .11, p lt .008
controlling for ethnicity, poverty and gender
31
Does Consistent Good Family Management Moderate
this Effect?
?
BAS
32
Family management practices moderate the effect
of BAS on Age 27 Alcohol Dependence Symptoms
? .15, p lt .01
? -.010, ns
Interaction, ? -.28, p lt .003
33
Twenty-first Century Addiction Science is Needed
to Identify the Efficacy of Interventions to
Effect Individual and Environmental Influences on
Addiction
Persistent Problem Use Alcohol TobaccoMarijuana

? ? ? ?
Intervention
Consistent FamilyManagement
Individual Differences e.g., BAS
34
Patterns of Use Change over the Course of
Development and Provide Clues to the Timing of
Influences and the Intervention
Binge Drinking
35
Factors Shaping Child and Adolescent Development
Snowball Risk Accumulates through Early
Developmental Challenges without Protection
Snowstorm Extended Exposure to Positive Norms
and Models of Problem Behavior without Protection
36
  • Applying Advances in Prevention Science to
    Children and Adolescents
  • The Seattle Social Development Project
  • Richard F. Catalano, Ph.D
  • Director
  • Social Development Research Group
  • School of Social Work
  • University of Washington
  • www.sdrg.org

 
37
Intervention Spectrum
Treatment
Prevention
Case Identification
Standard Treatment for Known Disorders
Maintenance
Compliance with long-term treatment (goal
reduction in relapse and recurrence)
Indicated
Selective
After-care (including rehabilitation)
Universal
Source Institute of Medicine (1994). Reducing
risks for mental disorders Frontiers for
preventive intervention research. Patricia J.
Mrazek Robert J. Haggerty, Eds. Washington DC
National Academy Press
38
Prevention Science Framework
Program Implementation and Evaluation
Interventions
Identify Risk and Protective Factors
Define the Problem
Response
Problem
39
Prevention Science Research Advances
  • Etiology/Epidemiology of Problem Behaviors
  • Identify risk and protective factors that predict
    problem behaviors and describe their distribution
    in populations.
  • Efficacy Trials
  • Design and test preventive interventions to
    interrupt causal processes that lead to youth
    problems.
  • Prevention Services Research
  • Apply lessons learned about etiology and
    effective interventions in real world settings.

40
Risk Factors Addressed by Seattle Social
Development Project
Family
X
X
X
School
X
X
X
Individual/Peer
X
X
X
41
Prevention Science Research Advances
  • Etiology/Epidemiology of Problem Behaviors
  • Identify risk and protective factors that predict
    problem behaviors and describe their distribution
    in populations.
  • Efficacy Trials
  • Design and test preventive interventions to
    interrupt causal processes that lead to youth
    problems.
  • Prevention Services Research
  • Apply lessons learned about etiology and
    effective interventions in real world settings

42
Seattle Social Development Project(SSDP)
  • Investigators
  • J. David Hawkins, Ph.D.
  • Richard F. Catalano, Ph.D.
  • Karl G. Hill, Ph.D.
  • Richard Kosterman, Ph.D.
  • Robert Abbott, Ph.D.
  • Social Development Research Group
  • School of Social Work
  • University of Washington
  • 9725 3rd Avenue NE, Suite 401
  • Seattle, Washington 98115
  • Funded by
  • National Institute on Drug Abuse, National
    Institute on Mental Health, Office of Juvenile
    Justice and Delinquency Prevention, Robert Wood
    Johnson Foundation

43
Seattle Social Development ProjectIntervention
Components
  • Component One Teacher Training in Classroom
    Instruction and Management
  • Component Two Parent Trainingin Academic
    Support and Behavior Management
  • Component Three Child Social and Emotional Skill
    Development

44
Teacher Education
  • Proactive classroom management (grades 1-6)
  • Establish consistent classroom expectations and
    routines at the beginning of the year
  • Give clear, explicit instructions for behavior
  • Recognize and reward desirable student behavior
    and efforts to comply
  • Use methods that keep minor classroom disruptions
    from interrupting instruction
  • Interactive teaching (grades 1-6)
  • Assess and activate foundation knowledge before
    teaching
  • Teach to explicit learning objectives
  • Model skills to be learned
  • Frequently monitor student comprehension as
    material is presented
  • Re-teach material when necessary
  • Cooperative learning (grades 1-6)
  • Involve small teams of students of different
    ability levels and backgrounds as learning
    partners
  • Provide recognition to teams for academic
    improvement of individual members over past
    performance

45
Parent Education
  • Raising Healthy Children (grades 1-2)
  • Observe and pinpoint desirable and undesirable
    child behaviors
  • Teach expectations for behaviors
  • Provide consistent positive reinforcement for
    desired behavior
  • Provide consistent and moderate consequences for
    undesired behaviors
  • Supporting School Success (grades 2-3)
  • Initiate conversation with teachers about
    childrens learning
  • Help children develop reading and math skills
  • Create a home environment supportive of learning
  • Guiding Good Choices (grades 5-6)
  • Establish a family policy on drug use
  • Practice refusal skills with children
  • Use self-control skills to reduce family conflict
  • Create new opportunities in the family for
    children to contribute and learn

46
Social, Cognitive and Emotional Skills Training
  • Listening
  • Following directions
  • Social awareness (boundaries, taking perspective
    of others)
  • Sharing and working together
  • Manners and civility (please and thank you)
  • Compliments and encouragement
  • Problem solving
  • Emotional regulation (anger control)
  • Refusal skills

47
Support Structures
  • School Staff
  • 5 days of teacher training
  • Coaching by teacher trainer
  • Principal support
  • Family
  • Training in each parenting curriculum
  • Family support coordinator

48
SSDP Design
  • Initiated in 1981 in 8 Seattle elementary schools.
  • Expanded in 1985, to include 18 Seattle
    elementary schools to add a late intervention
    condition and additional control students.
  • Quasi-experimental study
  • Full treatment (grades 1-6) 149 Late treatment
    (grades 5-6) 243 Control 206

49
SSDP Panel Retention
MEANAGE G2 10 11 12 13 14 15 16 (17) 18 21
24 27 30 N 808 703 558 654 778 783 770
-- 757 766 752 747 720 87 69 81 96 97 95
-- 94 95 93 93 91
Interview completion rates for the sample have
remained above 90 since 1989, when subjects were
14 years old.
50
SSDP Changed Risk, Protection and Outcomes
  • Intervention has specific benefits for children
    from poverty through age 18.
  • More attachment to school
  • Fewer held back in school
  • Better achievement
  • Less school misbehavior
  • Less drinking and driving
  • By the start of 5th grade, those in the full
    intervention had
  • less initiation of alcohol
  • less initiation of delinquency
  • better family management
  • better family communication
  • better family involvement
  • higher attachment to family
  • higher school rewards
  • higher school bonding
  • By age 18 Youths in the Full Intervention had
  • less heavy alcohol use
  • less lifetime violence
  • less lifetime sexual activity
  • fewer lifetime sex partners
  • improved school bonding
  • improved school achievement
  • reduced school misbehavior

Hawkins et al. 1999, 2005 in press Lonczak et
al., 2002.
  • At the end of the 2nd grade
  • boys less aggressive
  • girls less self-destructive
  • By age 21, broad significant effects were found
    on positive adult functioning
  • more high school graduates
  • more attending college
  • more employed
  • better emotional and mental health
  • fewer with a criminal record
  • less drug selling
  • less co-morbid diagnosis of substance
  • abuse and mental health disorder
  • By age 27, continuing significant effects were
    found on mental health and risky sexual activity
  • fewer mental health disorders and symptoms
  • fewer lifetime sexually transmitted diseases

Late
Grade Age
51
SSDP Proportion Who Met Criteria for GAD,
Social Phobia, MDE, or PTSD Diagnosis at Ages 24
and 27
plt .05
52
Discussion
  • Identify your field in these broad categories
  • Human neurobiological, Animal neurobiological,
    basic pyscho-social, intervention/prevention
  • Break up into small groups of 5 with a broad mix
    from these groups
  • Students discuss how the information presented
    today may help you develop new transdisciplinary
    research questions, faculty may contribute
  • Record research questions developed and report
    back to the whole group on 2-3 transdisciplinary
    research questions

53
Confederation of Addiction Research Centers
Addiction Mechanisms, Prevention, Treatment,
Conjoint 556
  • Lecture 1
  • Creation of 21st Century Addiction Science
  • Rico Catalano
  • Professor
  • School of Social Work
  • 543-6382
  • catalano_at_u.washington.edu
  • www.sdrg.org

54
SSDP could allow exploration of effects of social
development interventions on genetic expression
Dopaminergic TH DRD4, 5 DAT DBH MAOA
Persistent Problem Use Alcohol TobaccoMarijuana
Persistent Comorbidity
Serotonergic TPH1,2 HTR1B,2A SERT MAOA
Individual Differences e.g., BAS
BIS Cognitive Difficulties etc.
Drug Metabolism ADH1B ADH1C ALDH2 CYP2D6
55
Family management and genetic influences
Dopaminergic TH DRD4, 5 DAT DBH MAOA
Persistent Problem Use Alcohol TobaccoMarijuana
Persistent Comorbidity
Genetic Influences
Serotonergic TPH1,2 HTR1B,2A SERT MAOA
Drug Metabolism ADH1B ADH1C ALDH2 CYP2D6
56
From Gottesman Gould, 2003 .
Measurable components unseen by the unaided eye
along the pathway between disease and distal
genotype.
57
Adapted from Gottesman Gould, 2003 .
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