GHB

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NIDA
Bringing the full power of Science to bear on

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Topics

• Drug Abuse The Big Picture
• The Science of Addiction
• Key Intervention Concepts
• Implementing Science into Practice

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Illicit Drug Use Disorders Are COMMONLifetime
and 12-Month Rates Among Adults 18 Y.O. in the
U.S.

NIAAA National Epidemiologic Survey on Alcohol
and Related Conditions, 2006
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Drug Use Has Been Declining Since 1990s
Student Past Year Use of An Illicit Drug



Denotes significant difference between recent
peak year and current year.
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Sedative Use Has Been Increasing 12th Grader
Past Year Use of Sedatives


Denotes significant increase 2001-2005.
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Prescription Opioid Abuse is Alarming
Percent of 12th Grade Students Reporting Past
Year Nonmedical Use of Vicodin OxyContin
Note year-to-year differences are not
statistically significant, but 2002 to 2005 is
higher for OxyContin.
Source Monitoring the Future, University of
Michigan
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Methamphetamine Has Been A MAJOR Issue in Many
Parts of the USA
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Treatment Admission Rates per 100,000
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Treatment Admission Rates per 100,000
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Universal Family-based Prevention Interventions
Reduce Methamphetamine
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The Science of Addiction
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Biological Factors Interact with Environmental
Factors to Produce Addiction
Biology/Genes
Biology/ Environment Interaction
Environment
DRUG
Addiction
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So What Does All This Mean for Drug Abuse Service
Delivery?
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Outcome In Diabetes
Pre - During - Post
Treatment Research Institute
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Outcome In Hypertension
Pre - During - Post
Treatment Research Institute
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Outcome In Addiction
Pre - Post
Treatment Research Institute
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If we treat a diabetic and symptoms dont
subside.what do we do?
Would we increase the dose? Would we change
medications? Would we change treatment
approaches? Would we fail to provide ongoing
treatment for a diabetic?
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We need to shift the paradigm of addiction
treatment from an acute to a chronic care model
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Substance Use Careers Last for Decades
1.0
.9
.8
Cumulative Survival
Years from first use to 1 years abstinence
.7
Median duration of 27 years!
.6
.5
.4
.3
.2
.1
0.0
30
25
20
15
10
5
0
Scott, Dennis, Funk (1998)
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Treatment Careers Last for Years
1.0
.9
.8
Cumulative Survival
Years from first Tx to 1 years abstinence
.7
Median duration of 9 years and 3-4 episodes of
care
.6
.5
.4
.3
.2
.1
0.0
25
20
15
10
5
0
Scott, Dennis, Funk (1998)
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Substance Use Careers are Shorter the Sooner
People get to Treatment
Year to 1st Tx Groups
1.0
.9
.8
Cumulative Survival
Years from first use to 1 years abstinence
.7
20
.6
.5
.4
.3
10-19
.2
.1
0.0
0-9
plt.05 (different from 20)
30
25
20
15
10
5
0
Scott, Dennis, Funk (1998)
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Recovery from drug addiction requires effective
treatment followed by management of the disorder
over time.
Chronic Disease Model
Initial Services
Clinical Practices
Engage Sustain
Assessment
Therapeutic Interventions
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Recovery Management Checkups Faster return to
treatment and improved long-term outcomes
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Under Construction
For Criminal Justice Involved Individuals
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In-Prison Treatment Plus Post-Release Aftercare
Improve 5 Year Outcomes in Prison Addicts
Participants 80 African American
AFTERCARE is Indispensable
Arrest-Free

Drug-Free




p lt .05 from Comparison
Martin, Butzin, Saum, Inciardi (2004), Crime and
Delinquency
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CJ System Replete with Addiction Access to
Medications is Needed
Maryland Prison Study Treatment Linkage and
Opiate-Free One Month Post Release (N100)
C Counseling Only CT Counseling
Treatment Referral CM Counseling Methadone
Started in Prison
Preliminary Analysis Tim Kinlock, et al., 2006
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Medications to Keep an Eye On

• Disulfiram (cocaine)
• Topiramate (alcohol, cocaine, nicotine)
• Marinol rimonabant (marijuana)
• Bupropion Vigabatrin, Topiramate, Modafinil
  (methamphetamine)
• Depot (injection) naltrexone (opiate, alcohol)

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The Consequences of Drug Abuse and Addiction
Disproportionately Affect Minority Populations
100
1
4
6
12
15
23
80
11
16
60
50
40
70
65
20
26
0
Population
White
Black
Hispanic
Other
Sources 2002 NSDUH, DHHS, SAMHSA, 2003.
CDC HIV/AIDS Surveillance
Report 2002.
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HIV Screening as Cost-Effective as Screening for
Colon Cancer and Other Conditions How can this
apply to CJ and other at-risk populations?
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Implementing Science into Practice
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Adoption of Innovations in Substance Abuse
Treatment of Facilities (N766) Reporting Use
of Selected Interventions
Source Roman et al., National Treatment Center
Study data
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Adoption of Innovation Potential Impact of CTN
Protocol Participation
P N.S.
P lt .05
Source Ducharme et al., JSAT, In press.
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Whats NIDA Doing About This?
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Braiding Funding Streams

• 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 (with SAMHSA) for State
  Substance Abuse Authorities (FY2005) and
  Community Based Organizations (FY2006)

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Testing the Communities That Care (CTC)
Prevention System
Research Centers
Coordinating Center
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Clinical Trials NetworkState GrantsAddiction
Technology Transfer Centers
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Priority Areas for NIDA
Prevention Research (Children and Adolescents)
Treatment Interventions (New Targets
New Strategies)
HIV/AIDS Research
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NIDA
Bringing the full power of Science to bear on