NIDA at 25: Looking Back and Ahead
By David Anderson
On the Front Page...
The National Institute on Drug Abuse was created by an act of Congress on May 14, 1974, in part as a response to burgeoning drug use among the nation's youth. NIDA's mandate is to conduct and facilitate research leading to effective drug abuse prevention and drug addiction treatment, and to educate the public about drug abuse and its consequences. Today, NIDA funds more than 85 percent of the world's research on drug abuse and drug addiction.
"In NIDA's first 25 years, the power of science has discredited ideologies, myths and superstitions about drug abuse and addiction," says director Dr. Alan I. Leshner. "It has demonstrated that drug abuse is a preventable behavior, and that drug addiction is a treatable disease."
One of NIDA's most important achievements has been the use of science to clarify central concepts in the field of drug abuse. Consider, for example, addiction. When NIDA began, correct approaches to drug policy and drug treatment were often thought to hinge on determining whether a particular drug was "physically addicting" or only "psychologically addicting." We now know that addiction has biological, behavioral and social components. It is best defined as a chronic, relapsing brain disorder characterized by compulsive, often uncontrollable drug craving, seeking, and use, even in the face of negative health and social consequences. NIDA-supported research has also shown that this compulsion results from specific drug effects in the brain. This definition opens the way for broad strategies and common approaches to all drug addiction.
NIDA's application of science has imposed another kind of unity on its subject. The variety of drugs that people will use to become intoxicated is vast. In NIDA's quarter century of existence, the nation has faced surges in the abuse of marijuana, heroin, LSD, crack cocaine and, recently, methamphetamine. Also in the current mix are inhalants (from paint thinner to hair spray and beyond), the sedative/hallucinogen Ecstasy and other "club drugs," the "date rape" drug GHB, and myriad others. In response to this diversity, research conducted and supported by NIDA has identified specific neurotransmitter systems in the brain that produce the emotional and cognitive effects and the craving produced by many common drugs of abuse. Scientists have used genetic engineering techniques to produce new animal models for the study of drug effects on the brain. Using powerful neuroimaging techniques, they have documented the dynamics of neurotransmitters during drug taking and demonstrated that the neurological abnormalities produced by drugs can continue long after drug taking stops. Current objectives of this research are to track the sequence of brain changes that occur during the process of addiction, and to document the effects of drug abuse in the higher functional areas of the brain.
In the treatment area, NIDA has supported research leading to the development of behavioral and pharmacological approaches. NIDA researchers conducted studies that led to the use of the nicotine replacement patch and gum to help nicotine addicts taper their habit and avoid the hazards of tobacco smoke while doing so. NIDA scientists developed LAAM, a medication that blocks craving for heroin and other opiates, allowing patients to resume normal lives despite their addiction. They established the use of naltrexone to block the effects of opiates, helping abstinent addicts avoid relapse. NIDA-supported research, and a novel collaboration with a pharmaceutical company, has brought buprenorphine, another anti-opiate medication, to the final stages of FDA review. Still another research strand has evaluated the efficacy of many of the strategies and interventions used by drug abuse treatment providers throughout the country. Based on this effort, NIDA is about to publish Principles of Treatment for Drug Addiction: A Research-Based Guide for health care providers, administrators and policy makers. The booklet describes research-based principles of drug addiction treatment and provides examples of effective therapies.
NIDA research has shown that treatment is effective in reducing drug use and related crime, unemployment, and health care consequences and costs. With the best treatments today, episodes of drug taking are reduced 40 percent to 60 percent, reductions in drug-related crimes are even greater, and many patients are able to obtain and keep jobs. This is comparable to the reductions in acute episodes and disability produced by treatments for other chronic illnesses such as hypertension and asthma. By conservative estimates, every $1 spent on drug addiction saves society $4 to $7 in criminal justice and health care costs.
To keep abreast of trends in drug use, NIDA relies primarily on two monitoring systems that have been conducted annually since the 1970's. The Monitoring the Future Study asks youths in middle school and high school to report, confidentially, their level of drug use in the past month and in the past year. The community epidemiology work group functions as an early warning system, providing biannual estimates of drug abuse prevalence and trends using data collected in hospital emergency rooms, treatment centers and law enforcement agencies in more than 20 metropolitan areas. NIDA uses the epidemiological information it gathers to warn the nation and prepare a prompt scientific response. The institute was able to alert citizens early to the current spread of methamphetamine abuse, as well as to special problems arising from wide availability of high-purity heroin.
NIDA-supported research has identified social and physiological factors that increase an individual's risk for initiating drug abuse and has shown that genetic factors can increase the risk of addiction. This information has made possible the development of interventions that can prevent people from using drugs. To shape effective prevention messages and direct them to appropriate populations, the institute relies on knowledge gained from studies that have identified vulnerability factors that increase the risk of using drugs, and resilience factors that decrease it. For example, some children are at increased risk because they have risk-taking temperaments, while others are suffering in some way that prompts them to self-medicate with drugs. The strongest resiliency factor among children is parental involvement in their lives.
As NIDA enters its second quarter century, the institute is poised to undertake in the words of Leshner "a revolutionary advance in the study and treatment of drug abuse, and addiction, and the most important initiative the institute has ever taken." This will be the National Drug Abuse Treatment Clinical Trials Network (CTN), a nationwide system of "nodes," each one consisting of a regional research and training center linked in partnership with 10-15 local community treatment programs. Based on a model pioneered by other NIH institutes, the CTN will provide an infrastructure to test whether new and improved treatment components are effective in real-life settings with diverse patient populations. The nodes will work in concert, delivering and testing behavioral and pharmacological treatments and determining the conditions under which new treatments are successfully adopted. To capitalize on their front-line experience and observations, the community treatment programs will be full partners in decision-making about research directions and activities.
NIDA's prevention and treatment research activities also address health risks that arise as a result of drug abuse. In 1986, the institute assumed a major role in the fight against AIDS, and in every year since, a third of every NIDA budget is reserved for AIDS research. A key result has been the demonstration that drug addicts can and will modify behaviors, including needle sharing and sexual activities, that increase the risk of transmitting or acquiring infection with HIV. Participation in treatment lowers an addict's risk of HIV infection by as much as 40 percent. NIDA-supported research contributed to reversing the rise in tuberculosis incidence that occurred in the late 1980's and early 1990's, partly in conjunction with the AIDS epidemic. Today, NIDA is focusing intensely on hepatitis. Hepatitis C is highly prevalent among drug abusers, especially those who inject, 70 percent or more of whom are thought to be presently infected. A stealth virus, hepatitis C causes no symptoms during a long latency period, but silently accumulates damage that culminates in liver failure and cancer in a large portion of cases. Hepatitis B is also potentially lethal.
As an essential part of its mission, NIDA mounts comprehensive campaigns to inform the public and policy makers concerning the scientific facts of drug abuse. The institute creates authoritative publications and media messages for Congress and policy makers, for research and treatment professionals, for parents and children, and for drug abusers themselves. This year, NIDA launched one of its largest and best-received efforts ever: "NIDA Goes to School," a science education packet, was sent to every one of the country's 18,000-plus middle schools. In addition, NIDA has conducted 15 town meetings on drug abuse, cosponsored with city governments, state officials and other local partners. More informally, but a lifeline for many people, NIDA's staff answer individual queries, many seeking help with individual or family drug abuse problems that have become acute.
NIDA's celebrations will reach a zenith Sept. 27 , when it hosts a major scientific meeting in Masur Auditorium, Bldg. 10. Look for NIDA's 25th anniversary banners, which will fly over the campus for the remainder of 1999.
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