# Presentation: 657830

## NIDA

***Bringing the full***
***power of Science ***
***to bear on... ***
***          ***

*NIDA*

## Topics

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

## Illicit Drug Use Disorders Are COMMON:Lifetime and 12-Month Rates Among Adults 18+ Y.O. in the U.S.

**%**

***NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2006***

## 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.

*****

*****

*****

## Sedative Use Has Been Increasing:  12th Grader Past Year Use of Sedatives

*******	**Denotes significant increase 2001-2005.

*****

*****

**Sedative Use Has Been Increasing:  ****12****th**** Grader Past Year Use of Sedatives**

## Prescription Opioid Abuse is Alarming

**Note:  year-to-year differences are not statistically significant, but 2002 to 2005 is higher for OxyContin.**

**Percent of 12th Grade Students Reporting Past Year **
**Nonmedical Use of Vicodin & OxyContin**

- Source:  Monitoring the Future, University of Michigan

## Methamphetamine Has Been A MAJOR Issue in Many Parts of the USA

## Treatment Admission Rates per 100,000

**Treatment Admission Rates per 100,000**

## Treatment Admission Rates per 100,000

**Treatment Admission Rates per 100,000**

## Universal Family-based Prevention Interventions Reduce Methamphetamine

**Universal Family-based Prevention Interventions Reduce Methamphetamine**

## The Science of Addiction

## Addiction

**Addiction**

**DRUG**

**Environment**

**Biology/Genes**

**Biology/**
**Environment**
**Interaction**

**Biological Factors Interact with Environmental Factors to Produce Addiction **

## So What Does All This Mean for Drug Abuse Service Delivery?

##  Outcome In Diabetes

**Treatment Research Institute**

** **Outcome In Diabetes

**Pre - During - Post **

##  Outcome In Hypertension

**Treatment Research Institute**

** **Outcome In Hypertension

**Pre - During - Post **

##  Outcome In Addiction

**Treatment Research Institute**

** **Outcome In Addiction

- Pre - Post

## If we treat a diabetic and symptoms don’t subside....what do we do?

***If we treat a diabetic and symptoms don’t 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?**

## We need to shift the paradigm of addiction treatment from an acute to a chronic care model

## Substance Use Careers Last for Decades 

**Cumulative Survival**

**Years from first use to 1+ years abstinence**

- 30

- 25

- 20

- 15

- 10

- 5

- 0

- 1.0

- .9

- .8

- .7

- .6

- .5

- .4

- .3

- .2

- .1

- 0.0

**Median duration of 27 years!**

- Scott, Dennis, Funk (1998)

**Notes:**
Explain survival analysis -- why you do it...and how
Time frames related to age of use, treatment, and death were measured across all sources and waves of information (taking the earliest first use, treatment episode, and 12 month period of abstinence or death).
Age at last use was defined as the age when a person first completed a period of 12 month abstinence 
Censoring 35 or 2.6% of the people who died in 3 years
Durations were estimated with Cox Proportional Hazards Regression
censoring people who were in treatment or still using, 
censoring years past which we had less than 100 people to make the estimate, and
creating a 30 year window of observation on the trajectory of substance use disorders starting at the time of first use

## Treatment Careers Last for Years 

**Cumulative Survival**

**Years from first Tx to 1+ years abstinence**

- 25

- 20

- 15

- 10

- 5

- 0

- 1.0

- .9

- .8

- .7

- .6

- .5

- .4

- .3

- .2

- .1

- 0.0

**Median duration of 9 years **
**and 3-4 episodes of care**

- Scott, Dennis, Funk (1998)

**Notes:**
Figure shows the time from 1st treatment to 1+ years of abstinence or death, the median was 8 years with wide inter-quartile range (3 to 20 years).

## Substance Use Careers are Shorter the Sooner People get to Treatment

**Cumulative Survival**

**Years from first use to 1+ years abstinence**

**20+**

**0-9***

**10-19***

**Year to 1****st**** Tx**
**Groups**

- 30

- 25

- 20

- 15

- 10

- 5

- 0

- 1.0

- .9

- .8

- .7

- .6

- .5

- .4

- .3

- .2

- .1

- 0.0

*** p<.05 (different from 20+)**

- Scott, Dennis, Funk (1998)

## Recovery from drug addiction requires effective treatment followed by management of the disorder over time.

**Clinical**
**Practices**

- Initial Services

- Engage & Sustain

- Therapeutic
- Interventions

- Assessment

**Chronic Disease Model**

## Recovery Management Checkups:  Faster return to treatment and improved long-term outcomes

**Notes:**
Go back and re-explain how to read this. Bullet out....

Participants assigned to RM-ERI were significantly more likely than control group participants to: return to substance abuse treatment 

return to substance abuse treatment 
	(64% vs. 51%, Odds Ratio of 1.34, X2(1)=6.8, p<.01), 

return to treatment sooner (Figure 5)
	(Median of 376 vs. 600 days, (Wald=5.2, p<.05), 

receive more total days of treatment in months 4 to 24
	(mean of 59 vs. 39 days, t(221)=4.39, p<.05), and

## For Criminal Justice Involved Individuals

**Under Construction**

## In-Prison Treatment Plus Post-Release Aftercare Improve 5 Year Outcomes in Prison Addicts

**In-Prison Treatment Plus Post-Release Aftercare Improve 5 Year Outcomes in Prison Addicts**

**Drug-Free**

**Arrest-Free**

**Martin, Butzin, Saum, Inciardi (2004), *****Crime and Delinquency***

- *

- *

- *

- *

- *

***AFTERCARE ***
***is Indispensable***

***Participants 80%***
***African American***

## CJ System Replete with Addiction: Access to Medications is Needed

**C = Counseling Only; **
**C+T = Counseling & Treatment Referral; **
**C+M = Counseling & Methadone Started in Prison**

**Maryland Prison Study: Treatment Linkage and Opiate-Free One Month Post Release (N=100)**

- Preliminary Analysis:  Tim Kinlock, et al., 2006

**CJ System Replete with Addiction: *****Access to Medications is Needed***

**Notes:**
The data are from the first 100 participants in the Prison Methadone study.
The proportions of participants in treatment at 1-month post-release are:
-Counseling only, 9%
-Counseling+ Transfer, 42%
-Counseling + Methadone, 65% 
Chi-square goodness-of-fit tests found that there were significant differences between Counseling Only and Counseling+Methadone (p<.001) and Counseling+Transfer (p<.01).
The proportion of participants testing positive for opiates are:
-Counseling only, 76%
-Counseling + Transfer, 50%
-Counseling + Methadone, 34%
Chi-square goodness-of-fit tests found significant differences between Counseling Only and Counseling + Methadone (p<.05). 

## 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)

## The Consequences of Drug Abuse and Addiction Disproportionately Affect Minority Populations

**0%**

**20%**

**40%**

**60%**

**80%**

**100%**

**70**

**11**

**12**

**6**

**Population **

**65**

**16**

**15**

**4**

**26**

**50**

**23**

**1**

**White**

**Black**

**Hispanic**

**Other**

- Sources:   *  2002 NSDUH, DHHS, SAMHSA, 2003.
-                  **  CDC  HIV/AIDS Surveillance Report 2002.

**The Consequences of Drug Abuse and Addiction Disproportionately Affect Minority Populations**

## HIV Screening as Cost-Effective as Screening for Colon Cancer and Other Conditions

***How can this apply to CJ and other at-risk populations?***

## Implementing Science into Practice

## Adoption of Innovations in Substance Abuse Treatment:  % of Facilities (N=766) Reporting Use of Selected Interventions

**Source:  Roman et al., National Treatment Center Study data**

## Adoption of Innovation:  Potential Impact of CTN Protocol Participation

**Source: Ducharme et al., JSAT, In press.**

**P < .05**

**P = N.S.**

## What’s NIDA Doing About This?

## Braiding Funding Streams

**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 CSAP’s National SPF-SIG Program (FY2004)
- Service to Science Grants (with SAMHSA) for State Substance Abuse Authorities (FY2005) and _*Community  Based Organizations (FY2006)*_

## Testing the Communities That Care (CTC) Prevention System

- Research Centers

- Coordinating Center

**Testing the Communities That Care (CTC) Prevention System**

## Clinical Trials NetworkState GrantsAddiction Technology Transfer Centers

## Priority Areas for NIDA

**Priority Areas for NIDA**

**Treatment Interventions (New Targets &**
**                                            ****New Strategies)**

**Prevention Research **
**(Children and Adolescents)**
**	**

**HIV/AIDS Research**

## NIDA

***Bringing the full***
***power of Science ***
***to bear on... ***
***          ***

*NIDA*