# Presentation: 007665

**Nora D. Volkow, M.D.**
**Director**
**National Institute on Drug Abuse**

***Understanding & Treating***
** **
**                       **
***             ******A Major Research Priority ***
***                          ******for NIDA***

**Co-Occurring Conditions:**

## Addiction

**Addiction**

**Medical**

**Economic**

**Social**

**DRUGS**

## Slide 3

## Priority Areas for NIDA

**Priority Areas for NIDA**

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

**Prevention Research (Children and Adolescents)**
**	****genetics**
**         ****development**
**	****environment**
**	****co-morbidity**

**HIV/AIDS Research**

## Drug Addiction is a Developmental Disease that Starts in Adolescence and Childhood

***NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003***

**% in each age group who develop first-time cannabis use disorder**

**0.0%**

**0.2%**

**0.4%**

**0.6%**

**0.8%**

**1.0%**

**1.2%**

**1.4%**

**1.6%**

**5**

**10**

**15**

**18**

**25**

**30**

**35**

**40**

**45**

**50**

**55**

**60**

**65**

**70**

**Age**

**Brain areas where volumes are smaller in adolescents than young adults.  **

***Sowell, E.R. et al., Nature Neuroscience, 2: 859-861, 1999***

**Age at cannabis use disorder as per DSM IV**

## Animals Pre-Exposed to Nicotine During 

***Source: Adriana, W. et al., J of Neurosci, 23(11), pp. 4712-4716, June 1, 2003.***

**During A Between Session **
**Progressive Ratio Schedule for **
**Nicotine Self Administration**

**Animals Pre-Exposed to Nicotine During **
**Peri- and Post-Adolescence Differed  **

**For Transcript Levels of Different**
**Subunits of the nAChRs in **
**the Ventral Midbrain**

## Addictive DisordersOften Co-Exist WithMental Disorders

**Addictive Disorders****Often *****Co-Exist***** With****Mental Disorders**

## Comorbidities: Smoking Epidemiology

**Comorbidities: Smoking Epidemiology**

**normal population: 23%**
**alcoholism:****	****          90%+**
**other addictions:     90%+**
**schizophrenia:         85%**
**depression:****	****          80%**

**Schizophrenic Patients **
**have Fewer Nicotinic **
**Receptors in Hippocampus**

***Source: Freedman et al, ***
***Biol Psychiat 38, 22-33, 1995 ***

**control**
**subjects**

**schizophrenic**
**patients**

**mRNA Levels of  **
******7 AChR are Lower in **
**Schizophrenic Patients**

***Perl, O et al., FASEB Journal,***
***17, pp. 1948-1950, October 2003.***

## The Adjusted Effect of ADHD &

**Unmedicated ADHD **
**vs Controls**
**OR (95% CI) **

**Medicated ADHD**
**vs Unmedicated ADHD**
**OR (95%CI) **

**Any SUD at Follow-up**
**  ****Alcohol A/D**
**  ****Marijuana A/D**
**  ****Cocaine/Stimulant A/D**
**  ****Tobacco A/D**

**6.3  ****(1.8-21.4)**
**5.8  ****(1.7-19.3)**
**3.1  ****(0.8-12.5)**
**7.5  ****(0.3-163.4)**
**0.85****(0.15-4.8)**

**0.15 ****(0.04-0.6)**
**0.16 ****(0.05-0.57)**
**0.42 ****(0.11-1.7)**
**0.20 ****(0.02-2.1)**
**2.4   ****(0.5-12.3)**

**Untreated ADHD was a significant **
**risk factor for SUD in adolescence**

**Pharmacotherapy was associated with a**
**reduction in risk for SUD in ADHD youth**

***Source: Biederman J. et al., Pediatrics, 104(2) August 1999.***

**The Adjusted Effect of ADHD &**
**Pharmacotherapy on SUD Incidence**

## Priority Areas for NIDA

**Priority Areas for NIDA**

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

**Prevention Research (Children and Adolescents)**
**	****genetics**
**         ****development**
**	****environment**
**	****co-morbidity**

**HIV/AIDS Research**

## Bench

**Bedside**

**Community**

## TRANSLATIONAL BOTTLENECK

***Source: Hyman, S.E. and Fenton, W.S.  Science, 299, pp. 350-351, January 17, 2003.***

**TRANSLATIONAL BOTTLENECK**

## Percentage of Recommended Care Received

**0**

**20**

**40**

**60**

**80**

**100**

**Senile cataract**
**Breast cancer**
**Prenatal care**
**Low back pain**
**CAD**
**Hypertension**
**Congestive heart failure**
**Cerebrovascular disease**
**COPD**
**Depression**
**Orthopedic conditions**
**Osteoarthritis**
**Colorectal cancer**
**Asthma**
**Benign prostatic hyperplasia**
**Hyperlipidemia**
**Diabetes mellitus**
**Headache**
**UTI**
**Community-acquired pneumonia**
**STDs**
**Dyspepsia and peptic ulcer disease**
**Atrial fibrillation**
**Hip fracture**
**Alcohol dependence**

**Percentage of Recommended Care Received**

***Source: McGlynn, E.A., NEJM, 348, pp. 2635-2645, June 26, 2003***

##   Defining Health Services Research

**A multidisciplinary field that examines how:**

**  ****Defining Health Services Research**

***Ultimately, the goals of health services research are to***
***identify the most effective ways to organize, manage, ***
***finance, and deliver high quality care****** ***

**access to and utilization of healthcare,**
**quality and cost of healthcare, and**
**our health and well-being.**

** ****social factors,**
** ****financing systems,**
** ****organizational     structures and processes,**
** ****health technologies and**
** ****personal beliefs and  behaviors**

**affect**

## CJ-DATS Criminal Justice Drug Abuse Treatment Studies

**CJ-DATS***** ******Criminal Justice Drug Abuse Treatment Studies***

## Priority Areas for NIDA

**Priority Areas for NIDA**

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

**Prevention Research (Children and Adolescents)**
**	****genetics**
**         ****development**
**	****environment**
**	****co-morbidity**

**HIV/AIDS Research**

## Proportions of AIDS Cases Among Adults & Adolescents 

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**70**

**1986**

**1988**

**1990**

**1992**

**1994**

**1996**

**Year of Diagnosis**

- Percent of Cases

**Proportions of AIDS Cases Among Adults & Adolescents**** **

**by Exposure Category and Year of Diagnosis,**** **

**1985 - 2001, United States**

**1998**

**2000**

***Source: Centers for Disease Control and Prevention (CDC)***

**Men who have sex with men (MSM)  **

**Injection drug use (IDU)     **

**Heterosexual contact**

**MSM who inject drugs    **

**% of Cases**

**Notes:**
Proportion of Estimated Adult/Adolescent AIDS Cases, by Exposure Category and Year of Diagnosis, 1985-2000, U.S.

The proportional distribution of AIDS cases by exposure category has shifted since the beginning of the epidemic.  Whereas in 1985, men who have sex with men (MSM) accounted for the greatest proportion of diagnosed AIDS cases, the proportion has decreased from nearly 65% of cases diagnosed in 1985 to approximately 40% of cases diagnosed in 2000.

The proportion of estimated AIDS cases attributed to injection drug use increased between 1985 and 1994, then remained stable or declined, accounting for approximately 27% of diagnosed cases in 2000.  

## The Consequences of Drug Abuse and Addiction Disproportionately Affect Minority Populations in the U.S.

**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 in the U.S.**

## Acceleration of HIV Degeneration of Dopamine Cells With Cocaine

**Acceleration of HIV Degeneration of Dopamine Cells With Cocaine**

**Seronegative**

**HIV**

**HIV + Drug**

**Notes:**
  Generalized cerebral atrophy most prominent in the frontal and temporal regions as well as basal ganglia atrophy with its shrinkage of the head of the caudate is noted.
  Diffuse periventricular white matter high signal intensity lesions are seen on a T2 weighted image.

## DOJ

**NIH**

**NIDA**

**ONDCP**

**White**
**House**

**SAMHSA**

***Working With Other Agencies***
***          ******Is Enabling Us To...***
***     ******Ensure that our research is***
***      ******responsive to public need***
*** ***
***      ******Translate research findings***
***      ******into relevant clinical practice***

**FDA**

**DOJ**

**DOE**

**DEA**

**DHHS**

**NIAAA**

**NIMH**

**AHRQ**

**HRSA**

## PAs and RFAs Relating to

***Coming Soon...***

**NIDA/NIMH Program Announcement on**
**Services Research for Co-Occurring **
**Mental and Substance Abuse Disorders**

**PAs and RFAs Relating to**
**Co-Occurring Disorders**

## NIDA’s Initial Goals Based on 

**#*****2     *****Increase research**** on organizational,           management, and economic issues to enhance policy, programs and practices**
***#3     *****Lead and collaborate in ****the development of standards**** for evidence-based practice**
** **
***#4     *****Evaluate ****causal associations**** **

**NIDA’s Initial Goals Based on **
**The Blue Ribbon Report**

##        Health Services Research 

**           ****Task Force Members **
**           ****Co-Chairs:  **
**            ****Thomas McLellan, PhD,**
**	**** ****Constance Weisner, DrPH, MSW**
**     ****Andrea Barthwell, MD****	****           Richard Frank, PhD**
**     ****Caryn Blitz, PhD****	****	****           Warren Hewitt, MS**
**     ****Rick Catalano, PhD****	****           James Inciardi, PhD**
**     ****Mady Chalk, PhD****	****           Marguerita Lightfoot, PhD**
**     ****Linda Chinnia, MEd****	****           Isaac Montoya, PhD**
**     ****Lorraine Collins, PhD****	****           Claire Sterk, PhD**
**     ****Wilson Compton, MD, MPE     Janet Wood, MBA, MEd**
**     ****Michael Dennis, PhD****	**