NIDA Research and Training Opportunities Jack B. Stein, MSW, Ph.D. N ational Institute on Drug Abuse National Institutes of Health US Department of Health and Human Services Delivery Systems for Substance Abuse Treatment September 5-7, 2005

Bringing the full power of Science to bear on… Bringing the full power of Science to bear on… Drug Abuse & Addiction Drug Abuse & AddictionNIDANIDA

Hey, we’re over here!

NIMH NCI NIAID NIAAA NINDS NICHD NIBIB NIDCD NHGRI NCMHD FIC NHLBI NIA NIAMS NIDCR NIDDK NIEHS NEI NIGMS NINR NCRR NCCAM NLM CIT CSR CC NIDA NIH Yoohoo… Here we are!

The NIDA Mission To lead the Nation in bringing the power of science to bear on drug abuse and addiction, through: osupport and conduct of research across a broad range of disciplines oensuring rapid and effective dissemination and use of research results to improve prevention, treatment, and policy

Neuroscience Risk and Resilience Risk and Resilience Children and Adolescents Children and Adolescents AIDS and Other Medical Consequences AIDS and Other Medical Consequences Behavioral Science Behavioral Science Epidemiology Treatment Prevention Health Disparities Health Disparities NIDA Research Is Multidisciplinary

NIDA FY 2005 Initiatives Prevention oGene/environment interactions oDrug exposure and the developing prenatal brain oYouth/adolescent interventions Treatment Interventions oBehavioral and pharmacological approaches oLinking drug abuse services with other health care systems Translating Research into Practice oUsing science to improve providers’ knowledge and skills

Effective treatment should attend to multiple needs of the individual. Intake Processing / Assessment Treatment Plan Pharmacotherapy Continuing Care Clinical and Case Management Self-Help / Peer Support Groups Behavioral Therapy and Counseling Substance Use Monitoring Detoxification Child Care Services Vocational Services Medical Services Educational Services AIDS / HIV Services Family Services Financial Services Legal Services Mental Health Services Housing / Transportation Services

Medications are an important part of treatment for individuals with substance use disorders. Methadone-opiate abuse Buprenorphine-opiate abuse Naltrexone-opiate and alcohol abuse Disulfiram (Antabuse)-alcohol abuse Acamprosate-alcohol abuse

Behavioral counseling is a critical component of effective treatment. Behavioral therapy remains the sole available treatment for most classes of drug addiction. No pharmacotherapies exist for marijuana, sedatives, amphetamines, hallucinogens, inhalants. Combination behavioral/medication therapies is key.

Behavioral Treatments with Strong Scientific Support Cannabis Youth Treatment Series Behavioral Treatments for Smoking Cessation Cognitive-Behavioral Treatment Combined Pharmacotherapies and Behavioral Therapies Complementary and Alternative Treatments Contingency Management Treatments Dialectical Behavioral Therapy Drug Counseling Family Treatments Group Behavior Therapy HIV Risk Reduction Motivational Interviewing/Enhancement Multisystemic Therapy

Treatment does not need to be voluntary to be effective. Public Health Approach -disease -treatment Public Safety Approach -illegal behavior -punish

Integrated Public Health-Public Safety Strategy Blends functions of criminal justice and treatment systems to optimize outcomes

Treatment Strategies Clinical Practice and the Community

Developing an Evidence-Based-Practice is only one piece of the translation puzzle Intervention (“EBP”) Access and Engagement Provider knowledge and behavior Organization Structure and Climate External Environment (stigma, financing )

Science to Services Initiative Capacity-Building Collaboration Commitment Implementation and Monitoring Research and Development Translation and Dissemination Untapped Research Opportunities

Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) Research Centers Coordinating Center National Drug Abuse Treatment Clinical Trials Network (CTN)

Drug Abuse Treatment Core Components and Comprehensive Services Child Care Services Vocational Services Mental Health Services Medical Services Educational Services AIDS / HIV Risk Services Family Services Housing / Transportation Services Financial Services Legal Services Intake Processing / Assessment Treatment Plan Pharmacotherapy Continuing Care Self-Help (AA, NA) Meetings Clinical & Case Management Supportive Group and Individual Counseling Substance Use & Urine Monitoring Abstinence- Oriented Substance Abuse Counseling Motivational Interviewing Motivational Incentives Buprenorphine Detox TELE

“Technology Transfer and the Treatment of Addiction” Journal of Substance Abuse Treatment ( Volume 22, Number 4, 2002)

ProgramImprove-mentProgramImprove-ment Stages of Transfer 1-Exposure (Training) (Training) Lecture Lecture Self Study Self Study Workshop Workshop Consultant Consultant1-Exposure (Training) (Training) Lecture Lecture Self Study Self Study Workshop Workshop Consultant Consultant Program Change Model ProgramChangeProgramChange Organizational Dynamics Institutional & Personal Readiness StaffStaff 2-Adoption (Leadership decision) 2-Adoption 4-Practice (Routine use) 4-Practice 3-Implementation (Exploratory use) 3-Implementation ResourcesResourcesMotivationMotivation Climate for Change StaffAttributesStaffAttributes Source: Simpson (2002)

NIDA’s International Goals Promote International Research Activities Support Research Training and Exchange Opportunities Globally Communicate and Disseminate Science-Based Information on Drug Abuse Support International Research Collaboration

Binational Agreements NIDA and the Spanish National Plan on Drugs Exchange of Letters DHHS and the Mexican Ministry of Health Letter of Intent NIDA and Pavlov Medical University, Russia Exchange of Letters NIDA and the Dutch Addiction Program Exchange of Letters

NIDA FY 2005 International Activities by Country Research Support Fellowships and Meetings Research + Fellowships and Meetings

NIDA Supports International Research Administrative Supplements Domestic Grants With Foreign Components Foreign Grants Partnerships With Other NIH Institutes

Administrative Supplements Proposed by U.S. Grantees Related to Existing Grant Maximum of o$100,000 or o25% of direct costs Requires NIDA Approval

U.S. Grants With Non-U.S. Components Typically Awarded to U.S. Researchers Propose Research at U.S. and International Sites International Component Part of Original Application and Review Process

International Research Collaboration on Drug Abuse Program Announcement PAS Support New and/or Competitive Continuation R01 Grants for Projects Conducted in Whole or in Part Outside the U.S. Research Must Be Conducted by U.S. Investigators in Collaboration With non-U.S.-Based Investigators Recent Awards: oDA17317—Addiction Treatment in Russia: Oral and Depot Naltrexone oDA17620—Interventions With HIV+ and HIV- IDUs in Ukraine

Non-U.S. Grants Awarded to non-U.S. Researchers Research Conducted Outside the U.S. Scored Competitively by NIH Must Represent a “Special Opportunity”

NIDA Partnerships With the Fogarty International Center Available in Most Countries oFIRCA (Fogarty International Research Collaboration Award)-U.S. grantee oICOHRTA (-International Clinical, Operational, Health Services Research Training Award)-non-U.S. grantee

Training and Exchange Opportunities Fellowships Research Exchanges

INVEST Research Fellowships Rigorous Postdoctoral Research Training oIn the U.S. oWith a NIDA-funded scientist Professional Development Activities oMeet with NIDA officials oIdentify NIDA grantees interested in future collaboration Stipend Plus oTravel oHealth insurance oProfessional development activity allowance

NIDA Humphrey Drug Abuse Research Fellowships 10-Month Academic Program oFor midcareer professionals oPreeminent U.S. university 6-Week Professional Affiliation With NIDA-Funded Researcher Professional Development Activities oMeet with NIDA officials oIdentify NIDA grantees interested in future collaboration Tuition and Monthly Stipend Plus oTravel support oHealth insurance oProfessional development activities allowance

Distinguished International Scientist Collaboration Awards and U.S. Distinguished International Scientist Collaboration Awards Support for 1- to 3-Month Research Exchanges o$6,500 per month for traveling researcher oTravel support Choose the Travel Option That Works Best for the Research oDISCA: non-U.S. based researcher travels to U.S. oUSDISCA: NIDA grantee travels to partner’s country Highly Qualified Senior Researchers

Dissemination and Exchange of Information International Program web site International Meetings NIDA International Forum Satellite to CPDD

Announcements Fellowships and Other Research Opportunities oINVEST, DISCA and USDISCA application forms Travel Awards Meetings oUpcoming events oSummaries of past meetings Additional Resources Frequently Asked Questions

NIDA International Forum Satellite to CPDD June 17–20, 2005, Orlando, Florida Plenary Sessions Workshops Poster Presentations Networking Travel Awards (Deadline: February 1) Growth of Forum Participation

NIDA International Program Alumni Contribute to the Scientific Community NIDA and NIH Awards Scientific Publications Working With International Organizations

NIDA International Program Alumni Contribute to the Scientific Community Examples of Scientific Publications in 2004

Where Do We Go From Here? Some Research Questions to Consider We need a “science of larger social units” What are the components and characteristics of (integrated) treatment systems able to deliver effective interventions that can: -serve large numbers of people -be broadly adopted by different settings -be consistently implemented with fidelity -produce replicable and long-lasting effects -at a reasonable cost

Steven W. Gust, Ph.D., Director Dale S. Weiss, Program Analyst