1. NIDA’s Public Health Division: The Division of Epidemiology, Services and Prevention Research
Wilson M. Compton, M.D., M.P.E.
Director, Division of Epidemiology, Services and Prevention Research
National Institute on Drug Abuse
Department of Health and Human Services
I’m not crazy about this title
NIDA’s 2005 Operational Plan:
DESPR’s Report Or
The Report from DESPR
Penn State University
29 November 2006

2. NIDA National Institute on Drug Abuse Office of the Director EEO
Nora D. Volkow, MD
Director
Special Populations Office
Director, AIDS Research
Timothy P. Condon, Ph.D.
Deputy Director
Laura S. Rosenthal
EEO
Associate Director
for Management
Office of
Extramural
Affairs
Office of Planning
& Resource
Management
Office of
Science Policy &
Communications
Center for the
Clinical Trials
Network
Intramural
Research
Program
Teresa Levitin, PhD
Laura Rosenthal
Timothy Condon, PhD
Betty Tai, PhD
Barry Hoffer, MD, PhD
Division of
Basic Neurosciences
& Behavior Research
David Shurtleff, PhD
Division of
Pharmacotherapies &
Medical Consequences
of Drug Abuse
Frank Vocci, PhD
Division of Clinical
Neuroscience,
Development &
Behavioral
Treatment
Joseph Frascella, PhD
Division of
Epidemiology,
Services &
Prevention Research
Wilson Compton, MD, MPE

3. DESPR Organization and Vision
EPIDEMIOLOGY RESEARCH BRANCH
PREVENTION RESEARCH BRANCH
SERVICES RESEARCH BRANCH
DESPR seeks to improve
the nation’s public health by
promoting integrated approaches to
understand and address interactions
between individuals and environments
that contribute to the continuum of problems
related to drug use.
Our goal is to develop scientific knowledge with clear application to practice and public policy.

4. First, a story exemplifying linkages of Epidemiology, Prevention and Services…

5. Epidemiological Finding: Childhood and Adult Antisocial Behavior Strongly Associated with Drug Use/Disorders
Odds Ratios for Lifetime Antisocial Personality Disorder by Specific Drug Disorders, Reference group is persons without the drug disorder (NESARC Study, Compton 2004)

6. From Longitudinal Epidemiology comes evidence for a plausible pathway:
Poor academic achievement
Early Aggression
Deviant peer association
Adolescent/Early Adult
Antisocial Behavior and Drug Abuse

7. From Prevention: comes tests of the theory and tests of a plausible intervention strategy:
— Support for theory and development of practical and useful interventions.

8. From Prevention: Reducing Early Aggressive Behaviors Reduces Drug Use13 12 11 10 9 8 7
ESTIMATED CUMULATIVE RISK
Control: 33%, reference
CC: 25%, aRR 0.61 ( )
FSP: 25%, aRR 0.70 ( )
CC=Classroom Centered FSP=Family-School Partnership
AGE OF FIRST TOBACCO USE
Modified from: Storr, et al., Drug and Alcohol Dependence, 66:51-60, 2002.

9. From Prevention: Enhancing Social Bonding Reduces Violence
Hawkins, et al., Arch Pediatr Adolesc Med 1999

10. From Services: Early Interventions Can Be Cost-Effective
Cost per Taxpayer
Participant and Crime
Victims Net Benefit
Nurse Home Visiting Program $ 7,733 $15,981
Seattle Social Development
Project $ 4,355 $14,169
Big Brothers/Sisters Mentoring $ 1,054 $ 4,524
Aos, et al., The Comparative Costs and Benefits of Programs to Reduce Crime, Washington State Institute for Public Policy, 2001

11. From Scientific Knowledge It Needs To Be Used In Practice
Ongoing Problem:
To Reap Any Benefits
From Scientific Knowledge
It Needs To Be Used In Practice

12. From Services: Few Schools Use Effective Prevention Programs
Ringwalt, et al. (2002), Prevention Science

13. Thus, all three branches of DESPR contribute to a unified story about pathways to drug use and how to intervene in these pathways.

14. And now… A Few Key Findings

15. Cigarette Smoking Declines Markedly Since Mid-1990’s
ERB:
Cigarette Smoking Declines Markedly Since Mid-1990’s *
* Denotes significant difference between recent peak year and current year.
Denotes significant difference between and 2005.
Source: University of Michigan, MTF 2005

16. Life Course View of Addiction Refines Understanding of Recovery & Benefit Cost
SRB:
Benefit Cost
Zarkin, Dunlap, Hicks, & Mamo. (2005). Benefits & costs of methadone treatment: results from a lifetime simulation model. Health Economics, 14,
Recovery
Multiple treatment episodes is the norm.
27 years = Median time from first to last drug use
9 years = Median time from first treatment episode to last use
Dennis, Scott, Funk, & Foss. (2005). The duration & correlates of addiction & treatment. JSAT, 28, S51-S62.
MacLeod and colleagues demonstrated in a RCT significant differences in 90-day continuous abstinence rates, with the combination treatment showing greater efficacy than NRT alone at both 3 months and 6 months.
Zhu also studied the California quitline as an adjunct to NRT, but the control group was not compelling (those who dropped out of the counseling program).
Sydney, Australia

17. Lifetime and Past Year Meth Use at 4½-6½ Years Past Baseline
Universal Family-based Prevention Interventions Reduce Methamphetamine
PRB:
Source: Spoth, et al. (2005). Two randomized studies of the long-term effects of brief, partnership-based universal preventive interventions on adolescent methamphetamine use
Lifetime and Past Year Meth Use at 4½-6½ Years Past Baseline

18. HIV Screening Can Be As Cost-Effective As Screening for Hypertension and Other Medical Conditions
DESPR:
Source: Paltiel, et al. and Sanders et al., NEJM 352(6), 2005.
Increase in Life Expectancy
Due to Screening (Yr)
2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
Life expectancy
Quality-adjusted
life expectancy
AGE (Yr)
200,000
180,000
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
Screening ($/quality-adjusted life year)
Incremental Cost-Effectiveness of
Costs and benefits to partners excluded
Costs and benefits to partners included
Prevalence of Unidentified HIV (%)

19. DESPR provides a foundation for NIDA’s
Public Health Mission.

20. Priority Areas for NIDA
Prevention Research
Children and Adolescents
Genetics
Comorbidity
Development
Treatment Interventions
(New Targets & New Strategies)
HIV/AIDS Research
HIV/AIDS
DRUG ABUSE

21. Summary: Drug Abuse Research Needs a Systems Approach
social
DRUGS OF
ABUSE
behavior
neuronal circuits
protein expression
genome

22. DESPR: 2006 Major Research Questions
What new theoretical approaches can inform our research?
What intrapersonal and environmental factors interact with each other and with genetic factors?
How can we blend science and services to measurably impact public health outcomes?

23. Prevention 2006 Key Research Goal
Develop and maximize use of high quality preventive interventions in real world settings through research on
Individual factors
Relationship of drug abuse prevention to HIV prevention
Environmental strategies
Community-based participatory research

24. What are we doing to develop and promote these themes?
Workgroups, Meetings, Publications, etc.

25. Translational Research is NOT Unidirectional: There are Feedback Loops
So what we are talking about is two types of Translational Research that the field is now calling Types 1 and 2, which reflects a linear conceptualization.
I contend that it is not a linear process, feedback is possible at all points in the research process.
However, for consistency I will use the current NIH terminology – there is already enough confusion.
Type 1
Type 2

26. Bi-Directional Influences
Basic science laboratories prevention:
Sensation Seeking
Neurobehavioral disinhibition
Early-onset antisocial behavior
Psychiatric co-morbidity
Stress reactivity
Prevention basic neuroscience laboratories:
What are the biological mechanisms that explain the emergence of drug abuse during adolescence?
What specific vulnerabilities are familial?
What are the biological mediators of social interactions?

27. Linking Public Health Research to Neuroscience

28. Circuits Involved In Drug Abuse and Addiction
PFC
ACG
INHIBITORY
CONTROL
OFC
SCC
MOTIVATION/
DRIVE
Hipp
Amyg
MEMORY/
LEARNING
NAcc VP
REWARD
All Should Be Considered In
Strategies to Prevent and
Treat Addiction

29. GO Non Addicted Brain Addicted Brain STOP Control Drive Reward Memory

30. Promise of Translation: HPA axis plasticity
Psychosocial intervention
Init.
3 mo.
6 mo.
Concordant behavior change
Source: Fisher P, OSLC

31. Key Basic Epidemiology Finding: Addiction is a Developmental Disorder With Onset During Adolescence
Source: NESARC Study,

32. Recent Studies Have Shown that Maturation of the
Brain’s Gray Matter Moves from Back to Front
Brain areas where volumes
differ in adolescents compared to young adults
Source: Sowell, E.R. et al., Nature Neuroscience, 2(10), pp , 1999

33. During Adolescence the COGNITION-EMOTION Connection is Still Undergoing Development
Amygdalo-cortical Sprouting Continues
Into Early Adulthood
Low-power light photomicrographs of immunoperoxidase-labeled, biocytin-containing
amygdalofugal varicose fibers within the mPFC of animals at 6 stages of development
Source: Cunningham, M et al., J Comp Neurol 453, pp , 2002.

34. Implications:
Developmental differences must be considered in designing prevention strategies.
Can frontal lobe functioning be strengthened?

35. Sensation-Seeking Targeting
Translating Sensation Seeking Research into Clinical Study: Communications Research
Sensation-Seeking Targeting
(Palmgreen et al., 2001)
Used Activation model of information exposure to design messages for target audiences
RESULTS: All 3 targeted television campaigns reversed upward trends in 30-day marijuana use among high SS
How will D2 receptor research inform this field?

36. Community
Bedside
Bench

37. Developing an intervention is only one part of translating research into practice.
Access
and Engagement
Organization Structure and Climate
Intervention
I think this slide is a nice visual to emphasize that it is not just about having evidence – there are a lot of things that impact on the use of that evidence and what evidence is needed to improve the lives of those with mental illnesses. We need to research all these interfaces --- in fact, we are doing that now. We are developing the sciences of dissemination/implementation, and adaptation (of EBPs)
External Environment (stigma, financing)
Provider knowledge and behavior

38. Interagency Collaborations are indispensable
Bench
Bedside
Community
Interagency Collaborations are indispensable

39. DHHS Collaborations to Translate Research
NIH
SAMHSA
NIDA
NIDA
Collaborations to Translate Research
Findings Into Relevant Clinical Practice

40. Testing the Communities That Care (CTC) Prevention System
Research Centers
Coordinating Center

41. Linking grant programs
“Braiding” funding streams to enhance both research and services
Each agency doing what it does best
Examples:
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 for State Substance Abuse Authorities (FY2005) and for CBOs (FY2006)

42. Developing the Health Services Research Program
Bench
Bedside
Community
Developing the Health Services Research Program

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

44. New Opportunities: Science to Services Interactions New Theories
Medical Settings
Screening (especially SBIRTs)
Prescription Drug Abuse (especially opioids)
HIV
Interactions
Implementation Science
New Theories
Economics
Organization/Management

45. Division of Epidemiology, Services and Prevention Research
Providing a foundation for NIDA’s public health mission.