NIDA Research and Training Opportunities

Jack B. Stein, MSW, Ph.D.National Institute on Drug AbuseNational Institutes of HealthUS Department of Health and Human Services

Delivery Systems for Substance Abuse Treatment

September 5-7, 2005

Bringing the fullpower of Science to bear on…

Bringing the fullpower of Science to bear on…

Drug Abuse & Addiction Drug Abuse & Addiction

NIDANIDANIDANIDA

Hey, we’re over here!

NIMHNIMH

NCINCI

NIAIDNIAIDNIAAANIAAA

NINDSNINDS

NICHDNICHD

NIBIBNIBIB

NIDCDNIDCD NHGRINHGRI

NCMHDNCMHD

FICFICNHLBINHLBI

NIANIA

NIAMSNIAMS NIDCRNIDCR

NIDDKNIDDK

NIEHSNIEHS

NEINEI

NIGMSNIGMS

NINRNINR

NCRRNCRR

NCCAMNCCAM

NLMNLM

CITCIT CSRCSR CCCC

NIDANIDA

NIHNIHYoohoo…Here we

are!

The NIDA MissionThe NIDA Mission

• To lead the Nation in bringing the power of science to bear on drug abuse and addiction, through:o support and conduct of research across a broad range of

disciplineso ensuring rapid and effective dissemination and use of

research results to improve prevention, treatment, and policy

NeuroscienceNeuroscience

Risk and Resilience

Risk and Resilience

Children and Adolescents

Children and Adolescents

AIDS andOther Medical

Consequences

AIDS andOther Medical

Consequences

BehavioralScience

BehavioralScience

EpidemiologyEpidemiologyTreatmentTreatment

PreventionPrevention

Health Disparities

Health Disparities

NIDA Research Is MultidisciplinaryNIDA Research Is Multidisciplinary

NIDA FY 2005 InitiativesNIDA FY 2005 Initiatives

• Prevention o Gene/environment interactionso Drug exposure and the developing prenatal

braino Youth/adolescent interventions

• Treatment Interventionso Behavioral and pharmacological approacheso Linking drug abuse services with other

health care systems

• Translating Research into Practice o Using science to improve providers’

knowledge and skills

www.drugabuse.gov

Effective treatment should attend to multiple needs of the individual.

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 ServicesAIDS / 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.

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 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 SupportBehavioral 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.

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

TreatmentStrategies

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

Col

lab

orat

ion

Commitment

Impl

emen

tatio

n an

d M

onito

ring R

esearch and Developm

ent

Translation and DisseminationUntapped Research Opportunities

Criminal Justice Drug Abuse Treatment Studies

(CJ-DATS)

Research Centers Research Centers Coordinating Center Coordinating Center

National Drug AbuseTreatment Clinical Trials

Network (CTN)

Drug Abuse Treatment Core Components and Drug Abuse Treatment Core Components and Comprehensive ServicesComprehensive 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)

ProgramProgramImprove-Improve-

mentment

ProgramProgramImprove-Improve-

mentment

Stages of TransferStages of TransferStages of TransferStages of Transfer1-Exposure1-Exposure ((TrainingTraining))

• LectureLecture• Self StudySelf Study• WorkshopWorkshop• ConsultantConsultant

1-Exposure1-Exposure ((TrainingTraining))

• LectureLecture• Self StudySelf Study• WorkshopWorkshop• ConsultantConsultant

Program Change ModelProgram Change Model

ProgramProgramChangeChange

ProgramProgramChangeChange

Organizational DynamicsOrganizational Dynamics

Institutional & Institutional & Personal ReadinessPersonal Readiness

StaffStaffStaffStaff 2-Adoption2-Adoption(Leadership decision)(Leadership decision)2-Adoption2-Adoption(Leadership decision)(Leadership decision)

4-Practice4-Practice(Routine use)(Routine use)4-Practice4-Practice(Routine use)(Routine use)

3-Implementation3-Implementation(Exploratory use)(Exploratory use)3-Implementation3-Implementation(Exploratory use)(Exploratory use)

ResourcesResourcesResourcesResourcesMotivationMotivationMotivationMotivation

ClimateClimatefor Changefor Change

ClimateClimatefor Changefor Change

StaffStaffAttributesAttributes

StaffStaffAttributesAttributes

Source: Simpson (2002)

NIDA’s International GoalsNIDA’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 AgreementsBinational Agreements

NIDA and the Spanish National Plan on DrugsExchange of Letters

DHHS and the Mexican Ministry of Health DHHS and the Mexican Ministry of Health Letter of IntentLetter of Intent

NIDA and Pavlov Medical University, Russia NIDA and Pavlov Medical University, Russia Exchange of Letters Exchange of Letters

NIDA and the Dutch Addiction ProgramNIDA and the Dutch Addiction ProgramExchange of LettersExchange of Letters

NIDA FY 2005 International Activities by CountryNIDA FY 2005 International Activities by Country

Research Support

Fellowships and Meetings

Research + Fellowships and Meetings

NIDA Supports International ResearchNIDA Supports International Research

• Administrative Supplements

• Domestic Grants With Foreign Components

• Foreign Grants

• Partnerships With Other NIH Institutes

Administrative SupplementsAdministrative Supplements

• Proposed by U.S. Grantees

• Related to Existing Grant

• Maximum of o $100,000 or o 25% of direct costs

• Requires NIDA Approval

U.S. Grants With Non-U.S. ComponentsU.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-03-023International Research Collaboration on Drug Abuse Program Announcement PAS-03-023

• 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:o DA17317—Addiction Treatment in Russia: Oral and Depot

Naltrexoneo DA17620—Interventions With HIV+ and HIV- IDUs

in Ukraine

Non-U.S. GrantsNon-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 CenterNIDA Partnerships With the Fogarty International Center

• Available in Most Countrieso FIRCA (Fogarty International Research Collaboration

Award)-U.S. grantee

o ICOHRTA (-International Clinical, Operational, Health Services Research Training Award)-non-U.S. grantee

Training and Exchange Opportunities Training and Exchange Opportunities

Fellowships

Research Exchanges

INVEST Research FellowshipsINVEST Research Fellowships

• Rigorous Postdoctoral Research Training o In the U.S. o With a NIDA-funded scientist

• Professional Development Activitieso Meet with NIDA officials o Identify NIDA grantees interested in future collaboration

• Stipend Pluso Travelo Health insuranceo Professional development activity allowance

NIDA Humphrey Drug Abuse Research FellowshipsNIDA Humphrey Drug Abuse Research Fellowships

• 10-Month Academic Program o For midcareer professionalso Preeminent U.S. university

• 6-Week Professional Affiliation With NIDA-Funded Researcher

• Professional Development Activitieso Meet with NIDA officials o Identify NIDA grantees interested in future collaboration

• Tuition and Monthly Stipend Pluso Travel supporto Health insuranceo Professional development activities allowance

Distinguished International Scientist Collaboration Awards and U.S. Distinguished International Scientist Collaboration Awards

Distinguished International Scientist Collaboration Awards and U.S. Distinguished International Scientist Collaboration Awards

• Support for 1- to 3-Month Research Exchangeso $6,500 per month for traveling researchero Travel support

• Choose the Travel Option That Works Best for the Researcho DISCA: non-U.S. based researcher travels to U.S.o USDISCA: NIDA grantee travels to partner’s country

• Highly Qualified Senior Researchers

Dissemination and Exchange of Information Dissemination and Exchange of Information

International Program web site

International Meetings NIDA

International Forum

Satellite to CPDD

www.international.drugabuse.govwww.international.drugabuse.gov

• Announcements

• Fellowships and Other Research Opportunitieso INVEST, DISCA and USDISCA application forms

• Travel Awards

• Meetingso Upcoming events o Summaries of past meetings

• Additional Resources

• Frequently Asked Questions

NIDA International Forum Satellite to CPDDNIDA 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

26

68

27

92

44

145

51

219

0

50

100

150

200

250

2001 2002 2003 2004

Countries

Participants

NIDA International Program Alumni Contribute to the Scientific Community 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 CommunityNIDA International Program Alumni Contribute to the Scientific Community

Examples of Scientific Publications in 2004

Where Do We Go From Here?

Some Research Questions to ConsiderWhere 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., DirectorDale S. Weiss, Program Analystwww.international.drugabuse.gov