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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