Understanding Drug Abuse and Addiction: Myths vs. Reality - Des Moines, Iowa

United States

Abstracts and Speaker Biographies

Understanding Drug Abuse & Addiction: Myths vs Reality

Alan I. Leshner, Ph.D.
Director, National Institute on Drug Abuse, National Institutes of Health

Research advances made over the past several decades have led to a better understanding of the full complexity of drug abuse and addiction and have built a sound scientific foundation on which to design prevention and treatment strategies that work. Metaphors that once were used to describe the harmful effects of drugs can now be replaced by scientific evidence showing real drug-induced physiological changes in the brains of drug abusers. Intuition- or ideology-driven interventions can be discarded for ones that are science-based. In addition to advancing the science base about drug abuse and addiction, it is equally critical that the knowledge gained from research be moved from the laboratory to the community. To make any real progress, all of the factions that play a role in this effort - researchers, practitioners, community leaders, and parents - must work together to identify the most feasible and effective means of using the science that is being generated to serve the needs of individuals and our communities.

Dr. Alan I. Leshner was appointed Director of the National Institute on Drug Abuse (NIDA) in February 1994. NIDA, one of the Institutes within the National Institutes of Health (NIH), supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. Before joining NIDA, Dr. Leshner had been with the National Institute of Mental Health (NIMH) from 1988, holding the position of Deputy Director and then Acting Director. He came to NIMH from the National Science Foundation (NSF), where he held a variety of senior positions focusing on basic research in the biological, behavioral, and social sciences, as well as on science education. Dr. Leshner went to the NSF after 10 years at Bucknell University, where he was a professor of psychology. Dr. Leshner's research has focused on the biological bases of behavior. He is the author of a major textbook on the relationship between hormones and behavior and numerous book chapters and papers in professional journals. Dr. Leshner received his undergraduate degree in psychology from Franklin and Marshall College and his master's and doctorate degrees in physiological psychology from Rutgers University.

Focus on Methamphetamine

Timothy P. Condon, Ph.D.
Associate Director, National Institute on Drug Abuse, National Institutes of Health

This presentation will provide an overview of methamphetamine abuse, addiction prevention and treatment research. Trends and factors influencing patterns of drug use will be discussed from an historical perspective to the current epidemic. The presentation will cover the national and regional epidemiology of methamphetamine use; the acute and chronic effects of methamphetamine on the brain and body; the state-of-the-art in prevention and treatment of methamphetamine abuse and addiction; and discussion of the public health consequences of methamphetamine abuse and addiction including HIV and other infectious diseases, violence, and aggression.

Dr. Timothy P. Condon was appointed NIDA's Associate Director in 1996. Dr. Condon also serves as the Director of the Office of Science Policy and Communications (OSPC). In these roles he oversees the Institutes's science planning, policy, congressional, and communications activities, and he coordinates NIDA's research training and science education programs. Prior to coming to NIDA in 1992, Dr. Condon served in several senior policy positions involving the coordination of research and service programs at the former Alcohol, Drug Abuse, and Mental Health Administration. From 1986 to 1989 he served as Science Policy Analyst and Project Director in the Office of Technology Assessment at the U.S. Congress. Dr. Condon received his B.S. in biology and psychology from Boston College and completed his M.S. and Ph.D. in the neurosciences at the Department of Physiology, College of Medicine, Ohio State University.

Applying Research-Based Prevention Principles

Elizabeth B. Robertson, Ph.D.
Chief, Prevention Research Branch, Division of Epidemiology and Prevention Research, National Institute on Drug Abuse, National Institutes of Health

This brief overview will address principles of prevention identified through synthesizing findings from research-based prevention interventions sponsored by NIDA over the past 20 years. The importance of the developmental status of the targeted group and the social environment in the selection of appropriate programming will be discussed. A systems perspective will be used to highlight the importance of interactions and transactions between individuals and the social context in defining risk and protective factors. Several research-based principles derived from each of the three most common intervention program contexts (community, school, and family) will be discussed in some detail. Other potential contexts for prevention interventions will be mentioned.

This topic will be discussed in further detail in an afternoon workshop.

Dr. Elizabeth B. Robertson is the Branch Chief of the Prevention Research Branch, Division of Epidemiology and Prevention Research, National Institute on Drug Abuse. Her graduate degrees are in human development and family studies, and she completed a 3-year NIMH-sponsored postdoctoral fellowship with the Carolina Consortium on Human Development at the University of North Carolina at Chapel Hill. Her portfolio of grants at NIDA includes research projects that examine the efficacy and effectiveness of universal, selective, and indicated prevention interventions for families. In addition, she has a research emphasis on the epidemiology and etiology of substance abuse problems in rural and frontier areas of America. Her publications examine the utilization of drug abuse services and the influences of environmental and family factors on child development and family relations.

Relapse Prevention Approaches in Substance Abuse Treatment

Richard A. Rawson, Ph.D.
Executive Director, Matrix Center and Matrix Institute

Much of the early research in the field of substance abuse treatment focused on development of techniques for assisting individuals in withdrawing from alcohol and drug use. Once medications were developed to alleviate withdrawal discomfort and risk, emphasis shifted from helping people discontinue alcohol and drug use to helping them avoid a return to alcohol and drug use. The development of a set of strategies to assist in the prevention of relapse, along with empirical evidence to support these techniques, has been one of the most important advancements in the treatment of substance abuse disorders.

The work of researchers including Alan Marlatt and Kathleen Carroll and others has been instrumental in moving these techniques into the mainstream of substance abuse treatment. This presentation will review some of the basic cognitive behavioral concepts underlying the groups of techniques referred to as "Relapse Prevention" techniques, will illustrate some specific examples of how these techniques are applied to substance abuse disorders, and will review some of the research evidence to support the value of the relapse prevention procedures.

This topic will be discussed in further detail in an afternoon workshop.

Dr. Richard A. Rawson received a Ph.D. in experimental psychology from the University of Vermont in 1974. Since that time he has spent his career conducting research and developing treatment systems for substance abuse disorders. Dr. Rawson, a member of the UCLA Department of Psychiatry for more than 20 years, is currently the Deputy Director of the UCLA Alcoholism and Addiction Medicine Service and Co-Director of the UCLA Drug Abuse Research Center. Dr. Rawson, along with Dr. Walter Ling, is co-founder of and Research Director for the Los Angeles Addiction Research Consortium (LAARC). In this role, Dr. Rawson oversees a portfolio of addiction research ranging from brain imaging studies and numerous clinical trials on pharmacological and psychosocial addiction treatments, to the study of how new treatments are applied in the treatment system. Dr. Rawson and colleagues established the Matrix Center and Matrix Institute in 1984 as a substance abuse treatment delivery organization in Southern California. More than 500 individuals per year receive treatment assistance from the network of 6 outpatient offices.

Dr. Rawson has published more than 100 professional papers and has conducted over 1,000 workshops, paper presentations, and training sessions. His research grant history includes numerous awards from NIDA, the National Institute on Alcohol Abuse and Alcoholism, the Center for Substance Abuse Treatment, the Robert Wood Johnson Foundation, and private organizations. He is currently a member of Attorney General Reno's Methamphetamine Advisory Taskforce. His recent activities have included serving as the Chair for the CSAT TIP (Treatment Improvement Protocol) on the Treatment of Stimulant Dependence, providing methamphetamine training services to numerous Native American tribes in Montana, and serving as a substance abuse treatment consultant for a joint Israeli-Palestinian project to develop substance abuse services in the Palestinian territories.

Managing Managed Care: Issues for Drug Treatment Programs

Dennis McCarty, Ph.D.
Human Services Research Professor; Director, Brandeis/Harvard Research Center on Managed Care and Drug Abuse Treatment, Institute for Health Policy, Heller Graduate School, Brandeis University

The presentation has three goals: (1) describe features of managed care, (2) discuss facets of drug abuse that complicate the design of managed care plans, and (3) outline studies from the Brandeis/Harvard Research Center on Managed Care and Drug Abuse Treatment. Our investigations of managed care's influence on the organization, delivery, and financing of substance abuse treatment services find that contracts with managed care companies can both improve and inhibit the utilization of services. Studies of provider practice patterns find wide variations in service delivery and suggest that some providers are inefficient and that the quality of care may be inconsistent.

Dr. Dennis McCarty is a Research Professor at the Institute for Health Policy in Brandeis University's Heller Graduate School. He collaborates with policymakers and community-based programs to study the effects of managed care on the organization, financing, and delivery of substance abuse treatment services. Currently, Dr. McCarty directs the NIDA-funded Brandeis/Harvard Research Center on Managed Care and Drug Abuse Treatment. He has been a co-editor for two Institute of Medicine reports, "Managing Managed Care: Quality Improvement in Behavioral Health Care" and "Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment."

Afternoon Workshops

Workshop A: Relapse Prevention Approaches in Substance Abuse Treatment

Richard A. Rawson, Ph.D.

Much of the early research in the field of substance abuse treatment focused on development of techniques for assisting individuals in withdrawing from alcohol and drug use. Once medications were developed to alleviate withdrawal discomfort and risk, emphasis shifted from helping people discontinue alcohol and drug use to helping them avoid a return to alcohol and drug use. The development of a set of strategies to assist in the prevention of relapse, along with empirical evidence to support these techniques, has been one of the most important advancements in the treatment of substance abuse disorders.

The work of researchers including Alan Marlatt and Kathleen Carroll and others has been instrumental in moving these techniques into the mainstream of substance abuse treatment. This presentation will review some of the basic cognitive behavioral concepts underlying the groups of techniques referred to as "Relapse Prevention" techniques, will illustrate some specific examples of how these techniques are applied to substance abuse disorders, and will review some of the research evidence to support the value of the relapse prevention procedures.

Workshop B: Managing Managed Care: Issues for Drug Treatment Programs

Dennis McCarty, Ph.D.

The workshop builds on the morning overview and has two goals: (1) review managed care plans to illustrate features that policymakers must address, and (2) examine variables that affect decisions to carve out behavioral health services. Medicaid managed care initiatives in Massachusetts, Maryland, and Nebraska are discussed with respect to their common features and unique elements. Lessons from these States are drawn and discussed.

Workshop C: Understanding Drugs and the Brain: Biobehavioral Impact of Drug Abuse

Scott E. Lukas, Ph.D.
Associate Professor of Psychiatry (Pharmacology), Harvard Medical School; Director, Behavioral Psychopharmacology Research Laboratory, McLean Hospital

The impact of drug abuse reaches nearly every person in this country, either directly or indirectly. Efforts are currently underway to study some of these factors in an attempt to develop new and improved prevention and treatment strategies. A review of some of the most promising research discoveries will be presented, including new treatment medications for cocaine and heroin addiction, promising behavioral therapies for drug abuse, male/female differences in cocaine effects, and the nicotine patch for treatment of tobacco dependence. The above issues will also be discussed within the context of their impact on the fetus and children.

Dr. Scott Lukas is an Associate Professor of Psychiatry (Pharmacology) at Harvard Medical School and is the Director of the Behavioral Psychopharmacology Research Laboratory at McLean Hospital. He is on the Board of Directors of the College on Problems of Drug Dependence, serves on grant review panels for NIDA, and has written two books for teens on drug abuse.

Dr. Lukas' current research, funded by NIDA and the National Institute on Alcohol Abuse and Alcoholism, uses new neuroimaging techniques to explore how cocaine, marihuana, and alcohol affect the various brain functions that relate to addiction.

Workshop C: Brain Targets of Drugs of Abuse

T. Celeste Napier, Ph.D.
Professor, Department of Pharmacology; Director, Neuroscience and Aging Institute, Division for Research on Drugs of Abuse, Loyola University, Chicago

Recent NIDA-funded research has led to the important conclusion that drug addiction is a disease of the brain, and that this disease will respond to treatment. To develop new treatments for addiction, we must understand the physiology of the "feel good" sensations that accompany the use of these drugs, as well as the intense desire for more drugs after these effects have worn off. This presentation will focus on NIDA-supported research underway to identify and characterize brain regions that are involved in these aspects of addiction. This work is providing new insights that should aid in the development of effective therapies for cocaine and heroin addicts.

Dr. T. Celeste Napier received her Ph.D. in Pharmacology and Experimental Therapeutics in 1982 from the Texas Tech University Health Sciences Center. After her postdoctoral training at the University of North Carolina Medical School, she accepted a faculty position at Loyola University, Chicago School of Medicine, where she is a Professor of Pharmacology and Neuroscience and Director of the Neuroscience and Aging Institute Division for Research on Drugs of Abuse. Dr. Napier is an author and editor of numerous publications in scientific journals and a book on the anatomy and function of the forebrain. Her involvement in neuroscience endeavors also includes memberships on several NIH Grant Review Committees and service as Secretary (1994-1995) and President (1996) of the Chicago Chapter of the Society for Neuroscience.

Workshop D: Applying Research-Based Prevention Principles

Elizabeth B. Robertson, Ph.D.

This workshop will address principles of prevention identified through synthesizing findings from research-based prevention interventions sponsored by NIDA over the past 20 years. The importance of the developmental status of the targeted group and the social environment in the selection of appropriate programming will be discussed. A systems perspective will be used to highlight the importance of interactions and transactions between individuals and the social context in defining risk and protective factors. Several research-based principles derived from each of the three most common intervention program contexts (community, school, and family) will be discussed in some detail. Other potential contexts for prevention interventions will be mentioned.

Workshop D: Where Do We Go From Here: Community-Based Tools for Prevention

Virginia Molgaard, Ph.D.
State Family Life Specialist, Iowa State University Extension

Dr. Molgaard will be copresenting with Dr. Robertson; please see above abstract.

Dr. Virginia Molgaard is a Family Life Specialist for the Iowa State University Extension. In that role she serves as a consultant for Extension field staff across Iowa. She also serves as a prevention researcher at the Iowa State University Institute for Social and Behavioral Research. She develops and tests family-focused interventions designed to reduce substance abuse by teens.