What do substance-abusing schizophrenics, women with post-traumatic stress disorder, and women with borderline personality disorder have in common? All these groups contain a large number of patients who have failed multiple attempts at rehabilitation, often because their needs weren't ad-dressed adequately in either drug abuse treatment or mental health clinics. These groups also share another characteristic: They are among the special subpopulations of drug abusers included in the first 12 studies funded under NIDA's behavioral therapies development program.
The program, which NIDA launched last year to develop, test, and standardize new behavioral treatments for drug abuse, is putting a special emphasis on developing new treatments for groups, such as substance abusers with mental disorders, who have been overlooked in past research. The ultimate goal of the program is to improve the effectiveness of behavioral treatments for all drug abuse patients.
Behavioral therapies include a broad range of approaches, such as psychotherapy, behavioral therapy, cognitive therapy, skills training, counseling, and other rehabilitative therapies. Such therapies are the most widespread - often the only - form of treatment currently available for drug abuse. Although several of these therapies have shown some effectiveness in treating drug abuse, many questions remain about which therapies work best, with whom, and under what conditions.
Behavioral therapies, such as group counseling, shown above, are often the only form of treatment available for drug abuse. NIDA is putting special emphasis on developing new behavioral treatments for groups of patients, such as drug-addicted women with mental disorders, who have been overlooked in past research.NIDA's behavioral therapies development program seeks to answer these questions by developing therapies specifically designed to treat drug abuse, targeting treatments to specific populations, analyzing treatment components and mechanisms of action, and demonstrating that treatments that have worked in research clinics can be transferred successfully to community settings. Ultimately, NIDA plans to work with the Center for Substance Abuse Treatment to disseminate proven therapies to counselors and therapists in community drug abuse treatment clinics.
Some of the initial 12 studies being conducted by researchers in the new program are developing therapies intended to modify traditional behavioral treatments for drug-addicted patients who also have mental disorders, such as drug-addicted schizophrenics or women with posttraumatic stress disorder. Other studies are taking more novel approaches by applying basic theoretical principles about behavior and substance abuse to the development of new therapies for other groups of difficult-to-treat drug-addicted patients.
"We want to find [behavioral] treatments for drug abuse that work, and we want to find out why they work and how they work," says Dr. Lisa Onken of NIDA's Division of Clinical and Services Research, who is heading the program. Understanding why a behavioral treatment is effective in treating drug abuse would enable both researchers and clinicians to modify treatments for individual patients or different patterns of drug abuse, Dr. Onken says.
To accomplish its goals, the program will put new therapies through a rigorous three-stage process that involves formulating, testing, and refining the therapies in a series of small-scale studies, larger clinical trials, and replication studies in different treatment settings. The process is comparable to that used by the Institute's medications development program to discover new medications and show that they are effective in treating drug abuse. (See "How to Develop a Behavioral Therapy")
Compared to the development of treatment medications, the development of new behavioral therapies for drug dependence is in its infancy. As recently as 2 years ago, most of the behavioral research that NIDA supported consisted of clinical studies of established therapies. Little support existed to do the preliminary work needed to justify clinical trials of new behavioral approaches tailored to the specific needs and problems of drug-dependent individuals, Dr. Onken notes.
Recognizing the need to develop new psychotherapies, NIDA began to expand its support for research on theoretically based psychosocial therapies for drug abuse in 1992. In 1993, the Institute issued a request for applications to conduct research on new behavioral therapies that paved the way for the behavioral therapies development program announced last year. The new program has greatly increased NIDA's support for all stages of research needed to take behavioral treatments from concept to the community clinic.
As with the search for new medications, it is expected that some new therapies in the early stages of development will either fail or have limited success, says Dr. Onken. But, it is also expected that some will succeed, she says. Ultimately, the paths followed by researchers in NIDA's new behavioral therapies development program and its established medications development program should lead to more effective behavioral and biomedical treatments for drug abuse.