Now is a time of extraordinary opportunity in drug abuse science. Thanks to the exemplary research achievements of recent decades, we have advanced from a rudimentary understanding of drug abuse and addiction to a firm understanding of their essential behavioral and physiological mechanisms.
Twenty-five years ago, discussions about the harmfulness of drugs often took the form of pointless arguments as to whether this or that substance was "truly addictive." Today, we know that exposure to every commonly abused drug can produce significant harmful consequences, which may include neurological damage, severe behavioral and social problems, and increased risk for infectious diseases or cancer.
In the 1970s, debates about the nature of addiction revolved around whether this was a physical or psychological phenomenon. Now, we know that addiction is multidimensional-a brain disease with biological, behavioral, and social components. These advances in knowledge paved the way to much more effective treatments. In the 1970s, methadone was the only available medication. Today practitioners also have levo-alpha-acetylmethadol (LAAM), naltrexone, and nicotine replacements, and will soon have buprenorphine, each of which acts directly on the brain mechanisms of addiction. In addition, researchers have identified the roles that ancillary medications, such as antidepressants, can play in alleviating risk factors for initiating or relapsing to drug abuse. Scientific testing has also demonstrated that several types of behavioral therapy are effective, and more important, has elucidated the underlying principles of successful treatment.
With respect to prevention, in the past two decades, scientists have identified many factors that strongly influence whether an individual will initiate drug abuse and hence be at risk for addiction and other adverse consequences. There are individual factors related to personality, family factors related to parenting and parents' drug abuse, and community factors related to attitudes and opportunity to obtain drugs. Some factors are more important than others, but each provides a potential target for prevention activities.
While past achievements have positioned researchers to ask more probing- and practical-questions, the new tools and techniques that are revolutionizing all of health science powerfully enhance their ability to find answers. New brain scanners, for example, can provide extremely detailed information on drugs' impact on each part of the brain, which can then be linked to effects on cognition and behavior. New genetic techniques can be used to explore the biochemical actions of drugs in the brain, as well as to shed light on possible genetic risk factors. New computerized chemical databases permit much more rapid and economical screening of compounds to see whether they show promise as potential treatment medications.
In this context of opportunity, NIDA's strategic plan provides a framework for rapid progress (see figure below). The plan identifies research objectives in the areas of prevention, treatment, and information dissemination that are likely to facilitate rapid reductions in drug abuse and addiction and their health and social consequences.
A common theme that runs throughout the objectives of the new strategic plan is integration. Thus, NIDA's new Clinical Trials Network will incorporate local community concerns directly into research agendas and speed research results into practice. On the conceptual level, researchers will elucidate the ways that biological, behavioral, and social factors combine to produce and sustain drug abuse and cause addiction and relapse. Likewise, researchers will model the interactions between individual, family, and community factors that culminate in the initiation of drug abuse. Ultimately, these initiatives will make possible treatment and prevention plans that are attuned to the specific needs of individuals and communities.
Drug abuse and addiction are deeply rooted, complex problems. Science is our only hope for reducing and ultimately eliminating their terrible impact on the Nation. NIDA's strategic plan is designed to fully exploit that hope.
