How many Americans abuse drugs and what are the costs to society? What strategies work best to prevent young people from becoming addicted to drugs? Are there ways to change the service delivery system that will improve success in preventing and treating drug abuse?
These questions fall within the purview of NIDA's Division of Epidemiology, Services and Prevention Research (DESPR). Dr. Wilson Compton, the division's director, says its broad mission is to track the Nation's drug use and provide empirically based information that researchers and service providers can use to prevent drug abuse and deliver treatment.
"DESPR is NIDA's primary interface with public health organizations, providing the latest information on the status of the national drug abuse situation," says Dr. Compton. The division supports the development and assessment of prevention interventions, the study of treatment services and potential improvements to their effectiveness, and epidemiological research to understand the status, patterns, trends, and determinants of drug-use behavior in the United States. DESPR comprises three branches: the Epidemiology Research Branch, the Services Research Branch, and the Prevention Research Branch.
"We look for patterns and take an analytic approach to addressing drug use and the associated health and behavior problems," Dr. Compton says.
The Epidemiology Research Branch
Drug abuse patterns, trends, and pathways occupy this DESPR branch, which is currently headed by Acting Branch Chief Dr. Marsha Lopez. The branch considers the individual, developmental, social, and environmental factors associated with the course and outcomes of drug abuse.
The Epidemiology Research Branch, for example, oversees and manages the Monitoring the Future (MTF) survey, which is an important tool for epidemiologists, program planners, and policy officials who track U.S. drug abuse trends. This survey has been conducted annually since 1975 by the University of Michigan Institute for Social Research under a grant from NIDA. The MTF distributes a questionnaire to approximately 45,000 students in the 8th, 10th, and 12th grades nationwide.
From the MTF survey results, policymakers and researchers assess how well prevention interventions and policies are working. In August 2008, for example, when a group of college presidents recommended that the minimum drinking age be lowered to 18 because the increase to 21 "isn't working," MTF statistics showed otherwise, indicating that teen alcohol use had declined since the minimum alcohol-purchase age was raised in the 1980s.
Recently, the MTF survey drew attention to a new and disturbing trend: high school students abusing two prescription pain medications at increasing rates. In 2008, some 10 percent of high school seniors said they had abused Vicodin, and 5 percent reported abusing OxyContin. The findings prompted calls for renewed focus on the risks posed by abuse of prescription medications.
Each year the results of the MTF and other NIDA-funded epidemiologic studies provoke a fresh set of questions for DESPR. "The first question is: What new or ongoing problems are evident in the findings?" Dr. Compton says. "The next question is: What can we do about these problems?"
The Epidemiology Research Branch also oversees and manages NIDA-funded research on the genetic epidemiology of drug abuse. "We know that alcohol and drug abuse run in families," says DESPR Deputy Director Dr. Kevin Conway. "These studies aim to quantify the interplay of genetic and environmental factors in the tendency to abuse drugs." Recent studies performed under DESPR auspices suggest that besides influencing physiological responses to drugs, a person's genetic inheritance may increase his or her likelihood of choosing peers, relationships, and environments that make drug abuse more likely. Dr. Conway says, "This means that genetics and environment work together to increase or decrease risk."
Another challenge is to grasp how the still developing adolescent brain differs from that of the adult. NIDA research overseen by DESPR's Epidemiology Research Branch shows that adolescents are more likely than adults to experiment with drugs and that teens may be more addiction-prone than adults.
Dr. Conway says, "We plan to look at exposure to drugs in adolescence and the impact of that exposure on subsequent patterns of drug use and risk for addiction. Individual vulnerabilities that appear in early adolescence, for example, might reveal prime targets for intervention."
Substance Use Influenced More by Family Environment Early in Life and Genetics Later On: With NIDA funding under the auspices of DESPR, researchers examined 1,796 pairs of male twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. The vertical axes represent the contribution of genetic effects, family, or individual environment to observed variations in liability to drug use. The width of the colored lines at each point is one standard error, a measure of statistical uncertainity, above and below the point estimate.The Services Research Branch
The goal of the Services Research Branch is to identify the most effective ways to organize, manage, finance, and deliver high-quality drug abuse prevention and treatment and related health services. The branch chief is Dr. Redonna Chandler.
This branch has overseen NIDA-funded studies demonstrating the value of drug and alcohol treatment services, particularly those integrated into comprehensive health care systems. For example, this research has shown that timely alcohol-counseling sessions for trauma patients can increase the number of participants entering alcohol treatment and dramatically reduce their alcohol consumption after they are released from the hospital. NIDA-funded work is now testing these approaches for drug abusers who receive care in trauma centers, emergency departments, and general medical settings.
The Prevention Research Branch
Under the leadership of Drs. Elizabeth Robertson and Eve Reider, the Prevention Research Branch focuses on developing, testing, and applying interventions to deter drug use initiation or progression to abuse and dependence, as well as the transmission of HIV among drug-using populations.
The branch's current projects include several that address the well-documented link between aggressive behavior in a child's early school years and increased risk of problems later in life. "These are the kids who are alienated from classmates as soon as they start school," Dr. Compton says. "They fall in with other children who are at risk and adopt behaviors that make drug abuse more likely." The branch oversees research on programs designed to reduce aggressive behavior and facilitate children's effective functioning in school right from the start. The results indicate that interventions limited to high-risk children and interventions delivered to all children in a school regardless of their risk status can both be effective.
Challenges Across the Branches
DESPR also studies the interplay between drug use and other problems, such as mental or psychological disorders and HIV infection. These challenges involve all of the division's branches. "Human behavior is multifaceted and complex. Problem behaviors are not isolated factors that can be addressed in a vacuum," Dr. Compton says.
All three DESPR branches address the challenge of improving strategies for reducing HIV among drug abusers and their contacts. NIDA-funded research supervised by the Prevention Research Branch, for example, demonstrated that peer-educator outreach and the distribution of sterile injection equipment can lower the incidence of HIV infection. That 3-year study took place along the China-Vietnam border.
In a study overseen by the Epidemiology Research Branch, researchers at Yale University concluded that the public health and economic benefits of routine HIV testing in many medical settings would far outweigh the costs. Implementation of such testing may be more acceptable to the public than previously because stigmatization of infected individuals has eased.
A project under the auspices of the Services Research Branch showed that over more than a decade, outpatient drug treatment programs increasingly provided HIV testing and related services, but there is still a distance to go. "We know everyone entering drug treatment should be tested for HIV," Dr. Compton says, "but that is not happening yet."