Fiscal Year 2007 Budget Information

Congressional Justification

Authorizing Legislation: Section 301 of the Public Health Service Act, as amended.

This document provides justification for the Fiscal Year 2007 activities of the National Institute on Drug Abuse, including HIV/AIDS activities. A more detailed description of NIH-wide Fiscal Year 2007 HIV/AIDS activities can be found in the NIH section entitled "Office of AIDS Research (OAR)." Detailed information on the NIH Roadmap for Medical Research may be found in the Overview section.

Introduction

NIDA is the world's largest supporter of research on drug abuse and addiction. Our scientific research addresses the most fundamental and essential questions about drug abuse, including how drugs work in the brain, who is most vulnerable to becoming addicted, and how we can best develop and test new drug treatment and prevention approaches. We also track emerging drug use trends - and this year we have some good news to report. Our Monitoring the Future survey (MTF) revealed a 19 percent decline in overall illicit drug use among 8th, 10th, and 12th graders combined over the last four years. However, the MTF survey also reports that inhalant abuse has risen among 8th graders between 2002 and 2005 and the abuse of prescription painkillers is continuing at alarming rates, especially among 12th graders, for whom Vicodin and OxyContin are among the most commonly abused drugs. Also, while methamphetamine abuse is decreasing in teens, it appears to be growing in popularity in a number of new locations and populations around the country. Therefore, much remains to be done.

Drug abuse is costly to Americans, tearing at the fabric of our society and taking a huge financial toll on our resources. Beyond its inextricable link to the spread of infectious diseases, such as HIV/AIDS, sexually transmitted diseases (STDs), tuberculosis, and hepatitis C, drug abuse is often implicated in family disintegration, loss of employment, failure in school, domestic violence, child abuse, and other crimes. The 2004 National Survey on Drug Use and Health puts the number of people dependent on illicit drugs at approximately 5 million. Placing dollar figures on the problem, smoking and illegal drugs cost this country about $338 billion a year, with illicit drug use alone accounting for about $180 billion in crime, productivity loss, health care, incarceration, and drug enforcement.

Scientific knowledge is the best tool for addressing the disease of addiction.

Decades of leading edge research have advanced our progress in achieving the goal of preventing and treating drug abuse. Now, with new tools, techniques, and knowledge, we are poised to take advantage of what we know to change the course of drug addiction in this country. We aim to address the nation's most important research needs while remaining sufficiently flexible to respond to new scientific opportunities. Through innovative use of brain imaging technologies, for example, we can now literally see into the brains of people addicted to drugs and discover how drugs are impacting brain function. Advances in genetics are letting us begin to identify genes of vulnerability or protection so we can tailor our interventions to have the greatest impact. And growing knowledge about the dynamic interactions of genes with environment confirms addiction as a complex and chronic disease of the brain with many contributors to its expression in individuals.

Understanding the brain is key to understanding and preventing addiction.

The basic and clinical research NIDA has sponsored for more than 30 years has led to an ever-increasing body of knowledge about how drugs of abuse exert their effects in the brain. Recent studies have illuminated many of the cellular, molecular, and basic brain circuits involved in addiction, revealing detailed cascades of cellular events, some of which lead to long-lasting structural and functional changes caused by drug abuse. This knowledge has helped us to zero in on potential molecular targets for addiction medications and will allow us to see whether our treatments are working as intended. Neuroimaging tools such as functional magnetic resonance imaging (fMRI) allow us for the first time to study how the human brain functions and how it is affected by drugs during the transition from childhood to adolescence to adulthood.

Addiction is a developmental disease.

We know now that the brain continues to develop into early adulthood. Recent imaging data reveal that the prefrontal cortex - the region of the brain involved in judgment, decision-making, and control of emotional responses - is one of the last areas of the brain to mature. This knowledge suggests that age matters when it comes to drug abuse: exposure to drugs of abuse during adolescence or childhood may adversely affect brain development and increase vulnerability to drug effects and addiction. Yet, the inherent plasticity during this period of continued development might also present opportunities for resiliency and for receptivity to intervention that can alter the course of addiction. NIDA's enhanced capacity to investigate the motivational processes at work in the young brain can give us valuable insight into teen decisions whether to use drugs, and help us to develop prevention messages and intervention strategies that are more likely to succeed with them.

Additionally, NIDA has been supporting a number of longitudinal studies on cohorts of children prenatally exposed to drugs, which gather information about their cognitive and emotional development, as well as their vulnerability to addiction later in life. The application of high-resolution brain-imaging technologies and new genetic databases to these cohorts will reveal more about the trajectory of addiction and the contribution of social-environmental factors, including stress in childhood (e.g., physical or sexual abuse, poverty). As we gain knowledge of the individual differences in genes and the gene-environment interactions that make a person more vulnerable to addiction, we can tailor interventions for those at high risk.

We must continue to translate knowledge into effective treatments for drug abuse.

As a chronic disease, drug addiction for many people requires some level of continuous care, just like other chronic diseases, such as diabetes, asthma, and hypertension, which have similar rates of relapse (50-75 percent). Treatment can help people stay off drugs and recover function of compromised brain systems that enable motivation, memory, and initiation of drive. Unfortunately, most people who need drug abuse treatment do not receive it.

In response, NIDA is creating an infrastructure for translating science into real-world treatment settings, to enable evidence-based treatments to move from "bench to bedside to community". We are taking an aggressive approach, reaching out to physicians, judges, law enforcement, and other pivotal members of society to educate them about substance abuse disorders and to promote a more integrated and compassionate system that addresses the reality of co-occurring diseases and other drug abuse consequences.

It is not enough merely to have the infrastructure needed to address our ambitious goals of blending science and practice. We must also now use it to translate our findings into effective community-based prevention and treatment programs. Our landmark "Blending Initiative" aims to do just that. NIDA has partnered with SAMHSA, and with researchers, clinicians, practitioners, and state alcohol and drug abuse directors to share strategies for incorporating research-based treatment findings into community settings (see Story of Discovery). Further, a recent evaluation of our dissemination efforts showed that the substance abuse information we convey to the public through multiple publications and websites is being applied across a variety of settings, extending our outreach efforts.

The selected initiatives summarized below are those that we feel best represent the areas we will continue to emphasize. NIDA is proud of these efforts and of our strategic planning approach that focuses resources on those areas that could make the greatest difference to Americans directly or indirectly affected by drug abuse and addiction. Through sponsoring pivotal research and working with others, we are bringing new insights into the mechanisms of addiction to communities around the country, helping to reduce associated stigma and suffering. Our initiatives also support two of the three goals of the President's National Drug Strategy: (1) stopping use before it starts and (2) healing America's drug users.

NIDA is working with ONDCP and other government agencies on the Data Initiative to better plan and coordinate drug-related data collection, analysis, and dissemination to support drug control policies at the National level. Relevant, accurate, and timely data serve as a foundation for sound policy decisions and informing research priorities. Policy officials have a critical need for key data on the scope of drug use and its consequences in determining the Federal response to the problem.

As scientifically appropriate NIDA supports preserving the consistency and trendability of its key date systems. The short-term objectives include ensuring that critical data sets remain viable, developing a list of priority policy questions, aligning available data with questions, and conducting a data gap analysis. The long-term objective is to plan for improvements to data systems that require long-term budgeting. Key data activities supported by NIDA include:

The Monitoring the Future (MTF) Study: MTF is one of the key legacy data sets that help inform both policy and research. MTF is a continuing series of surveys, supported by a NIDA grant, which assesses the changing lifestyles, values, and preferences of American youth with respect to drug use. Data from 8th, 10th, and 12th graders in the coterminous United States are collected annually. The school sample is designed to allow for the generation of estimates at the national and regional levels.

The Community Epidemiology Work Group (CEWG): The CEWG provides a valuable service in identifying emerging threats, use patterns, and vulnerable populations. The group monitors drug abuse trends and associated consequences by tracking multiple sources of existing data within and across multiple metropolitan and non-metropolitan areas in the U.S. and the State of Texas. CEWG area representatives access, analyze and interpret existing data from Federally-supported and local sources.

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