The President’s Budget for FY13 has just been released and offers a timely opportunity to review NIDA’s funding priorities for the research we support. To best fulfill our public health mission to “lead the Nation in bringing the power of science to bear on drug abuse and addiction” requires that we focus on those areas likely to produce the greatest return on the public’s investment. To that end, NIDA’s research priorities include those that advance the development of medications, the application of innovative genetics/epigenetic tools and brain imaging technologies, and the translation of evidence-based findings into better drug abuse prevention and treatment interventions with greater access worldwide.
Making the most of new tools and technologies
A commitment to the use of next-generation methods and tools positions NIDA to make the most of our research. This includes novel approaches, such as anti-addiction vaccines, and new techniques for capturing and analyzing vast and diverse emergent datasets on everything from genetics to neuroimaging to social networks. NIDA continues to support research to refine vaccines being tested against cocaine, heroin, and methamphetamine, as well as nicotine, aiming to derive better adjuvants and haptens to increase the immune response. NIDA is also poised to harness complete genome and “deep” sequencing capabilities and a growing portfolio of epigenetic initiatives to elucidate how environmental factors (e.g., chronic stress), biological processes (e.g., brain development), and exposure to various neurological insults (e.g., drugs of abuse) can alter the expression of specific genes that influence brain organization and function—and the consequent expression (or not) of substance use disorders.
The overlaying of structural, neurochemical, and functional brain imaging information (for both the healthy state and during the pathological state of addiction) will further accelerate discovery by linking molecular and cellular data with human behavior. For example, a new functional magnetic resonance imaging (fMRI)-based approach can probe the resting brain (i.e., one not performing any specific task) to illuminate circuit-level functions that may prompt behavioral responses, including those related to diseased states or vulnerability. Individual differences found in these images could provide useful biomarkers (neural signatures) of illness risk, course, and treatment response. Integrating data across all levels of inquiry will help to identify new targets for the development of addiction medications, including those that in the future may be capable of selectively turning genes “on and off” in the affected brain circuits.
The amount and diversity of data being generated by genetics, epigenetic, and imaging studies highlight the need to develop harmonization standards to facilitate the integration of data across laboratories. In parallel, we need to focus on training a new generation of interdisciplinary scientists, including those proficient in developing modern analytical tools for integrating and managing large pooled data sets and for modeling and analyzing complexity.
Evidence-based interventions: expanding availability, adoption, and access
The Affordable Care Act of 2010 and other recent healthcare reform legislation should help expand access to and coverage of substance abuse and HIV treatment services at better cost and quality. Healthcare reform also may open opportunities to study how innovations in service delivery, organization, and financing can be used to improve access to and use of effective prevention and treatment interventions. Potential questions to answer are how to reach newly covered populations in a host of general healthcare settings and which implementation models will expand adoption of evidence-based programs to get them into routine clinical practice. Likewise, NIDA is encouraging research on how best to integrate screening, brief intervention, and referral to treatment into primary care and emergency room settings to identify substance related problems early on and prevent their escalation, or to better link those who need treatment with appropriate healthcare services.
Expanding the availability and quality of these services is essential to reach the populations who need them most. A particular challenge is reaching HIV-infected persons, a population that overlaps significantly with drug abusers. In response, NIDA is supporting research to test the “seek, test, treat, and retain” (STTR) model for identifying and addressing HIV in diverse environments, including criminal justice settings, U.S. cities with high rates of injection drug use, and regions of the world where drug abuse is a prominent vector for HIV transmission. An overarching goal is to create the infrastructure needed to implement STTR and to integrate treatment for substance abuse and HIV, reducing the prevalence and consequences of both.
NIDA's portfolio reflects a comprehensive, integrated, and nimble approach. It is one that insists on interdisciplinary and collaborative science and takes full advantage of research advances to transform how we prevent and treat drug abuse and addiction in this country and abroad.