Drug Abuse and Addiction Research: 25 Years of Discovery to Advance the Health of the Public

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This Sixth Triennial Report to Congress on drug use and drug use research clearly demonstrates that we are continuing to make important progress in better understanding the consequences of illicit drug use through research supported by the National Institute on Drug Abuse (NIDA). Drug use and drug addiction are among the largest and most challenging problems facing society today. Scientific advances have contributed greatly to our understanding of drug use and addiction, but there will never be a "magic bullet" capable of making these problems disappear. Drug use and addiction are complex social and public health issues, and they require multifaceted approaches.

As we celebrate NIDA's 25th anniversary in 1999, numerous research accomplishments discovered throughout the years will be remembered. We recognize that research is the linchpin of our effort to develop more effective drug use prevention and treatment. We now understand clearly that drug addiction is a treatable brain disease, although there still exists a tremendous gap between what science tells us about the nature of addiction and the application of these findings by people in a wide variety of communities. We must bridge this disconnect to change the perception of many health professionals and the general public that addiction is a simple social problem or a failure of will. To do this, we must capitalize on the variety of effective addiction treatments that have been developed as part of NIDA-sponsored research. Both behavioral and pharmacological treatments have been shown to reduce drug use, crime and delinquency, and the spread of HIV/AIDS and other infectious diseases that are associated with drug use and addiction.

Now is the time to capitalize on these discoveries. In response to the development of a host of new treatment methods, NIDA has launched what is perhaps its most important effort ever-a national Treatment Initiative designed to improve the quality of drug addiction treatment programs in the United States. The Initiative has both a research emphasis and a communications thrust. The research emphasis will stimulate additional work to improve current treatments and to develop new treatments and will transfer them to community-based drug addiction treatment clinics. The communications thrust will increase the exchange of useful information about drug addiction and its treatment among the research and treatment communities and the general public. By spurring additional drug addiction treatment research and speeding the evaluation and application of research-tested treatments in the real world, NIDA's Treatment Initiative can have a significant impact on the Nation's public health.

NIDA has also launched a Methamphetamine Initiative to expand scientific research on methamphetamine and to apply the findings to the prevention and treatment of methamphetamine use before methamphetamine use reaches the scale and scope of other illicit drugs. Specifically, the Methamphetamine Initiative builds on the substantial body of knowledge yielded by previous NIDA-supported methamphetamine research, which shows that smoking, snorting, ingesting orally, or injecting methamphetamine produces euphoria by stimulating production of excessive levels of the neurotransmitter dopamine. More important, this research in animals has shown that even at low levels, methamphetamine can destroy substantial numbers of these dopamine-producing nerve cells, which can lead to permanent serious physical and behavioral effects. With a sense of urgency, the Institute has used supplemental funding from the White House Office of National Drug Control Policy and the Office of the Director, National Institutes of Health, to increase funding for efforts to develop new behavioral and pharmacological treatments to treat methamphetamine use.

Since describing the state of drug use and drug addiction research in the Fifth Triennial Report to Congress, NIDA's continuing support of more than 85 percent of the world's research on drug use and drug addiction had generated important new findings on the effects of drugs on the structure and function of the brain. This work is now leading investigators to develop the next generation of treatments and preventive methods to combat drug use and addiction. Scientists have identified neural circuits that subsume the actions of every known drug of abuse, and they have specified common pathways that are affected by almost all such drugs. Researchers have also identified and cloned the major receptors for virtually every abusable drug as well as the natural molecules within the brain that interact with these receptors. In addition, they have elaborated many of the biochemical cascades within nerve cells that follow receptor activation by drugs. Research has also begun to reveal major differences between the brains of addicted and nonaddicted individuals and to indicate some common brain elements of addiction, regardless of the substance.

We have also discovered more about how a person's external milieu can affect brain function and, therefore, the addiction process. One of the most significant breakthroughs in this area has been the identification of areas of the brain that are specifically involved in the phenomenon of craving. Research converging from many laboratories using modern neuroimaging technologies has laid out in detail the brain circuits that are activated when addicts experience craving for drugs. Because craving is probably the single most important factor that can lead to relapse, understanding the systems that mediate this phenomenon provides the foundation for developing much more effective therapies to prevent or reverse the addiction process.

With drug use beginning at an earlier age than ever before, NIDA is now dedicating a large portion of its research portfolio to study the effects that drug use and addiction have on infants, children, and adolescents. Prevention serves as the cornerstone of this Initiative, although NIDA's research portfolio also addresses other important issues, including the study of the consequences of prenatal drug exposure, the etiology and epidemiology of drug use among our youth, and drug use aspects of child and adolescent HIV/AIDS.

Drug addiction, like other health conditions, such as high blood pressure and depression, is a chronic, relapsing disease of the brain that is treatable. The NIDA-supported research described in this report chronicles our progress toward more effective prevention and treatment of drug addiction.

Alan I. Leshner, Ph.D.
Director, National Institute on Drug Abuse