The United States has a history of ambivalence to alcohol and drugs. The macho cowboy ambling up to the bar and the stumbling Bowery drunk are past pictorial depictions of the glory and tragedy of drink. Legends of Carrie Nation's hatchet saving starving widows and children compete with beliefs that the Prohibition Act, which limited the legitimate sale of alcohol, began the era of organized crime. Television images of 1970s college students in drugged states dancing merrily are set awry by today's headlines of college students falling off buildings because of alcohol and/or drugged states. The message of the award-winning movie "Traffic" is "It's hard to tell the good folks from the bad folks."
Today, policy planners like the Robert Wood Johnson Foundation alert us to the shifting burden of disease from infectious organisms to disorders with behavioral causes. Some estimate that lifestyle behaviors alone contribute to almost half of an individual's health status. And yet, the ambivalence of this country toward alcohol and drug use is expressed in the limited funds for prevention and treatment in contrast to the ever-expanding funds for law enforcement. As is true for the spectrum of behavioral, social and mental health disorders, according to the Institute of Medicine "less than 5 percent of approximately $1 trillion spent annually on health care nationwide is devoted to reducing risks posed by behavioral and social factors."
Expanding opportunities for psychology science and practice
Despite this ambivalence, psychology and psychologists are having a major impact on research and policy development in addictions. The National Institute on Drug Abuse (NIDA) has recently launched a precedent-setting, multisite research program (see page 28). In 14 sites throughout the nation, they are using the scientist and practitioner model espoused in the Health Leadership breakfasts at APA's Annual Convention co-chaired by Bruce Overmier, Ruth U. Paige and myself. The NIDA sites will have researchers and practitioners work together on looking at effective treatments. Betty Tai, Clinical Trials Network (CTN) branch chief, says, "We always wanted to use the CTN as a platform to test behavior therapies for their effectiveness in drug abuse treatment. This is a tremendous opportunity for psychology research as well as for transferring psychology research into practice."
Other psychologists involved in CTN include Lisa Onken, behavioral development treatment branch chief; Cora Lee Wetherington, women and gender research coordinator; Mary Ann Stephens, coordinator of protocols for testing new opiate treatment medications in adolescents; and Cecilia McNamara, who coordinates focused aftercare protocols.
The three major academic substance abuse organizations are all led by APA-member psychologists: College on Problems of Drug Dependence by Dorothy Hatsukami, Research Society on Alcoholism by Stephanie O'Malley and the Society for Research on Nicotine and Tobacco by Ken Perkins. Div. 28 (Psychopharmacology and Substance Abuse) Council of Representatives' member Maxine Stitzer from the Johns Hopkins School of Medicine, has also been very involved in these efforts.
For practitioners, the multiple areas of addiction offer expanding opportunities. The APA Practice Organization's College of Professional Psychology offers a Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders for qualified psychologists who pass the certification exam. Since 1993, APA's Div. 50 (Addictions) President Kenneth E. Leonard stated that the division has been committed to an integration of research, practice, education and public policy to address the problems associated with alcohol, tobacco and other psychoactive substance use, as well as other behaviors that have an "addictive" quality about them.
On another note
For three-and-a-half years, we have been extremely fortunate in having Richard McCarty as our executive director for science. Richard will begin his tenure on July 1 as dean of arts and science at Vanderbilt University. He arrived at APA in January 1998 from his position as chair of the department of psychology at the University of Virginia. During this time, he has made major contributions to psychology and to APA, including organizing the Decade of Behavior. On a personal note, I will miss Richard very much. His sense of humor, his intelligence, his ability to bring psychologists together into partnerships with other disciplines, his knowledge and his integrity are but a few of the attributes I've admired and enjoyed. One of the benefits of being active in APA is having the opportunity to know psychologists like Richard, and I wish him the best.