SCIENCE DIRECTIONS

NIDA turns 25

By Richard McCarty
APA Executive Director for Science

As the National Institute on Drug Abuse (NIDA) celebrated its 25th Anniversary in late September, it seems a fitting time to reflect on the role psychologists and psychological science have played along the way. The sequelae of drug withdrawal, among other behavioral phenomena associated with chronic drug use had been studied at the Addiction Research Center in Lexington, Ky., since 1935. But it was in 1972 that the federal government legitimized the field of drug-abuse research by establishing the National Institute on Drug Abuse, originally as an arm of the National Institute of Mental Health (NIMH). Although NIMH, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and NIDA were fully welcomed into the NIH family in 1992, drug-abuse researchers must continue to deal with the perception that drug dependence results from volitional behavior that the afflicted individual can stop at any time.

Now, in some sense, that perception is true. Short of being "slipped a mickey," most experimentation with illicit drugs begins by a personal choice, but at some point, subsets of these individuals transition from use, through abuse, to dependence. Who these people are, how to prevent the transition, why they make the transition and how to treat them once they've made it, are some of the central questions that have guided NIDA's research portfolio over the past 25 years. And, as NIDA's Director Alan Leshner is fond of saying, that portfolio includes everything "from molecules to managed care."

Psychology's contributions

However, psychological science has been an important player all along. Behavioral neuroscientists identified brain pathways shown to mediate many forms of reinforced behavior; behavioral pharmacologists developed drug self-administration, place preference and drug discrimination paradigms to identify which drugs serve as reinforcers and by what mechanism of action. Behavior geneticists have defined phenotypes of mice and humans that express the full range of drug-taking behaviors in models of vulnerability; and cognitive psychologists have used neuroimaging to show selective activation of the brain in drug-dependent individuals using models of drug craving.

This basic research related to the process of drug dependence has been anchored on both sides by dramatic advances in prevention and treatment research. NIDA is justifiably proud of its research-based guide, "Preventing Drug Use Among Children and Adolescents." Similar efforts are under way to disseminate manualized therapies for both community reinforcement and cognitive-behavioral approaches for the treatment of cocaine dependence.

While established pharmacological interventions such as methadone and naloxone have played a central role as therapeutic agents in the treatment of opiate dependence, the efficacy of those medications is markedly improved when delivered in the context of psychosocial treatments. The success of NIDA's behavioral treatment research portfolio is a direct reflection of its research investment over the last several years and a tribute to the creativity of NIDA grantees. NIDA's Behavioral Therapy Development Program (BTDP) has been testing new therapies in three distinct Stages: 1) early development, 2) efficacy testing and 3) transportability to the community at large. Following the success of the first RFA in 1993, the BDTP became a standing Program Announcement in 1994 and has since grown to include 55 grants in Stage 1 of which 16 have progressed to late Stage 1 or Stage 2.

A remarkable past--and future

BTDP grants have yielded surprising results. For example, in studies involving voucher-based contingency management of abstinence behavior, the experimental groups achieve greater abstinence during treatment as might be expected. However, the predictor of long-term success appears to be the duration of abstinence achieved during treatment rather than the assigned experimental condition. Further, comparisons of contingency management and relapse prevention have demonstrated the enduring, and in some cases delayed emergence of psychotherapeutic effects months after the end of treatment. Recognizing the promise of these results, NIDA elevated the BDT Program to Branch status effective Oct. 1.

The question of whether these Stage 2 therapies can be transported will be answered by NIDA's most ambitious effort to date: the National Drug Abuse Clinical Trials Network (CTN). Again, rather than reinventing the wheel, NIDA is following a model used successfully by other NIH institutes to provide a framework for evaluating the most promising interventions in real-life settings. Such networks are expensive undertakings but during the last four years the NIDA budget has increased by some 27 percent and Dr. Leshner has been very successful in justifying the need for increased funding to members of Congress. Recent estimates suggest that alcohol and drug abuse costs our nation $246 billion per year. If this price tag is ever reduced, NIDA staff and grantees will play a critical role.

Please join me in a hearty chorus of "Happy Birthday to NIDA." I think we all know what Dr. Leshner will wish for as he blows out the candles--greater support for this remarkable institute.



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