Special Report Volume 14, Number 1 (April, 1999) |
By Robert Mathias
Editor's Note: The scientists pictured on these pages represent just a sampling of the hundreds of scientists who have advanced drug abuse research during NIDA's 25 years.
NIDA's Roots
The 1970s
NIDA-supported scientists develop an animal model that shows that animals will self-administer most of the same drugs that people do. Researchers still use this model today to screen and characterize the abuse liability of new drugs and the treatment potential of new compounds being considered as drug abuse medications.
NIDA-supported researchers make a series of groundbreaking discoveries about the brain and its molecular and neurochemical methods of communication. The discovery of opioid receptors in the body, identification of naturally occurring chemicals that act at these receptors to mediate mood and pain, and the finding that opiates such as heroin act at these same receptors revolutionized thinking about the addictive process and brain function in general. The concept of drug and receptor interactions provided the first clue about how drugs exert their effects in the brain and paved the way for development of new medications to treat drug abuse and other diseases.
NIDA establishes the first national-level surveillance network to assess current drug use patterns and identify emerging trends in major metropolitan areas around the country. This network, called the Community Epidemiology Work Group (CEWG), has been meeting semiannually for more than 21 years. Using the CEWG model, a number of State Epidemiology Work Groups in the United States and an International Epidemiology Work Group now monitor drug use patterns and trends around the world. NIDA undertakes comprehensive research on nicotine addiction to study how the drug is absorbed and distributed by the body. NIDA's nicotine research has defined the central role of nicotine in tobacco dependence and cigarette smoking, laid the groundwork for recent State and Federal actions to regulate the advertising and sale of tobacco products, and provided the scientific basis for the development of nicotine replacement therapies in the 1990s. The Institute initiates research on the health and developmental consequences of prenatal drug exposure for infants and children. This research led to the development of a pharmacological treatment to ease newborn infants' withdrawal from prenatal exposure to narcotics. Today, NIDA supports more than 30 long-term studies of the effects of women's use of narcotics, cocaine, and other drugs on preg-nancy, maternal health, and infant and child development. The 1980s
AIDS becomes a major NIDA research priority because of the central role that injection drug use plays in the transmission of HIV. From 1986 to 1987, NIDA's budget increased dramatically to support new research on both AIDS and drug abuse with AIDS funding nearly tripling. Among the effective responses developed by NIDA were the National AIDS Outreach Demonstration Projects. These projects provided out-of-treatment drug injectors and their sexual partners with AIDS prevention and education messages, encouraged drug users to enter drug abuse treatment, and demonstrated that drug users can reduce AIDS risk behaviors. An inexpensive, highly addictive, smokeable form of cocaine called "crack" makes its debut on the streets and spurs an epidemic of cocaine use. In response, NIDA expands basic and clinical research on cocaine and launches major cocaine prevention campaigns. Expanded basic research on cocaine pays off when NIDA's intramural researchers identify a protein called the dopamine transporter as the primary site in the brain where cocaine acts to initiate the drug's euphoric and addictive effects. Today, NIDA-supported researchers are pursuing development of a number of promising cocaine treatment medications targeted at this brain molecule.
After years of NIDA-supported research in collaboration with the private sector, naltrexone joins methadone as the only medications approved by the Food and Drug Administration (FDA) for treating heroin addiction. Naltrexone blocks heroin's effects and is used to prevent relapse to drug use among recovering addicts. NIDA-supported researchers continue to build the scientific base for effective drug abuse prevention programs by identifying individual, family, school, and neighborhood factors that place children at risk for drug abuse and addiction. To date, researchers have identified a constellation of these risk factors and, equally important, a large number of protective factors that help to buffer the risk factors and reduce the likelihood that young people will abuse drugs. Drug abuse prevention researchers have since developed a broad array of effective family, school, and community programs that target these factors. The 1990s
NIDA intramural and extramural researchers clone the dopamine transporter, cocaine's primary site of action in the brain. NIDA-supported researchers have since cloned the brain receptors at which every major drug of abuse acts to trigger the complex cascade of biochemical events that produces those drugs' psychoactive and behavioral effects. Researchers now use these cloned molecules to design and screen new compounds and medications approved for other conditions for possible efficacy as drug abuse treatments.
MDD successfully shepherds LAAM (levo-alpha-acetyl-methadol), a heroin treatment medication, through FDA's regulatory process. LAAM was the first new medication for the treatment of addiction to heroin and other opiates approved by FDA since the agency had approved naltrexone nearly a decade earlier. LAAM provides treatment practitioners with a long-acting alternative to methadone and is used to stabilize heroin addicts in long-term treatment. MDD currently has several next-generation heroin treatment medications, including buprenorphine and a longer acting form of naltrexone, in the latter stages of the FDA approval process. The Institute establishes its Behavioral Therapies Development Program. The Program seeks to enhance existing behavioral treatments; develop, replicate, and standardize new behavioral therapies; and promote the use of those treatments that are effective in reducing drug abuse. The Program has produced a host of science-based cognitive-behavioral treatments for drug abuse and addiction, including new family therapies, relapse prevention approaches, brief motivational enhancement therapies, and improved counseling techniques.
NIDA expands research on women, gender, and drug abuse. Gender-based research now is integrated throughout NIDA's grant portfolio. The research seeks to identify the critical biological and behavioral factors that differentially affect the initiation, progression, and consequences of drug abuse and addiction in females and males of all ages and how these variables should be addressed in drug abuse prevention and treatment. A new brain imaging center opens at NIDA's IRP in Baltimore. This center, and NIDA's new Regional Neuroimaging Center at Brookhaven National Laboratory in Upton, New York, affirm NIDA's commitment to brain imaging as a vital drug abuse research tool. Brain imaging studies conducted by intramural and extramural researchers have greatly increased understanding of the neurobiological basis of drug abuse and addiction.
The National Conference on Drug Abuse Prevention Research is convened to spread the word about effective, science-based school, family, and community drug abuse prevention programs developed by NIDA-supported researchers. To further aid communities in applying research findings to their local drug abuse prevention efforts, NIDA published and disseminated the first research-based guide to preventing drug abuse among children and adolescents.
NIDA's Drug Abuse Treatment Outcome Study (DATOS), a major nationwide study of drug abuse treatment outcomes in the 1990s, finds that the most common forms of drug abuse treatment programs all are effective in reducing drug use. DATOS data also shows that treatment led to significant improvements in other aspects of patients' lives, such as increased full-time work and reduced involvement in illegal activities. NIDA expands health services research to give drug abuse treatment and prevention service providers scientific data and research-based methodologies to gauge how well their programs work for patients in real-life settings. This research is giving service providers the tools to determine whether their programs provide cost-effective, accessible services that reduce drug abuse and addiction and related costs to society.
The Institute launches its Vulnerability to Addiction Initiative to increase knowledge of genetic and environmental factors and how they interact to increase or reduce vulnerability to drug abuse and addiction. Ultimately, the Initiative will increase understanding about the origins of drug abuse and addiction and provide knowledge that can be applied to the development of more effective drug abuse prevention and treatment strategies. NIDA begins to develop an extensive clinical trials network throughout the Nation to launch the next generation of drug abuse research. This network will establish a partnership between drug abuse treatment researchers and practitioners to test, refine, and speed the adoption of effective drug abuse treatments to enhance existing community-based treatment programs around the country. NIDA-supported research continues to replace old perceptions about drug abuse and addiction with new scientific knowledge. |
NIDA NOTES - Volume 14, Number 1 |
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