U.S. – Netherlands Addiction Workshop and Binational Symposium on Drug Abuse, Addiction Research and Innovation

October 19-20, 1999

Executive Summary

During a two-day meeting in Amsterdam, the national organizations responsible for drug addiction research in the United States and The Netherlands signed documents agreeing to promote collaboration in biomedical and behavioral research on drug abuse and drug-related health issues. The formal Exchange of Letters was signed by Alan I. Leshner, NIDA Director; Henk J. Smid, The Netherlands Health Research and Development Council (ZON); and Eduard Klasen, The Netherlands Organization for Scientific Research (NWO) during October 1999 ceremonies at the Royal Netherlands Academy of Arts and Sciences. The two nations agreed to cooperate by exchanging information and materials about drug addiction research, support exchange visits by scientists, and hold joint symposia to promote collaborative research efforts.

Exchange efforts began immediately, as a small group of researchers from both countries discussed an agenda for future research cooperation between NIDA and the Dutch agencies during the U.S. – Netherlands Addiction Workshop, chaired by Dr. Leshner and Dr. Jan M.van Ree, Rudolf Magnus Institute for Neurosciences, Utrecht. The following day, approximately 100 Dutch researchers, policymakers, and healthcare providers joined the addiction workshop participants to review current research and areas for potential collaboration at the Binational Symposium on Drug Abuse, Addiction Research, and Innovation, which was organized by NIDA and the Netherlands Research and Development Program on Substance Use and Addiction (Programma Verslaving) in cooperation with the Amsterdam Institute of Addiction Research and The Netherlands National Institute of Mental Health and Addiction (Trimbos-institute).

Addiction Workshop

On the first day, during the addiction workshop, Dr. Smid, Dr. Klasen, and Dr. M. Patricia Needle, International Program Director, NIDA Office of Science Policy and Communications, presented the two nations’ aims for the collaborative agreement and ways to stimulate binational cooperation among researchers. Five speakers introduced possible areas for cooperation: Dr. Kathleen Merikangas, Yale University, focused on risk, resiliency, and vulnerability; Dr. Henk Rigter, Trimbos-institute, examined addiction prevention; Dr. Terry Robinson, University of Michigan, Ann Arbor, reviewed multidisciplinary research on relapse and craving; Dr. Wim van den Brink, University of Amsterdam, discussed drug abuse treatment; and Dr. Claire Sterk, Emory University, Atlanta, addressed monitoring drug use and accessing hard-to-reach populations.

Following the general session, participants met in small groups to discuss each topic, reviewing ongoing research efforts in both countries and identifying promising areas of potential collaboration.

At the end of the workshop the chairs Dr. Van Ree and Dr. Leshner concluded that the binational collaboration offers unique opportunities to implement prevention and treatment programs in different cultural contexts. Attention could be given to the abuse of benzodiazepines and other prescription drugs. Four areas of common research interest were noticed: validation of outcome measures; the impact of anxiety, depression and stress on prevention and relapse; human and animal research on relapse, including treatment options combining pharmacotherapy and behavioral therapy; and drug use patterns in relation to the environment and individual characteristics of drug users.

Binational Symposium

On the second day, participants in the Binational Symposium focused on four research topics: (1) pathways to addiction, (2) prevention, (3) drug abuse treatment and relapse prevention, and (4) monitoring illicit drug use. Presenters included Dr. C. Hendricks Brown, University of South Florida, Tampa; Dr. Mirjam Gerrits, Rudolf Magnus Institute for Neurosciences, Utrecht; Dr. Stephen T. Higgins, University of Vermont, Burlington; Dr. Klasen; Dr. Leshner; Dr. Merikangas; Dr. Needle; Dr. Richard Rawson, University of California, Los Angeles; Dr. Rigter; Dr. Robinson; Dr. Gerard M. Schippers, University of Amsterdam Medical Center; Dr. Ton Schoffelmeer, Free University, Amsterdam; Dr. Smid; Dr. Sterk; and Dr. Van den Brink.

Speakers discussed research into pathways of addiction, including studies about the progression from experimental drug use to addiction; risk factors such as genetic vulnerability, gender, stress, depression, anxiety, and pre- and postnatal exposure; expectancies models; and integrating animal models with human models. Researchers also explored those factors that protect individuals from progressing to addiction. In the sessions on prevention research, speakers reported on the research-based principles of effective prevention developed through NIDA-supported research as well as on ways to develop and target prevention interventions, increase and measure their effectiveness, and conduct randomized prevention trials. Participants were enthusiastic about the U.S. development of an international registry to list ongoing prevention trials. Discussing drug abuse treatment and relapse prevention, speakers addressed behavioral and pharmacotherapy treatment models; the biomedical and behavioral bases of drug-seeking behaviors; the use of neuroimaging techniques in treatment research; and the need to develop or expand multidisciplinary research, longitudinal studies, outcome measures, clinical treatment trials, and drug abuse treatment for individuals with comorbid psychiatric and somatic diagnoses. Participants also reviewed the effective approaches to addiction treatment identified by 30 years of NIDA-supported scientific research and clinical practice, which are presented in the newly published Principles of Drug Addiction Treatment: A Research-Based Guide. Addressing efforts to monitor illicit drug use, participants discussed techniques to conduct basic epidemiological research, focusing on accessing hard-to-reach populations, female drug users, and new drug users; network-based outreach efforts; and ways to predict developments in drug use patterns. Speakers also explored the impact culture, policy, rituals, and market dynamics can have on drug use patterns. Following formal presentations that reviewed the state of the science in the four discussion areas, participants met in small groups to identify research similarities, differences, and priorities for both countries. They suggested that future priorities include efforts to validate prevention and treatment outcome measures and called for expanded efforts to integrate animal and human models and for additional research on topics such as relapse, craving, risk factors, benzodiazepine addiction, cognitive psychology, expectancies models, treatment options that combine behavioral therapies with pharmacotherapy, and environmental and individual patterns that contribute to drug use and addiction.

Next Steps

After two days the researchers concluded that collaboration could create unique opportunities to improve understanding of drug use and addiction as well as prevention and treatment of drug abuse. Collaborative research on both sides of the Atlantic has serious potential for significant, innovative, quality research with additional value for both countries.

It seems appropriate to build a network to exchange ideas. This network would be helpful in creating a research agenda including bridging animal and human research and validating outcome measures for prevention and treatment research, including the effectiveness and efficacy of prevention and treatment programs.

Participants recommended combining U.S. and Dutch research on important future themes. An important area that was identified was relapse, both in biomedical and behavioral research. The theme could be the umbrella for several studies on the role of genes and brain structures, expectancy factors, and combined pharmacological and behavioral treatment programs. Another important area would be new vulnerability factors for addiction such as stress, anxiety, and depression. Combined research would also create unique possibilities to understand the effects of prevention and treatment programs by transporting them to another local context. Furthermore, it would help to join forces on new issues such as addiction to prescription drugs (e.g. benzodiazepines) and the harmfulness of MDMA (ecstasy).

The four major themes that were discussed were biomedical, behavioral and social scientific research on becoming addicted (risk, resiliency and vulnerability factors), prevention addiction (effectiveness of preventive interventions models), treating addiction (combining pharmacotherapy with behavioral models), preventing relapse (multidisciplinary research of relapse and craving) and monitoring of illicit drug use (including reaching difficult-to-reach groups). Future research on risk, resiliency and vulnerability should bridge the gap between animal and human research (e.g., prenatal drug exposure and postnatal maternal deprivation). Serious risk factors for addiction such as stress, anxiety, and depression, could be the themes for combined biomedical and behavioral research. Special efforts should be made to elaborate expectancy models.

In the area of future prevention research, participants recommended emphasizing combinations of preventive interventions in community-based trials. Binational experiments interventions and could also form the basis for international registration of prevention trials. Effective prevention outcomes could be linked with biological markers. The research agenda for treatment and relapse prevention could include fundamental research on combined pharmacotherapy and behavioral treatment, effectiveness studies of behavioral treatment models, and long term treatment and follow up studies on the pharmacological aspect of craving and relapse prevention. The agenda could also include efficacy studies, implementation of evidence-based treatment, and research on combinations of addiction and other psychiatric disorders. There is also a great need for improved instruments to measure treatment outcomes. Neuroimaging techniques would certainly add to the success of addiction research. Furthermore, research on medications to treat cocaine addiction should continue.

Qualitative research on drug use is necessary to disclose patterns of drug use among difficult-to-reach groups such as homeless people and ethnic minorities. Monitoring studies could include cultural aspects and rituals of drug use among these groups. Participants added that research should also focus on female users.

The two-day gathering of researchers proved to be a good basis for generating ideas for binational studies on addiction and drug use. It was concluded that such meetings should take place on a regular basis in both countries.

This program book is also available in pdf format for download [1.2 Mb].