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Executive Summary

For the past three decades, the National Institute on Drug Abuse (NIDA) has led the way in supporting research to prevent and treat drug abuse and addiction and mitigate the impact of their consequences. These include the spread of HIV/AIDS and other infectious diseases. To confront the most pressing aspects of this complex disease and to tackle its underlying causes, our strategic approach is necessarily a multi-pronged one. It takes advantage of research programs in basic, clinical, and translational sciences: genetics, functional neuroimaging, social neuroscience, medication and behavioral therapies, prevention, and health services, including effectiveness and cost-effectiveness research. Our burgeoning portfolio has given us a large and growing body of knowledge that informs our strategic directions for the future. These directions are grouped into four major goal areas, reflected in the chapters that follow:

Prevention
Treatment
HIV/AIDS
Cross-cutting Priorities

These four chapters and accompanying strategic goals and objectives are summarized below.

1. Prevention.
   Strategic goal: to prevent the initiation of drug use and the escalation to addiction in those who have already initiated use.
   Our prevention research has led to today's improved understanding of addiction and has positioned NIDA to build upon solid epidemiological findings and new insights from genetics and neuroscience. Findings have revealed the myriad contributors to addiction and the involvement of multiple brain circuits in addictive processes. A major goal of our efforts is to better understand why some people get addicted while others do not. Our prevention efforts encompass both illicit and licit drugs, such as nicotine and prescription medications. We support research that strives to identify the factors that put people at increased risk of drug abuse or protect them from it. Results will lead to more effective counter strategies, particularly to prevent young people from ever using drugs in the first place. We are applying modern technologies (e.g., genetics and brain imaging tools) to our prevention studies and are devising creative and targeted communications strategies to motivate their use.
   
   NIDA's Prevention objectives include:
   
   
   1. To identify the characteristics and patterns of drug abuse.
   2. To understand how genes, environment, and development influence the various risk and protective factors for drug abuse.
   3. To improve and expand our understanding of basic neurobiology as it relates to the brain circuitry underlying drug abuse and addiction.
   4. To apply this knowledge towards the development of more effective strategies to prevent people from ever taking drugs and from progressing to addiction if they do.
   
   
2. Treatment.
   Strategic goal: to develop successful treatments for drug abuse and addiction, and to improve their accessibility and implementation.
   Given the complex interactions of biological, social, environmental, and developmental factors that underlie this disease, NIDA acknowledges the need to take a "whole systems" approach to treating it. We are well positioned to capitalize on recent discoveries that have uncovered an expanded range of possible brain targets to affect craving, euphoria, motivation, learning, memory, and inhibitory control—key contributors to addiction and relapse. To bring about more customized treatments, our comprehensive therapeutic research portfolio will push for more effective medication and behavioral therapies. Innovative approaches that consider genetic variation, comorbid conditions (e.g., mental illness, chronic pain), and the addicted person's changing needs over time will usher in promising medications to counteract drug-induced changes in the brain and enhance behavioral therapies. Effectiveness research will help us optimize strategies for disseminating and implementing research-based treatments in healthcare and criminal justice settings. This objective requires that we continue to strengthen our productive partnerships—with treatment practitioners, State substance abuse programs, and other Federal agencies—to move proven treatments into clinical practice at the community level.
   
   NIDA's Treatment objectives include:
   
   
   1. To develop effective medications and behavioral interventions to treat drug abuse/addiction and to prevent relapse.
   2. To develop treatments for abuse/addiction in association with comorbid conditions.
   3. To develop the knowledge that will lead to personalized or customized treatments.
   4. To translate research-based treatments to the community.
   
   
3. HIV/AIDS.
   Strategic goal: to diminish the spread of drug abuse-related HIV and minimize the associated health and social consequences of the disease.
   Drug abuse continues to be a major vector for the spread of HIV/AIDS through its connection with other risky behaviors, such as needle sharing and unprotected sex. Our research advances the less acknowledged link between drug abuse in general and the resulting impaired judgment that can lead to risky sexual behavior and HIV transmission. This highlights the value of drug abuse treatment in preventing HIV spread. We plan to continue to support primary prevention research to find the most effective HIV risk-reduction interventions for different populations. Young people are a major focus for these efforts, prompting strategies that start early and can adapt as the individuals age. NIDA also supports research to develop effective secondary prevention strategies designed to reduce HIV transmission. This includes seeking out the best ways to incorporate HIV education, testing, counseling, and treatment referral and supporting research to identify and overcome barriers, such as stigma and HIV and drug abuse treatment access. NIDA also sponsors research to learn more about the multiple interactions that occur with neurological complications of HIV, substance abuse, other comorbid psychiatric disorders. This knowledge can inform the development of more responsive counter interventions. Additionally, we will continue to target HIV/AIDS-related health disparities and integrate HIV/AIDS initiatives worldwide.
   
   NIDA's HIV/AIDS objectives include:
   
   
   1. To support research to better understand the etiology, pathogenesis, and spread of HIV/AIDS among drug abusing populations.
   2. To help prevent the acquisition (primary prevention) and transmission (secondary prevention) of HIV among drug abusers and their partners.
   3. To decrease the health disparities associated with HIV/AIDS.
   4. To support international research on the intertwined epidemics of drug abuse and HIV/AIDS.
   5. To improve HIV treatment and outcomes in drug abusers through a better understanding of interactions with drugs of abuse, HIV/AIDS disease processes, and the medications used to treat both.
   
   
4. Cross-Cutting Priorities.
   Several additional priority areas span NIDA's portfolio and contribute to our overall mission to prevent or reduce drug abuse and addiction. These areas are highlighted below:
   
   
   1. To foster research on other health conditions that may inform, influence, or interact with drug abuse and addiction (e.g., pain, compulsive behavioral disorders).
   2. To decrease health disparities related to drug addiction and its consequences.
   3. To educate a variety of audiences (e.g., criminal justice, medical, and educational systems in the community, plus media and legislators) about the science underlying drug abuse.
   4. To train and attract new investigators with diverse experiences, including those from minority or disadvantaged backgrounds; and to actively recruit chemists, physicists, bioengineers, and mathematicians to conduct translational research in drug abuse.
   5. To promote collaborative international research activities that address nicotine addiction, HIV/AIDS, and emerging trends, as well as training and dissemination of science-based information on drug abuse.