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Congressional Justification
Authorizing Legislation:
Section 301 of the Public Health Service Act, as amended.
Budget Authority: |
|
FY 2004 Actual |
FY 2005 Appropriation |
FY 2006 Estimate |
Increase or Decrease |
BA |
$994,605,000 |
$1,006,419,000 |
$1,010,130,000 |
$3,711,000 |
FTE |
342 |
348 |
348 |
0 |
This document provides justification for the Fiscal Year 2006 activities of the National Institute on Drug Abuse, including HIV/AIDS activities. A more detailed description of the NIH-wide Fiscal Year 2006 HIV/AIDS activities can be found in the NIH section entitled "Office of AIDS Research" (OAR).
Introduction
Supporting and conducting science that will help prevent and treat drug abuse is the ultimate
goal of the National Institute on Drug Abuse (NIDA). The economic burden of drug abuse on
our society is estimated to be more than $484 billion per year according to the Office of National
Drug Control Policy (ONDCP) and the Robert Wood Johnson Foundation. As the world's largest supporter of research on the health aspects of drug abuse and addiction, NIDA supports a
comprehensive research portfolio that continues to bring us new knowledge about addiction and
has led to our current understanding of addiction as a disease. From research we know that
addiction is a chronic relapsing disease associated with long lasting changes in the brain and the
body that can affect all aspects of a person's life. Having more widespread acceptance of the
disease model of addiction is a top priority for the Institute, our patient population, and the field.
We are making progress in this area by working with others to bring science to communities
across the country and convincing them that addiction is a preventable and treatable disease, and
in turn reducing the stigma associated with addiction.
New research supported by NIDA and others is revealing that drug addiction is a "developmental
disease." That is, it often starts during the early developmental stages in adolescence and
sometimes as early as childhood. Last year almost 3 million 12-17 year olds reported using
illicit drugs. This is a time when the brain is undergoing major changes in both structure and
function. We now know that the brain continues to develop throughout childhood and into early
adulthood. Exposure to drugs of abuse at an early age may increase a child's vulnerability to the
effects of drugs and may impact brain development. NIDA has increased its emphasis on
adolescent brain development (see the "Initiatives" section for more information) to better
understand how developmental processes and outcomes are affected by drug exposure, the
environment and genetics. Recent advances in genetic research have enabled researchers to start
to investigate what genes make a person more vulnerable, which genes protect a person against
addiction, and how genes and environment interact. As part of the prevention portfolio we are
also involving pediatricians and other primary care physicians to develop tools, skills and
knowledge to be able to screen and treat patients as early as possible, including patients with
mental disorders who may be at a high risk to develop addiction. We know that if we do not
intervene early, drug problems can last a lifetime, making prevention a high research priority.
Treatment is another priority area for NIDA. Tremendous effort is underway to develop, test,
and ensure the delivery of evidence-based interventions to all practitioners and patients across
the country. Building on advances from our basic neuroscience and behavioral research program
NIDA has introduced a number of effective medications and behavioral treatments.
For example, there are about 60,000 people who are being treated with a medication that NIDA
helped to develop. Buprenorphine, sold under the brand name Suboxone is the very first
medication that can be prescribed by physicians in their office setting to patients who are
addicted to heroin or prescription pain killers. Our increased understanding of the brain
mechanisms involved in addiction is providing us with new targets for addiction, including
testing new compounds for America's most abused illegal substance -- marijuana. NIDA is
developing new treatments for marijuana abuse and addiction, especially for adolescents and
those who suffer from co-occurring mental illnesses.
We are also continuing to look for more innovative, efficacious, and cost-effective ways to treat
patients for a variety of addictions, including addiction to nicotine. Because data tell us that
there are about 46 million people who smoke cigarettes and that about 70% report that they want
to quit, NIDA is encouraging more research on smoking cessation quitlines. Quitlines can
provide telephone-based counseling, and in some cases nicotine replacement therapies to
smokers who want to quit smoking. When they're used as part of a comprehensive tobacco
control plan, they can help increase smoking abstinence rates and reach out to new audiences,
like pregnant smokers and minority populations. (See our nicotine "Story of Discovery.") We
are also trying new approaches, like the Internet, to reach out to new populations and to recruit
patients for our clinical trials, particularly adolescents and young adults who may be in need of
treatment. For example, we have placed an electronic ad so that individuals who conduct
searches for "no prescription Vicodin" and similar requests will now be invited to read the
patient recruitment brochure on "Buprenorphine/Naloxone-Facilitated Rehabilitation for Heroin
Addicted Adolescents/Young Adults," conducted through NIDA's Clinical Trials Network or to
contact the study site nearest to them. This innovative recruitment effort exemplifies how we are
using our National Drug Abuse Treatment Clinical Trials Network (CTN) to help respond to
emerging public health needs like prescription drug abuse and the increases in patients who are
seeking treatment for both substance abuse and mental disorders, like attention deficit
hyperactive disorder (ADHD). (See the "Initiatives" section for more information.)
Another important treatment priority for NIDA is curtailing the spread of HIV/AIDS. Because
illicit drug use can impact decision-making and increase the likelihood that an individual will
engage in risk-taking behaviors, treatment for drug abuse is, itself, HIV prevention. Drug abuse
treatment can reduce activities related to drug use that increase the risk of getting or transmitting
HIV. NIDA is especially interested in reducing HIV/AIDS rates in racial and ethnic minority
populations, which are disproportionately affected by this disease. Almost half of HIV/AIDS
cases occur among African Americans even though they constitute only about 12% of the
population according to the latest Census data. Understanding the factors that are driving this
epidemic in these populations is an important research area for NIDA.
Recognizing substance abuse as a disorder that can affect the course of other diseases, including
HIV/AIDS, mental illness, trauma, cancer, cardiovascular disease and even obesity is critical to
improving the health of our citizens. We have launched several efforts to reach out to numerous
professions within the medical community. For example, to reach psychiatrists we partnered
with the American Psychiatric Association at their annual conference to focus on how to better
integrate the science of addiction into psychiatric practice. Topics such as comorbidity of
substance abuse and mental illness, the effects of substance abuse during pregnancy on children,
and the effects of stress and trauma on substance abuse disorders will help the 30,000
psychiatrists in attendance better diagnose and treat patients with substance abuse disorders.
In these times when science is advancing very rapidly, but resources may not be, it is imperative
that we retain the flexibility to address issues of concern and to meet scientific needs. NIDA has
initiated a number of activities to ensure we are best utilizing our resources and identifying the
most critical research priorities. We are doing this systematically in light of two major factors:
National needs and scientific opportunities. We have reached out to our National Advisory
Council and others to assist us in our priority setting exercises. Some of the new and expanded
initiatives that we think will improve the health of all Americans, especially those directly
affected by drug abuse and addiction, are presented here.
Download complete document - CJ2006.pdf, [544 Kb, PDF format]
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