Role of Research
Minority Population Studies
Drug use is a major health problem among racial and ethnic minority populations in the United States. NHSDA data show that Hispanics and African Americans are more likely than whites to have tried cocaine at least once and to use cocaine weekly. Moreover, the consequences of drug use are often more severe for racial and ethnic minorities than for other populations; they are more likely to die, suffer from severe drug-related illnesses, receive inadequate treatment, and be involved in disputes and crimes. As minority groups grow and become an increasingly larger proportion of the U.S. population, it becomes more critical to understand the medical and social consequences of drug use among these populations.
The special needs of these communities were highlighted by a recent comprehensive NIDA-funded survey of 294 drug treatment programs in an inner city environment. Special populations were grouped by health status, ethnic background, language needs, and gender-related needs. Survey results indicated a generally high proportion of programs capable of meeting the unique needs of a variety of special population clients, and most programs have some mix of special population clients in their current caseload. About 62 percent of programs reported being able to serve clients who were primarily Spanish speakers; clients using American Sign Language could be served by only 11 percent of programs; and about 40 percent of the programs reported not being able to serve pregnant women, including almost half of the hospital inpatient programs and one-quarter of the outpatient drug-free programs. Although almost 70 percent of programs reported being able to serve clients with mobility impairments, only 26 percent of the residential programs reported this capacity. [117]
Preventing AIDS in Communities of Color
Working in predominantly Puerto Rican and African-American communities of the inner cities, researchers are witness to a widening divide between the spread of HIV among non-Hispanic whites-generally white men who have sex with men-and the spread of HIV in communities of color. A recent study describes the dramatic and increasing overrepresentation of AIDS cases diagnosed each year in the United States among communities of color, despite the work of public health and community-based educators. The investigators suggest that the increases in HIV and AIDS among persons of color reflect specific shortcomings in current AIDS prevention work. For example, risk group categories may have a role in tracking and predicting the course of the epidemic, but they have little utility when used to lump individuals of differing ethnicities, cultures, and experiences into the same social category because they share a common potential route of infection. In addition, the theoretical models of motivation and behavioral change that predominate in AIDS prevention tend to focus on the individual level, with little consideration of family, communities, and the broader society. The researchers propose that the lessons learned from their work in AIDS prevention serve as guideposts for the development of new approaches to combat the epidemic in communities of color, particularly the need to refocus AIDS prevention as social prevention, with decreased attention on individual-level prevention models and epidemiologic risk exposure categories, and much greater emphasis on three emergent contexts of AIDS risk reduction: networks, neighborhoods, and natural social groups. [118]
As part of a NIDA Cooperative Agreement, a study was conducted to identify variables associated with HIV seropositivity among migrant workers in rural southern Florida. Researchers studied male and female migrant workers, of whom more than half were born in the United States. All the migrant workers surveyed currently used drugs, primarily crack cocaine, and 11.2 percent of the participants were HIV positive, including 18 percent of African Americans born in the United States and 8.0 percent of U.S. born non-Hispanic whites. The investigators identified race/ethnicity, gender, and age as significantly associated with being HIV positive. Immigration status, current drug use, and current sexual activity were not related to HIV seropositivity. These findings indicate that HIV prevention programs must address risks associated with heterosexual transmission of HIV as well as drug use both locally and where migrants travel and work. [119]
Risk Factors for Substance Use in African-American Children
Investigators have now developed and tested a model of parental and family influences on risks for substance use in inner-city African-American primary grade children and their adolescent siblings. The risk factors investigated were conceptually grouped into three broad domains of family influences and the respective indexes computed: (1) parental risk attributes, (2) family risk attributes, and (3) parenting styles. Parenting styles were captured as indicators of a latent construct, "poor parenting." In the first of two studies, the investigators hypothesized that the parental and family risk variables would be mediated through parenting styles to predict intentions to use drugs, actual drug use, positive drug attitudes, and negative drug attitudes. In a second study, the substance use risk model was tested on a sample of adolescent siblings to determine whether the pattern of parental and family factors that contributed to early high-risk attitudes and behaviors in children would predict drug attitudes and behaviors in teen siblings. The results confirmed expectations that parental and family risks were important predictors of children's negative drug attitudes and intentions to use drugs in the future and that positive parental and family characteristics would protect against future risk by enhancing negative drug attitudes. Also, substance use attitudes and behaviors in teen siblings were predicted primarily by family risk characteristics. The family risk index also predicted frequency of use of hard drugs but only when mediated through poor parenting. [120]
Trends Among American Indian Youth
Drug use among American Indian youth residing on reservations continues to be much more common than among their non-Indian peers. Although overall drug use has decreased from its high levels of the 1970s and 1980s, heavy involvement with drugs is reported by about 20 percent of Indian adolescents, a proportion that has not changed since 1980. The investigator concludes that Indian youth, particularly dropouts, remain at high risk for drug use and abuse. Similar trends for these youth and their non-Indian counterparts suggest that prevention strategies effective with other youth can be effective with Indian youth. [121]
Outreach and International Programs
A critical component of NIDA's mission has to include efforts to make the results of the Institute's research programs available to as wide an audience as possible. During the past 3 years, the Institute has not only increased the number of publications issued each year but has also broadened the audience for information on drug use and addiction and made all its current publications available for review and downloading via the Institute's Web site at www.nida.nih.gov.
Science education plays an important role in NIDA's outreach efforts, and three new teaching resources-"The Neurobiology of Addiction," "The Brain & the Actions of Cocaine, Opiates, and Marijuana," and the "Mind Over Matter" series-represent important contributions to the science education field. The Mind Over Matter series recently won a Silver Certificate in the Astrid Awards given by MerComm, Inc. The series was developed by NIDA to teach middle school students about how drugs of abuse act in the brain. The series consists of six full-color glossy magazines-one each on marijuana, opiates, stimulants, hallucinogens, inhalants, and steroids-that unfold into posters, along with a teacher's guide that provides additional information on the brain and the effects of drugs.
The Institute also added three new titles to its series of Research Reports, bringing the series total to five. The reports in this series aim to simplify the science of research findings for the educated lay public, legislators, educational groups, and clinical practitioners. The new reports cover heroin use and addiction, methamphetamine use and addiction, and nicotine addiction. Each report defines in clear language what the drug is, why it is addictive, the extent of use in this country, and the medical consequences of drug use, all based on the latest scientific findings. The reports also provide lists of further reading and Web sites that contain additional information.
A highlight of the past year's outreach effort was including the publication of two new Therapy Manuals for Drug Addiction. Manual 1, "A Cognitive-Behavioral Approach: Treating Cocaine Addiction," and Manual 2, "A Community Reinforcement Approach: Treating Cocaine Addiction," have received widespread praise from the medical and treatment communities. These manuals present clear, helpful information to aid drug treatment practitioners in providing the best possible care that science has to offer. They describe scientifically supported therapies for addiction and give guidance on session content and on how to implement scientific techniques.
NIDA has also sponsored a continuing series of meetings and symposia for the medical and research community. For example, in 1998 NIDA sponsored the National Conference on Drug Addiction Treatment: From Research to Practice. This meeting brought together more than 800 leaders of national professional organizations, treatment practitioners and providers, criminal justice and law enforcement personnel, constituent organizations, policymakers, and the media. The meeting allowed researchers and service providers to exchange findings about what treatments work; what aspects of individual programs are transferable to other sites; and how treatment programs can be tailored for specific populations, such as women, children, and adolescents. NIDA's "Addicted to Nicotine" Conference held in July was also well received.
The Institute has also sponsored a series of public "Town Meetings" around the country to confront local drug use and addiction issues. To date, NIDA-sponsored town meetings have taken place in Boston, Dallas, Philadelphia, and most recently, Des Moines. For example, the Boston Town Meeting, "Understanding Drug Abuse and Addiction: Myths vs. Reality," was coordinated by the Institute following the outrage that followed the heroin overdose death of a popular Boston firefighter. Attendees included scientists, civic leaders, policymakers, public officials, and drug use prevention and treatment professionals. Key drug use researchers discussed trends and patterns of drug use in the Boston area, community attitudes toward alcohol and drug use, effective drug prevention and treatment strategies, and the impact of managed care. In addition, participants considered how the results of research could be used to improve local responses to the problem and to shape local and statewide policy. The general public was invited and encouraged to participate in an open discussion on the problem of drug use in the State of Massachusetts and in the Boston area.
NIDA also published a new guide to help communities determine the nature of their local drug problems. The guide, titled "Assessing Drug Abuse Within and Across Communities," is an 80-page tool for communities to use to detect, quantify, and categorize the local drug use problem. It explains the use of community epidemiology surveillance networks for drug use and why they are needed and describes how a community can establish such a network. It then provides extensive information about organizing and interpreting data from different sources, including drug use treatment data, medical examiner and coroner data, law enforcement data, HIV/AIDS data, and data from State and local drug use surveys. It also provides several exhibits of data collection efforts done by various States and cities as well as an appendix of resources to assist with the local assessment. Information generated through this assessment can be used to alert prevention, treatment, and public health officials, as well as the general public, so that timely action can be taken.
The Institute also sponsored a 1-day seminar with the Ohio Department of Alcohol and Drug Addiction Services titled "Strengthening Communities Through Prevention: Applying Research to Policies and Programs." The event, which brought together local and State policymakers, focused on state-of-the-art approaches to preventing drug and alcohol use.
NIDA has also started several new outreach programs. The NIDA InfoFax service makes information on drug use and addiction available 24 hours a day by fax or the Internet. The documents, available in Spanish and English, provide information that the public can understand on every drug of abuse as well as on research, treatment, and prevention issues.
NIDA has also continued its well-regarded international program to disseminate the latest research findings beyond our Nation's borders and to benefit from the work of leading scholars from outside the United States. The Institute has continued funding two fellowship programs, INVEST (International Visiting Scholars and Technical Exchange Program) Research Fellowship and the NIDA Hubert H. Humphrey Drug Abuse Research Fellowship. In addition, NIDA funds a travel awards program to enable meetings between NIDA-sponsored investigators and their international colleagues.
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