Wilson M. Compton, M.D., M.P.E. Director, Division of Epidemiology, Services and Prevention Research National Institute

1. Wilson M. Compton, M.D., M.P.E. Director, Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse Funding Opportunities at the National Institutes of Health (NIH) 19 April 2013

2. National Institutes of Health To seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce the burdens of illness and disability. • World’s largest source of funding for biomedical research • Support more than 300,000 research personnel at over 3,000 universities and research institutions • 27 Institutes and Centers (ICs) with specific research agendas

3. Mapping Your Career with NIH • Learn the NIH application and review process • Review IC priorities and goals. Each IC has a research training and career development program. • Identify the grant programs offered by each IC • Make early contact with program officers • Find innovative, well-respected mentors and collaborators • Study successful grant applications- talk to your mentor • Propose your best and most creative ideas • Apply !

4. Getting to know NIH staff Program Official: extramural staff scientist responsible for developing research initiatives and programmatic, scientific, and/or technical aspects of assigned applications and grants Scientific Review Officer: extramural staff scientist and the federal official responsible for ensuring that applications receive an objective and fair initial peer review

5. Concept Paper Sumarizes your research plans concisely and facilitates productive discussions with NIH Program Officials • Study Goals • You want support to do what? • Problem/Significance • Why does this topic need study? • Research Question • What hypotheses will you test? • Design/Analysis • What study design and statistical approach do you propose? • Team • Who will be the key participants and collaborators?

6. NIDA Supports International Researchto develop knowledge jointly that neither partner could have developed independently. • Administrative Supplements • Related to existing grant • Requires NIDA approval • Partnerships With Other NIH Institutes • John E. Fogarty International Center • National Institute on Alcohol Abuse and Alcoholism • National Institute of Allergy and Infectious Diseases • National Institute of Diabetes and Digestive and Kidney Diseases • National Institute of Mental Health • National Institute of Neurological Disorders and Stroke

7. NIDA Supports International Researchto develop knowledge jointly that neither partner could have developed independently. • Foreign Grants • Awarded to non-U.S. principal investigators • Research conducted outside the United States • Scored competitively by NIH • Must demonstrate a special opportunity • Domestic Grants With Foreign Components • Typically awarded to U.S. principal investigators • Propose research at U.S. and foreign sites • Foreign component part of original application and review process

8. NIDA International Program Mission international.drugabuse.gov Research Training Exchange • Grants • Supplements • NIH Partnerships • Binational Agreements • Fellowships • Online Courses • Virtual Seminars • Web site • E-News • Meetings

9. NIDA International Research Priorities • Seek-test-treat and retain HIV/AIDS interventions • Abuse of ATS, synthetic, or other designer drugs • Smoking during pregnancy • Impact of prenatal or early tobacco exposure on development of • Addiction • Other diseases • Cognition • Drugged driving

10. Substance Abuse & Addiction Involve Multiple Factors Biology Genes/Development Environment DRUG/ALCOHOL Brain Mechanisms Addiction

11. NIDA Organization Chart: Funding Opportunities

12. Priority Areas Prevention Genetics Environment Development Neurobiology Interventions Policy Treatment Neural mechanisms Brain circuitry Medications Development Implementation Consequences HIV/AIDS Fetal Exposure

13. Addiction Is Developmental Age of Onset of Drug Abuse and Dependence Source: Compton, et al. Archives of General Psychiatry2007. NESARC Study.

14. Prevention Programs Should Enhance Protective Factors and Reduce Risk Factors ` Reduce these Elevate these

15. The Challenges How can we motivate communities to implement evidence-based prevention programs and assess their effectiveness? How can communities retain the core elements of proven programs while adapting them for their unique conditions (i.e., risk and protective factors)? How can communities implement and sustain effective programs?

16. Drug Overdose Death Rates in USA More Than Tripled Since 1990. Nearly 17,000 Died of Rx Opioid Overdose in 2010. Increases in deaths parallel opioid sales and prescription opioid treatment admissions National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS

17. Preventing Rx Drug Abuse: Multiple Strategies and Targets • Availability of drugs within homes and from friends/family • Potential for overdose intervention (naloxone) • Misperceptions about Rx drugs • Drug disposal resistance and concerns • Regulatory approaches • Automated Prescription Drug Monitoring • Primary prevention and addiction treatment

18. Priority Areas Prevention Genetics Environment Development Neurobiology Interventions Policy Treatment Neural mechanisms Brain circuitry Medications Development Implementation Consequences HIV/AIDS Fetal Exposure

19. Basic Research Medications Medications Basic Research Translating Basic Science Discoveries Into New and Better Treatments

20. Non-Addicted Brain Control STOP Saliency Drive Cycloserine Memory Treatments for Relapse Prevention: Medications Vaccines Enzymatic degradation Naltrexone DA D3 antagonists CB1 antagonists AddictedBrain Interfere with drug’s reinforcing effects Control Biofeedback Modafinil Bupropion Stimulants Executive function/ Inhibitory control GO Adenosine A2 antagonists DA D3 antagonists Strengthen prefrontal- striatal communication Drive Saliency Interfere with conditioned memories Antiepileptic GVG N-acetylcysteine Memory Teach new memories Counteract stress responses that lead to relapse CRF antagonists Orexin antagonists

21. Low Uptake of Pharmacotherapy in Specialty Programs in 2007 Knudsen et al, 2011, J Addict Med; 5:21-27 21

22. Access and Engagement Organization Structure and Climate Intervention External Environment (stigma, financing) Provider knowledge and behavior Developing an intervention is only one part of translating research into practice.

23. Implementation Science Implementation science is not intended to test interventions,per se, but to study how to get evidence-based interventions adopted, adapted, and sustained.

24. Measurement Domains Organizational attributes Contextual factors Change process attributes Intervention attributes Client attributes Networking - cross-agency linkages and collaborations

25. Addressing Drugs and Crime Public Health Approach - disease - treatment Public Safety Approach - illegal behavior - punish High Attrition High Recidivism

26. Successful Reentry Programs Use an Integrated Public Health-Public Safety Strategy Close supervision Community-based treatment Blends functions of criminal justice and treatment systems to optimize outcomes Consequences for noncompliance are certain and immediate Opportunity to avoid incarceration or criminal record

27. Key Issue: Many patients don’t feel they need treatment and therefore won’t seek it on their own. Felt They Needed Treatment and Did Not Make an Effort (766,000) Did Not Feel They Needed Treatment(19.8 million) Felt They Needed Treatment and Did Make an Effort (233,000) 20.8 Million in US Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use (Source: NSDUH, 2008)

28. Mainstreaming Addictions in Medicine • Promising Practice: Screening and Brief Intervention or Referral to Treatments (SBIRT). More studies are needed!

29. Priority Areas Prevention Genetics Environment Development Neurobiology Interventions Policy Treatment Neural mechanisms Brain circuitry Medications Development Implementation Consequences HIV/AIDS Fetal Exposure

30. HAART as HIV Prevention NIDA AvantGarde 2008: Dr. Julio Montaner, Univ. of British Columbia Montaner et al., Lancet 2008 Decline in Community Viral Load is Strongly Associated with Declining HIV Incidence among IDUs (ALIVE) GD Kirk, N Galai1, J Astemborski, B Linas, D Celentano, SH Mehta, D Vlahov

31. IDU HIV+ Are Much Less Likely to Receive HAART Percentage Of Providers Who Would Defer ART By CD4+ Count and Injection Drug Use Status Westergaard RP et al., J Int AIDS Soc 2012; 15:10.

32. Figure 4.2. Incidence of acute hepatitis C, by age group — United States, 2000–2010 Source: National Notifiable Diseases Surveillance System (NNDSS)

33. Emerging Topics • Combining HIV and drug treatment services • HIV, illicit drugs and alcohol • Adherence/retention in care • Family-based approaches may be very important • Improvements in Criminal Justiceand Social/Health Outcome with Tx • Client-centered services • Primary Prevention

34. Emerging Topics: ATS and Comorbidity Group • New approaches to epidemiology monitoring of drug abuse and comorbidity to use as indicators of effectiveness (or cost-effectiveness) of prevention or treatment. • Include ATS-associated crime and accidents • Implementation of prevention/clinical services for ATS • What are the most effective approaches for developing and maintaining a workforce? • Comorbidity with Mental Illness • Combined medications? • Impact on STTR cascade? • Genetics of response to amphetamine • Psychosis potential • CNS effects

35. social behavior neuronal circuits protein expression genome Summary:Addiction Research Needs a Systems Approach DRUGS OF ABUSE Prevention Treatment Consequences

36. www.drugabuse.gov