Delivery Systems for Substance Abuse Treatment September 5-7, 2005

1. NIDA Research and Training Opportunities Jack B. Stein, MSW, Ph.D.National Institute on Drug AbuseNational Institutes of HealthUS Department of Health and Human Services Delivery Systems for Substance Abuse Treatment September 5-7, 2005

2. Drug Abuse & Addiction NIDA Bringing the full power of Science to bear on…

3. Hey, we’re over here!

4. Yoohoo… Here weare! NIH NCI NIBIB NIDDK NIDA NCRR NCMHD NIAID NIAAA NIEHS NIGMS NCCAM NICHD NIA NIDCD NEI NINDS NHGRI NIMH NIAMS NIDCR NHLBI NINR NLM FIC CIT CSR CC

5. The NIDA Mission • To lead the Nation in bringing the power of science to bear on drug abuse and addiction, through: • support and conduct of research across a broad range of disciplines • ensuring rapid and effective dissemination and use of research results to improve prevention, treatment, and policy

6. NIDA Research Is Multidisciplinary Epidemiology Treatment Neuroscience Behavioral Science Risk and Resilience Prevention AIDS and Other Medical Consequences Children and Adolescents Health Disparities

7. NIDA FY 2005 Initiatives • Prevention • Gene/environment interactions • Drug exposure and the developing prenatal brain • Youth/adolescent interventions • Treatment Interventions • Behavioral and pharmacological approaches • Linking drug abuse services with other health care systems • Translating Research into Practice • Using science to improve providers’ knowledge and skills

8. www.drugabuse.gov

9. Child Care Services Vocational Services Family Services Detoxification Housing / Transportation Services Intake Processing / Assessment Mental Health Services Behavioral Therapy and Counseling Substance Use Monitoring Treatment Plan Self-Help / Peer Support Groups Clinical and Case Management Pharmacotherapy Financial Services Medical Services Continuing Care Legal Services Educational Services AIDS / HIV Services Effective treatment should attend to multiple needs of the individual.

10. Medications are an important part of treatment for individuals with substance use disorders. • Methadone-opiate abuse • Buprenorphine-opiate abuse • Naltrexone-opiate and alcohol abuse • Disulfiram (Antabuse)-alcohol abuse • Acamprosate-alcohol abuse

11. Behavioral counseling is a critical component of effective treatment. • Behavioral therapy remains the sole available treatment for most classes of drug addiction. • No pharmacotherapies exist for marijuana, sedatives, amphetamines, hallucinogens, inhalants. • Combination behavioral/medication therapies is key.

12. Cannabis Youth Treatment Series Behavioral Treatments for Smoking Cessation Cognitive-Behavioral Treatment Combined Pharmacotherapies and Behavioral Therapies Complementary and Alternative Treatments Contingency Management Treatments Dialectical Behavioral Therapy Drug Counseling Family Treatments Group Behavior Therapy HIV Risk Reduction Motivational Interviewing/Enhancement Multisystemic Therapy Behavioral Treatments with Strong Scientific Support

13. Treatment does not need to be voluntary to be effective. Public Health Approach -disease -treatment Public Safety Approach -illegal behavior -punish

14. Integrated Public Health-Public Safety Strategy Blends functions of criminal justice and treatment systems to optimize outcomes

15. Clinical Practice and the Community Treatment Strategies

16. Access and Engagement Organization Structure and Climate Intervention (“EBP”) External Environment (stigma, financing) Provider knowledge and behavior Developing an Evidence-Based-Practice is only one piece of the translation puzzle

17. Implementation and Monitoring Research and Development Translationand Dissemination Collaboration Science to Services Initiative Capacity-Building Commitment Untapped Research Opportunities

18. Research Centers Coordinating Center National Drug Abuse Treatment Clinical Trials Network (CTN) Criminal Justice Drug Abuse Treatment Studies (CJ-DATS)

19. Drug Abuse Treatment Core Components and Comprehensive Services Motivational Interviewing TELE Child Care Services Family Services Vocational Services Motivational Incentives Intake Processing / Assessment Housing / Transportation Services Mental Health Services Abstinence-Oriented Substance Abuse Counseling Supportive Group and Individual Counseling Pharmacotherapy Substance Use & Urine Monitoring Clinical & Case Management Continuing Care Financial Services Medical Services Legal Services Educational Services Buprenorphine Detox AIDS / HIV Risk Services Treatment Plan Self-Help (AA, NA) Meetings

20. “Technology Transfer and the Treatment of Addiction” Journal of Substance Abuse Treatment (Volume 22, Number 4, 2002)

21. Program Change Model Institutional & Personal Readiness Motivation Resources Stages of Transfer Program Change Staff • 1-Exposure • (Training) • Lecture • Self Study • Workshop • Consultant 2-Adoption (Leadership decision) 3-Implementation (Exploratory use) Program Improve- ment 4-Practice (Routine use) Organizational Dynamics Climatefor Change Staff Attributes Source: Simpson (2002)

22. NIDA’s International Goals • Promote International Research Activities • Support Research Training and Exchange Opportunities Globally • Communicate and Disseminate Science-Based Information on Drug Abuse • Support International Research Collaboration

23. NIDA and the Spanish National Plan on Drugs Exchange of Letters Binational Agreements NIDA and Pavlov Medical University, Russia Exchange of Letters NIDA and the Dutch Addiction Program Exchange of Letters DHHS and the Mexican Ministry of Health Letter of Intent

24. NIDA FY 2005 International Activities by Country Research Support Fellowships and Meetings Research + Fellowships and Meetings

25. NIDA Supports International Research • Administrative Supplements • Domestic Grants With Foreign Components • Foreign Grants • Partnerships With Other NIH Institutes

26. Administrative Supplements • Proposed by U.S. Grantees • Related to Existing Grant • Maximum of • $100,000 or • 25% of direct costs • Requires NIDA Approval

27. U.S. Grants With Non-U.S. Components • Typically Awarded to U.S. Researchers • Propose Research at U.S. and International Sites • International Component Part of Original Application and Review Process

28. International Research Collaboration on Drug Abuse Program AnnouncementPAS-03-023 • Support New and/or Competitive Continuation R01 Grants for Projects Conducted in Whole or in Part Outside the U.S. • Research Must Be Conducted by U.S. Investigators in Collaboration With non-U.S.-Based Investigators • Recent Awards: • DA17317—Addiction Treatment in Russia: Oral and Depot Naltrexone • DA17620—Interventions With HIV+ and HIV- IDUs in Ukraine

29. Non-U.S. Grants • Awarded to non-U.S. Researchers • Research Conducted Outside the U.S. • Scored Competitively by NIH • Must Represent a “Special Opportunity”

30. NIDA Partnerships With the Fogarty International Center • Available in Most Countries • FIRCA (Fogarty International Research Collaboration Award)-U.S. grantee • ICOHRTA (-International Clinical, Operational, Health Services Research Training Award)-non-U.S. grantee

31. Training and Exchange Opportunities Research Exchanges Fellowships

32. INVEST Research Fellowships • Rigorous Postdoctoral Research Training • In the U.S. • With a NIDA-funded scientist • Professional Development Activities • Meet with NIDA officials • Identify NIDA grantees interested in future collaboration • Stipend Plus • Travel • Health insurance • Professional development activity allowance

33. NIDA Humphrey Drug Abuse Research Fellowships • 10-Month Academic Program • For midcareer professionals • Preeminent U.S. university • 6-Week Professional Affiliation With NIDA-Funded Researcher • Professional Development Activities • Meet with NIDA officials • Identify NIDA grantees interested in future collaboration • Tuition and Monthly Stipend Plus • Travel support • Health insurance • Professional development activities allowance

34. Distinguished International Scientist Collaboration Awards and U.S. Distinguished International Scientist Collaboration Awards • Support for 1- to 3-Month Research Exchanges • $6,500 per month for traveling researcher • Travel support • Choose the Travel Option That Works Best for the Research • DISCA: non-U.S. based researcher travels to U.S. • USDISCA: NIDA grantee travels to partner’s country • Highly Qualified Senior Researchers

35. Dissemination and Exchange of Information International Meetings NIDA International Forum Satellite to CPDD International Program web site

36. www.international.drugabuse.gov • Announcements • Fellowships and Other Research Opportunities • INVEST, DISCA and USDISCA application forms • Travel Awards • Meetings • Upcoming events • Summaries of past meetings • Additional Resources • Frequently Asked Questions

37. NIDA International Forum Satellite to CPDD • June 17–20, 2005, Orlando, Florida • Plenary Sessions • Workshops • Poster Presentations • Networking • Travel Awards (Deadline: February 1) Growth of Forum Participation

38. NIDA International Program Alumni Contribute to the Scientific Community • NIDA and NIH Awards • Scientific Publications • Working With International Organizations

39. NIDA International Program Alumni Contribute to the Scientific Community Examples of Scientific Publications in 2004

40. Where Do We Go From Here?Some Research Questions to Consider • We need a “science of larger social units” • What are the components and characteristics of (integrated) treatment systems able to deliver effective interventions that can: -serve large numbers of people -be broadly adopted by different settings -be consistently implemented with fidelity -produce replicable and long-lasting effects -at a reasonable cost

41. Steven W. Gust, Ph.D., DirectorDale S. Weiss, Program Analyst www.international.drugabuse.gov