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March 14, 2000
Presented by Alan I. Leshner, Ph.D., Director, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services
Presented to Committee on Government Reform - Subcommittee on Criminal Justice, Drug Policy, and Human Resources

Statement for the Record

Mr. Chairman and Members of the Subcommittee, thank you for inviting me to participate in this hearing. I am pleased to have this opportunity to tell you about the research that the National Institute on Drug Abuse (NIDA) of the National Institutes of Health supports and how NIDA staff coordinate both formally and informally with our sister agency, the Substance Abuse and Mental Health Services Administration (SAMHSA) , to disseminate research findings which will help to lessen the burden of drug abuse and addiction on society.

I would like to start out by giving you a brief summary about NIDA's history and the role that Congress has identified for us. As the Nation's drug problem soared in the late 1960s and early 1970s, it became clear that a research agency specifically dedicated to understanding and finding solutions to the drug problem was needed. Toward this end, in 1974 Congress created NIDA as the Federal focal point for research, treatment, prevention and training services, and data collection on the nature and extent of drug abuse. Soon thereafter, it was placed within the newly established Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA).

NIDA and the Nation saw several major changes throughout the next several decades, including the emergence of the AIDS epidemic, which became and continues to be a high priority for NIDA. As NIDA's responsibilities continued to increase, from combating the AIDS problem to the formal establishment of NIDA's Medications Development Program in 1990, it became clear that NIDA's research program should become a component of the world's premier biomedical research institute, the National Institutes of Health.

Thus, to strengthen both the research and service missions of the Federal Government, a comprehensive and important bipartisan legislation reorganized ADAMHA (the ADAMHA Reorganization Act [PL 102-321]) in 1992. The three research entities of ADAMHA -the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and NIDA were merged into the National Institutes of Health (NIH). The service-oriented arms of ADAMHA became the current Substance Abuse and Mental Health Services Administration.

Under the auspices of the NIH, NIDA is now the supporter of more than 85% of the world's research on the health aspects of drug abuse and addiction. We have a very comprehensive and diverse research portfolio which incorporates many fields of scientific inquiry and addresses the most fundamental and essential questions about drug abuse, ranging from the causes of drug abuse and addiction, to the course of the disease, and to its prevention and treatment.

NIDA's mission, then, is to lead the Nation in bringing the power of science to bear on drug abuse and addiction. This charge has two critical components: The first is the strategic support and conduct of research across a broad range of disciplines, including biomedical, behavioral, health services research, and research training. The second is to ensure the rapid and effective dissemination and use of the results of that research to significantly improve drug abuse and addiction prevention and treatment.

NIDA recognizes that simply supporting and conducting high quality science is not enough. For science to be truly useful it must be conveyed in a way that makes it useable. We believe that even the most basic research has relevance beyond the research community. For example, using neuroimaging techniques we can now look into the brains of awake and behaving individuals to see the profound effects that drugs can have on the brain. This advance is revolutionizing our understanding of addiction and its treatment. In the past couple of years, we have discovered many of the mechanisms by which these long-lasting brain changes can compromise an individual's cognitive and behavioral abilities. And, of course, understanding the mechanisms responsible for the impaired behaviors of addicts has tremendous implications for the treatment of addicted individuals.

Moreover, these brain images are also being used in our prevention efforts as we educate people about the harmful effects of drugs on the brain. As a final example, these basic neuroscience findings, coupled with advances in molecular genetics, are providing us with targets to develop new and improved addiction medications and allowing us to better determine who may be most susceptible to becoming a drug addict.

In another domain, NIDA-supported advances in science are significantly advancing drug treatments. For example, we have brought standardized notable behavioral interventions, such as cognitive behavioral therapies and contingency management, to treatment providers; helped to develop and bring effective treatments for nicotine addiction (such as the nicotine patch and gum) directly to the citizens of this nation who can now purchase these treatments in their local supermarkets; and we have developed the most effective medications to date for heroin addiction, LAAM (levo-alpha-acetyl-methadol) and methadone. The breadth of NIDA's treatment program does not stop there. NIDA is also working to develop medications to treat cocaine addiction. In fact, NIDA's medications development program is taking the first promising anti-cocaine medication into multisite Phase III clinical trials. NIDA is also intensifying its efforts to develop treatments for methamphetamine and other emerging drug problems.

Because treatment researchers are finding that integrating behavioral and pharmacological treatment approaches in ways specific to an individual's needs is likely the best way to treat addictive disorders, NIDA has a strong behavioral therapies development program to complement its medications development program.

Research has taught us that we need to develop medications that will be readily used and accepted by the populations we are treating. This is one of the reasons why we are working to bring a new medication for heroin addiction, buprenorphine and buprenorphine combined with naloxone, to the Nation's forefront. This medication will expand access to previously inaccessible populations. Bringing this new medication to fruition is an example of the type of collaborative work we do with our colleagues from SAMHSA. As NIDA develops and tests the safety and efficacy of this new treatment, NIDA is working with SAMHSA's Center for Substance Abuse Treatment and other federal agencies to improve access to this medication.

Ultimately, however, we know that our best treatment is prevention. NIDA has a comprehensive, multidisciplinary prevention research program that examines the multiple factors that contribute to drug abuse and how these factors interact. We have found that prevention interventions need to be directed at the specific needs of different groups of youths at risk for drug abuse, including members of different ethnic groups and those living in different socioeconomic situations. NIDA works with its own grantees and with SAMHSA to ensure that NIDA's science-based drug prevention principles and programs are effectively integrated into communities and social settings throughout the country.

We are also working with SAMHSA to demonstrate the effectiveness of other prevention and treatment-oriented activities. For example, the MATRIX program, a model methamphetamine treatment program developed and proven to be efficacious by a NIDA grantee, is now being tested by SAMHSA's knowledge development program in three states. SAMHSA is identifying and addressing service barriers to this program in different populations. Given the current popularity of methampehtamine among many young adults and the long lasting changes in the brain that this drug has, it is imperative that we develop effective accessible treatments for this menacing drug.

NIDA also works with SAMHSA to disseminate current research information to practitioners, policymakers and frontline workers. This is best exemplified by an upcoming national conference that we will be co-sponsoring with SAMHSA on drug use, HIV and Hepatitis.

Curtailing the spread of infectious diseases such as hepatitis and AIDS is another major research area for NIDA. Our research shows that drug addiction treatment is effective in reducing the spread of HIV, reducing drug use by up to 60 percent and diminishing the public health and safety consequences of this destructive disease, including decreasing criminal behavior.

NIDA-funded scientists have demonstrated that comprehensive treatment of drug-addicted prison inmates, when coupled with treatment after release from prison, reduces almost by 70% the probability of their being rearrested and the likelihood they will return to drug use. This type of research clearly demonstrates how science is being implemented into practice. We are seeing a blending of public health and public safety approaches to drug problems in states and communities throughout the United States. There appears to be an increased understanding among the citizens of this Nation that if we don't treat criminals while they are under criminal justice supervision, they will not only return to drug use, but may pose a threat to the safety of the community. It makes good sense to treat drug addicted criminals; research demonstrates that we can no longer simply incarcerate them without treating them.

Given that research has repeatedly demonstrated that addiction is eminently treatable and its treatment results are comparable with those from other chronic disorders such as diabetes or asthma, it is imperative that we not only ensure that we have the capacity to treat addicted individuals, but ensure that we are referring drug addicts to programs that have been shown scientifically to be effective. Good treatment is not only effective, but cost effective as well.

NIDA is taking enormous steps to improve the quality of drug addiction treatment in this country. As is the case for other chronic disorders, effective treatments for addiction exist. However, the efficacy of these new treatments has been demonstrated primarily in specialized treatment research settings, with somewhat restricted patient populations. As a consequence, few of these new treatments are being applied on a wide-scale basis in real life practice. In response, NIDA has expanded on a model pioneered by other NIH institutes and established the National Drug Abuse Treatment Clinical Trials Network (CTN).

Under NIDA's overall guidance, the CTN will provide a much-needed national research and dissemination infrastructure to more rapidly and systematically bring new science-based addiction treatments into real-life treatment settings. The network will both test new treatments and systematically research how to correctly incorporate new and improved interventions into community-based drug treatment. By meeting these two overall objectives, NIDA will not only be improving treatment capacity, but also improving the quality of drug abuse treatment. NIDA will use proven research methods to ensure that treatments are not only effective, but that they address the critical needs of the community-based treatment programs and are suitable for those settings. We have already established the first six nodes of the CTN and have brought 42 local treatment providers into this infrastructure. We are about to begin implementing the first three treatment protocols, just months after making the first of the grant awards.

The CTN epitomizes NIDA's role as a supporter and conveyor of reliable science based information. Each node is in the process of establishing an information dissemination component so local experts affiliated with the CTN can share their research findings. We will also look to our colleagues in federal agencies, such as SAMHSA's Addiction Technology Transfer Centers and programs administered by the Department of Justice and the Department of Education, for example, to disseminate these findings, to ensure that only treatment programs that have been rigorously tested in a research environment are used.

By building this permanent research infrastructure NIDA will have a large population base to answer future research questions that go beyond the immediate treatment arena, such as the medical consequences of long-term drug use and the role that genetics plays in determining one's vulnerability to addiction. We anticipate that the CTN will be a valuable asset not only for improving the quality of our Nation's drug treatment, but also serve as a platform to study ways to reduce morbidity and mortality of other drug-abuse related diseases such as hepatitis and tuberculosis.

To conclude, I have presented you with an overview of the type of research that NIDA currently supports, while also providing you with a glimpse into our future research plans. We are optimistic about where the science is taking us and how these scientific advances are offering us the tools and practical solutions to reduce the devastating problems of drug abuse and addiction.

I will be pleased to answer any questions you may have.