As we all know, drug abuse is costly—to individuals, families, communities and our society as a whole. And like addiction itself, the strategies for lessening its impact are often complex and necessarily diverse. The variety of drugs, drug abusers, risk and vulnerability factors, and other variables underlying this disease demands a counter approach that cuts across multiple domains. The mission of the National Institute on Drug Abuse (NIDA) is to lead the way in supporting research, basic and applied, and to rapidly disseminate drug abuse and addiction research results to improve the public health.
Revolutionary science advances over the last 20 years have deepened our understanding of how drugs of abuse cause neurobiological changes that produce addiction behaviors—knowledge that will enable us to better prevent and treat it.
Basic research is leading the way with groundbreaking discoveries. For example, researchers have identified variants in a cluster of nicotinic receptor subunit genes that influence both the likelihood of nicotine addiction and a person’s risk for the severe health consequences from tobacco use. This discovery not only helps to target those who are most vulnerable, but also reveals novel targets for medications development. Innovative research has also produced the first candidate vaccines against nicotine and cocaine, which block their entry into the brain and thus their psychoactive effects. Though still in early clinical trials, this concept provides a novel approach that may be useful in arresting addiction, or someday may even help prevent it.
But research alone, transformational as it may be, will not put an end to this devastating disease. The results of that research must reach those who need them. To that end, NIDA’s National Drug Abuse Clinical Trials Network and Criminal Justice-Drug Abuse Treatment Studies have created unique partnerships to involve communities (treatment providers and criminal justice personnel, respectively) in testing and implementing evidence-based treatments—with the ultimate goal of promoting their adoption and availability.
A new player in this arena is the medication Vivitrol, a long-acting form of the opioid antagonist naltrexone. The Food and Drug Administration recently approved Vivitrol for treating opiate addiction, based on positive research findings in heroin-addicted patients in Russia. As the first non-narcotic, non-addictive, extended-release medication approved for opioid dependence, Vivitrol stands to play a key role in situations where opiate replacement therapy is rejected or patients are hard to reach, including within the criminal justice system, where NIDA is studying its effectiveness. NIDA is also focused on increasing physician involvement, particularly in screening and brief intervention, as a critical first line of defense against substance abuse and its escalation to addiction.
On a personal level, as a physician I have never met an addicted person who chose to be addicted or who expected that this compulsive, uncontrollable behavior would emerge when they started taking drugs. Like any other medical disorder that impairs the function of vital organs, repair and recovery of the addicted brain depends on targeted and effective treatments that must address the complexity of the disease. Research is the cornerstone in proving how this can be done.
Dr. Nora Volkow, Director, National Institute on Drug Abuse