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News Volume 13, Number 1 (June, 1998)

Interagency Pacts and NIH Collaborations Extend NIDA's Research Reach

Teamwork with sister Institutes of the National Institutes of Health (NIH) and other Federal agencies is increasing the cost-effectiveness and extending the reach of NIDA's research.

In one current research collaboration, NIDA is a key participant in a broad new effort extending across several Federal agencies to examine the links among violence, crime, and drug abuse. Research focuses on a host of criminal, medical, and social problems that are often related to drug abuse. These problems include sexual and physical abuse of children, violence against women, teenage crime and violence, trends in public attitudes toward violence, and violence-related demands on the Nation's courts, prisons, and delivery of health services.

Called the Violence Initiative, the cooperative research enterprise involves more than 20 Federal agencies collaborating under an Interagency Agreement. Two departments spearhead the Initiative: the Department of Health and Human Services (HHS), with NIDA taking a lead role; and the Department of Justice, represented by its research agency, the National Institute of Justice (NIJ). NIJ conducts research to fight crime, improve criminal justice, and evaluate criminal justice programs.

The 3-year Interagency Agreement for violence-related research also involves the Department of Housing and Urban Development, which has an interest in crime and social issues in public-supported housing. Also participating are the Department of Education, the Centers for Disease Control and Prevention (CDC), and other NIH Institutes in addition to NIDA - agencies with diverse objectives but a common interest in violence, its causes, and its consequences. (See tee roster of participating Federal agencies)

The Initiative is formally named the Interagency Consortium for Research on Violence Against Women and Violence Within the Family. It allows NIDA and the other agencies to bridge the gap between two bodies of research - studies relating to drug abuse, drug addiction, and mental health and studies relating to social and criminal justice questions. The Initiative spans academic disciplines to make the benefits of NIDA's biological and behavioral drug abuse research - ranging from basic neuroscience studies to investigations of the cost-effectiveness of drug abuse treatment innovations - applicable to those agencies interested in the many drug-related aspects of violence.

The research interests of NIDA and NIJ frequently overlap. For example, NIJ is vitally interested in causes of recidivism - the return to jail of inmates who have committed new crimes since their release - says Dr. Donald Vereen, NIDA's representative to the founding interdepartmental group. Recidivism and other disruptive or criminal behaviors may relate to what research has shown are drug-induced changes in the brains of drug abusers, which may be associated with drug craving, explains Dr. Vereen, who is NIDA's special assistant to the Director for medical affairs. Thus, drug abuse research can help in designing inmate drug abuse education and treatment programs, he says. NIDA-funded research already has provided much of the impetus toward innovative "drug courts" that seek to address both criminal justice and addiction problems by striving to keep offenders enrolled in drug abuse treatment programs, he says.

The initial research findings under the Initiative have not yet been reported, but previous cooperation between NIJ and NIDA has already proved productive, says Sally Hillsman, NIJ deputy director. "For example, we have benefited greatly from the work of NIDA's Community Epidemiology Work Group [which monitors trends in drug use patterns in selected U.S. cities]."

After the agreement was signed in late 1995, the participating agencies called for research proposals relating to various aspects of violence. Ten projects have now been funded, all of them studying drug or alcohol abuse-related violence issues, according to Dr. Coryl Jones of NIDA's Epidemiology Research Branch, who is monitoring the projects. Sometimes the substance abuse factor in the violence studies becomes much more apparent as the project continues, she says. For example, one Initiative project is studying violence toward female care providers - wives and daughters - over age 55. As the project continues, researchers are finding strong evidence that drug and alcohol abuse by the women's mates or parents is an important factor in their victimization by violence, she says.

Planning for the $1.8 million Violence Initiative evolved from policymakers' interest in the Violence Against Women Amendment to the Violent Crime Control and Law Enforcement Act of 1994. "Early on, NIDA Director Dr. Alan Leshner got involved. He pushed us to get people from agencies outside of NIDA to participate," says Dr. Vereen.

The agencies are able to collaborate thanks to the Interagency Agreement, a formal contract that spells out terms and financial commitments for participant agencies. "The Interagency Agreement is tailor-made for broad cooperative efforts like the Violence Initiative," says Dr. Vereen. "It's good for research as an enterprise, and it's good for science. It takes advantage of an existing infrastructure. All the participating agencies get something out of it." "The Interagency Agreement is a good tool for funding in situations when there is no handy grant mechanism," says Carol Cornwell, a budget analyst in NIDA's Program and Financial Management Branch, who manages the Initiative's funds since NIDA was designated "banker" for the collaborative operation. "Several of the Violence Initiative's participating agencies do not have a grant-issuing mechanism. But they can participate in the Interagency Agreement, making funding contributions, and have a say in the type of research that is funded."

NIDA is also involved in other Interagency Agreements, including collaborating with the State Department to improve drug abuse research in South America (see "NIDA Advances Drug Abuse Research in Andean Countries," NIDA NOTES, September/October 1997). The Institute is also working with other NIH Institutes, the Department of Energy, and the Department of Veterans Affairs to develop improved "informed consent" policies to ensure that people participating in research are adequately informed of related ethical issues and risks to their health.

Interagency Agreements are only one way that NIDA teams up with fellow Federal agencies. There are also collaborations in which NIDA joins with other NIH Institutes to conduct mutually beneficial research. These collaborations have proven to be productive and beneficial, says Dr. Vincent Smeriglio of NIDA's Clinical Medicine Branch.

NIDA currently is involved in four major collaborations with other NIH Institutes and public health agencies. In the Maternal Lifestyles Study, NIDA collaborates with the National Institute of Child Health and Human Development (NICHD), the HHS Administration on Children, Youth, and Families, and the Center for Substance Abuse Treatment. The agencies are studying the health and development of infants and children who are exposed to illicit drugs during their mothers' pregnancies. More than 11,000 mothers were interviewed about their pregnancies and drug use, and some 1,400 infants are enrolled in followup studies.

The continuing project is building valuable information for developing enhanced interventions to better address prenatal drug exposure and its possible consequences.

The Women and Infants Transmission Study (WITS) is a six-site collaborative project studying mother-to-infant transmission of HIV. NIDA is collaborating with the National Institute of Allergy and Infectious Diseases (NIAID), the lead NIH Institute involved in HIV and AIDS research, and NICHD. More than 1,200 HIV-infected women and 800 of their children have been enrolled. Approximately half of the WITS participants are current or former drug abusers. NIDA joined the collaboration to support and promote focused research regarding the impact of drug use on the transmission and course of HIV disease.

Reaching for Excellence in Adolescent Care and Health (REACH) is an NICHD-initiated project with NIDA as a key collaborator. REACH seeks to learn more about HIV disease progression and its relationship to other health factors, such as drug use among adolescents aged 12 to 19. NIDA support emphasizes research on both the impact of drug use on the course of HIV disease as well as the impact of HIV on drug use. Also participating in the REACH collaboration are NIAID and the Health Resources and Services Administration. The Women's Interagency HIV Study (WIHS) and the companion HIV Epidemiology Research Study (HERS) investigate the medical and psychosocial impact of HIV on women. Most of the women being studied have a history of current or past drug use. The studies have enrolled 2,500 HIV-positive women and 775 HIV-free women. NIDA collaborates in these studies with NIAID, NICHD, the National Cancer Institute, the National Institute of Dental Research, and the CDC. NIDA funding supports research on how drug use and addiction may influence women's vulnerability or resistance to HIV infection, the consequences of coinfection with HIV and other diseases associated with drug abuse, the effectiveness of HIV medical treatment, and biomedical factors related to the development of HIV disease.

"Each of these collaborations ensures that NIDA's knowledge and expertise in drug abuse and related conditions are pooled with the knowledge of our colleagues in other Institutes and agencies conducting vital HIV research," says Dr. Smeriglio. "It's a highly cost-effective way to bolster NIDA's clinical research and to expand interest in drug abuse issues among a larger pool of investigators." Together with the Interagency Agreements, these collaborations broaden the consequences of NIDA research and extend NIDA's science-based findings into new realms.

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