2008 NIDA International Forum: Globally Improving and Applying Evidence-Based Interventions for Addictions

June 13-17, 2008
San Juan, Puerto Rico

Executive Summary

More than 200 registrants from 53 countries participated in the 13th NIDA International Forum, which was held June 13-17, 2008, in San Juan, Puerto Rico. The meeting, Globally Improving and Applying Evidence-Based Interventions for Addictions, was sponsored by the NIDA International Program and focused on the benefits of multidisciplinary, public health approaches to drug abuse research, prevention, and treatment. Plenary session speakers addressed the public health approach to drug dependence, principles of evidence-based prevention and treatment, and the impact of public policy on drug treatment. Presenters in concurrent workshops illustrated numerous ways researchers and service providers can forge partnerships; integrate public policy, science, and practice; and implement effective — and cost-effective — programs to prevent and treat drug abuse and addiction. More than 130 meeting participants presented their research at a joint NIDA International Forum/College on Problems of Drug Dependence (CPDD) international poster session.

NIDA Deputy Director Dr. Timothy P. Condon highlighted recent advances in NIDA-supported addiction research that have provided new insights into the complex neurophysiological, genetic, and epigenetic components of drug abuse and addiction. Researchers now understand that addiction is a developmental disease that usually begins during the mid-teens, but more research is required to better understand how drugs of abuse impact brain development. Translating these basic science advances to treatment, NIDA is currently focusing on developing targeted behavioral, pharmacological, and biofeedback treatment interventions that decrease the rewarding properties of drugs of abuse, possibly through vaccines; increase the rewarding value of nondrug reinforcers, such as contingency management vouchers; weaken the learned positive associations with drugs and drug cues; and strengthen prefrontal control.

Addressing ways to strengthen the public health approach to drug dependence, Dr. Vladimir B. Poznyak, coordinator of the World Health Organization (WHO) Management of Substance Abuse Team, reported that drug use and dependence impose a high disease burden and elevated social costs and are linked to other major health problems, such as HIV/AIDS and nicotine addiction. Despite the scientific evidence documenting the effectiveness and cost-effectiveness of interventions, he cited numerous challenges that public health experts face in addressing drug use disorders, including lack of awareness or understanding, stigma, outright denial that drug dependence is a health condition, inappropriate balance between supply- and demand-reduction efforts, and insufficient human and capital resources. Dr. Poznyak described WHO priorities and activities designed to promote adoption of the public health approach to drug dependence, particularly development and testing of screening and brief interventions for drug use in health care settings and promotion of effective treatment for opioid dependence.

Dr. Gilberto Gerra, chief of the United Nations Office on Drugs and Crime (UNODC) Division of Operations Health and Human Development Section, described the evidence supporting the existence of genetic, familial, and community-level risk factors for substance abuse and dependence. He reviewed how scientists are beginning to measure drug-related psychobiological changes in brain structure and function, and urged nations to develop medical and social standards for treating drug-dependent patients using a case-by-case approach that offers a variety of treatment methods and respects human rights and dignity. Dr. Gerra called for increased advocacy, outreach, training, and dissemination efforts to implement evidence-based addiction prevention and treatment programs in health care systems, schools, and social programs.

Introducing participants to the ways public policy influences drug abuse treatment and population health, Dr. Tom Babor, University of Connecticut, imagined a world where governments encouraged a drug treatment delivery system as efficient and ubiquitous as the "caffeine addiction treatment delivery system" developed by Starbucks. Describing the fragmented and arbitrary way drug treatment expanded during the past 60 years, he discussed how policy changes and resource allocation decisions influence the type, availability, and effectiveness of treatment services, concluding that the current mix of drug treatment policies does not always follow rationally from the evidence base. Dr. Babor suggested that researchers employ evolving policy research technologies, such as quasi-experimental designs, health services research, natural experiments, qualitative methods, mixed methods, treatment mapping, historical analysis, and econometric methods, to guide the transfer of treatment technologies and to build more effective treatment systems.

NIDA International Program Director Dr. Steven W. Gust called for a new era of scientific diplomacy, describing research that found U.S. science and technology is highly respected internationally, even in regions where public opinions of U.S. foreign policy are extremely low. Dr. Gust summarized research documenting benefits to the U.S. scientific community from contributions by foreign scientists, particularly by creating opportunities to conduct research in parts of the world critical to scientific advancement. The NIDA International Program supports activities designed to promote scientific diplomacy, and Dr. Gust outlined major initiatives to:

• Foster publication of international research, through support for the International Society of Addiction Journal Editors (ISAJE) Web site, Publishing Addiction Research Internationally (www.parint.org).
• Help grantees maintain contacts with former students and postdoctoral fellows, through NIDA International Forum Web-based communication and training tools and fellowship alumni activities.
• Reach out to junior scientists in other countries through NIDA fellowships and research training grants.
• Encourage international collaboration through NIDA research exchange programs and international research grants.

CPDD International Committee Chair Dr. Gabrielle Fischer of Austria introduced the 2008 WHO/NIDA/CPDD International Traveling Fellows — Yu Liu, Ph.D., Chinese National Institute on Drug Dependence, Peking University; and Rasmon Kalayasiri, M.D., a psychiatrist and instructor at Chulalongkorn University, Thailand.

During the poster session, drug abuse scientists from around the world presented their research to NIDA Forum and CPDD participants while representatives from nine NIDA components and the National Institutes of Health Fogarty International Center presented posters summarizing their goals, research interests, international focus, and international funding priorities.

Concurrent workshops focused on:

• Collaborative, multidisciplinary drug abuse research in Central and Eastern Europe, India, and Vietnam that is supported by International Clinical, Operational, and Health Services Research and Training Awards (ICOHRTA).
• REDLA (the Latin American drug epidemiology network) and potential areas for collaboration with REDLA investigators.
• Screening tools to identify drug abuse symptoms, an evidence-based intervention registry, and training programs for counselors using brief interventions in treatment programs.
• Using observational data to better understand drug-related harms, modify drug-using behaviors, and develop approaches to reduce the incidence of HIV/HCV transmission.
• Unresolved issues in inhalants research, including possible subtypes of abused substances, and mortality statistics from the United Kingdom.
• Two different models designed to integrate research findings into the practices of community-based treatment providers: the NIDA Clinical Trials Network and the UNODC and TreatNet model.
• The challenges and processes required to successfully adapt evidenced-based research that addresses gender and family in order to stem the high rates of HIV among multi-ethnic and international substance-abusing populations in Brazil, Kazakhstan, India, Russia, and South Africa.
• NIDA's current and future HIV/AIDS activities in Latin America and Eastern and Central Europe.

A special workshop allowed Forum registrants to practice using the NIDA International Program's online collaboration and education tools. Researchers met individually or in small groups to learn about the NIDA International Virtual Collaboratory (NIVC), Drug Abuse Research and Training Network (DART), and interactive learning modules. NIVC is a password-protected suite of Web-based communication, education, and information exchange tools for geographically distant scientists engaged in collaborative research and discussion groups. NIVC registrants learned how to conduct live audio/video virtual meetings, create a discussion forum or wiki, add or retrieve information from the resource center, and register in the profile directory. Forum participants also reviewed online training programs in preparing program evaluations and designing and managing clinical trials. Currently being developed, the DART network will collect and disseminate drug abuse research news and provide online training tools, a data resource center, and collaboration tools.

An alumni meeting of the NIDA Hubert H. Humphrey Drug Abuse Research Fellows was organized by J. Randy Koch, Virginia Commonwealth University, United States, and featured presentations on their postfellowship experiences by Rehana Kader, South Africa; Desirée Molina, Venezuela; and Tomás Zabranský, Czech Republic. Participants planned discussion topics for the NIVC Humphrey AlumniNet and discussed ways to initiate drug abuse projects at the conclusion of their fellowships, collaborate on joint publications, and recruit potential applicants.

The NIDA International Program presented its 2008 Awards of Excellence to honor mentors, researchers, and binational collaborative teams whose efforts support the International Program mission, including the following: Excellence in Mentoring, Linda B. Cottler, United States; Excellence in International Leadership: Juana M. Tomás-Rosselló, Austria; and Excellence in Collaborative Research: In Kyoon Lyoo, South Korea, and Perry Renshaw, United States. ISAJE and WHO presented the first Young Scholars Award to Dr. Jaeuk Hwang, South Korea.