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Thursday, December 23, 2010

Substance Use and Abuse During Holiday Periods

Research has shown that during the December-January holiday period, substance abuse problems can emerge and/or be exacerbated.  Brenda Iliff, Clinical Director of Hazelden in Naples, FL, discusses substance abuse problems and relapse during the holidays in an interview posted on Recovery Resource BLOG.

Holiday substance abuse problems not only affect individuals and families, but also have a major impact on public health and welfare.  Consider for example some statistics on holiday alcohol-related fatalities from Finland and from the United States.  A study by Makela and colleagues reported that in Finland over the 15-year period from 1987-2001, alcohol-related deaths spiked on Christmas Eve and New Years Day in men (58 and 48% increases, respectively) and in women (121 and 77% increases, respectively, see the figure).

Comparable statistics on alcohol-related traffic deaths in the US from 2001-2005 were reported by the US National Highway Traffic and Safety Administration (NHTSA), and showed that alcohol-related fatalities were 25 and 50% higher during the 3 to 4-day holiday periods surrounding Christmas and New Years Day, respectively.

The Office of National Drug Control Policy (ONDCP) in its Of Substance Blog suggested that party hosts plan to offer guests non-alcoholic beverage choices, and even provided several alcohol-free drink recipes to consider.

In addition, a number of anti-alcohol media campaigns targeting holiday drunken driving are underway, including one highlighted by the Addiction Inbox BLOG.

Alcohol seems to be the main holiday-related substance abuse problem.  However, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that in 2009, 10 million people drove while intoxicated with prescription or illicit drugs (compared to 30 million people drove while alcohol-intoxicated).  In fact, in some age groups, the prevalence of drugged-driving exceeds that of drunk driving.

Although statistics do not seem to be available yet clarifying whether drug-intoxication deaths (driving or otherwise) increase during the holidays, this week, President Obama issued a Proclamation naming December 2010 as National Impaired Driving Prevention Month, with a focus on preventing drunken and drugged driving.

CPDDBLOG welcomes CPDD member’s thoughts on this issue, thanks you for looking in over the past few months, and wishes you and yours a happy, healthy, prosperous, and especially a safe holiday season and new year.

Saturday, December 11, 2010

Naming of a new Addiction Institute: Injecting Politics into Science?

Originally posted on the CPDD Listserv, posted here on behalf of Jim Anthony 
 
Folks in CPDD:
Many of us within CPDD view alcohol/ethanol and tobacco/nicotine as 'drugs'.
We view the early-mid-1970s substitution of the term 'substance' as an inappropriate
politics maneuver, and possibly a supercilious denial that ethanol/alcohol and
tobacco/nicotine are drugs.
In consequence, the idea of a new NIH agency called "Institute for Substance Use,
Abuse, and Addiction" may be a bit of an injection of politics into the science.
There is a Facebook group that advocates a different name such as: "National
Institute on Drug Use and the Public's Health."
I invite you to join that Facebook group and to help us make sure that the politics
are not injected into the science of NIH research.
(I appreciate that there may be an intent for a reach toward 'internet addiction',
'gambling addiction', 'food addiction', 'exercise addiction',  'sugar addiction',
etc., and to bring these related conditions into the fold. This goal can be
accomplished by taking a page from the NESARC program - e.g., 'National Institute
on Drug Use and Related Conditions' although my personal preference is to bring
those conditions into the fold via the allusion to the Public's Health.)
The most important piece of this "pontification" is not to saddle future generations
of scientists with the politics that were involved when early-mid-1970s political
considerations got injected into the naming of SAMHSA.
Also, please note that, to date, the leaders of CPDD resisted any notion of changing
the name of the college to 'College on Problems of Substance Dependence' even though
the reach of CPDD includes all of the above-listed 'related conditions'. We can deal
with this issue in the 'fine print' of the new institute's description and in its
program announcements or funding opportunity statements, exactly where we also can
deal with the fact that the domain of 'drug' can extend to aspirin, chlorpromazine,
and other 'drugs' of less central prominence within the new institute's range.
Goodcheer!
Jim Anthony
CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Monday, December 6, 2010

NIMH, NIDA, and NIAAA Institute Directors Briefing at the 49th Annual Meeting of the American College of Neuropsychopharmacology (ACNP)

MIAMI, Fla. — Presentations were made yesterday afternoon to attendees of the ACNP 49th Annual Meeting by Tom Insel, Director, National Institute of Mental Health (NIMH), Kenneth Warren, Director, National Institute on Alcohol Abuse and Alcoholism (NIAAA), and Nora Volkow, Director, National Institute on Drug Abuse (NIDA).  The Institute Directors briefed ACNP meeting attendees on Institute priorities and budget issues.

Dr. Insel spoke first and focused on strategic and budgetary themes.  He remarked that there is some frustration in Congress regarding the return on the financial investment that has been made to support research.  He suggested that NIH research needs to become more like the research program maintained by the Defense Advanced Research Project Agency (DARPA), that works off of directives and is focused on innovation.

He reported that NIMH Council recommended that it is important to stop conducting large studies that yield small effects, and that there should be a focus on methods standardization, data integration, and data sharing.  Insel also noted that NIMH is committed to preserving the New Investigator R01 pipeline, and this year is funding New Investigator R01s up to the 25th percentile.

In terms of budget issues, he said that the President’s FY11 budget proposed increased funding by 3.2%, but that actual budget increases have been below the level of inflation for the last 5 budget years.  Importantly, only a fraction of each year’s budget, ~25% for NIMH, goes into new awards, with ~75% already committed to existing programs.  If the President’s FY11 budget is approved, then the current funding line for new applications would be ~21% funding.  However, because Congress is working on a Continuing Budget Resolution, the current funding line is ~17.8%.  And, if the budget is funded at FY08 levels, the preference of some Congressional leaders, the new application funding level would reduce to a scary ~13.3%.  This could mean a ~30% cut in the number of newly funded projects.

To offset this grim possibility, Insel mentioned that NIMH is considering a number of options including shifting some resources from intramural to extramural programs.  He remarked that we are in the best of times scientifically and the worst of times financially.

Dr. Kenneth Warren of NIAAA spoke next and noted that he was glad to be speaking after Dr. Insel, who provided a perspective on a budget environment that affects all NIH Institutes.  Dr. Warren outlined the NIAAA mission and reported that the President’s FY11 budget request for NIAAA called for a 2.7% budget increase but the Senate markup called for only a 2.5% increase, both below inflation levels.  He then noted that the final budget could be flat or worse than flat.

Dr. Warren then spoke about the Scientific Management Review Board’s recommendation to form a new addiction research institute, and noted that the NIH Director appointed a task force to be led by NIH Principal Deputy Director Lawrence A. Tabak, D.D.S., Ph.D. and National Institute of Arthritis and Musculoskeletal and Skin Diseases Director Stephen I. Katz, M.D., Ph.D., to develop a new institute model by summer 2011.  Warren remarked that he had been told that those appointed to be task force members would “have no skin in the game”, presumably to eliminate conflicts of interest, but he expressed concern that the task force may not have all the expertise needed to formulate an optimal structuring plan.  Dr. Warren urged the audience to volunteer their time and advice, if requested by the task force, to consult on the structuring plan.  He then outlined a the timeline for the process, indicating that the structuring plan would have to be completed by summer 2011 in order to be able to start in FY 2013.

Dr. Warren spent the balance of his time discussing NIAAA accomplishments and priorities.

NIDA Director Dr. Volkow spoke last, agreeing with Dr. Insel in that these are extraordinary times scientifically.  She remarked that science is advancing at speeds not seen before because of open access to research data via the internet.  She termed the budget picture “challenging” and “competitive”.  She noted that the proposed NIDA budget is about $1 billion, but could be rolled back to FY2008 levels.  NIDA is considering a pre-emptive measures to respond to this possibility, and among other actions is not going to commit to new large program projects that run for long time periods.

She then focused on the SMRB recommendation to form a unified addiction institute, and indicated that she was “delighted” with the recommendation.  Dr. Volkow said that in her opinion, dividing research on alcohol from that on other drugs is bad, because of the high comorbidity between alcohol abuse and abuse of nicotine and illicit drugs.

Dr. Volkow noted that most animal models of alcohol abuse don’t include nicotine, which is relevant clinically and scientifically because of the high comorbidity of alcohol abuse and smoking, and because nicotine is neuroprotective and also can trigger alcohol relapse.  She noted that more alcoholics die from smoking-related diseases than from alcohol-related diseases.

She observed that supporters of NIAAA and NIDA research programs all are afraid that funding for these research areas will be reduced in an integrated institute, and that it will be critical to include mechanisms in a new institute structure that minimize inappropriate allocations.

Dr. Volkow lamented that the restructuring process has resulted in a polarization between NIDA and NIAAA, but that it is important to start working together to figure out how to best integrate resources and manage the change.  She also appealed to the audience to serve as consultants if asked to help provide guidance on integration.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Thursday, December 2, 2010

The Drug Enforcement Administration bans synthetic marijuana products including “Spice”, “K2”, “Blaze”, and “Red X Dawn”

So, the Food and Drug Administration (FDA) has been regulating tobacco products for a number of months now and recently banned the sale of caffeinated alcoholic beverages.  This past week, the Drug Enforcement Administration (DEA) placed temporary controls, effectively, a 1-year ban, on possession or distribution of synthetic marijuana, also known as “fake pot”.  The ban will allow a period of study to determine whether these fake pot products should be permanently controlled as Schedule I drugs.

These and other synthetic marijuana products already are banned in a number of European countries.

Synthetic marijuana is produced by spraying herb blends to be smoked with one or more of the following chemical substances, JWH-018 or analogs JWH-073 or JWH-200, or CP-47,497 or analog cannabicyclohexanol.

The JWH series of compounds were initially synthesized for research purposes by medicinal chemist John W. Huffman.

Together with Billy Martin and colleagues, Dr. Huffman published a pharmacology study in Drug and Alcohol Dependence showing that JWH-018 and JWH-073 have high affinity at cannabinoid CB1 and CB2 receptors, and are several times more potent at binding to these receptors than the primary active ingredient in marijuana, delta-9-tetrahydrocannabinol (THC).

Compound CP-47,497 is another synthetic cannabinoid synthesized originally by Pfizer.

National Public Radio recently interviewed Dr. Huffman who characterized the products containing these compounds as being “…pretty toxic.”

The American Association of Poison Control Centers issued 3 press releases this year in July, October, and November, reporting alarmingly high numbers of calls to Poison Control Centers related to these products (see Figure), particularly when compared to the small numbers of calls received in prior years.

In his NPR interview, Dr. Huffman pointed out that there are many other synthetic THC analogs with similar effects, some of which are many times more potent than THC.  Thus, more products like the banned substances likely will emerge pretty quickly and may need to be studied and possibly regulated.

At the CPDD Annual meeting held in June, Boos and colleagues from the DEA reported finding synthetic cannabinoids more frequently of late in seized products (Abstract 59, 2010 Abstract Book PDF page 15, downloadable at www.cpdd.vcu.edu).  Their abstract indicated that since 2000, 5 designer drugs have been added to the controlled substances act.  That number could be quickly doubled if the 5 synthetic cannabinoids under discussion also are added, and could grow even further and very quickly if other synthetic cannabinoids are added.

CPDDBLOG welcomes CPDD member’s thoughts on this issue. 

Friday, November 19, 2010

More on a possible reorganization of NIDA and NIAAA into a new addiction Institute

Yesterday, NIH Director Francis Collins issued a statement regarding a possible reorganization of NIDA and NIAAA indicating he had received the formal reccommendation from the Scientific Management Review Board to formulate a new addiction research Institute.

The statement indicated that a task force is being formed to determine which programs among NIH's 27 Institutes would be moved to the new Institute, and which programs currently within the portfolios of NIDA and NIAAA would be moved to other Institutes.

Drug Monkey published a interesting discussion of the process.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Wednesday, November 17, 2010

FDA Issues Warning Letters to Manufacturers of Several Caffeinated Alcoholic Beverages

Today, the Food and Drug Administration issued warning letters to 4 manufacturers of caffeinated alcoholic beverages, indicating that their products present a public health concern and violate the Federal Food, Drug, and Cosmetic Act (the FFDCA), because the manufacturers have not shown that their beverage combinations of caffeine and alcohol are generally recognized as safe.

Warning letters were sent to Charge Beverages Corp. (for Core High Gravity HG, Core High Gravity HG Orange, and Lemon Lime Core Spiked), New Century Brewing Co., LLC (Moonshot), United Brands Company Inc. (Joose and Max), and Phusion Projects, LLC (Four Loko).  Four Loko has been the subject of prior posts on this blog.

These companies were given 15 days to document that they have implemented steps to "remedy the violation and prevent its recurrence".

The action could result in seizure of these products under federal law.

Phusion Projects, LLC already has indicated that they will remove caffeine from Four Loko.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Monday, November 15, 2010

Report: FDA Soon To Take Action on Caffeinated Alcoholic Beverages Including Four Loko

A report in today's New York Times online indicates that the Food and Drug Administration (FDA) is about to take action on caffeinated alcoholic beverages, such as Four Loko.

It has been over a year since the FDA began collecting data from the companies that market these beverages to determine whether the addition of caffeine to alcohol-containing beverages is generally recognized as safe.

The Connecticut Attorney General Richard Blumenthal was quoted in the New York Times article as saying “To be very blunt, there’s just no excuse for the delay in applying standards that clearly should bar this kind of witch’s brew”.

The maker of Four Loko, Phusion Projects, states on their website that “The FDA does not currently regulate caffeinated alcoholic beverages; the Alcohol and Tobacco Tax and Trade Bureau, (TTB), a division of the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) does.”

A statement posted on the TTB website in reference to this issue indicates that the TTB and the FDA both have jurisdication over different aspects of alcoholic beverages, and that the FDA enforces provisions of the Federal Food, Drug, and Cosmetic Act, and determines safety of additives used in the production of alcoholic beverages.

According to the TTB statement, the FDA did not raise objections to caffeine levels in beverages up to 200 parts per million (ppm), the limit set for cola products.

Although Four Loko does not currently list the caffeine content on its product label, if it exceeds 139 mg (200 ppm in a 23.5 fluid ounce serving), a concentration at the low end of the range of caffeine concentrations present in 8 oz servings of generic brewed coffee, then this may exceed the limit that has been allowed by the FDA.

Stay tuned for updates.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Thursday, November 11, 2010

Substance Abuse Problems in Veterans

On this Veteran’s Day, we salute the men and women of our armed forces, past and present, for their service to our country.

Substance abuse professionals have been studying the prevalence and effects of substance abuse in active duty soldiers and veterans.  Unfortunately, the statistics are quite sobering.  There is evidence that the prevalence of substance abuse (alcohol and drug abuse) disorders among veterans of the post-Vietnam conflict era is more than 50% higher than among the general population, as is tobacco use.

Other statistics show that among soldiers who have been deployed and have experienced combat situations, new-onset alcohol problem prevalence rates are higher than nondeployed soldiers, with the youngest deployed soldiers at highest risk for developing alcohol problems.

Today, R. Gil Kerlikowske, Director of the Office of National Drug Control Policy (ONDCP), issued a statement reaffirming the nation’s commitment to provide access to high quality treatment for addiction and other mental health disorders to active duty service members and veterans, in whom the prevalence of prescription drug misuse now is more than double that of the non-military population.

This is timely given the fact that there are major unmet needs for alcohol and substance abuse treatment among veterans.

A new means to reach out to veterans in need of substance abuse treatment capitalizes on technology developed by the Veterans Administration (VA) to enhance internal medicine care: Tele-health In-Home Messaging Device internet technology.  An abstract presented at the CPDD 2010 meeting by Santa Ana and colleagues (www.cpdd.vcu.edu/, 2010 Abstract Book PDF, p. 145, abstract 578) described initial efforts to develop the IHMD to conduct remote substance abuse risk assessments, treatment sessions, and to determine whether respondents should be contacted by health professionals for additional follow up.

Should the system work, it might provide a means to assess, monitor, and treat veterans who do not have easy access to VA or other substance abuse treatment centers.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Saturday, November 6, 2010

More on Four Loko and other caffeinated alcoholic drinks

In follow up to the last posting on caffeinated alcoholic beverages, more states and colleges have enacted or are considering bans of these types of beverages.  The State of Michigan now has banned sales of these drinks effective next month, the State of Oklahoma halted sales of Four Loko and similar beverages, and the State of New York State Liquor Authority is considering modifying the state law so they can ban these types of drinks.  These are in addition to the State of Utah, which never permitted sales of these types of beverages.  In addition, the University of Rhode Island has banned these beverages.

Some feel that these beverages are marketed in such a way that they are attractive to adolescent drinkers, in whom the combination of caffeine and alcohol may be particularly problematic.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Saturday, October 30, 2010

Four Loko: a caffeinated high-alcohol content beverage—is it safe or should it be regulated or banned?

More and more people are consuming alcoholic beverages that contain caffeine, which seems to mask some of alcohol’s intoxicating subject effects.

A recent incident at Central Washington University in Washington State involving the caffeinated alcoholic beverage Four Loko was associated with 9 hospitalizations, and received widespread national press coverage including reports in the New York Times, the Washington Post, the LA Times, Business Week, and National Public Radio.

That incident followed on a similar one in September at Ramapo College in New Jersey in which a number of students were hospitalized after drinking Four Loko.  Ramapo’s President Peter Mercer instituted a campus ban of Four Loko and similar drinks.  Central Washington University followed with its own ban soon after.

Four Loko is available in a 23.5-ounce can that contains 12% alcohol content (roughly five 12-oz beers’ worth of alcohol) with an unspecified amount of caffeine added.  Four Loko has been referred to as “blackout in a can” or “liquid cocaine”.

One of the main problems with these beverages is that they reduce some of the symptoms of alcohol intoxication while impairing motor coordination, so people may feel less impaired than they are, which can increase their risk for experiencing injuries, sexual assaults, and for developing problems with alcohol.

For example, a web-based survey study in over 4,000 college students from 10 North Carolina universities reported that consumption of alcohol mixed with energy drinks was associated with increase negative consequences including future heavy drinking and higher rates of being injured and of requiring medical treatment.

A recent study reported that several measures of cognitive performance were reduced in subjects who consumed a caffeine-containing beverage including 6% alcohol, which had about one-third the amount of alcohol in Four Loko.

In November 2009, the Food and Drug Administration, which maintains a list of manufacturers of such beverages and their products sent letters to these manufacturers requesting that they document safety of their products within 30 days.  The FDA has not yet issued a report on findings resulting from this inquiry.

There is an increasing push to have these beverages regulated if not banned altogether including calls for a statewide ban by the Washington State Attorney General and, even before the recent incidents noted above, calls for FDA action by several United States Senators including Charles Schumer (D) of New York.

Clearly, these types of beverages have the potential to cause harm and more research in this area is needed to determine whether they should be regulated or banned.

CPDDBLOG welcomes CPDD member’s thoughts on this issue. 

Saturday, October 16, 2010

Substance use in movies and documentaries

Most everyone likes films and substance use long has been a central theme in films and documentaries, from the 1930s to the present.

A comprehensive website created by Dr. Russell Curtis from the Department of Sociology at the University of Houston catalogues films portraying substance use as a central theme from 1935 – 2003.   While the site has a disclaimer: “IMPORTANT:  this is for research; not for quotation or general distribution”, it really is worth viewing if you are interested in this film genre.

The Office of National Drug Control Policy (ONDCP) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have sponsored research reports on Substance Use in Popular Movies and Music, Substance Use in Popular Prime Time Television, and Substance Use in Popular Music Videos.

There also are a number of websites simply listing, describing, and/or ranking films and documentaries with substance use themes, including (shown in no particular order):

Chasing the Frog, Epinions, Listverse, Associated Content, Wikipedia, Bukisa, and Oddfilms.

CPDD has recognized the importance of films and documentaries in communicating the causes, consequences, and effects of substance abuse.

In 2007, producers of the HBO documentary series “ADDICTION” (Nevins, Hoffman, Froemke), won the CPDD/NIDA Media Award.  “ADDICTION” includes several excellent films that can be streamed online.

In 2008, CPDD started including a movie or “Film Night” as part of its annual meeting program.  The film “The Panic in Needle Park” (1971) was shown.  It portrays life among heroin addicts living in “Needle Park” New York City.  It won Best Actress award (Winn) at the Cannes Film Festival.  Also shown was “Days of Wine and Roses” (1962), the story of an alcoholic who falls in love with a young woman he encourages to join him in his addiction.  The film won an Oscar for Best Original Song (Mancini and Mercer).

In 2009, “Fighting the Dragon with Luck” (an independent documentary film on heroin addiction treatment in Australia, 2008) was shown along with “Clean and Sober” (1988), the story of a realtor’s life turned upside down by cocaine.

In 2010, two films were shown including “Narcotic Farm” (based on the book by the same name published by the 2009 CPDD/NIDA Media Award Winner Dr. Nancy Campbell), which is a documentary on the history of drugs, policy, and research, along with “Lost Weekend” (a story about a struggle with alcoholism).  Lost Weekend won 4 Oscars (Best Leading Actor (Milland), Best Director (Wilder), Best Picture, and Best Screenplay, in 1946.

It is my understanding that plans are in the works to continue having a Film Night at the CPDD annual meeting—any suggestions?

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Wednesday, September 29, 2010

Prescription Drug Abuse, the DEA’s “Take-Back” Initiative, and CPDD research.

BOSTON,  MA  –  In New England alone, over 25,000 pounds of prescription drugs were collected this past Saturday from 401 of the 4000 locations participating in the Drug Enforcement Administration’s (DEA) national “Take-Back” program, the first of planned bi-annual events.

R. Gil Kerlikowske, Director of the White House Office of National Drug Control Policy (ONDCP), visited one of the Take-Back sites in Philadelphia during the event and pointed out that “More than 70 percent of people who abuse prescription drugs get them from friends or family…”  National Public Radio had an interesting interview focusing on the event, noting that prescription drug abuse affects all socioeconomic levels.

Statistics regarding the DEA Take-Back program’s success along with grim statistics about the prevalence and consequences of prescription drug abuse can be found on the DEA, ONDCP, and National Institute on Drug Abuse (NIDA) websites.

Prescription drug abuse has become a major public health problem, eclipsing most forms of illicit drug abuse and catalyzing a spike in criminal activity.  A report in the New York Times noted that some people now show up at real estate open houses not to look at homes but to search medicine cabinets for pain pills.

CPDD researchers are making progress in understanding the scope of the problem, its causes, and in finding possible solutions.  A number of abstracts presented at the 72nd Annual CPDD meeting in Scottsdale focused on prescription drug abuse.

For example, researchers from Michigan State University reported that more than 3% of people who took prescription pain medications for nonmedical purposes developed dependence soon afterward, and 20% developed some features of dependence (Adelaja et al., CPDD abstract book PDF, page 2).  To view this abstract and other abstracts on this and other topics, download the CPDD meeting abstract book PDF (2nd link under the 2010 "MEETING INFO..." heading on the left panel).

And, the epidemic extends to other types of prescription medications.  In this regard, a recent report in CPDD’s journal Drug and Alcohol Dependence described how non-prescription stimulant use also has been associated with rapid development of dependence at alarmingly high rates.

Clearly, much work needs to be done to stem the tide of prescription drug diversion and abuse by agencies that control the flow of prescription drugs and by researchers working to find new medications that are less likely to be abused.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Tuesday, September 21, 2010

Formation of a new Addiction Institute: what could this mean for NIDA and NIAAA training programs?

The Substance Use, Abuse, and Addiction Workgroup (SUAA) of the Scientific Management Review Board (SMRB) recommended last Wednesday (September 15, 2010) to dissolve NIDA and NIAAA and form a new Addiction Institute, which would oversee all NIH-funded addiction related research from those Institutes.  In addition, addiction-related research currently within portfolios of other NIH Institutes would be moved to the new Institute.

Although NIH Director Collins has yet to act on this recommendation, people are beginning to speculate on how consolidation would affect existing NIDA and NIAAA programs, including existing training programs.

Indeed, one of the main reasons cited in support of the SUAA recommendation to form a new Addiction Institute (Working Group Report, Sept. 2010) was to “overcome cultural barriers [that create] significant challenges to training early stage investigators…”  The cultural barriers referred to in the report are that NIDA and NIAAA have “distinct professional societies [College on Problems of Drug Dependence and Research Society on Alcoholism]…and insufficient communication between them, despite commonalities.”

The report stated further that: “By creating a single institute, comprehensive training programs integrating both multi- and interdisciplinary approaches to addiction research could be developed and supported.”

Currently, there are more than 60 NIDA-supported training programs and 28 NIAAA-supported training programs.

The map shows the approximate geographic locations of institutions supporting training programs for NIDA, NIAAA, and for both Institutes.  Of note, only 11 of 64 institutions currently with NIDA or NIAAA training programs support NIDA and NIAAA programs, meaning that simply merging existing training programs is not going to be an effective strategy to achieve the interdisciplinary training goals outlined in the SUAA report.

So, people are wondering how training programs would transition to become more interdisciplinary in structure.

Another question people are considering is the time frame over which existing training programs would be required to migrate their curricula (and possibly) faculty to become more interdisciplinary.  Would transitions have to occur within training program funding cycles or by the time of the next competing renewal application?

And, since research is a key component of training, what would happen to programs based at institutions not having established NIDA- and NIAAA-supported research programs?

What would happen to trainees starting under the current system—would they be allowed to complete their program or would they have to develop more interdisciplinary competencies?

Obviously, there are many details that would need to be worked out to get from where we are to where the SUAA recommends we should be, should NIH Director Collins accept that recommendation and form a new Addiction Institute.

CPDDBLOG welcomes CPDD member’s thoughts on this issue, especially members currently affiliated with training programs.

Wednesday, September 15, 2010

SMRB Vote on SUAA Working Group Recommendations and Report

And the vote is in...

Vote for Option 1, a structural merger (recommendation to form a new addiction institute): carries, 12 in favor, 3 against.

This recommendation will be reviewed by NIH Director Francis Collins, who will determine next steps.


CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Monday, September 13, 2010

Scientific Management Review Board September 14-15 meeting information

The Scientific Management Review Board Meeting will review recommendations regarding a NIDA-NIAAA merger.  Information about the meeting including webcast details can be found here.

Wednesday, September 8, 2010

Update on changes to CPDD's journal Drug and Alcohol Dependence

By Eric C. Strain
Editor in Chief, Drug and Alcohol Dependence

I have been asked to contribute to the CPDD blog regarding the College’s journal, Drug and Alcohol Dependence (DAD), as the new Editor in Chief of the journal.  I’m pleased to do so, and to outline a couple of the changes that have occurred over the past few months with the journal. 

First, there have been several changes in the ranks of the Associate Editors (or AEs).  I should explain that the AEs for DAD are true editors – each manages all aspects of their assignments.  I assign a new submission to an AE, but after that the AE invites reviewers, keeps track of getting reviews, makes decisions about whether to continue to consider the paper, and gives the authors feedback.  There are now seven AEs for DAD (and their topic areas follow each name): Deborah Hasin (Comorbidity, Psychiatric Epidemiology, Etiology, Nosology and Genetics); Kyle Kampman (Treatment and Services); Lin Lu (Neuropsychopharmacology and Treatment); Linda Porrino (Preclinical and Clinical Neuroscience); Craig Rush (Behavioral Pharmacology); Steffanie Strathdee (Etiology, Epidemiology, Prevention and Policy); and, Wim van den Brink (Etiology, Treatment and Human Genetics).  Craig, Lin, Linda, and Kyle are all new AEs as of this summer.

Another change in the wings is that the Instructions to Authors has recently been revised and updated.  Some of these changes are minor (such as fixing urls), but there are a couple of note.  One is that we are now asking that all abstracts be structured.  The second is that there are guidelines for word limits to papers.  We previously had a word limit for Short Communications (2000 words), but now have added recommendations for Regular Articles (4000 words) and Reviews (6000 words).  We also are now encouraging authors to suggest reviewers when they submit a paper. 

Another change is by the College, which has decided to no longer provide a paper copy of the journal to members as a membership benefit.  I’ll let the College fill you in on this change, but it looks like members will no longer get the paper copy starting in January of 2011. 

I want to end by encouraging all to be involved with DAD – the journal publishes terrific work, and it is seeking the best work from all fields of addictions research.  I hope that you will read the journal, submit your papers, and agree to help review.  I believe that addictions research is stimulating, challenging, and exciting – it brings together neuroscientists, clinicians, epidemiologists, policy makers, and countless others, all interested in bettering our understanding of substance abuse.  Don’t hesitate to let me know how DAD can further help to move our field forward.

CPDDBLOG welcomes CPDD member’s thoughts on this posting. 

Tuesday, September 7, 2010

Scientific Management Review Board to make recommendation on a possible NIDA-NIAAA Merger

Some of you may be aware of an upcoming meeting on September 14-15 that could lead to a merger of NIDA and NIAAA.  The Scientific Management Review Board (SMRB) was created as part of the NIH Reform Act of 2006.  The Substance Use, Abuse, and Addiction (SUAA) Workgroup within the SMRB will be making a recommendation as to whether a merger would optimize research and maximize human health.

The pros and cons of a merger have been widely discussed by interested parties including CPDD Past President Linda Porrino, who made a presentation for SUAA (available for download at the presentation tab of the SUAA website) and who commented on the merger in CPDD Newsline (January 2010).

CPDD Charter Fellow and former CPDD President and Nathan B. Eddy Award Winner Mary-Jeanne Kreek also made a presentation (available for download at the presentation tab on the SUAA website).

An interesting discussion of the merger and its potential advantages and disadvantages took place as part of the 123rd NIAAA National Advisory Council Meeting in February 2010.  A summary can be viewed here.

The Research Society on Alcoholism website (RSoA) includes commentary on the potential merger by researchers (RSA e-NEWS: Brief Synopsis of the SMRB Meeting Report) and comments to the SUAA by former NIAAA Directors T.-K. Li (NIH-Substance Use, Abuse and Addiction (SUAA) workgroup testimony by Dr. Ting-Kai Li) and Enoch Gordis (NIH- Substance Use, Abuse and Addiction (SUAA) workgroup testimony by Dr. Enoch Gordis).

Addiction Professional Magazine highlighted concerns that NIAAA research and researchers might get the short shrift in any merger of the two institutes.

And, according to Tom Kelly, member of the Advisory Committee to the NIH Director, reporting at the 100th Advisory Committee meeting (NIH Record, June 25, 2010), the SMRB was split on whether to recommend a functional merger (that facilitates interactions between independent institutes including interdisciplinary research) or a structural merger (that combines institutes).  The NIH Record article quoted NIDA Director Nora Volkow as favoring a structural merger while NIAAA Acting Director Kenneth Warren favored a functional merger but not a structural merger.

Even groups with scientific interests that generally differ from addiction researchers have come out against the precedent of a structural merger, such as the National Alliance for Eye and Vision Research (NAEVR), which in May warned about the possibility that certain types of research could be lost between the cracks if institutes with particular specialties are absorbed into other institutes.

There seems to be general agreement among addiction researchers that functional changes enhancing interactions across institutes (e.g., via interdisciplinary research) could be helpful but that a structural merger, particularly one resulting in a contraction of funding for addiction research, would be an unfortunate and unwise outcome.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Monday, August 30, 2010

NIDA Funded ARRA Grant Wasteful Spending?

In a continuation of a theme discussed in my August 20 posting on how politics and scientific research policy sometimes interact, thanks go out to Ken Grasing for alerting the CPDD membership via the Listserv about the congressional oversight report sponsored by Senators McCain and Coburn (a physician) calling a NIDA-funded ARRA grant wasteful.

This is what their report, entitled "Summertime Blues", said:

"Researchers at Wake Forest University think that, in at least one case, it is good to monkey around with stimulus dollars. The Department of Health and Human Services has sent $144,541 to the Winston-Salem college to see how monkeys react under the influence of cocaine. The project, titled “Effect of Cocaine Self-Administration on Metabotropic Glutamate Systems,” would have the monkeys self-administer the drugs while researchers monitor and study their glutamate levels. When asked how studying drug-crazed primates would improve the national economy, a Wake Forest University Medical School Spokesman said, “It's actually the continuation of a job that might not still be there if it hadn't been for the stimulus funding. And it’s a good job.” He added, “It’s also very worthwhile research.”

Congressional candidates such as Frank Guinta, who is campaigning for a New Hampshire Congressional seat, have called out this grant for elimination as part of his election platform.

As Ken noted in his Listserv email, Alan Leshner, former NIDA Director and current Chief Executive Officer of the American Academy for the Advancement of Science (AAAS), replied to the McCain/Coburn report in an opinion piece written for Politico by calling it a "...cheap shot at important research critical to finding medications for cocaine addiction."

Based on the rhetoric used by Senators McCain and Coburn ("...drug-crazed primates...") and by candidate Guinta ("...We’re using federal stimulus money to watch what happens when monkeys get high...") to describe this research, it seems like some politicians and political candidates have targeted this project and perhaps addiction research in general in their crosshairs.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Friday, August 20, 2010

Politics of Addiction Research

On a topic somewhat related to a prior post, no doubt many of you recently applied for ARRA grants via the Recovery Act and some of you even received an award.  Recently, one of those awards became a focus in a skirmish between Republicans and the Obama Administration.  The debate was covered by Greg Sargent, of the Washington Post, in his recent posting entitled “Obama admin skewers GOP attack on stimulus cocaine monkeys”.

Interestingly enough, 2 of our recent CPDD Media Award Winners, Dr. Nancy Campbell, Associate Professor in the Department of Science and Technology Studies at Rensselaer Polytechnic Institute and author of Discovering Addiction, and William C. Moyers, vice president of foundation relations at Hazelden's Center for Public Advocacy, also have weighed in on this subject.

Dr. Campbell wrote, in Chapter 1 of her book "Discovering Addiction":

“What American publics and institutions define as worthy cures for drug addiction depends on who is perceived to be addicted, on what drugs addicts depend, on the meanings attributed to addiction, and on patterns of social status.  The modal late nineteenth-century American addict was an upper- or middle-class white woman maintained on morphine by her physician.  Respectable “medical addicts” gave way to an urban underclass that used narcotics for “nonmedical” purposes or “recreation”.  These new addicts were culturally distinct from their precursors:  these poor, working-class, increasingly African American and while ethnic males were viewed as part of the “dangerous classes.”1  How addicts are treated very much depends on their membership in specific social groups; they cannot be lumped together as raceless, classless, or genderless…”

Mr. Moyers wrote online in the Politics of Addiction:

“…addiction is a bipartisan illness and that it does not discriminate…President Barack Obama's  drug czar, former Seattle Police Chief Gil Kerlikowske, has called for an outright end to the failed "war on drugs," shifting the emphasis from tough law enforcement and international interdiction to prevention and treatment.”

Sheril Kirshenbaum also had an interesting piece echoing these themes at the Discover website.

Whether or not scientists get involved, politics shapes addiction research and law enforcement funding policy, so its worth seeing how different sides debate this issue.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Thursday, August 19, 2010

2010 CPDD/NIDA Media Award Winner, Dr. Allan Brandt

For those of you who missed the CPDD meeting Plenary Session, this year's CPDD/NIDA Media Award winner is Dr. Allan Brandt, Dean of the Graduate School of Arts and Sciences at Harvard University.

Dr. Brandt is a member of the Institute of Medicine of the National Academy of Sciences and of the American Academy of Arts and Sciences.  His book entitled “The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America” describes ways science was misused by tobacco manufacturers to market cigarettes.

Dr. Brandt set up an interesting and informative website associated with this book, making his work on this topic a truly multimedia experience.

To meet Dr. Brandt, you can watch an entertaining interview of him by Jon Stewart on Comedy Central’s “The Daily Show”, originally airing on June 13, 2007.

Wednesday, August 18, 2010

Drug Addiction Demand Reduction (Research) Funding Getting Shortchanged?

The Public Policy Forum at the recent CPDD Annual Meeting in Scottsdale included a fascinating discussion about the ways our government and most western governments approach substance abuse.  Dr. John Strang of King’s College London, Dr. Peter Reuter, from the University of Maryland, Robin Room of the Turning Point Alcohol and Drug Center at the University of Melbourne, Australia, and Dr. Tom Babor of the University of Connecticut discussed different control strategies and evidence for their efficacies.

The discussion covered a number of interesting facts including that government funds are allocated primarily to supply side reduction (~75%, roughly the same in most westernized countries), such as eradication of drugs at their sites of production (e.g., burning coca fields in Columbia) and interdiction (finding and confiscating drug shipments before distribution).  This leaves about 25% for demand reduction programs including research and treatment.

The big problem with this math, according to these experts, is that there is very little evidence available demonstrating efficacy of most supply side methods.  In fact, two of the most obvious measurements of supply side efficacy, street prices for cocaine or heroin, are the lowest they have been in years, meaning that there is no apparent supply shortage.  The United States Drug Enforcement Agency reports that drug purity is down, which could in part explain price reductions, but other statistics support the idea that supply side reduction is not particularly effective.

By contrast, there is recent evidence documenting that good research, when turned into good treatment, is effective at reducing substance abuse and dependence.  For example, each dollar invested in substance abuse treatment has been estimated to save taxpayers $7 in overall costs (healthcare, insurance, crime, etc.).

So, where does this leave us?  In this era when its been harder than ever to obtain federal research funding, wouldn’t it be nice if we could find ways to persuade congress to shift a small fraction of federal resources from supply side to demand side efforts, including research?

Imagine shifting a modest 5% of the total supply side funding (a 7% decrease) to demand side funding (a 20% increase)—how many innovative research and treatment programs would be stabilized, how many new programs would be enabled, and how many $7 returns per dollar of federal treatment investment would be accrued?

In his CPDD Plenary Session address several days before the Public Policy Forum, Dr. Tom McLellan, Deputy Director for Demand Reduction in the White House Office of National Drug Control Policy noted that ONDCP is devoting substantial effort to coordinate substance abuse intervention efforts by different federal agencies.  Perhaps efficiencies that result from this program might make modest funding redistributions from supply to demand side a zero-sum gain for research.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Sunday, August 15, 2010

Welcome to the CPDD Community Website, a.k.a. CPDDBlog.

Over the past few years, online social networking and media sites have become important portals for communicating information, opinion, and news of many types.  This site is intended to serve as an information portal for CPDD members, the media, and the general public.

While this site is accessible to everyone, contributions will be limited to CPDD members and invited guests.  To post, members are required to submit the current CPDD member password along with their contribution.  Contributions will be reviewed by the moderator prior to posting to insure that the site includes informative and professional content.

We hope that member contributions to this site along with contributions from invited guests will help keep CPDD in focus for members and other interested parties over the entire year, and reinforce the concept that CPDD and its membership are thought leaders in the area of addiction research, treatment, and policy.

Over time, we hope to add links to other informative websites and community sites/Blogs that are relevant to CPDD and its mission.  Please email feedback and/or suggestions for relevant additions to the moderator for consideration (CPDDBLOG@gmail.com).