Skip to main content

Addiction Science: A Rationale and Tools for a Public Health Response to Drug Abuse

Abstract

New scientific knowledge and effective, evidence-based interventions have provided health leaders and policymakers a remarkable paradigm to guide the development of addiction treatment services around the world. The definition of addiction as a brain disease, validated screening and assessment tools, medication-assisted treatment, and effective behavioral treatments have served as vehicles for both the United States and other countries to guide the transformation of their substance abuse treatment systems. Seeking to expand international research and infrastructure, the National Institute on Drug Abuse (NIDA)’s International Program has engaged international investigators and institutions in addiction research to promote dissemination of addiction science globally. This paper presents three mixed-methods case studies to exemplify the use of advancements in evidence-based practice in addiction treatment as guides and tools for the creation or further development of treatment systems in three countries, Vietnam, Lebanon, and Abu Dhabi. Results indicate that a framework of evidence-based medicine and empirical science creates a necessary platform from which objective conversations about addictions may begin. Other facilitative factors that help create treatment programs internationally include: a receptive and supportive government, support from international donors and technical experts, networking and interest from other international organizations, and often a synergistic and concerted effort by multiple entities and partners. Despite substantial differences in the circumstances that generated these initiatives and the varying scope of the services, common themes across these efforts have been the implementation of science-based approaches to systems transformation and support for a public health approach to addressing drug abuse and addiction.

References

  1. Rawson RA, Obert JL. The substance abuse treatment system in the US. What is it? What does it do? Myths and misconceptions. In: Zweben JE, Lambert S, (editors). Occupational Medicine: A State of the Art Review. Philadelphia (PA): Hanley and Belfus; 2002. p. 1–21.

    Google Scholar 

  2. United Nations International Drug Control Programme. The social impact of drug abuse. Copenhagen: World Summit for Social Development; 1995.

    Google Scholar 

  3. National Drug Intelligence Center. The economic impact of illicit drug use on American society. Washington (DC): United States Department of Justice; April 2011. Available from URL: http://www.justice.gov/archive/ndic/pubs44/44731/44731p.pdf (Accessed 10 September 2013).

    Google Scholar 

  4. National Center on Addiction and Substance Abuse. Family matters: substance abuse and the American family: a CASA white paper. New York (NY): CASA at Columbia University; 2005.

    Google Scholar 

  5. Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009;301:183–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Jensen E, Gerber J, Mosher C. Social consequences of the war on drugs: the legacy of failed policy. Crim Justice Policy Rev. 2004;15:100–21.

    Article  Google Scholar 

  7. Schroedel JR, Fiber P. Punitive versus public health oriented responses to drug use by pregnant women. Yale J Health Policy Law Ethics. 2001;1:217–35.

    CAS  PubMed  Google Scholar 

  8. Dole VP, Nyswander M. A medical treatment for diacetylmorphine (heroin) addiction: a clinical trial with methadone hydrochloride. JAMA. 1965;193:646–50.

    Article  CAS  PubMed  Google Scholar 

  9. National Institutes of Health. NIH grant will help translate addiction research into practice. Bethesda (MD): NIH; 2011. Available from URL: http://www.nih.gov/news/health/oct2011/niaaa-26.htm (Accessed 10 September 2013).

    Google Scholar 

  10. National Center on Addiction and Substance Abuse. Addiction medicine: closing the gap between science and practice. New York (NY): CASA at Columbia University; 2012.

    Google Scholar 

  11. Institute of Medicine. Bridging the gap between practice and research: forging partnerships with community-based drug and alcohol treatment. In: Lamb S, Greenlick MR, McCarty D (editors). Committee on Community-Based Drug Treatment. Washington (DC): National Academy Press;1998.

    Google Scholar 

  12. National Institute on Drug Abuse. Clinical Trials Network. Bethesda (MD): NIDA; 2013. Available from URL: http://www.drugabuse.gov/about-nida/organization/cctn/ctn (Accessed 10 September 2013).

    Google Scholar 

  13. Addiction Technology Transfer Center. Who we are. 2013. Available from URL: http://www.attcnetwork.org/aboutus/index.asp (Accessed 10 September 2013).

    Google Scholar 

  14. Condon TP, Miner LL, Balmer CW, Pintello D. Blending addiction research and practice: strategies for technology transfer. J Subst Abuse Treat. 2008;35:156–60.

    Article  PubMed  Google Scholar 

  15. Substance Abuse and Mental Health Services Administration. TIP Series: Treatment Improvement Protocols. Rockville (MD): SAMHSA. Available from URL: http://store.samhsa.gov/list/series?name=TIP-Series-Treatment-Improvement-Protocols-TIPS (Accessed 10 September 2013).

    Google Scholar 

  16. National Institute on Drug Abuse. Fellows World Map, Text-only Version. Bethesda (MD): NIDA; 2013. Available from URL: http://international.drugabuse.gov/fellowships/fellows-world-map-accessible (Accessed 10 September 2013).

    Google Scholar 

  17. Tomás-Rosselló J, Rawson RA, Zarza MJ, Bellows A, Busse A, et al. United Nations Office on Drugs and Crime international network of drug dependence treatment and rehabilitation resources centres: Treatnet. Subst Abuse. 2010;31:251–63.

    Article  Google Scholar 

  18. Saenz E, Busse A, Tomas-Rosello J, Clark N. Major international challenges in addiction treatment: the experience of Treatnet and beyond. In: El-Guebaly, N. Galanter, M. and Carra, G (editors). The Textbook of Addiction Treatment International Perspective. Springer. In press.

  19. United Nations Office on Drugs and Crime. Drug dependence treatment: training package. Vienna: UNODC; 2007. Available from URL: http://www.unodc.org/ddt-training/treatment/general.htm (Accessed 10 September 2013).

    Google Scholar 

  20. Leshner AI. Addiction is a brain disease, and it matters. Science. 1997;278:45–7.

    Article  CAS  PubMed  Google Scholar 

  21. Volkow ND, Fowler JS, Wang GJ. The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology, 2004;47:3–13.

    Article  CAS  PubMed  Google Scholar 

  22. Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. Mt Sinai J Med. 2000;67:347–64.

    CAS  PubMed  Google Scholar 

  23. Centers for Disease Control. Methadone maintenance treatment. IDU/HIV Prevention; February 2002. Available from URL: http://www.cdc.gov/idu/facts/MethadoneFin.pdf (Accessed 10 September 2013).

    Google Scholar 

  24. Corsi KF, Lehman WK, Booth RE. The effect of methadone maintenance on positive outcomes for opiate injection drug users. J Subst Abuse Treat. 2009;37:120–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Langendam MW, van Brussel GH, Coutinho RA, van Ameijden EJ. Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study. Addiction. 2000;95:591–600.

    Article  CAS  PubMed  Google Scholar 

  26. U.S. Food and Drug Administration. Subutex and Suboxone approved to treat opiate dependence. Silver Spring (MD): FDA; 8 October 2002. Available from URL: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm191521.htm (Accessed 10 September 2013).

    Google Scholar 

  27. Carrieri MP, Amass L, Lucas GM, Vlahov D, Wodak A, Woody GE. Buprenorphine use: the international experience. Clin Infect Dis. 2006;43:S197–215.

    Article  Google Scholar 

  28. Mark TL, Kassed CA, Vandivort-Warren R, Levit KR, Kranzler HR. Alcohol and opioid dependence medications: prescription trends, overall and by physician specialty. Drug Alcohol Depend. 2009;99:345–9.

    Article  PubMed  Google Scholar 

  29. Arfken CL, Johanson CE, di Menza S, Schuster CR. Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: national surveys of physicians. J Subst Abuse Treat. 2010;39:96–104.

    Article  PubMed  Google Scholar 

  30. Mintzer IL, Eisenberg M, Terra M, MacVane C, Himmelstein DU, Woolhandler S. Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings. Ann Family Med. 2007;5:146–50.

    Article  Google Scholar 

  31. Krupitsky E, Nunes EV, Ling W, Illeperuma A, Gastfriend DR, Silverman BL. Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial. Lancet 2011;377:1506–13

    Article  CAS  PubMed  Google Scholar 

  32. Krupitsky EM, Zvartau EE, Masalov DV, Tsoi MV, Burakov AM, et al. Naltrexone for heroin dependence treatment in St. Petersburg, Russia. J Subst Abuse Treat. 2004;26:285–94.

    Article  PubMed  Google Scholar 

  33. Krupitsky E, Zvartau E, Woody G. Use of naltrexone to treat opioid addiction in a country in which methadone and buprenorphine are not available. Curr Psychiatry Rep. 2010;12:448–53.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Humeniuk R, Ali R, Babor T, Souza-Formigoni ML, de Lacerda RB, et al. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in clients recruited from primary healthcare settings in four countries. Addiction. 2012;107:957–66.

    Article  PubMed  Google Scholar 

  35. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test: guidelines for use in primary care. 2nd edition. Geneva: World Health Organization; 2001.

    Google Scholar 

  36. Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Arch Pediatr Adolesc Med. 1999;153:591–6.

    CAS  PubMed  Google Scholar 

  37. Skinner HA. The Drug Abuse Screening Test. Addict Behav. 1982;7:363–71.

    Article  CAS  PubMed  Google Scholar 

  38. Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. J Subst Abuse Treat. 2007;32:189–98.

    Article  PubMed  Google Scholar 

  39. McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. J Nerv Ment Dis. 1980;168:26–33.

    Article  CAS  PubMed  Google Scholar 

  40. Saitz R, Alford DP, Bernstein J, Cheng DM, Samet J, Palfai T. Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med. 2010;4:123–30.

    Article  PubMed  PubMed Central  Google Scholar 

  41. D’Onofrio G, Degutis LC. Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med. 2002;9:627–38.

    Article  PubMed  Google Scholar 

  42. Humeniuk R, Dennington V, Ali R. The effectiveness of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care settings: a technical report of phase III findings of the WHO ASSIST randomized controlled trial. Geneva: World Health Organization; 2008.

    Google Scholar 

  43. McLellan AT, Cacciola JS, Alterman AI. The ASI as a still developing instrument: response to Mäkelä. Addiction. 2004;99:411–2.

    Article  Google Scholar 

  44. Brunette M, Mueser K, Drake R. A review of research on residential programs for people with severe mental illness and co-occurring substance use disorders. Drug Alcohol Rev. 2004;23:471–81.

    Article  PubMed  Google Scholar 

  45. Marlatt GA, Donovan DDM, (editors). Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York (NY): Guilford Press; 2005.

    Google Scholar 

  46. Carroll KM, Onken LS. Behavioral therapies for drug abuse. Am J Psychiatry. 2005;162:1452.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Higgins ST, Delaney DD, Budney AJ, Bickel WK, Hughes JR, et al. A behavioral approach to achieving initial cocaine abstinence. Am J Psychiatry. 1991;148:1218–24.

    Article  CAS  PubMed  Google Scholar 

  48. Prendergast M, Podus D, Finney J, Greenwell L, Roll J. Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 2006;101:1546–60.

    Article  PubMed  Google Scholar 

  49. Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York (NY): Guilford press; 1991.

    Google Scholar 

  50. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. New York (NY): Guilford press; 2002.

    Google Scholar 

  51. United Nations Office on Drugs and Crime. World Drug Report 2013. Vienna: UNODC; 2013. Available from URL: http://www.unodc.org/wdr/ (Accessed 10 September 2013).

    Google Scholar 

  52. Rawson R, Ling W, Mooney L. Clinical management: methamphetamine. In: Galanter M, Kleber HD, (editors). Textbook of Substance Abuse Treatment. Arlington (VA): American Psychiatric Publishing; 2014.

    Google Scholar 

  53. Rawson R, Marinelli-Casey P, Anglin MD, Dickow A, Frazier Y, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction. 2004;99:708–17.

    Article  PubMed  Google Scholar 

  54. Vietnam Ministry of Health. Report on HIV/AIDS situation and prevention and control HIV/AIDS in 2011. Direction and major tasks in 2012. 2012;73. [In Vietnamese]

    Google Scholar 

  55. Vuong T, Ali R, Baldwin S, Mills S. Drug policy in Vietnam: A decade of change? Int J Drug Policy. 2012;23:319–26.

    Article  PubMed  Google Scholar 

  56. Vietnam Ministry of Health, Hai Phong Provincial AIDS Center, Ho Chi Minh City Provincial AIDS Committee, FHI 360, U.S. Agency for International Development. Effectiveness evaluation of the pilot program for treatment of opioid dependence with methadone in Hai Phong and Ho Chi Minh Cities: Component II — Impact on physical health, mental health, society and quality of life; 2011.

    Google Scholar 

  57. Nguyen TTM, Nguyen LT, Pham MD, Vu, H, Mulvey KP. Methadone maintenance therapy in Vietnam: an overview and scaling-up plan. Adv Prev Med. 2012;2012:732484.

    Article  PubMed  PubMed Central  Google Scholar 

  58. United Nations Office on Drugs and Crime. Amphetamine-type stimulants in Viet Nam–Review of the availability, use and implications for health and security. Vienna: UNODC; 2012.

    Google Scholar 

  59. Hemenway D. Why don’t we spend enough on public health? N Eng J Med. 2010;362:1557–8.

    Article  Google Scholar 

  60. Rawson RA, Rieckmann T. Report on Skoun Chiyah Clinic. Zurich: Drosos Foundation; 2013.

    Google Scholar 

  61. Al Ghafri H. The National Rehabilitation Center of Abu Dhabi. Annual Meeting of the Saudi Arabia Psychiatric Association. Riyadh, Saudi Arabia; 2013.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Richard A. Rawson PhD.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Rawson, R.A., Rieckmann, T. & Gust, S.W. Addiction Science: A Rationale and Tools for a Public Health Response to Drug Abuse. Public Health Rev 35, 6 (2013). https://doi.org/10.1007/BF03391705

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/BF03391705

Key Words