Skip to main content

Advertisement

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

Article metrics

  • 560 Accesses

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. 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.

  2. 2.

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

  3. 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).

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 8.

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

  9. 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).

  10. 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.

  11. 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.

  12. 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).

  13. 13.

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

  14. 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.

  15. 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).

  16. 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).

  17. 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.

  18. 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. 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).

  20. 20.

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

  21. 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.

  22. 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.

  23. 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).

  24. 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.

  25. 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.

  26. 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).

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. 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

  32. 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.

  33. 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.

  34. 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.

  35. 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.

  36. 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.

  37. 37.

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

  38. 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.

  39. 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.

  40. 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.

  41. 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.

  42. 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.

  43. 43.

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

  44. 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.

  45. 45.

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

  46. 46.

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

  47. 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.

  48. 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.

  49. 49.

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

  50. 50.

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

  51. 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).

  52. 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.

  53. 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.

  54. 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]

  55. 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.

  56. 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.

  57. 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.

  58. 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.

  59. 59.

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

  60. 60.

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

  61. 61.

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

Download references

Author information

Correspondence to Richard A. Rawson PhD.

Rights and permissions

Reprints and Permissions

About this article

Key Words

  • Addiction science
  • international addiction treatment systems