National Institute on Drug Abuse Strategic Plan on Reducing Health Disparities

Unlike other diseases, drug addiction poses many peculiar challenges to health researchers, providers, and public health officials in the search for effective prevention and treatment strategies and policies. These challenges emanate primarily from the fact that drug abuse and addiction are usually the result of illegal activity and drug abusers are often viewed as morally corrupt or weak-willed individuals who engage in not only voluntary self and socially destructive behavior but also criminal activity. In short, despite the fact that we know unequivocally that addiction is a disease like any other medical disease, it remains a stigmatized disease. And this stigma spills over to all aspects of drug abuse research, prevention and treatment (e.g., obtaining measures of use, safety and legal concerns, early intervention is compromised by efforts to hide the disease, and denial of dependency)

Multi-Level Assessment Protocol (MAP) for Adoption in Multisite Clinical Trials

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is intended to test promising drug abuse treatment models in multisite clinical trials and to support adoption of new interventions into clinical practice. Using qualitative research methods we asked the following question: how might the technology of multisite clinical trials be modified to better support adoption of tested interventions? A total of 42 participants, representing eight organizational levels ranging from clinic staff to clinical trial leaders, were interviewed about their role in the clinical trial, its interactions with clinics, and intervention adoption. Among eight clinics participating in the clinical trial, we found adoption of the tested intervention in one clinic only. Analysis of interview data revealed four conceptual themes likely to affect adoption and may be informative in future multisite clinical trials. Planning for adoption in the early stages of protocol development will better serve the aim of integrating new interventions into practice

Individual differences in rhesus monkeys' demand for drugs of abuse

A relatively small percentage of humans who are exposed to drugs of abuse eventually become addicted to or dependent on those drugs. These individual differences in likelihood of developing drug addiction may reflect behavioral, neurobiological or genetic correlates of drug addiction and are therefore important to model. Behavioral economic measures of demand establish functions whose overall elasticity (rate of decrease in consumption as price increases) reflects the reinforcing effectiveness of various stimuli, including drugs. Using these demand functions, we determined the reinforcing effectiveness of five drugs of abuse (cocaine, remifentanil, ketamine, methohexital and ethanol) in 10 rhesus monkeys with histories of intravenous drug‐taking. There was a continuum of reinforcing effectiveness across the five drugs, with cocaine and remifentanil showing the most reinforcing effectiveness. There was also a continuum of sensitivity of the monkeys; two of the 10 animals, in particular, showed greater demand for the drugs than did the remaining eight monkeys. In addition, monkeys that demonstrated greater demand for one drug tended to show greater demand for all drugs but did not show a similar relatively greater demand for sucrose pellets. These findings suggest that the tendency to find drugs to be reinforcing is a general one, not restricted to particular drugs and also, that a minority of animals show a substantially enhanced sensitivity to the reinforcing effects of drugs. The possibility that differences in responsiveness to the reinforcing effects of drugs may form the basis of individual differences in drug‐taking in humans should be considered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93669/1/adb335.pd

Valuing families' preferences for drug treatment: a discrete choice experiment

The burden on family members of those who are dependent on illicit drugs is largely unidentified despite the presence of significant negative financial, health and social impacts. This makes it difficult to provide appropriate services and support. This study aimed to assess the preferences for treatment attributes for heroin dependence among family members affected by the drug use of a relative and to obtain a measure of the intangible economic benefit. Discrete choice experiment. Data were analysed using mixed logit which accounted for repeated responses. Australia PARTICIPANTS: Eligible participants were Australian residents of 18+ years of age with a relative with problematic drug use. Complete data on 237 respondents were analysed; 21 invalid responses were deleted. Participant preference for likelihood of staying in treatment, family conflict, own health status, contact with police and monetary contribution to a charitable organisation providing treatment. All attributes were significant, and the results suggest there was a preference for longer time in treatment, less family discord, better own health status, less likelihood of their relative encountering police, and while they were willing to contribute to a charity for treatment to be available, they prefer to pay less not more. In order of relative importance, participants were willing to pay an additional $4.46 (95$42.00 (95% CI 28.30-55.69) to avoid 5 days per week of family discord, $87.94 (95$129.66 (95% CI 53.50-205.87) for each 1% decline in the chance of police contact. Drug treatment in Australia appears to have intangible benefits for affected family members. Families are willing to pay for treatment which reduces family discord, improves their own health, increases time in treatment and reduces contact with police. BACKGROUND AND AIMS DESIGN SETTING MEASUREMENTS FINDINGS CONCLUSION

Experiences of drug use and ageing: health, quality of life, relationship and service implications

roe b., beynon c., pickering l. & duffy p. (2010)Experiences of drug use and ageing: health, quality of life, relationship and service implications. Journal of Advanced Nursing66(9), 1968–1979

Re-envisioning Addiction Treatment: A Six-Point Plan

This article is focused on improving the quality of addiction treatment. Based on observations that patients are leaving treatment too early and/or are continuing to use substances during their care, the authors propose six actions that could help reorient and revitalize this kind of clinical work: (1) conceptualize and treat addictive disorders within a psychiatric/mental health framework; (2) make the creation of a strong therapeutic alliance a core part of the healing process; (3) understand patients’ addictions and other problems using models based on multiple internal parts, voices, or modes; (4) make contingency management and the use of positive reinforcement systems a standard and central practice in all treatment settings; (5) envision long-term change and healing through the lens of identity theory; and (6) integrate the growing developments in recovery culture with formal treatment

‘Because it’s fun’: English and American girls’ counter-hegemonic stories of alcohol and marijuana use

Girls’ alcohol and other drug (AOD) use are depicted culturally as problematic. In this comparative, qualitative, study the voices of 59 English and American justice-involved girls give a counter-hegemonic portrayal of their alcohol and marijuana use. In their stories we see how their AOD use is pleasurable and boundaried. AOD use involves negotiated risk within the situated context of shared experience and friendship networks that heighten and promote pleasure and fun. The findings offer the opportunity to address the ‘credibility gap’ (Measham 2006) in international health promotion policy. Our aim is to promote the adoption of policy approaches that recognize the complexity of girls’ lives and draw on strategies they have devised

Study protocol for a randomised trial of nicotine-free cigarettes as an adjunct to usual NRT-based cessation practice, in people who wish to stop smoking

This trial is funded by a programme grant from the Health Research Council of New Zealand.