low-cost incentives improve outcomes in stimulant abuse … · 2016-04-20 · 2 nida notes | volume...

www.drugabuse.gov Volume 21, Number 1 U.S. Department of Health and Human Services | National Institutes of Health

NIDA Notes | Volume 21, Number 1 1

ALSO IN THIS ISSUE

Research Findings

4 Study Finds Withdrawal

No Easier With Ultrarapid

Opiate Detox

7 Buprenorphine Plus

Behavioral Therapy Is

Effective for Adolescents

With Opioid Addiction

9 Brain Mechanism Turns

Off Cocaine-Related

Memory in Rats

12 Marijuana Smoking Is

Associated With a

Spectrum of Respiratory

Disorders

Director’s Perspective

2 Steroid Abuse Is a High-

Risk Route to the Finish

Line

Research in Brief

3 • Office-Based

Buprenorphine

• Ethnicity Influences

Early Smoking

• Pain Tolerance

• Methylphenidate

Bulletin Board

14 • New National Advisory

Council Members

• 10th Annual PRISM

Awardees

Tearoff

15 NIDA Launches Criminal

Justice Publication in

Chicago

16 What the Numbers Say

Low-Cost Incentives ImproveOutcomes in StimulantAbuse TreatmentIn community-based treatment programs, the intervention added$2.42 per patient per day to counseling costs.

BY LORI WHITTEN,NIDA Notes Staff Writer

T he opportunity to win rewards worthas little as $1 for abstinence can helpmotivate outpatients to stay in behav-ioral therapy and remain drug-free,

according to a NIDA Clinical Trials Network(CTN) study. At eight community-based addic-tion treatment programs across the UnitedStates, stimulant abusers who could earn achance to win a prize by providing drug-free urinesamples were four times as likely as peers whowere not offered this incentive to attain 12 weeksof continuous abstinence. Prizes for the incen-tive intervention cost the programs about $200,or $2.42 a day per participant.

“Many addiction treatment clinics face thechallenge of high patient dropout rates. Reinforc-ing abstinence helps keep patients interested inattending treatment for longer periods, whichcan facilitate behavioral changes to keep them offdrugs for the long haul,” says Dr. Nancy Petry ofthe University of Connecticut School of Medi-cine, coleader of the study. Prior research hasfound that, no matter how it is achieved, dura-tion of abstinence during treatment is one of thebest predictors of abstinence 1 year later. “Morepatients achieve this therapeutic milestone witha boost from incentive programs,” says the

study’s other coleader, Dr. Maxine Stitzer of TheJohns Hopkins University School of Medicine.

The CTN investigators randomly assigned 415treatment-seeking stimulant abusers (see chart)to one of two conditions: usual care or usual careplus abstinence-based incentives for 12 weeks.Usual care typically consisted of group counsel-ing, although some patients received individualand family therapy. Patients gave urine andbreath samples twice weekly. Research assistantstested the urine samples for stimulants, opiates,and marijuana, and tested the breath samples for alcohol.

CHARACTERISTICS OF STUDY PARTICIPANTSPatients at eight community-based clinics across thecountry were ethnically diverse and generally reflectedthe national population of treatment-seeking stimu-lant abusers.

Characteristic %Ethnicity

White 42African-American 35Hispanic 12Other 9

Male 44Unemployed 65On parole or probation 35

Abuse of other drugsAlcohol 42Marijuana 20Opioids 9

[ Continued on page 6 ]

2 NIDA Notes | Volume 21, Number 1

■ DIRECTOR’S PERSPECTIVE By NORA D. VOLKOW, M.D., NIDA Director NIDA Notes

Steroid Abuse Is a High-RiskRoute to the Finish Line

Starting last fall, capitalizing on the interest raised by the Winter Olympics in Turin,Italy, NIDA intensified its campaign to warn young people that steroid abuse is adangerous way to become faster, stronger, and bigger.

Boys and girls who abuse these drugs before reaching their full natural height may pre-maturely halt bone growth, resulting in permanently shorter stature. Boys and men whoabuse steroids risk shrinkage of the testicles, reduced sperm count, infertility, baldness,development of breasts, and an increased risk for prostate cancer. Girls and women aresubject to menstrual abnormalities, voice deepening, breast shrinkage, male-pattern bald-ness, and an increase in sex drive, acne, body hair, and clitoris size. Some of these adverseeffects—including breast enlargement in men, menstrual abnormalities in women, andreduced height in both sexes—may be permanent. For both sexes, steroid abuse increasesthe risk of liver and heart disease, stroke, aggression, and depression. Users of injectablesteroids may acquire hepatitis, HIV, and other infections if they use contaminated needles.

In recent animal studies, NIDA-supported researchers tested the effects of chronicexposure to anabolic (muscle-building) and androgenic (masculinizing) steroids on braincircuits that underlie aggression and reproductive behaviors. They found that in mice, aregimen corresponding to chronic human abuse of these drugs reduced levels of the recep-tor for the neurochemical GABA. Adolescent female mice were particularly sensitive to theeffects of the steroid on GABA, which is critical to the display of female sexual behaviorsand is involved in the regulation of hormone release and ovarian maturation.

The need to educate young people about the serious health risks associated withsteroids remains urgent. Among American teens, such abuse declined over the pastdecade, but that encouraging trend shows signs of weakening, especially among youngerboys and girls. In 2005, according to the annual NIDA-funded Monitoring the Future(MTF) Survey, the number of high school seniors reporting steroid abuse dropped signif-icantly, to 1.5 percent, from peak levels of about 2.5 percent just a year before. The rateswere unchanged, however, among 10th graders (1.3 percent) and 8th graders (1.1 percent).

NIDA has responded by updating our Research Report on Steroids to provide the public with the newest information about steroids and their abuse. The Research Report isavailable on NIDA’s Web site at www.drugabuse.gov/ResearchReports/Steroids. A Spanishversion is available at www.drugabuse.gov/ResearchReports/Esteroides/Esteroides.html.“Game Plan,” a public service announcement that has aired more than 8,000 times in 75television markets across the United States, reminds young athletes that “quick fixes”can be dangerously deceptive and that cheating is damaging in the long run. NIDA will continue to conduct and publicize research on steroids, and to drive home the pointthat, ultimately, steroid abuse is a losing strategy. ■

EDITOR

David Anderson Public Health Advisor, Public Information and Liaison Branch, Office of Science Policyand Communications

MANAGING EDITOR

Johanna Weekley MasiMax Resources, Inc.

ASSOCIATE MANAGING EDITOR

Simon Weavers MasiMax Resources, Inc.

STAFF WRITER

Lori Whitten, Ph.D. MasiMax Resources, Inc.

CONTRIBUTING WRITER

Patrick Zickler

COPY EDITOR

Debra Davis MasiMax Resources, Inc.

DESIGN/LAYOUT

Maggie Bray MasiMax Resources, Inc.

EDITORIAL BOARD

David Anderson, Chair; Public Health Advisor, Public Information andLiaison Branch, Office of Science Policy and Communications

Jessica Campbell Chambers, Ph.D., Health Science Administrator, Division of Epidemiology, Services and PreventionResearch

J.C. Comolli, Public Health Advisor,Division of Pharmacotherapies and MedicalConsequences of Drug Abuse

Gaya Dowling, Ph.D., Deputy BranchChief, Science Policy Branch, Office of SciencePolicy and Communications

Stephen J. Heishman, Ph.D., Associate Director for Education and Training,Intramural Research Program

Mary Ellen Michel, Ph.D., Deputy Director, Center for the Clinical Trials Network

Joni Rutter, Ph.D., Program Director,Genetics and Molecular Neurobiology ResearchBranch, Division of Basic Neuroscience andBehavioral Research

Vincent Smeriglio, Ph.D., Research Psychologist, Division of ClinicalNeuroscience and Behavioral Research

Jack Stein, Ph.D., Deputy Director,Division of Epidemiology, Services andPrevention Research

Frank Vocci, Ph.D., Director, Division of Pharmacotherapies and MedicalConsequences of Drug Abuse

Cora Lee Wetherington, Ph.D.,Psychologist, Behavioral and Cognitive Science Research Branch, Division of BasicNeuroscience and Behavioral Research

This publication was produced andprinted by MasiMax Resources, Inc.,under Contract No. N01DA-4-1117 fromthe National Institute on Drug Abuse.


■ R E S E A R C H I N B R I E F Highlights of recently published NIDA-supported studies

First-time PatientsOpt for Office-BasedBuprenorphinePatients startingbuprenorphine treatment in aNew Haven, Connecticutprimary care clinic (PCC) aremore likely to be new totreatment than thosebeginning methadone at anopioid treatment program(OTP), report Dr. LynnSullivan and colleagues at YaleUniversity School of Medicine.The findings suggest that compared with methadone,office-based buprenorphinetreatment attracts individualswho have less extensive addic-tion histories, are relativelyhealthier, and have moresocioeconomic resources.

The investigators compared96 patients entering a clinicaltrial of buprenorphine/naloxone in a PCC with 94 par-ticipants entering a local OTP.Fifty-four percent of PCCpatients were new to treatment,compared with 39 percent ofthose in the OTP. Among PCCpatients, treatment noviceswere younger and more likelyto be White than peers withprior methadone treatment.PCC patients reported feweryears of opioid addiction (10versus 15, on average), lowerrates of injection drug use (44

versus 60 percent), and lesshepatitis C (25 versus 61percent).

Three-fourths of PCCpatients versus half of OTPparticipants were male, andmore PCC patients wereemployed full-time (46 versus15 percent). Consistent withprior research, methadone his-tory did not affect treatmentretention or abstinence ratesattained with buprenorphine.> Drug and Alcohol Dependence79(1):113-116, 2005.

Ethnicity InfluencesEarly Smoking andProgression to DrugAbuse African-Americans are lesslikely than European-Americans and Latinos tobegin smoking in earlyadolescence or report depend-ence on illicit drugs duringyoung adulthood. In a 10-yearstudy, Dr. William Vega at theUniversity of Medicine andDentistry of New Jersey and Dr. Andres Gil at Florida International University moni-tored smoking and progressionto other drug abuse in 1,208students, starting at age 11 andending at age 20. Amongparticipants who begansmoking in early adolescence,African-Americans were leastlikely to report that they stillsmoked or that they abused orwere dependent on illicit drugsas young adults. European-Americans were most likely tostill be smoking as 20-year-olds, and U.S.-born Latinosmost likely to report abuse ordependence on drugs other

than marijuana. Theserelationships held when theresearchers factored in theinfluences of gender, socioeco-nomic status, education,parental smoking, and earlyalcohol use.> Addiction 100(9):1358-1369,2005.

Stress Response MayUnderlie African-Americans’ ReducedPain ToleranceRecent NIDA-funded researchsuggests a physiological differ-ence as the explanation forAfrican-Americans’ reportedlow tolerance for pain. Dr.Susan Girdler and colleagues at the University of North Carolina at Chapel Hillmonitored the stress responsesof 51 African-American and 55other participants, mostly Cau-casians, while subjecting themto three different types ofpainful stimuli—ischemic,heat, and cold. The results sug-gest that blood pressure risesand physiological stressresponses helped to offset painsensations among the non-African-Americans, but not theAfrican-Americans. Forexample, among the non-African-Americans, greaterstress-induced increases inblood pressure and release ofnorepinephrine correlatedwith more tolerance to

subsequent pain. No such relationship was seen amongAfrican-Americans, who exhibited less marked bloodpressure rises and relativelylow levels of the stresshormones. > Psychosomatic Medicine67(6):948-956, 2005.

Methylphenidate forComorbid CocaineAbuse, ADHDIn an inpatient study with 14non-treatment-seeking volun-teers, Columbia Universityresearcher Dr. StephanieCollins and colleaguesreported that a regimen of 40-60 mg/day of sustained-releasemethylphenidate (SR-MPH)reduced ratings on scales of“feel high,” “good drug effect,”and other measures ofcocaine’s reinforcing effectsamong seven abusers affectedby attention deficit hyperactivitydisorder (ADHD). The medica-tion increased the cardiovascu-lar effects seen with cocainealone, but not to dangerouslevels. Although preliminary,the findings suggest that a ther-apeutic approach of usingslow-acting stimulants toreduce craving for cocaine—parallel to the use ofmethadone or buprenorphinein opiate addiction—may bepossible for cocaine-addictedpatients with ADHD. Althoughthe researchers did not formallyassess SR-MPH’s effects onparticipants’ ADHD symptoms,they did not note any obviousbenefits.> Drug and Alcohol Dependence82(2):158-167, 2006.


■ R E S E A R C H F I N D I N G S

Study Finds Withdrawal No EasierWith Ultrarapid Opiate DetoxThree serious adverse events among 35 ultrarapid procedures were all related to unreported preexisting medical conditions.

BY LORI WHITTEN,NIDA Notes Staff Writer

Heroin-addicted patients whoundergo so-called ultrarapid,anesthesia-assisted detoxifica-tion suffer withdrawal symp-

toms as severe as those endured by patientsin detoxification by traditional methods,according to a NIDA-funded clinical trial.Researchers Dr. Eric Collins and colleaguesat the College of Physicians and Surgeons ofColumbia University concluded that there isno compelling reason to use general anesthe-sia in the treat-ment of opiatedependence,especially as itpresents particu-lar safety con-cerns. The newfindings corrob-orate those ofthree interna-tional studies.

The ultrarapiddetox technique,developedabout 15 yearsago by clinicianswho hoped tomitigate the discomfort ofwithdrawal andspeed the initia-tion of relapseprevention ther-apy, relies on a

general anesthetic to sedate the patient forseveral hours while an opiate blocker precip-itates withdrawal.The method is not coveredby insurance, which makes it difficult todetermine how many patients have receivedanesthesia-assisted detox.

To compare anesthesia-assisted detoxwith other approaches, Dr. Collins and col-leagues enrolled 106 people seeking heroindetox at Columbia University Medical Cen-ter’s Clinical Research Center. The patients,aged 21 through 50, had abused heroin everyday during the past month. All spent 3 daysas Center inpatients during detox, then were

scheduled for twice-weekly outpatientrelapse prevention psychotherapy and naltrexone maintenance (50 mg/day) for 12 weeks.

The investigators randomly assigned theparticipants to one of three detox methods(see chart). The goal of each method was tominimize patients’ discomfort during with-drawal. In the ultrarapid approach, physi-cians put patients under anesthesia for 4 to 6hours while administering naltrexone, a med-ication that precipitates withdrawal by block-ing opioid molecules from their receptors inthe brain. In the second method, patients

RESEARCHERS COMPARE THREE OPIATE DETOX METHODS Investigators studied the safety profile and withdrawalsymptom control of three detoxification methods used in 106 patients at Columbia University Medical Center.

Ane

sthe

sia-

Ass

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Anesthesia 4-6 h ➜ 2 hmonitoring in post-anes-thesia unit ➜ naltrexoneinduction (50 mg)

Clonidine and nonopioidmedications as neededfor withdrawal symptoms

Begin naltrexone maintenance (50 mg/day)(continue through end of study)

Ancillary withdrawalmedications continued

Discharge from inpatient treatment

Ancillary withdrawal medications continued

Twice-weekly psychotherapy

Naltrexone maintenance medication (50 mg/day)

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Clonidine and nonopioid medications as neededfor withdrawal symp-toms

Naltrexone induction(12.5 mg)

Ancillary withdrawalmedications continued


Naltrexone induction continues (25 mg)



Naltrexone maintenance medication (50 mg/day)

Clo

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ted

Clonidine and nonopioidmedications as neededfor withdrawal symptoms





Begin 2-day naltrexone induction on day 7 (12.5 mg,then 25 mg), followed by naltrexone maintenance starting on day 9 (50 mg/day)

Day 0 Day 1 Day 2 Day 3 Day 4 through week 12

Inpatient treatment Outpatient treatment

regimen of daily tablets because of the med-ication’s side effects of anxiety and restless-ness. Long-acting monthly injections of nal-trexone, which are now available foralcoholism treatment, may work better for patients and show promise in NIDA-supported clinical trials.

Dr. Montoya also points out that with thecurrent epidemic of prescription painkillerabuse, clinicians need more research on cost-effective detox methods for these opiates(see “2003 Survey Reveals Increase in Pre-scription Drug Abuse, Sharp Drop in Abuseof Hallucinogens” NIDA Notes, Vol. 19, No.4). Some clinics are using buprenorphine forthis purpose, and NIDA-funded investigatorsare studying various methods to improve pre-scription opiate detox and help patientsengage in longer term treatment. ■

SOURCECollins, E.D., et al. Anesthesia-assisted vs buprenor-phine- or clonidine-assisted heroin detoxification andnaltrexone induction: A randomized trial. Journal of theAmerican Medical Association 294(8):903-913, 2005.


treatment also were com-parable, roughly 63 per-cent, across the threedetox methods.

“NO ADVANTAGE”

“Although providersadvertise anesthesia-assisted detox as a fast andpainless method to kickopiate addiction, the evidence does not supportthose statements,” says Dr.Collins. “Patients shouldconsider the many risksassociated with thisapproach, including fluidaccumulation in the lungs,metabolic complicationsof diabetes, and a worsen-ing of underlying bipolarillness, as well as otherpotentially serious adverseevents,” he says. Thosewith preexisting medical conditions—includ-ing some psychiatric disorders, elevatedblood sugar, insulin-dependent diabetes,prior pneumonias, hepatitis, heart disease,and AIDS—are particularly at risk for anesthesia-related adverse events. “Carefulscreening is essential with the anesthesia-assisted method, because the thought ofsleeping through withdrawal is so compellingthat some patients may conceal their medicalhistories,” says Dr. Collins.

“We now have several rigorous studiesindicating that anesthesia-assisted detox—a costly and risky approach—offers no advan-tage over other methods,” says Dr. Ivan Montoya of NIDA’s Division of Pharma-cotherapies and Medical Consequences ofDrug Abuse. Dr. Montoya notes, “The lowretention of patients in subsequent outpa-tient treatment in the present study, which isnot unusual for the opiate-addicted popula-tion, highlights the need to engage people inlong-term recovery after detoxification.” Naltrexone can help motivated patients stay off opiates, but many do not stick to the

remained awake and took a single dose ofbuprenorphine, a medication that eases with-drawal symptoms by moderating andsmoothing the rate of opioid clearance fromthe brain. In the third approach, patients alsoremained awake and received clonidine andother nonopioid medications as needed tocounter symptoms for all 3 inpatient days.These medications were available to allgroups as needed for the duration of the inpa-tient phase. Throughout detox, theresearchers closely monitored patients forcomplications, assessed physical indicationsof withdrawal, and asked the participants torate their subjective experiences.

Once awakened from anesthesia, patientsin the ultrarapid detox group demonstratedand reported symptoms of discomfort com-parable to those experienced by participantsreceiving the buprenorphine- and clonidine-assisted methods (see chart). Three patientsreceiving the anesthesia-assisted methodexperienced serious adverse events—pulmonary and psychiatric complications aswell as a metabolic complication of diabetes,all of which required hospitalization. Thecomplications were related to preexistingmedical conditions that the patients hadfailed to reveal when they were screened for admission into the study. No adverse events occurred with the other detox methods.

Treatment outcomes among the three groups were similar. Following detox,the researchers offered all the patientsrelapse prevention therapy consisting of out-patient counseling and naltrexone, whichcounteracts the pleasurable effects of subse-quently administered opioids. More than 90percent of the patients who received theanesthesia- and buprenorphine-assisteddetox completed naltrexone induction; only21 percent of those receiving clonidine com-pleted induction. By the third week, morethan half the patients in all three groups haddropped out of the study; only 18 percentremained in treatment the full 12 weeks. Thepercentages of patients submitting opiate-positive urine samples during outpatient

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IN THREE DETOX METHODS, WITHDRAWAL SYMPTOM SEVERITY WAS SIMILAR During a 72-hourinpatient detoxification stay, patients rated each of 16 withdrawalsymptoms—for example, “I feel like vomiting,” “I have cramps inmy stomach,” “I feel anxious,” and “My eyes are tearing”—on ascale from 0 (not at all) to 4 (extremely). Symptom severity gener-ally did not differ between heroin-addicted patients receiving anesthesia-, buprenorphine-, or clonidine-assisted methods.Researchers did not assess withdrawal symptoms for the anesthesia-assisted group during general anesthesia and theimmediate recovery period.


INCENTIVES ACCENTUATE

THE POSITIVE

“Incentive programs, including low-costones, add excitement and additional rea-sons to attend substance abuse treatment.Many substance abusers are ambivalentabout treatment, and rewards may helpthem stay involved in counseling,” says Dr.Petry. Extending retention in treatmentmay prolong abstinence, in part, because itgives counselors more time to help patientsre-engage in a drug-free lifestyle, says Dr.Stitzer. Helping patients sustain abstinenceonce they leave therapy is a challenge for all

treatments, including incentive programs. Some previous clinical trials of voucher-

based incentive programs showed benefitsof the treatment persisting for 1 to 2 years,but others found no added value over thelong term compared with usual care. Fur-ther research will focus on followup withpatients to determine the conditions underwhich incentive interventions, particularlyas applied by community-based treatmentprograms, support extended abstinence.

Other relatively small, often single-siteNIDA-funded clinical trials over the past 15years have demonstrated that motivational

Each participant in the incentive condi-tion received immediate feedback on his orher samples. After submitting stimulant-and alcohol-negative samples, the patientcould draw from an opaque container with500 chips, each with words of encourage-ment or an assigned value: Half of the chipssimply said, “good job;” 209 could be traded for $1 prizes, 40 for $20 prizes, and 1for a $100 prize. Prizes were conferredimmediately and included many options,ranging from toiletries, snacks, and bustokens to kitchen items, telephones, andretail store certificates for televisions,music players, and DVD players. The num-ber of draws earned increased by one eachweek in which all the patient’s sampleswere stimulant- and alcohol-negative, butfell back to one following a positive sampleor an unexcused absence. When a partici-pant first achieved two consecutive weeksof abstinence, he or she received a $20prize. Participants who submitted stimu-lant- and alcohol-negative samples couldearn two bonus draws a week if their urinesamples were also opioid- and marijuana-negative.

More patients in the incentive program(49 percent) than in usual care (35 percent)completed 12 weeks of counseling. Patientsin the incentive group achieved an averageduration of sustained abstinence of 4.4 con-secutive weeks, compared with only 2.6weeks among counseling-only patients.Nineteen percent of patients receiving theincentive intervention attained 12 weeks ofcontinuous abstinence compared with 5percent of those in usual care. Interventionpatients also attended more counselingsessions (19 versus 16) and submitted morestimulant-negative urine samples duringtreatment than patients in usual care (48 versus 36 percent).

Blending Initiative DisseminatesInformation on Low-Cost Incentives

Clinicians and administrators who wish to learn more about using low-cost incentives to

motivate patients to stay off drugs can get information through the Blending Initiative, a

program established by NIDA and the Substance Abuse and Mental Health Services Admin-

istration to speed the adoption of scientific findings into drug abuse treatment. The Blend-

ing Initiative has developed an awareness program that disseminates practical informa-

tion on low-cost incentive programs and a summary of research evidence that supports

their use as an adjunct to addiction treatment.

A DVD/CD-ROM describes the principles underlying incentive programs, the range of

behaviors that clinics can target, and findings from studies of the intervention with a vari-

ety of patient populations. In the video component, clinicians, patients, and managers

describe their experiences with the use of low-cost incentives in Manhattan and Connecti-

cut outpatient methadone treatment programs. Viewers observe a group of Connecticut

clients participating in a prize draw and a panel of directors and clinical managers discussing

implementation challenges, ways to overcome problems, and the reasons they think

the low-cost incentive program is effective. The CD-ROM component includes a flexible

PowerPoint presentation suited for executive briefings or a 3-hour workshop. The Blend-

ing Initiative expects to release the information package in fall 2006, and it will be posted

on NIDA’s Web site, www.drugabuse.gov and on the Addiction Technology Transfer Center

(ATTC) Web site, www.nattc.org.

“We anticipate that the awareness campaign will leave the addiction treatment com-

munity wanting more, for example, Web-based training and workshops on how to imple-

ment low-cost incentive programs,” says Ms. Lonnetta Albright, director of the Great Lakes

ATTC and leader of the Promoting Awareness of Motivational Incentives Blending Team.

The 2006 Blending Initiative program, “Bridges to the Future,” was held October 16 and

17, 2006 in Seattle, Washington (see www.sei2003.com/blendingseattle/topics.htm).

■ L O W - C O S T I N C E N T I V E S[ Continued from page 1 ]


incentives are an effective adjunct to stan-dard therapy for opiate-, marijuana-, alcohol-, and cocaine-addicted patients.Patients in most of those early studiesalways received vouchers exchangeable forgoods or services, rather than chances towin prizes, for positive behaviors; costs typ-ically ran to about $1,000 per patient over 3months, with the result that few communityprograms adopted the motivational incen-tive approach. Dr. Petry developed herprize-drawing system to make incentivesaffordable for community programs. Shehas tested it successfully in several Con-necticut treatment programs, and now itseffectiveness is confirmed by the CTN trial.NIDA is collaborating with the SubstanceAbuse and Mental Health Services Admin-istration’s Addiction Technology TransferCenter to promote awareness of the low-cost motivational incentive technique (see textbox, page 6).

The CTN researchers note that somecommunity-based treatment providersresist the idea of motivational incentivesbased on a belief that clinicians should notreward patients for behaviors “that they aresupposed to do anyway.” In response, theresearchers point out that groups and indi-viduals often use external incentives tomotivate others—from employees’ bonusesto children’s allowances for householdchores. Dr. Stitzer advocates a shift in per-spective from punishing lapses to celebrat-ing successes. She observes that counselorshave often changed their views when theyhave seen incentives help revolving-doorpatients stay in therapy. “Incentive pro-grams—the idea of catching people beinggood and rewarding the behavior—caninfuse addiction treatment with a positiveoutlook and reinvigorate patients andcounselors,” says Dr. Stitzer. ■

S O U R C EPetry, N.M., et al. Effect of prize-based incentives onoutcomes in stimulant abusers in outpatient psy-chosocial treatment programs: A National Drug AbuseTreatment Clinical Trials Network Study. Archives ofGeneral Psychiatry 62(10):1148-1156, 2005.


Buprenorphine PlusBehavioral Therapy IsEffective For AdolescentsWith Opioid AddictionA new study looks at extending the role of buprenorphine for treatment of adolescents.

BY PATRICK ZICKLER,NIDA Notes Contributing Writer

A dolescents addicted to opioids responded better tobuprenorphine than clonidinein a clinical trial in which all

patients also received behavioral therapy.In the NIDA-supported comparison trial atthe University of Vermont, adolescentswho received buprenorphine attendedmore scheduled counseling sessions thanpeers who received clonidine and had higherrates of successful induction to a relapseprevention regimen of naltrexone. The study, led by Dr. Lisa Marsch, is the first pub-lished randomizedcontrolled study of treatments for adolescentsaddicted to opioids.

“Heroin abuseamong Americanteens has doubledover the pastdecade, and abuseof prescriptionopioids such asOxyContin andVicodin hasincreased evenmore,” says Dr.Marsch. “In light of

those figures, it’s important to have a sci-entific basis for selecting treatments foropioid-dependent teens. We know fromprevious research and clinical experiencethat buprenorphine and, to a lesser extent,clonidine are among the medications thathave been shown to be effective for treat-ing opioid-addicted adults, but we haven’tknown how helpful they can be for adolescents.”

Dr. Marsch and colleagues enrolled 36opioid-addicted adolescents, aged 13 to 18,in a 28-day outpatient treatment program.Half the participants (9 male, 9 female)received buprenorphine in tablet form, the

BUPRENORPHINE DETOXIFICATION SETS STAGE FORRECOVERY Opioid-addicted adolescents who entered a detoxificationprogram with buprenorphine were more likely than others receiving cloni-dine to maintain abstinence throughout a 28-day detoxification programand more likely to begin treatment with naltrexone after detoxification.

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“Dr. Marsch’s research is an importantfirst step in systematically studying adoles-cents who are addicted to opioids,” says Dr. Ivan Montoya of NIDA’s Division ofPharmacotherapies and Medical Conse-quences of Drug Abuse. “We know thatthere are differences in the patterns of opi-ate abuse and addiction in young peoplecompared with adults. We need dedicatedstudies like this one to understand howteens are affected by opiate drugs and howbest to treat them.”

The next step in Dr. Marsch’s researchwill involve a larger sample of young opioidabusers. “We want to evaluate buprenor-phine’s effectiveness if treatment is extended to 2 months rather than 28 days,”she says. “We will also examine the mosteffective doses and dosing regimens forvarious subgroups of young patients.” ■

S O U R C EMarsch, L.A., et al. Comparison of pharmacologicaltreatments for opioid-dependent adolescents: A ran-domized controlled trial. Archives of General Psychiatry62(10):1157-1164, 2005.

in vouchers redeemable for rewards suchas ski passes, CDs, gym passes, and clothing.

Buprenorphine and clonidine both sup-ported high rates of abstinence. Amongparticipants who completed treatment,rates were 78 percent and 81 percent,respectively, confirmed by urine samplesprovided at the thrice-weekly sessions.However, nearly twice as many buprenor-phine as clonidine recipients completed the4-week treatment (72 percent comparedwith 39 percent). “The high rate of reten-tion in the buprenorphine group is particu-larly noteworthy,” Dr. Marsch says,“because long-term success in recovery isdirectly related to the amount of timepatients spend in treatment.” And, sheadds, the willingness of most patients whoreceived buprenorphine to continue treat-ment with naltrexone following comple-tion of the 28-day program is similarlyencouraging. Sixty-one percent of thebuprenorphine group, but only 5 percent of those who received clonidine acceptednaltrexone.


rest (5 male, 13 female) clonidine via trans-dermal patch; each patient also was given aplacebo resembling the other treatment.Medication dosages varied depending oneach participant’s weight and the amount ofdrug he or she reported abusing beforebeginning treatment; dosages of buprenor-phine were in the low to moderate range ofthose typically given to opioid-addictedadults.

All participants also received behavioraltherapy based on the Community Rein-forcement Approach: three 1-hour sessionseach week of counseling on methods tominimize involvement in situations thatmight lead to drug-taking, training to helprecognize and control urges to abuse opi-oids, and encouragement to recruit familymembers as allies for abstinence. Partici-pants earned vouchers worth $2.50 for thefirst opioid-negative urine sample, plus anadditional $1.25 for each subsequent one,and a $10 bonus for each set of three con-secutive negative samples. Continuousabstinence could earn participants $152.50

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Scientists at the University of Cal-ifornia, Irvine, have added to evi-dence that a brain enzyme con-trols key memory processes that

link drug experiences, the surroundings inwhich they take place, and the urge torepeat them. In a series of experiments,inhibiting the enzyme attenuated a ratbehavior that is a laboratory stand-in forhuman cue-induced drug-seeking. Thefindings suggest that in the future, thera-peuticallymanipulatinglevels of theenzyme mightcut addictedindividuals’vulnerability toenvironmentaltriggers fordrug cravingand abuse.

The NIDA-funded scien-tists, Drs.CourtneyMiller and JohnMarshall,focused on theenzyme in anattempt to elu-cidate the wayscellular activi-ties promotecue-induceddrug-seeking.

“Although studies have established thatnerve cells in the core of the nucleusaccumbens are critically involved,” Dr.Miller says, “we haven’t had much informa-tion about the molecular mechanisms thattransform environmental cues into an urgeto repeat drug-associated behavior.” Onelikely candidate for a role in the process,however, was extracellular signal-regulatedkinase (ERK). This enzyme is known bothto foster the new cellular connections thatregister emotional and object recognitionmemories in the brain and to be affected bycocaine.

ENZYME BLOCKAGE DISRUPTS DRUG-SEEKING In experiments with rats, researchers used a compound called U0126 toblock ERK, an enzyme that facilitates memory formation and consolidation.

Days 1-9 Day 10 Day 11 Day 26 Conclusions

Researchers trainedrats to associatecocaine with a specific setting.The animals signaled their successful conditioningby exhibiting conditioned place preference—spending more time in a chamberwhere they hadreceived cocaine injections over 9 days.

Gro

up 1

Rats received infusions ofU0126 or a control vehicle.After 30 minutes, they weretested for CPP.

Rats given U0126 showed no preference for a cocaine-associated chamber. Controlrats did show preference for the cocaine-associatedchamber.

Rats given U0126 stillexhibited no CPP.

Control rats retainedCPP.

Inhibiting ERK activitycan block retrieval ofcocaine-associated memories for 24 hours.

Gro

up 2 Rats were tested for

CPP and immediately infused with either U0126 or the control vehicle.

Rats given U0126showed no CPP.

Control rats showed CPP.

Inhibiting ERK activityimmediately aftercocaine-associated memories are retrievedcan make the memoriesunavailable for subse-quent retrieval at 24 hours and for at least 2 weeks.

Gro

up 3 Rats were tested for

CPP and immediately infused with either U0126 or the control vehicle.

Rats given U0126showed no CPP.

Control rats showedCPP.

Gro

up 4 Rats received an infusion of

U0126 and remained in theirhome cage with no testing andtherefore no opportunity formemory retrieval.

Rats showed a strongCPP for the cocaine-associated environment.

ERK inhibition is effective only wheninduced at the time ofmemory formation ormemory retrieval.

The researchers explored ERK’s role in abehavior called conditioned place prefer-ence (CPP). By exhibiting CPP—lingeringin a part of a cage where it has had a drugexperience—an animal indicates that itremembers the experience, associates itwith the preferred cage area, and is seekingto have it again (for more on CPP, see “Ani-mal Experiments in Addiction Science,”NIDA Notes, Vol. 20, No. 5). In previousresearch, blocking ERK activity in the nucleus accumbens (NAc) prior toexposing rats to drugs prevented them

Brain Mechanism Turns Off Cocaine-Related Memory in RatsAn exploration of memory’s molecular basis suggests potential novel therapeutic approaches to cue-induced craving.


from developing CPP. Drs. Miller and Marshall reasoned that if blocking ERKforestalls initial formation of the memorylinks underlying CPP, it might also weakenlinks that had already been formed. Thepotential therapeutic implications wouldbe significant if this were so; they wouldsuggest that manipulating ERK might be ameans to disrupt drug-environment asso-ciations that are already established by thetime patients begin therapy.

To test their hypothesis, the researchersadministered cocaine to rats daily for 9days, after which the rats exhibited CPPwhenever they were placed back in theirtest cage. The researchers then conducted aseries of trials and assays that showed:■ CPP involves activation of ERK: Rats

that lingered in the cocaine-associatedarea of the test cage had higher ERK lev-els in the core area of the NAc than agroup of rats that had not been exposedto cocaine or a third group exposed tococaine but not trained to exhibit CPP.

■ Inhibiting ERK activity can blockretrieval of cocaine-associated memoriesfor 24 hours: The investigators infuseda compound called U0126, whichreduces ERK activity, directly into theNAc cores of some of the CPP-trainedrats. When placed in the test cage 30minutes later, these rats gravitated tothe cocaine-associated area much lessconsistently than did a group of CPP-trained rats that were injected withsaline rather than U0126. Tested again24 hours later, they still exhibited littleor no preference for the area.

■ Inhibiting ERK activity at the timecocaine-associated memories areretrieved can make them unavailable forsubsequent retrieval for at least 2 weeks:Rats were placed in the test cage andgiven U0126 immediately after exhibit-ing CPP. When retested the followingday, they showed no partiality to thedrug-associated cage area, nor did a similarly treated group of animals

New Findings on MemoryHave Implications ForTreatment

Groundbreaking research on the molecular basis of long-term memory could open a new

path to the treatment of drug addiction, post-traumatic stress disorder (PTSD), and other

conditions in which memories exert a powerful influence on behavior, according to

neuroscientists who presented research at a NIDA conference, “Frontiers in Addiction

Research.” Their findings suggest that when long-term memories are recalled, they

return to a state in which they can be altered or erased before undergoing “reconsoli-

dation” for future potential use. This discovery could lead to the development of

medications that disrupt the reconsolidation process and thereby prevent memories

associated with drug abuse or trauma from being reestablished.

Dr. Karim Nader of McGill University in Montreal, Canada, explained the process of

reconsolidation and how interventions based on that process might work. The goal, he

said, is not to simply erase memory,but rather to modulate the memory so that its effects

are more manageable in conditions such as PTSD or addiction.“Our research shows that

when a consolidated long-term memory is reactivated, it returns to a labile state simi-

lar to short-term memory. Neurons must synthesize new proteins in order for the mem-

ory to persist. If protein synthesis is inhibited after reactivation, reconsolidation can’t

occur,” he said.

Although he cautioned that there is an enormous amount of work to be done before

testing the effect in human patients, Dr. Nader said his animal studies have significant

clinical implications. “In the case of drug addiction, if drug-related memories could be

reactivated and prevented from being restored, drug-seeking behavior could in princi-

ple be greatly reduced in one session,” he said. “It sounds like science fiction, but it

is not.”

Dr. Susan Volman of NIDA’s Division of Basic Neuroscience and Behavioral Research

and Dr. Barbara Sorg from Washington State University cochaired the session on “Recon-

solidation of Memory:A New Approach to Treat Drug Addiction?”at the conference,which

was held in Washington, D.C., November 11, 2005, in conjunction with the annual

meeting of the Society for Neuroscience.

tested 2 weeks later. “These animals hadeffectively recollected their cocaineexperience on day 1, but on day 2 andeven 14 days later, there was no evidencethat the memory was active,” Dr. Millernotes.

“This last observation provides power-ful evidence that disruption of ERK activityblocks memory reconsolidation,” Dr. Millersays. “Memories are unstable during theinterval between being recalled and beingrefiled, and, if the reconsolidation process


Blocking Protein Also StopsDrug-Linked Memory

NIDA-sponsored researchers at Mount Sinai School of Medicine, New York, have found

another way to break the chain of molecular events that binds drug-taking to a

familiar environment: inhibiting protein synthesis. Earlier research established that

gene-directed protein manufacture is necessary to stabilize a new memory and that

blocking this molecular process can keep lasting memories from being formed and

even disrupt an established memory.

The Mount Sinai researchers, led by Dr. Cristina Alberini, performed experiments

similar to those done by Drs. Miller and Marshall, but exposed the rats to morphine

rather than cocaine and used chemicals that blocked protein synthesis rather than ERK.

Like ERK inhibition, the protein blocker weakened conditioned place preference, but

it did so only when given in close conjunction with an actual morphine administration.

Unlike the ERK inhibition technique used by the UC researchers, “blocking protein

synthesis only worked after a repeat of the full experience,” says Dr. Susan Volman of

NIDA’s Division of Basic Neuroscience and Behavioral Research. But the take-home

message is the same: “It is possible to disrupt the strong association between a drug

and place cues.”

The chemicals used in this experiment inhibit protein synthesis in general, and

it will take a lot more research to develop pharmacotherapy that goes after specific

proteins and molecular pathways involved in CPP, Dr. Volman says. But potential appli-

cations, she suggests, might go beyond the addiction-environment link: “If we can use

protein synthesis inhibition to uncouple place from relapse, perhaps we’ll ultimately

be able to uncouple cues like paraphernalia, or even the memory of the drug

experience.”

SOURCEMilekic, M.H., et al. Persistent disruption of an established morphine conditioned place preference.Journal of Neuroscience 26(11):3010-3020, 2006.

is disrupted, the memory can be lost. Theanimals behave as though it had never beenformed to begin with. The fact that power-ful memories associated with drugs maybecome pliant and susceptible to disrup-tion by ERK inhibition during reconsolida-tion suggests opportunities for new thera-pies.” For example, pending much furtherresearch, it is conceivable that an approachcombining exposure to a cue with admin-istration of an ERK inhibitor might preventa patient from reconsolidating—and thuserase—the memory chain linking the cueto craving.

“This research provides important newunderstanding of the processes that takeplace when the brain is manipulating mem-ories, and it identifies specific moleculesthat help shape those processes,” com-ments Dr. Jerry Frankenheim of NIDA’sDivision of Basic Neuroscience and Behav-ioral Research. “The fact that the interven-tion with U0126 came after the animals hadalready learned the cocaine-place associa-tion may be important for translating thisresearch to possible clinical application.There are many ways to block the initialconsolidation of memory, but the approachused in this research—interrupting recon-solidation—is much more relevant to inter-vening in cocaine abuse,” he adds. ■

S O U R C EMiller, C.A., and Marshall, J.F. Molecular substrates forretrieval and reconsolidation of cocaine-associatedcontextual memory. Neuron 47(6):873-884, 2005.

NIDA at YourFingertipsNews and information about NIDAresearch, programs, and events isquickly and easily accessible throughNIDA’s home page:

www.drugabuse.gov■ Information on Drugs of Abuse

■ Publications (including NIDA Notes)

■ Calendar of Events

■ Links to NIDA Organizational Units

■ Funding Information

■ Internal Activities

■ Links to Related Web Sites



Marijuana Smoking Is AssociatedWith a Spectrum of RespiratoryDisordersTwo NIDA-funded studies identify health risks that underscore the importance of curbing marijuana abuse.


A large new epidemiologicalstudy suggests that marijuanasmoke can cause the sametypes of respiratory damage

as tobacco smoke. Significant associationsbetween marijuana smoking and a varietyof respiratory diseases also have been confirmed by an extensive review of clinicalliterature.

MONITORING THE EFFECTS OF

TOBACCO AND MARIJUANA

Dr. Brent Moore and colleagues at YaleUniversity, the National Cancer Institute,and the University of Vermont evaluateddata from a nationally representative sam-ple of 6,728 adults. Their analysis indicatedthat a history of more than 100 lifetimeepisodes of smoking marijuana, with atleast one episode in the past month,increased an individual’s risk of chronicbronchitis, coughing on most days, wheez-ing, chest sounds without a cold, andincreased phlegm.

“The most significant differencebetween tobacco smoke and marijuanasmoke is their principal active ingredi-ents—nicotine in tobacco and delta-9-tetrahydrocannabinol (THC) in marijuana.Beyond that, marijuana contains at least asmuch tar and half again as many carcino-gens as smoke from conventional tobacco,”says Dr. Moore. “Quitting marijuana smok-ing may benefit respiratory health as much

as quitting cigarettes, in addition to theclear and considerable health, psychologi-cal, and social benefits of no longer abus-ing an illicit drug.”

The information Dr. Moore and his col-leagues analyzed was gathered through thethird National Health and Nutrition Exam-ination Survey (NHANES III), conductedbetween 1988 and 1994. Participants included4,789 nonsmokers of either tobacco or mar-ijuana; 1,525 smokers of tobacco but notmarijuana; 320 smokers of both marijuanaand tobacco; and 94 who smoked marijuanaonly. On average, marijuana abusers hadsmoked the drug on 10 of the preceding 30days, with 16 percent reporting daily or almost daily smoking. Tobacco smokersconsumed roughly the same number of cigarettes—averaging 19.2 perday—whether ornot they alsosmoked marijuana.Survey partici-pants answeredquestions abouttheir experiencesof a range of respi-ratory symptomsand were exam-ined for signs ofrespiratory abnor-malities.

The researchersconcluded thattobacco smokerswho also smoked

marijuana had a higher prevalence of mostrespiratory symptoms than tobacco-onlysmokers. Compared with tobacco-onlysmokers, however, those who also smokedmarijuana were less likely to have hadpneumonia during the previous year or toshow spirometric evidence of obstructivepulmonary disorder. Commenting on thisfinding, Dr. Moore says that it is importantto note that the marijuana smokers in thesample were significantly younger (averageage 31.2 years) than the tobacco smokers(average age 41.5 years). “The marijuana-related respiratory effects correspond to arelatively young population, and NHANESIII did not ask participants older than age59 about drug use,” he adds. “It is likely thatrespiratory effects will be higher in older

RESEARCHERS CITE PUBLIC HEALTH IMPACT More than 2 million adult Americans are heavy marijuana smokers, and increasedefforts to prevent marijuana use may have significant public health benefits.


effect on a variety of malignancies.Although the results of epidemiologicalstudies are also mixed, a large, recentlycompleted case-control study has failed tofind a direct link between marijuana use(including heavy use) and lung, throat, orother head and neck cancers. “Neverthe-less, there is evidence that suggests precar-cinogenic effects in respiratory tissue,” Dr.Tashkin says. “Biopsies of bronchial tissueprovide evidence that regular marijuanasmoking injures airway epithelial cells,leading to dysregulation of bronchialepithelial cell growth and eventually to pos-sible malignant changes.” Moreover, headds, because marijuana smokers typicallyhold their breath four times as long astobacco smokers after inhaling, marijuanasmoking deposits significantly more tarand known carcinogens within the tar, suchas polycyclic aromatic hydrocarbons, in theairways. In addition to precancerouschanges, Dr. Tashkin found that marijuanasmoking is associated with a range of dam-aging pulmonary effects, including inhibi-tion of the tumor-killing and bactericidalactivity of alveolar macrophages, the pri-mary immune cells within the lung.

Taken together, Dr. Tashkin’s survey ofclinical and epidemiological studies and Dr.Moore’s assessment of self-reported andclinically observed effects provide anextensive catalog of respiratory and pul-monary damage associated with marijuanasmoking. Smokers are subject to:■ Coughing and phlegm production on

most days;■ Wheezing and other chest sounds;■ Acute and chronic bronchitis;■ Injury to airway tissue, including edema

(swelling), increased vascularity, andincreased mucus secretion; and

■ Impaired function of immune systemcomponents (alveolar macrophages) inthe lungs. ■

S O U R C E SMoore, B.A., et al. Respiratory effects of marijuana andtobacco use in a U.S. sample. Journal of GeneralInternal Medicine 20(1):33-37, 2005.

Tashkin, D.P. Smoked marijuana as a cause of lunginjury. Monaldi Archives for Chest Disease 63(2):93-100,2005.

Hashibe, M., et al. Marijuana use and aerodigestivetract cancers: a population-based case control study.Cancer Epidemiology, Biomarkers & Prevention (InPress).

marijuana smokers, and, because of thehigh prevalence of tobacco use among mar-ijuana smokers, there appears to be anincreased risk for illness due to cumulativeeffects of smoking both drugs.”

MARIJUANA’S LONG-TERM

PULMONARY EFFECTS

Further evidence of marijuana’s respira-tory toxicity emerged from a study con-ducted by Dr. Donald Tashkin at the Uni-versity of California, Los Angeles. Dr.Tashkin conducted an extensive review ofclinical and epidemiological research todetermine the extent to which chronic mar-ijuana smoking might lead to long-termpulmonary effects and diseases similar tothose caused by tobacco. Unlike theNHANES III data examined by Dr. Moore,the studies evaluated by Dr. Tashkin madeit possible to assess a possible associationbetween marijuana smoking and respiratorycancers.

The results of animal and cell culturestudies are mixed with respect to the car-cinogenic effects of THC, some studiesshowing that THC promotes lung cancergrowth and others showing an anti-tumoral

0

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NonsmokersTobacco smokersMarijuana smokers

Current asthma

Chronic bronchitis

Cough (most days)

Phlegm Shortness of breath

Wheezing Chest sounds

Pneumonia FEV /FVC ratio <70%

Resp

irato

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ym

pto

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(%)

1†

SOURCE: National Health and Nutrition Examination Survey (NHANES III)†FEV /FVC ratio measures lung obstruction or restriction.1

SURVEY TIES MARIJUANA ABUSE AND RESPIRATORY SYMPTOMS In a nationally representative sample of 6,728 U.S. adults, self-reportedmarijuana use was associated with chronic bronchitis, coughing on most days, phlegm production, wheezing, and chest sounds without a cold. Medicalexaminations provided overall chest findings and measures of pulmonary function.


■ B U L L E T I N B O A R D

NIDA’s National Advisory CouncilWelcomes New Members

The National Advisory Council on Drug Abuse introduced fournew members at its May meeting at NIDA headquarters inRockville, Maryland.

Warren K. Bickel, Ph.D., is a professor in the College ofMedicine and College of Public Health at the University ofArkansas for Medical Sciences (UAMS), Little Rock. He holds theWilbur D. Mills Chair of Alcoholism and Drug Abuse Preventionand serves as director of the UAMS Center for Addiction Researchand the Center for the Study of Tobacco Addiction. Dr. Bickel’srecent research includes the application of behavioral economicsto drug dependence.

Ellie E. Schoenbaum, M.D., is director of AIDS research,Department of Epidemiology and Population Health at MontefioreMedical Center in New York City. She is also professor of epidemi-ology and population health, medicine, and obstetrics-gynecologyand women’s health and vice chair, Department of Epidemiologyand Population Health at Albert Einstein College of Medicine. Dr. Schoenbaum’s research focuses on HIV, drug use, and women’shealth.

Marina E. Wolf, Ph.D., is chair of the Department ofNeuroscience at the Chicago Medical School, Rosalind FranklinUniversity of Medicine and Science. An elected member of theAmerican College of Neuropsychopharmacology, Dr. Wolfconducts research on the role of neuronal plasticity in drugaddiction.

Janet Wood, M.B.A., M.Ed., is director of behavioral healthservices, Colorado Department of Human Services in Denver,and the mental health commissioner for the State of Colorado.

The Council advises NIDA in its efforts to identify, review, andsupport scientific research that supports the Institute’s mission.It comprises 18 members—12 experts in scientific fields and 6members of the public, and ex officio members from otherGovernment entities.

Walk the Line Is Among 10thAnnual PRISM Awardees

Winners of the 10th Annual PRISM Awards include Walk theLine, a film portraying the life of singer Johnny Cash and hisbattle with drug addiction. The awards, cosponsored by NIDA,the Entertainment Industries Council, Inc., and Fox BroadcastingCompany’s FX Network, recognize accurate depictions ofsubstance abuse and addiction in television, feature film, video,music, and comic book entertainment.

“What films and TV shows do is help to put a face on the issueof substance abuse and addiction, helping the public to betterunderstand how addiction affects the addict and how treatmentcan lead to hope,”says NIDA DirectorDr. Nora D. Volkow,who cohosted theaward ceremony in Los Angeles onApril 27.

Walk the Line, afeature from Fox2000 Pictures, TreeLine Films, and Cat-fish Productions,was singled out inthe “feature filmwide release” category.

Other award recipients include :■ The “Off the Tracks” episode of Without a Trace (TV drama

episode); ■ Saturday Night Live (TV comedy episode); ■ Several episodes of Reba (TV comedy multi-episode storyline);■ Behind the Camera: The Unauthorized Story of Mork and Mindy

(TV movie or mini series); ■ The Montel Williams Show entitled “Drug Abuse: Rebuilding a

Family” (TV talk show episode); ■ Kelly Rowan in The O.C. (performance in a drama episode); ■ Georgia Engel in Everybody Loves Raymond (performance in a

comedy series); ■ S. Epatha Merkerson in Lackawanna Blues (performance in a

TV movie); and■ Lori Loughlin in Summerland (performance in a drama multi-

episode storyline). The 10th Annual PRISM Awards will air as a 1-hour TV special onthe FX Network.

(L-R) NIDA Deputy Director Dr. Tim Condon, National Advisory Councilmembers Ms. Janet Wood, Dr. Warren K. Bickel, Dr. Ellie E. Schoenbaum,Dr. Marina E. Wolf, and NIDA Director Dr. Nora D. Volkow

(L-R) Fox Broadcasting CompanyEntertainment President Mr. Peter Ligouri;NIDA Director Dr. Nora D. Volkow; andEntertainment Industries Council, Inc.President and CEO Mr. Brian Dyak


■ T E A R O F F Information to clip, save, and share

NIDA LaunchesCriminal JusticePublication in Chicago

NIDA Director Dr.Nora D. Volkowjoined Chicago MayorRichard M. Daley;

Cook County, Illinois, Chief JudgeTimothy Evans; and Illinois Treat-ment Alternatives for Safe Com-munities, Inc. (TASC) DirectorMelody Heaps at a July 24 pressconference in Chicago to launchNIDA’s Principles of Drug AbuseTreatment for Criminal JusticePopulations: A Research-BasedGuide. The event also featuredtalks by six former clients of TASC,a not-for-profit organization thatprovides treatment managementprograms and services.

Principles of Drug Abuse Treat-ment for Criminal Justice Popula-tions outlines 13 research-basedprinciples of successful treatmentof drug abusers who have enteredthe criminal justice system:1. Drug addiction is a brain dis-

ease that affects behavior.2. Recovery from drug addiction requires effective treatment,

followed by management of the problem over time.3. Treatment must last long enough to produce stable behavioral

changes.4. Assessment is the first step in treatment.5. Tailoring services to fit the needs of the individual is an impor-

tant part of effective drug abuse treatment for criminal justicepopulations.

6. Drug use during treatment should be carefully monitored.7. Treatment should target factors that are associated with

criminal behavior.8. Criminal justice supervision should incorporate treatment

planning for drug-abusing offenders, and treatment providersshould be aware of correctional supervision requirements.

9. Continuity of care is essen-tial for drug abusers reen-tering the community.

10. A balance of rewards andsanctions encouragesprosocial behavior andtreatment participation.

11. Offenders with co-occurringdrug abuse and mentalhealth problems oftenrequire an integrated treat-ment approach.

12. Medications are an important part of treatment for many drug-abusing offenders.

13. Treatment planning for drug-abusing offenders who are livingin or reentering the community should include strategies toprevent and treat serious, chronic medical conditions, such asHIV/AIDS, hepatitis B and C, and tuberculosis.The publication also provides answers to frequently asked ques-

tions about addiction as a chronic disease; co-occurring mental,emotional, and environmental conditions that make relapse morelikely; recommendations for the components of treatment; cost-effectiveness of treatment; and the role of medication in treatingsubstance-abusing offenders.

The press conference highlighted innovative substance abuseprograms in Cook County, including a NIDA-sponsored projecttraining judges about the neuroscience of addiction and treatment,so they can be better prepared to place addicted defendants in adequate treatment environments.

Principles of Drug Abuse Treatment for Criminal Justice Popula-tions and its companion publication, Principles of Drug AddictionTreatment (issued in 1999) can be accessed on NIDA’s Web site(www.drugabuse.gov) or by calling 800-729-6686. ■

Cook County, Illinois, ChiefJudge Timothy Evans addresses the conference

Mr. Tim Bell describes his journey and his ongoing sobriety

Celebrating the accomplishments of the TASC program: ChicagoMayor Richard M. Daley (third from left) with TASC program graduatesMr. Benny Lee, Ms. Cheryl Cline, Ms. Yvonne Thomas, Mr. MichornThompson, Mr. Tim Bell, and Mr. Angel Cruz

■ WHAT THE NUMBERS SAY

U.S. Departmentof Health andHuman Services

National Institutes of Health

National Institute on Drug Abuse

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NIDA Notes Subscriptions Department:

MasiMax Resources, Inc.1375 Piccard Dr., Suite 175Rockville, MD 20850

Fax: 240-632-0519E-mail: [email protected]: 240-632-5614

Additional Copies

National Clearinghouse for Alcohol and Drug InformationP.O. Box 2345Rockville, MD 20847-2345

Phone: 800-729-6686 or 301-468-2600TDD number: 800-487-4889Fax: 301-468-6433E-mail: [email protected]

NIDA Notes is a publication of the U.S. Government produced

by the National Institute on Drug Abuse. Use of funds for print-

ing this periodical has been approved by the Director of the

Office of Management and Budget. Except for material specifi-

cally identified as copyrighted, all materials appearing in NIDA

Notes are in the public domain and may be reproduced without

permission. Citation of the source is appreciated.

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High School Seniors Steadily Increase Nonmedical Use of Sedatives Over 15 Years

The annual Monitoring the Future Survey identified a disturbing pattern in the nonmedicaluse of sedatives, including barbiturates, among 12th graders: The overall prevalence hasrisen steadily since 1992, and now stands at 7.2 percent.

low-cost incentives improve outcomes in stimulant abuse … · 2016-04-20 · 2 nida notes | volume...

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