Editor’s Note: The Teaching Points series is a celebration of pedagogy on drugs. In our second installment for the back-to-school season, we look at a rare specimen– a med-psy class that emphasizes history and its relevance for clinicians, researchers, and treatment providers. Guest blogger Christine Grella is Professor of Psychiatry and Biobehavioral Sciences at the Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, and Associate Director of ISAP. Her research focuses on the relationship of service delivery to addiction treatment outcomes, and she brings that “meta” perspective to graduate students and postdocs when she teaches “Addiction Research: History, Policy, and Practice.”
Addiction Research: History, Policy, and Practice
This course will take a big-picture view of research on substance abuse and its relationship to social interventions and policies that attempt to address problems related to substance use.
The goal is for you to understand the history and evolution of the field of substance abuse research, so that you can situate your own research interests within this context, as well as understand the influences that continue to shape research priorities (and associated funding streams), social policies regarding substance abuse, and the organization and delivery of drug treatment within the context of the broader health care system. Moreover, because prior research on drug users, especially those who were incarcerated, was interwoven with the development of current policies regarding research with human subjects, we will examine these issues. We will address questions such as:
- What is the origin and evolution of research on drug use and addiction in the United States?
- What is the relationship of the federal government to addiction research and how has this relationship changed over time?
- What is the relationship of basic research on the effects of psychoactive substances, pharmacology and behavioral pharmacology, treatment-outcome and patient-oriented research, market-oriented research on drug development, and emerging new fields of addiction research (e.g., neurobiology, behavioral economics, translational research)?
- In what ways does (or does not) research on drug abuse and its treatment inform social policies aimed at eradicating problems that stem from drug misuse?
- What are implications of health care reform for the organization, financing, and delivery of drug treatment?
- How do we determine the effectiveness of substance abuse treatment and what are current efforts to improve the quality and delivery of treatment services?
N.C. Campbell. (2007). Discovering Addiction: The Science and Politics of Substance Abuse Research. Ann Arbor: University of Michigan Press.
Report of the Blue Ribbon Task Force on Health Services Research at the National Institute on Drug Abuse. (2004). Bethesda, MD: National Institute on Drug Abuse.
Institute of Medicine. Committee on Crossing the Quality Chasm. (2005). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, D.C.: The National Academies Press.
NIDA 35th anniversary papers in Drug and Alcohol Dependence, 107(1), 80-118.
National Center on Addiction and Substance Abuse at Columbia University. (2012). Addiction Medicine: Closing the Gap between Science and Practice. New York: CASAColumbia.
Week 1: Introduction to addiction research and social policy in the U.S.: History, policy, and practice
The field of addiction research has been described as having amnesia with regard to its history. What can we learn from the history of addiction research about our current research priorities and practices? What are the social policy precursors of our current efforts to regulate alcohol and drug use? This class will present a “Brief History of Alcohol & Drug Use and Social Policy in the U.S.”
Week 2: From the Lexington Narcotics Farm to NIDA: History of addiction research in the U.S.
The federal government played an important role in advancing addiction treatment and research beginning in the 1930s, which laid the foundation for the various sub-areas of research (e.g., epidemiology, neurobiology, pharmacology, behavioral pharmacology, behavioral treatment, prevention, health services research). The early scientific and governmental structures that arose from this work culminated in the establishment of NIDA and the modern field of addiction research as we know it.
Week 3: The “Disease Concept” of addiction: Old Wine in New Bottle?
How “addiction” is defined and understood is critical to social policies that aim to address problems associated with it. Even the terminology of how we refer to these phenomena, and the diagnostic criteria for determining it, are subject to intense debate. New technologies, such as neuroimaging, are employed to support the “disease” model of addiction, yet the disease concept has a long history and has taken on various meanings in different contexts.
- Courtwright, David T., (2010). The NIDA Brain Disease Paradigm: History, Resistance and Spinoffs. History Faculty Publications. Paper 2.
- McLellan, A.T. (2000). Drug dependence: A chronic medical illness. JAMA, 284, 1689-1695.
Week 4: Addiction research with prisoners: Where science, public policy, and ethics collide.
Given the strong relationship between drug addiction and criminal behavior, much of addiction research, both historically and currently, is conducted with individuals who are involved with the criminal justice system. Moreover, research on the biological basis of addiction has its early roots in research conducted with prisoners. We will discuss the relationship between drug policy and criminal justice policy and how addiction research is used (or not) to inform both. We will also discuss the human subjects issues raised by research conducted with offender populations.
- Chandler, R.K., Fletcher, B.W., & Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and safety. JAMA, 301(2):183-190.
Week 5: Public advocacy and research on addiction: Lessons learned from the AIDS Movement.
Public images of drug users are pervasive in both popular media and culture. The AIDS Movement provides an example of a social movement that dramatically shaped public policy, the scientific process of medication development, and the delivery of health care to people with AIDS. How do public perceptions of affected groups (e.g., drug addicts, people with HIV, mentally ill individuals) and public advocacy groups influence public policies regarding intervention strategies? What is the role of “consumers” (i.e., users, patients, treatment providers, families) in influencing scientific research and public policy? How are health care disparities associated with substance use reproduced within the context of the health services system?
- Valdiserri, R. O. (2011). Commentary: Thirty years of AIDS in America: A story of infinite hope. AIDS Education & Prevention, 23(6), 479–494.
Week 6: Qualitative research on drug abuse: The drug user as subject.
There is a long history of ethnographic research on drug users, which has influenced popular conceptions as well as research agendas. How does qualitative research, with its roots in sociology and anthropology, interface with other forms of research on addiction, such as epidemiology and intervention development? What scientific and human subjects issues are unique to this form of research and in what ways does qualitative research inform the larger field of addiction research?
- Hunt, G., Moloney, M., & Evans, K. (2009). Epidemiology meets cultural studies: Studying and understanding youth cultures, clubs and drugs. Addiction Research & Theory, 17(6), 601-621.
Week 7: State of the art regarding treatment effectiveness and implementation.
There is considerable emphasis now on improving the quality of treatment for substance use disorders, stemming from the influential Institute of Medicine Report in 2005. This report ushered in the development of evidence-based practices, practice guidelines, and consensus panels for treatment standards as well as stimulated efforts to disseminate evidence-based treatment into practice through “research-to-practice” and “technology transfer.” What do these all mean and what are obstacles to improving substance abuse treatment effectiveness?
- Glasner-Edwards, S., & Rawson, R. (2010). Evidence-based practices in addiction treatment: Review and recommendations for public policy. Health Policy, 97(2-3), 93-104.
- Humphreys, K., & McLellan, A.T. (2011). A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients. Addiction, 106(12):2058-66.
Week 8: Addiction treatment and the broader health services system: How are current changes in the delivery of health services influencing the delivery of addiction treatment?
Implementation of major policy changes, including the Mental Health and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act (i.e., “health care reform”) of 2009 are expected to have a major impact on the organization, financing, and delivery of substance abuse treatment services. Potential expansion of substance abuse treatment through Medicaid, as well as greater integration of addiction treatment within primary health services, patient-centered treatment outcomes, and focus on comparative treatment effectiveness will all influence the nature of addiction treatment in the coming years.
- Buck, J.A. (2011). The looming expansion and transformation of public substance abuse treatment under the affordable care act. Health Affairs, 30(8), 1402-1410.
- Rawson, R.A, Gonzales, R., Crèvecoeur-MacPhail, D., Urada, D., Brecht, M.Ls, Chalk, M., Kemp, J., & Cunningham M. (2010). Improving the accountability of California’s public substance abuse treatment system through the implementation of performance models. Journal of Psychoactive Drugs, Sup 6, 211-214.
- Rosenberg, L. (2012). Primary and behavioral healthcare integration: Threat or opportunity for addiction treatment organizations? Journal of Behavioral Health Services & Research, 39(2), 101-102.
Week 9: Substance abuse treatment providers: How do organizational characteristics influence treatment outcomes?
The last ten years have witnessed increased attention to the organizational features of substance abuse treatment providers, including characteristics of program administrators, the treatment workforce, program resources and revenues streams, and physical aspects of treatment settings. How do these factors influence who goes into treatment and the content of services they receive? How are these programmatic features likely to change under the influence of health care reform?
- Broome, K. M., Flynn, P. M., Knight, D. K., & Simpson, D. D. (2007). Program structure, staff perceptions, and client engagement in treatment. Journal of Substance Abuse Treatment, 33(2), 149-158.
- D’Aunno, T. A. (2006). The role of organization and management in substance abuse treatment: Review and roadmap. Journal of Substance Abuse Treatment, 31(3), 221-233.
- Fuller, B. E., Rieckmann, T., Nunes, E. V., Miller, M., Arfken, C., Edmundson, E., & McCarty, D. (2007). Organizational readiness for change and opinions toward treatment innovations. Journal of Substance Abuse Treatment, 33(2), 183-192.
- Roman, P. M., Ducharme, L. J., & Knudsen, H. K. (2006). Patterns of organization and management in private and public substance abuse treatment programs. Journal of Substance Abuse Treatment, 31(3), 235-243.
Week 10: Conclusion