Dispelling the Myths About Addiction Strategies to Increase Understanding and Strengthen Research (1997) / Chapter Skim
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This and other Institute of Medicine committees have defined drug addiction as a brain disease similar to other chronic, relapsing conditions, such as heart disease and diabetes, and manifested by a complex set of behaviors that are the result of genetic, biological, psychosocial, and environmental interactions. The term "addiction" has tended to be applied more frequently to use of illegal drugs than to legal ones; yet, addiction may occur as a consequence of using both socially acceptable, legal drugs or illicit drugs.
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Researchers can now turn to the very difficult problems of understanding the precise brain mechanisms by which drugs alter brain function and come to dominate behavior. In the process, a great deal will be learned about the normal control of motivation and emotion in the brain.
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Universal includes interventions aimed toward an entire population, such as warning labels on tobacco products and alcoholic beverages, advertising bans, smoke-free airline flights and buildings, taxes, and the role of primary care physicians and providers in inquiring about and providing information on smoking, drinking, and use of illicit drugs. Selective interventions are those aimed toward individuals who are members of a subgroup or population that is known to be at higher risk for a given disorder, for example, aiming interventions at teenagers to prevent drug abuse and drinking.
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Department of Education should provide incentives for schools to increase emphasis on the physiological and psychosocial aspects of drug abuse and addiction in science and health education classes at elementary, middle school, and high school levels; and · Professional societies should facilitate expanding coverage of a science-based approach to understanding drug abuse and addiction at the
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] should review curricula in medical schools, and in psychology, social work, and nursing departments for the adequacy of drug addiction courses and should require basic competence in these areas for certification and recertification on medical specialty board examinations and in other relevant disciplines; · Deans, administrators, and professional societies should undertake systematic evaluation of existing curricula to assess how they encourage or discourage training in addiction research and develop curricula tailored to different levels of schooling and specialty.
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All treatment professionals should have some knowledge of basic neuroscience and how alcohol, nicotine, and other drugs work on brain pathways, influence behavior, and interact with ~liv~rc~ ~nn~litinn~ Tree`_ ment professionals should include physicians, nurses, clinical psychologists, social workers, drug abuse peer counselors, and other health care providers who work in conjunction with one another in treating patients with an addictive disease; · Continuing education courses to update treatment professionals' knowledge base on addiction should be instituted systematically and widely; and · Competence-based documentation of treatment professionals' knowledge base on addiction should be sought in licensing and recertification examinations. The committee identified several problems with the mechanisms that support careers in addiction research.
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mechanism now at NIMH: and NIDA to provide seed money for young investigators should be expanded; Programs for student-directed summer research should be estab lished by NIDA and NIAAA; Industry and private foundations should cooperate with universities to provide supplemental funds for career development and research support of young investigators, especially during transition periods between awards, or to provide partial salary support for clinical researchers; Increases should be made in the percentage of NIDA and NIAAA extramural research funding spent on training programs to reach the NIH institute average (currently 5 percent to 6 percent) , funds for which should not be redirected from the research budgets of these institutes; .
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The federal government should establish a debt deferral or forgiveness program for scientists conducting clinical research in drug addiction or treating persons with drug abuse in publicly funded settings; and Federal funds should be made available from NIH, SAMSHA, HRSA, or AHCPR to provide training for primary care physicians (e.g., obstetricians, family physicians, and internists) to recognize, treat effectively, or refer patients with drug abuse problems.
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· Liaison relationships and joint activities should be explored among advocacy groups to increase public understanding of addictive disorders. Activities could include meetings of representatives of provider groups, state and local health departments, and established grassroots advocacy groups to develop cohesive, workable strategies to accomplish change.
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Yet it is important to emphasize that the course of addiction can be modified by its consequences and that biological urges can be overridden. The addiction as a brain disease model tends to obscure this clinical reality." 2.
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