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NIDA

2009 NIDA International Forum: Commonalities Among the Diseases of Addiction: Implications for Treatment and Prevention

June 19–23, 2009
Reno, Nevada

Executive Summary

NIDA International Forum Focuses on Commonalities Among the Diseases of Addiction

Drugs. Sex. Gambling. Obesity.

Plenary session speakers at the 14th NIDA International Forum documented the commonalities among these "Disorders of Desire," citing clear overlaps in implicated brain regions and similar patterns of compulsive self-administration, tolerance, craving, comorbidity, disruption of inhibitory control, and impaired decision-making.

NIDA International Program Director Dr. Steven W. Gust chaired the meeting, which was held June 19–23, 2009, in Reno, Nevada, as a satellite to the Annual Scientific Meeting of the College on Problems of Drug Dependence (CPDD). More than 250 participants from 48 countries participated in the plenary session, workshops, and networking activities. A joint CPDD/NIDA International Forum poster session featured presentations by 150 U.S. and international researchers as well as representatives from 10 NIDA components. The NIDA International Program also supported a second CPDD satellite, Treating Addiction During Pregnancy: Exploring Multinational Perspectives To Build a Treatment Approach Consensus.

NIDA Deputy Director Dr. Timothy Condon reviewed the Institute's priority areas, which include prevention research on adolescent brain development, genetic and epigenetic factors, social neuroscience, and prescription drug abuse; treatment interventions such as new pharmacotherapies and behavioral treatments, pilot clinical trials for substance-related disorders, and research into prescription opioid abuse and pain management; the relationships between non-injection drug use and health disparities on HIV/AIDS; translational research; and transdisciplinary collaboration. Dr. Condon reported that NIDA received almost $261 million in economic stimulus funding, half of which will fund research grants already approved but not yet funded, particularly for NIDA signature projects to eradicate tobacco addiction and elucidate the genetics of brain development, and initiatives to prevent and treat substance abuse among military personnel and veterans.

The new CPDD International Committee chair, former NIDA Humphrey Fellow Dr. Flavio Pechansky of Brazil, urged international researchers to evaluate the potential for failure as well as success as they choose which U.S. technologies and research methods to adapt for use in their countries. He also encouraged international scientists to become active in CPDD and NIDA International Program activities, particularly the Forum and the online NIDA International Virtual Collaboratory.

The NIDA International Program presented its 2009 Awards of Excellence to honor mentors, researchers, and binational collaborative teams whose efforts support the International Program mission, including the following: Excellence in Mentoring, Dr. James C. Anthony, United States; Excellence in International Leadership: Dr. Ian Stolerman, United Kingdom; and Excellence in Collaborative Research: Dr. Steffanie Strathdee, United States; Dr. María Remedios Lozada Romero, Mexico; and Dr. Carlos Magis-Rodríguez, Mexico.

Disorders of Desire

The NIDA International Forum plenary session on the disorders of desire was chaired by Dr. Joseph Frascella, director of the NIDA Division of Clinical Neuroscience and Behavioral Research, who described how obesity—like drug addiction—results from a complex interaction of biological mechanisms, genetic vulnerabilities, and social, cultural, and environmental influences to affect an individual's neurobiology and behavior. He presented research results documenting similar reductions in dopamine receptor activation for morbidly obese individuals and those addicted to cocaine, methamphetamine, alcohol, and heroin. Dr. Frascella also discussed other research demonstrating changes in brain function for addicted or obese individuals who, when compared to control individuals, exhibit decreased activity in the prefrontal cortex and anterior cingulate gyrus that control inhibitions and satiety as well as increased activity in the mesocorticolimbic system that governs rewards to drugs of abuse or food.

Pathological gambling (PG) has traditionally been classified as a behavioral disorder, such as obsessive-compulsive disorder (OCD) or impulse control disorder (ICD), but Dr. Wim van den Brink, University of Amsterdam, presented evidence that PG seems to share many epidemiological, clinical, neurobiological, and treatment characteristics with substance use disorders (SUD) and fewer characteristics with OCD or ICD. He concluded that the strongest correlations have been documented in high rates of comorbidity—more than 25 percent of treatment-seeking pathological gamblers also have SUD—and similarity in symptoms. Dr. van den Brink warned that relatively few studies directly compare PG with SUD or behavioral disorders, so the specificity of these findings is not clear.

Dr. Anna Rose Childress, University of Pennsylvania, discussed imaging studies that document increased signals to "GO" (supranormal, preconscious activation of mesocorticolimbic brain circuitry that is exquisitely sensitive to the rewards of food, drugs of abuse, and sex) and decreased signals to "STOP" (either genetically or traumatically induced poor frontal cortical activity that leads to decreased inhibitory controls). She described new research using real-time fMRI feedback as a behavioral modification intervention to retrain those implicated brain circuits and concluded that similar behavioral modifications might be combined with potential pharmacotherapies to eliminate the extremes of increased desires and decreased inhibitions that contribute to addiction.

 

NIDA/CPDD Satellite on Treating Addiction During Pregnancy

Invitees to the NIDA/CPPD satellite on treating addiction during pregnancy completed a premeeting survey that attracted enthusiastic responses from researchers in 22 different countries on six continents. More than 90 percent of respondents agreed with 11 of 13 proposed principles of drug treatment for pregnant women. Dr. Hendrée Jones of Johns Hopkins University chaired the meeting; Dr. Gabriele Fischer of the Medical University of Vienna was co-chair. Dr. Marianne Springer-Kremser, Medical University of Vienna, reviewed ethical considerations involved in conducting addiction research with pregnant participants. Three other speakers reviewed research findings on studies of pregnant women in their countries: from Australia, Dr. Lucy Burns, National Drug and Research Centre; from France, Dr. Laurent Gourarier, Maison Blanche Hospital; and from Israel, Dr. Einat Peles, Tel Aviv Sourasky Medical Center.

Participants agreed that treating addiction during pregnancy is a serious public health issue and supported the development of treatment guidelines and a global consensus statement on the principles and best practices of drug addiction treatment for pregnant patients. The group agreed to identify experts and stakeholders to develop a draft consensus statement that could be reviewed at a future international meeting, contact WHO to learn about its guideline development process, and develop a journal supplement on the topic.

Forum Workshops

Concurrent workshops focused on ethical issues in the conduct of research, chaired by Dr. Linda B. Cottler, Washington University; multinational assessment and prevention of inhalant abuse, chaired by Ms. Debra Dell, Canadian Youth Solvent Addiction Committee; new formulations and indications for the pharmacotherapy Naltrexone, co-chaired by Dr. Ivan Montoya, NIDA Division of Pharmacotherapies and Medical Consequences of Addiction, and Dr. David R. Gastfriend, Alkermes, Inc.; and the interaction of violence and substance use affecting women's treatment and interventions in the global arena, chaired by Dr. Wendee M. Wechsberg, RTI International.

The International Society of Addiction Journal Editors (ISAJE) presented two concurrent breakout sessions focused on practical and ethical issues in publishing addiction science. The session on practical issues, chaired by Dr. Robert L. Balster, editor of Drug and Alcohol Dependence, was designed to help published and unpublished researchers choose an appropriate journal, avoid common pitfalls between submission and acceptance, and understand what editors want most from prospective authors. Dr. Thomas F. McGovern, editor-in-chief of Alcoholism Treatment Quarterly, chaired the session on ethical issues, which addressed issues such as good citation practices, how to deal with authorship credits, and conflict of interest related to funding sources. Participants received a copy of the newly revised book, Publishing Addiction Science (second edition, Babor et al., 2008).

The alumni meeting of the NIDA International Fellowship Programs was co-chaired by Ms. Dale Weiss, NIDA International Program, and Dr. J. Randy Koch, Virginia Commonwealth University. Dr. David Otiashvili, Union Alternative Georgia, and Dr. George Woody, University of Pennsylvania, discussed how NIDA international fellowships and funding initiatives helped them build a productive international research team. The University of Pennsylvania currently partners with researchers in the Republic of Georgia, Ukraine, Russia, Brazil, Indonesia, and Iceland. Dr. James E. Herrington, Fogarty International Center, reviewed National Institutes of Health funding opportunities to support global health research.

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