NIH Pub Number:
Published: December 2010
Author: National Institute on Drug Abuse
This issue presents an article by Dr. Thomas J. Gould that reviews current knowledge on the cognitive effects of drugs and the neurological underpinnings for those effects. In addition, Margaret Mroziewicz and Dr. Rachel F. Tyndale introduce the field of pharmacogenetics and provide examples demonstrating the impact of genetic variation on drug effects and drug dependence. Dr. Steve Martino reviews the empirical basis of evidence-based treatments for addiction and describes strategies for training counselors in using them; and Drs. Jody L. Sindelar and Samuel A. Ball examine cost considerations of adopting evidence-based treatments and analyze, as an example, whether adopting contingency management is the best use of a certain program's resources. Dr. Michael S. Robbins and colleagues present challenges encountered and solutions developed during a scientifically rigorous trial of Brief Strategic Family Therapy implemented in a community setting.
From the Director
A Note From NIDA's Director
Nora D. Volkow, M.D.
From the Editor
From Insight to Intervention
Addiction and Cognition
Thomas J. Gould, Ph.D.
The brain regions and neural processes that underlie addiction overlap extensively with those that support cognitive functions, including learning, memory, and reasoning. Drug activity in these regions and processes during early stages of abuse foster strong maladaptive associations between drug use and environmental stimuli that may underlie future cravings and drug-seeking behaviors. With continued drug use, cognitive deficits ensue that exacerbate the difficulty of establishing sustained abstinence. The developing brain is particularly susceptible to the effects of drugs of abuse; prenatal, childhood, and adolescent exposures produce long-lasting changes in cognition. Patients with mental illness are at high risk for substance abuse, and the adverse impact on cognition may be particularly deleterious in combination with cognitive problems related to their mental disorders.
RESPONSE: ADDICTION, MEMORY, AND SPIRIT
Vitka Eisen, Ed.D., M.S.W., and John Wanner, M.A., L.C.A.D.C.
Pharmacogenetics: A Tool for Identifying Genetic Factors in Drug Dependence and Response to Treatment
Margaret Mroziewicz, M.Sc., and Rachel F. Tyndale, Ph.D.
Pharmacogenetics research looks at variations in the human genome and ways in which genetic factors might influence how individuals respond to drugs. The authors review basic principles of pharmacogenetics and cite findings from several gene-phenotype studies to illustrate possible associations between genetic variants, drug-related behaviors, and risk for drug dependence. Some gene variants affect responses to one drug; others, to various drugs. Pharmacogenetics can inform medication development and personalized treatment strategies; challenges lie along the pathway to its general use in clinical practice.
Strategies for Training Counselors in Evidence-Based Treatments
Steve Martino, Ph.D.
Evidence-based treatments (EBTs) for substance abuse and dependence have demonstrated superiority over treatment as usual when applied with strict fidelity in controlled clinical trials. Effective counselor training is critical if substance abuse programs are to realize these interventions' full potential to enhance client outcomes in community practice. Although few empirical evaluations of training in EBTs have been conducted to date, the existing data warrant tentative conclusions concerning the appropriate roles and effectiveness of workshops, clinical supervision, distance learning, and blended learning. Among several outstanding research issues are questions of benchmarks for counselors' performance in training and the relationships between such performance and clients' substance abuse outcomes.
RESPONSE: FIDELITY AND FLEXIBILITY
Michael Shopshire, Ph.D.; Michael Levy, Ph.D.; and Carrie Dodrill, Ph.D.
Cost Evaluation of Evidence-Based Treatments
Jody L. Sindelar, Ph.D. and Samuel A. Ball, Ph.D.
Many treatment programs have adopted or are considering adopting evidence-based treatments (EBTs). When a program evaluates whether to adopt a new intervention, it must consider program objectives, operational goals, and costs. This article examines cost concepts, cost estimation, and use of cost information to make the final decision on whether to adopt an EBT. Cost categories, including variable and fixed, accounting and opportunity, and costs borne by patients and others, are defined and illustrated using the example of expenditures for contingency management. Ultimately, cost is one consideration in the overall determination of whether implementing an EBT is the best use of a program's resources.
RESPONSE: THOUGHTFULNESS REQUIRED
Greg Brigham, Ph.D.; Ron Jackson, M.S.W.; and Janet Wood, M.B.A., M.Ed.
Science and Practice in Action
Transporting Clinical Research to Community Settings: Designing and Conducting a Multisite Trial of Brief Strategic Family Therapy
Michael S. Robbins, Ph.D.; Elizabeth Alonso, Ph.D.; Viviana E. Horigian, M.D.; Ken Bachrach, Ph.D.; Kathy Burlew, Ph.D.; Ibis S. Carri
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Other Articles of Interest
Addiction Science & Clinical Practice
Following the publication of Volume 6, Number 1, NIDA will no longer be the publisher of Addiction Science & Clinical Practice. The journal will subsequently be published by Biomed Central and can be found at ascpjournal.org.