Drug use and substance use disorders (SUDs) affect millions of Americans and impose enormous costs on our society. In 2014, nearly 27 million people in the United States were current users of illicit drugs or misused prescription drugs, and almost 67 million people smoked or used other harmful tobacco products.1 NIDA’s mission as the lead federal agency devoted to research on the health effects of drug use is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health through:
- Strategically supporting and conducting basic and clinical research on drug use (including nicotine), its consequences, and the underlying neurobiological, behavioral, and social mechanisms involved
- Ensuring the effective translation, implementation, and dissemination of scientific research findings to improve the prevention and treatment of substance use disorders and enhance public awareness of addiction as a brain disorder
The NIDA Strategic Plan for 2016 to 2020 outlines our plan for fulfilling this mission through the end of this decade. The strategic priorities outlined in this plan are intended to leverage the vast array of new tools and technologies at our disposal for studying the biological, environmental, behavioral, and social causes and consequences of SUDs and to help researchers integrate and analyze the unprecedented amounts of information being generated in the era of Big Data and precision medicine.
SUDs are complex disorders involving disruption of brain circuits involved in reward, decision-making, learning, and self-control. They are mediated by complex biological, social, environmental, and developmental factors that dynamically interact to influence risk, trajectory, and outcomes. Understanding this complexity will require drawing upon multiple disciplines across biomedicine, including neuroscience, genetics/epigenetics, behavioral and social sciences, development research, and information sciences. Technological advances over the past several years in neuroimaging, optogenetics, gene editing technology, epigenomics, and other innovations are giving us the ability to probe this complexity in entirely new ways, enabling researchers to deepen our understanding of the brain and its responses to drug use in ways that would have been unimaginable even a decade ago.
Over the next 5 years, NIDA will harness the new opportunities presented by scientific and technological advances, changes to the health care landscape, ongoing criminal justice reform, and a growing public attention on drug-use-related issues to increase the impact of our research and improve the translation of new findings into real-world interventions that can maximize limited resources and reach more people.
While advancing basic and clinical research, NIDA will continue to prioritize science that is relevant to the most pressing health challenges in our Nation, such as the prescription opioid and heroin overdose epidemic, the slow adoption of evidence-based prevention and treatment interventions, new synthetic drugs flooding the market, and the spread HIV resulting from drug use.
The strategic priorities outlined in this plan are intended to address the full breadth of addiction science (from basic to translational, clinical, and health services research) and to encompass drug use ranging from occasional use to SUDs of all severity levels (from problematic use to addiction). NIDA’s strategic priorities for the next 5 years are designed to increase our understanding of the basic science of the brain as it relates to behavior and translate what is learned into more effective prevention and treatment interventions that can ultimately reduce the negative impacts of drug use and SUDs on society. To achieve this mission, NIDA will focus on advancing the following high-level strategic goals centered on basic science, prevention, treatment, and public health, respectively:
GOAL 1: Identify the biological, environmental, behavioral, and social causes and consequences of drug use and addiction across the lifespan. Recent technological advances now enable scientists to study the multiple causal factors for substance use and addiction and how they interact to influence vulnerability for initiation of drug use, escalation, and transition between the stages of SUDs. They also enable us to study how drug use and SUDs impact an individual’s health, environment, behavior, and social interactions. The objectives of this goal include:
- Objective 1.1: Characterize the genetic, neurobiological, environmental, social, and developmental factors that mediate risk and resilience for drug use and addiction
- Objective 1.2: Identify the factors that influence drug use trajectories
- Objective 1.3: Establish the effects of drug use, addiction, and recovery on genes, molecules, cells, brain circuits, behavior, and health across the lifespan
- Objective 1.4: Identify the bidirectional effects of drug use and common comorbidities
GOAL 2: Develop new and improved strategies to prevent drug use and its consequences. We now have considerable evidence that SUDs can be prevented through interventions targeting both individual and community risk and protective factors. To design targeted prevention approaches and deliver them to the individuals and communities that could most benefit, NIDA will support research that leverages the accumulating basic science on mechanisms underlying risk for drug use and addiction and that builds on our growing experience evaluating implementation of prevention interventions. Thus for this goal, NIDA will support research on the following objectives:
- Objective 2.1: Determine the mechanisms that underlie individual risk and resilience for addiction and common comorbidities
- Objective 2.2: Develop and test innovative prevention interventions that target mechanisms underlying risk factors
- Objective 2.3: Develop and test strategies for effectively and sustainably implementing evidence-based prevention interventions
- Objective 2.4: Develop and test novel strategies for preventing prescription opioid misuse and addiction
GOAL 3: Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery. Despite our rapidly increasing understanding of the biology of addiction, the range of available treatment options for most SUDs is limited. However, there are many promising approaches that may be added to our treatment toolkit in future years. These include new medications, behavioral therapies, vaccines/immunotherapies, biofeedback, and manipulation of brain activity using transcranial magnetic stimulation or electrical deep brain stimulation. To facilitate the development of innovative intervention strategies, NIDA will support research to:
- Objective 3.1: Develop and test novel treatments based on the science of addiction
- Objective 3.2: Develop and test metrics for measuring the quality and efficacy of treatment
- Objective 3.3: Identify biomarkers that predict response to treatment and risk for relapse
- Objective 3.4: Develop and test strategies for effectively and sustainably implementing evidence-based treatments
GOAL 4: Increase the public health impact of NIDA research and programs. Many people in the United States need help for SUDs right now and cannot wait for new treatments. Approximately 7.1 million Americans are dependent on or abuse illicit drugs, yet only about 15 percent receive treatment for their disorder.1 The good news is that this is an ideal time to address the "bench-to-bedside gap" and advance SUD treatment across the Nation. The Affordable Care Act, the Excellence in Mental Health Act, and laws requiring parity of insurance coverage for SUD and other behavioral health treatments will significantly expand access to needed services and create new incentives for integrating SUD care into the general health care system. These changes create an unprecedented opportunity to advance SUD treatment in this country. To promote science-informed decision-making to improve Americans' health, NIDA will:
- Objective 4.1: Determine the impact of drug use and addiction on individuals, families, peers, and society
- Objective 4.2: Assess the impact of federal-, state-, and systems-level policies related to drug use and substance use disorders on public health and well-being
- Objective 4.3: Increase strategic partnerships with the community to improve dissemination and implementation of evidence-based research findings into policy and practice
Priority Focus Areas
In addition to these four goals, NIDA has identified four priority focus areas presenting unique opportunities to leverage during the next 5 years. These areas include:
- Understanding the complex interactions of factors influencing drug use trajectories. NIDA will capitalize on emerging technologies and discoveries to facilitate integration and analysis of diverse data sources, including genomic, epigenomic, behavioral, neurobiological, environmental, and other phenotypic data associated with the stages of drug use and addiction.
- Accelerating development of treatments. NIDA will translate basic knowledge of the molecular pathways and brain circuits involved in SUDs to develop new approaches that modulate specific targets and networks, accelerating development of new therapeutics for SUDs. NIDA will also leverage existing safety profiles and pharmacology data to lower development costs and shorten the timeline for obtaining approval from the U.S. Food and Drug Administration.
- Addressing real-world complexities. NIDA will conduct research to better understand the barriers to successful and sustainable implementation of evidence-based practices and develop implementation strategies that effectively overcome these barriers to ensure that all populations benefit from the Nation’s investments in scientific discoveries.
- Advancing bidirectional translation. NIDA is fostering stronger collaborations across basic and clinical researchers, in part through a recent reorganization of the Institute’s organizational structure2, to integrate and coordinate human and animal research on the substrates of addiction across scales—from molecular to societal—and across the trajectory—from initiation to recovery.
The strategic plan also highlights a number of exciting initiatives that will transform the science of drug abuse and impact a wide range of other health fields over the coming years, including:
- The Adolescent Brain Cognitive Development (ABCD) study, a collaborative 10-year longitudinal imaging study to understand the role of environmental, social, and genetic factors in health, behavior, and life outcomes, including substance use and addiction
- The Addictome project, to harness Big Data for addiction science
- JJ-Trials, an implementation science initiative to prevent and treat SUDs in the criminal justice system
- Avenir Awards, to support innovative, high-risk, high-reward research
- The NIDAMED Initiative, to train health care providers to prevent, identify, and treat SUDs
- The PATH Study, a collaborative, longitudinal cohort study on tobacco use behaviors, attitudes, beliefs, exposures, and related health outcomes
Drug use and addiction remain major health problems in our country, but it is a time of optimism in the field: New technologies, meaningful changes to the health care system, and increased awareness of SUDs as brain disorders are just now providing new opportunities for addressing the problem. As NIDA enters 2016, we look forward to capitalizing on these trends and exerting a profound and lasting impact on drug-use- and addiction-related health outcomes across the country.