GOAL 4: Increase the public health impact of NIDA research and programs
Substance use disorders (SUDs) and their consequences present a significant and ongoing public health burden in our nation. While it is important to support scientific research that will increase our understanding of the SUD disease processes and ultimately lead to better prevention and treatment options, it is also crucial to understand that there are many people in need of help right now. An estimated 7.1 million individuals in the United States are dependent on or abuse illicit drugs, yet only about 15 percent receive treatment.1 In addition, more than 25 percent of Americans, an estimated 66.9 million people, currently use tobacco products; despite significant declines in cigarette smoking, it is still the leading cause of preventable death in the United States, accounting for more than 480,000 deaths every year.1,4
A range of public health issues are associated with the current crisis of opioid abuse, including opioid use disorders, opioid overdoses, neonatal abstinence syndrome, and increased spread of infectious diseases like HIV and hepatitis C (HCV).8–11,47 Science can help to inform these issues as well as other public health challenges including the significant unmet need for SUD treatment, changes in state policies related to marijuana, emerging drug trends including synthetic cannabinoids and cathinones, and the emergence of electronic cigarettes and vaporizers.
Right now there are unprecedented opportunities for advancing SUD treatment across the Nation. The combined effects of the Affordable Care Act, the Excellence in Mental Health Act, and requirements for parity of insurance coverage for behavioral health treatment are leading to a significant expansion in access to prevention and treatment services for SUDs and are creating financial incentives for integrating care for behavioral health disorders within the general health care system.111 These changes, along with recent advances in addiction treatment and criminal justice reforms, present a unique opportunity for advancing the SUD treatment field.
In addition, the rapid acceleration in the development and adoption of health care technologies—including electronic health records and mobile apps and sensors—has the potential to revolutionize health care as well as research. These advances will facilitate health information exchange, real-time patient monitoring and outreach, more efficient coordination of patient care, use of real-time analytics to drive a "learning health care system," new approaches for implementing evidence-based practices, use of biosensors to predict and intervene in advance of a relapse, and collation of large clinical data sets for pragmatic trials and population studies.
Mobile Health: New Applications for Consumer Technologies
The mobile health (mHealth) industry is growing rapidly with new technologies that have the power to revolutionize health care. From automated text messaging services that educate parents and teachers about how to talk to children about the dangers of drugs to counseling apps that provide real-time support for patients in need, these technologies present incredible opportunities for preventing and treating SUDs.
One example is a mobile app developed by researchers at the University of Wisconsin, Madison, called Addiction-Comprehensive Health Enhancement Support System (A-CHESS). A-CHESS is designed to help patients transition from treatment into a stable recovery by enhancing their coping skills, providing a social support network, and linking them to aftercare services. The app includes:
- programmed routine check-ins with a care manager
- self-monitoring and feedback
- access to a "panic button" that immediately links the patient to a counselor
- social support through an online bulletin board or text messaging to other A-CHESS users
- GPS that alerts the patient to nearby resources and possible triggers (e.g., old hangouts)
- reminders for medication, appointments, and treatment milestones
- guided relaxation exercises
Importantly, these technologies have the potential to reach people who cannot or will not participate in the traditional treatment system, whether because of cost, lack of treatment providers in the area, or fear of stigma or discrimination. Technologies including telehealth and behavioral intervention software tools can also be used to support more efficient use of the SUD treatment workforce. The mHealth field is rapidly evolving, and NIDA will continue to support research on how to harness these technologies to more effectively and efficiently prevent and treat SUDs.
NIDA serves a number of roles relevant to public health, including supporting health services and epidemiology research, educating the public and relevant stakeholders on the science of drug use and addiction, helping to inform science-based decision-making, and engaging in strategic partnerships to translate scientific advances into public health gains. Science can help to inform many important questions, including:
- How can limited resources be most effectively used?
- How can prevention and treatment programs be better implemented?
- How can society best reduce harms associated with drug use, such as drugged driving and transmission of infectious diseases?
- What impacts are various policies likely to have?
- How can we best leverage technology?
- How can we identify and intervene with high-risk individuals and populations?
- Which health care models and payment systems promote the highest quality care?
To promote the use of science-informed decision-making to improve public health, NIDA will: