Determination of the cost and cost-effectiveness of brief drug abuse and HIV prevention programs that have been integrated into primary care, mental health and community settings, including federally qualified community health centers.
Pooling longitudinal data from prevention interventions to determine the long-term effects of drug abuse prevention programs on lesbian, gay, bisexual and transgender (LGBT) youth.
Independent replication studies of efficacious drug abuse and HIV prevention programs in substance using populations in multiple sites to determine cross-site and cross-population generalizability.
Monitoring long-term effects through the analysis of longitudinal data to determine effects of drug abuse prevention programs on diagnoses of abuse and or dependence, associated health risk behaviors such as unsafe sexual practices leading to HIV infection, emerging drugs of abuse, and on ancillary benefits such as reduced criminal justice involvement and improved educational or vocational outcomes.
I. ETIOLOGY AND MECHANISMS OF DRUG ABUSE: In both animal and human research, study sex/gender differences in the basic behavioral and biological mechanisms underlying drug abuse and dependence across the lifespan; and conduct laboratory, epidemiological, and clinical studies of male-female differences in the determinants of initiation, progression, and maintenance of drug use and dependence. Examples include:
Methodological research is needed in the field of drug abuse prevention on promising data collection, data management, analysis, and reporting techniques. Special attention should be given to the hierarchical and longitudinal nature of most prevention trial data, the adaptation of measures for intervention cohorts over the course of time and development, the measurement and analysis of complex theoretical process models including moderating and mediating variables, the development of adaptive designs, the problems of missing data and attrition when following intervention and control subjects over time, and the development of analytic strategies to determine important features of prevention interventions (i.e., core components). NIDA supports the adaptation and assessment of proven scientific procedures from other disciplines to determine their applicability to drug abuse prevention research such as those from systems science. Specific areas of research include:
Male-female differences have been identified in various aspects of drug abuse treatment and services research including barriers to treatment, treatment entry characteristics, treatment and services needs, and predictors of treatment engagement, retention, and outcomes. Research often finds that treatments are not equally efficacious in males and females. These male-female differences in treatment research, along with research showing male-female differences in the determinants and predictors of drug abuse, raise the possibility that even when treatments are shown to be equally effective for males and females, outcomes could be improved by the addition of gender-based approaches that are informed by this growing body of research.
Research on prevention intervention programs and strategies should focus on the manipulation of presumed causal, malleable factors derived from basic prevention and other studies on the origins, pathways and mechanisms of vulnerability to drug abuse, addiction, and drug-related HIV. Even relatively modest prevention intervention research trials can address complex and varied questions on drug etiology, theory testing, mechanisms of intervention effects, process measures, fidelity measures, and implementation cost in addition to assessing short term and long term trial outcomes. Three types of prevention intervention research that will be discussed further here include efficacy, effectiveness, and systems research.
Animal and human laboratory research has shown that males and females often differ in their behavioral and biological responses to drugs. Animal studies, for example, have found male-female differences in the motor-activating effects of stimulants, speed of acquisition of drug self-administration, the amount of drug self-administered, the percentage of subjects that acquire self-administration, escalation of drug self-administration, motivation for self-administration, and the tendency to relapse following drug cessation. Further, factors that affect those outcomes often do so differently in males and females. Human and animal pharmacokinetic studies often report male and female differences, as do studies of adverse effects of abused drugs. Both human and animal studies have established that the menstrual/estrous cycle is a determinant of drug action, both pharmacokinetic and behavioral. Growing numbers of brain-imagining studies are reporting male-female differences. Despite the important progress made in laboratory sex/gender-based research, it is in an early stage and most researchers fail to analyze their data by sex/gender.
The life course developmental perspective suggests that individual and environmental factors interact to increase or reduce vulnerability to drug use, abuse and dependence. Vulnerability can occur at many points along the life course but peaks at critical life transitions. Thus, prevention researchers should recognize the significance of timing interventions to coincide with important biological transitions, such as puberty; normative transitions, such as moving from elementary to middle school; social transitions, such as dating; and traumatic transitions, such as the death of a parent. In addition, because vulnerability to drug abuse involves dynamic intrapersonal (e.g., temperament), interpersonal (e.g., family and peer interactions) and environmental (e.g., school environment and neighborhood) influences, prevention intervention research must target interactions between individuals and social systems across the life span. To address this complexity, intervention research needs to test strategies designed to alter specified modifiable mediators to determine which are most related to and effective in reducing drug use initiation and escalation, with what audiences, and under what conditions. There is recognition that developmental patterns may vary by gender, gender identity, race/ethnicity, sexual orientation, and other population-based or cultural factors, and that these need to be better understood so that they can be addressed in interventions as appropriate. Drug use, abuse, and dependence often co-occur with delinquency and criminal behavior, interpersonal violence, mental health problems, HIV, other sexually transmitted infections, and reproductive health problems. Therefore, understanding the prevention of co-occurring problems and their contribution to elevated levels of risk is important to NIDA's mission.
Such research also examines domains pertaining to the availability, utilization, appropriateness, and cost-benefit/cost-effectiveness of prevention interventions and services. In preparation for large scale prevention services research projects, pilot studies often are needed to empirically validate the feasibility of intervention and implementation protocols, implementation and fidelity measures and monitoring systems, as well as training and implementation methodologies. Such pilot studies would be appropriate for support under this FOA. This FOA encourages feasibility research on the following and related topics:Evaluating the feasibility of integrating drug and alcohol prevention interventions and strategies into pre-existing infrastructures and systems such as medical settings (e.g., primary healthcare, obstetrics and gynecology, pediatrics, adolescent medicine, HIV/STI clinics, AIDS service organizations, emergency departments) and other service systems, particularly where high risk populations are found (e.g., child welfare, foster care, justice) Developing and feasibility testing models for implementing efficacious and effective prevention interventions in real world service settings and systems, such as healthcare, schools, workplaces, justice, militaryDeveloping and feasibility testing innovative strategies and models for improving key implementation processes: adaptation and customization processes, implementation fidelity, sustainabilityDetermining the feasibility of innovative strategies for training and retaining prevention personnelEvaluating the feasibility and acceptability of integrating screening and combined biomedical and behavioral strategies for HIV prevention in populations where alcohol and drug use often occurs Feasibility and pilot testing innovative technology and communication strategies and platforms (e.g., eHealth, mobile and portable devices, social media) for integrating and delivering efficacious prevention interventions into healthcare and other settings and infrastructures, such as schools, workplaces, recreational settingsDeveloping and pilot testing innovative strategies and models that address organizational and/or workforce factors, or financing to improve implementation and sustainability of evidence-based drug abuse prevention interventions in systems and settings.Special ConsiderationsWomen and Gender: Accumulating epidemiological research indicates that risk and protective factors for drug and alcohol use and drug and alcohol use problems often differ in males and females.