Don’t Cut Drug-Abuse Research, Experts Tell Hill Staffers

Congress must continue to support National Institutes of Health (NIH) research efforts to improve effective treatments, ease dissemination, and use technology to help military personnel and their families deal with substance abuse in the aftermath of the conflicts in Iraq and Afghanistan, researchers and health officials told congressional staff at a briefing in Washington, D.C., March 12.

The Capitol Hill briefing was organized by the Friends of the National Institute on Drug Abuse. APA was a cosponsor.

“Many of our returning service members have multiple problems, but pain is number one,” said Michael Kilpatrick, M.D., deputy director of force health protection and readiness programs for the Office of the Deputy Assistant Secretary of Defense for Force Health Protection and Readiness. “We have to take care of that first, without leading them toward addiction.”

Better battlefield medicine has helped more troops survive serious injury, but that also means that more live with chronic physical pain and consequent prescription of muscle relaxers, sedatives, and opiate pain relievers, with attendant potential for abuse, pointed out Wilson Compton, M.D., M.P.E., director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse (NIDA).

“There has been an especially marked increase in the misuse of prescription drugs since 2002,” he said. “Chronic pain increases the risk of mental health disorders, including substance abuse disorders.”

Furthermore, mild traumatic brain injury (mTBI), even without a concussion diagnosis, affects the orbitofrontal cortex, which is also implicated in the onset and progression of addictions, said Compton.

Rates of illicit substance use in military populations are low because of longstanding zero-tolerance policies, but age-adjusted rates of smoking and binge drinking are greater than in the civilian world, Compton noted.

“Substance abuse complicates other problems and disorders, especially PTSD, TBI, and depression,” added Kathleen Carroll, Ph.D., a professor of psychiatry at Yale University School of Medicine.

Overcoming those problems calls not only for better treatments but for moving out treatments known to work to clinics and patients, she emphasized, noting three issues are now being studied by researchers funded by NIDA.

“First, we need to know if treatments that work for one disorder will work with patients who have multiple problems,” she said. Research funded by NIDA and by the Department of Veterans Affairs (VA) has shown, for example, that integrating PTSD and substance abuse treatment speeds recovery from both.

Second, moving proven evidence-based treatments into widespread clinical practice may not be easy, but it is possible, she said. She cited the case of “contingency management,” the concept of rewarding the patient for doing the right thing, such as taking medications or avoiding use of illicit drugs. The VA held four national training sessions on using contingency management and added follow-up telephone support and a commitment from management, she noted. Results among the 800 veterans enrolled in the study so far show that 91 percent have tested negative for drugs.

Third, technology must be used to increase access and reduce the cost of providing evidence-based treatments, said Carroll. Web-based therapies can be standardized and are confidential and available to veterans in remote locations on their own time.

She cautioned that “we have to carefully test Web-based treatment programs and remember that technology is a ‘therapist extender,’ not a replacement for therapy or therapists.”

Compton noted that NIH and the Department of Defense have recently called for research proposals about health promotion and prevention interventions to reduce onset and progression drugs of abuse and related mental and physical health problems.

“Please support continued NIH research efforts to improve the quality and access of treatment and prevention for military personnel, veterans, and their families,” Carroll said at the briefing’s end. ■

A NIDA publication titled “Substance Abuse in the Military” is posted at http://www.drugabuse.gov/publications/drugfacts/substance-abuse-in-military.