Understanding & Treating Co-Occurring Conditions: A Major Research Priority for NIDA
Nora D. Volkow, M.D.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, stressed that drug addiction is a complex interplay of the chronic effects of drug administration, biological factors (including genetics), and environmental factors. She discussed three
of NIDA’s current priority areas: (1) prevention research aimed at children and adolescents, which includes areas of genetics, development, environment, and comorbidity; (2) treatment development, utilization of treatment strategies, and elimination of translational bottlenecks between publishing important research findings and testing treatments in clinical trials; and (3) HIV/AIDS research and drug addiction as it relates to the HIV/AIDS epidemic. Volkow explained that drug addiction is a developmental disease that starts in early adolescence. NIDA aims to examine whether drug addiction affects the adolescent brain differently than an adult brain, and learn why addiction begins in the early stages of development. Volkow also highlighted data on the prevalence of comorbidity between smoking and certain mental disorders and addictions, and how comorbidity has directly influenced the field of health services research and treatment.
A Socio Cultural Framework for Mental Health and Substance Abuse Service Disparities Research with Multicultural Populations
Margarita Alegria, Ph.D.
Dr. Margarita Alegria, professor of psychiatry at Harvard University and director of The Center of Multicultural Mental Health Research at Cambridge Hospital, presented a sociocultural framework of mental health and substance abuse service disparities with multicultural populations.
Racial and ethnic minorities have less access to substance abuse and mental health services, are less likely to receive needed care, and are more likely to receive poor quality care when needed. There are currently no models to facilitate the understanding of mental health and substance abuse disparities for ethnic and racial minorities.
Alegria’s team expanded the IOM definition of service disparities by postulating six, rather than two, sources of service disparities and by including access-related factors, which were discussed at length. Alegria presented information on how the use of specialty care by poor Latinos is effected by poverty and minority status and the percentage of Medicaid patients receiving various types of treatment for depression 6 months after diagnosis (by ethnicity). Alegria also touched on healthcare policies and regulations at the state and Federal levels, healthcare market forces, community systems, provider/clinician stereotyping, and patient- and family-level factors of healthcare disparities.
Drug-Involved Women and HIV: Co-Occurring Risk Factors
Nabila El-Bassel, Ph.D.
Dr. Nabila El-Bassel, professor at Columbia University and director of The Center for Intervention and Prevention Research on HIV and Drug Abuse, presented information on incidence disparities in HIV/AIDS among women in the United States; co-occurring risk factors for HIV among African-American and Hispanic drug-involved women; and implications for HIV prevention, intervention, and services for drug-involved women. Her data included new AIDS cases and rates among women by race/ethnicity (White, Black, Hispanic, Asian/Pacific Islander, American Indian/Alaska Native); prevalence of HIV/AIDS among women in the U.S.; and AIDS incidence by region, race/ethnicity,
and exposure category. Some risk factors El-Bassel covered were ontogenetic and interpersonal factors including history of childhood sexual abuse, post-traumatic stress disorder, drug use, and intimate partner violence. Structural factors involved lack of access and availability to women-specific treatment and services, and macro factors addressed economic and social power imbalances, attitudes toward drug-involved women, and sexual gender roles.