National Institute on Drug Abuse
Thank you, Meyer [Glantz], and good morning, everyone.
Yes, the two people are one. And it is my pleasure to welcome you here
to this meeting to focus on the impact of childhood interventions on
subsequent drug abuse, an extremely complex area of drug abuse etiology
that we need to know much more about. Let me start, please, by thanking
everyone. We are really proud that we at NIDA have joined with the National
Institute of Mental Health (NIMH) in sponsoring what promises to be
a most interesting, productive, and, I hope, provocative exchange in
our area of common interest.
A number of people deserve special recognition, including
Dr. Glantz, the meeting Chair; and from NIDA, Drs. James Colliver,
Elizabeth Robertson, Vincent Smeriglio, and Naimah Weinberg,
who will be serving as Session Chairs; and Drs. Lynda Erinoff and
Kathleen Etz for their efforts on the Junior Investigator Committee.
I know that a number of individuals at NIMH were prominently involved
here, too, including Drs. Editha Nottelmann, Doreen Koretz, and
Benedetto Vitiello. Thank you to all of them.
We at NIDA feel very fortunate to have recruited many
of the Nation=s most renowned experts in this area
to help review the knowledge base, to identify research gaps and as
yet untapped sources of potentially useful data, and to provide some
resources for future research. We are hopeful that topics addressed
and the discussion generated over the next few days will encourage and
facilitate research in this novel and necessary area and, more specifically,
identify and explore ways to resolve problematic methodological issues
and motivate those already looking at separate aspects of this complex
picture to extend the breadth of focus in their study designs.
As many of you know, in our attempts to identify and quantify
potential risk factors for drug abuse, NIDA has had a longstanding interest
in assessing the impact of various childhood psychopathologies. In fact,
nearly 3 years ago, in July 1997, we held a workshop to look at the
extent of our knowledge in this area. Back then, following 2 days of
overview and databased, speculative, and synthesizing discussions, the
panel of experts that had been brought together unanimously endorsed
the conclusion that a wide range of diagnosable psychiatric disorderspremorbid
to substance abuseare associated with subsequent substance abuse.
Intuitively, it would then follow that treatment for these disorders
should have a positive impact on reducing later risk for drug abuse;
that is, for some children and adolescents, interventions for existing
psychopathologies may serve as existing drug abuse prevention approaches.
The problem is, of course, that we do not know for certain that this
is always the case and for whom. For example, one possible exception
may be ADHD, the most common childhood Axis I mental disorder.
In recent years one of the major controversies concerning
ADHD, as you know, has centered on the use of psychostimulants to treat
the condition, and the potential abuse liability of these drugs. Psychostimulants,
including amphetamines, methylphenidate, and pemoline, are by far the
most widely researched, clinically effective, and commonly prescribed
treatments for ADHD. And yet, despite evidence documenting these compounds= efficacy in treating ADHD, questions
about the need for or effectiveness of these compounds, and concerns
about the potential for abuse or addiction, remain in the minds of too
manyboth in the public at large and within segments of the medical
community. Again, although there are some data to the contrary, many
worry that use of psychostimulants in childhood can increase an individual=s risk for drug abuse later in life.
Really, then, more research is needed to delineate the long-term benefits
and any potential risks.
The impact of treating other psychopathologies experienced
in childhood also is uncertain. The research, although clearly needed,
has not yet been done. Few if any drug abuse prevention programs target
childhood psychopathologies. Mental health research to develop and test
treatments for psychopathologies in children typically do not look at
long-term substance abuse outcomes.
We at NIDA are interested in exploring a new area of drug
abuse etiology, particularly one that offers additional possibilities
of prevention and early intervention. The approach we are proposing
to take in building a research program in this area is also relatively
unique in that, when possible, we would like to build on programs and
methods that are already in progress. Ongoing trials of mental health
interventions for childhood psychopathologies, for example, might be
extended to incorporate a focus on drug abuse outcomes. We are interested
in developing a program that maximizes the efforts and knowledge gained
by both mental health and drug abuse researchers studying the relationship
between childhood psychopathologies and later drug abuse.
So, on behalf of NIDA, I would like to express my gratitude
to all the meeting participants for your willingness to share your knowledge
and your perspectives on this important issue. Our motive in bringing
together clinicians and researchers, including a number of relatively
young scholars from both the drug abuse and mental health fields, is
to bring a broad array of views and ideas to bear on this issue. By
facilitating an interchange on areas of mutual interest, we hope we
can successfully encourage many of you to incorporate additional issues
into the future research you undertake and help us build this sorely
needed knowledge base. Again, thank you. I look forward to the views
in the presentations and discussions to follow.