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Assessing the Impact of Childhood Interventions on Subsequent Drug Use Home
Assessing the Impact of Childhood Interventions
on Subsequent Drug Use
skip navigation About the Conference
Richard Millstein, J.D.
Deputy Director
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 disorders—premorbid to substance abuse—are 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 many—both 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.

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