The Search for a Cure

In the past several decades our understanding of addiction and its many aspects has increased at a tremendous rate. We now know that addiction is a complex disorder involving several chemical systems in the brain and that the brains of addicts function in an abnormal manner. We have seen that genes play an important role in a person's vulnerability to addiction. We have also seen that social factors, conditioning, emotional elements, and the characteristics of the drugs themselves contribute to the disease of addiction.

Great strides have been made in the development of effective treatments for addiction. Until the mid-1960s, hospital treatment for alcoholism and drug dependence was almost nonexistent and often consisted simply of medical detoxification and advice that the person stop drinking or using drugs.

We now have more effective therapies and medications that help the addict recover.

But there is much work left to be done. Current research targets several different areas, including the following: (1) epidemiology - tracking the prevalence and types of addictions and who is affected, (2) genetics - identifying addiction genes to discover who is at risk, (3) pharmacology - understanding more fully how addictive drugs work and developing new medications to counteract the effects of addiction, and (4) treatment - devising and testing treatment strategies and measuring outcomes.

Epidemiology

The National Institutes of Health and its divisions on alcohol and drug abuse maintain numerous data collection vehicles concerning all aspects of addiction. (Most of these surveys can be readily obtained on the Web sites listed in appendix B.) A few examples of data collected by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) are the National Hospital Discharge Survey (which tracks alcohol-related illness), information on traffic fatalities and blood alcohol levels provided by the National Highway Traffic Safety Administration and related agencies, alcohol consumption data from state alcohol agencies and the alcoholic beverage industry, and the National Longitudinal Alcohol Epidemiological Survey. A comprehensive listing of current survey reports and the reports themselves can be obtained directly from NIAAA.

The National Institute on Drug Abuse (NIDA) maintains several sources of surveillance data, including the Drug Abuse Warning Network (DAWN) composed of selected emergency rooms, medical examiners, crisis centers, and other agencies.

DAWN tracks illnesses and deaths believed to be the result of addiction and is often able to provide early indications of new trends in drug abuse such as the recent resurgence of heroin addiction. Prescription audits and recapture studies by the Drug Enforcement Administration also provide useful data. (Recapture studies were first done to gather information on wildlife. When an animal is captured, it is measured and tagged, and when recaptured it is measured again.) Identified contacts within the drug community are tracked, and their activities provide useful information about trends in substance abuse. The National Institute of Justice conducts an ongoing survey of arrestees at selected urban sites across the country called the Arrestee Drug Abuse Monitoring Program (ADAM). Data is collected quarterly and includes both an interview and a urine drug screen. The United Nations also tracks several sources of data through its various agencies, including WHO and UNESCO.