Services Research at NIDA Future Directions Funding

							      Services Research at NIDA
Future Directions & Funding Opportunities


              Beverly Pringle, Ph.D.
      Acting Chief, Services Research Branch

 Division of Epidemiology, Services & Prevention Research
              National Institute on Drug Abuse
         Department of Health and Human Services
                      October 7, 2004
                 SRB Staff
• Bill Cartwright, Ph.D. – Economics
• Redonna Chandler, Ph.D. – Criminal Justice, DSM
• Jerry Flanzer, Ph.D. – Primary Care, Homelessness
• Bennett Fletcher, Ph.D. – CJ-DATS
• Tom Hilton, Ph.D. – Organization &.Management
• Dionne Jones, Ph.D. – Gender Issues, Rural Care
• Noble Jones, M.A. – Adolescents, Bioethics
    Services Research & Related
     Program Announcements
• PA-01-097 Drug Abuse Health Services Research
• PA-01-013 Economics of Drug Abuse Treatment and
  Prevention Services
• PA-03-011 Services Research in the National Drug Abuse
  Clinical Trials Network
• PA-02-164 Economic Evaluation of Drug Abuse
  Treatment and Prevention Services for HIV/AIDS
• PA-04-153 Health Disparities Among Minority and
  Underserved Women
• PA-04-061 Research on Rural Mental Health and Drug
  Abuse Disorders
• PA-03-139 Women, Gender Differences and Drug Abuse
    NIDA’s Services Research Mission

Multidisciplinary field of scientific inquiry that:
 Examines how:                            Affect:

Social Factors                    Access & Utilization
Financing
                                  Quality of Care
Organization
Management                        Cost of Care
Technologies                      Outcomes: Public
Behaviors                         health & well being

For individuals, families, organizations & institutions,
           and communities & populations
                  SRB: 2005 Priorities
Research Domains:       Organization & management
                        Economics
                        Technology transfer


Research Contexts:      Chronic relapsing nature of substance abuse
                        Co-occurring conditions, including HIV/AIDS
                        Alternative treatment settings


Research Methods:       Rigor, appropriate designs


Researchers &           New investigators
Research Environments: Transdisciplinary research teams
          Overarching Theme:
          Maximize Return on
              Investment
• Conduct secondary data analyses.
• Embed questions, measures, &
  novel topics within existing
  research (e.g., CTN).
• Build on studies in other institutes.
• Examine existing programs (e.g.,
  SAMHSA, State Initiatives).
 Services Research in the CTN
• Economic Evaluations in the CTN:
  Methods & Applications (Sindelar)
• CTN Membership & Adoption of
  Innovative Treatment Practices (Roman)
• Organizational Processes in Treatment
  Programs (Arfken)
• Cost-Effectiveness Analysis in the CTN:
  Buprenorphine/Naloxone Treatment for
  Opioid Addicted Youth (Polsky)
        #1 Research Domains


• Organization &
  Management


• Economics

 http://www.drugabuse.gov/about/organization/nacda/HSRReport.pdf
  Economics & Organization/Management


Typical prevention and treatment practitioner
questions about a new intervention:


     “What will it cost?”
     “What is the benefit that can be expected?”
     “How will this fit into my organization?”
Buprenorphine for treatment of concurrent opiate
   and cocaine dependence (Montoya, 2004)
Possible Economics Questions For the
         Buprenorphine Trial

• What is the cost of treatment (i.e.
  without research costs)?


• Is the daily16-mg dose more cost-
  effective than the daily 8-mg dose for
  opiate reduction? What about for
  cocaine reduction?
        #1 Research Domains


Technology Transfer
– to measurably
impact public health
prevention and
treatment outcomes


                       http://nihroadmap.nih.gov
  Evidence of efficacy is necessary
          but insufficient

Client                       Organization
Access and                   Structure
Engagement                   and Climate


               Tx Efficacy
                             External
Provider                     Environment
knowledge                    (stigma,
and behavior                 financing)
 Research Domains:
Technology Transfer
        DA-05-002
  Enhancing State Capacity
   to Foster Adoption of
  Science-Based Practices

 FY05 $1.35m RFA with SAMHSA
         18 applications –
 to be reviewed December 2004
       #2 Research Contexts
• Chronic & relapsing
  nature or substance
  abuse
• Co-occurring
  conditions, including
  new issues in the
  emerging HIV/AIDS -
  drug abuse nexus
• Many treatment
  settings
Co-occurring Conditions & Alternate
        Treatment Settings
                  DA-04-006
   Prevention and Treatment of Drug Abuse
           in Primary Care Settings
        $3.6m RFA with SAMHSA & AHRQ
                7 grants awarded

               DA-04-015
       HIV/AIDS Among Drug Users
        in Criminal Justice Settings
                   $1.5m RFA
                6 grants awarded
       #3 Research Methods

• Attention to fit between research questions
  and study design


• Randomized trials where appropriate &
  feasible


• Nonexperimental methods that permit
  greater causal inference
      #4 Researchers &
    Research Environments
Develop             Develop new services
transdisciplinary   research investigators.
research teams to
better elucidate
this chronic
condition, its
prevention, and
treatment.
Division of Epidemiology, Services
      & Prevention Research




    Providing a foundation for
   NIDA’s public health mission
           DESPR Organization
                 EPIDEMIOLOGY
                   RESEARCH
                    BRANCH




               OFFICE OF THE
                 DIRECTOR
                 ANALYTIC UNIT
                  WORKGROUPS
                     AIDS/HIV
                  Health Disparities
               Translational Research
SERVICES         Research Training
                                        PREVENTION
RESEARCH                                 RESEARCH
 BRANCH                                   BRANCH
  Priority Areas for NIDA
• Prevention Research (Children/Adolescents)
   –   Genetics
   –   Development
   –   Environment
   –   Co-morbidity
• Treatment Interventions
   – New Targets & New Strategies
• HIV/AIDS Research
• Criminal Justice, Health Disparities,
  Prescription Drug Abuse
• Collaborations with Other NIH Institutes and
  Other Federal, State and Local Partners