This is an archive page. The links are no longer being updated.
Hearing before the
Senate Committee on the Judiciary
"Treatment, Education, and Prevention:
Adding to the Arsenal in the War
Alan I. Leshner, Ph.D.
National Institute on Drug Abuse
March 14, 2001
Dirksen Senate Office Building
Mr. Chairman, and Members of the Committee, it is a great pleasure to be here today to share
with you what we have been learning from science about the nature of drug abuse and addiction,
and their prevention and treatment. Scientific advances supported by the National Institute on
Drug Abuse (NIDA) are coming at an extraordinary rate and are significantly influencing the
way this Nation approaches drug abuse and addiction. We are seeing science, rather than
ideology, intuition, or common sense, beginning to drive the national discourse on these issues.
As you and members of this Committee are well aware, drug abuse and addiction take a
tremendous toll on our Nation and their consequences are pervasive throughout every aspect of
society. Drug use is a major factor in crime and delinquency, and in some communities, drug use
is now the major vector for the spread of HIV/AIDS, tuberculosis and hepatitis. The good news
in this grim and extremely costly scenario is that scientific advances both in the laboratory and in
the clinical setting are providing us with tools to slow the drain of drugs on society. For
purposes of today's discussion, my comments will be directed to all substances of abuse with the
exception of alcohol, whose purview is that of another NIH Institute.
Research has brought us to the conclusions that drug abuse is a preventable behavior and that
addiction is an eminently treatable disease. We have gained greater insight into why people use
drugs in the first place. For example, we now know there are at least two major categories of
drug users, and, importantly, they are clearly distinguishable. One group includes people who are
simply novelty seekers, using drugs solely for their sensational effects. The second group is
using drugs as if they are anti-anxiety or anti-depressant substances, trying to compensate for
untreated mental disorders like depression or for terrible living situations such as dysfunctional
families. The prevention and treatment approaches directed at each group differ significantly.
For individuals self-medicating, for example, attention must be paid to the underlying mental
disorder or emotional state, as well as to the substance of abuse. Similarly in prevention,
messages must be developed that are targeted to the individual's motivation to use drugs.
We have learned in tremendous specificity the biological mechanisms by which drugs of abuse
exert their psychoactive effects. Two decades of research have spelled out in great detail the
brain mechanisms by which each drug of abuse changes mood, perception, or emotional state.
Moreover, although each drug has its unique way of changing the brain, they all also share
critical common characteristics. Virtually every drug of abuse, including nicotine, marijuana,
cocaine, heroin, and methamphetamine, elevates levels of the neurotransmitter dopamine in the
brain pathways that control the experience of pleasure.
Prolonged use of these drugs eventually changes the brain in fundamental and long-lasting ways,
explaining why people cannot just quit on their own, why treatment is essential. In effect, drugs
of abuse take over, or "highjack" the brain's normal pleasure and motivational systems, moving
drug use to the highest priority in the individual's motivational hierarchy, which overrides all
other motivations and drives. These brain changes, then, are responsible for the compulsion to
seek and use drugs that we have come to define as addiction. Moreover, these brain and
behavioral changes persist long after the individual has stopped using drugs. As one example,
just last week, researchers reported in the American Journal of Psychiatry that methamphetamine
abusers who were drug-free for up to eleven months still had significant memory and
coordination deficiencies that were directly tied to brain changes produced by their prior drug
use. (SEE FIGURE 1)
Findings like these not only increase our understanding of addiction but also help point us to
even more effective new treatments. In fact, NIDA has already developed and brought to the
clinic an array of both behavioral and pharmacological treatments for addiction and has
demonstrated their effectiveness in clinical trials. Numerous studies have shown that addiction
treatments are just as effective as those for other illnesses. One very important analysis recently
published in the Journal of the American Medical Association (JAMA, October 4, 2000) clearly
shows that addiction treatments work just as well as treatments for other chronic, relapsing
illnesses such as asthma, hypertension, and diabetes. In this analysis, treatment compliance,
drop-out rates, and relapse rates were similar for all four diseases. In short, addiction treatment
success rates are comparable to those for other chronic illnesses.
Our research also shows that comprehensive treatments that focus on the whole individual, and
not just on drug use, have the highest success rates. These programs provide a combination of
behavioral treatments, medications, and other services, such as referral to medical, psychological,
and social services. The array of services provided must be tailored to the needs of the individual
Scientific discoveries are also fueling the development of more successful strategies to deal with
addicted criminal offenders. The core phenomenon is that untreated addicted offenders have
extremely high rates of post-release recidivism both to drug use and to criminality. However,
providing science-based treatments while offenders are under criminal justice control can
dramatically reduce recidivism, again both to drug use and to later crime. Thus, understanding
addiction as a treatable, chronic illness has beneficial ramifications for our national drug control
efforts. The blended public health/public safety approach of dealing with addicted offenders
benefits not only the patient, but the family and community as well.
Perhaps the most visible example of the blending of public health and public safety approaches
can be seen by the growing number of drug courts that have been established over the years.
More than 600 drug courts, which mandate and arrange for treatment, monitor progress, and
arrange for other necessary services as needed, are currently operating across the country. NIDA
is currently supporting research that is looking at the effectiveness of some of the different drug
court approaches that are being utilized.
To truly reap the benefits of this blended public health/public safety approach it is imperative
that we adhere to science-based principles of effective drug treatment. Not just anything called
treatment will do. For example, studies in states such as Delaware and New York have shown
that comprehensive treatment of drug-addicted offenders, when coupled with treatment after
release from prison, can reduce drug use by 50 to 70% when compared to those who are
untreated. Treated offenders are also 50-60% less likely to end up back in prison. These findings
hold true for at least four years after release. However, if the after-care component is left out, the
effects of in-prison treatment are dramatically reduced. In addition, the treatment provided must
be comprehensive. It must attend to all the needs of the individual and help return him or her to
becoming a fully productive member of society. This means that a continuum of care is crucial
for success, including offering treatment and services to individuals as they transition to the
In the same way that we have developed and sent to the field general principles that define
effective addiction treatment, we are now laying out the principles of effective corrections-based
treatment which should be available within the year. In the interim, we recommend that the
corrections systems use our widely acclaimed publication Principles of Effective Drug Addiction
Treatment as a guide in developing and evaluating programs.
Research has also shown that drug addiction treatment programs that adhere to scientific
principles benefit not only the patient and his immediate community, but the larger society as
well. Besides reducing criminality, as I just mentioned, our studies have established that drug
treatment reduces the spread of infectious diseases such as HIV and hepatitis C, and restores the
ability of addicted individuals to be functioning, contributing members of society. Science-based
treatments are also extremely cost effective, since they can save millions of dollars that would
have been spent on the public health and safety consequences of drug abuse and addiction.
NIDA-supported science is not only helping us to deal with already addicted individuals, but is
also steadily improving our ability to prevent the initiation of drug use. You may recall that in
March 1997 we published the first-ever science-based guide to drug abuse prevention,
Preventing Drug Use Among Children and Adolescents, that spelled out the principles that
account for effective drug abuse prevention programs. Subsequent research has provided
important details for effectively implementing those principles in diverse American communities
and populations. Thus, we are currently updating the book to reflect new findings, and we plan
to release it at our National Prevention Conference later this summer.
Advances in the prevention arena showing great promise to help prevent initial drug use are
coming from researchers closely studying what makes people more susceptible or vulnerable to a
potential drug problem. No single, unique factor determines which individuals will use drugs;
rather, drug abuse appears to develop as the result of a variety of genetic, biological, emotional,
cognitive, and social risk factors.
As researchers continue to identify risk and protective factors, the challenge becomes to
understand how these factors interact to make individuals more or less vulnerable to not only
initially trying drugs, but also abusing drugs and/or going on to become addicted to drugs.
As with treatment programs, tailoring prevention programs to an individual's needs is critical.
For example, researchers who are specifically targeting programs to youth who may be more
vulnerable to drug use are showing promising results. NIDA-supported scientists recently
reported that they could reduce marijuana use among a targeted group of teens by focusing on
their specific underlying emotional styles. We have learned that this kind of motivation-directed
message targeting is critical to the success of prevention efforts. By developing and targeting
prevention interventions such as public service announcements to specific teen personality-types
who are sensation-seekers, researchers were able to reduce marijuana use by over 25%.
These research findings, which can help reduce the Nation's overall drug use, are being shared
with the broadest audiences possible. NIDA has an aggressive media and education campaign to
disseminate our research findings and to educate the public about what science is teaching us
about addiction. One example of this can be seen in a recent outreach activity in which we
developed and mailed a "NIDA Clinical Toolbox" to nearly 12,000 drug treatment programs
around the country. The toolbox provides treatment professionals with a wealth of materials on
new and effective approaches to help patients with drug-related problems.
Another example of how we are disseminating and sharing our research findings can be found in
the way we have established our National Drug Abuse Treatment Clinical Trials Network (CTN).
Through our CTN, which now consists of 14 research centers geographically distributed across
the country who work with over 80 different community treatment providers, we are able to
rapidly disseminate new research findings. Each Center, working with its partner community
treatment providers, has established specially designed clinical research training programs and
clinical education programs for local treatment providers. Because of the scope of the CTN,
NIDA is confident it has created the infrastructure and enthusiasm that will enable the quickest
implementation of new therapies and intervention strategies possible across the entire Nation.
This clinical trials network will be central to achieving our millennial goal of improving the
quality of drug abuse treatment throughout the Nation using science as the vehicle.
I hope the examples I have provided in this statement demonstrate NIDA's commitment to
having science replace ideology, intuition and common sense as the primary basis for our
national discourse on drug abuse and addiction. The advances that continue to emerge from our
research portfolio are providing us with renewed hope that we will be able to prevent initial drug
use and have a full clinical toolbox of treatments to offer those who do become addicted.
Thank you for the opportunity to testify before this Committee. I will be happy to respond to any
questions you may have.