Prevention Research at the National Institute on Drug Abuse

Eve E. Reider, Ph.D.

August 5, 2013

Mission

NIDA’s Prevention Research Branch supports a theory driven program of basic, clinical, and services research across the lifespan to reduce risks and prevent the initiation and progression of drug use to abuse and prevent drug-related HIV acquisition, transmission and progression.

Approach

Bio, Psycho, Social Behavioral Approach to Prevention

= Whole Person

In Context Across the Life Course

Family

Surrounding Context

Cultural, Economic and Political Factors

TIME

School

Work

Prevention Intervention Development

Attachment Theory

Personality Theories

Learning Theories

Identity Theory

Developmental Theories Life Course

Theory

Social Cognitive Theory

Family Systems Theories

Ethology

Some Theories Contributing to Prevention Intervention Development

Target Group Characteristics

• Genetic Vulnerability • Gender • Learning Style • Developmental Status • Sexual Orientation • Race/Ethnicity • Geographic Location • Socio-economic status

Levels of Risk

• Universal • Selective • Indicated • Tiered

Environments and Level of Risk

Family Peer group School Community Workplace Clinic Media Policy

Foster Care WIC Juvenile Justice

Pre-natal Clinics Rape Clinics STD Clinics

Continuation Schools

College Drug Violation Programs

Universal Selective Indicated

Age Risk

How do Prevention Interventions Work

MODERATORS

MODIFIABLE RISKS

INTERVENTION

Age Gender Race/ethnicity Poverty level

Early aggression Social skills deficit Academic problem Misperceived drug use norms Association with deviant peers Neighborhood availability Media glamorization

Parent skills training Social skills training Tutoring Norms training Refusal skills Community policing Health Literacy

Prevention Approaches Aim to Enhance Protective Factors & Reduce Risk Factors

Reduce these Elevate these

Intervention Strategy

Emotional Regulation Social Skills Academic Competency Resistance Skills Parenting Skills Normative Change Surrounding Environment Change (e.g., Family, Teacher/School, Practitioner Training) Larger Environment Change (e.g., Alcohol, Tobacco, RX, Drugged Driving Policies)

Intrapersonal

Interpersonal

Prevention Research Branch:

Important Findings

Infancy

Nurse Family Partnership – Age 12 Kitzman et al.,Arch Pediatr Adoles Med, 164(5) 412-418, 2010

Olds et al., Arch Pediatr Adoles Med, 164(5) 419-424, 2010

0

1

2

3

4

5

6

Nurse Comparison0

1

2

3

Nurse Comparison

Percent of Children Who Used Tobacco, Alcohol, or Marijuana (Last 30 Days)

Percent of Mothers with Role Impairment

due to Alcohol or Drug Use

P = .04 OR = 0.31

P = .04

Early Childhood

• ***Higher scores on academic achievement ages 5 & 7.5 (Woodcock-Johnson)

• ****Faster rate of growth in child inhibitory control from ages 2 to 9.5 (Rothbart scale)

• These improvements typically mediated by improvement in positive behavior support or child disruptive behavior in early childhood

Intervention findings from Early Steps Multisite Study Family Check Up: Follow-up to Age 9.5

*Dishion, Brennan, Shaw et al., 2013 **Sitnick et al., 2013 ***Brennan, Shaw et al., in press ****Chang, Shaw et al., 2013

Elementary School Years

The Good Behavior Game: Drug Abuse or Dependence Disorders for Males in Young Adulthood

0

.2

.4

.6

.8

1 2 3 4 5 6

Pro

babi

lity

of D

rug

Abu

se/D

epen

d

Teacher Ratings of Aggression: Fall of 1st Grade

GBG (n = 72 ) All Controls (n = 134 )

Kellam et al. (2008). Drug and Alcohol Dependence 95 S, S5-S28.

Transition to Middle School

Sixth Graders in Middle School Behave Worse than Sixth Graders in Elementary School

Predicted Probability of Infraction

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

4 5 6 7 8 9

Grade

Attended 6th inElementary

Attended 6th inMiddle

95% CI

Duke Univ TPRC - P20 DA017589 - Philip Cook, Robert MacCoun and Clara Muschkin (2008). The Negative Impacts of Starting Middle School in Sixth Grade. Journal of Policy Analysis and Management, 27: 104-121

Source: n = 76,915 - Administrative database covering all public schools and students in the state of North Carolina. The indicators of behavioral problems are derived from a statewide database of disciplinary infractions recorded during the 2000-2001 academic year. Each disciplinary report reflects a decision on the part of a school official (usually a teacher) of whether to “write up” a student for misbehaving, and then a decision on the part of the principal of whether to report to the state.

Middle School

Effects of Preventive Intervention on Lifetime Prescription Drug Use: Data from 2 Studies

8.7

3.1

4.6

1.3 0.6

0 0

2

4

6

8

10

12

NarcoticMisuse

BarbiturateMisuse

ControlPDFYISFP

7.7

10.5

6.6

8.3

3.9

7.7

0

2

4

6

8

10

12

PD Misuse(11th)

PD Misuse(12th)

Control

LST

LST+SFP10-14

Adapted from Spoth, Trudeau, Shin, & Redmond (2008).

High School and Young Adulthood

Project TND: No Effects for Self-Instruction Condition

00.10.20.30.40.50.60.70.80.9

1

tobacco alcohol marijuana harddrugs

health educatorself instruction

p=024

.

Sussman, Sun, McCuller & Dent. (2003). Project TND: Two-year outcomes comparing health educator delivery to self-instruction. Preventive Medicine, 37 (2), 155-162.

Odds Ratios

p=.016

Adult Years

Video Doctor: Health In Pregnancy Discussion of Risks by Randomization

60.0% 15 6 9 Control

100.0% 19 0 19 Intervention

Tobacco **

23.5% 17 13 4 Control

85.0% 20 3 17 Intervention

Total No Yes Domestic Violence *

Discussed with provider

* p = 0.0002 ** p = 0.0037

Humphreys et al., 2011, Women’s Health Issues, 21 (2), 136-144; Calderon et al, 2008, Am J Prev Med 2008;34(2):134–137

New Video Doctor Makes House Calls

• Launch of Video Doctor for service members, veterans and their families

• Anonymous, web-based program that gives the opportunity to consult with a video doctor about depression, anxiety, PTSD, alcohol, bipolar disorder, and brief screen for adolescent depression

• Asks about symptoms and readiness to change

• Provides self-care tips and recommendations on how and where to access mental health resources

• www.militarymentalhealth.org

Prevention of Drug Misuse in Chronic Pain:

Therapeutic Interactive Voice Response

Naylor et al. (2008) Pain, 134, 335–345

High Risk Populations Benefit the Most: Effects of a Brief Intervention for Rape Victims on Marijuana Use

Do EBIs implemented on a wide scale, under real world conditions,

have positive outcomes?

PMTO Fidelity Across Generations Certification

56

78

29 54 68N=

G1 G2 G3

Forgatch & DeGarmo, 2011, Prevention Science, 12, 235-246. 31

ADAPT = After Deployment: Adaptive Parenting Tools

• Grant funded through military RFA-DA-10-001

• PMTO adapted for military families and culture

• Web-enhanced, group-based format

• Targets common post-deployment adjustment reactions

• Focuses on emotion regulation within a parenting context

Gewirtz, Erbes, Polusny, Forgatch, & DeGarmo. (2011). Helping military families Through the deployment process: Strategies to support parenting. Professional Psychology, 42,56-62.

Communities That Care

Creating

Communities That Care

Get Started

Get Organized

Develop a Profile Create a Plan

Implement and Evaluate

24 Communities; ~45,000 participants

Fagan, Hawkins & Catalano, 2007; Quinby et al, 2007

-0.3

-0.2

-0.1

0.0

0.1

0.2

0.3

5 6 7 8 9 10

Targ

eted

Risk

Fac

tor S

core

Grade

Control CTC

CTC Change in Targeted Risk Factors

Note. Observed means averaged over 40 imputations. N = 4407

p < .05

ns

Hawkins et al., 2011, Archives of Pediatrics and Adolescent Medicine

Summary • Compared to control communities, 10th

graders in CTC communities showed:

– Lower incidence of delinquent behavior, alcohol use, and cigarette use.

– Lower prevalence of past-month cigarette use.

– Lower prevalence of past-year delinquency

– Lower prevalence of past-year violence. Hawkins et al., 2011, Archives of Pediatrics and Adolescent Medicine

PROSPER Partnership Model

State Management Team

Prevention Coordinator Team

Local Community Teams Linking Extension and Public School Systems

PROSPER Impact on Illicit Substance Use Index

Spoth, Redmond, Shin, Greenberg, Feinberg, et al. (2013). Preventive Medicine, 56, 190-196.

Reduced Growth in Use Through 6½ Years Past Baseline

0.00

0.50

1.00

1.50

2.00

2.50

Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

Control

Intervention

PROSPER Illicit Substance Use Index: Higher- vs. Lower-Risk Subgroups

Spoth, Redmond, Shin, Greenberg, Feinberg, et al. (2013). Preventive Medicine, 56, 190-196.

Trajectories Through 6½ Years Past Baseline

0.00

0.50

1.00

1.50

2.00

2.50

3.00

Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

Higher-Risk in Control

Lower-Risk in Control

Higher-Risk in Intervention

Lower-Risk in Intervention

Are Drug Abuse Preventions Cost-Beneficial?

Drug Abuse Prevention can be

Cost Beneficial

• Nurse Family Partnership: $2.88 saved for each dollar invested.

• Seattle Social Development Project : $3.14 saved for each dollar invested.

• The Good Behavior Game: $25.92 saved for each dollar invested

Aos et al. (2004). Benefits and Costs of Prevention and Early Intervention Programs for Youth. Washington State Institute for Public Policy.

Participant Taxpaye

r Other TOTAL Smoking $671 $140 -- $812

Delinquency -- $2,033 $2,405 $4,438

Total Benefits $671 $2,173 $2,405 $5,250

Costs $991

Net Present Benefit $4,259

Benefit-Cost Ratio $5.30

1 2

$991

$5,250

Cost Benefit

Benefits & Costs Per Youth

$6,000

$4,000

$5,000

$3,000

$2,000

$1,000

$0

Delinquency $4,438

Smoking $812

CTC Benefit-Cost Analysis

Benefit - Cost Analysis Per Youth

CTC returns $5.30 for every $1.00 invested.

Kuklinski et al. (2012) Cost-benefit analysis of Communities That Care outcomes at eighth grade. Prev Sci. ,13(2), 150-61.

Questions/Discussion