Substance use prevention research funded by the NIH.

BACKGROUND: Substance use is a leading preventable cause of death in the U.S. The National Institutes of Health (NIH) provides public funding to advance understanding on the causes of substance use disorders and apply that knowledge to improve public health through research that develops new and improved strategies to prevent substance use. The purpose of this study was to characterize substance use prevention research funded by the NIH. METHODS: Leveraging a dataset of NIH-funded prevention research, we identified grants studying substance use during 2012-2017. We coded the substances and types of prevention research studied in these grants. We generated descriptive statistics and estimated trends using weighted data representing the entire NIH substance use prevention research portfolio. RESULTS: Approximately 2.4% of all NIH research awards focused on substance use prevention during 2012-2017, with most focused on Epidemiologic Research. Alcohol and Nicotine were the top two substance categories studied. Marijuana prevention research showed a significant upward trend in funding over time (p = 0.002). Among studies of College Students and Military/Veterans, over three-quarters focused on Alcohol. Studies of Pregnant/Port-partum Women mostly focused on Nicotine. CONCLUSIONS: While substance use is a leading cause for morbidity and mortality, substance use prevention grants comprised a small portion of NIH's research portfolio during 2012-2017. These grants demonstrated breadth in the substances studied and the types of prevention research. Opportunities for further study are discussed.

Age of onset and temporal sequencing of lifetime DSM-IV alcohol use disorders relative to comorbid mood and anxiety disorders.

CONTEXT: Understanding the temporal sequencing of alcohol use disorders (AUDs) and comorbid mood and anxiety disorders may help to disentangle the etiological underpinnings of comorbidity. Methodological limitations of previous studies, however, may have led to inconsistent or inconclusive findings. OBJECTIVE: To describe the temporal sequencing of the onset of AUDs relative to the onset of specific comorbid mood and anxiety disorders using a large, nationally representative survey. RESULTS: AUD onset tended to follow the onset of 2 of the 9 mood and anxiety disorders (specific and social phobia). The onset of alcohol abuse tended to precede the onset of 5 of the 9 mood and anxiety disorders (GAD, panic, panic with agoraphobia, major depression, and dysthymia), whereas the onset of alcohol dependence tended to precede the onset of only 2 of the 9 mood and anxiety disorders (GAD and panic). Lag times between primary and subsequent disorders generally ranged from 7 to 16 years. Comorbid individuals whose alcohol dependence came after panic with agoraphobia, hypomania, and GAD had increased risk of persistent alcohol dependence. CONCLUSION: Alcohol abuse, but not dependence, precedes many mood and anxiety disorders. If the primary disorder does in fact play a causative or contributing role in the development of the subsequent disorder, this role can best be described as "temporally distal." However, in assessing the risk for persistent alcohol dependence, clinicians should not only consider the type of comorbid mood/anxiety disorder, but also the temporal ordering of these disorders.

Alcohol abuse and dependence in college and noncollege samples: A ten-year prospective follow-up in a national survey.

OBJECTIVE: This prospective study examines the association of educational status in 1984 and the risk for past-year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol-use disorders (AUDs) in 1994, 10 years later. METHOD: A sample of 8,661 respondents was drawn from the National Longitudinal Survey of Labor Market Experience in Youth. Measures included baseline heavy episodic drinking, alcohol-dependence symptoms, early problem behaviors (antisocial behaviors, illicit substance use, family history of alcoholism, and age at onset of alcohol use), demographic characteristics (gender, race/ethnicity, age, marital status), and 1994 assessment for past-year DSM-IV AUDs. RESULTS: Findings from this 10-year prospective study indicate that education beyond high school had a protective effect for alcohol dependence, and dropping out of high school resulted in an elevated long-term risk for alcohol dependence. These associations remained significant when other early behavioral problems were included in the models. CONCLUSIONS: The risk of alcohol dependence and, consequently, the need for appropriately tailored prevention efforts is greater among high school dropouts and college nonattenders than among college students, although much of the current literature has focused on the latter.

Services integration and cost-effectiveness.

Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these services. This symposium presents some recent studies in this area. The small but growing body of studies in this area has great potential to inform public policy debates.