www.drugabuse.gov Volume 23, Number 1 U.S. Department of Health and Human Services | National Institutes of Health Behavior Game Played in ALSO IN THIS ISSUE Primary Grades Reduces Later Research Findings 8 Young Opioid Abusers Drug-Related Problems Benefit From Extended Buprenorphine-Naloxone Treatment Positive effects are most pronounced in disruptive boys. 10 Vouchers Boost Smoking Abstinence During Pregnancy BY NIDA NOTES STAFF in the Good Behavior Game (GBG), a classroom 11 Attention to Bipolar activity designed to inculcate appropriate behav- Disorder Strengthens Substance Abuse warding smiley-face stickers to ior during children’s first 2 years in school. Treatment teams of first-graders in Balti- “The GBG gives teachers an effective method more for the good behavior of the of managing behavior in the classroom and of Director’s Perspective 2 Helping Doctors Become individual team members greatly teaching children how to be students,” says Dr. First Responders to Aincreased the likelihood that the students would Sheppard Kellam of the American Institutes for Substance Abuse experience an adolescence free of substance Research in Washington, D.C. Research in Brief abuse and dependence. Teachers gave out the Dr. Kellam and colleagues began the longitu- 3 • Some Teens Reporting stickers and other token rewards and penalties dinal study of the GBG while at Johns Hopkins Nonmedical Use of Prescriptions Develop University in close partner- Dependence Disorders ship with the Baltimore City • Peer Interaction AS THE TWIG IS BENT Young adults who had played the Good Enhances Adolescent Rats’ Behavior Game in first and second grade were less likely to smoke ciga- Public School System. Dr. Drug Reward • Stroop rettesr o abuse drugs than those who hadn’t played the game. Males Kellam suggests that the Test Identifies Patients whose first-grade teachers identified them as aggressive and disruptive at Risk for Treatment benefited the most. activity produces a broad Dropout • Genetic Overlap spectrum of long-term ben- Between Substance Abuse and Bipolar Disorder efits by steering 5- and 6-year- Good Behavior Game Control 4 NIDA at Work olds away from aggressive and 70% NIDA’s Genetics disruptive behaviors, which Workgroup Directs Search for Genes That Influence 60% have long been recognized as precursors of many negative Addiction 50% adolescent and adult out- Bulletin Board comes. The study found that 14 • Dr. Phil Skolnick Now 40% Leads NIDA’s Medications the GBG was protective not Development Efforts only against substance abuse • How-To Guides Provide 30% Tips for Publishing and dependence but also Addiction-Related Articles 20% against teenage delinquency, • Dr. James A. Inciardi antisocial personality disor- (1939–2009) 10% der, and suicide attempts. Tearoff 15 Reality Videos Bring NIDA Prevalence of Problem Behaviors at Age 19–21 Prevalence of Problem Behaviors at Scientists to Web Site for 0 HOW TO PLAY THE GAME Drug Abuse Smoking Drug Abuse Smoking Drug Abuse Smoking Teens Teachers first set the rules All Females All Males Males Disruptive in First Grade of the game, presenting a list 16 What the Numbers Say [ Continued on page 6 ] NIDA Notes | Volume 23, Number 1 1 ■ DIRECTOR’S PERSPECTIVE By NORA D. VOLKOW, M.D., NIDA Director NIDA Notes EDITOR David Anderson Public Health Advisor, Office of Science Policy and Communications, National Institute on Drug Abuse DEPUTY EDITOR Julie Ann Miller, Ph.D. RTI International Helping Doctors Become First MANAGING EDITOR Andrew Keegan RTI International Responders to Substance Abuse SENIOR SCIENCE WRITER Lori Whitten, Ph.D. RTI International very day, the Nation’s primary care and family physicians see patients whose use SCIENCE WRITER Laura Bonetta, Ph.D. of addictive substances causes them problems. Too often, physicians cannot RTI International appropriately diagnose and treat those problems because the patients do not ASSOCIATE EDITOR disclose their substance abuse. Patients’ fear of revealing sensitive and poten- Debra P. Davis RTI International tially stigmatizing information and the omission of the topic of addiction in many physi- E DESIGN/LAYOUT cian training programs lead to suboptimal medical care. Maggie Bray To remedy this situation, NIDA has developed RTI International NIDAMED, the Institute’s first comprehensive EDITORIAL BOARD David Anderson, Chair; Public Physicians’ Outreach Initiative. NIDAMED aims Health Advisor, Office of Science Policy to integrate screening and treatment for the disease of addiction with mainstream medi- and Communications cal care. A toolkit developed by NIDAMED guides doctors in assessing a patient’s risk Nicolette Borek, Ph.D., Research Psychologist, Division of Clinical Neuroscience of developing an addiction problem, advising patients on the health effects of substance and Behavioral Research abuse and, if needed, arranging a referral to specialty care. The toolkit contains : J.C. Comolli, Public Health Advisor, Division of Pharmacotherapies and Medical ■ NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test Consequences of Drug Abuse (NM-ASSIST)—This evidence-based instrument, available on an interactive Web site Jennifer Elcano, M.A., Science Writer, or in print, guides clinicians through a brief screening interview about use of addictive Office of Science Policy and Communications Lynda Erinoff, Ph.D., Associate substances, including illicit drugs, prescription drugs taken for nonmedical purposes, Director, AIDS Research Program, Division tobacco, and alcohol. of Epidemiology, Services and Prevention Research ■ Clinician’s Resource Guide—This accompanying online guide presents clinicians Jacqueline Lloyd, Ph.D., Health Science with more detailed instructions, directions on how to access further information on Administrator, Division of Epidemiology, substance abuse, and comprehensive referral resources. Services and Prevention Research Marsha F. Lopez, Ph.D. , Health Science ■ Screening Tool Quick Reference Guide—This pocket-size resource summarizes the Administrator, Division of Epidemiology, screening tool, risk levels, and followup actions. Services and Prevention Research Gerald McLaughlin, Ph.D. , Chief, Grants ■ Patient Information Card—This postcard-size handout for physicians’ waiting Review Branch, Office of Extramural Affairs rooms encourages patients to “Tell Your Doctors About All the Drugs You Use” to get Mary Ellen Michel, Ph.D., Deputy the best care and also offers Web links to more information. Director, Center for the Clinical Trials Network Ivan Montoya, M.D., M.P.H., Medical Another critical component of NIDAMED is outreach to medical students, residents, Officer, Division of Pharmacotherapies and and those who train them. Through a partnership with eight medical schools around Medical Consequences of Drug Abuse the country, NIDA’s Centers of Excellence for Physician Information provide innova- Mary Pfeiffer, Ph.D., Editor and Writer, Intramural Research Program tive, science-based curriculum resources on substance abuse, addiction, and their health Kenzie Preston, Ph.D., Chief, Clinical consequences. Pharmacology and Therapeutics Research Doctors can access the new tools at www.drugabuse.gov by clicking on the Branch Joni Rutter, Ph.D., Program Director, NIDAMED icon. The Institute also recently updated Principles of Drug Addiction Genetics and Molecular Neurobiology Research Treatment: A Research-Based Guide, which summarizes more than three decades of Branch, Division of Basic Neuroscience and Behavioral Research research. In addition, a poster that encourages patients to disclose their drug use is avail- Anna Staton, M.P.A., Public Health able by calling 1-877-NIDA-NIH. NIDA is collaborating with the U.S. Health Resources Analyst, Office of Science Policy and Communications and Services Administration, Food and Drug Administration, and New York City Health Cora Lee Wetherington, Ph.D., Department to place the poster in health clinics throughout the Nation. ■ Psychologist, Division of Basic Neuroscience and Behavioral Research This publication was produced and printed by RTI International, under Contract No. N01DA-4-1117 from the National Institute on Drug Abuse. 2 NIDA Notes | Volume 23, Number 1 ■ RESEARCH IN BRIEF Highlights of recently published NIDA-supported studies 56 days, on average, in the year include peer contact may more inhibited. In the Boston trial, under review, and those who closely mimic early stages of this difference—of about 30 were dependent on the drugs drug abuse, which typically seconds, on average—was 24 had used them for 87 days. occurs in a group setting percent greater among patients Girls were significantly more > Psychopharmacology 204(3):391- who dropped out than among likely to become dependent 402, 2009. those who completed therapy. on nonprescribed pain reliev- > Drug and Alcohol Dependence 96(3):202-212, 2008. > Neuropsychopharmacology Some Teens Reporting ers than boys, a finding that 33(4):827-836, 2008. Nonmedical Use of the researchers suggest may Prescriptions Develop reflect, in part, girls’ greater Genetic Overlap Disorders tendency to share prescribed Between Substance Dr. Li-Tzy Wu and colleagues pain relievers with friends. Abuse and Bipolar at Duke University and the > Journal of the American Disorder Pacific Institute for Research Academy of Child and Adolescent According to a recent literature and Evaluation found that 1 Psychiatry 47(9):1020-1029, 2008. analysis by Dr. Ranga Krishnan percent of the 36,992 respon- of Duke University Medi- dents