Racial inequities and addiction research.

What accounts for variation across racial and ethnic groups in drug use and harms related to substance use? While explanatory mechanisms for racial and ethnic disparities include differential access to and use of health services, a myriad of other factors, including racism and historical trauma, contribute to drug-related disparities. Furthermore, the addiction scientific workforce, like the full biomedical research enterprise, lacks diversity. This deficit undercuts U.S. scientific leadership and is a major challenge for the field. To address these entrenched problems, the National Institute on Drug Abuse (NIDA) is prioritizing research on health disparities and supporting multiple efforts to enhance scientific workforce diversity. Studies on substance use trends and emerging threats must measure disparities and track progress in reducing disparities, but also acknowledge the limitations of race and ethnicity-based data. Researchers must take the bold step of proposing studies that elucidate causal mechanisms which have the potential to be ameliorated by novel policies and practices. Critically, the impact of racism on all aspects of the substance use trajectory must be assessed to better tailor prevention, harm reduction, treatment, and recovery-support interventions to the specific circumstances of those who need them. Particular attention should be given to people who are incarcerated, who are experiencing homelessness, and who have a history of adverse childhood experiences. Training the next generation of the addiction science workforce needs to address structural barriers to participation with partnerships between funders, such as NIDA, and grantee organizations.

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.

Commentary on Participation in Preventive Interventions.

In this commentary on the special issue, Preventive Parenting Interventions: Advancing Conceptualizations and Enhancing Reach, operationalization of participation, who engages in prevention interventions, and common themes from the studies are discussed. The papers in the special issue illustrate the importance of studying factors that increase participation in prevention and point out the need for additional research to understand these factors. These papers highlight the diverse conceptualizations of participation as well as a need to move toward standardization of methods to assess related constructs. Research is needed to elucidate the potential of enhanced participation and engagement in interventions to meaningfully impact intervention outcomes and ultimately improve the population-level benefit attributable to prevention efforts. Prevention scientists should attend to factors influencing participation in prevention as early in the intervention research process as possible in order to increase the likelihood that the target population will utilize evidence-based prevention interventions in real-world settings, under real-world conditions.

Advancing American Indian and Alaska Native substance abuse research: current science and future directions.

American Indians and Alaska Natives (AI/AN) have disproportionately high rates of substance abuse yet there is little empirical research addressing this significant public health problem. This paper is an introduction to a special issue that includes cutting edge science in this research area. We identify several areas that require consideration in this field and indicate how the papers in the special issue address these gaps. These overarching areas of need, which should be considered in any substantive research, include attention to heterogeneity within the population, research that has tangible health benefits, continued work on research methods and strategies, increased focus on strength based and community oriented approaches, and the need for strong research partnerships. The special issue marks a major step forward for AI/AN substance abuse research. However, articles also highlight where more work is need to improve public health in AI/AN communities by addressing identified gap areas.