Confederation of Northwest Addiction
Research Centers: Addiction: Mechanisms,
Prevention, Treatment, Conjoint 556
Lecture 1
Creation of 21st Century Addiction Science
Rico Catalano
Professor
School of Social Work
543-6382
Con federation of Addiction Research Centers
150 faculty
Major grants from NIAAA, NIDA, and NIMH
UW Centers:
Addictive Behaviors Research Center
Alcohol and Drug Abuse Institute
Center for Drug Addiction Research
Center for Functional Genomics & HCV-Related Liver Disease
Center for Healthcare Improvement for Addictions, Mental
Illness and Medically Vulnerable Populations
Center for the Study of Health & Risk Behaviors
Fetal Alcohol and Drug Unit
Fetal Alcohol Syndrome Diagnostic & Prevention Network
Innovative Programs Research Group
2
Reconnecting Youth Research Group
Social Development Research Group
Why is Addiction a Problem?





Rates of alcohol, tobacco and other drug
use begin early and increase through the
mid 20’s
Early use increases the risk of addiction
Consequences of alcohol, tobacco and
drug use are great.
Addiction affects all strata of society
Costs of addiction are high including
death, lost productivity, costs to society
and families
Prevalence of Binge Drinking,
Tobacco Use, Marijuana Use, and
Other Drug Use
Why is Addiction a Problem?





Rates of alcohol, tobacco and other drug use by
children and adolescents and young adults are
high
Early adolescent use increases the risk of
addiction
Alcohol, tobacco and drug use have negative
consequences.
Addiction affects all strata of society
Costs of addiction are high including death, lost
productivity, costs to society and families
Adolescent Binge Drinking
Trajectories
10
Chronic Bingers (3% )
Binge Drinking Frequency
9
Increasers (4% )
8
Late Onsetters (23% )
7
Nonbingers (70% )
6
5
4
3
2
1
0
13
14
15
16
Age (Years)
17
18
Both Early Chronic Bingers and
Increasers had Problems at Age
21
Early Chronic Bingers fewer completed
high school, more were obese, and more
had hypertension
 Increasers were more likely to have a
diagnosis of alcohol abuse or
dependence

Hill, et al. 2000
Why is Addiction a Problem?





Rates of alcohol, tobacco and other drug
use by children and adolescents and
young adults are high
Early use increases the risk of addiction
Consequences of alcohol, tobacco and
drug use are great.
Addiction affects all strata of society
Costs of addiction are high including
death, lost productivity, costs to society
and families
Why a New Addiction
Science



Research conducted over the last thirty years
has identified reliable predictors of use and
addiction in the social environment and the
individual
New research over the last 20 years has begun
to identify biological and genetic factors
involved in addiction processes
Research over the last 20 years has identified
effective prevention and treatment programs to
reduce problem use and addiction

The health and behavior problems of
concern to us are predicted by
malleable risk and protective factors in
social environments and individuals.
Community
Family
School
Individual/Peer
Protective Factors
Individual Characteristics
– High Intelligence
– Resilient Temperament
– Competencies and Skills
In each social domain (family, school, peer
group and neighborhood)
– Prosocial Opportunities
– Reinforcement for Prosocial Involvement
– Bonding
– Healthy Beliefs and Clear Standards
Prevalence of 30 Day Alcohol Use
by Number of Risk and Protective Factors
Six State Student Survey of 6th-12th Graders, Public School
Students
100%
90%
Number of
Protective Factors
80%
Prevalence
70%
0 to 1
2 to 3
4 to 5
6 to 7
8 to 9
60%
50%
40%
30%
20%
10%
0%
0 to 1
2 to 3
4 to 5
6 to 7
Number of Risk Factors
8 to 9
10+
Prevalence of 30 Day Marijuana Use
By Number of Risk and Protective Factors
Six State Student Survey of 6th-12th Graders,
Public School Students
100%
90%
Number of
Protective
Factors
80%
Prevalence
70%
0 to 1
2 to 3
4 to 5
6 to 7
8 to 9
60%
50%
40%
30%
20%
10%
0%
0 to 1
2 to 3
4 to 5
6 to 7
Number of Risk Factors
8 to 9
10+
Prevalence of Any Other Illicit Drug Use
(Past 30 Days)
By Number of Risk and Protective Factors
Six State Student Survey of 6th - 12th Graders,
Public School Students
100%
90%
80%
Number of
Protective
Factors
Prevalence
70%
60%
0 to 1
50%
2 to 3
40%
4 to 5
6 to 8
30%
20%
10%
0%
0 to 1
2 to 3
4 to 5
6 to 8
Number of Risk Factors
9 or More
Prevalence of “Attacked to Hurt”
By Number of Risk and Protective Factors
60%
Prevalence
50%
40%
30%
20%
Protection, Level 0
Protection, Level 1
Protection, Level 2
Protection, Level 3
Protection, Level 4
10%
0%
Risk, Level Risk, Level Risk, Level Risk, Level Risk, Level
0
1
2
3
4
Prevalence of Other Problems
by Number of Risk Factors
50
40
depressive
symptomatology
30
deliberate self harm
%
homelessness
20
early sexual activity
10
0
0-1
2-3
4-6
Risk factors
7-9
>=10
Bond, Thomas, Toumbourou,
Patton, and Catalano, 2000
Probability of Meeting Standard
Number of School Building Risk
Factors and Probability of Meeting
WASL Standard (10th Grade Students)
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16
Number of Risk Factors
Arthur et al., 2006
Math
Reading
Writing
Probability of Meeting Standard
Number of School Building Protective
Factors and Probability of Meeting
WASL Standard (10th grade students)
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
0
1
2
3
4
5
6
Number of Protective Factors
Arthur et al., 2006
Math
Reading
Writing
7
Why a New Addiction
Science



Research conducted over the last thirty years
has identified reliable predictors of use and
addiction in the social environment and the
individual
Research over the last 20 years has begun to
identify genetic and neurobiological factors
involved in addiction processes
Research over the last 20 years has identified
effective prevention and treatment programs to
reduce problem use and addiction
Candidate genes
have been identified
Table 1. Genes having one or more variants that have been reported to be
associated with one or more addictions.
Kreek et al.
(Nature,
Dec 2005)
provides a
reasonable
list of
candidate
genes for
substance
use.
Gene
System
Protein
Chromosomal
location
Drug
OPRM1
Opioid
µ opioid receptor
6q24-25
Heroin/opiate; Alcohol
OPRK1
Opioid
κ opioid receptor
8q11.2
Heroin/opiate
PDYN
Opioid
Preprodynorphin
20pter-p12.2
Cocaine/stimulants
TH
Dopaminergic
Tyrosine Hydroxylase
11p15.5
Alcohol
DRD2
Dopaminergic
Dopamine receptor 2
11q23
Alcohol
DRD3
Dopaminergic
Dopamine receptor 3
3q13.3
Alcohol
DRD4
Dopaminergic
Dopamine receptor 4
11p15.5
Heroin/opiate;
Cocaine/stimulants; Alcohol
DBH
Dopaminergic
Dopamine β-hydroxylase
9q34
Cocaine/stimulants
DAT
Dopaminergic
Dopamine transporter
5p15.3
Alcohol
TPH1
Serotonergic
Tryptophan hydroxylase 1
11p15.3-p14
Alcohol
TPH2
Serotonergic
Tryptophan hydroxylase 2
12q21.1
Heroin/opiate; Alcohol
HTR1B
Serotonergic
Serotonin receptor 1B
6q13
Heroin/opiate; Alcohol
HTR2A
Serotonergic
Serotonin receptor 2A
13q14-q21
Alcohol
SERT
Serotonergic
Serotonin transporter
17q11.1-q12
Heroin/opiate; Alcohol
MAOA
CatecholaminergicS
erotonergic
Monoamine oxidase A
Xp11.23
Alcohol
COMT
Catecholaminergic
Catechol-O-methyl transferase
22q11.2
Heroin/opiate; Alcohol
GABRA1
GABAergic
GABA receptor subunit α-1
5q34-q35
Alcohol
GABRA6
GABAergic
GABA receptor subunit α-6
5q31.1-q35
Alcohol
GABRB1
GABAergic
GABA receptor subunit β-1
4p13-p12
Alcohol
CHRM2
Cholinergic
Muscarinic acetylcholine
7q35-q36
Alcohol
CNR1
Cannabinoid
Cannabinoid receptor 1
6q14-q15
Cocaine/stimulants Alcohol
FAAH
Cannabinoid
Fatty acid amide hydrolase
1p35-34
Alcohol
NPY
Neuromodulatory
Neuropeptide Y
7p15.1
Alcohol
ADH1B
Ethanol Metabolism
Alcohol dehydrogenase 1B
4q22
Alcohol
ADH1C
Ethanol Metabolism
Alcohol dehydrogenase 1C
4q22
Alcohol
ALDH2
Ethanol metabolism
Alcohol dehydrogenase 2
12q24.2
Alcohol
CYP2D6
Drug metabolism
Cytochrome CYP450
22q18.1
Heroin/opiate
ANKK1
Signal transduction
Ankyrin repeat and kinase
domain-containing 1
11q23.2
Alcohol
Why a New Addiction
Science



Research conducted over the last thirty years
has identified reliable predictors of use and
addiction in the social environment and the
individual
New research over the last 20 years has begun
to identify biological and genetic factors
involved in addiction processes
Research over the last 20 years has identified
effective prevention and treatment programs to
reduce problem use and addiction
Ineffective Prevention
Strategies
Universal Prevention




Peer counseling,
mediation, positive peer
culture
Non-promotion to
succeeding grades
After school activities with
limited supervision,
programming
Selected, Indicated
Prevention






Gun buyback programs
Firearm training
Mandatory gun ownership
Redirecting youth behavior
Shifting peer group norms
Neighborhood Watch
Drug information, fear
arousal, moral appeal.
24

DARE
U.S. Surgeon General, U.S. Department of Health and Human Services, 2001;
National Institute of Justice, 1998; Gottfredson, 1997.
Wide Ranging Approaches to
Prevention Have Been Found
To Be Effective
1. Prenatal & Infancy
Programs
2. Early Childhood Education
3. Parent Training
4. After-school Recreation
5. Mentoring with Contingent
Reinforcement
6. Youth Employment with
Education
7. Organizational Change in
Schools
8. Classroom
Organization,
Management, and
Instructional Strategies
9. School Behavior
Management Strategies
10. Classroom Curricula
for Social Competence
Promotion
11. Community & School
Policies
12. Community
25
Mobilization
Why We Need a New
Addiction Science



Although efficacious preventive and treatment
interventions have been identified, many
individuals do not respond to these interventions
It is likely that there are important
neurobiological differences that contribute to this
non-response
We need a better understanding of the
neurobiological-environment interaction as well
as the neurobiological-environment-development
interaction in order to develop more effective
preventive and treatment interventions
Genetic Influences
Twenty-first Century Addiction Science is
Needed to Identify the Role of Genetic,
Individual and Environmental influences
Consistent
+ Family
Management
Individual Differences
e.g.,
BAS
Persistent
Problem Use:
Alcohol
Tobacco
Marijuana
Genetic Influences
Behavioral Activation Syndrome
(BAS) may be genetically
influenced (Reuter, et al. 2005).
Individual Differences
BAS
Does BAS predict Alcohol Dependence
Symptoms in Adulthood?
Alcohol
Dependence
Symptoms
Age 27
BAS
8th and 9th Grades (ages 14-15)
BAS is predictive of Alcohol
Dependence Symptoms at age 27
Alcohol Dependence Symptoms Age 27
1.60
1.40
1.20
1.00
 = .11, p < .008
0.80
0.60
0.40
0.20
0.00
1
2
3
controlling for ethnicity, poverty and gender
4
BAS
5
6
Does Consistent Good Family
Management Moderate this Effect?
Consistent
+ Family
Management
?
BAS
Alcohol
Dependence
Symptoms
Age 27
Family management practices
moderate the effect of BAS on Age
27 Alcohol Dependence Symptoms
Alcohol Dependence Symptoms Age 27
1.6
1.4
Consistently Poor Family Management
Consistently Good Family Management
1.2
 = .15, p < .01
1
0.8
0.6
 = -.010, ns
0.4
Interaction,  = -.28, p < .003
0.2
0
1
2
3
4
BAS
controlling for ethnicity, poverty and gender
5
6
Genetic Influences
Twenty-first Century Addiction Science is
Needed to Identify the Efficacy of
Interventions to Effect Individual and
Environmental Influences on Addiction
?
Intervention
?
?
Consistent
+ Family
Management
?
Individual Differences
e.g.,
BAS
Persistent
Problem Use:
Alcohol
Tobacco
Marijuana
Patterns of Use Change over the
Course of Development and Provide
Clues to the Timing of Influences and
the Intervention
Cigarette Use
10
Non Initiator (72%)
Binge Drinking Frequency
9
Chronic (3%)
8
Increaser (4%)
7
Late Onsetter (21%)
6
5
4
3
2
1
0
13
14
15
16
Age
18
Binge Drinking
30
6
Marijuana Use
Escalator (4.5%)
25
Desister (3.3%)
Early Onsetter (4.3%)
Late Onsetter (6.9%)
5
Non-Initiator (88.8%)
Hard Drug Use Frequency
Marijuana Use Frequency
Late Onsetter (18.7%)
Non-Initiator (73.5%)
20
15
10
5
Other Illicit Drug
Use
4
3
2
1
0
0
13
14
15
16
Age
18
13
14
15
Age
16
Snowstorm:
Extended
Exposure
to
Snowball:
Risk
Accumulates
Factors Shaping Child and
Positive Norms and Models of Problem
through
Early
Developmental
Adolescent
Development
Behavior without Protection
Challenges without Protection
Community
Peers
School
Parents
1 2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19
Applying Advances in Prevention Science to
Children and Adolescents:
The Seattle Social Development Project
Richard F. Catalano, Ph.D
Director
Social Development Research Group
School of Social Work
University of Washington
www.sdrg.org
Intervention Spectrum
Treatment
Source: Institute of Medicine (1994). Reducing risks for mental disorders:
Frontiers for preventive intervention research. Patricia J. Mrazek & Robert J.
Haggerty, Eds. Washington DC: National Academy Press
Prevention Science
Framework
Program
Implementation
and
Evaluation
Interventions
Define the
Problem
Problem
Identify Risk
and Protective
Factors
Response
Prevention Science
Research Advances
Etiology/Epidemiology of Problem Behaviors
 Identify risk and protective factors that
predict problem behaviors and describe
their distribution in populations.
Efficacy Trials
 Design and test preventive interventions
to interrupt causal processes that lead to
youth problems.
Prevention Services Research
 Apply lessons learned about etiology and
effective interventions in real world
settings.
Risk Factors Addressed by Seattle Social
Development Project
Family
X
X
X
School
X
X
X
Individual/Peer
X
X
X
Prevention Science
Research Advances
Etiology/Epidemiology of Problem Behaviors
 Identify risk and protective factors that
predict problem behaviors and describe
their distribution in populations.
Efficacy Trials
 Design and test preventive interventions
to interrupt causal processes that lead to
youth problems.
Prevention Services Research
 Apply lessons learned about etiology and
effective interventions in real world
settings
Seattle Social Development Project
(SSDP)
Investigators:
J. David Hawkins, Ph.D.
Richard F. Catalano, Ph.D.
Karl G. Hill, Ph.D.
Richard Kosterman, Ph.D.
Robert Abbott, Ph.D.
Social Development Research Group
School of Social Work
University of Washington
9725 3rd Avenue NE, Suite 401
Seattle, Washington 98115
Funded by:
National Institute on Drug Abuse, National Institute on Mental Health, Office
42
of Juvenile Justice and Delinquency Prevention, Robert Wood Johnson
Foundation
Seattle Social Development Project
Intervention Components



Component One: Teacher Training
in Classroom Instruction and
Management
Component Two: Parent Training
in Academic Support and Behavior
Management
Component Three: Child Social and
Emotional Skill Development
Teacher Education
Proactive classroom management (grades 1-6)
•
•
•
•
Establish consistent classroom expectations and routines at the beginning of the
year
Give clear, explicit instructions for behavior
Recognize and reward desirable student behavior and efforts to comply
Use methods that keep minor classroom disruptions from interrupting
instruction
Interactive teaching (grades 1-6)
•
•
•
•
•
Assess and activate foundation knowledge before teaching
Teach to explicit learning objectives
Model skills to be learned
Frequently monitor student comprehension as material is presented
Re-teach material when necessary
Cooperative learning (grades 1-6)
•
•
Involve small teams of students of different ability levels and backgrounds as
learning partners
Provide recognition to teams for academic improvement of individual members
over past performance
Parent Education
Raising Healthy Children (grades 1-2)
•



Observe and pinpoint desirable and undesirable child behaviors
Teach expectations for behaviors
Provide consistent positive reinforcement for desired behavior
Provide consistent and moderate consequences for undesired behaviors
Supporting School Success (grades 2-3)
•


Initiate conversation with teachers about children’s learning
Help children develop reading and math skills
Create a home environment supportive of learning
Guiding Good Choices (grades 5-6)
•



Establish a family policy on drug use
Practice refusal skills with children
Use self-control skills to reduce family conflict
Create new opportunities in the family for children to contribute and learn
Social, Cognitive and
Emotional Skills Training









Listening
Following directions
Social awareness (boundaries, taking
perspective of others)
Sharing and working together
Manners and civility (please and thank you)
Compliments and encouragement
Problem solving
Emotional regulation (anger control)
Refusal skills
Support Structures

School Staff
– 5 days of teacher training
– Coaching by teacher trainer
– Principal support

Family
– Training in each parenting curriculum
– Family support coordinator
SSDP Design
• Initiated in 1981 in 8 Seattle elementary schools.
• Expanded in 1985, to include 18 Seattle
elementary schools to add a late intervention
condition and additional control students.
• Quasi-experimental study
Full treatment (grades 1-6) = 149
Late treatment (grades 5-6) = 243
Control = 206
SSDP Panel Retention
Elementary
Middle
High
Adult
MEAN
AGE G2
10
11
12
13
14
15
16
N
808
703
558
654
778
783
770
--
757
87%
69% 81% 96% 97% 95%
--
%
(17) 18
21
24 27 30
766
752
747 720
94% 95% 93%
93% 91%
Interview completion rates for the sample have remained
above 90% since 1989, when subjects were 14 years old.
SSDP Changed Risk,
Protection and Outcomes
Intervention has specific benefits for children
By from
the start
of 5th grade,
those
the full
poverty
through
agein18.
By age 18 Youths in the Full
Hawkins et al. 1999,
intervention
had attachment to school
• More
2005; in press;
Intervention had
• less initiation
of alcohol
• Fewer
held back in school
Lonczak et al., 2002.
• less heavy alcohol use
• lessndinitiation
of delinquency
• Better
achievement
age 21,
broad significant effects were
At the end of the 2 • lessBy
lifetime
violence
• better family
By management
age
27,misbehavior
continuing significant effects
• Less
school
on sexual
positive
adult functioning:
grade
• lessfound
lifetime
activity
• better family
communication
weredrinking
found
onand
mental
health and risky
•• Less
driving
more
high
school
graduates
• boys less aggressive
• fewer
lifetime
sex partners
• better family
involvement
activity:college
• sexual
more
attending
• girls less self-destructive
• improved
school
bonding
•
fewer
mental
• higher attachment
to
family
• more employed health disorders and symptoms
• improved
school
achievement
• fewer
lifetime
sexually
transmitted
• better
emotional
and mental
health diseases
• higher school
rewards
• reduced
• fewerschool
with a misbehavior
criminal record
• higher school
bonding
• less drug selling
Late diagnosis of substance
• less co-morbid
abuseFull
andIntervention
mental health disorder
Late
Full Intervention
Control
Control
Grade
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
Age
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
SSDP: Proportion Who Met Criteria
for GAD, Social Phobia, MDE, or PTSD
Diagnosis at Ages 24 and 27
Prevalence
30%
25%
20%
27%
26%
21%
18%*
Control
22%
15%*
15%
Full
10%
5%
0%
Age 24
*p< .05
Late
Age 27
Discussion




Identify your field in these broad categories:
– Human neurobiological, Animal
neurobiological, basic pyscho-social,
intervention/prevention
Break up into small groups of 5 with a broad
mix from these groups
Students discuss how the information presented
today may help you develop new
transdisciplinary research questions, faculty may
contribute
Record research questions developed and report
back to the whole group on 2-3 transdisciplinary
research questions
Confederation of Addiction Research Centers:
Addiction: Mechanisms, Prevention,
Treatment, Conjoint 556
Lecture 1
Creation of 21st Century Addiction Science
Rico Catalano
Professor
School of Social Work
543-6382
catalano@u.washington.edu
www.sdrg.org
53
SSDP could allow exploration of
effects of social development
interventions on genetic expression
Dopaminergic
TH
DRD4, 5
DAT
DBH
MAOA
Serotonergic
Social
Developmental
Interventions
Persistent
Problem Use:
Alcohol
Tobacco
Marijuana
Persistent
Comorbidity
TPH1,2
HTR1B,2A
SERT
MAOA
Drug Metabolism
ADH1B
ADH1C
ALDH2
CYP2D6
Individual Differences
e.g.,
BAS
BIS
Cognitive Difficulties
etc.
GxT or PxT
Family management and genetic
influences
Genetic Influences
Dopaminergic
TH
DRD4, 5
DAT
DBH
MAOA
Serotonergic
Consistent
+ Family
Management
rGE or rPE
Persistent
Problem Use:
Alcohol
Tobacco
Marijuana
Persistent
Comorbidity
TPH1,2
HTR1B,2A
SERT
MAOA
Drug Metabolism
ADH1B
ADH1C
ALDH2
CYP2D6
Individual Differences
e.g.,
BAS
BIS
Cognitive Difficulties
etc.
GxE or PxE
.
From
Gottesman & Gould, 2003
“Measurable components unseen
by the unaided eye along the
pathway between disease and
distal genotype.”
.
Adapted from
Gottesman & Gould, 2003
?
?
?
?
?