Thematic categories for research clusters in addiction research
The research themes for the MRC-led addiction and substance misuse research strategy have been decided though consultation with a cross-section of the UK addiction research community and relevant stakeholders, primarily in Government. The themes that emerged were considered the priority areas of research at that time. Priority areas might change in the future. Download this page as a Word document.
- Thematic categories for addiction research clusters
- How the themes were selected
- Additional information about this initiative
- Ethics
Thematic categories for addiction research clusters
Table 1: Addiction research themes | ||
Theme |
Details |
No. of clusters |
Cause |
C1 - Routes into, and relapse from, adolescent drug/substance use (illicit drugs/alcohol/tobacco) and gambling C2 - The causes of addiction and gambling – identification of risk factors, individual differences in vulnerability |
3 |
Harm |
H1 - Understanding the biological and social harms caused by illicit drugs/substance use and gambling H2 - Quantitative monitoring of problematic gambling and drug use and costs to health, community and criminal justice systems |
1 |
Treatment |
T1 - Developing preventive strategies and new treatments for addiction and relapse (pre-clinical development and proof-of-principle studies) T2 - Implementing and evaluating interventions to reduce addiction and relapse and promote rehabilitation |
2 |
Alcohol |
A1 - Estimating the true harm of alcohol misuse A2 - New approaches to reducing alcohol misuse |
5 |
These themes have been refined to present clear packages of addiction research topics on which the clusters are expected to focus. However, there is bound to be overlap across the categories for many of the clusters and, indeed, the aim of this initiative is to increase collaboration and cross-disciplinary work. Clusters should not feel constrained by the cluster definitions, especially if the strategic aims of the proposed cluster cross one or more of the thematic categories.
Alcohol misuse has been singled out because of its high public health significance in the UK, but that does not mean that research on alcohol is excluded from other categories or vice versa, especially given that polydrug use is common and alcohol dependence is highly co-morbid with compulsive gambling. Selecting the cluster codes may be a balanced decision depending on the overall emphasis of the strategic aims of the cluster.
Cause: Causes, risk factors and natural history of addiction
Research undertaken in these clusters will focus on adolescence under two themes:
C1 - Routes into, and relapse from, adolescent drug/substance use (illicit drugs/alcohol/tobacco) and gambling (naturalistic time course).
C2 - The causes of addiction and gambling – identification of risk factors, individual differences in vulnerability.
Clusters focusing on both of these themes should aim to use existing cohorts where suitable and available. The emphasis should be on adding value to ongoing investigations, such as building-in genetic studies, while synergies between drug, alcohol and gambling studies should also be considered.
Cause (C1)
It is envisaged that clusters focusing on C1 could:
- Investigate routes of entry into substance misuse and problem gambling, focusing on adolescence and preferably collecting information at an early age before dependence occurs;
- Compare those who do and do not go on to develop addiction with a potential to identifying future problem drug users at an early stage;
- Seek to establish the factors determining the transition from use through misuse to addiction, recovery and relapse;
- Investigate the factors that can lead to changes in the intensity of addiction over time and factors that influence diversion from use;
- Seek to understand the above from a population level perspective as well as those factors at an individual, family and community level.
Cause (C2)
Clusters focusing on C2 could:
- Determine more accurately the relationship between drug use/misuse, alcohol dependency and compulsive gambling and a range of variables at, for example, the genetic, individual, family, social, environmental and population level (e.g. policy to control access and availability) and consider which variable might be most receptive to intervention.
C2 clusters should recruit the necessary modellers and social scientists to quantify social, economic and environmental factors for comparison with biological ones so that novel information can be gleaned on the interplay between genetic and environmental risk in the initiation of illicit drug and gambling, and subsequent misuse.
Harm: Monitoring the incidence and prevalence of drug use/substance abuse and gambling and understanding biological and social harms
The research undertaken in these clusters will focus on addressing the harms under two themes, although there will be overlap:
H1 – Understanding the biological and social harms caused by illicit drugs/substance use and gambling.
H2 – Quantitative monitoring of problematic gambling and drug use and costs to health, community and criminal justice systems.
Harm (H1)
H1 clusters will investigate the biological and social harms caused by illicit drugs and gambling. The cluster expertise should span biological and social domains.
Relevant aims of a cluster might address the following:
- UN/European priorities on the global risks of drug misuse, i.e. overdose death, blood borne viruses, drug driving and sexual risk behaviour;
- The effects of drug abuse on the development of mental health problems - for example, depression - and the effect of substance misuse on cognitive ability and potential for recovery from addiction;
- Understanding the harmful effects of drugs and regular gambling on the central nervous system;
- The harms related to gender and age, including the antenatal period;
- Influence of regular gambling and drug use on perceptions of risk and reward and the processing of information about them;
- The relative harms of different volumes and types of criminal offence associated with drug addiction.
Harm (H2)
The MRC addiction workshop and various consultations highlighted a lack of clarity and potential inconsistency in the relationship between incidence, prevalence and harms, and the need to strengthen the evidence on the time-specific impacts of drug policy and specific interventions. Therefore, the overall aim of this cluster should be to address, or provide a resource for, the quantitative monitoring of problematic gambling, drug use and co-factors, and the costs to health services, communities and criminal justice. The aim is to strengthen the existing evidence base, and to answer a number of pressing policy questions, such as:
- Polydrug and alcohol misuse: what is the added harm?
- What is the size of the cocaine using population?
- What forms of gambling are most risky and what is the incidence of gambling-related harms; what is the maximum frequency of gambling consistent with safe usage?
- What is the relation between opiate use and opiate overdose deaths?
- What is the real cost of addiction to social and family functioning, employment, debt and crime and in particular the effects on social inequality and gender?
- How do social inequalities relate to harms – especially from opiates, crack and machine gambling?
- What are the effects of population level policies and interventions in magnifying or reducing harm?
Methodologically, H2 clusters will be expected to
- Design better ways of monitoring the impacts of the use of drugs and gambling and measuring the incidence of drug use and gambling;
- Develop appropriate ‘evidence synthesis methods’ that combine information from police, health, social and other services to provide more accurate estimates of the scale of substance misuse and excessive gambling, the amount of harm, and the relationship between harm and misuse/excess.
Both of these approaches need novel thinking about the way in which data should be collected, for instance, through the development of new surveillance systems, new questions posed, or through facilitation of record linkages.
Treatment: Development and implementation of treatment and intervention
Research undertaken in these clusters will focus on development or translation of treatment under two themes:
T1 - Developing preventive strategies and new treatments for addiction and relapse (pre-clinical development and proof-of-principle studies)
T2 - Implementing and evaluating interventions to reduce addiction and relapse and promote rehabilitation
The overall aim of clusters in this category is to increase the intervention options and increase the number of people in treatment.
Translation (T1)
Clusters could focus on some of the following:
- Translational research for new treatments based on mechanistic studies of recovery and relapse;
- Pre-clinical development of potential new treatments;
- Developmental clinical sciences (experimental medicine) approaches to accelerate the development of new interventions through proof-of-principle studies of promising therapies;
- Translating from, and back-translating to, animal models for the implementation of learning theory and testing drugs;
- Exploiting cutting-edge brain imaging;
- Medicinal chemistry for new drug targets for animal studies;
- Cross-drug/substance and gambling synergies.
Translation (T2)
Clusters could focus on some of the following:
- Exploring combination therapies (drug, psychological, social interventions) as a basis for future trials;
- Development of personalised interventions – socio-medical and medical;
- Delivering new approaches to drug treatment;
- Treatments that consider the social, psychological and medical needs of individuals, to help people to become and remain stabilised in society;
- Development of evidence-based family support programmes;
- Community and family level interventions, especially in high-risk groups and introduced before substance misuse has developed;
- Wider population level interventions to control supply of alcohol and addictive substances;
- The role of social and personal capital and recovery networks in prevention of relapse in drug addiction;
- Ethical considerations.
Alcohol: Harm and developing new approaches to reducing alcohol abuse
Alcohol is considered a special case in relation to Government strategies and public health problems. The focus of these clusters will not necessarily be alcoholism but investigating the effects of hazardous drinking and supporting interventions to reduce heavy alcohol consumption.
It is envisaged that the research undertaken in these clusters will focus on the following two themes:
A1 - Estimating the true harm of alcohol misuse
A2 - New approaches to reducing alcohol misuse
Alcohol (A1)
These clusters could focus on estimating the true harm of alcohol misuse.
This might include:
- The quantification of the role of alcohol, directly and as a dependent co-factor, in criminal justice harms, morbidity and mortality;
- Studies on the relationship between alcohol use and alcohol-related health outcomes, for example in;
- physical health, eg liver disease such as cirrhosis;
- the central nervous system;
- mental health, eg depression;
- social and family functioning, employment, debt, crime and drug use;
- death rates;
- Indirect impacts through closely connected factors, e.g. compulsive gambling.
Further information on the relationship between substance misuse and inequalities is an explicit need for some stakeholders.
Alcohol (A2)
These clusters could focus on developing novel interventions to reduce problem drinking in the UK population, for example:
- Exploring combination therapies (drug, psychological, social interventions) as a basis for future trials;
- Development of personalised interventions;
- Qualitative work to evaluate/improve public information campaigns, communications and community engagement, including school based education;
- Interventions at the population level that may seek to prevent or reduce harm from alcohol consumption, eg through policies to control supply or price of alcohol;
- Treatments that consider the social, psychological and medical needs of individuals to help people to become - and remain - stabilised in society;
- Programmes targeted at children identified as at increased risk of alcohol abuse.
Linking in with government in developing some of the suggested interventions in this cluster is crucial.
How the themes were selected
An Addiction Project Group (the forerunner of the current Oversight Group) was established to guide the early development of the strategy. It determined the four priority themes for addiction research. The Project Group was informed by
1. Expressions of Interest from academics interested in participating in the strategy;
2. Outcomes from a workshop on 4 November 2008, at which a cross-section of the UK addiction research community drew up priorities for addiction research;
3. Further discussion with key stakeholders, primarily Government.
Alcohol emerged as a separate theme because it was considered a special case in relation to current high public health burden and Government strategies.
Additional information about this initiative
- The scope of this initiative covers the misuse of alcohol and illicit substances, addiction to illicit substances and gambling and dependence on nicotine;
- Research on the dependence on nicotine can be included and is encouraged in the context of the co-morbidities between smoking and other forms of substance misuse or addiction;
- Research addressing gaps in knowledge identified in the ACMD report on Cannabis Classification and the Public Health would be welcomed, where such needs can be delivered through biological, medical and related sociological research and are relevant to this call. This would apply to subsequent reports of the Advisory Council on the Misuse of Drugs where relevant to this initiative;
- Research clusters are asked to consider, where relevant, whether gambling, as a non-substance based addiction, might constitute a control condition in their research;
- For research that would inform strategies for the prevention and treatment of gambling, specialist advisors to this initiative suggested that it would be valuable to systematically study (in natural settings) the interaction between various gambling products and those who use them regularly for extended periods.
Two desirable general cross-cutting themes across all clusters are:
- Innovative proposals to address the gaps in knowledge identified in the Academy of Medical Sciences Report on Addiction and Brain Sciences where such needs can be delivered through biological, medical and related sociological research. Please note that this report also refers to research on cognition enhancers, which would be outside the scope of this initiative.
- Ethical issues in addiction research are also encouraged as a theme crossing all clusters.
Ethics
- Clusters are expected to consider ethical issues related to addiction and addiction research.