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
Reconnecting Youth Research Group 2

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% )
9
Increasers (4% )
Binge Drinking Frequency

8
Late Onsetters (23% )
7
Nonbingers (70% )
6
5
4
3
2
1
0
13 14 15 16 17 18
Age (Years)
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
80% Protective Factors

70% 0 to 1
Prevalence

60% 2 to 3
50% 4 to 5
40% 6 to 7
30% 8 to 9
20%
10%
0%
0 to 1 2 to 3 4 to 5 6 to 7 8 to 9 10+
Number of Risk Factors
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
80% Factors

70%
0 to 1
Prevalence

60%
2 to 3
50% 4 to 5
40% 6 to 7
30% 8 to 9

20%

10%

0%
0 to 1 2 to 3 4 to 5 6 to 7 8 to 9 10+
Number of Risk Factors
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
70%
Factors
Prevalence

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 9 or More

Number of Risk Factors

Prevalence of “Attacked to Hurt”
By Number of Risk and Protective Factors

60%

50%

Protection, Level 0
40%
Protection, Level 1
Prevalence

Protection, Level 2
30%
Protection, Level 3
20% 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 7-9 >=10
Risk factors Bond, Thomas, Toumbourou,
Patton, and Catalano, 2000
Number of School Building Risk
Factors and Probability of Meeting
WASL Standard (10th Grade Students)
Probability of Meeting Standard

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

Math Reading Writing

Arthur et al., 2006
Number of School Building Protective
Factors and Probability of Meeting
WASL Standard (10th grade students)
Probability of Meeting Standard

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

Number of Protective Factors

Math Reading Writing

Arthur et al., 2006
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.
Gene System Protein Chromosomal Drug
location
OPRM1 Opioid µ opioid receptor 6q24-25 Heroin/opiate; Alcohol

Kreek et al.
OPRK1 Opioid κ opioid receptor 8q11.2 Heroin/opiate
PDYN Opioid Preprodynorphin 20pter-p12.2 Cocaine/stimulants

(Nature, TH Dopaminergic Tyrosine Hydroxylase 11p15.5 Alcohol

Dec 2005) DRD2

DRD3
Dopaminergic
Dopaminergic
Dopamine receptor 2
Dopamine receptor 3
11q23
3q13.3
Alcohol
Alcohol
provides a DRD4 Dopaminergic Dopamine receptor 4 11p15.5 Heroin/opiate;
Cocaine/stimulants; Alcohol
reasonable DBH Dopaminergic Dopamine β-hydroxylase 9q34 Cocaine/stimulants

list of DAT
TPH1
Dopaminergic
Serotonergic
Dopamine transporter
Tryptophan hydroxylase 1
5p15.3
11p15.3-p14
Alcohol
Alcohol
candidate TPH2 Serotonergic Tryptophan hydroxylase 2 12q21.1 Heroin/opiate; Alcohol

genes for HTR1B

HTR2A
Serotonergic
Serotonergic
Serotonin receptor 1B
Serotonin receptor 2A
6q13
13q14-q21
Heroin/opiate; Alcohol
Alcohol
substance SERT Serotonergic Serotonin transporter 17q11.1-q12 Heroin/opiate; Alcohol

use. 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 11q23.2 Alcohol
domain-containing 1
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 Selected, Indicated
 Peer counseling, Prevention
mediation, positive peer  Gun buyback programs
culture  Firearm training
 Non-promotion to  Mandatory gun ownership
succeeding grades  Redirecting youth behavior
 After school activities with  Shifting peer group norms
limited supervision,  Neighborhood Watch
programming
 Drug information, fear
arousal, moral appeal.
24
U.S. Surgeon General, U.S. Department of Health and Human Services, 2001;
 DARE National Institute of Justice, 1998; Gottfredson, 1997.
Wide Ranging Approaches to
Prevention Have Been Found
To Be Effective
1. Prenatal & Infancy 8. Classroom
Programs Organization,
2. Early Childhood Education Management, and
Instructional Strategies
3. Parent Training
9. School Behavior
4. After-school Recreation Management Strategies
5. Mentoring with Contingent 10. Classroom Curricula
Reinforcement for Social Competence
6. Youth Employment with Promotion
Education 11. Community & School
7. Organizational Change in Policies
Schools 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
 Twenty-first Century Addiction Science is
Needed to Identify the Role of Genetic,
Individual and Environmental influences
Genetic Influences

Persistent
Problem Use:
Alcohol
Consistent Tobacco
+ Family Marijuana
Management

Individual Differences
e.g.,

BAS
 Behavioral Activation Syndrome
(BAS) may be genetically
influenced (Reuter, et al. 2005).
Genetic Influences

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
1.60
Alcohol Dependence Symptoms Age 27

1.40

1.20

1.00

0.80
 = .11, p < .008
0.60

0.40

0.20

0.00

1 2 3 4 5 6
BAS
controlling for ethnicity, poverty and gender
Does Consistent Good Family
Management Moderate this Effect?

Consistent Alcohol
+ Family Dependence
Management
Symptoms
Age 27
?

BAS
 Family management practices
moderate the effect of BAS on Age
27 Alcohol Dependence Symptoms
1.6
Alcohol Dependence Symptoms Age 27

1.4
Consistently Poor Family Management
Consistently Good Family Management
1.2
 = .15, p < .01
1

0.8

0.6

0.4  = -.010, ns
Interaction,  = -.28, p < .003
0.2

0
1 2 3 4 5 6

BAS
controlling for ethnicity, poverty and gender
 Twenty-first Century Addiction Science is
Needed to Identify the Efficacy of
Interventions to Effect Individual and
Environmental Influences on Addiction
Genetic Influences

Persistent
? ? Problem Use:
Alcohol
Consistent Tobacco
Intervention + Family Marijuana
? Management

Individual Differences
e.g.,

BAS
 Patterns of Use Change over the
Course of Development and Provide
Clues to the Timing of Influences and
the Intervention
10
9
Non Initiator (72%) Cigarette Use
Chronic (3%)
Binge Drinking Frequency

8
Increaser (4%)
7 Late Onsetter (21%)
6
5
4
3
2
1
0
13 14 15 16 18
Age Binge Drinking

30 6

Marijuana Use
Early Onsetter (4.3%)
Escalator (4.5%) Late Onsetter (6.9%)
25 5
Desister (3.3%) Non-Initiator (88.8%)
Late Onsetter (18.7%)

Hard Drug Use Frequency

Other Illicit Drug
Marijuana Use Frequency

20 Non-Initiator (73.5%) 4

15 3
Use
10 2

5 1

0 0
13 14 15 16 18 13 14 15 16
Age Age
 Factors Shaping Child and
Snowstorm:
Snowball: Extended
Risk Exposure
Accumulates to
Positive Norms and Models of Problem
through
Adolescent Early Developmental
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
Identify Risk
and Protective
Factors
Define the
Problem

Problem 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

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
of Juvenile Justice and Delinquency Prevention, Robert Wood Johnson 42
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 (17) 18 21 24 27 30
N 808 703 558 654 778 783 770 -- 757 766 752 747 720
% 87% 69% 81% 96% 97% 95% -- 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,
poverty through those
agein18.
the full
Hawkins et al. 1999, By age 18 Youths in the Full
intervention had attachment to school
• More
2005; in press; Intervention had
Lonczak et al., 2002. • less initiation
• Fewer of alcohol
held back in school
• less heavy alcohol use
• lessndinitiation
• Better of delinquency
achievement
At the end of the 2 • lessBy age 21,
lifetime broad significant effects were
violence
• better family By management
• Less age 27,misbehavior
school continuing significant effects
grade • lessfound
lifetimeon sexual
positive adult functioning:
activity
• better family
•• Less communication
weredrinking
found onand
mental health and risky
driving
• boys less aggressive • fewer more high
lifetime school graduates
sex partners
• better family
• sexual
more involvement
activity:college
attending
• girls less self-destructive
• improved school bonding
• higher attachment to family
• more employed health disorders and symptoms
• fewer mental
• improved• fewer school
lifetimeachievement
sexually transmitted
• higher school
• better rewards
emotional and mental health diseases
• reduced
• fewerschool
with a misbehavior
criminal record
• higher school bonding
• less drug selling
Late • less co-morbid
Late diagnosis of substance
Full Intervention abuseFull
andIntervention
mental health disorder
Control Control

Grade 1 2 3 4 5 6 7 8 9 1
0
1
1
1
2

Age 7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
SSDP: Proportion Who Met Criteria
for GAD, Social Phobia, MDE, or PTSD
Diagnosis at Ages 24 and 27

30% 27% 26% Control

25% 21% 22%
18%*
Prevalence

Late
20% 15%*

15% Full
10%
5%
0%
Age 24 Age 27
*p< .05
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
Persistent
TH Problem Use:
DRD4, 5 Alcohol
DAT Tobacco
DBH Social Marijuana
MAOA Developmental
Interventions Persistent
Serotonergic Comorbidity
TPH1,2
HTR1B,2A
SERT
MAOA
Individual Differences
Drug Metabolism e.g.,
GxT or PxT
ADH1B BAS
ADH1C BIS
ALDH2 Cognitive Difficulties
CYP2D6 etc.
 Family management and genetic
influences
Dopaminergic
Persistent
Genetic Influences

TH Problem Use:
DRD4, 5 Alcohol
DAT Tobacco
DBH Consistent Marijuana
MAOA + Family
Management Persistent
Serotonergic Comorbidity
rGE or rPE
TPH1,2
HTR1B,2A
SERT
MAOA
Individual Differences
Drug Metabolism e.g.,
GxE or PxE
ADH1B BAS
ADH1C BIS
ALDH2 Cognitive Difficulties
CYP2D6 etc.
Gottesman & Gould, 2003

“Measurable components unseen

by the unaided eye along the
pathway between disease and
distal genotype.”
From

.
 Adapted from
Gottesman & Gould, 2003

?
?

?
?
?