Dual-Diagnosis Market Analysis and Reports | Sweden Conference Series

Market Analysis - Dual-Diagnosis 2018

Research structures of other organizations in Europe
 
Over the past two decades a number of international organizations have played an important role in the development of an international coherence to the drug field in Europe. However, very little of this activity involves research and in many ways it is not the role of these organizations to undertake research within individual countries or across different regions. But they have a potentially important role in assisting communication and networking.
 
 
In 1995 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was established with a specific monitoring and observation function. It has assisted individual MS to develop and share data on all kind of drug-related issues (e.g. epidemiological information, patterns of drug use, drug-related social and health problems or service utilisation). The relationship between EMCDDA and MS is two-way and the Centre supports information exchange, monitoring and cooperation in the field of drugs at EU level and towards Member States. EMCDDA does not assist increase in research capacity, skills and infrastructure. EMCDDA produces scientific information that can be used in research activities on drugs and fosters information exchange between scientific experts.
 
 
The Pompidou Group has a long tradition in the field of research issues and established an early research network in epidemiology that initiated such of the linked epidemiological research in Europe. Currently the Pompidou Group promotes the importance of research at all levels but does not have the funding or remit to support any major projects. The Pompidou Group’s new mandate to link policy, practice and science is at the core of the activities carried out by the research platform which supersedes the group of experts in epidemiology active between 1982 and 2004. There has been a change of function from developing data collection and monitoring methodologies to assessing the impact of research on policy. The research platform has developed a database of research activity and reports over 300 registrations since 2007. This important activity provides a snapshot of research activity however the overall participation in the research registry does not currently provide a comprehensive picture of current research activity in Europe.
 
 
UNODC has a global remit. Europe is, of course, an important component of that remit.  UNODC is supported by EMCDDA to develop indicators that are useful for national monitoring purposes in 3rd countries. UNODC is not a research organization, but there are some small research projects that directly relate to some aspects of UN drug policy. Nevertheless its prospective input to EU research is very limited. The major focus for UNDOC is on the supply reduction end of policy research which can include approaches and methods for mapping cultivation, and other laboratory and related research, although available funding is limited. Expansion in EU policy research on supply reduction could be of considerable assistance to the overall global drug strategy.
 
WHO Europe
 
WHO Europe is the regional office for WHO Geneva and has modest resources to cover a large area. Its focus and priority most recently has been around the problems faced by countries in Eastern Europe with a particular focus on HIV prevention in injecting drug users. Also it has conducted important work on health in prisons in Europe, again with a key focus on injectingdrug use and HIV. Altogether its major focus is the promotion of public health strategies to enhance population well being, and not the funding of research but it has been involved in aspects of communication and coordination on some topics.
 
The Australian government has an integrated approach to tobacco, alcohol and other drugs and many of the key priorities for research match the national drug policy priorities. A review commissioned by Australia’s generic health and medical research council in 1998 concluded that the majority of Australian illicit drug research at that time was focused on epidemiology and interventions (Hando et al., 1998). During 2000-2007 over 650 research projects were commissioned (approximately 100 per annum). The vast majority was in the field of interventions and epidemiology. There was some research in the field of criminal justice policy and supply control. Based on information provided in the Australian country report, approximately 40% of drug-related research is in the interventions arena in the broadest sense (including evaluation research and clinical practice research) and less than one third falls under the heading of epidemiology (28%). The overall assessment of the Australian situation is that for
a relatively small country there was a substantial amount of high quality research and this has major national and international impact.
 
The Canadian Government developments have interesting parallels with the Australian government in that the period of 2000 onwards has been a period of new investment in health research including addictions research. It is harder in Canada to separate out specifically how much research activity has gone specifically to addictions research because funding is allocated generically. But as part of the overall research initiative some key infrastructure has been developed with seven professorial chairs being supported. A major focus in the health research initiative has been on bio-medical research. A proposal to develop a dedicated National Structure similar to NIDA was not supported by the Federal Government despite a strong bid by key players in the field to promote such a centre. The key areas supported from 2000 onwards were epidemiology (14 funded applications), interventions (23 applications) and policy (24 applications).
 
In the US, the key research institution supporting addictions type research is the National Institutes of Health’s National Institute on Drug Abuse (NIDA), and there has been long term strategic support in financing both NIDA and its research output. The US has substantially more research projects and publications than either of the two other countries (and by comparison with any other single country) and that by comparable size the EU and MS would be the second in size of activities on addictions research.
 
Research trends
 
The trend in all three countries was for increasing amount of activity over time and in both Canada and the US an increasing emphasis on neuroscience, and molecular genetics of addictions, reflecting the overall growth in research on brain science and micro biological aspects of health research. The trend is also for increasing investment on the need to understand the basic mechanisms underlying addiction, with the longer term aim of improving strategies for prevention interventions. In all three countries there is a major emphasis on improving links between researchers and policy makers, and improving the impact of research on policy and practice by emphasizing technology transfer
 
Research capacity and infrastructure
 
Australia, Canada and the US have adopted different structural approaches which reflect their political and administrative history and approach. All have used a mixture of developing some core activity and funding, and mixing this with a competitive application programme with an investigator-driven application process. The overall spend in the different settings varies considerably, but the implementation of a research strategy shaped around the overall national drug strategy, has provided structural coherence and research impetus in all settings.
 
Australia
 
The Australian system is a federal system and funding and support can occur at either a state or a federal level. The key strategic developments have occurred at federal level through the National Health and Medical Research Council (NHMRC). The major event in the history of drug-related research in Australia was the creation of the first national strategy aimed at druguse - the National Campaign against Drug Abuse (NCADA) which was adopted in 1985. Prior to 1985, Australian drug research was neither co-ordinated nor centralised. Research occurred in a number of universities as part of medical, psychology and criminology faculties as well as in some hospitals. The NCADA included the creation of two national drug research centres20 in 1986 and a third centre21 was opened in Adelaide 1991.
 
A National Drug Research Coordinating Committee was established around 1999 and worked for some years on various coordination functions, but has subsequently been dissolved. A specific drug abuse research funding body, the Research into Drug Abuse Program (RIDAP) which was established in the late 1980s, has also ceased operations. They commissioned a review of Australian illicit drugs research. This review of illicit drug research in Australia (Hando et al., 1998) documented research related to prevalence and patterns of use, risk factors,  elated harms, and health interventions, finding that the majority of research being conducted at the time of the review was focused on interventions and epidemiology, with little research on risk factors. In 2004, the Alcohol and other Drugs Council of Australia noted the strong international reputation of Australian drug research and noted that the establishment of the three national centres referred to above has "created a strategic and cooperative partnership between the drug research community, decision makers and service delivery personnel". They identified areas for further consideration including research quality, the use of evidence in decision making, the balance between commissioned and investigatordriven research, ethics approvals and various other aspects to Australian drug research.
 
Canada
 
The situation in Canada over the past decade has dramatically improved with the establishment of the Canadian Institutes of Health Research (CIHR) as Canada’s primary health research funding agency, along with several other relevant federal entities for direct and indirect health research support and substantially elevated levels of funding since 2000. The Canadian system of health research funding relies primarily on investigator-driven proposals and projects (i.e. is subject to extrinsic or strategic direction only to a limited degree and reflects the capacities, interests and priorities of its active researchers). The amount of research funds available, capacity development efforts and publications output in the field of addiction research have substantially increased since 2000. The area of illicit drugs is handicapped by the fact that within
the CIHR system22, the topic of ”addiction” is subsumed within the Institute of Neuroscience, Mental Health and Addictions (INMHA), where it plays a somewhat subordinated role and is limited in terms of strategic development or support opportunities. Traditionally, the bulk of research funding for substance use research – as is the case for health research funded by CIHR overall – has been committed to the areas of bio-behavioural (“basic”) science research. However, in recent years, the relative amount of funding devoted to other areas (e.g. social science/population health) of research has grown. Overall, the addiction research landscape inCanada is limited in the coordination of content between different funding levels and institutions and somewhat fragmented in its activities. The principal objectives of CIHR were to facilitate scientific excellence in health research and capacity development and to provide a substantially higher and sustained funding level. It also aimed to create a support framework of health research reaching beyond the boundaries of mainly biomedical research, partly in recognition of the importance of the social determinants of health and population health principles in the health status of Canadians, as well as incorporating clinical and health systems research as key domains.
 
United States
 
In 1992 the US Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) was reorganised to separate the services supported operations from those that represented research. The newly created service organization became the Substance Abuse and Mental Health Services Administration (SAMHSA)23. The research organizations, the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Institute of Mental Health (NIMH) were moved under the large umbrella of the National Institutes of Health (NIH). Although NIDA always had both an intramural and an extramural research programme, by joining the NIH it was able to draw on a more extensive granting experience and support. Although there is no single body that builds the nation’s infrastructure to conduct and fund drug abuse research, NIDA remains the most influential in the
drugs field. Every five years NIDA in partnership with a large number of constituent groups develops a strategic plan for the next half decade. At the late 1990s, the then Director of NIDA supported the development of a five-year plan (NIDA, 2004)24, the new strategic plan is in draft
form awaiting comments. The centres that are funded by NIDA are university-based and conduct multidisciplinary research in key areas such as prevention, treatment, epidemiology, and neuroscience and are formally structured for training both within the centre through post-doctoral work and through course offerings such as summer institutes, seminars, or workshop series. The USA has a more centralised institutional approach to funding and has the highest level of spending and a broad range of topics. However international commentators have noted that there is a poor level of translation of research to policy and practice and a marked shortfall in the joining up of research to the translation from bench to clinical setting.
 
Research funding budgets
 
Australia
 
Funding sources for Australian illicit drug research include government (commissioned) research, generic competitive research funding bodies such as the NHMRC, and philanthropy. The two national drug research centres, National Drug and Alcohol Research Centre (NDARC) and the National Drug Research Institute (NDRI) are both significant players in Australian illicit
drug research. The Commonwealth government provides annual core funds to both centres, which amounted to a total of AUS $3,357,000 (approx. 2,014,200 €) in 2006. The estimate of the illicit drug research costs in Australia for the year 2006 is AUS $16.8 million (10.1 million €). This represents a per capita spending of $0.81 cents (0.49 €) per annum perAustralian. Relative to overall Australian investment in health research it is a very small amount. The NHMRC annual fund is $539 million (323 million €), of which $9.9 million (6 million €) is invested in illicit drugs research (1.8% of the total competitive health research investment).
 
Canada
 
The CIHR is the centrepiece of the domestic public funding for health – and thus illicit drug use related research in Canada. CIHR has seen a substantial increase in its budget between its creation in 2000 and its most recent budget (2008), although budget increases have levelled off since 2005, partly determined by a new government in office since 2006. Overall, these developments have led to an unprecedented net increase in research operations and capacity development funding for health and addictions research in Canada since 2000. In the mid- to the late 1990s, the state of funding for health research in Canada had been deteriorating considerably. The key health research funding agency at the time, the federal Medical Research Council (MRC), had to take substantial budget reductions in the wake of general public expenditure cuts. The MRC’s budget was reduced by 13% from 1994 to 1998 alone, to a total funding amount of CAN $237.5 million (168.6 million €) in 1998. This funding amount was recognized as being considerably lower than funding amounts devoted to health research in e.g. Australia or the United Kingdom, and massively lowers than that available in the USA (Single et al., 2000). At the time substantially more health research funding came to the support of Canadian health researchers from US sources than the total funding amount available domestically. Furthermore, the MRC’s funding support was largely devoted to biomedical research as its ”principal forte” (MRC, 1997), and rarely funded research outside of this realm. Federal politicians increasingly recognized this situation as untenable, especially when the federal government managed to balance its annual budget at the turn of the century and had the fiscal opportunity for additional public spending. In this context, the federal government created the CIHR in June 2000 as a pivotally important event in the evolution and state of health research funding in present and future Canada.
 
United States
 
The White House Office for National Drug Control Policy (ONDCP) estimated that the range of funding for treatment and prevention research in the field of illicit drugs increased from $702.4 million (583.0 million €) to $1,024 million (850.0 million €) between Fiscal Year (FY) 2000 and 2007 (ONDCP, 2008)25. The funding levels for the same period of time provided by NIDA (that include research management and support) range from $690 million (573 million €) in FY 2000 to $1,000 million (830 million €) (in FY 2007 (NIDA, 2004; 2008). Information was available on NIDA’s website for the distribution of research funding by category of research for FY 2007. According to this, clinical neuroscience research received $429.1 million (356.2 million €), epidemiology, services (treatment) and prevention, $249.6 million (207.0 million €), pharmacotherapies and medical consequences, $116.6 million (96.8 million €), clinical trials, $54.9 million (45.6 million €) and intramural research, $81.8 million (67.9 million €). Research management and support received $55.8 million (46.3 million €) for salaries and processing of research and research applications (NIDA, 2008). Altogether, these amounts sum up to $987.8 million (819.9 million €), representing a per capita spending of approximately $3.3 (2.7 €) per annum per inhabitant.
 

Country Report: AUSTRIA

Summary
 
It could be said that drug-related research in Austria is characterised by great diversity and little planning; whereas the initiatives of individual institutions and researchers play an important role. This is mainly due to the fact that a general (at national and provincial level) research strategy or coordinating body for the field of drugs and addiction does not exist. There is also no specific institution responsible for centralised allocation of means for these issues. Drug-related research is included in the general structure of research promotion in Austria. Research funding is undertaken by the Federal Ministries as well as by major institutions who accept relevant applications.
 
History of strategic development and vision behind the development of research capacity and funding structure in the field of (drug) addiction
 
In general, in Austria in the field of drug-related research there is great diversity and little planning. The initiatives of individual institutions and researchers play a significant role. Moreover, there is an important distinction between research contracts and funded research. Research contracts are mainly awarded by the federal government (e.g., consumption surveys in the general and school population) or the provincial governments (e.g., evaluation studies, demand surveys). Research funding is applied on the other hand for research institutes and individual researchers. No established structures exist to cultivate the interaction between politics, practice and research; nonetheless, especially with regard to commissioned research, decisions are influenced by research results. There is no general research strategy or coordinating body for the field of drugs and addiction - neither at national nor at provincial level (EMCDDA Austrian National Report, 2007).
 
Future strategic approaches aimed at building research capacity and funding infrastructure
 
Austria has no national (federal) drug strategy or action plan; nonetheless the development of a strategy is currently in progress. As such it could be assumed that for the moment no officially stated strategic approaches exist.
 
RESEARCH TOPICS AND INFRASTRUCTURE
 
Key research structures involved at country level
 
In Austria there are two interdisciplinary research institutes specifically dedicated to the issue of addiction. The Ludwig Boltzmann Institute of Addiction Research (LBI Sucht) is based on a cooperation between the Anton Proksch Institute, which is the largest therapy centre assisting persons addicted to alcohol and/or drugs in Austria, and the Ludwig Boltzmann Society, an umbrella organisation with the aim of promoting scientific research in Austria. The Addiction Research Institute was established as a branch of the University of Innsbruck in 1990 and is based at the treatment centre for addiction patients Maria Ebene hospital in Vorarlberg. At university level drug-related research is mainly found in the medical field of hospitals. The Hospitals of Psychiatry of the Universities of Vienna and Innsbruck should be mentioned in this context as centres of continuous substitution-specific research. Single projects in the field of basic research into social issues may be found at university departments dedicated to social studies. Individual drug help services, e.g., ChEck iT!, are also committed to questions that are relevant for research, and to a growing extent, private institutes in the field of drug-related research accept contracts as well. Gesundheit Österreich GmbH / Austrian Health Institute (GÖG/ÖBIG) also carries out research in the context of drugs and addiction. Based on the study’s desk work most drug related research projects in Austria are conducted at universities or, at public/governmental organisation, for example the Ludwig Boltzmann Institute for the Sociology of Health and Medicine of the University of Vienna, the University Hospital of Psychiatry at the University of Innsbruck, the European Institute for Social Services or the Institute for the Sociology of Law and Criminal Sociology.
 
FUNDING STRUCTURE
 
Funding agencies and research budgets
 
At federal level, apart from research funding by the Federal Ministries there are major funding institutions that accept applications of drug-related research projects according to their focus.  One example is the Austrian Research Promotion Agency (FFG), the central organisation for the promotion of research and innovation in this country. The Austrian Science Fund (FWF) is Austria’s central institution for the promotion of basic research. The Österreichische Nationalbank (OeNB), the central bank of the Republic of Austria, in 1966 founded the Jubilee Fund for the promotion of academic research and teaching. The means are awarded for scientific projects of high quality in the fields of economic studies, medical science, social sciences and humanities. Especially in the field of health, the Healthy Austria Fund (GÖG/FGÖ) also finances application-oriented research projects and studies on the further development of health promotion and comprehensive primary prevention, as well as epidemiology, evaluation and quality assurance in these areas. Other sponsors of addiction and drug-related research can be found at the level of provinces and in the promotion programmes of the European Union (EU). The multiplicity of structural levels involved (federal and provincial levels EU level) and the great variety of research funding sources make it difficult to survey the sphere of research promotion in Austria. Because of the great number of funding institutions, no funding figures could be given, neither for research in general nor for drug-specific research. Three out of the five projects identified by our desk work were funded by national public agencies. One project received funding from the European Commission. Specific research budgets are not available.
 
Coordination of research funding
 
In Austria there is no specific institution competent for centralised allocation of means for drug  or addiction-relevant issues. Therefore drug-related research is included in the general structure of research promotion. In the field of basic research, competence mainly lies with the federal authorities.
 
Priorities
 
Due to the lack of a national (federal) drug strategy or action plan (please see section “Future  strategic approaches aimed at building research capacity and funding infrastructure”) it could be presumed that no official national or federal priorities in the field have been declared. In this sense, the areas of interest of the two research institutes working on addiction issues (see also “Key research structures involved at country level”) could probably be indicative of the drug research priorities. By way of illustration the research in the framework of the LBI Sucht focuses on epidemiology, drug-specific problem areas (e.g., traffic safety), drug policy, social history, evaluation research, studies on addiction treatment and prevention as well as papers dealing with statistics and methodology. In recent years there were increased research activities within the framework of international studies in the field of evaluation of primary prevention. Research undertaken by the Addiction Research Institute focuses on physical, psychological and social disorders and diseases in the context of alcohol, nicotine, illicit drugs and psychotropic substances (EMCDDA Austrian National Report, 2007).