A Fix Special Report—The Maddening State of Addiction Research Funding | The Fix
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A Fix Special Report—The Maddening State of Addiction Research Funding

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FEDERAL TRIALS AND TRIUMPHS

NIDA is not without its successes. In its view, one of the most exciting, innovative areas of research it is currently funding is likely to lead to an intranasal delivery system for naloxone, an important medication that can immediately stop overdose. “This could be a huge advance in the area of harm reduction,” says a NIDA spokesperson. “Imagine a world where addicts or their loved ones could have (on hand) a user-friendly and nearly mistake-free delivery system to save a life.” 

NIDA’s research spans complex neuroscience and cellular biology, the development of medications to assist in treatment and broad-based epidemiological studies. It also includes community-based research and initiatives intended to inform drug prevention strategies. There are more than 2,000 grantees around the world working in a wide variety of areas of research. According to NIDA, “Each potential grantee thinks his/her area of research is the most important; and, given the low rate of research acceptance across NIH in general, there are naturally many disappointed scientists who will not agree with how funds have been prioritized.”

In 2013, out of 1,874 NIDA applications, 365 were awarded grant money for a myriad of research goals. These included $25,000 to the International Cannabinoid Research Society in Winston-Salem, NC for sponsorship of the ICRS Symposium on the Cannabinoids and $615,063 to Johns Hopkins University researchers for the evaluation of the effectiveness of employment-based reinforcement to simultaneously promote high rates of Vivitrol(R) adherence and increase opiate abstinence.

On the other hand, examples of the unfunded include a nicotine addiction study by Brett E Froeliger, PhD, an assistant professor of Neurosciences at the University of South Carolina medical school. Dr. Froeliger studies populations particularly vulnerable to nicotine dependence, including individuals suffering from major depressive disorder (MDD) and post-traumatic stress disorder (PTSD).

Also unfunded was a promising New York harm reduction program. “Over the course of the past 20 years, we collaborated with NDRI, a research organization, to do follow-up studies on graduates of our successful ARRIVE program, one of the first in the US to employ harm reduction practices,” says Howard Josepher, LCSW, president and CEO of Exponents in New York City, a non-profit community-based organization dedicated to helping men and women suffering from the effects of substance abuse reclaim their lives. “I don't remember the specifics but our applications to NIDA were rejected.”

Although his early studies in the 1960s and 1970s showed great promise and an alternative view of addictive behavior, Bruce Alexander, PhD, a Canadian psychologist, was never able to secure NIDA funding or mainstream support to continue his Rat Park experiments. Dr. Alexander found that, when isolated, rats would consume large quantities of heroin, cocaine, or morphine. Then, when placed in a community of other rats, consumption dropped dramatically.

“When I talk to addicted people, whether they are addicted to alcohol, drugs, gambling, Internet use, sex, or anything else, I encounter human beings who really do not have a viable social or cultural life,” writes Dr. Alexander. “They use their addictions as a way of coping with their dislocation: as an escape, a pain killer, or a kind of substitute for a full life. More and more psychologists and psychiatrists are reporting similar observations. The view of addiction from Rat Park is that chronic isolation causes people to look for relief.” 

THE COMPETITION TRIALS IN TODAY'S GRANTS

A NIDA or NIAAA grant application undergoes three levels of review. The first is the NIH peer review system, which is followed for all NIH institutes. At this level reviewers decide whether the application merits discussion by the larger committee. About 50% get a "no-discuss" at this stage. Other applications go on to NIDA’s Advisory Council. If an application makes it through round two, it is sent on for a third trial - a review by NIDA’s director, Nora Volkow, MD, who makes the final decision on the merit of an application for funding.  

The overall success rate in 2013 for all NIH grant applicants, not just substance abuse researchers, was 17.8%. The success rate for NIDA was 19.5%, meaning that out of each 100 grant applications, 19 received funding.

Although previously highly respected, the NIH peer review system has come under fire recently. Among the challenges to NIH, there is a perception that the quality of grant application evaluations has declined. Some critics point to as a flawed system of overburdened reviewers and reviews being relegated to younger, less experienced scientists. Additionally, some dissenters believe Dr. Volkow’s focus on the brain disease model of addiction limits research potential. Currently, the majority of NIDA’s research funding has an emphasis on various aspects of the brain disease model, and with an ideological focus on abstinence.
“All of NIDAs money is tied in brain research and Dr. Volkow  selects where the money will go and she can pull the trigger on others,” says Stanton Peele, PhD, author of Love and Addiction and the recently released, Recovery!  “If more treatment is provided but it reinforces the brain disease model, the net effects will be negative - disastrously so. People recover from addiction all the time. With an emphasis on the brain, we are creating a cultural meme.”  

NIDA takes issue with such claims. “We are basing our decisions on multi-step open calls for research and not focusing on specific outcomes,“ says NIDA’s Dr. Stein. “In peer review, good applications rise to the surface and in general we fund in priority order.”

WHO GETS THE MONEY?

Many in the research community would take issue with Stein, including at least one Nobel Prize winner. 

“The system now favors those who can guarantee results rather than those with potentially path-breaking ideas that, by definition, cannot promise success," according to an essay published in April by four scientists, among them Harold Varmus, MD, Nobel Prize co-recipient and director of the National Cancer Institute.

The article, “Rescuing US biomedical Research From Its Systemic Flaws,” published in the Proceedings of the National Academy of Sciences, argues that the hyper-competition for resources to conduct science suppresses the creativity, cooperation, risk-taking and original thinking required to make fundamental discoveries. "Young investigators are discouraged from departing too far from their postdoctoral work, when they should instead be posing new questions and inventing new approaches,” wrote the four scientists. “Seasoned investigators are inclined to stick to their tried-and-true formulas for success rather than explore new fields.”

A denial of funding is a devastating blow to a scientist who spends many long hours researching, writing and revising grant applications. “I basically spent 20 years in science and developed a herpes simplex virus type II vaccine, but I’m a nobody at a no-name university,” says Bill Halford, PhD, an associate professor of microbiology at Southern Illinois University School of Medicine, Springfield.  “In the NIH system, it doesn’t matter. I’m not important enough.”

The way Stanford's Dr. Humphreys explains it, the average age time it takes a researcher to obtain his or her first grant is nearly 10 years more than in the past. One consequence: after repeated rejections, younger scientists are leaving research. Most funding now goes to researchers who are over 60. In 1980 less than 1% of fundees were over age 65; today it is 7%. And in 1980, close to 18% of all fundees were under age 36; today it’s 3%. 

“They don’t take a risk on new people. Certainly people retain creativity as they age but historically more innovation comes from younger researchers,” Humphreys says. “And it is not sustainable. Who will be there to study when those in their 60s and 70s are retired and the younger people have given up, particularly the MDs? They can make more money treating patients."

Occasionally, Humphreys notes, a small project from a younger investigator will get funded in an early stage. "But you lose programmatic continuity when a small study that shows promise gets funded and now you’re ready for the big grant and can’t get it, so the initial grant goes to waste.”

Has he been affected? “I’m in the fortunate group, it doesn’t mean it’s easy for me, but it is much easier for me versus a newcomer. It’s hard to get a leg up [especially] if you are at a state university or smaller college. Not at Stanford or Harvard or other established institutions.”

In Dr. Topolski’s lab, a reduction in funding meant a research group of 20 scientists was reduced to 8. And these days he no longer writes grants because he is so busy finishing grant projects left behind by retrenched researchers. Initially, Topolski says, when the funding crunch came he considered early retirement. He chose not to retire, he says, because he is getting to learn about new things with new partners. His most recent study, for example, is in collaboration with the Missouri Departments of Corrections and Mental Health, the St. Louis Drug Court and Alkermes, the company that manufactures Vivitrol, an injectable extended release naltrexone used for alcohol dependence and to prevent opioid relapse. “We are really blessed,” says Dr. Topolski. “We have visionary leaders.”

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