A major new event in the addictions landscape – the organisers claimed. To date, there hasn’t been a Europe-wide meeting on addictions. Many smaller conferences took place around the old continent, including the Annual Symposium of the Society for the Study of Addiction in York – the oldest addiction society in the world (anno 1884). I hoped that Lisbon can bring together people that attend the other meetings but never together. Here, I note my thoughts from three out of the 17 keynotes that I attended.
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| photocredit: lisbonaddictions.eu |
Robert West (@westr) on Wednesday 23 September 11:00 – 12:30, Plenary Session I (other speakers: Anne Line Bretteville-Jensen, Gabriele Fischer, Mark Kleiman, Marina Picciotto).
| photo credit: rawest.co.uk |
Speaking about the addictions from a multi-disciplinary perspective, Prof West highlighted that the tendency to monetize everything is destructive. We also tend to compartmentalize the models of addiction. Whether we think addiction is a self-medication or a social construct, all of those things have some validity, but we need to bring them together. Whether it’s speaking at a conference or dealing with an addictive behavior, three things are critical in order for change to happen: capability, motivation and opportunity (COM-B model of behavior). How hard can it be? The audience laughed. If we crack the addiction, we crack something that is at the heart of the human civilization. The taxation policies can be informed by the neuroscience, as they can be by counseling. West concluded his talk with a proposal for how we can deploy our resources better. He discouraged people from fighting over the money to be spent on addiction research. At the moment, we tend to direct addiction research towards our own interests, hunches and areas of expertise. This needs to change. A major review of research strategy underpinning approaches to combating addiction as the moment.
Keith Humphreys o (@keithNHumphreys) n Thursday 24 September 09:00 – 10:30, Plenary Session II (other speakers: Linda Bauld, Felix de Carvalho, Marina Davoli, Margriet Van Laar).
| photo credit: stanford.edu |
Translating research into policy and practice, Prof Humphreys reviewed the US science and policy on addiction in the last 7 years, especially the 2008 MHPEA, the 2010 “Obama care” and the 2008 MIPPA that eliminated the co-pays by 2014. Has the science affected the policy in any way? Is parity on everything possible? When kids reach 18, they leave their parents’ health insurance. The ACA changed it to 26 years. The addiction care providers cheered as this critical period in human development became covered. The welcome to Medicare exam introduced by MIPPA includes a depression and problem-drinking screen. Did scholarship in our field contribute to these policy changes? Is science supposed to decide policy by itself? The science doesn’t tell what we care about as a society. “Scientific evidence alone is not sufficient basis for health policy,” as Humphreys and Piot argue in a BMJ analysis. Just because we’re experts in science, it doesn’t make us experts in the governance. The fundamental political decisions are made outside of us and that’s good, because we’re not “Queens and Kings.” Humphreys went on to describe the four routes through which policy was translated into practice: press releases, professional organizations and grassroots advocates, scientists engaging the bureaucracy formally and informally, scientists in policymaking roles. In sum, the policy on alcohol and drugs related care in US is dramatically different than 7 years ago. Scientists didn’t cause that to happen by their own. On the other hand, the political will alone doesn’t guarantee smart policies (Figure 1).
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| Figure 1. Summary slide of Prof Humphrey’s presentation. |
Thomas Babor on Thursday 24 September 16:00 – 17:45, Plenary Session III (other speakers: Gerhard Bühringer, Henrique Lopes, Pia Mäkelä, Susana Jiménez Murcia).
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| photo credit: sea-addiction.org |
Discovering, new frontiers in addiction research, Prof Babor asked why do we pay attention to infrastructure in addiction science? Starting in the 1970’s, there was a gradual increase in the number of addiction research centres. When medical temperance people began to publish articles for peer-reviewed journals, specialized journals emerged. Starting from the 1960’s the number of journals exploded. Large proportion of the article production comes from U.S. and other “developed” countries; hoverer, there’s the bias of the dominance of the English language in the scientific areas. Now, people are starting to think of themselves as addiction specialists, especially if they get specialised training in that area. We’ve got large numbers of people who can be identified as addiction scientists. The science of bibliometrics tells us that there are over from 130.000 Occasional contributors (Bronze league), to 250 Platinum contributors (The Invisible College), who are publishing large numbers of articles per year. Some troubling trends – the predatory publishers corrupt the peer-review process. Science has become interested in the private interest – business model. Industry funding biases and sets the agenda for research. Where does this leave us? It leads to the fact that policy makers seem to be looking for a different kind of science that we’ve been doing. If we put all these trends together, the population and the public health impact of our research has not been demonstrated.
Have you attended the fourth Plenary about Challenges of addiction in an interconnected world on Friday? Post your thoughts below.