Substance use disorders (SUDs) are chronic, recurring disorders of major cost to society at all stages of the life cycle. They are of particula concern in Ukraine, whose rate of alcohol use is 5th highest in the world and whose lifetime rate of illicit drug use is already 21% by age 16 (WHO, 2011). At the same time, because of long periods of political turmoil and limited national resources, intervention programming to address these issues is primarily focused on chronic, end stage disorder, and concomitant professional training and addiction science have a similar focus. Both developmental/etiologic science and the intervention programming derivative from that are absent, although a small subset of researchers familiar with developments over the past decade in western countries have been appreciative of this changed perspective, and have been looking for ways to import it. Working in collaboration with two nationally visible physician scientists (MD/PhDs) from this cadre, and drawing on the experience gleaned from a successful program of substance abuse research infrastructure development in other Eastern European countries over the last 10 years, this project would implement a set of substance abuse research training experiences at several different levels of specificity, duration, and focus. The content goal is for transfer of knowledge pertaining to the developmental etiology of SUDs and implementation of intervention techniques that build upon that scientific base. In the latter years of the program, we would mentor and collaborate in design and pilot testing of an early screening and intervention program that ultimately will have the potential for national dissemination. The proposed program involves collaboration among faculty from 16 disciplines at the University of Michigan (UM), Department of Psychiatry (Addiction Research Center), at the Ukrainian Scientific Research Institute of Social, Forensic Psychiatry and Narcology (USRISFPN), and at the National University of Kyiv- Mohyla Academy (NUKMA). A set of interlocking training experiences at different levels of intensity and career status will include the following: (a) Yearly workshops (~ 35 attendees) held in various sites in Ukraine, for all levels of post-doctoral substance abuse scientists interested n the developmental psychopathology of SUD, research methodology, and SUD prevention and intervention strategies in non-clinical or community-based settings. (b) Year-long fellowships at UM, for 5 early-career post-doctoral fellows to learn more research methodology and work with mentors in areas of common interest, (c) Home-country research projects that these fellows develop while in the U.S., (d) 3 intermediate-term fellowships at UM for mid-career substance abuse researchers. (e) 3 short-term fellowships for senior research faculty to consult at UM and NIH about future program directions. (f) Creation of a Research/Intervention Program working group to develop a clinical trial on SUD screening and early intervention in targeted communities; and (g) Support of increased scientific collaboration between Ukrainian substance abuse researchers and other Eastern European researchers.
Although recent science has documented the developmental nature of substance disorders, the implications of that work for their prevention, early identification, and early intervention, is, for a variety of reasons, not yet widely known to professionals responsible for identification and treatment of them. In partnership with the two premier academic institutions in Ukraine that are focused on addiction research, this project would build research capacity to (a) incorporate this knowledge base into a more developmentally focused view of etiology, course, and treatment across the lifespan; (b) build translational interventions that would utilize it in community based-screening and early identification; (c) implement clinical trials to evaluate effectiveness. Capacity building would tae place through in-country workshops and research fellowships, with later stage work aimed at changing policy at the national level about how to address this very early appearing, albeit ultimately chronic family of disorders.
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