Applying a Public Health Approach to Drug Abuse Research
Compton, Wilson M., Journal of Drug Issues
Applying a public health perspective to drug abuse research has far-reaching implications. First, the health of the entire community is of concern, not just the individual patient. Because of the social impact of drug abuse, these problems become the responsibility of all citizens to address. Second, the perspective requires treating drug abuse as a health issue, not as a criminal justice, moral, or social issue. Third, as in other branches of medicine, applying this perspective to drug abuse research will encourage development of the most effective ways to enhance drug abuse prevention and treatment interventions through cross-disciplinary approaches. The public health approach requires studies that (1) determine need for intervention; (2) provide clues about etiology; (3) determine effective approaches, systems, and financing strategies; and (4) measure the impact of interventions and services on the health of a population. Overall, attending to the public health implications of research will help to assure the maximum impact of scientific findings.
What is meant by "public health research"? Public health research is defined as an approach to improving health that focuses on population-based measures. Applying this rubric to drug abuse research means that the tools of epidemiology are used to help determine need, provide clues about etiology, plan services, and determine effectiveness of interventions through measures of the impact on the health of a population. As seen in Figure 1, epidemiology is seen as linked in a reciprocal manner with basic research to elucidate answers to questions about etiology and with interventions research to inform the need for and outcomes of prevention and treatment services.
So what is the purpose of writing an article about a public health approach to drug abuse research? In this era of burgeoning neuroscience, it may be useful to review how the techniques and focus of public health care research can continue to contribute to productive avenues of research. It is quite obvious how such an approach is important to drug abuse prevention and treatment service delivery planners. In these cases, it is imperative to understand the changing patterns of drug abuse in one's community whether that is a town, county, state, region, or nation. But how does a public health approach help us in the research arena where the goals are quite different than policy and treatment planning? In the research area, we look to the ways that a public health perspective allows us to move the field forward in terms of elucidating possible causes and outcomes of drug abuse so that more effective interventions can be developed for prevention and treatment.
Therefore, this article provides a brief review of the ways in which a public health perspective has informed the study of drug abuse in the recent past and how researchers can build on these foundations. From a practical perspective, this outline will also serve as a guiding document for the Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse (NIDA) of the U.S. National Institutes of Health. Within NIDA, it is in this division where a public health focus is most generally disseminated.
What are the implications of a public health focus in drug abuse research? The implications of this focus are that researchers can move the field forward by applying tried and true methods of epidemiology. This means determining the web of causation for specific drug abuse epidemics based on careful detective work.
How does this perspective inform the larger scientific field? The model includes a focus on population groups so that results can be generalized to well-defined groups. Using this public heath perspective, sampling frames are always carefully considered. Therefore, the public health approach explicitly acknowledges the limitations of sampling design so that policy-relevant conclusions are more likely than in other areas of research in which the lack of representative samples often makes results of uncertain relevance. …