of research positions (NRC, 1994). This is also a problem for Ph.D.-trained clinical researchers (IOM, 1994). These financial pressures may detract from their enthusiasm for a research career.
Another barrier for many clinical researchers is trying to balance teaching, clinical, and research responsibilities. Academic departments have exerted added pressure for many investigators to increase their clinical efforts, impairing their ability to pursue research. Combined with shifts in health care funding and in support by the federal and state governments, excessively heavy clinical workloads are likely to have significant consequences for future research careers. As one young M.D./Ph.D. investigator stated, "There is always tension between the need to deliver services for my department while at the same time trying to keep my research going." Another commented on "the challenge of protecting the time for research through grant dollars that is becoming increasingly difficult due to grant funding limitations." The demands of clinical practice place enormous pressure on the clinical researcher's schedule.
To encourage excellence in clinical research on the problems of addiction, the committee recommends that:
The federal government should establish a debt deferral or forgiveness program for scientists conducting clinical research in drug addiction or treating persons with drug abuse in publicly funded settings; and
Federal funds should be made available from NIH, SAMSHA, HRSA, or AHCPR to provide training for primary care physicians (e.g., obstetricians, family physicians, and internists) to recognize, treat effectively, or refer patients with drug abuse problems.
In recent years, there has been increasing recognition that the behavioral sciences and neurosciences have advanced the field of addiction research and treatment (IOM, 1996). The behavioral sciences have contributed to our understanding of the complex behaviors of initiation, maintenance, cessation, and relapse to addiction, while the neurosciences have described neural mechanisms and common reward pathways responsible for addictive behaviors. That research may illuminate the underlying causes of addiction and provide theory-guided direction for the development of treatment and prevention strategies. Integration and collaboration of these research perspectives will benefit all types of research, basic and applied.