Sunday Gazette - Mail; Charleston, W.V. (May 17, 11:27 PM)  NEW YORK - Doctors treating substance abuse are looking to expand their impact.

Abuse of opiate painkillers, such as Vicodin and OxyContin, has risen substantially in the past five years, making this the nation's highest-priority drug problem, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

Volkow and other experts hope they can better tackle substance abuse by integrating the latest research on addiction into psychiatric practice. To that end, addiction-related topics were featured recently at the American Psychiatric Association's national meeting in New York City.

"To me it is very straightforward," Volkow said during a news briefing at the meeting. "I'm a psychiatrist, and one of the things that was very frustrating to me ... was the realization that most of psychiatric patients have substance abuse problems. And yet we were not really properly trained to actually solve these problems."

People might first develop a mental disorder, then an addiction - perhaps as an attempt to self-medicate, she said. Or kids may first take drugs and then develop a mental illness. "Could the substance abuse in any way have made that kid more vulnerable?" she asked, adding that it's a question to which researchers don't yet know the answer.

The jump in prescription painkiller abuse is relatively new, so there is no epidemiological data yet to track its source, Volkow said. The increase probably has multiple causes, she said, including a relatively new phenomenon: sale of opiate painkillers on the Internet. Also, legal prescriptions of the drugs have increased dramatically in recent years.

"One of the things we saw in the '90s was an attempt to improve prescribing for pain," said Dr. Herbert Kleber, a psychiatrist and researcher at Columbia University. "And indeed it happened. You had lawsuits about physicians who did not adequately prescribe enough narcotics for pain."

The increased availability has given not only legitimate patients a chance to abuse the drugs, but others as well. If you work with teens, Kleber said, you find that the first thing many baby sitters do is check the medicine cabinet.

Painkiller addiction is also a problem among the elderly, who are most likely to be prescribed opiate drugs, Volkow said. Sometimes faced with a number of pills to take, these patients could accidentally misuse them.

"That's a new group of subjects that all of a sudden we're facing," she said.

Female patients have indicated they can find Vicodin or OxyContin by asking around at their beauty salons, where someone invariably has the drug or knows how to get it, Kleber said.

It's not as if doctors and others haven't made progress in the fight against substance abuse. Illegal drug use among teenagers is down 11 percent, Volkow noted. And cigarette smoking is at its lowest level in teens since 1979.

Rates of abuse of stimulants and a class of drugs known as benzodiazepines (including Valium) have held steady, Volkow noted, even though prescriptions for stimulants, mainly to treat attention deficit/hyperactivity disorder, roughly double every five years.