The MRC Addiction Research Clinical Training programme: MARC

Addiction to alcohol, tobacco and drugs have a considerable economic and social impact on society in the UK and internationally. In addition concerns are growing about gambling, now classified as a behavioural addiction. Despite awareness of the magnitude of associated harms, the amount of evidence to address them can be limited compared to other physical and mental health disorders. Academic psychiatry has been at the forefront of the development of addiction research in the last 30 years and the UK has made key contributions to the international evidence base as well as contributing to NHS service development and national policy on addictions. Currently however in the UK there are only 7 professors in addictions with a background in clinical psychiatry or clinical psychology and all will have retired or be near retirement within the next decade. The majority of psychiatrists and psychologists do not get any experience working in an addiction service during their training or if they do, it is towards the end. Therefore opportunities of a career in clinical academic addiction are rarely presented with the result that there are very few existing potential candidates to become the future UK clinical research leaders in addiction. Consequently, there is a need to kick start clinical addiction research in order both to sustain capacity in this vital area of clinical neuroscience.

To meet such a need, the MRC Addiction Research Clinical Training (MARC) programme has been developed by bringing together the clinical addiction research expertise in three leading Universities, Imperial College London (IC), King's College London (KCL) and University of Bristol (UoB)). These three internationally renowned mental health and addiction researchers and their Universities can provide expertise in a broad range of techniques including neurosciences, genetics, epidemiology and clinical research as well excellent post-graduate education and training. MARC's initiatives will attract and mentor outstanding clinical trainees to addiction early in their career, support outstanding individuals to undertake research training for a PhD and support individuals with a PhD to establish their career with independent funding in order to build and sustain capacity in this vital area of clinical neuroscience, addiction. Research from the MARC programme will undoubtedly improve understanding of the nature of addiction, its impacts on public health, and methods to reduce the harm through development of more effective prevention, treatment and public policy approaches in addiction.

MARC will develop and support the future UK clinical research leaders in addiction by
1. Increasing exposure to addiction earlier in clinical training by increasing addiction psychiatry in foundation year posts, specialist interest sessions and
2. Supporting attendance at Summer schools, training and conferences. We will continue to run courses and scientific meetings within our institutions and national organisations eg Royal College of Psychiatrists, Society for Study of Addiction, British Association of Psychopharmacology.
3. Establising PhD posts. Each institution will establish at least 2 PhD posts (two from MARC and others through additional matched funding) that are modelled on '3+1' studentships where the first year involves research method training and completion of mini-projects plus formal training, followed by a 3 year PhD project. We offer a range of expertise - Imperial College: neuroimaging, neuropharmacology; King's College London: addiction psychiatry, imaging, genetics, clinical trials; Univeristy of Bristol: epidemiology, genetics, neuroscience. Their research project will add value to existing MRC projects and grants already established in the host institutions.
4. Supporting MARC fellows to make them competitive for existing schemes: MRC, Wellcome, NIHR clinical training research fellowships and career development/intermediate fellowships. This will be also offered to those outstanding individuals who are unable to take up a MARC posts.
5. Providing academic mentorship for those in the UK interested in a clinical academic career in addictions complementary to those run by Academy of Medical Sciences and utilizing institutional training and support.
6. Each Institution committing to sustaining MARC through strategic development of their strong track record in clinical addiction research and through associating posts with MARC to support additional training and PhD opportunities.

In order to deliver research of maximum impact on public health and to maintain the international competitiveness of UK addiction research, MARC will recruit, train and prepare a new cadre of clinical academic researchers in addictions to a high level of expertise. The research will be in a broad range of disciplines including imaging, genetics, epidemiology and clinical trials. The research outputs from MARC will undoubtedly improve our understanding of the nature of addiction, its impacts on public health, and methods to ameliorate the harm through development of more effective prevention, treatment and public policy approaches.

Currently addiction treatment is increasingly delivered not solely through the NHS but in services working with third sector organisations such as Turning Point, Addaction, CRI. The main beneficiaries of work from MARC will be people receiving treatment from such services who require more effective treatment interventions than we currently have. In addition, physical and/or mental ill health is generally also present and evidence to support their treatment is even more limited and requires development of novel approaches to enhance and sustain recovery. Indeed the lack of addiction clinical training and research contributes to the perpetuation of stigma and adverse outcomes. Improving treatment outcomes will indirectly benefit their families and local communities, and the wider public who bear the burden and costs of collateral damage from the addicted individual. New, more effective treatments of addictions are also urgently needed to reduce the considerable economic impact of addictions in the UK and internationally.

The MARC cohort of clinical academics in addiction will be well placed to develop, package and deliver the high quality evidence needed for the benefit of public health in the UK. At the heart of MARC is engagement with translational research. The increased presence of clinical academic trainees and academic clinicians in addiction services will also contribute to changes in the culture and attitudes of staff in clinical services by increasing knowledge about how research translates to their clinical practice. MARC events will be multidisciplinary and bring together the scientific and clinical communities with other stakeholders and policy makers.

The MARC programme will also build on existing extensive engagement with the pharmaceutical industry in the UK and internationally both in terms of encouraging investment in pharmacological approaches to addictions as well as providing the crucial clinical research expertise and facilities to conduct high quality pharmacological research with NHS patients. Securing industry interest and support in the development of new pharmacological approaches to addiction treatment will be crucial and MARC offers an ideal training platform to attract clinical academics of the future who are able to foster these collaborations with industry.