NATIONAL INSTITUTES OF HEALTH

II. METHODOLOGY

• The resources included in the National Institute on Alcohol Abuse and Alcoholism (NIAAA) are determined by the level of funding provided for NIAAA applied research on children and youth. This research focuses on underage use and its consequences. Actual expenditures were summarized for grants and contracts that address pertinent prevention and treatment research topics. Staff costs associated with monitoring these projects are also included.



• The National Institute on Drug Abuse (NIDA) is 100 percent drug-related. 

III. PROGRAM SUMMARY

• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH) is the primary Federal entity responsible for research on the causes, consequences, treatment and prevention of alcohol-related problems. NIAAA conducts and supports biomedical and behavioral research into the effects of alcohol on the human mind and body, research on prevention and treatment of alcohol abuse and alcoholism, and epidemiology studies of alcoholism and alcohol-related problems. Much of this research focuses on children and youth under age 21, the legal age of alcohol consumption. Accordingly, those activities focusing on underage use and consequences are included here as part of the National Drug Control Budget.



• The National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) supports over 85 percent of the world's research on the health aspects of drug abuse and addiction. NIDA-supported science addresses the most fundamental and essential questions about drug abuse, which range from the molecule to managed care and from DNA to community outreach research. NIDA is not only seizing upon unprecedented opportunities and technologies to further their understanding of how drugs of abuse affect the brain and behavior, but NIDA also is working to ensure the rapid and effective transfer of scientific data to policy makers, drug abuse practitioners, other health care practitioners and the general public. The scientific knowledge that is generated through NIDA research is a critical element to improving the overall health of the Nation.



• Ever-changing drug use patterns, such as the increasing drug use by our Nation's youth, the continuing transmission of infectious diseases such as HIV infection and hepatitis among drug abusers, and the need to develop effective treatment and prevention interventions underscore the importance of research in finding new and better ways to alleviate the pain and devastation of addiction. Never before has there been a greater need to increase our knowledge about drug abuse. NIDA researchers are seizing upon the unprecedented opportunities and technologies that now exist for understanding how drugs of abuse affect the brain and behavior and using these resources and findings to develop even more effective treatment and prevention strategies. Continued research on drug abuse and addiction will continue to hold the best hope for solving the Nation's drug problems.

Goal 1: Educate and enable America's youth to reject illegal drugs as well as alcohol and tobacco.

• Community Trials to Prevent Alcohol-Related Problems. The NIAAA supports an integrated group of seven community-based trials of interventions to prevent alcohol-related problems. Three of the trials are co-funded by the Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration. The focal problems to be prevented include alcohol-related trauma, underage drinking, and drinking and driving.



• Preventing High Risk Behaviors Associated With Alcohol Use and Abuse. Much has been learned about alcohol use as an important behavioral cofactor for HIV infection. Yet, relatively little is known about possible interventions to reduce sexual risk-taking in the context of alcohol use and abuse. NIAAA is soliciting projects to test interventions that have the potential for reducing the risk of HIV transmission among alcohol using, abusing, and dependent populations, including youth.



• Prevention of Alcohol Abuse on College Campuses. Interventions to prevent alcohol abuse by college students have shown that brief motivational counseling sessions that target heavy drinking college students can reduce their alcohol-related problems and changing students' expectancies about the positive value of drinking can reduce alcohol consumption. Current research focuses on the prevention of alcohol abuse among fraternity and sorority students. NIAAA is also collaborating with private foundations to stimulate studies of environmental and policy interventions to reduce binge drinking on college campuses.



• Preventing High Risk Behaviors Associated With Alcohol Use and Abuse. Much has been learned about alcohol use as an important behavioral cofactor for HIV infection. Yet, relatively little is known about possible interventions to reduce sexual risk-taking in the context of alcohol use and abuse. NIAAA is soliciting projects to test interventions that have the potential for reducing the risk of HIVtransmission among alcohol using, abusing, and dependent populations, including youth.



• NIDA is one of the lead Federal agencies for research to monitor the nature and extent of drug abuse in the United States. Long-term goals in these areas continue to include expanding and refining existing epidemiological databases, improving the measurement of drug abuse, and improving methods for assessing the adverse consequences associated with drug abuse. The early identification of children and adolescents at high risk for drug abuse continues as a high priority for the Institute.

Goal 3: Reduce health and social costs to the public of illegal drug use.

• All drugs of abuse act in the brain by altering normal biological processes, which in turn causes changes in behavior and thinking patterns. Advances in molecular biology and neuroimaging have allowed us to visualize the effects of drugs on the brain and to use drug probes to specify where drugs go in the brain, how long they remain there, and how long brain dysfunction remains after drug use ceases. These techniques are not only of great value as basic research tools, but continue to be invaluable in developing medications, studying the neurobiology of drugs and cognitive processes, and assessing treatment progress. These techniques will ultimately be translated into tremendous improvements in prevention and treatment.



• NIDA's top priority remains the development of an effective anti-cocaine medication or "cocaine blocker." We are now on the threshold of being able to provide this country with such a medication. Over the last several years we have seen tremendous advances in understanding how cocaine affects the brain at the cellular and molecular levels. NIDA/NIH supported scientists have identified and genetically specified the major receptor site where cocaine works on the brain, and have discovered many of the mechanisms of action both at the receptor and the molecular levels. Building on this knowledge about the specific receptors and sites in the brain where cocaine acts, NIDA now has the unprecedented opportunity to systematically explore methods to interrupt, modify, attenuate or extinguish this process through a rational process of medication design and testing. 

IV. BUDGET SUMMARY

1997 Base Program

• The FY 1997 base program includes $226.5 million for prevention and treatment research activities which support Goal 1 of the National Drug Control Strategy. This amount consists of $25.6 million for NIAAA Research, and $200.9 million for NIDA Research.



• The FY 1997 base contains an estimated $288.3 million for drug-related treatment research in NIDA which supports Goal 3 of the National Drug Control Strategy. In FY 1997, NIDA plans to focus on research areas which provide both continuity and commitment of purpose in a continuing pursuit of basic and essential objectives.

1998 Request

• The total FY 1998 drug control budget request is $548.5 million, an increase of $33.7 million over the FY 1997 enacted level.

Goal 1: Educate and enable America's youth to reject illegal drugs as well as alcohol and tobacco.

• The total drug control request for Goal 1 activities for FY 1998 is $240.6 million, a net increase of $14.1 million over FY 1997. Of that amount, $26.6 million is requested for NIAAA alcohol prevention activities. The 1998 request includes the following program enhancements:



• Neurobiology of Addiction. At the time of NIDA's establishment, NIDA-supported researchers began aggressively studying the neurobiological mechanisms for drug abuse, understanding that the effects of drugs on behavior must be mediated by the effects of drugs on the brain. These studies rapidly led to the development of an animal model of drug self-administration and the discovery that animals will self-administer most drugs that people do. This model, as well as research on the brain-stimulation reward system, moved drug abuse research into the neuroscience laboratory and sparked the search for the brain's opioid receptors and their natural ligands. With the landmark discoveries of endogenous opiate receptors by NIDA-funded researchers and the subsequent isolation and characterization of endogenous opiates, the fields of neuroscience and drug abuse research became inextricably linked.



• Drugs and the Brain. Advances in molecular biology and neuroimaging have allowed us to visualize the effects of drugs on the brain and to use drug probes to specify where drugs go in the brain, how long they remain there, and how long brain dysfunction remains after drug use ceases. These techniques will ultimately be translated into tremendous improvements in prevention and treatment.



• Medications Development. NIDA's top priority remains the development of an effective anti-cocaine medication or "cocaine blocker." NIDA/NIH supported scientists have identified and genetically specified the major receptor site where cocaine works on the brain, and have discovered many of the mechanisms of action both at the receptor and the molecular levels. NIDA is in the process of obtaining promising existing compounds from several sources, including the academic community and chemical supply houses, and from chemical libraries of pharmaceutical companies. In addition, NIDA will continue research toward development of potential new therapeutic compounds, and toward development of additional medications for opiate addiction.



• NIDA is also proposing to use the basic science of development to identify the determinates of drug taking behaviors among children and adolescents, and apply these findings to implement effective prevention and treatment approaches.



• Prevention of Fetal-Alcohol Syndrome and Alcohol-Related Birth Defects. NIAAA is funding a study among four Native American tribes of relationships between drinking patterns and the prevalence of fetal alcohol syndrome (FAS). A supplement to the study supports a survey of indigenous community-based preventive interventions and field tests of more utilitarian FAS screening and diagnostic techniques. This is as a prelude to designing a large-scale community-based intervention study to reduce the prevalence of FAS among high-risk groups.



• Studying Alcohol Use and Abuse in Rural Communities. The NIAAA is currently funding a range of studies that focus on rural populations. These include: Project Northland, which is testing community, school and parent interventions in Northeast Minnesota; a study of drinking patterns and drinking norms among adolescents and their families in rural Georgia; a study of psychosocial predictors of alcohol use among rural adolescents in Iowa; and, several studies of American Indians living on reservations.



• Preventing Alcohol-Related Violence. NIAAA is currently encouraging new research that will test interventions to reduce alcohol-related violence and its sequelae, particularly in the context of family interactions. A large collaborative working group of judges, prosecutors, and researchers is developing studies of youth driving under the influence (DUI) offenders.

Goal 3: Reduce health and social costs to the public of illegal drug use.

• The drug control request for Goal 3 activities for FY 1998 is $307.9 million, a net increase of $19.6 million over FY 1997. The FY 1998 request includes the following program enhancements:



• Treatment Improvement. NIDA has established major programs to identify, evaluate, and develop pharmacological and behavioral therapies for drug addiction. As the breadth of NIDA-supported research is expanded, we anticipate that novel approaches from such areas as molecular biology, developmental and cognitive psychology, and social learning theory, will present opportunities to improve treatment efficacy. One of NIDA's major initiatives has been to ensure the appropriate integration of behavioral and pharmacological therapies to optimize treatment effectiveness. Although it will require major changes in policy, regulation, medical training, and public perception, NIDA is firmly committed to providing the knowledge to encourage and enable drug abuse treatment to be included in the mainstream of modern medical practice.



• Medications Development. NIDA maintains an ongoing high-priority program for discovering new medications to treat crack/cocaine abuse. NIDA intramural researchers have discovered possible compounds that can block the effects of cocaine without interfering with the normal mood-modulating effects of dopamine. Recent scientific advances have led us to the recognition of the dopamine re-uptake transporter as the major site for the behavioral and biochemical action of cocaine. In addition, researchers have found that there are multiple dopamine receptors that have been shown to respond differently to various compounds. In general, activation in the brain of one type of dopamine receptor, the D1, suppresses drug seeking behavior and relapse, whereas activation of another, the D2, triggers drug-seeking behavior. This suggests that D1-receptor agonists may diminish episodes of intense craving for cocaine in humans, and ultimately prevent relapse in people who have stopped using the drug. This important piece of information identifies the D1 dopamine-receptor system as a potential target for medications to treat cocaine addictions.



• Behavioral Treatments. Behavioral therapies often remain the only available effective treatment approaches to many drug problems, including cocaine addiction, where there are no viable medications yet. Behavioral interventions are needed, even when pharmacological treatments are being used. The continued improvement and development of behavioral and psychosocial treatments are essential in the battle against drug addiction and are necessary as adjunct therapies to ensure the success of pharmacologically based treatments. NIDA continues to assess the value of integrating behavioral therapies with medications and to support studies to match specific types of patients to particular behavioral interventions.



• Health Services Research. Through its Health Services Research program, NIDA is increasing its focus on the organization and financing of drug abuse treatment, especially as it relates to national studies or alternative delivery systems including managed care and managed behavioral health care systems. NIDA is also encouraging studies of financing and organization of HIV prevention within the contexts of drug abuse and larger health care systems. In addition, NIDA continues its research on the effectiveness of drug abuse prevention and treatment services, and efforts to maximize the linkage between primary medical care and drug abuse treatment.



• HIV Infection and AIDS. Drug abuse is currently the fastest growing vector for the spread of HIV in the United States. All drug users place themselves at great risk for infectious disease transmission when engaging in unsafe sexual behavior while under the influence of drugs. Injection drug users (IDU), in particular, are at high risk for exposure and transmittal of HIV/AIDS, as well as to other drug-health related problems ranging from blood borne infections such as hepatitis B and C, and tuberculosis, to physical deterioration and death. The goal of NIDA's research program on HIV/AIDS remains to reduce HIV transmission that is related to drug abuse. NIDA research has demonstrated that drug abuse outreach and intervention programs are highly effective in reducing behaviors associated with HIV/AIDS. The research has determined specific factors that should be present in intervention programs aimed at reducing the spread of HIV among youth and have continued to identify the most effective types of interventions appropriate for different groups and communities.



• Minority Populations. Racial and ethnic minority groups are disproportionately impacted by drug abuse and its sequelae, including AIDS. NIDA continues to support research to better understand the bases of cultural differences in drug-seeking and use; to develop new and enhance existing outreach/intervention approaches focused on racial and ethnic minorities; and to develop new, and adapt existing, drug abuse treatments shown to be effective with the general population to meet the special cultural needs of racial and ethnic minority groups. The Institute continues its efforts to recruit investigators from Historically Black Colleges and Universities and from the Hispanic community into the drug abuse research field.

V. PROGRAM STATISTICS

VI. PROGRAM ACCOMPLISHMENTS

• Identification of a Potential Long-Acting Medication for the Treatment of Cocaine Abuse: A recent study has demonstrated that a dopamine re-uptake inhibitor that has been reformulated to be long-acting substantially reduces cocaine self-administration but does not affect food intake.



• Chronic Morphine Use Produces Structural Changes in Brain Cells: Researchers have recently demonstrated that chronic morphine can cause marked structural changes in the dopamine neurons in the brain's ventral tegmental area (VTA).



• Changes in Brain Metabolism in Chronic Marijuana Users: NIDA-supported researchers have recently demonstrated that chronic marijuana users have significantly lower metabolic activity in the cerebellum of the brain than nonmarijuana users.



• Cognitive Deficits Associated with Drug Use in Adolescents: NIDA researchers have demonstrated that drug use by adolescents can result in long-lasting cognitive deficits.



• Opiates and Pain Fibers: Pain is carried to the brain by two classes of fibers: A-delta and C fibers. A-delta fibers generally mediate acute sharp pain, whereas chronic aching pain is mediated by C fibers. NIDA funded research has recently established a non-invasive method for exclusively activating either fiber class in rats.



• Effectiveness of School-Based Drug Prevention Programs: The effectiveness of different drug prevention programs were examined in a meta-analysis of 120 school-based programs in grades 5 through 12 that evaluated success on self-reported drug use measures.



• Discovery of Potential New Class of Therapeutic Drugs: Scientists have recently discovered a novel class of compounds that may pave the way for the development of new therapeutic drugs for the treatment of a variety of brain disorders.



• Advances in Understanding the Neurobiology of Drug Craving: Drug craving is a major factor in relapse to drug use. Using PET, scientists are beginning to determine the neurobiological mechanisms of craving. Recently, NIDA researchers have, for the first time, visualized changes in the brain triggered by drug craving.



• Maternal Drug Use and Mother-to-Infant HIV Transmission: Multivariate analyses in a recent report from the Women and Infants Transmission Study (WITS) indicate an almost three-fold increase (Odds Ratio 2.77) in the risk of mother-to-infant HIV transmission associated with prenatal drug use (i.e., a measure combining use of cocaine, heroin/opiates, methadone, and/or injecting drug use), for women with duration of membrane rupture greater than 4 hours.



• Brain Imaging Studies Reveal Possible Mechanism for Cocaine Binging: Using PET, scientists compared the properties of cocaine and methylphenidate (another drug that inhibits the activity of the dopamine transporter), in an effort to determine why cocaine is more addictive. It was determined that while both cocaine and methylphenidate have rapid uptake rates and bind to the dopamine transporter similarly, cocaine is cleared from the brain much more rapidly than methylphenidate. This rapid clearance may be responsible for the binging behaviors seen with cocaine.



• A 12-state controlled study of lower legal blood alcohol limits for young drivers showed that lowering these limits to "zero tolerance" resulted in large and statistically significant comparative reductions in alcohol-related fatal crashes. These data helped influence the passsage of a new federal legislation that strongly encourages the states to adopt "zero tolerance" policies for young drivers. Other data suggest that the intensity of enforcement of " zero tolerance" is a key variable affecting the law's success.



• NIAAA research findings have concluded that:



• Community-based prevention interventions for alcohol abuse and alcoholism that simultaneously focus on schools, parents, and the community at large can significantly reduce under age drinking;



• Community organizing efforts can increase the proportion of on-premise and off-premise alcohol outlets requesting age identification of youth and can decrease the prevalence of alcohol sales to youth;



• Community initiatives involving enhanced law endorsement, media and educational campaigns, and public and private collaboration can significantly reduce drinking and driving, related driving risks, and traffic deaths and injuries; and



• Enhanced law enforcement and attendant publicity can increase the perceived risk of arrest, which appears to be the mediating variable linking law enforcement and publicity to decreased car crashes.