National Institutes of Health

Agency Budget Summary

Department of Health and Human Services
National Institutes of Health
I. Resource Summary

II. Methodology

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

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.

III. Program Summary

Science, not ideology, must be the foundation of all drug abuse reduction efforts, and the National Institute on Drug Abuse (NIDA) provides the science that forms the foundation of the Strategy. Advances in science have revolutionized our understanding of drug abuse and addiction. We have learned, for example, that although initial drug use is a voluntary, and therefore a preventable behavior, drug addiction is an illness caused by the effects of prolonged drug use on the brain. Addiction is a chronic illness, similar to other chronicdiseases, characterized for many people by occasional relapses to drug use, even after successful treatment experiences. Addiction is a treatable, though chronic and relapsing, disease.

NIDA is the world's leader in generating and disseminating science-based findings on drug abuse and addiction. By supporting cutting edge research and quickly disseminating these findings to the field and to the general public, NIDA is enabling society to more effectively prevent and treat drug abuse and addiction, thus reducing its devastating health and societal effects.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH) is the lead Institute responsible for research on the causes, consequences, treatment and prevention of alcohol-related problems. Much of this research focuses upon children and youth who consume alcohol prior to age 21.

IV. Budget Summary
1999 Program
Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.
The FY 1999 budget for NIDA Goal 1 activities includes $250.0 million. Among the Goal 1 activities supported by NIDA in FY 1999:

Research: With drug use beginning at an earlier and earlier age, and continuing to increase among youth at all ages, NIDA is dedicating a large portion of its research portfolio to the study of the effects that drug abuse and addiction have on infants, children and adolescents. Prevention serves as the cornerstone of NIDA's Children and Adolescents Research Initiative. NIDA's research portfolio addresses other important issues, including the consequences of prenatal drug exposure, etiology and epidemiology of drug use, treatment of drug abuse and addiction, and drug abuse aspects of child and adolescent HIV/AIDS.

Education: NIDA pursues an aggressive campaign of public education, aimed at increasing understanding of drugs and drug abuse and addiction by children and adolescents. NIDA recently launched a new science education initiative for middle school students, teachers, and counselors called NIDA Goes to School.

Prevention: It is estimated that drug-related crime costs approximately $57.5 billion a year (The Economic Costs of Alcohol and Drug Abuse in the United States 1992, NIDA and NIAAA Report 1998). Drug abuse and its related activities, such as drug-dealing, play a major but often undefined role in violent behavior. Because of that link, NIDA is focusing attention on coordinating long-standing research efforts on the relationship between drug abuse and violence. Currently, NIDA-supported research is examining the connectionbetween drug use and a broad range of crimes, including homicide, rape, domestic violence, child abuse, and gang-related violence.

The FY 1999 budget for NIAAA Goal 1 activities includes $39.3 million. Among the Goal 1 activities supported by NIAAA in FY 1999:

Research on College Campuses: In early 1999, the U.S. Department of Education and the Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration (SAMHSA), will join NIAAA in issuing a Request for Applications (RFA) designed to promote research that develops and/or tests interventions with the potential for reducing alcohol-related problems among college students. These prevention strategies may focus upon the larger campus community in which drinking occurs, on individual student behaviors, or on groups of students known to engage in hazardous drinking behavior, such as sororities and fraternities. Interventions may also include campus or community policies.

Multicomponent, Community Prevention Trial: Environmental change is a major focus of Project Northland, a multicomponent, multiyear community trial nearing completion. Designed to investigate how best to delay, prevent and reduce the early onset of drinking and alcohol misuse disorders, the study population includes thousands of adolescents in 22 school districts in northeastern Minnesota. Students were recruited as 6th graders when the project began, and researchers are following them though their 12th-grade year. To date, interim results have been promising.

U.S. Mexican Border Community Study: Along the southern United States border, adjacent to Mexico, there are a number of known sites where underage youth, who are bound for covert drinking binges, engage in mass crossings. For example, Tiajuana, Mexico, historically one of the largest, most concentrated sites of binge drinking in the northern hemisphere, is a favorite locus of border crossings by underage residents of southern California. Similarly, Juarez, Mexico, with a like profile, is a favorite site for crossing from El Paso, Texas. Currently, NIAAA supports a Safe Border Project designed to test the efficacy of an intervention that makes border crossings harder to achieve. The project will compare the outcomes achieved for the Tiajuana locus, where intervention will be applied, to those for Juarez, where no Safe Border Project intervention will be applied.

Goal 3: Reduce health and social costs to the public of illegal drug use.
The FY 1999 budget for NIDA Goal 3 activities includes $358.2 million. NIDA-supported science addresses the most fundamental and essential questions about drug abuse, which range from the molecule to managed care and from DNA research to community outreach. Specific research priorities include:

Medications Development: NIDA maintains an ongoing high-priority program for discovering new medications to treat addictions. NIDA's highest priority is currently focused on an anti-cocaine agent. In the field of opiate addiction, NIDA will have had two new products (buprenorphine and buprenorphine combined with naloxone) submitted for FDAapproval. Additionally, products to treat withdrawal (lofexedine) and reverse tolerance/prevent relapse (dextromethorphan) in opiate addiction are in early stages of clinical trials. NIDA is also in the early stages of developing a medication to treat methamphetamine addiction.

Treatment: NIDA has made extensive progress in developing treatments for addiction, both pharmacological and behavioral. NIDA is supporting a new Treatment Initiative, which consists of a comprehensive, strategic set of activities designed to increase dramatically the quality and extent of drug treatment and to foster interchange of useful information on drug addiction treatment, including biological, behavioral and psychosocial components.

Methamphetamine: NIDA is increasing its research emphasis on methamphetamine. This involves the development of new and more effective prevention strategies, as well as work on various treatment approaches. NIDA will also foster the development of an anti-methamphetamine medication, clarify the long-term neurological and behavioral consequences of methamphetamine use, and continue to study the epidemiological trends of methamphetamine use.

HIV/AIDS: Injection drug use is the leading risk factor for new HIV infections in the United States. NIDA researchers in 23 sites have developed and are evaluating interventions directed to injecting drug users, now major transmitters of HIV/AIDS through the sharing of drug paraphernalia and through high-risk sexual behavior. These interventions have reduced the frequency of drug injection, needle sharing, and sexual encounters with injection drug abusers. NIDA plans to expand its research program on: HIV sexual risk reduction, HIV prevention tied to drug abuse treatment, and the development of novel interventions to reduce HIV risk behavior.

Advanced Instrumentation and computers in medicine and research: A variety of new technologies have finally enabled the study of brain function in awake, behaving individuals under varied conditions of drug use, drug abstinence, and drug craving. These studies are confirming for humans, concepts and relationships derived from animal models, the only approach previously possible, and revealing new relationships between behavioral states and brain structure and function.

2000 Request
Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.
The total drug control request for Goal 1 activities for FY 2000 is $297.7 million for NIH, of which, $41.8 million is for NIAAA programs and $256.0 for NIDA activities. This represents a net increase of $8.4 million over FY 1999. The 2000 request includes the following enhancements:

Prevention Research: Community trials will be initiated to identify and overcome the barriers to the successful implementation of NIDA's Preventing Drug Use Among Children and Adolescents: A Research-Based Guide. Research will be supported to demonstrate not only that these programs can be implemented, but also to learn how to tailor these programs to an individual community's needs. More research must be conducted to identify the needs of special populations and to develop targeted interventions to meet the specific needs of different groups of youth at risk for drug abuse.

Nicotine Research: NIDA will continue to provide scientific leadership in combating nicotine addiction. NIDA will support research on the treatment of nicotine addiction by focusing on the development of nicotine and non-nicotine replacement medications in combination with behavioral strategies. As promising new compounds are developed, their efficacy will be rapidly tested in multi-site clinical trials. Also, NIDA and the National Cancer Institute (NCI) will expand their joint initiative to develop trans-disciplinary research centers focusing on the prevention, development, and treatment of nicotine addiction and tobacco related cancers.

Fetal Methamphetamine Initiative: There is an increase in the use of amphetamines during pregnancy and an increasing number of babies in the adoption/foster care system in certain western and midwestern locations have been exposed in utero to methamphetamine. Currently, there is only anecdotal information on the effect of fetal methamphetamine exposure. Therefore, NIDA is launching a Fetal Methamphetamine Initiative to generate research on this growing issue. As an initial effort, a NIDA Fetal Methamphetamine workgroup is developing a symposium which would define what is known about the effects of methamphetamine on the developing fetus, and identify future research directions and gap areas.

Alcohol Intervention for Individuals Aged 18 - 21: Statistics reveal ages 18 through 21 are the period of heaviest alcohol consumption for most drinkers in the United States. In FY 1999, the NIAAA, in conjunction with the Department of Education and the Center for Substance Abuse Prevention (CSAP), is soliciting research grant applications for the study of interventions intended to prevent alcohol-related problems among college students. While high-risk drinking is greater among youth who attend college than among their non-college peers, the intervention calls for studying both groups.

Multicomponent, Community Prevention Trial: Scientifically-based alcohol prevention efforts, such as the Institute's Project Northland, have successfully demonstrated that comprehensive programs are effective in rural communities. Project Northland, a multicomponent, longitudinal trial, was implemented in 22 school districts and communities in Minnesota. After three years of intervention, the rates of alcohol use were significantly lower among students in the intervention districts when compared to reference districts. These results are promising in view of Project Northland's setting -- high risk communities with above-average incidence of underage drinking, coupled with social norms where heavy drinking is acceptable. However, the communities tested were small and cohesive, lacking ethnic and socioeconomic diversity. Accordingly, to assess the project's applicability tourban communities with diverse populations, further research in this area is needed to develop a model that is transferable.

Goal 3: Reduce health and social costs to the public of illegal drug use.
The total drug control request for Goal 3 activities for FY 2000 is $366.8 million for NIDA activities. This represents a net increase of $8.6 million over FY 1999. The 2000 request includes the following enhancements:

The National Drug Abuse Treatment Clinical Trials Network: To dramatically improve drug addiction treatment throughout this country, NIDA is establishing a National Drug Abuse Treatment Clinical Trials Network (CTN) to rapidly and efficiently test the effectiveness of behavioral and pharmacological treatments in real life settings. Using the model set by other NIH institutes, this network will serve as the major mechanism for moving science-based treatments into practice. The CTN will enable rapid, concurrent testing of a wide range of promising science-based behavioral therapies, medications, and their combined use, across a range of patient populations, treatment settings, and community environments nationwide.

Methamphetamine: NIDA has mounted a major, science-based methamphetamine initiative, including significant information dissemination efforts directed at increasing understanding of the dangers of this toxic drug and facilitating methamphetamine use prevention efforts. Through this initiative, NIDA-supported scientists are also working aggressively to develop more effective behavioral treatments and new medications to treat methamphetamine addiction, as well as new tools such as anti-methamphetamine antibodies to be used by emergency room physicians to treat the growing number of overdoses.

Genetics of Vulnerability of Addiction: NIDA will launch a Vulnerability to Addiction initiative directed at determining both the genetic and environmental factors that make individuals more or less susceptible to becoming addicted. A major element will be a series of multi-site studies of genetic determinants of vulnerability. Also included is the study of how individuals progress from their first drug exposure to regularly abusing drugs to addiction, information that will provide an important base for better prevention and treatment efforts. By understanding the integration of biological and environmental factors, NIDA will be better poised to prevent and treat drug abuse and addiction.

Medications and Behavioral Therapies: NIDA will continue to fulfill one of its primary goals of developing and bringing effective and innovative treatment approaches (both pharmacological and behavioral) to the national forefront and into practice. In medications development, NIDA will develop new treatments to counter the effects of stimulants such as cocaine and methamphetamine. Also, building upon the knowledge we have gained from neurobiological studies of addiction, NIDA will expand its efforts to develop novel medications by directing them at newly discovered neurobiologically relevant targets, such as the GABA and glutamate systems.

Planned Research: NIDA also plans research projects in "Understanding and Preventing Relapse," "The Neurochemistry of Addiction," and "Mapping the Brain Circuits of Drug Abuse and Addiction."

V. Program Accomplishments

NIDA's continued commitment to bring the full power of science to bear on drug abuse and addiction has yielded many advances with significant implications for and applications in real-life clinical practice and policy settings. For example, research has begun to reveal major differences between the brains of addicted and non-addicted individuals. This is what makes addiction fundamentally a brain disease; it is a condition of changes in brain structure and function. A variety of studies in both humans and other animals have demonstrated that chronic drug use changes the brain in fundamental ways that persist long after the individual has stopped taking a drug. These brain changes are intimately related to both the behavioral causes and the behavioral symptoms of addiction.

NIDA research in other domains has also contributed greatly to advances in prevention and treatment practice. Examples include the identification of prevention principles necessary for a program to be effective and how to assess drug problems in communities, as well as the notable expansion of drug treatments available for addiction disorders. Drug abuse research also has made numerous contributions in the development of brain imaging techniques that are applicable to a wide variety of scientific disciplines.

Several specific advances of note have been made in the science of drug abuse and addiction as a result of NIDA-supported research in the past year:

Gene Identified That Can Help Protect Against Nicotine Addiction: Recent research has shown that some individuals carry a gene that may help protect them from becoming addicted to nicotine. Nicotine is metabolized or broken down primarily by an enzyme in the liver known as CYP2A6. This study found that individuals who have decreased amounts or function of this enzyme are less likely to become addicted to nicotine. This study provides valuable information about vulnerability for nicotine addiction and may help lead to more effective treatments.

Community Intervention Can Reduce Drug Use Among High Risk Adolescents: Researchers evaluating a junior high school prevention program, found that even adolescents who were already using drugs could curtail their drug use if the program is properly tailored to that population. A NIDA-supported study evaluated the effectiveness of a multi-component community-based drug abuse prevention program in preventing drug use in a high-risk group of students, those who were already occasionally using drugs. Results showed significant reductions among this high-risk group in their use of tobacco, alcohol, and marijuana. The study counters a commonly held belief that drug use prevention is effective only with nonusers.

Molecular Genetic Techniques Demonstrate Multiple Brain Sites of Cocaine Action: It has long been known that one particular brain neurotransmitter system, dopamine, is centrally involved in cocaine's behavioral effects, and that the dopamine reuptake transporter (DAT) is the site in the dopamine system where cocaine is exerting its primary actions. This information has suggested that the dopamine transporter should be the primary target for developing new medications for cocaine addiction. The use of molecular genetic techniques, however, has suggested there likely are multiple sites of cocaine action in the brain and therefore there can be multiple brain targets where medications might be particularly effective.

Potential New Treatment for both PCP Abuse and Schizophrenia: PCP is a drug of abuse that produces bizarre behavioral and toxic effects that can have similarities to schizophrenia. Recently, PD 128,907, a drug that binds to and activates the D3 receptor subtype for the neurotransmitter dopamine, has been shown to prevent the psychotomimetic effects of PCP in animal models. These same studies found that PD 128,907 also has pharmacological actions that indicate it may also act as an antipsychotic. This discovery should be useful for better understanding of both the effects of PCP and the biological mechanisms of schizophrenia. It may also result in the ultimate development of clinically useful drugs for treating schizophrenia and addressing PCP abuse.

Prenatal Exposure to Cigarettes and Marijuana Can Affect a Child's Intelligence: In an examination of cognitive performance of 9-12 year olds who have been participating in a longitudinal study since birth, a direct correlation was found between the amount of prenatal cigarette exposure and performance on global intelligence tests. The greater the prenatal cigarette exposure the worse children performed on the global intelligence tests. In contrast, prenatal marijuana exposure was not associated with later global intelligence scores, but rather impaired executive function tasks that require impulse control and visual analysis/hypothesis testing, and with a number of intelligence subtests requiring these same abilities. The cigarette results extend observations made in this sample and others at earlier ages. These results indicate that prenatal exposure to drugs can have long-term impacts that are still evident among older children and the particular kind of drug exposure affects the later cognitive consequences for the child.

Genes Can Play a Role in Increasing the Likelihood That an Individual Will Abuse a Variety of Drugs: New research on pairs of male twins who had abused an illicit drug at some time in their lives found that the twins studied share a common liability factor to abuse a wide range of illicit drugs, including marijuana, sedatives, opiates, stimulants, and psychedelics. Genetic, family, environmental, and non-family environmental factors are all a part of this shared vulnerability. While previous research has shown that genetic and environmental factors can influence the risk of drug abuse, this study clearly shows that such factors also increase one's vulnerability to abusing every other illicit drug. Therefore an individual at risk for abusing one drug such as marijuana, also puts them at risk for abusing other drugs, such as cocaine and heroin. Which drug an individual uses is influenced by many factors including access and other environmental factors.

Preliminary findings through grade 11 are now available for Project Northland, a multicomponent, multiyear community trial, originally developed as a three-year intervention for early adolescents who were recruited as 6th graders. NIAAA extended the study through the completion of high school after its early, promising success with younger students. During grades nine and ten, intervention activities were greatly diminished for reasons that are not yet clear. For this period, the differences in alcohol use between intervention and comparison schools disappeared. Intensive intervention resumed in grade 11, however, and by the spring of that year, rates of past week alcohol use for intervention and comparison schools had again diverged. Grade 12 results are not yet available.

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1999 National Drug Control Strategy
Budget Summary Office of National Drug Control Policy