IV. Agency Budget Summaries

NATIONAL INSTITUTES OF HEALTH

1. RESOURCE SUMMARY

   

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

   • The resources included in the National Institute on Alcoholism and Alcohol Abuse (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.

3. PROGRAM SUMMARY
   • 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 underscores 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. Research on drug abuse and addiction will continue to contribute to solving the Nation's drug problems.

   • 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.

   • Alcohol abuse and alcohol dependence affects about ten percent - approximately 14 million - adult Americans. Unfortunately, they are not the only affected group. Approximately 6.6 million children under 18 years of age live in households with at least one alcoholic parent. Children growing up in homes where one or more household members abuse alcohol can suffer seriously. They may be at risk for a range of emotional and behavioral problems.

   • NIAAA is supporting research that approaches the problem of adolescent and childhood drinking from several complementary perspectives, specifically the effects of childhood home and school environments, employment, and social policies on pre-adult drinking. Understanding the contribution of each of these factors is critical to the development of effective prevention and education efforts.

   Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.
   • Prevention Research. NIDA has launched a Children and Adolescents Research Initiative, to provide scientific-based information to prevent drug abuse among our Nation's youth. The initiative has two major components: prevention of initial drug use and prevention of the health consequences of drug abuse. Both of these components will include the development of science-based prevention programs targeted specifically to children and adolescents

   • 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.

   • 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 challenging 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.

   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.

4. BUDGET SUMMARY

   1998 Program

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

   • The FY 1998 budget for NIDA Goal 1 activities includes $213.569 million, an increase of 5% over FY 1997. At this level, NIDA will continue its focus on important research objectives, for example, Neuroscience Research, a program studying the neurobiological mechanisms for drug abuse, understanding that drug's effects on behavior must be mediated by the drug's effects on the brain.

   • The FY 1998 budget for NIAAA Goal 1 activities includes $27.415 million and two FTE. This funds NIAAA Drug Control activities, representing an increase of 5% over FY 1997. At this level, the NIAAA would modestly enhance research on intervention and prevention strategies to combat the health, economic and social consequences of alcohol abuse and alcoholism as they affect underage youth.

   Goal 3: Reduce health and social costs to the public of illegal drug use.
   • The FY 1998 budget for NIDA Goal 3 activities includes $313.606 million, an increase of 5% over FY 1997. At this level, NIDA will continue its focus on important research objectives, for example, Medications Development, for discovering new medications to treat crack/cocaine abuse.

   1999 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 1999 is $262.259 million for NIH, of which, $29.5 million is for NIAAA programs and $232.759 million for NIDA activities. This represents a net increase of $21.275 million over FY 1998. The 1999 request includes the following enhancements:
     • Children and Adolescents Research. NIDA has made children and adolescents one of its highest priority areas, and is dedicating a large portion of its research portfolio to the study of the effect that drug abuse and addiction have on infants, children and adolescents. Prevention will serve as the cornerstone of research in this area, with a focus on the prevention of initial drug use, the prevention of health consequences of drug abuse and on the prenatal and developmental consequences of drug exposure.

     • Education and Information Dissemination. NIDA will continue to develop culturally appropriate research-based materials, work with local community based networks, and continue to hold town meetings to disseminate the latest scientific information to help communities prevent and treat drug abuse and addiction. NIDA will also continue to translate and disseminate research-based handbooks, such as "Marijuana: Facts for Teens," and "Marijuana: Facts Parents Need to Know" into Spanish and other languages.

     • Nicotine. NIDA will continue research on nicotine and addiction in FY 1999, expanding the program to evaluate the decision making processes of children as effective interventions for prevention.

     • Effects of Advertising on Youth. NIAAA will continue to fund projects which study the effects of advertising of distilled spirits on alcohol consumption, alcohol-related problems, and initiation of youthful drinking.

     • Focus on Alcohol Treatment for Adolescents. NIAAA will begin to solicit studies that will provide a scientifically-informed basis for developing effective adolescent treatment strategies, including consideration of different cultural and gender needs.

   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 1999 is $343.540 million for NIDA activities. This represents a net increase of $29.934 million over FY 1998. The 1999 request includes the following enhancements:

   • Development of Drug Abuse and Addiction Treatment. NIDA will continue to develop safe and effective medications to treat drug addiction, as well as the development and improvement of existing behavioral treatments. In FY 1999, NIDA will officially launch its new Treatment Initiative at the National Conference on Drug Addiction Treatment Research. This will include medications development research, and research on behavioral and psychosocial treatment approaches.

   • Treatment Improvement. The support of novel and creative approaches to the treatment of addiction is of critical importance if the drug addiction treatment field is to grow and flourish. Emerging scientific knowledge is not always incorporated rapidly into the treatment process. Because of the tremendous problems associated with drug addiction, including the spread of HIV/AIDS, NIDA has just launched a major Treatment Initiative to develop new and improved treatments, both pharmacologic and behavioral, for all drugs of abuse.

   • Nicotine. The use of tobacco products may be the Nation's deadliest and most costly health problem; it is addiction to nicotine that is at the root of this enormous problem. NIDA research has provided the basis for understanding the addictive properties of nicotine and has been instrumental in developing both pharmacological and behavioral treatments for nicotine addiction. Also, NIDA will conduct additional clinical research to increase effectiveness of long-term smoking treatments by focusing on the development of nicotine and non-nicotine based replacement medications.

   • 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. Building on this knowledge, NIDA will now develop a rational and systemic process based on both basic and clinical research in which to design and screen potential anti-cocaine medications.

5. PROGRAM ACCOMPLISHMENTS
   • Neuroimaging Techniques Identify Site of Cocaine's Effects. NIDA scientists have identified the brain structures that are involved in cocaine's effects. By detailing the brain circuits involved in these different behavioral states, these studies provide the foundation for the development of new, targeted medications to block individual aspects of cocaine's effects.

   • Effects of Long-Term Marijuana Use on the Brain Shown Similar to Other Addicting Drugs. A study has shown that long-term use of a cannabinoid can lead to changes in the nervous system that are similar to those seen after long-term use of other major drugs of abuse. In this study, corticotropin-releasing factor (CRF), a brain chemical which increases during periods of stress, was found to be elevated in the brains of animals following withdrawal from a cannabinoid. This suggests that there are certain common elements to the changes in brain structure and function that occur with long-term drug use and withdrawal.

   • Cocaine Binding Site Identified on the Serotonin Transporter. Researchers have now identified the precise locations on the serotonin transporter where serotonin and cocaine bind. This suggests that the cocaine binding site on the dopamine transporter will also overlap with the dopamine binding site. This has provided researchers with critical pieces of information to develop an effective anti-cocaine medication that does not interfere with normal brain functioning.

   • Prenatal Cocaine Exposure: Development of Children at School Age. Twenty-eight children whose mothers were considered light to moderate cocaine users during pregnancy were compared with 523 children whose mothers reported no cocaine use during pregnancy. At 6 years of age, there were no significant differences between the groups on growth, intellectual ability, academic achievement, or teacher-related classroom behavior. However, children prenatally-exposed to cocaine did show deficits in their ability to sustain attention on a computerized vigilance task.

   • Researchers Identify Effective Dose for Treating Heroin Addiction. A study of both male and female heroin addicts showed heroin use decreased as dosage of LAAM increased. Furthermore, 34% of patients receiving the highest dosage remained abstinent for 4 consecutive weeks, as compared to 11% at the lowest dosage. This study demonstrates the importance of identifying and administering the most effective doses of medications used to treat heroin addiction. Often patients receive less than the most effective doses which can lead to a greater rate of relapse.

   • NIAAA. Young adults have a higher prevalence of alcohol consumption and binge drinking than any other age group. They also drink more heavily and experience more negative consequences. Over time however, most heavily drinking adults "mature-out" of abusive drinking patterns. Research has shown that drinking patterns are affected by these factors: demographic, psychological, behavioral, social, minimum age drinking laws, and cost of alcohol. Motivational programs designed to reduce risks and consequences associated with young adult drinking have shown some efficacy.

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