National Advisory Council on Alcohol Abuse and Alcoholism

Summary of the 95th Meeting

September 13-14, 2000

In accordance with the provisions of Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S.C. and Section 10(d) of Public Law 92-463, the meeting was closed to the public from 7- 8 p.m., on September 13, for the review, discussion, and evaluation of individual applications for Federal grant-in-aid funds. The meeting was open to the public from 8:30 a.m. - 3:00 p.m. on September 14, for the discussion of program and policy issues.

Council Members Present:
Dr. Alpha Estes Brown
Dr. Richard Deitrich
Dr. Marc Galanter
Dr. Mark Goldman
Dr. Rueben Gonzales
Dr. Harold Holder
Ms. Linda Kaplan, CAE
Dr. Matthew McGue
Dr. Carrie Randall
Mr. Paul Samuels, J.D.

Council Members Absent:
Dr. Marilyn Aguirre-Molina
Dr. Henri Begleiter
Dr. Anna Mae Diehl
Ms. Sheryl Ramstad Hvass, J.D.
Dr. Barbara Mason

Ex-officio Council Members Present on September 14
Mr. Roger Hartman, ex-officio member from the Department of Defense (DOD)
Dr. Richard Suchinsky, ex-officio member from the Department of Veterans Affairs (VA)

Dr. Enoch Gordis, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), called to order the closed session of the ninety-fifth meeting of the National Advisory Council on Alcohol Abuse and Alcoholism at 7 p.m., September 13, for the consideration of grant applications.

Dr. Kenneth Warren, Director, Office of Scientific Affairs, reviewed the procedures for the conduct of grant application review, and reminded the Council members of the regulations pertaining to conflict of interest and confidentiality.

Members absented themselves from the discussion and evaluation of applications from their own institutions, or in situations in which a potential conflict of interest, real or apparent, might occur. Members also signed a statement to this effect.

Council members concurred with all initial review committee recommendations for all grant applications available to them as summarized below. Applications which were "Not Scored" or with a percentile score of 40 or worse were not reviewed by Council.

The following table is a summary of applications assigned to NIAAA for the September 13 Council meeting. The table excludes applications for Small Grants (R03s), Fellowships (Fs), conference grants (R13s) for $50,000 or less in annual direct costs, and foreign applications with a percentile score greater than 50 percent. Small Grants and Fellowships and most conference grant applications do not require Council approval since they are for $50,000 or less in annual direct costs. The total years' direct costs for "Scored" applications are at the IRG and Council recommended funding levels and the total years' direct costs for "Not Scored" applications are the requested amounts.

Dr. Enoch Gordis, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), called to order the open session of the ninety-fifth meeting of the National Advisory Council on Alcohol Abuse and Alcoholism at 8:30 a.m., on September 14.

Dr. Gordis said that the five Council members, Dr. Marilyn Aguirre-Molina, Dr. Henri Begleiter, Dr. Anna Mae Diehl, Dr. Barbara Mason, and Ms. Sheryl Ramstad Hvass were unable to attend the Council meeting.

Dr. Gordis presented certificates of appreciation to the three Council members in attendance whose terms ended on October 31 - Dr. Marc Galanter, Dr. Mark Goldman, and Dr. Carrie Randall. A Certificate of Appreciation will also be sent to Dr. Henri Begleiter.

Dr. Gordis then asked all of the Council members and other attendees to introduce themselves.

Dr. Gordis said that the FY2001 budget would probably include a good increase for the NIAAA and the NIH.

The full text of the recent report to the United States Congress on Alcohol and Health is now available on the NIAAA home page at http://www.niaaa.nih.gov. The Institute's award winning magazine, Alcohol Research and Health, is also available at the same web location. A booklet called How Does Alcohol Affect Your Child? has also been prepared in conjunction with the National Leadership Initiative to Keep Children Alcohol Free.

Dr. Gordis stated that there had been a recent reorganization within the Institute as described in the printed Director's Report to Council. This is the first major organizational change at NIAAA since the late 1980s when the Division of Clinical and Prevention Research was established.

A fine supplement to the British Journal Addiction has just been published on the issue of craving. The editors were Dr. Collin Drummond of the United Kingdom and Drs. Cherry Lowman, Raye Litten, and Walter Hunt from NIAAA.

Dr. Gordis then highlighted other parts of the Director's Report including the status of the College Drinking Initiative, the Governors' Spouses (Leadership) Initiative to Keep Children Alcohol Free, the Fetal Alcohol Interagency Work Group, the NIH Science Education Program for high school students, collaborative research on fetal alcohol syndrome in South Africa, collaborative efforts with Mothers Against Drunk Driving (MADD), the research to practice initiative in New York and North Carolina, and an upcoming issue of Alcohol Alert titled "From Genes to Geography: The Cutting Edge of Alcohol Research."

There will be a conference in November on QTL mapping organized by Dr. Robert Karp.

A new Laboratory of Physiologic Studies has been established by Dr. George Kunos, Scientific Director of NIAAA. The new laboratory will have two sections: Neuroendocrinology with Dr. George Kunos as Chief and Liver Biology with Dr. Bin Gao as Acting Chief.

Dr. Gordis reported that Dr. Mary Dufour, Deputy Director of NIAAA, has been promoted to the rank of Assistant Surgeon General in the Commissioned Corps of the United States Public Health Service.

Dr. Diedra Roach has joined the Office of Collaborative Research Activities as a Medical Officer.

Ms. Kelly Green Kahn has joined the Office of Policy, Legislation and Public Liaison (OPLPL) as a program analyst.

Ms. Amy Matush has also joined OPLPL as a designated Presidential Management Intern.

Dr. Mary Westcott has joined the Office of Scientific Affairs in the planning and evaluation area.

Dr. Roger Sorensen is a designated Presidential Management Intern in the Division of Basic Research in the neuroscience research area.

Dr. Harold Perl has been appointed Chief of the Health Services Research Branch in the Division of Clinical and Prevention Research.

Dr. Wendy Smith, Division of Clinical and Prevention Research, has moved to the Office of the Director of the National Cancer Institute as the manager of a new Research Development and Support Program in the Office of Cancer Complementary and Alternative Medicine.

Dr. Gordis then introduced Dr. Bin Gao, Acting Chief of the new Section on Liver Biology. Dr. Gao recently received the Young Investigator Award of the International Society for Biomedical Research on Alcoholism in recognition of his contributions to the field.

Dr. Sam Zakhari, Director of the Division of Basic Research at NIAAA, received the 13th Annual Research Society on Alcoholism Seixas Award for Service.

Dr. Norman Salem, Chief, Laboratory of Membrane Biochemistry and Biophysics and former Acting Scientific Director for NIAAA, was elected Vice President of the International Society for the Study of Fatty Acids and Lipids.

Dr. Jan Howard, Chief of the Prevention Research Branch, received the Lifetime Achievement Award in June from the National Prevention Network.

Dr. Gayle Boyd, of the Prevention Research Branch, received an award in June from Mothers Against Drunk Drivers (MADD) "in appreciation for her dedicated service as a member of MADD's College Commission addressing the impact of alcohol on America's College Campuses."

Dr. Gordis concluded his remarks by saying that Dr. Carrie Randall had been selected to receive the Fifth Annual Mark Keller Award in November. The title of Dr. Randall's Award Lecture will be "Alcohol and Pregnancy: Highlights from Three Decades of Research."

Dr. Mark Goldman, co-chair of the Council Subcommittee on College Drinking which includes former Council member Reverend Edward Malloy, President of the University of Notre Dame as co-chair, and Council members Dr. Marilyn Aguirre-Molina and Dr. Harold Holder, presented an update on the Subcommittee activities.

Dr. Goldman said that the Subcommittee would present its final report to Council in February. The Subcommittee consists of two panels on the Contexts and Consequences of College Drinking and on the Prevention and Treatment of College Drinking. The panels are composed of college presidents and research experts and have produced reports for consideration by the full Subcommittee and ultimately by Council.

Dr. Goldman stated that the problem of college drinking is actually much larger and more pervasive than anyone had yet realized. At the same time, it has been found that a great deal is known about what to do about it.

The Subcommittee report will therefore contain a description of the size of the problem and a set of preliminary directives about how college presidents can go about dealing with it on their campuses.

Mr. Stephen Long, Executive Officer for NIAAA, added that there would be a November 1 meeting of all the college presidents on the Council Subcommittee at Chicago's O'Hare Airport to review the Subcommittee report.

Dr. Suzanne Medgyesi-Mitschang, Special Advisor to the Institute Director, began by thanking three Council members, Dr. Marilyn Aguirre-Molina, Dr. Mark Goldman, and Dr. Harold Holder, for their involvement in the Leadership Initiative to Keep Children Alcohol Free. Mr. Roger Hartman, ex-officio Council member representing the DOD, has also been working with the Initiative regarding possible DOD participation as a collaborating and possibly funding partner.

The Leadership Initiative currently has 28 Governors' spouses signed up and hopes to get at least 37 to participate.

The Robert Wood Johnson Foundation has pledged $3 million for the second phase of the Initiative, which is scheduled to run for three years. The Office of Juvenile Justice and Delinquency Prevention has become a funding partner for over $1 million over the next three years. Several other Federal agencies, including the DOD, are also being invited to participate.

The national kick-off meeting was in March 2000 and two regional meetings are scheduled in September in San Francisco, California and Columbus, Ohio.

Several States have scheduled kick-off meetings to promote the Leadership Initiative and distribute publications and other materials to various groups such as, schools and alcohol outlets. Additional educational materials are being developed based on research findings, and educational materials on alcohol are being developed for seventh and eighth graders.

Dr. Medgyesi-Mitschang then presented a video to help educate adult audiences about why kids drink and what they can do to prevent drinking by children from ages 9 to 15.

Dr. Alpha Estes Brown suggested sending copies of the video to the Bush and Gore Presidential campaigns as a way of possibly interesting them in the issue of keeping children alcohol free.

Dr. Richard Suchinsky, ex-officio Council member representing the Department of Veterans Affairs, said that as Chair of the Council on Addiction Psychiatry of the American Psychiatric Association, the issue of preventing alcohol use by children was a top priority.

Mr. Paul Samuels asked about plans to link the Initiative to school and community-based prevention providers around the country.

Dr. Medgyesi-Mitschang said that representatives of such groups could be added to the Executive Working Group for the Leadership Initiative.

Dr. Michael Eckardt, Senior Scientific Advisor in the Office of Scientific Affairs, updated Council members on the activities of the Council Subcommittee on Research Priorities. The Council Subcommittee includes Dr. Henri Begleiter, Dr. Mark Goldman, Dr. Harold Holder, Dr. T.K. Li, who is a member of the Advisory Council to the Director of NIH, Dr. Matthew McGue, Dr. Carrie Randall, Mr. Paul Samuels, and former Council member, Ms. Migs Woodside of the Children of Alcoholic Foundation.

Dr. Eckardt reported that the Subcommittee on Research Priorities held its first meeting in January 1999 and its second meeting with two new members in March 2000.The Research Priorities Subcommittee is designed to look across the individual extramural portfolio review reports to identify areas of research emphasis, to perform special evaluations for the Institute, and to make annual recommendations for the Institute's consideration about strategic planning and priority setting. This includes identifying major scientific advances and stories of discovery for budget justification purposes and proposals for additional research funds under the NIH Director's areas of emphasis, i.e., biology of brain disorders, new approaches to pathogenesis, new preventive strategies against disease, development of therapeutics, genetic medicine, bioengineering computers, advanced instrumentation, and health disparities.

The Council Subcommittee on Research Priorities has identified five priority areas including intervention and delay of drinking for high school and college-aged drinking; medications development; early detection and interventions of fetal alcohol syndrome (FAS) and FAS related disorders; bioinformatics and neuroinformatics; and health disparities.

Mr. Roger Hartman, ex-officio Council member representing the DOD, said that Congress had appropriated $50 million in FY 2001 for the DOD medical research projects, an increase of $25 million over the FY 2000 funding level. Unfortunately, alcohol research was not specified by Congress as one of the 26 research categories listed for FY 2001. Alcohol research received six of the 16 projects funded by DOD in FY 2000.

Mr. Hartman said to contact him if anyone wanted information about applying for the DOD medical research funds.

The minutes of the June 7-8 Council meeting were approved as submitted.

Mr. James Vaughan, Council Executive Secretary, confirmed the 2001 Council meeting dates as February 7 and 8, June 6 and 7, and September 19 and 20.

Dr. Montgomery Bissell, Director of the Gastroenterology and Liver Disease Center, University of California at San Francisco, presented the report of the Council Subcommittee for the Review of the Extramural Biomedical Research Portfolio. Dr. Bissell chaired the Council Subcommittee which included Dr. Anna Mae Diehl and a number of other research experts.

Dr. Ronald Suddendorf, Scientific Review Administrator, Office of Scientific Affairs, provided staff support for the Subcommittee, and Dr. Michael Eckardt coordinated preparation of the Subcommittee report.

Dr. Eckardt briefly reviewed the history of extramural portfolio review at NIAAA which was first done in the late 1980s and again beginning in 1996. The following portfolio reviews have been reported to Council: health services research, fetal alcohol syndrome, genetics, neuroscience and behavior, prevention, epidemiology, and treatment. The last report is on biomedical research.

Dr. Bissell then highlighted some of the themes of the Subcommittee report including the protective effect of moderate alcohol use against coronary artery disease as opposed to the negative effects of alcohol abuse that results in cardiomyopathy in some individuals. There is a need for more research on the mechanisms of the protective effects of alcohol in coronary artery disease with a focus on signal transduction events in cardiomyocytes.

In the area of endocrinology, there are a vast and varied number of effects of alcohol on the endocrine system, including possible specific effects on the endocrine system of young people, as opposed to adults, and oxidant injury to effector cells and also cell death.

In the area of bone disorders, experimental models indicate that large amounts of alcohol causes bone thinning, however, epidemiologic data indicate that moderate drinking can reduce the rate of bone thinning, particularly in women. Further research is necessary with emphasis on mechanisms at the cellular level.

In the area of immunology, further research is needed on the effects of alcohol on antigen-specific cell-mediated immunity and on the repair response to injury, including scarring related to progression of liver disease such as fibrous and cirrhosis.

In the area of pancreatitis, about half of the cases of acute pancreatitis are related to alcohol abuse. More information is needed on ethanol metabolism in the pancreas, what is the ductular cell response to alcohol, and what is the biology of the wounding process in alcoholic pancreatitis?

While much is known about the cellular biology of alcoholic liver disease, more knowledge is needed about secondary risk factors since many heavy drinkers do not develop liver disease. The same is true for heart disease, infections, and bone disease.

In terms of cross-cutting research issues beyond specific organ damage, more research is needed on ethanol metabolism and acid aldehyde metabolism, the pharmacokinetics of ethanol metabolism, and how alcohol effects the metabolism of other drugs. This is a clinical issue since many patients with HIV disease also use alcohol to a significant degree.

The interaction of alcohol and cell membranes, particularly the phospholipid bilayer, may have consequences for the epithelial function, including intracellular signaling mechanisms.

Research on cell to cell communication and intracellular signaling is needed utilizing newer technologies.

The area of oxidant stress underlying organ injury in alcohol disease and why some people are susceptible to alcohol-induced organ injury is an important area of study.

Under model systems, the use of yeast drosophila and perhaps zebra fish were suggested because they are much more manipulable and genetically well characterized than other animal models.

Dr. Bissell then spoke of the need to study the interaction of environmental and genetic factors in the development of alcohol-related organ damage including tissue specific differences in ethanol metabolism and epidemiologic studies of the consequences of alcohol consumption.

Another priority area is the use of microarrays and to develop a central database for genetic research. Trans-NIH initiatives are also needed on crosscutting areas such as alcohol consumption as a risk factor for breast cancer.

Dr. Holder asked whether protective levels of alcohol consumption for heart disease could become a risk factor for other organs.

Dr. Bissell said that further research was needed on what is beneficial and moderate consumption for the liver as compared beneficial and moderate to consumption levels for the heart and bones.

Dr. Bissell added that research on the effects of moderate drinking may tell us as much about the pathophysiology of alcohol as research on the toxic effects. Research on moderate drinking may also be useful since most people are moderate drinkers.

Dr. Brown asked what Dr. Bissell defined as moderate drinking.

Dr. Bissell replied that moderate drinking was defined as up to 20 grams a day for women and up to 40 or 50 grams a day for men.

Dr. Gordis added that the usual definition was two drinks a day for men and one drink per day for women and older people.

Following the discussion, Council members unanimously approved the Council Subcommittee Report on the Review of the Extramural Research Portfolio for Biomedical Research.

Ms. Elyse Summers, Education Analyst in the Division of Human Subjects Protection, Office for Human Research Protection of the Department of Health and Human Services, presented Council with an overview of human subjects protection, especially with regard to the protection of secondary subjects in the conduct of family history research.

Ms. Summers distributed a handout on "The Involvement of Secondary Subjects in Interview, Survey, and Questionnaire Research" including two decision charts on the possible need for Institutional Review Board (IRB) review and informed consent for research involving secondary subjects. A secondary subject is defined as a subject about whom information is obtained in the context of a research study, but through no direct contact with the individual.

Ms. Summers said that the focus of the Office for Human Research Protection was on whether proper procedures are being followed by an institution, and the IRB as opposed to determining whether a particular research project should proceed. The critical issues which need to be answered are: who is a human subject, including who is a secondary subject; what level of IRB review, if any, is necessary and appropriate; and what are the issues of informed consent in a particular case?

Ms. Summers then reviewed the decision charts with regard to specific questions; such as, does the research obtain identifiable private information, such as a medical record, and is the research exempt under Human Subject Regulations or does it involve more than minimal risk? Minimal risk is defined as including criminal or civil liability, damage to a subject's financial standing, employability, or reputation.

If the research would involve identifiable information and more than minimal risk to the secondary subject, then IRB review is required either by the full IRB or by expedited IRB review.

Ms. Summers then reviewed the informed consent decision chart for secondary subjects on interview, survey, and questionnaire research. If the IRB determines there is more than minimal risk, then informed consent is required. Informed consent is usually in written form, but it can be oral if the consent document is the only link between the subject and the research, and the principal risk is the potential harm from a breach of confidentiality.

Another issue to address is whether the research involves procedures for which written consent is required outside the research context, such as a medical procedure.

Ms. Summers concluded her presentation by saying that the overall mandate of the Office of Human Research Protection is to enforce Human Subjects regulations and ensure that IRBs protect third parties whose rights and welfare are at stake in a research project, even if they are not directly contacted.

Dr. Goldman said that IRBs often have to make difficult judgments about gray areas with legal and bureaucratic consequences that tend to make them very cautious about approving research that involves obtaining information about family members without their consent. Requiring informed consent from all family members would mean the end of much family history and behavioral genetics research.

Ms. Summers said that similar issues had been raised by Dr. Francis Collins, Director of the National Human Genome Research Institute, and responded to in a letter from Dr. Gary Ellis, Director of what was then the Office for Protection from Research Risks (OPRR) at NIH. The letter from Dr. Ellis said that the OPRR policy was to look at each case individually and that an institution would not be penalized so long as the IRB is well trained and understands the regulations as reflected in the IRB minutes.

Dr. McGue raised the issue of variability among IRBs and the need for uniformity and national standards for multi-center collaborations.

Ms. Summers said that the newly established Office for Human Research Protection at HHS had established an advisory committee to provide guidance and assistance on overarching issues such as the need for consistency within multi-site studies.

Dr. Galanter said that one problem with some IRBs was the lack of familiarity with survey research-type questions by some IRB members. This indicates the need to develop case law for the human subject protection area.

Ms. Summers agreed that the OHRP needed to develop further guidance for IRBs on what is considered acceptable practice.

Dr. Gordis said that it would be helpful if the OHRP would inform the IRBs that the problem was more with the process than with the specifics of individual IRB decisions as indicated in Dr. Ellis' letter to Dr. Collins.

Alcohol Expectancies as a Final Common Pathway to Drinking: From Neurophysiology to Behavior

Dr. Mark Goldman, Distinguished Research Professor of Psychology at the University of South Florida in Tampa, gave an overview of the important role of learned expectations in determining human behavior in a wide range of social, psychological, and health situations.

Dr. Goldman began by saying that the human nervous system and maybe even other parts of human life functioning is based on learned expectancies as illustrated by Pavlovian or classical behavioral conditioning. This is illustrated by the placebo effect where placebos often do help people based on their expectations for treatment outcome.

Expectancy theory also plays a major role in cognition where the brain will automatically fill in the blanks or missing pieces of a picture of a face based on learned expectancies.

Dr. Goldman then provided additional examples of learned expectations and placebo effects on the nervous system, cognition and behavior. He proposed that similar learning and expectancies may take place in the human immune system and, in fact, be a fundamental organizational principle of life.

Dr. Goldman then explained the role of learned expectations on the motor and emotional functions of the brain, and how cognition affects emotions as well as the motor functions of the brain.

Research has shown that the mere expectation of ethanol availability enhances the release of dopamine in alcohol preferring rats, but not in non-ethanol preferring rats. This expectancy is a response to genetics.

Family history or genetics create expectancy templates for the pharmacologic effects of alcohol in individuals. Such genetically based expectancy templates are also mediators of family and cultural environments, peer influences, and ultimately behavior patterns such as alcohol usage.

Dr. Goldman said that expectancies correlate with drinking at all levels of drinking and can be found in children before they begin drinking, based on environmental influences, such as movies.

Common alcohol expectancies include that it will make you intoxicated, sexually aroused, courageous, funny, noisy, energetic, and sociable, or mean, mad, vulgar, and dangerous or mellow, and sleepy. Thus heavy drinkers mostly have positive expectations that alcohol will make them talkative, funny, happy, and energetic, whereas, light drinkers have negative expectations that alcohol will make them dizzy and sleepy.

Dr. Goldman then described a study of how visual priming and background cues from a television program can influence a person's drinking behavior without their even being aware of it. Changing people's expectancies about alcohol can, in fact, be used as a way to reduce their alcohol consumption. This points to the use of counter-advertising as a way to change people's alcohol expectancies.

Dr. Goldman also said that most people start using alcohol in fruity beverages where the alcohol taste is lessened because alcohol, by itself, as a chemical, is not obviously rewarding.

Dr. Carrie Randall asked if expectancy was used as a change variable in treatment outcome studies for either pharmacologic or psychologic treatment for alcohol abuse.

Dr. Goldman said that he was not aware of the use of expectancy change as a treatment outcome variable, but that it should be used as an important variable utilizing appropriate measurement tools.

Dr. Yvonne Maddox, Acting Deputy Director of NIH and Deputy Director of the National Institute on Child Health and Human Development, presented some overhead projections giving an overview of NIH efforts to reduce health disparities among various ethnic groups.

Dr. Maddox said that the NIH has been involved in minority health issues for more than 35 years, including significant programs in minority recruitment and training in biomedical sciences.

Dr. Maddox's background, at the National Institute on Child Health and Human Development, has made her very aware of the higher rates of infant mortality and problems associated with low birth weight and preterm births among Blacks, Hispanics, American Indians, and Alaskan Natives.

The incidence of prostate cancer is also very high for Black males as is their mortality rate from prostate cancer.

Although the incidence of breast cancer is lower for Black females, their mortality rate is higher than for Whites and Hispanics.

Rates for HIV/AIDS are also higher for Blacks and Hispanics as are asthma rates for African-American children and alcoholism rates for American Indians.

In terms of HHS plans to reduce health disparities, the six priority areas are infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV/AIDS, and immunization.

Dr. Maddox said that the NIH had developed a strategic research agenda and plan of action involving the training of investigators, community outreach, clinical trials involving minorities, building partnerships to advance the initiative and development of a plan to evaluate and assess progress. This plan was given to Dr. Harold Varmus, former Director of NIH, in December 1999 and subsequently to Dr. Ruth Kirschstein, Acting Director of NIH since January 2000.

Dr. Kirschstein has involved all of the Institute Directors in developing their own strategic plans for eliminating health disparities in the health research areas in conjunction with their constituency groups and Advisory Councils. These strategic plans are in turn being used in formulating the Institutes' FY 2002 budget requests. The health disparities elimination plans also recognize that socioeconomic status impacts gravely on health problems.

The NIH has a health disparities website and many of the Institutes have their strategic plans to eliminate health disparities on their websites.

In addition to increasing research on health disparities among minorities and increasing minority participation in clinical trials, NIH wants to increase the participation of minorities in peer review panels, National Advisory Councils, and NIH staff.

Dr. Maddox reviewed the effects of NICHD to reduce infant mortality, preterm births, birth defects, and Sudden Infant Death Syndrome (SIDS) in Washington, D.C., and throughout the country.

There is also a likelihood that Congress will authorize a Center for Health Disparities at NIH with its own funding and grant award authority. The Center will serve mainly as a coordinating function and do much of what the NIH Office of Research on Minority Health is currently doing in terms of stimulating and coordinating minority health research efforts at NIH.

Mr. William McColl, Executive Director of the National Association of Alcohol and Drug Abuse Counselors (NAADAC), said that NAADAC was working with a loose coalition of organizations on alcohol and drug abuse issues including The Therapeutic Communities of America, Partnership for Recovery, Legal Action Center, NASADAD, NCADD, and CADA.

The NAADAC focuses on several organizations, including research organizations such as NIAAA and NIDA, and service organizations such as SAMHSA and to a lesser extent, HRSA, the Department of Justice, and ONDCP.

Mr. McColl reviewed the FY 2001 budget increases projected for the Substance Abuse Prevention and Treatment Block Grant, the Center for Substance Abuse Treatment, and the Center for Substance Abuse Prevention.

The Safe and Drug Free Schools program is projected to receive a large increase as are NIDA and NIAAA.

Mr. McColl said that the number one drug problem in the country was nicotine immediately followed by alcohol, however, they are not receiving proportionately as much as funding as illicit drug use programs.

Mr. McColl concluded his remarks by mentioning the issue of charitable choice for religious providers of social services. The NAADAC is concerned that the possible lessening of rules regarding who is allowed to provide alcohol and drug abuse treatment, particularly licensing and certification laws. The NAADAC is working closely with Congress to ensure that this does not happen.

Dr. Rueben Gonzales said that he was glad to see the Health Disparities presentation and that it would be nice to have a review of NIAAA's efforts in the area of research training and recruitment with a focus on minority training.

Mr. Stephen Long said that the Institute's Health Disparities Strategic Plan, in which he and Dr. Faye Calhoun have the NIAAA lead, would address the research training area.

The NIAAA health disparities will soon be available in both printed form and on the NIAAA website. The Plan will be sent to Council members and could also be discussed at the February Council meeting.

Ms. Linda Kaplan said that Danya International of Silver Spring, Maryland has started a minority health issues section that could work with NIH and NIAAA. She announced that there would be a Washington Area Stigma Reduction Day at the D.C. Council of Governments Building.

Ms. Kaplan asked about the status of Project Combine.

Dr. Richard Fuller, Director of the Division of Clinical and Prevention Research at NIAAA, said that two preliminary studies have been done before the main trial. The results of the first preliminary study were presented at RSA in July and the results of the second preliminary study will be reported in late October or early November. A media advisory is planned to describe progress.

Dr. Gordis said that a brief presentation could be scheduled at the February Council meeting on the research protocol.

Dr. Alpha Estes Brown said that he hoped that the results of the research on expectations, described by Dr. Goldman, could be synthesized to educate legislators about the effects of a culture of alcohol abuse on children.

Dr. Richard Suchinsky, ex-officio Council member representing the Department of Veterans Affairs (VA), reported on the implementation of the Veterans' Millennium Health Care Act. The Department will distribute about $9.5 million for increased funding in FY 2001 for substance abuse treatment programs. There will also be about a $1.8 billion increase for the veterans' health care budget in FY 2001. There will probably be a modest increase for medical research in FY 2001.

There were no liaison representative reports or public comments.

The Council adjourned at approximately 3 p.m.

CERTIFICATION

I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.

Updated: January 4, 2001