CONTENTS
A. NIAAA Budget
Congressional Activity
Neither the House nor the Senate has scheduled markup of the FY2005 President's Budget. Below is a summary of the President's request.
|
|
FY 2003 Actuals |
FY 2004
Appropriation |
FY 2005
President's Request |
% Change
FY 05/FY 04 |
|
Extramural Research: |
|
|
|
|
|
Grants and Contracts |
$342,762 |
$352,338 |
$361,849 |
2.7% |
|
Research Training (NRSA |
10,440 |
11,240 |
11,512 |
2.4% |
|
Intramural Research |
40,969 |
42,471 |
45,481 |
7.1% |
|
Research Management and Support |
21,329 |
22,376 |
23,069 |
3.1% |
|
Total, NIAAA (including AIDS) |
415,500 |
428,425 |
441,911 |
3.1% |
|
AIDS (not added) |
(25,718) |
(26,784) |
(27,391) |
2.3% |
|
FTE's |
263 |
244 |
246 |
0.8% |
Budget Hearings
The NIAAA FY2005 President's budget request was recently presented before both the House and Senate appropriations subcommittees. The Senate Appropriations Subcommittee hearing was held on April 1; Dr. Zerhouni was the primary presenter for all of the NIH institute/centers (IC's). The House hearing schedule followed the format established two years ago whereby there were overview hearings followed by "theme" hearings combining the institute directors of several IC's at one hearing. The House overview hearings were on April 21st and 22nd, with Dr. Zerhouni presenting for all of NIH as well. NIAAA participated in the April 29 "theme" hearing, "Substance Abuse and Mental Health Research and Services Panel," along with the directors of the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA), the administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Deputy Undersecretary for Safe and Drug-Free Schools, Department of Education. Dr. Li's opening statement before the Senate and House Appropriations Subcommittees on the FY2005 President's Budget Request for NIAAA is on the NIAAA Web site at https://webarchive.library.unt.edu/eot2008/20080916101925/http://www.niaaa.nih.gov/AboutNIAAA/CongressionalInformation/Testimony/about_2004.htm.
B. Director's Activities
National Institute of Mental Health On February 6th, Dr. Li gave a presentation entitled "Alcohol and co-occurring Mental Disorders" to the national advisory council of the National Institute of Mental Health.
National Institute on Drug Abuse Advisory Council Dr. Li also spoke at the February 12th meeting of NIDA's national advisory council. The subject of his talk was "Alcohol Research: Understanding the Developmental Trajectory."
National Medical Leaders Meeting Also on February 12, Dr. Li gave a talk entitled "The Evidence Base for Screening and Brief Intervention for High-risk Drinking, Alcohol Abuse and Alcohol Dependence," at the National Medical Leaders Meeting hosted by the Department of Transportation's National Highway Traffic Safety Administration (NHTSA), Washington, DC.
Guze Symposium on Alcoholism The Midwest Alcoholism Research Center (MARC), affiliated with the Washington University School of Medicine (WUSM), is one 15 NIAAA-supported alcoholism research centers. MARC presents an annual symposium in memory of long-time faculty member and researcher Dr. Samuel Guze. The theme of this year's symposium was "Alcoholism and the Latest Genetics and Neuroscience Findings"; Dr. Li gave a presentation entitled "Alcoholism: A Common Complex Behavioral Disease."
Depression and Drinking on College Campuses Dr. Li joined directors of several other NIH institutes at a conference March 9-10 at the University of Michigan, Ann Arbor, on Depression on College Campuses: Connections to Stress, Sleep, and Alcoholism. Dr. Li gave a presentation entitled "Stress, Depression and Hazardous Alcohol Use: A Treacherous Intersection." Participants at the conference included health professionals, university leaders, preventive education specialists, third-party payers, journalists, parents, and college resident advisors and other students.
University of California, San Francisco Grand Rounds On April 7, Dr. Li was the featured speaker at Grand Rounds at the University of California, San Francisco Department of Psychiatry. The subject of his talk was "Genetic and Environmental Influences on Alcohol Drinking Behavior." On the same day, he gave a presentation entitled "Alcohol Research: Biology to Therapy" to the Kaiser Permanente Division of Research in Oakland.
American Association of Anatomists The American Association of Anatomists held its annual meeting in Washington, D.C. on April 18. Dr. Li was the keynote speaker, presenting a talk entitled "Old Problems, New Approaches in Alcohol Research."
American Society of Addiction Medicine At the Annual Medical Scientific Conference of the American Society for Addiction Medicine (ASAM), Dr. Li gave a presentation at the opening plenary session April 23 and then a talk on April 24 entitled "NIAAA: Advances in Alcoholism Treatment and Health Services Research." ASAM is an association of physicians dedicated to improving the treatment of alcoholism and other addictions, educating physicians and medical students, and promoting research and prevention. This year's conference took place in Washington, DC.
Fairbanks Circle of Hope Award Fairbanks, a non-profit addiction treatment facility in Indianapolis, Indiana, honored Dr. Li with the Richard M. Fairbanks Circle of Hope Award on May 3. The award recognizes outstanding contributions related to research, education or treatment of drug and alcohol abuse and addiction.
C. NIAAA Staff
Three New Division Directors at NIAAA Ralph Hingson, Sc.D., M.P.H., Antonio Noronha, Ph.D., and Mark Willenbring, M.D., have been appointed division directors for the Division of Epidemiology and Prevention Research (DEPR), the Division of Neuroscience and Behavior (DNB), and the Division of Treatment and Recovery Research (DTRR), respectively.
Dr. Hingson comes to NIAAA from the Boston University School of Public Health (BUSPH), where he has served since 2001 as Associate Dean for Research. From 1986-2000, Dr. Hingson served as professor and chair of the BUSPH Social and Behavioral Sciences Department. Dr. Hingson was a key contributor to NIAAA's landmark report A Call to Action: Changing the Culture of Drinking at U.S. Colleges. Dr. Hingson's research helped stimulate passage of Federal legislation that provided incentives for States to make it illegal for drivers under age 21 to drive after drinking.
Dr. Hingson is the recipient of numerous distinguished awards, including the 2001 Innovators Combating Substance Abuse Award from the Robert Wood Johnson Foundation and the 2002 Widmark Award, the highest award bestowed by the International Council on Alcohol, Drugs & Traffic Safety. In 2003, Mothers Against Drunk Driving (MADD) instituted the Ralph W. Hingson Research in Practice Annual Presidential Award, with Dr. Hingson as its first recipient.
Dr. Noronha was, prior to NIAAA's reorganization last year, chief of the Neuroscience and Behavioral Research Branch in the former Division of Basic Research. Dr. Noronha had served in that position since 1999, and from 1990 to 1999 in the Office of Scientific Affairs as science review administrator (SRA) for the Neuroscience and Behavior Review Subcommittee of the Alcohol Biomedical Research Review Committee. Dr. Noronha came to NIAAA from the National Institute of Neurological Disorders and Stroke where he was a research fellow and then senior staff fellow in the Laboratory of Cellular and Molecular Neurobiology. After earning his Ph.D. in neuroscience from the Stritch School of Medicine, Loyola University, Chicago, he conducted research on the biochemistry of myelin-associated glycoprotein, and on the role of cell adhesion molecules and other glycoconjugates in demyelinating disorders. His current research interests include alcohol and the brain, alcohol-induced behavioral effects, neurodegenerative disorders such as multiple sclerosis, peripheral neuropathies, and alcohol-related damage to the fetus. Dr. Noronha has received many honors and awards, among them the NIH Director's Award in 2001.
Dr. Willenbring has for the last 12 years been medical director of the Addictive Disorders Section at Veteran's Affairs Medical Center in Minneapolis, MN. He is also professor of psychiatry at the University of Minnesota School of Medicine, Minneapolis. Dr. Willenbring is a psychiatrist whose career has encompassed research, clinical work, teaching, and administration. His research interests include pharmacotherapies for alcohol and other drug abuse, the treatment of co-occurring disorders, and integrating research findings into clinical practice. Dr. Willenbring is a Distinguished Fellow in the American Psychiatric Association, and a Diplomate of the American Board of Psychiatry and Neurology and the National Board of Medical Examiners.
Dr. Willenbring brings to NIAAA expertise in a range of issues in clinical research on alcohol and other drugs of abuse, including experience with medications development-an area of critical importance to NIAAA's research agenda. In addition to serving as director, DTRR, Dr. Willenbring will be working with Dr. George Kunos and Dr. Markus Heilig in NIAAA's intramural program as well as scientists at other NIH institutes to advance knowledge of the treatment of alcohol abuse and alcoholism.
Anton Bizzell, M.D. Dr. Anton Bizzell has left NIAAA to be medical officer with SAMHSA's Center for Substance Abuse Treatment. At NIAAA, Dr. Bizzell was medical officer in the former Office of Collaborative Research, responsible for National Alcohol Screening Day and medical education grants.
Jan Howard, Ph.D., Retires Dr. Jan Howard retired after serving since 1987 as chief of the Prevention Research Branch in what was at that time the Division of Clinical and Prevention Research. Her leadership was central to the growth of NIAAA's portfolio of alcohol-focused prevention research grants. During her tenure, the funding level for prevention research grew from about $3 million to over $45 million. Part of this growth was the result of her forging partnerships with other federal agencies and private foundations, most notably SAMHSA's Center for Substance Abuse Prevention. Dr. Howard came to NIAAA after having worked as a senior scientist and then health scientist administrator at the National Heart, Lung, and Blood Institute and the National Cancer Institute; prior to that, she had been on the faculties of the University of California, San Francisco, Virginia Commonwealth University, and the University of California, Stanford. Dr. Howard won the Lifetime Achievement Award from the National Prevention Research Network in June 2000.
Geoffrey Laredo has left NIAAA to join SAMHSA as the legislative coordinator in the Office of Policy, Planning, and Budget. Mr. Laredo came to NIAAA in 1996 and was deputy director, and after 1999, director of the Office of Policy and Public Liaison. He worked to strengthen NIAAA's collaborative activities with national groups, government agencies, and scientific societies across the alcohol research, prevention, and treatment field and to maintain strong relationships with Congressional offices and staff. In particular, he helped develop and oversee NIAAA's Research to Practice initiative.
Chen-Hua Tian, M.D., Ph.D. Dr. Chen-Hua Tian is a Humphrey Fellow at The Johns Hopkins University who has spent the past 6 weeks at NIAAA to fulfill the "professional affiliation" portion of this fellowship experience. Humphrey Fellows are accomplished professionals from over 100 countries who come to the United States for a year of study and professional experience. Before joining the program, he served as a psychiatrist and associate professor at the Institute of Mental Health (the Sixth Hospital), Peking University. Dr. Tian is interested in alcohol treatment research and in the management and organization of government-sponsored research institutes. His long-term goal is to create a counterpart to NIAAA in China.
Forrest Weight, M.D., Retires A scientific symposium on May 4 at the Cloister, NIH, marked the retirement of Dr. Forrest Weight, chief of NIAAA's Laboratory of Molecular and Cellular Neurobiology since 1991. Having trained and then served as a section chief at the National Institute of Mental Health, Dr. Weight came to NIAAA in 1978 as chief of the Laboratory of Preclinical Studies and the Section of Electrophysiology. Dr. Weight has made important contributions to our understanding of synaptic modulation and the molecular mechanisms of alcohol action in the nervous system. In particular, his work has contributed a great deal to knowledge of the molecular mechanisms underlying acute alcohol intoxication, and has provided the basis for a more thorough understanding of neuroadaptations to chronic alcohol exposure involved in tolerance and dependence. In the course of this research, his laboratory made numerous seminal discoveries about ion channel function and modulation, and developed and implemented valuable techniques for analysis of neural function. Among his many honors have been the Public Health Service (PHS) Outstanding Service Medal, the PHS Meritorious Service Medal, and the NIH Director's Award.
D. Research Priority Emphasis and Core Support Teams
Team Consolidation A final restructuring of NIAAA's research teams resulted in the consolidation of 17 teams into 5 research emphasis and 2 infrastructure teams. The intent of the restructuring was to make sure that the teams focused on areas that NIAAA has flagged as priorities for expanded research efforts and to foster a stronger interdisciplinary focus. The new research teams are: (1) underage drinking, (2) medications development, (3) mechanisms of alcohol action and injury, (4) behavioral and environmental interventions, and (5) the etiology of risk: genes and environment. The core resource teams are technology and analysis and centers and training. The goals of the original establishment of the teams under NIAAA's recent reorganization were to help NIAAA lead the field by conducting the interdisciplinary research inherent to alcohol science, build a strong yet flexible structure to allow NIAAA to respond quickly to emerging opportunities, promote creativity and foster multidisciplinary approaches among NIAAA staff, and strengthen the scientific development of NIAAA staff through mentoring opportunities.
E. NIAAA Research Programs
Collaborative Research Efforts
Suicide Prevention NIAAA has collaborated with other NIH Institutes to reduce the burden of suicide consistent with the recommendations of the 2002 Institute of Medicine report, Reducing Suicide: A National Imperative. NIAAA's Dr. Charlene Le Fauve collaborated with NIMH, NIDA, and NIAAA program staff to develop an RFA and a PA for "Developing Centers on Interventions for the Prevention of Suicide" (DCIPS). Fourteen proposals were reviewed on April 1 and several focused on alcohol and suicidal behavior. NIAAA has made it a priority to support one center from this initiative.
Tobacco Use NIAAA and NIDA were active partners with the National Cancer Institute in issuing an RFA (CA-04-012), "Transdisciplinary Tobacco Use Research Centers (TTURC)," which will be funded in FY 2004. Nineteen applications were submitted for the January deadline. They will be reviewed in June and awarded in September 2004. NIAAA will manage at least one new center. The purpose of this program is to foster unique integrative transdisciplinary collaborations among scientists to study tobacco use problems. NIAAA are collaborating with NCI and NIDA on the renewal of the TTURC Program. The purpose of these centers is to facilitate a transdisciplinary approach to the full spectrum of basic and applied research on tobacco use. NIAAA worked on the development of the RFA for this renewal and in FY 2004 will cofund a competitive center that focuses on the alcohol tobacco interaction.
Translational Research in the Emergency Department NIAAA and SAMHSA announced in April a major collaborative study that will investigate ways to screen, identify, and treat patients in hospital emergency departments (ED) for alcohol problems. This initiative emerged from National Alcohol Screening Day. Fourteen grants have been awarded to emergency departments across the country to participate in the study, which will rely on emergency department personnel rather than research staff to conduct the screening and intervention. Each site is screening individuals for a 2-week period for the study, although part of the process evaluation will also look at whether the sites were able to incorporate screening into their routine service delivery for the long term as a result of their taking part in the study. Edward Bernstein, M.D., of the Boston University School of Public Health will coordinate the training of ED site personnel. Robert Aseltine, Ph.D., at the University of Connecticut Health Sciences Center in Farmington, CT, is heading the data coordinating center for the project. Approximately 1,000 patients from all 14 sites will be involved in the study. SAMHSA's funding for the study is $50,000; NIAAA is providing $1.2 million. NIAAA issued a press release on this initiative on April 7.
Trauma and Alcohol At a recent conference, trauma surgeons acknowledged that 40 to 60 percent of their patients have substance use problems. Participants agreed that it would be useful to identify those patients and to provide brief on-site interventions during the trauma visit. However, insurance laws in most states allow insurance companies to deny payment for medical treatment provided to patients for conditions "…sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician…" The trauma surgeons made it clear that they are unlikely to adopt an improved standard of care for screening patients with substance use problems until they and their hospitals are assured that such screening will not preclude payment for the medical treatments they provide.
With these issues in mind, NIAAA, CDC, and SAMHSA are collaborating on a research project to evaluate the impact of insurance laws, specifically the Uniform Accident and Sickness Policy Provision Law (UPPL), on interventions for alcohol problems among patients in emergency departments and trauma centers.
Frontiers of Knowledge in Sleep and Sleep Disorders NIAAA participated with nine other NIH institutes in sponsoring a two-day meeting entitled, "Frontiers of Knowledge in Sleep and Sleep Disorders: Opportunities for Improving Health and Quality of Life," in Bethesda, March 29-30. This innovative program comprised health care providers, public health and education experts, policy makers, patient advocacy organizations, sleep medicine specialists, individuals with sleep disorders, and other stakeholders. The purpose of the meeting was to address how current knowledge about sleep and sleep disorders can be translated into cost-effect strategies for 1) improving knowledge about sleep-related behaviors, 2) improving diagnosis and treatment of sleep disorders, 3) reducing health care costs related to sleep disorders, and 4) improving public health and quality of life.
Underage Drinking NIAAA staff have been involved in a number of efforts aimed at preventing underage drinking. The Interagency Coordinating Committee (ICC) on Preventing Underage Drinking, chaired by the administrator of SAMHSA, comprises principals from NIAAA, the Office of Juvenile Justice and Delinquency Prevention in the Department of Justice, NHTSA, the White House Office of National Drug Control Policy, the Centers for Disease Control and Prevention (CDC), the Office of the Surgeon General, and the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services (DHHS). A task force comprising staff from each ICC agency has been charged with producing an advisory document for the Secretary, DHHS, regarding underage drinking. Ultimately, the Secretary will report to Congress on progress by the Federal government regarding underage drinking. The task force met on April 13 and heard presentations from a number of organizations and advocacy groups with an interest in underage drinking, including representatives of the alcohol industry. The task force has begun work on the document and will meet again in June before submitting it to the Secretary.
On April 30, 2004, NIAAA Associate Director Dr. Mark Goldman made a short presentation outlining the institute's increased focus on underage alcohol consumption at the Planning Meeting on Adolescent Decision Making and Positive Youth Development of the Committee on Adolescent Health and Development, National Research Council, National Academies of Science. Presentations were also made by key researchers in adolescent development.
NIAAA's Underage Drinking Prevention Team met on May 14 with a small advisory panel of experts in adolescent development: Ronald Dahl, M.D., Director, Child and Adolescent Neurobehavioral and Sleep Laboratory and Staunton Professor of Psychiatry and Pediatrics, University of Pittsburgh; Ann Masten, Ph.D., Director, Institute of Child Development, University of Minnesota, and Linda Spear, Ph.D., Distinguished Professor of Psychology and chair of the Department of Psychology, Binghamton University, State University of New York. The purpose of the meeting was to inform the team's effort to integrate research in child and adolescent development with alcohol research. After a successful and stimulating meeting, all three experts have agreed to continue working with the underage drinking team to help develop the institute's initiative on understanding and preventing alcohol consumption by children and adolescents. A meeting with an expanded group of experts is planned for the fall.
DEPR director Dr. Ralph Hingson gave a presentation on community-level interventions for reduction of alcohol-related problems among youth at a meeting on "Research Designs for Complex, Multi-level Health Interventions and Programs." This invitational meeting, held on May 4-5 in Bethesda, was organized by NIH, CDC, and the Agency for Health Care Research and Quality to explore the strengths and weaknesses of various research designs and analytic strategies for community research.
Rural Underage Drinking On February 10-11, NIAAA co-sponsored an invitational conference with the Association of Academic Health Centers (AAHC) in Washington, D.C. The goal of the conference was to explore ways that NIAAA could partner with academic health centers (AHCs) to provide model longitudinal prevention/intervention community-based programs focusing on how individual families, school and community networks can help reduce high-risk behavior in youth in rural and small urban areas. In particular, the meeting sponsors hoped to explore ways in which AHCs in rural and small urban settings that have well-established networks with community organizations-school systems, juvenile justice agencies, social service agencies, departments of health, chambers of commerce, faith-based organizations, and health outreach programs-could be engaged in NIAAA-supported research initiatives.
Attending the meeting were more than 40 representatives from 20 AHCs from Arkansas, Illinois, Kansas, Kentucky, Michigan, Minnesota, Nebraska, North Carolina, North and South Dakota, Ohio, Texas, Tennessee, upstate New York, Virginia, Vermont, and Washington. The representatives comprised senior AHC administrators with direct responsibility for building academic/community partnerships, researchers and clinicians with expertise in or responsibility for carrying out experimental protocols to address childhood drinking using community-based methods, and scientific experts. In addition, members of the Association of Academic Health Centers, the Robert Wood Johnson Foundation, and NIAAA staff participated in discussions. In preparation for the meeting, the American Legacy Foundation-whose goal is reducing tobacco use among the young-hosted a reception for the participants. Dr. Li gave a presentation at this meeting on "Understanding the Developmental Trajectory of Alcohol Use Disorders: Implications for Intervention."
The AAHC has drafted a report on the meeting that incorporates background information on the participants, the goals of the meeting, the talks given by Drs. Li and Goldman, and a summary of discussions and comment provided by the participants. Dr. Li has approved a version of the report to be reviewed by NIAAA's national advisory council.
NIAAA has developed a memorandum of understanding with the Office of Juvenile Justice and Delinquency Prevention, Department of Justice, to evaluate the programs they will fund under an RFA, "Reduce Underage Drinking in Rural Populations," as a part of their Enforcing Underage Drinking Laws Program (EUDL). NIAAA staff worked closely with them to develop the RFA. Once prevention sites are selected our grantees will be assigned to improve the study plans and carry out an evaluation.
SIDS Among Native Americans NIAAA and NICHD have established a collaboration to follow up on data from a study conducted among Northern Plains Native American cultures that found a six-fold increased risk for sudden infant death (SIDS) among children born to mothers who binged during the periconceptional period or the first trimester of pregnancy. The Aberdeen Area Infant Mortality Study was conducted by NICHD, the Indian Health Service, CDC, and the Aberdeen Area Tribal Chairman's Health Board. Neurochemical analyses of brainstems of SIDS victims revealed deficits similar to those seen in SIDS victims from other communities and racial and ethnic groups. NIAAA and NICHD issued an RFA and have funded four 3-year cooperative agreement awards. The projects are collaborative multidisciplinary investigations using protocols with shared elements and conducted within populations in which there is a high risk for alcohol use and abuse by women during pregnancy. They also blend the expertise of investigators working on fetal alcohol syndrome, SIDS, and adverse pregnancy outcomes with active participation from members of the affected communities.
Project COMBINE
Combining Medications and Behavioral Interventions (Project COMBINE) Recruitment for this 12-site cooperative agreement was completed on schedule at the end of September 2003, slightly exceeding the target goal of 1,375 subjects. This represents, on average, 125 patients per clinical research unit (there are 11 clinical units and 1 coordinating center). Patient follow-up visits will be completed by the end of September 2004. Analyses of baseline data are ongoing with 16 manuscripts in preparation. Analyses of results from the within-treatment and end-of-treatment outcomes will begin in the late fall of 2004, followed by analyses of data from the follow-up visits. Two treatment manuals (Medical Management and Combined Behavioral Intervention) are now in press and are expected to be available in the summer of this year. A monograph on methodology for conducting combination trials has been prepared and is being readied for submission. A satellite session on the same topic will be presented by the investigators at the Research Society on Alcoholism meeting in Vancouver in June. The Data Safety and Monitoring Board met in May.
Research Grant Application and Peer Review Activities
For this review round, 318 new and competing continuation research grant applications were assigned to NIAAA for funding consideration. Extramural Project Review Branch staff conducted 29 review meetings to evaluate a total of 149 grant applications or 47 percent of the total initially assigned to NIAAA. These were reviewed by either the institute's standing review subcommittees or by special emphasis panels. The remaining applications were reviewed by study sections of the NIH Center for Scientific Review.
A special review committee is being established at NIAAA for the evaluation of applications received in response to the following initiative: Medications Development to Treat Alcoholism and Alcohol-Related Diseases (SBIR/STTR) (RFA No. AA04-002). The outcome of this evaluation will be presented at a future council meeting.
Research Reports
NIAAA Press Release: Adolescent Brains Show Reduced Reward Anticipation Adolescents show less activity than adults in brain regions that motivate behavior aimed at obtaining rewards, according to a study in which magnetic resonance imaging (MRI) was used to examine real-time adolescent response to incentives. In contrast, after monetary rewards, brain activation was similar in both adolescents and young adults in the study. The observation helps resolve a longstanding debate about whether adolescents experience enhanced reward from risky behaviors or seek out alcohol and other stimuli because they require enhanced stimulation. NIAAA issued a press release on this advance on February 25. A number of articles on adolescent behavior discussed the MRI results, including pieces in the Los Angeles Times, Newsday, New Scientist, USA Today, Time magazine, and JAMA. (Bjork, J.M., Knutson, B., Fong, G.W., Caggiano, D.M., Bennett, S.M., and Hommer, D.W. The Journal of Neuroscience 24:1793-1802, 2004.)
NIAAA Press Release: Alcohol Problems Often Missed in Hospital Admissions Medical records of hospital patient admissions included a diagnosis of an alcohol use disorder in less than half the cases in which patients were identified by personal interview as having such a disorder. This study built on an earlier one which found that 24 percent of hospitalized individuals who identified themselves as current alcohol drinkers met standard diagnostic criteria for alcohol use disorders. The authors conclude that screening for alcohol problems should be a routine part of hospital admissions, with referral to further evaluation and treatment as needed. NIAAA issued a press release on this work on April 12. (Smothers, B.A., Yahr, H.T., and Ruhl, C.E. Archives of Internal Medicine 164:749-756, 2004.)
NIAAA and NIDA Press Release: Adult Marijuana Abuse and Dependence Increased During the 1990s A comparison of marijuana use in the U.S. population in 1991-92 and 2001-02 revealed that the number of people reporting use of the drug remained substantially the same in both time periods, but the prevalence of abuse or dependence increased markedly. The study is the first to assess long-term trends in marijuana abuse and dependence in the United States using the DSM-IV classification system. Data from two NIAAA national epidemiologic surveys conducted 10 years apart-the National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC)-were used in this analysis. Overall, marijuana abuse or dependence rose by 22 percent from 1991-1992 to 2001-2002. NIAAA and the National Institute on Drug Abuse issued a joint release on this work on May 4. (Compton, W.M., Grant, B.F., Colliver, J.D., Glantz, M.D., and Stinson, F.S. Journal of the American Medical Association 291:2114-2121, 2004.)
Special Issue of Nature Neuroscience The May issue of Nature Neuroscience is a special focus issue on "Scaling Up Neuroscience." NIAAA joined with the other neuroscience institutes at NIH-the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute of Neurological Disorders and Stroke, the National Eye Institute, and the National Institute of Deafness and Other Communication Disorders-to underwrite this special issue. Nine perspective articles discuss various aspects of high-throughput methodologies in neuroscience, their progress, potential, and challenges. Subjects include neurogenomics, microarrays, proteomics, neuroimaging, and data and resource management and access. Dr. Li and the directors of the six sponsoring institutes authored a sponsor's forward. (Nature Neuroscience vol. 5, no. 7, published ahead of print on April 27, 2004.)
Personality Disorders Co-occur Frequently With Alcohol Use Disorders In a nationally representative survey of 43,093 respondents, 28.6 percent of individuals with a current alcohol use disorder and 47.7 percent of individuals with a current drug use disorder had at least one personality disorder (PD). Alcohol use disorders were most strongly associated with antisocial, histrionic, and dependent PDs. The study, NIAAA's 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), is the largest longitudinal alcohol use and comorbidity survey to date. Data from NESARC will provide much-needed information on the prevalence and co-occurrence of alcohol and drug use disorders, cormorbid conditions, and a wide range of other information on alcohol use and its impact on health. (Grant, B.F., Stinson, F.S., Dawson, D.A., Chou, S.P., Ruan, W.J., and Pickering, R.P. Archives of General Psychiatry 61:361-368, 2004.)
COGA Identifies Gene Linked to Alcoholism Risk NIAAA's Collaborative Study on the Genetics of Alcoholism (COGA) has identified a gene that is strongly linked to an individual's risk of developing alcoholism. The gene, GABRA2, is one of several that function in assembling parts of the receptor for the brain's primary inhibitory neurotransmitter, GABA. The gene is also related to a brain-wave pattern that has been found to differ in alcoholics vs. non-alcoholics. The gene appears to be involved in the regulation, not the coding, for the gene for this part of the GABA receptor. The authors suggest that the GABRA2 gene may influence risk of alcohol dependence by modulating neural excitation. (Edenberg, H.J., Dick, D.M., Xuei, X., Tian, H., Almasy, L., Bauer, L.O., Crowe, R.R., Goate, A., Hesselbrock, V., Jones, K., Kwon, J., Li, T-K., Nurnberger, J.I., O'Connor, S.J., Reich, T., Rice, J., Schuckit, M.A., Porjesz, B., Foroud, T., and Begleiter, H. American Journal of Human Genetics 74:705-714, 2004.)
Ethanol, CRF, and GABA A recent finding makes a key connection between the acute rewarding effects of ethanol and the neurobiology of stress. One component of ethanol's rewarding effect is its enhancement of the activity of the neurotransmitter GABA. In this study, both ethanol and corticotrophin releasing factor (CRF)-a neuropeptide that is central to the body's response to stress-increased GABA neurotransmission in mice. This response was absent, however, in knockout mice missing the CRF1 receptor, but not the CRF2 receptor, suggesting that the CRF1 receptors mediate this effect of ethanol on GABA. People drink to relieve stress, but in chronic heavy drinkers who become dependent, CRF plays a role in the anxiety and depression that accompany withdrawal. Continuing research should provide a more complete picture of the role of CRF in alcohol's rewarding effects and the development of addiction, and possibly point to therapeutic targets for future medications. (Nie, Z., Schweitzer, P., Roberts, A.J., Madamba, S.G., Moore, S.C., and Siggins, G.R. Science 303:1512-1514, 2004.)
Naltrexone in Alcohol Abusing Patients with Schizophrenia In a placebo-controlled study with 31 patients with schizophrenia and alcohol abuse, patients taking naltrexone had fewer drinking days and fewer heavy drinking days than those on placebo. Naltrexone-treated patients also reported less craving. Alcohol abuse is more common among schizophrenic patients than in the general population and alcohol abuse compounds the problems faced by schizophrenic individuals. The study suggests that naltrexone may be helpful in treating this group-no medications have been approved to date for treatment of comorbid schizophrenia and alcohol dependence. (Petrakis, I.L., O'Malley, S., Rounsaville, B., Poling, J., McHugh-Strong, C., Krystal, J.H. Psychopharmacology 172:291-297, 2004.)
Endocannabinoids and Synaptic Function Activation of the CB1 cannabinoid receptor inhibits neurotransmission at numerous synapses in the brain. Recent intramural research findings are shedding light on the mechanisms involved in this process, including how endocannabinoids are involved in long-term changes in synaptic function. Synaptic efficacy is important in brain information storage; mechanisms like those being elucidated in this work are likely to play a role in certain forms of learning and memory. (Ronesi, J., Gerdeman, G.L., Lovinger, D.M. The Journal of Neuroscience 24:1673-1679, 2004.)
Binge Drinking and Bone Alcohol abusers are at increased risk of bone fractures due to the modulation of bone turnover by ethanol. This study is the first to demonstrate that as little as three bouts of binge alcohol consumption stimulates bone resorption, resulting in decreased mineral density and bone strength. The adverse effects of alcohol on the skeleton could be prevented by weekly treatment with risedronate, a drug used to treat osteoporosis, during the period of binge alcohol exposure. (Callaci, J.J., Juknelis, D., Patwardhan, A., Sartori, M., Frost, N., Wezeman, F.H.. Alcohol: Clinical and Experimental Research 28(1): 182-91, 2004.)
Choline and Prenatal Alcohol Exposure Postnatal choline supplementation to rats exposed to alcohol during the third trimester equivalent was previously shown to enhance performance on a learning and memory task. Thus, choline appears to be a candidate compound for treatment of deficits associated with fetal alcohol spectrum disorders (FASD). The current findings demonstrate that ethanol-induced motor deficits are not affected by choline supplementation. This highlights the fact that the effects of ethanol are multifaceted and that a single drug or supplement is not likely to be a panacea for deficits seen in FASD. (Thomas, J.D., O'Neill, T.M., Dominguez, H.D. Neurotoxicology and Teratology 26(2):223-9, 2004.)
Role of Reactive Nitrogen Species in Alcoholic Liver Disease Increasing evidence suggests that reactive oxygen species (ROS) play a central role in the pathogenesis of alcoholic liver disease (ROS are highly reactive molecular fragments capable of inflicting serious damage on cells.) In this study, researchers evaluated the role of reactive nitrogen species (RNS) in alcoholic liver injury by using knockout mice that are genetically altered to be missing an enzyme (iNOS) needed to make free radical (reactive) nitric oxide (NO). Chronic ethanol administration caused severe fatty accumulation, mild inflammation, and necrosis (cell death) in the liver of wild mice but had no effect in iNOS knockout mice. These results suggest that iN0S is required for the initiation of alcohol-induced liver injury by production of free radical nitric oxide. (McKim, S.E., Gäbele, E., Isayama, F., Lambert, J.C., Tucker, L.M., Wheeler, M.D., Connor, H.D., Mason, R.P., Doll, M.A., Hein, D.W., and Arteel, G.E. Gastroenterology 125 (6): 1834-1844, 2003).
Intramural Research in News Section of Science The work of NIAAA intramural investigators was the focus of a news feature in Science on a gene that codes for the enzyme monoamine oxidase (MAOA). In studies in mice and humans, variants in the gene (sequence repeats that alter its length) have been linked to the level of aggression. The article summarizes the results of work to identify which primates carry which variants. (Science 304:818, 2004.)
F. Outreach
National Efforts
National Alcohol Screening Day The sixth annual National Alcohol Screening Day (NASD) took place on April 8, 2004. Sponsored by NIAAA and SAMHSA, National Alcohol Screening Day is an annual event that provides information about alcohol and health as well as free, anonymous screening for alcohol-use disorders. This year NHTSA was a very active partner, involving all ten of the agency's regional offices. In addition, there were active outreach initiatives focused on colleges, the military, the Latino community country-wide, and the minority urban population. The total number of sites registered for NASD increased from 3,225 last year to 5,349 this year.
For National Alcohol Screening Day (NASD) 2004, U.S. Surgeon General Richard Carmona, M.D., participated in a 3-hour satellite media tour that aired to at least 3 million viewers in major television markets. NIAAA also sponsored a radio media tour featuring NHTSA spokesperson Todd Thoma, M.D., that aired to approximately 28 million individuals. NIAAA staff members Faye Calhoun, D.P.A., Mark Goldman, M.D., and Peggy Murray also participated in a radio media tour that reached more than 12 million individuals. Several national radio broadcast services-including AP, ABC, CNN, Metro, and Urban News Radio-broadcast the NASD messages under the tag line "Alcohol and Your Health-Where Do You Draw the Line?" Local print coverage reached millions more with the same messages concerning potential health and safety risks associated with alcohol consumption. NIAAA and SAMHSA issued a joint news release on April 1.
One part of NIAAA's efforts in support of Alcohol Screening Day was a short, targeted outreach program directed to African American and Latino audiences in Philadelphia. The project involved 19 dedicated screening sites, 31 program partners, and 6 full days of community training. During this outreach period, team members disseminated more than 10,000 pieces of program materials (postcards, flyers, posters) to screening sites, strategic locations and program partners and the local media.
PRIDE Conference On April 2, NAAA Deputy Director Dr. Faye Calhoun addressed 3,000 youth and parents attending the annual PRIDE conference in St. Louis, MO. PRIDE-Parents' Resource Institute for Drug Education-is an organization whose aim is to encourage youth to be involved in preventing drug use and violence. Dr. Calhoun spoke about NIAAA's underage drinking research initiatives. She also participated in a town hall meeting with NIDA director Dr. Nora Volkow and Missouri First Lady Lori Hauser Holden (co-chair of Leadership to Keep Children Alcohol Free). NIAAA is one of the co-sponsors of the annual PRIDE conference. Other NIAAA activities included a workshop on alcohol and the brain and pretesting of the institute's new youth website.
Reach Out Now Teach-In On April 26, Dr. Li joined Mrs. Hope Taft, first lady of Ohio and co-chair of Leadership to Keep Children Alcohol-Free, in a teach-in on the dangers of underage alcohol use that took place in fifth grade classrooms in Canton, Ohio. In addition to Dr. Li and Mrs. Taft, SAMHSA administrator Charles Curie and U.S. Representative Ralph Regula (R-OH) participated. The Ohio event was part of a national program of teach-ins conducted during Alcohol Awareness Month and sponsored by SAMHSA and Scholastic, Inc. Between April 26 and 30, teach-ins took place in every state. Seventeen governors' spouses participating in the Leadership initiative led classrooms in a teach-in. The Reach Out Now program also produces and distributes educational materials aimed at teachers, parents, and students.
Leadership to Keep Children Alcohol Free The Leadership held a regional meeting on "Innovative Educational Programs to Prevent Childhood Drinking" in Dallas, Texas on May 4th and 5th. In keeping with NIAAA's focus on alcohol abuse as a developmental disorder, the regional meeting highlighted school-based alcohol education programs that are available from primary grades through high school. Speakers included NIAAA-supported researcher Dr. Aaron White, who gave a state-of-the-art presentation on alcohol and the adolescent brain; Dr. Ralph Hingson, DEPR director, who spoke on the magnitude of underage drinking problems; Dr. Trish Powell, NIAAA health science administrator, who discussed early alcohol expectancies and their influence upon adolescent development; and Jason Lazarow from NIAAA's Health Sciences Education Branch, who presented NIAAA's science education programs aimed at middle and high school students. Eleven Leadership states were represented, with governors' spouses joined by commissioners of education.
Governors' spouses Mrs. Lori Holden (MO) and Mrs. Hope Taft (OH), and past First Lady Mrs. Vicky Cayetano (HI) represented the Leadership to Keep Children Alcohol Free in interviews with Parents magazine and Lifetime highlighting the issue of childhood drinking. An article in Parents is slated for September and will focus on "tweens" drinking, what parents should know about childhood drinking, and guidance for parents. The Leadership URL will be listed in the article.
Local Outreach
Ocean City Play It Safe For the second consecutive year, NIAAA is assisting the Play it Safe Committee of Ocean City, MD in developing and evaluating science-based alcohol information materials for their annual alcohol-free high school senior beach week program. The committee consists of representatives from the Maryland Governor's office, Town of Ocean City, state Alcohol and Drug Abuse Administration, and Worcester County Health Department. It provides a comprehensive program of alcohol-free activities for recent high school graduates each year during the month of June. For more information contact Fred Donodeo, 301-443-6370, fdonodeo@niaaa.nih.gov.
Alcohol and Pregnancy Campaign in DC This summer, NIAAA is completing its "Play it Smart. Alcohol and Pregnancy Don't Mix" campaign, a 2-year multi-media public awareness campaign targeting African-American women of child-bearing age in Washington DC. The research-based campaign, containing culturally appropriate messages about the consequences of drinking during pregnancy, focused on women ages 21-29. The research-based messages were targeted to women of childbearing age, their friends and family. NIAAA conducted the campaign through the National Organization on Fetal Alcohol Syndrome (NOFAS), with additional funding from the National Center on Minority Health and Health Disparities (NCMHD) at NIH. Literature searches and focus group testing provided information about the attitudes and beliefs of the target audience, as well as feedback on the draft materials. The campaign included a combination of print and broadcast materials, including radio and television public service announcements, mass transit displays, information booths, magnets, posters, and bookmarks. It also included community events with local government agencies, hospitals, and churches, as well as innovative metrorail dioramas and cinema advertising in targeted theaters. The campaign was designed to serve as a prototype for possible replication in other cities and to date more than 100,000 products and displays featuring the campaign tagline, themes, messages, and a dedicated telephone help line have been disseminated among the intended audiences. For information, contact Diane Miller, 301-443-3860, dmiller1@niaaa.nih.gov, or Fred Donodeo, 301-443-6370, fdonodeo@niaaa.nih.gov.
Family Health in the Nation's Capital NIAAA was invited to participate in the District of Columbia Eighteenth Annual Maternal and Child Health Citywide Coordinating Conference entitled "Ensuring the Health of Families in the Nation's Capital: A Plan of Action." The February 24 conference was held at the Convention Center in the District of Columbia and was open to the public. The goals of the conference were dissemination of information about the availability of health care services for District families, educating the District community on how individuals could help improve and become involved in some of the District health programs, sharing current research and research methods related to maternal and child health initiatives, and the provision of a networking opportunity for public and private entities, non-profit organizations, advocacy groups, families and professionals. NIAAA's Dr. Megan Adamson facilitated a workshop on "Fetal Alcohol Spectrum Disorders: Identification, Linkages and Advocacy Services for Children and Their Families." The audience included teachers, health care workers, mothers, family members, and care-takers.
Share the Health Exposition NIAAA was a major presence at "Share the Health: NIH's Premier Health and Fitness Expo," held April 24 at Montgomery Blair High School in Silver Spring, Maryland. Sponsored by the NIH Office of Community Liaison and the NIH Recreation and Welfare Foundation, the event featured interactive exhibits and health seminars led by NIH scientists and staff. At least 1,500 members of the community attended the event. NIAAA exhibits and staff were highlighted in NIH press releases as well as in the Washington Post and the Bethesda Gazette. Exhibits and presentations hosted by NIAAA staff included "The Drunken Brain" exhibit, a discussion of social and peer pressures and the dangers involved in underage drinking, the effects of alcohol on behavior and the body, a breathalyzer demonstration, alcohol screening, and a preview of NIAAA's website for youth ages 11-14 "The Cool Spot." For more information on NIAAA's participation in "Share the Health," contact Dr. Dennis Twombly, Division of Neuroscience and Behavior, 301-443-9334, dtwombly@mail.nih.gov.
G. Multi-Media Products from NIAAA
NIAAA Products Win Awards NIAAA public/professional information products have garnered numerous awards:
- In two separate competitions of the Society for Technical Communication (the local chapter and international level), judges placed Helping Patients With Alcohol Problems: A Health Practitioner's Guide in the top category of "Distinguished Technical Communication." The international society has 25,000 professional writers, editors, illustrators, and designers as members. The Guide, published in spring 2003, also won an NIH Plain Language Award (see below).
- A Family History of Alcoholism: Are You at Risk and Harmful Interactions: Mixing Alcohol With Medicines have won Blue Pencil awards in the category of brochures/booklets from the National Association of Government Communicators (NAGC). Both were published in spring 2003, and are available in Spanish.
- The television public service announcement, The Party's Over, has won NAGC's Gold Screen award in the category of PSAs; it also has received a Platinum"Best of Show" in the 2004 Aurora Awards. The Aurora Awards is an international competition designed to recognize excellence in the film and video industries. The Party's Over was first distributed in spring 2003.
- Two NIAAA publications, Helping Patients With Alcohol Problems: A Health Practitioner's Guide, and Alcohol: A Women's Health Issue (published in fall 2003), won NIH Plain Language Awards in April. The Guide earned the top honor of "Outstanding" and the women's booklet honorable mention. This year, 12 members of the NIH Director's Council of Public Representatives were on the committee judging the publications.
Publications and Periodicals
Alcohol Research & Health An issue of Alcohol Research & Health on "Epidemiology in Alcohol Research," has been printed and distributed. The issue on the brain will be sent to the printers in early June and we are completing work on the two issues focused on the liver. Three new topics have been approved for upcoming issues: young adult drinking, screening and brief intervention, and health services research/economics.
Alcohol: A Women's Health Issue The booklet Alcohol: A Women's Health Issue has been adapted for Spanish-speaking women. This version was pretested in focus groups; comments from the groups are being incorporated.
Helping Patients With Alcohol Problems: A Health Practitioner's Guide A second HMO has independently reviewed and adopted the Guide into its clinical practice guidelines. In February, Kaiser Permanente of Southern California adopted the Guide and requested 5,000 copies for its physicians and other health care providers. Last year an Ohio HMO requested 9,000 copies to distribute to its practitioners, citing its valuable information and ease of use. This May, the same Ohio HMO requested 9,000 of the small pocket guides to mail along with a letter that reminds and encourages network practitioners to conduct alcohol screening in the office setting.
A complex chart on drinking patterns has been simplified and a reprinting was done in February in preparation for the National Medical Leaders meeting hosted by NHTSA. In addition, the Guide is undergoing review within NIAAA to ascertain ways to improve the screening and intervention algorithm. In April, a group of ASAM members provided feedback on a preliminary revision.
NIAAA Newsletter The Winter 2004 issue of the NIAAA newsletter featured articles on Council's approval of the definition of binge drinking, National Alcohol Screening Day, NIAAA's move to Fishers Lane, new personnel appointments, and new Institute publications. The Spring/Summer 2004 issue will be disseminated at RSA as well as on the NIAAA website.
Electronic Media
NIAAA's The Coolspot Website A completely revised version of The Coolspot, NIAAA's website aimed at providing 11- to 13-year-olds with information about alcohol and resisting peer pressure to drink, will be online in early June. The new content is excerpted and adapted from field-tested curriculum for grades 6-8 developed by the University of Michigan for an NIAAA-funded project called the Alcohol Misuse Prevention Study. Topics include facts about alcohol, norms perception correction, expectations, peer pressure, and resistance skills. The site features interactive components and vivid graphics based on a Japanese comic book style called anime, which children in this age group find appealing. In March, NIAAA received positive feedback on a prototype of the revised site from nearly 300 teens who attended the PRIDE conference in St. Louis. Some 90 percent of respondents found the site easy to use, liked how it looked, and wanted to visit the site again to learn more. The site will continue to undergo focus testing, refinements, and the addition of new content after it goes online. The web address is www.thecoolspot.gov.
NIAAA Website New items added recently to NIAAA's website include the following:
Antecedentes de alcoholismo en la familia-¿Está usted a riesgo? The Spanish-language version of A Family History of Alcoholism-Are You at Risk? provides easy-to-read facts along with sources of more information for anyone who is concerned about a family history of alcoholism.
Assessing Alcohol Problems: A Guide for Clinicians and Researchers, 2nd edition. Full text of the 700-page Guide is now available on the NIAAA website.
Health Sciences Education/Teacher Curricula Materials (see below) for more information on these new curricula.
Reacciones peligrosas: Mezclando bebidas alcohólicas con medicamentos. The Spanish-language version of Harmful Interactions: Mixing Alcohol with Medicines highlights the risks of using alcohol while taking medications or herbal preparations and lists common medicines and their possible reactions with alcohol.
Underage Drinking Prevention Materials. The television public service announcement, "The Party's Over" and other underage drinking prevention materials are now available online.
The April 16 Family Almanac column in the Washington Post referred readers to the NIAAA website with the remark, "It's one of the best."
Public Service Announcements The Office of Juvenile Justice and Delinquency Prevention (OJJDP) Drug-Free Communities Support Program (within the Department of Justice) is promoting NIAAA's television PSA, The Party's Over, to its constituencies. OJJDP has posted an announcement and link to our site on their Drug-Free Communities website and to their grantee listserv announcing the availability of NIAAA's underage drinking prevention public information products.
Three radio PSAs targeting 14-year-olds and two targeting parents have been developed, pretested in focus groups, and approved for dissemination. The radio PSAs will be sent to 4500 stations across the country.
Science Curricula
Science Education Curricula Now Available Two NIAAA science curricula are available aimed at educating middle school students about alcohol through science investigation. The first, Better Safe Than Sorry-Preventing a Tragedy, was developed by researchers at the University of North Carolina, Chapel Hill as well as teachers and education consultants. The materials and lessons are aligned with the National Science Education Standards (NSES) and are based on current research relevant to a life-science curriculum. Kits include teacher instructions, data tables and background, a video with lab instruction and information on FAS, a CD-ROM with all hardcopy materials and a post-assessment game, color transparencies, and brochures.
The second curriculum is one title in a curriculum supplement series coordinated by NIH's Office of Science Education (https://webarchive.library.unt.edu/eot2008/20080916101925/http://science.education.nih.gov/). It incorporates six hands-on, inquiry-based lessons that are also aligned with NSES content standards. The lessons include web-based components with simulations of intoxicated and sober mice, depictions of intoxicated drivers, and a piece that requires students to synthesize information and consider legal and social policy issues.
NIAAA's Jason Lazarow has introduced the curricula to teachers and state educational leaders at National Science Teachers Association national and western area conventions in Atlanta and Reno, and at a Dallas meeting of the Leadership to Keep Children Alcohol Free in May. Curriculum content can be viewed or ordered online at /www.niaaa.nih.gov/.
H. What's Ahead
Complexities of Co-occurring Conditions NIAAA co-sponsoring a conference on "Complexities of Co-Occurring Conditions," June 23-25 at the Marriott Wardman Park Hotel in Washington, DC. The conference will showcase theoretical models and research findings on prevention, treatment, and aftercare services for individuals at risk for or suffering from co-occurring mental illness, problem alcohol or drug use, and other medical or physical conditions. Other sponsors for the conference are the National Institute of Mental Health, SAMHSA, the Agency for Healthcare Research and Quality, and the Health Resources and Services Administration. Contact: Dr. Charlene LeFauve, 301 402-9401, clefauve@niaaa.nih.gov, or Dr. Harold Perl, 301 443-0788, hperl@niaaa.nih.gov.
Prepared: June 18, 2004