National Advisory Council on Alcohol Abuse and Alcoholism

Summary of the 94th Meeting

June 7-8, 2000

The National Advisory Council on Alcohol Abuse and Alcoholism convened for its ninety-fourth meeting at 7 p.m., on June 7 at the Pook=s Hill Marriott Hotel, Bethesda, Maryland, and 8:30 a.m., on Thursday, June 8, in Conference Room E1/E2 of the Natcher Conference Center, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland.

Dr. Enoch Gordis, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), presided during both the open and closed sessions.

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 February 9, 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. - 2:15 p.m. on June 8 for the discussion of program and policy issues with a closed session from 11:10 - 11:30 a.m.for consideration of MERIT nominations.

Dr. Henri Begleiter
Dr. Alpha Estes Brown
Dr. Richard Deitrich
Dr. Anna Mae Diehl
Dr. Marc Galanter
Dr. Mark Goldman
Dr. Rueben Gonzales
Dr. Harold Holder
Ms. Linda Kaplan, CAE - June 8 only
Dr. Barbara Mason
Dr. Matthew McGue
Dr. Carrie Randall

Ms. Sue Thau, Consultant for Public Policy for the Community Anti-Drug Coalitions of America.

Other Attendees on June 8

In addition to Council members and special guests there were approximately 70 observers present during the open meeting including NIAAA staff, liaison organization representatives, and other observers.

Dr. Enoch Gordis, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), called to order the closed session of the ninety-fourth meeting of the National Advisory Council on Alcohol Abuse and Alcoholism at 7 p.m., June 7 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. Thirty-three of the applications with priority scores of two hundred or better, percentile scores of 20.0 or better, and no human or animal subjects or minority or gender or other concerns were approved in early May by Council under the Procedures for Expedited En Bloc Council Concurrence for Grant Applications approved at the September 16, 1999 Council meeting. Applications which were ANot 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 June 7 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 AScored@ applications are at the IRG and Council recommended funding levels and the total years= direct costs for ANot Scored@ applications are the requested amounts.

Council members also recommended three MERIT extensions and approved six MERIT nominations for funding consideration by NIAAA.

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

Dr. Gordis began by having all of the Council members and other attendees introduce themselves.

Dr. Gordis said that the three Council members, Dr. Marilyn Aguirre-Molina, Ms. Sheryl Ramstad Hvass, and Mr. Paul Samuels were unable to attend due to other commitments.

Dr. Gordis highlighted parts of the written Director=s Report to Council which will also be posted on the NIAAA home page at http://www.niaaa.nih.gov.

The House allowance for the FY 2001 budget for NIAAA represents a 19 percent increase over the FY 2000 appropriation and the Senate allowance provides for a 15 percent increase. The final amount will not be known until later this year.

Dr. Gordis welcomed Dr. George Kunos, the new Scientific Director of the NIAAA Intramural Research program. Dr. Kunos is a distinguished international scientist with many publications and a record of scientific leadership and mentoring at the Medical College of Virginia.

National Alcohol Screening Day took place on April 6 at about 1500 sites with many thousands of interviews especially at college campuses.

Dr. Gordis said that a recent report by the National Institute of Environmental Health Sciences listed alcohol as a carcinogen for the oropharnyx and upper respiratory tract.

A description of the Federal Government=s dietary guidelines with regard to alcohol is listed on page 8 of the Director=s Report. The dietary guidelines are a combined effort of the U.S. Department of Agriculture and Department of Health and Human Services. They are available online at http://www.health.gov/dietaryguidelines/.

Dr. Thomas Gentry, of the Office of Collaborative Research Activities at NIAAA, will report the results of a study on the caloric value of alcohol at the Research Society on Alcoholism meeting in Denver in late June. The study was conducted in conjunction with the Department of Agriculture at Beltsville, Maryland, and Johns Hopkins University at Baltimore, Maryland.

Ms. Dorothea DeZafra, of the Office of Collaborative Research Activities, is working with experts in the alcohol research field to develop curriculum materials on alcohol science for high schools.

A large number of applications were received in response to the Request for Applications (RFA) for Research on Spirituality and Alcoholism. The focus of the RFA is the role of spirituality in alcoholism treatment and recovery.

The NIAAA has a listing of about 400 liaison organizations interested in alcohol research. About 15 to 20 liaison organization representatives meet with Dr. Gordis and senior Institute staff on an informal basis after every Council meeting.

Dr. Gordis said that the research to practice efforts were progressing well in New York and North Carolina. The real world obstacles to innovation include issues of inertia, funding, pharmaceutical costs, job security issues, training costs, and financial constraints related to managed care.

The Institute has developed a booklet entitled AMake a Difference: Talk to Your Child About Alcohol.@ There has been a tremendous demand for the booklet and hundreds of thousands of copies have been requested across the country. The booklet will also be published in Spanish.

Dr. Alpha Estes Brown said that he had received a copy through his daughter=s school and that the booklet was very well done.

The Health Services Research Program has been elevated to Branch status within the Division of Clinical and Prevention Research.

Dr. Vivian Faden has been designated as Acting Chief of the the Epidemiology Branch in the Division of Biometry and Epidemiology.

Ms. Peggy Murray, of the Office of Collaborative Research Activities, has received the 2000 Distinguished Alumni Award from St. Mary=s College of Maryland.

Dr. Susan Martin, of the Division of Clincial and Prevention Research, Prevention Research Branch, has received a Breaking the Glass Ceiling Award from the National Center for Women in Policing at their annual conference in Baltimore.

Dr. Harold Perl, of the Division of Clinical and Prevention Research, has received a special recognition award from the NIH Office of Equal Opportunity for his service as an EEO counselor.

Dr. Mark Goldman, co-chair of the Council Subcommittee on College Drinking, reviewed the history and status of the Subcommittee which includes a number of college presidents and 12 researchers. The co-chair is Father Edward Malloy, President of the University of Notre Dame and former Council member.

The Subcommittee has two panels. The first panel on Contexts and Consequences is designed to look at the college drinking environment and the nature of the problems related to college drinking. The second panel on Prevention and Treatment is designed to look at which programs are effective and which are not effective in preventing and treating alcohol-related problems.

Both panels are developing reports which will be used to develop an overall Subcommittee report for presentation to Council at its February 2001 meeting. There are also plans to widely disseminate the report which will have a receptive audience among college presidents and administrators, fraternities, and other student organizations.

The two panels met again on June 6 and 7 to review the expert papers before they are finalized over the summer and turned into a report for the Subcommittee. The Subcommittee will meet again before the September Council meeting and on November 1 at O=Hare Airport in Chicago to finalize the Subcommittee=s report. It is hoped that the college presidents will endorse and support the Subcommittee=s report at the November 1 meeting.

Dr. Goldman emphasized the complex issues facing college presidents and the need for useful research recommendations.

Dr. Suzanne Medgyesi-Mitschang, Special Advisor to the Director, NIAAA, said that up to 37 Governors= spouses may participate in the National Leadership Initiative to Keep Children Alcohol Free. The next phase of the Initiative will run for three years and is designed to sustain the momentum and interest in the issue of preventing the use of alcohol by children between the ages of 9 and 15. The National Highway Traffic Safety Administration (NHTSA), the Office of Juvenile Justice Programs and the Substance Abuse and Mental Health Services Administration (SAMHSA) are already active supporters.

Dr. Medgyesi-Mitschang said that the Initiative was already producing a great demand for the booklet on ATalking to Your Child About Alcohol@ and that more educational materials were being developed.

Dr. Harold Holder said that the National Leadership Initiative was providing a valuable constituency for transmitting research findings into practice at the State and local levels by bringing together Governors= spouses and their staff, alcohol researchers, State alcohol and drug abuse directors, and members of national organizations with an interest in the issue.

Alcohol research experts have provided a summary of the best evidence about strategies and actions that could be done at the State and local levels to prevent the onset of drinking and drinking problems among young people. There will also be presentations on the Initiative at the Western Governors= Association Conference, the National Governors= Association Conference, and the American Bar Association meeting.

There have been press conferences on the Initiative by several Governors= spouses and there will be regional forums in the northwest, midwest, and east coast.

The Initiative will have five task forces for special events, media outreach, social environment, minority concerns, and research. A web site will be developed and media tours conducted to bring more media awareness to the issue. Mothers Against Drunk Driving (MADD) has expressed a strong interest in the Initiative, and the Kettering Foundation has expressed interest in supporting issue forums.

Dr. Alpha Estes Brown asked if there was any intent to reach the local mayors and their spouses about the Initiative.

Dr. Medgyesi-Mitschang said that contact is being made with the U.S. Conference of Mayors.

Dr. Gordis introduced Dr. Mary McCaul, Associate Professor of Psychiatry in the Department of Psychiatry and Behavior at Johns Hopkins, and Dr. Peter Monti, Director of the Center for Alcohol and Addictive Studies at Brown University. Drs. McCaul and Monti chaired the Council Subcommittee, which included Dr. Barbara Mason and a number of other leading research experts as noted in the Subcommittee Report.

Dr. Michael Eckardt, Senior Scientific Advisor in the Office of Scientific Affairs, provided staff support for the Subcommittee and coordinated preparation of the Report.

Dr. Eckardt said that the Council extramural portfolio review process provided a way for outside experts to identify research opportunities and gaps in research knowledge.

Dr. Peter Monti recognized the research experts who participated in the portfolio review including Dr. Marc Galanter and Dr. Barbara Mason of the National Advisory Council.

Dr. Monti then listed the major recommendations of the Subcommittee in rank order as summarized below:

Some of the issues which cut across the five priority areas include special populations, measurement issues, patient treatment watching, and technology transfer.

Dr. Monti summarized some additional issues related to mechanisms of action, effectiveness studies in the treatment communities, a research career award (K25) to develop a cadre of biostatisticians in the field, the involvement of other Federal agencies such as DOD, VA, and CSAT in treatment studies, trans-Institute studies at NIH, and involvement of the pharmaceutical industry.

Dr. Elizabeth McCaul then elaborated on the need for more theory-based research on the mechanisms of action for treatment and the need for an RFA for this area. Dr. McCaul concluded her remarks by asking for Council member comments on the RFA concept.

Dr. Alpha Estes Brown said that it was his experience that environmental factors have a great influence on treatment relapse once an individual returned to a community following treatment.

Dr. Monti agreed that the environmental factors were very important and cited the example of many Viet Nam veterans stopping the heavy use of drugs once they returned to this country.

Dr. Marc Galanter suggested a model of a developmental program for treatment research that NIAAA might want to adopt. It consists of developmental (R21) grants to develop a theoretically grounded treatment model, followed by a controlled study, and multisite clinical studies.

Ms. Linda Kaplan said that the report was excellent and that she was pleased with the focus on practitioners and their ability to deliver various treatments under real world circumstances.

Dr. Henri Begleiter commented on the possible problems with the use of the word mechanism with regard to the psychotherapeutic process. Dr. Begleiter also said that the mechanisms for psychopharmacology were also very poorly understood at the molecular level, including for acamprosate and naltrexone. Thus, conducting research involving the use of both behavioral and pharmacologic mechanisms may be very difficult.

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

In response to a question from Dr. Mark Goldman at the February Council meeting, Mr. Edward Linehan, Program Analyst in the Office of Scientific Affairs, provided a three-page handout on the number of new investigatiors who received awards in FY 1999 and in FY 2000 to date.

The data show that NIAAA had an almost 20 percent ratio of new investigators in FY 1999 for regular research grants (RO1s). The ratio was even higher for Small Grants (R03) at 65 percent and Exploratory/Developmental Grants (R21) at 38 percent. The overall ratio for all three mechanisms was almost 25 percent.

For FY 2000 to date, about 21 percent of RO1s are for new investigators with a 27 percent ratio for all three mechanisms.

The overall NIH ratio for new investigators for RO1s is about 25 percent as compared to 27 percent for NIAAA over the last three years.

Dr. Goldman said that he was impressed with the data and asked how NIAAA compared to the National Institute on Drug Abuse (NIDA).

Mr. Linehan said that the NIDA ratio was about 20 percent for new investigators on RO1 grants over the last three years.

Dr. George Kunos said that in his experience as a departmental chair, it was even more important for young investigators to get their first competing renewal award.

Dr. Kenneth Warren, Director of the Office of Scientific Affairs at NIAAA, said that a study has shown that first time recipients of regular research grants did better at receiving competing renewal awards than those first time investigators who received the now terminated First Independent Reseach Support Transition (FIRST) Award (R29). Dr. Warren agreed with Dr. Kunos that the renewal rate for first time investigators was important.

Dr. Kunos said that it was also very important for new investigators to receive their awards where other alcohol researchers were present to provide mentoring.

Dr. Matthew McGue raised the issue of the human subjects protection and confidentiality in the conduct of family history research since it often involves sensitive data. Human subjects research was, in fact, halted at Virginia Commonwealth University as a result of confidentiality issues. This in turn has impacted on the willingness of Institutional Review Boards (IRBs) to approve family history research at other universities.

Dr. Warren said that the issue was being discussed at NIH. The key issue is who is a human subject and does it include people that are having data collected about themselves, even if they are not being directly interviewed. Some other Councils have invited spokespersons from appropriate DHHS offices to discuss the issue, and NIAAA can also do this for the September Council Meeting.

Both Dr. McGue and Dr. Goldman expressed support for having a presentation by an OHRP spokesperson at the September Council Meeting.

Mr. James Vaughan presented the minutes of the February 9-10, 2000. The minutes were approved as written.

Mr. Vaughan then reviewed the proposed meeting dates for the September 2000 meeting and proposed dates for the 2001 Council meetings. The future Council meeting dates will be September 13-14; and February 7-8, 2001, June 6-7, 2001, and September 19-20, 2001.

Dr. Richard Deitrich, Professor of Pharmacology and Director of the Alcohol Research Center, Department of Pharmacology, University of Colorado Health Sciences Center, presented an overview of the University of Colorado Alcohol Research Center including a list of researchers at the Center, the members of the Center Advisory Board, and some key advisors at the University of Colorado.

The focus of the Center is on the selective breeding of mice and rats for different behavioral responses to alcohol.

Dr. Deitrich then presented some slides illustrating the effects of alcohol on animals that are resistant to the effects of alcohol (short sleep animals) and animals that are sensitive to alcohol effects (long sleep animals).

Animals that are not sensitive to alcohol develop tolerance to alcohol very quickly, but animals that are sensitive to alcohol develop tolerance much more slowly.

The Colorado researchers have identified a number of the alleles that they think are responsible for the resistance to alcohol=s effect in the short sleep animals and sensitivity to alcohol in the long sleep animals. This in turn has resulted in being able to establish a correlation between a neurophysiological and a behavioral phenotype.

Related studies have identified adenyl cyclase as a possible marker related to human alcoholism.

Evidence has also been found for an alcohol receptor by Dr. Adron Harris, of the University of Colorado, now at the University of Texas, in conjunction with Dr. John Mihic while he was at the University of Colorado, now also, at the University of Texas, and Dr. Neil Harrison at the University of Chicago.

Dr. Deitrich then described genetic research with the alcohol tolerant and alcohol sensitive animals using quantitative trait locis (QTL) to identify specific genes associated with alcohol related behavior.

Studies are being conducted on the development of tolerance to alcohol by alcohol resistant and alcohol sensitive animals.

Sensitivity to alcohol is in fact, a good predictor of alcoholism in humans.

The overall goal of the Center=s research is to produce information that can be used as a scientific basis for the development of new medications for prevention and treatment of alcohol.

Ms. Sue Thau, consultant for public policy for the Community Anti-Drug Coalitions of America, briefed Council members on budget and legislative issues affecting NIH and NIAAA.

Ms. Thau began by saying that she thought the collaboration between the research and practice communities has improved in recent years thanks to efforts by Dr. Gordis and other NIAAA staff.

Ms. Thau said that the Community Anti-Drug Coalitions of America (CADCA) represents 5,000 community coalitions across America including at the local level, usually, law enforcement, education, social service providers, grassroots people, politicians, and decisionmakers, business, parents, students, etc. The purpose is to bring a community together to look at the substance abuse issue and come up with comprehensive ways to deal with it.

The CADCA provides technical assistance training through publications, and a big forum every year in conjunction with NIAAA and other organizations. About 1,000 community-based people receive training at the forum each year.

The CADCA emphasizes the need for mutual support among the various groups in the substance abuse field especially between research and services.

The research showing that the younger an individual initiates alcohol use, the more likely they are to have lifelong alcohol problems is very valuable in educating policymakers to the need for more prevention and treatment services. Congress is very interested in having a strong interaction between the research and service communities in order to assure the most effective use of prevention and treatment funds.

Dr. Richard Suchinsky, ex-officio Council member representing the Department of Veterans Affairs (VA), said that the VA was increasing funding for post traumatic stress disorders and substance use disorders by $15 million in FY 2000. The substance abuse amount is about $9.5 million of the $15 million increase.

The VA has an initiative to turn research into practice looking at the effectiveness of primary care physicians and providers in both detecting and providing early intervention for alcohol problems.

Dr. Suchinsky also said that NIAAA had been very successful in providing information about alcohol issues at the American Psychiatric Association Meeting in Chicago in May.

Mr. Roger Hartman, ex-officio Council member representing the Department of Defense (DOD), distributed information about the FY 2000 DOD health research program, which includes $25.0 million for medical research. The priority in the alcohol research area is on alcohol abuse prevention research. Seven alcohol abuse prevention research projects were funded in FY 1999.

Mr. Hartman announced that Dr. Jarrett Clinton will be the Acting Assistant Secretary of Defense for Health Affairs. Dr. Clinton is a rear admiral in the U.S. Public Health Service.

Ms. Linda Lewis, representing the International Certification and Reciprocity Consortium, called Council=s attention to a new publication titled AAssuring Public Safety in the Delivery of Substance Abuse Prevention Services.@ The position paper calls for State and federally funded prevention programs to have credentialled prevention specialists as a requirement to receive Federal funds.

Mr. Warren Stafford, of Alcoholics Anonymous World Services, said that there would be an A&E television program on June 12 titled AInside Alcoholics Anonymous.@ The Alcohol Anonymous web site has been reconfigured and is available at http://www.aa.org.

Ms. Irene Gainer, representing Treatment Accountability for Safer Communities (TASC), previously known as Treatment Alternatives to Street Crime, said that TASC was also focusing on people with alcohol as well as illegal drug problems, since they are often closely related.

The Treatment Accountability for Safer Communities will have a conference in Orlando, Florida, October 22-25. The TASC is working closely with the National Association of Alcohol and Drug Addiction Counselors in Arlington, Virginia.

Ms. Lynetta Albright, of the Great Lakes Addiction Technology Transfer Center, at the University of Illinois at Chicago, spoke on behalf of the National Addiction Technology Transfer Center (ATTC) Network which has centers in 13 regions around the country.

The ATTC Network is working with NIAAA on the research to practice symposium in New York and Colorado. Ms. Albright also distributed copies of the National ATTC Annual Report.

Dr. Peggy Bailey, of the American Hospital Association, spoke in support of more treatment research of practical use to the treatment providers such as how long does effective treatment take and other details of treatment.

Mr. Robert Fleming, of Recovery Works, said that he was trying to organize treatment and prevention providers in the Washington, D.C. area to encourage cooperation and improve public understanding of the availability and effectiveness of treatment. The web site is http://www.recoveryworks.org.

Mr. Geoffrey Laredo, Director of the Office of Policy Legislation and Public Liaison at NIAAA, said that Al-Anon had sent a copy of their 1999 membership survey report and that copies were available on the publications table.

There were no public comments.

The Council adjourned at 2:15 p.m.

CERTIFICATION

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

Posted: August 11, 2000