Contents
A. Legislation, Budget, and Policy
Congressional Activity
Legislation Introduced for NIAAA Name Change Congressman Patrick Kennedy and Senator Joseph Biden have introduced parallel bills in the House and Senate to change the names of NIAAA and the National Institute on Drug Abuse (NIDA). Cong. Kennedy introduced H.R. 1348, the NIDA and NIAAA Name Redesignation Act, on March 6. Senator Joseph Biden introduced S. 1011, the Recognizing Addiction as a Disease Act, on March 28. Senators Edward Kennedy (D-MA) and Mike Enzi (R-WY), the Chairman and ranking minority members, respectively, of the Senate Health, Education, Labor and Pensions Committee, are co-sponsors of the Senate bill. Both bills would change NIAAA's name to the National Institute on Alcohol Disorders and Health and NIDA's to the National Institute on Diseases of Addiction.
The new name for NIAAA reflects the Institute’s current mission to study alcohol use and its influence on health, including alcohol-induced disorders across the lifespan.
In his introductory remarks, Sen. Biden said, “These name changes accomplish two important objectives. First, they remove the pejorative term ‘abuse’ from the institutes' names and properly help to distance that notion from the disease of addiction. Second, the new names more clearly link the concepts of addiction and disease, a connection that scientific study clearly supports. Identifying addiction as a neurobiological disease will diminish the social stigma, discrimination, and the personal shame that is often a barrier to seeking treatment, and it will further a common understanding of diseases of addiction.”
Neither bill has seen any legislative action since their recent introductions; no additional information is available that would indicate when either bill might be taken up by either the House or Senate committees.
Theme Budget Hearings On Thursday, March 1st, Dr. Li presented the NIAAA FY 2008 President's budget request before the House Labor, HHS, and Education Subcommittee. Similar to past House appropriations hearings, this was a "theme" hearing that included NIDA Director Nora Volkow and National Institute of Mental Health Director Thomas Insel, as well as the recently-appointed Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), Terry Cline. On Monday, March 26th, Dr. Li participated in the Senate Appropriations Subcommittee hearing on "Mind, Brain and Behavior" and presented the FY 2008 President's Budget request to the Senate subcommittee. Also in attendance at this Senate theme hearing were NIDA and NIMH, as well as National Institute of Neurological Disorders and Stroke Director Story Landis and National Institute on Deafness and Other Communication Disorders Director James Battey. Dr. Li's statement before the House appropriations subcommittee can be found on the NIAAA web site at http://www.niaaa.nih.gov/AboutNIAAA/CongressionalInformation/Testimony/housestatement03_07.htm. Dr. Li's statement before the Senate appropriations subcommittee can be also be found on the NIAAA web site at http://www.niaaa.nih.gov/AboutNIAAA/CongressionalInformation/Testimony/senatestatement03_07.htm.
STOP Legislation Signed On December 20, 2006, the President signed into law the Sober Truth on Preventing Underage Drinking Act (STOP Underage Drinking Act) as P.L. 109-422. Representative Lucille Roybal-Allard (D-CA) introduced the legislation in the House (H.R. 864) on Feb. 16, 2005; on the same day, then Senator Mike DeWine (R-OH) introduced a companion bill in the Senate. The legislation formalizes and enhances the Interagency Coordinating Committee on the Prevention of Underage Drinking. It also calls for modified enforcement of drinking laws, steps to reduce alcohol’s availability to teenagers, increased research on underage drinking, and additional resources for local community efforts. The legislation will also begin the process of developing an adult-oriented media campaign and improve the monitoring of the alcohol advertising reaching youth.
NIAAA Budget
FY 2007 Joint Resolution On February 15, the President signed into law H. J. Res. 20, the "Revised Continuing Appropriations Resolution, 2007," as P.L. 110-5. The measure was passed by the Senate on February 14, with the third continuing resolution expiring on February 15. This joint resolution provides funding for the NIH. The joint funding resolution includes increases above the FY 2006 funding levels, including a $620 million increase for NIH to reverse a projected decline in new NIH research project awards and support an additional 500 research project grants, 1500 first time investigators, and expand for high risk and high impact research. The NIAAA FY 2007 joint resolution budget is $436 million, which is a $5.2 million increase over the FY 2007 President’s budget. A summary of the FY 2007 joint resolution budget is reflected in the table below.
FY 2008 President’s Request The FY 2008 budget request for the NIAAA is $436.5 million, including HIV/AIDS, an increase of $0.5 million and 0.1 percent over the FY 2007 joint resolution level. The budget request for HIV/AIDS research is $27.3 million. The following highlights some of the major components of the FY 2008 budget request:
· Research Project Grants Under the President’s request, the Institute plans to support approximately 201 competing research project grants which would equal approximately a 29 percent success rate for competing research project grants (RPGs). The FY 2008 request holds the average cost of competing RPGs at the FY 2007 level. There will be no inflationary increases for direct, recurring costs in non-competing continuation RPGs.
· Alcohol Research Centers The centers program budget will support 18 research centers at $27.3 million.
· Other Research $12 million is provided to support 93 research career awards in FY 2008. Cooperative agreements will be funded at $8.7 million.
· Research Training Research training is provided $11.3 million for 280 pre- and post-doctoral trainees in full-time training positions, which is flat with FY 2007. Stipend levels for post-doctoral NRSA trainees will remain at the FY 2007 level.
· Research and Development Contracts Research and development contracts are provided $33.7 million.
· Intramural Research Program $45 million has been allocated to maintain the intramural research program’s overall level of effort with 118 FTE’s for FY 2008.
· Research, Management, and Support (RMS) RMS activities are provided $25 million with 112 FTE’s for FY 2008.
Below is a summary of the FY 2008 President’s Budget request (dollars in thousands):
|
FY 2006
Actual
|
FY 2007
Revised
Joint Resolution
|
FY 2008
Revised
President's Budget |
| Extramural Research: |
|
|
|
Grants and Contracts......................
|
$350,790 |
$354,403 |
$349,176 |
|
Research Training (NRSA)............... |
10,889 |
11,284 |
11,284 |
| Intramural Research........................ |
45,574 |
45,521 |
45,202 |
| Research Management and Support |
24,330 |
24,849 |
25,098 |
| Total, NIAAA (including AIDS).......... |
435,479 |
436,057 |
436,505 |
| Percent increase over prior year....... |
|
0.1% |
0.1% |
| AIDS (dollars in overall budget)........ |
(26,923) |
(26,942) |
(27,390) |
FTEs.............................................
|
225 |
227 |
230 |
Medicare/Insurance Coding Changes
The U.S. Centers for Medicare and Medicaid Services (CMS) has added new codes for use in seeking reimbursement for alcohol and drug screening and brief intervention. The codes are part of the level II Healthcare Common Procedure Coding System (HCPCS) maintained by CMS to ensure that claims for health services and products can be processed in a consistent manner. The new codes became available January 1, 2007; they should facilitate provision of and reimbursement for these services. Research has demonstrated the effectiveness of screening and brief intervention in identifying at-risk and problem drinkers and helping them reduce their drinking.
B. Director's Activities
Asian American and Pacific Islander Scientific Conference On February 12-13, the University of California at Los Angeles Integrated Substance Abuse Programs hosted the Asian American and Pacific Islander (AAPI) Scientific Conference/Workshop in Santa Monica, California. The workshop showcased interdisciplinary addiction research by renowned AAPI and other researchers working to translate basic research discoveries into medications, treatments, or prevention methods. Dr. Li gave the keynote address on “Alcohol Use Disorders: A Global Problem.”
Briefing With Congressman Patrick Kennedy NIAAA received a request for a briefing on the latest science regarding the origins and treatments of addiction from Congressman Patrick Kennedy (D-RI). The briefing took place on Wednesday, Feb. 14, in Cong. Kennedy's office on Capitol Hill. Congressman Kennedy and Mr. Chris Lawford (Cong. Kennedy's cousin and author of Symptoms of Withdrawal: A Memoir of Snapshots and Redemption) attended. Drs. Li and David Goldman and Ms. Patricia Brown attended from NIAAA. The briefing lasted for two hours, an unusually long time for a meeting with a congressman or senator. Those present were interested and engaged throughout the briefing; some of the topics covered included genetics, metabolism, brain remodeling, youth and lost opportunities, lack of resiliency and control, correlation between obsessive compulsive disorder and alcoholism, frequency of drinking, the Clinician's Guide, screening and brief intervention, insurance parity, and evidence-based treatment. As a follow-up to the meeting, Dr. Li asked Connie Weisner to attend an insurance parity hearing held by Cong. Kennedy in Redwood City, California. (Dr. Weisner is a professor in the Department of Psychiatry at the University of California at San Francisco, and an NIAAA grantee.) Dr. Weisner had an opportunity to meet Congresspersons Kennedy, Anna Eshoo (D-CA), and Jim Ramstad (R-MN). Dr. Weisner provided Cong. Kennedy with a copy of a paper on family costs from the NIAAA Family Utilization study.
National Advisory Council on Minority Health and Health Disparities On February 27, Dr. Li addressed a meeting of the advisory council to the National Center on Minority Health and Health Disparities. The title of his talk was “Alcohol Research and Health.”
Alcohol Research Center Directors Meeting The biennial meeting of directors of NIAAA’s alcohol research centers met on March 12 and 13 at Howard University’s Alcohol Research Center in Washington, DC. The theme was alcohol abuse and dependence among ethnic populations. Dr. Li gave an update on NIAAA programmatic activities.
Chinese Academy of Science Representatives of the Chinese Academy of Science visited NIH on April 13, meeting with officials from six institutes at the Fogarty International Center. The Chinese scientists were interested in a number of areas, among them, collaborative research on complex diseases (such as metabolic syndrome and diabetes), stem cells, and alcohol-related areas, such as alcohol abuse in the population and genetic studies relevant to the Chinese. Dr. Li spoke about NIAAA programs, including collaborative studies underway with Chinese medical and research centers. Zhaoxia Ren also attended the meeting.
Memorial for Henri Begleiter On April 16, the State University of New York Downstate Medical Center in Brooklyn dedicated its neurodynamics laboratory to the memory of Henri Begleiter. Dr. Begleiter was an internationally renowned investigator in neurophysiology and genetics and a key figure in the Collaborative Study on the Genetics of Alcoholism. Drs. Li and Ken Warren were among those who made remarks at the ceremony. Antonio Noronha and Sam Zakhari also attended the event.
Institute of Psychiatric Research The Institute of Psychiatric Research (IPR) at the Indiana University School of Medicine held a 50th anniversary symposium in Indianapolis on May 4. IPR’s mission is to understand the neurobiological origins and treatment of psychiatric disorders and to communicate this understanding to all interested persons. Dr. Li gave the keynote address, “Clinical and Research Advances in Alcoholism: The NIAAA Perspective.”
American College of Neuropsychopharmacology Dr. Li presented a lecture on “Drinking Patterns and Negative Consequences: Implications for Alcoholism Clinical Trial Endpoints” at a workshop convened on May 10 by the American College of Neuropsychopharmacology. The intention of the workshop, which took place at the National Press Club in Washington, DC, was to bring together representatives from academia, industry, and government to define important issues in medications development for addictive disorders and to identify strategies to improve success in drug discovery for substance abuse treatment.
C. NIAAA Staff and Organization
Beata Buzas, Ph.D. Beata Buzas has joined NIAAA as a scientific review administrator in the Extramural Project Review Branch (EPRB). Before joining EPRB, Dr. Buzas was the head of NIH's Inter-Institute Initiative on Functional Genomics of Affective Disorders, and was an investigator in NIMH’s Mood and Anxiety Program, and the Laboratory of Neurogenetics, NIAAA. She was also an assistant professor at the Uniformed Services University of the Health Sciences.
Peter Delany, Ph.D. Peter Delany received The Excellence in Healthcare Leadership Award from the Health Service Officers Professional Advisory Group of the U.S. Public Health Service Commissioned Corps. This award is presented to a health services officer who has demonstrated outstanding accomplishments with 8-10 years of healthcare management or public health administration experience. The administrative officer must exhibit exceptional leadership ability and exemplary service, while substantially advancing the health of our Nation through innovative and strategic solutions as well as having a significant impact on the mission of Public Health Service.
Ivana Grakalic, Ph.D. Ivana Grakalic recently joined the Division of Neuroscience and Behavior (DNB) to direct a research program on learning and motivational aspects of alcohol addiction. Dr. Grakalic joined DNB from the Preclinical Pharmacology Section, Intramural Research Program at NIDA, where she conducted research on the role of stress and learning mechanisms in the hedonic actions of morphine, alcohol, and cocaine in animal paradigms. Dr. Grakalic received a Ph.D. in behavioral neuroscience from American University in Washington, DC. She has also served as an adjunct faculty member in Department of Psychology at American University.
Robin Kawazoe Robin Kawazoe becomes the Associate Director for Administration, NIAAA, on May 27, 2007. Her selection to this Senior Executive Service (SES) position required approval by the Office of Personnel Management and the Department of Health and Human Services. In this capacity she serves as the Executive Officer and Director of the Office of Resource Management (ORM) where she manages and oversees staff in three branches: the Financial Management Branch, Administrative Services Branch, and Ethics and Management Analysis Branch. She is the Deputy Ethics Counselor for NIAAA. For the immediate future, Ms. Kawazoe will continue to serve as the Acting Deputy Director, NIAAA, and Acting Chief of the Ethics and Management Analysis Branch. She joined the Institute in August 2005 as Senior Advisor to the Director, NIAAA. Before coming to NIAAA, Ms. Kawazoe was Director of the Office of Science Policy and Planning in the Office of the Director, NIH, a position she had held since December 1996. She came to NIH in 1988, joining the NIDA as Special Assistant to the Deputy Director and then Deputy and Acting Director of NIDA’s Office of Science Policy and Communications.
Angela Martinelli, Ph.D., R.N. Captain Angela Martinelli has joined the Division of Treatment and Recovery Research as a program administrator. She is on active duty in the U.S. Public Health Service and has served in the U.S. Army and Air Force nurse corps. Her research focuses on active and passive smoking and nicotine and has been funded by the Department of Defense. Prior to coming to NIAAA, she was assigned to the Office of the U.S. Surgeon General and the Office of Science Policy at NIDA. Dr. Martinelli continues to practice nursing as a volunteer with Operation Smile International. Since 1993 she has worked in such places as Mombassa, Kenya; Santa Cruz, Bolivia; Columbia, South America; Surin, Thailand; Kazan, Russia; and Fez, Morocco.
Dr. Martinelli has received the 2007 O. Marie Henry Publication Award by the Nurse Professional Advisory Committee, U.S. Public Health Service Commissioned Corps. The award recognizes publications that describe clinical nursing practice; this year’s award recognizes the paper by Dr. Martinelli, “Notes from the Field: Surgery for a Smile,” Federal Practitioner, February 2006, pp. 36-38.
John Matochik, Ph.D. John Matochik has joined DNB to direct a research program related to neuroimaging of alcohol use disorders. Prior to coming to NIAAA, Dr. Matochik worked in the Neuroimaging Research Branch at the NIDA Intramural Research Program, where he was involved with both functional and structural brain imaging studies. At NIDA, in addition to providing image analysis support and neuroanatomical expertise, he developed a research program to study the effects of drugs of abuse (e.g. cocaine, marijuana) on brain morphology using magnetic resonance imaging. He also worked with collaborators at the National Institute of Aging to develop a structural brain imaging program to study the effects of long-term dietary calorie restriction in rhesus monkeys. Dr. Matochik received his Ph.D. from Vanderbilt University. Prior to working at NIDA, he was a staff fellow in the Laboratory of Cerebral Metabolism in the National Institute of Mental Health Intramural Research Program. Dr. Matochik has 39 peer-review publications in the area of neuroimaging.
Matt Packard Following military duty, Matt Packard has resumed his position as Chief of the NIAAA Contracts Management Branch in the NIDDK Office of Acquisitions (OA). (NIAAA’s contracts office was consolidated with NIDDK’s in a reorganization effective in 2005.) Patrick Sullivan, who had been acting in Mr. Packard’s absence, has become Deputy Director of the NIDDK OA.
Bob Ward Bob Ward joined NIAAA’s Administrative Services Branch as an Administrative Officer (facilities) at the beginning of March. He is working on facility issues as they relate to NIAAA’s intramural research buildings (5625 and Flow). He comes to NIAAA from the National Institute of Allergy and Infectious Diseases (NIAID) where he served as an intramural administrative officer (AO) and was heavily involved in the construction and activation phases of the C.W. Bill Young Center for Biodefense and Emerging Infectious Diseases (Building 33). In his position as intramural AO at NIAID, Mr. Ward assisted intramural staff with regard to financial, human, and facility resource needs. Prior to his arrival at NIH, Mr. Ward held several managerial positions with the Royal Ahold Corporation.
Kenneth Warren, Ph.D. Ken Warren, Associate Director for Basic Research, has been named Acting Director, Office of Science Policy and Communications.
Joanna Yoon M.S.P.H. Joanna Yoon has joined the Division of Epidemiology and Prevention Research (DEPR) as a public health analyst. Ms. Yoon has an M.S.P.H. in biostatistics and an M.P.H. in environmental health science, both from the University of South Carolina. Prior to coming to NIAAA, she was a statistician and section manager in the Division of Biostatistics, South Carolina Department of Health and Environmental Control. Her research interests include hierarchical model analysis, survival analysis, child health-related epidemiology, environmental epidemiology, and reproductive health issues. She will be working with staff to use nationally representative survey data to address important alcohol epidemiology research questions.
D. Research Priority Emphasis and Core Support Teams
Surgeon General’s Call to Action on Underage Drinking On November 1, 2005, then Surgeon General Admiral Richard Carmona announced that his office would produce a Surgeon General’s Call to Action on underage drinking. The Calls to Action are intended to focus the Nation’s attention on important public health issues. The Office of the Surgeon General (OSG) designated NIAAA and SAMHSA as the lead agencies to work on the Call to Action. Vivian Faden and Patricia Powell served as NIAAA’s representatives to the OSG as well as the senior scientific editors. Because of the work of NIAAA’s ongoing underage drinking prevention initiative, the Institute was well positioned to provide the scientific foundation for the Call to Action.
Acting U.S. Surgeon General Kenneth Moritsugu issued the Call to Action to Prevent and Reduce Underage Drinking on March 6, 2007. The Call to Action identifies six goals:
· Foster changes in society that facilitate healthy adolescent development and that help prevent and reduce underage drinking.
· Engage parents, schools, communities, all levels of government, all social systems that interface with youth, and youth themselves in a coordinated national effort to prevent and reduce underage drinking and its consequences.
· Promote an understanding of underage alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences.
· Conduct additional research on adolescent alcohol use and its relationship to development.
· Work to improve public health surveillance on underage drinking and on population-based risk factors for this behavior.
· Work to ensure that policies at all levels are consistent with the national goal of preventing and reducing underage alcohol consumption.
Drs. Li, Faden, and Powell, along with Diane Miller and Fred Donodeo, joined Dr. Moritsugu and SAMHSA officials, including SAMHSA Administrator Terry Cline, for the events surrounding the roll-out of the Call to Action. These included a legislative briefing on March 5, and briefings for constituent groups and the press on March 6. North Carolina First Lady Mary Easley, Co-Chair of Leadership to Keep Children Alcohol Free, and Emeritus First Lady of Pennsylvania Michelle Ridge, who is a board member for the Leadership to Keep Children Alcohol Free Foundation, also participated in the press conference, along with Koren Zailckas, author of Smashed: The Story of a Drunken Girlhood.
NIAAA printed 15,000 copies of the Call to Action and 10,000 copies of three accompanying "People's Pieces:" A Guide to Action for Families, A Guide to Action for Communities, and A Guide to Action for Educators. The "People's Pieces" provide in simple language the same basic information found in the larger Call to Action and give readers the knowledge and tools needed to take action against underage drinking. Going forward, NIAAA will be involved in disseminating the science and promoting the Call to Action, in conjunction with the OSG, especially in individual states, and through NIAAA’s Office of Communications.
E. NIAAA Research Programs
Epigenetics Roadmap In an effort to identify new areas for NIH’s Roadmap, NIH institute/center directors have selected new topics to be considered for future development as Roadmap initiative proposals. Drs. Li and Sam Zakhari have been participating in meetings to shape the epigenetics proposal. More information on the Roadmap is available at http://nihroadmap.nih.gov.
Publications by Extramural Staff
Alcohol-Related Gender Effects Diane Lucas is the co-author of a paper on “Alcohol and Hepatitis C Mortality Among Males and Females in the United States: A Life Table Analysis,” that appeared in Alcoholism: Clinical and Experimental Research 31(2), 285-292, Feb. 2007. The paper reports that heavy alcohol consumption is a key risk factor contributing to premature death from hepatitis C virus (HCV) in the United States; further, effects of heavy drinking on HCV mortality are different in men and women.
Puberty, Hormones, and Sex Differences Related to Alcohol Ellen Witt is the author of a paper on “Puberty, Hormones, and Sex Differences in Alcohol Abuse and Dependence,” that appeared in Neurotoxicology and Teratology 29:81-95, 2007. The article reviews studies of gonadal and stress-related hormone changes in puberty and their effect on alcohol drinking and actions.
Extramural Project Review Branch
The Extramural Project Review Branch has been involved with numerous review meetings since the last council meeting in February. There are 10 reverse site visits/reviews under way now for P50 and P60 Alcohol Research Centers (9), and the Consortium on Fetal Alcohol Spectrum Disorder (1). In addition to these workgroups and special emphasis panels (SEPs), and the regular chartered study section meetings (AA1, AA2, AA3), several SEPs were organized to manage the review of member conflicts, fellowships, K05 applications, contract proposals and U01, R01s, R21s and SBIR/STTRs in response to program announcements on brain development, medications development, epigenetics, endophenotypes, NeuroAIDS and alcohol. Twenty P20 applications were also reviewed by seven separate panels based on research themes.
RFAs: Applications
NIAAA has received, or is expecting, numerous applications in response to RFAs for 2007. Below is a summary of applications that have been received or are expected based on letters of intent:
· RFA-AA-07-004 Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) (U01 and U24): 12 applications
· RFA-AA-07-006 Impact of Adolescent Drinking on the Developing Brain (R21): 19 applications
· RFA-AA-07-007 Alcohol, Puberty, and Adolescent Brain Development (R01): 3 applications
· RFA-AA-07-008 Alcohol, Puberty, and Adolescent Brain Development (R21): 5 applications
· RFA-AA-07-009 Medications Development for the Treatment of Alcoholism (SBIR, R43/R44): 2 applications
· RFA-AA-07-010 Medications Development for the Treatment of Alcoholism (STTR, R41/R42): 1 application
· RFA-AA-07-011 Epigenetic Mechanisms in the Neurobiology of Alcohol Tolerance and Dependence (R01): 4 applications
· RFA-AA-07-012 Epigenetic Mechanisms in the Neurobiology of Alcohol Tolerance and Dependence (R21): 1 application
· RFA-AA-07-013 Animal Models of Endophenotypes and Intermediate Phenotypes for Alcohol Related Behaviors (RO1): 2 applications
· RFA-AA-07-014 Animal Models of Endophenotypes and Intermediate Phenotypes for Alcohol Related Behaviors (R21): 6 applications
· RFA-AA-07-015 and -016 Mechanisms of Nervous System Dysfunction: Impact of Alcohol Abuse on HIV-1 Neuropathogenesis (R01 and R21): 12 letters of intent
· RFA-AA-07-019 Announcement of a Limited Competition for the Continuation of the Cooperative Agreement on the Interaction of HIV Infection and Alcohol Abuse on Central Nervous System Morbidity (U01): 1 application
· RFA-AA-07-020 and -021 Integrative Prevention Research for Alcohol Users At-Risk for HIV/AIDS (R01 and R21): 9 letters of intent
Research Reports
The following items represent examples of the breadth and quality of research supported by NIAAA.
Receptor Variant Enhances Alcohol Reward Molecules known as opioid peptides bind to opioid receptors in the brain to signal experiences of reward and reinforcement, as well as the euphoria and other positive subjective effects produced by alcohol. Previous studies have shown that, among the brain’s various subtypes of opioid receptors, the mu-subtype is most likely responsible for transmitting alcohol’s positive effects. An intramural study reports that a genetic variant of the mu-opioid receptor heightens the stimulating effects of early exposures to alcohol and increases alcohol consumption in rhesus monkeys. The study extends previous research that suggests an important role for a similar brain receptor variant in the development of human alcohol use disorders. The effects of the variant were restricted to male monkeys; this adds to evidence that opioid transmission plays more of a role in alcohol problems among men, particularly those with early onset alcoholism and a positive family history, than among women. (Barr, C.S., Schwandt, M., Lindell, S.G., Chen, S.A., Goldman, D., Suomi, S.J., Higley, J.D., and Heilig, M. Archives of General Psychiatry 64:369-376, 2007)
Brain Growth and Family History in Alcoholics Studies have shown that alcohol-dependent men and women have smaller brain volumes than non-alcohol-dependent individuals. In this intramural study, researchers found reduced brain growth among alcohol-dependent individuals with a family history of alcoholism or heavy drinking compared with those with no such family history. Family history did not affect the frequency, quantity, or other aspects of drinking behavior of the alcoholics themselves, suggesting that differences in intracranial volume between family history positive and negative alcoholics are not the result of different drinking patterns. The researchers also found that adult alcoholic children of alcoholic parents had IQ scores that averaged 5.7 points lower than IQs of alcohol dependent individuals with no parental drinking. The authors note that a possible implication of their findings is that the increased risk for alcoholism among children of alcoholics may be due to a genetic or environmental effect, or both, related to reduced brain growth. (Gilman, J.M., Bjork, J.M., and Hommer, D.W. Biological Psychiatry published online ahead of print doi:10.1016/j.biopsych.2006.10.029)
Most With Drug Disorders Never Get Treatment An analysis of data from NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that only 8 percent of people identified as drug abusers, and fewer than 40 percent of those diagnosed with drug dependence, have ever gotten any kind of intervention or treatment. The survey results show that rates of drug abuse and dependence are generally higher among certain populations, including men, respondents aged 18 to 44 years, and people who have never married. The study, conducted by scientists at NIDA and NIAAA, also confirmed that the onset of drug abuse and dependence typically occurs during late adolescence or early adulthood. These findings suggest that certain groups are more vulnerable and should be targeted for early intervention efforts. This study and others indicate that significant associations exist between drug abuse and co-occurring mental illness, including mood and anxiety disorders, and personality disorders. In fact, help-seeking behavior was more common in those with co-occurring psychiatric disorders. The authors advise that a person with a substance use disorder should also be evaluated for mental illness, and conversely, a person with a mental disorder should be evaluated for possible substance abuse. In the NESARC survey, among those individuals with drug use disorders who received treatment, most went to physicians and other health care professionals, although many also used self-help groups. This finding underscores the continued importance of the detection and referral roles of primary care physicians. Future research efforts should focus on developing instruments to screen, identify, and refer patients with suspected drug abuse or dependence in primary care settings. The authors analyzed data gathered from face-to-face interviews with more than 43,000 U.S. adults age 18 and older, as part of the 2001-2002 NESARC. NESARC—designed and conducted by NIAAA—constitutes the largest study conducted on the co-occurrence of psychiatric disorders among U.S. adults. (Compton, W.M., Thomas, Y.F., Stinson, F.S., and Grant, B.F. Archives of General Psychiatry 64:566-576, 2007)
Prenatal Alcohol Effects on Stress Responses Research has shown that prenatal alcohol exposure can alter the development of the hypothalamic-pituitary-adrenal (HPA) axis, a system that plays a central role in responses to stress. Prenatal alcohol also has an impact on signaling by serotonin, a neurotransmitter known to have regulatory effects on the HPA axis. In this study, scientists administered serotonin agonists—compounds that mimic the effects of serotonin on two serotonin receptors—to rats that had been exposed to prenatal alcohol, and compared the responses of the HPA system in these rats to animals not exposed to alcohol. The prenatal alcohol altered HPA responses to the serotonin agonists, suggesting that one way prenatal alcohol affects the HPA axis is through changes in the serotonin system. Prior data have shown that prenatal alcohol can increase anxiety-like behavior in adult animals—this work may shed light on the factors that contribute to symptoms of anxiety and depression reported in children prenatally exposed to alcohol. (Hoffman, C.E., Elli, L., Yu, W.K., and Weinberg, J. Alcoholism: Clinical and Experimental Research 31:345-355, 2007)
Tracking Brain Changes in Heavy Drinking and Recovery MRI imaging has been used to track brain atrophy associated with heavy drinking as well as the recovery of brain tissue following abstinence. A new MRI technology—deformation tensor morphometry—makes it possible to compare brain changes at a very finely-focused scale, as opposed to comparing volume changes in overall regions of the brain. The results of this study using the new technique were consistent with earlier research showing atrophy of brain tissue in the frontal and temporal lobes, and recovery that was greater in subjects who abstained completely. The authors point out that this method can probe for small scale changes in local brain volume and thus complements and expands the capabilities of existing MRI technology. (Cardenas, V.A., Studholme, C., Gazdzinski, S., Durazzo, T.C., and Meyerhoff, D.J. Neuroimage 34:879-887, 2007)
Fetal Alcohol Acts on Sonic Hedgehog Protein Sonic hedgehog (Shh) is a regulatory protein that controls many developmental pathways during embryonic growth. To carry out its growth-regulatory functions, Shh must be linked to cholesterol after the protein is translated from a DNA template. This study exposed embryonic zebra fish—an animal model for development—to various concentrations of alcohol and found that the alcohol blocked the modification of Shh by cholesterol. Alcohol had a dose-dependent effect on the embryos, causing a set of structural abnormalities that mimic those seen in fetal alcohol spectrum disorders (FASD). Supplementing the alcohol-exposed embryos with cholesterol prevented the defects. The authors note that the tissue concentrations of alcohol reached during the 6-hour exposures were comparable to blood concentrations reached in a human after as little as one, and no more than a few, drinks. The study suggests a mechanism for the pattern of defects in FASD as well as a possible strategy for preventing them. (Li, Y.-X., Yang, H.-T., Zdanowicz, M., Sicklick, J.K., Qi, Y., Camp, T.J., and Diehl, A.M. Laboratory Investigation 87:231-240, 2007)
Compound Suppresses Stress-Related Drinking in Animals Corticotropin-releasing factor (CRF) is a neuropeptide that plays an important role in responses to novelty and stress. Both short and long-term alcohol consumption have an impact on the activity of the CRF system; research suggests that the adaptive response of this system to long-term heavy drinking may contribute to alcohol dependence. Evidence suggests that compounds that could block certain CRF receptors could help reduce drinking in alcohol dependent individuals. This intramural study—a collaborative effort with Eli Lilly and Company and research centers in Canada and Italy—found that a newly identified compound, MTIP, blocks the CRF-1 receptor with high and selective affinity. In rats, MTIP suppressed the anxiety-like behavior observed during withdrawal from an acute dose of alcohol, without affecting normal exploratory behavior. In addition, in rats trained to press a lever for alcohol, and then deprived of it long enough to extinguish the behavior, MTIP suppressed the stress-induced resumption of responding for alcohol, but only in rats with a history of induced dependence, or rats with a genetic predisposition to consume alcohol. MTIP’s pharmacologic properties and its effects on alcohol-related behavior in this study suggest that it may have promise as a medication to help treat alcohol dependence in human patients. (Gehlert, D.R., Cippitelli, A., Thorsell, A., Lê, A.D., Hipskind, P.A., Hamdouchi, C., Lu, J., Hembre, E.J., Cramer, J., Song, M., McKinzie, D., Morin, M., Ciccocioppo, R., and Heilig, M. Journal of Neuroscience 27:2718-2726, 2007)
Alcohol Reduces Stress via CRH One of the long-term adaptive responses to heavy drinking is an increase in signaling of the stress hormone corticotropin releasing hormone (CRH). In rats with a history of dependence, this increase in CRH activity results in animals that are unusually sensitive to stress. Studies of rats bred to voluntarily consume alcohol (msP rats) report that these rats mimic the situation induced by long-term alcohol exposure in dependent rats; expression of a key receptor for CRH is elevated in the msP rats in areas of the brain involved in alcohol consumption. This study—a collaboration between intramural scientists and scientists in Italy—found that alcohol reduced expression of the receptor in msP rats (in behaviorally relevant brain areas), adding to evidence that one of the driving forces behind drinking is its anxiety-reducing effects, achieved by the impact of alcohol on CRH. Compounds that could safely reduce CRH activity have potential as medications for the treatment of alcoholism. (Hansson, A.C., Cippitelli, A., Sommer, W.H., Ciccocioppo, R., and Heilig, M. Addiction Biology 12:30-32, 2007)
Imaging Brain Metabolism in Fetal Alcohol Syndrome Magnetic resonance spectroscopy (MRS) is a noninvasive imaging technique that can provide information on the living biochemistry and metabolism of the brain. This study used MRS to examine the brains of 10 adolescents and young adults with some degree of fetal alcohol spectrum disorders. The study revealed changes in brain metabolism—indicated by altered ratios of key brain metabolites—consistent with earlier findings from studies of brain structure and function in fetal alcohol spectrum disorders. The results suggest that prenatal alcohol exposure results in lasting changes in metabolism in numerous brain areas; MRS can detect metabolic abnormalities even when structural changes are not apparent but function is nonetheless impaired. (Fagerlund, Å, Heikkinen, S., Autti-Rämö, I., Korkman, M., Timonen, M., Kuusi, T., Riley, E.P., and Lundbom, N. Alcoholism: Clinical and Experimental Research 30:2097-2104)
Racial Disparities in Completion Rates for Alcohol Treatment Many possible factors could underlie racial disparities in alcohol-related morbidity and mortality, among them, differences in access to and effectiveness of treatment. This study surveyed all publicly funded outpatient and residential alcohol treatment recovery programs in Los Angeles County—the second largest, after New York, publicly funded system of drug and alcohol treatment services in the Nation—during 1998 to 2000. African Americans in the study were significantly more likely to leave treatment before completion than their white counterparts in both outpatient and residential settings. Patient characteristics—most importantly economic factors—partly accounted for the difference, but about 60 of the difference in completion rate remained unexplained. The authors urge a broadened research agenda to investigate such factors as program design, geography and transportation assistance, access to primary medical care, cultural awareness of treatment staff, and client preferences and views of treatment. (Jacobson, J.O., Robinson, PL. and Bluthenthal R.N. Health Services Research 42:773-794, 2007)
Gene X Environment Effects in Rats One way to study how environment and genetics interact to shape alcohol related behavior is to manipulate the social environment of different rat strains and watch the effects. Housing rats in isolation, for example, can have distinct effects on their behavior. This study looked at whether being housed in isolation changed the alcohol consumption and other behaviors in strains of rats bred to consume alcohol at different levels (alcohol preferring and non-preferring rats). In a test in which rats had 20-minutes of access to an ethanol solution each day, isolation housing led to increased alcohol consumption in alcohol preferring, but not non-preferring rats. Results of tests of behavioral manifestations of anxiety did not reveal any patterns consistent with this increased drinking. The authors conclude that the effect on limited access drinking may provide a model of an interaction of genetic vulnerability with features in the environment. (Ehlers, C.L., Walker, B.M., Plan, J.P., Roth, J.L., and Slawecki, C.J. Behavioral Neuroscience121:111-119, 2207)
Brief Intervention for Drinking in Pregnancy Improves Outcomes While research suggests that even low amounts of alcohol consumed in pregnancy may have negative effects on a fetus, surveys find that more than 12 percent of pregnant women drink alcohol. This study looked at the effectiveness of brief intervention for pregnant mothers determined to be drinking. The study focused on low-income minority women served by a publicly funded preventive nutrition program aimed at low-income mothers and children. Women who received brief intervention consisting of 10- to 15-minute counseling by a nutritionist were five times more likely to report abstinence after intervention than women assigned to assessment only. Newborns of the mothers receiving brief intervention had higher birth weights and birth lengths, and lower mortality. The authors conclude that brief intervention provided by nonmedical health professionals can be effective in improving pregnancy outcomes; for women without health insurance, public nutrition programs can provide a context for successful intervention. (O’Connor, M.J. and Whaley, S.E. American Journal of Public Health 97:252-258, 2007)
Choline Treatment for Fetal Alcohol Exposure Although prenatal alcohol is known to have lasting harmful effects on the children exposed, it is not always possible to prevent a mother from drinking during pregnancy. One goal of research is to identify treatments that could mitigate alcohol-caused damage even if administered after the alcohol exposure. In this study, choline, a compound that is an essential nutrient and a precursor of the neurotransmitter acetylcholine, attenuated the hyperactivity and spatial learning defects in rat pups that had been exposed to alcohol in utero. (Female pups in the study were more vulnerable to the effects of alcohol than males and it was in the affected females that the beneficial effects of the choline were apparent.) The choline was administered after the alcohol exposure and at a period in the rats’ development that would be analogous to early infancy and childhood in humans. Choline was effective over a range of doses and the positive effects were evident for months, suggesting that choline’s effects are long lasting. Choline may have therapeutic potential for use in children exposed to alcohol prenatally. (Thomas, J.D., Biane, J.S., O’Bryan, K.A., O’Neill, T.M., and Dominguez, H.D. Behavioral Neuroscience 121:120-130, 2007)
F. Scientific Meetings
NIAAA staff organized and chaired symposia and workshops and made numerous presentations at scientific meetings in the United States and abroad, including the following:
NIH Regional Seminars on Program Funding and Grants Administration Roger Sorensen participated in the 2007 NIH Regional Seminar Series held March 5-7 in Salt Lake City, Utah. These seminars are intended to help demystify the grant application and review process, clarify Federal regulations and policies, and highlight current areas of special interest or concern in applying for NIH grants. The intended audience is both research investigators and sponsored programs administrators. Dr. Sorensen co-presented three sessions titled “Grant Writing for Success,” which provided helpful guidance and insights on preparing a grant application for submission; “Budget Basics for Investigators,” which reviewed Federal policies for grant budgets and provided tips for calculating and defending a budget request; and “How the NIH Program Official Works with Investigators,” which discussed the role of the program official at the NIH and how NIH program staff can assist investigators at all steps of the granting process.
Workshop on Pharmacotherapy Research Laurie Foudin chaired a session on “In Utero Exposure to Alcohol” and was a discussant at an NIDA workshop titled, “Pharmacotherapy Research for the Treatment of In Utero Substance Exposed Neonates: Advances and Future Directions,” held in Rockville March 8-9. The goal of the workshop was to develop ideas, concepts, and research questions for future directions in clinical research for the treatment of neonates affected by prenatal exposure to substances of abuse.
NIH Initiatives in South Africa On April 17, Kenneth Warren presented an overview on the findings from 10 years of NIAAA-supported research on fetal alcohol syndrome (FAS) undertaken in the city of Cape Town and the surrounding wine producing communities, at a conference on NIH-supported initiatives in Southern Africa. The conference was organized by NIDA. Dr. Warren's presentation covered various findings all arising from NIAAA-supported studies in South Africa in topic areas including genetics, metabolism, epidemiology, community prevention, and school-based interventions surrounding issues in FAS.
University of Pennsylvania George Kunos gave an invited presentation on “Endocannabinoids and Energy Homeostasis” at a symposium April 23 on Gut-Brain-Adipose Interplay in Health and Disease at the University of Pennsylvania Center for Digestive and Liver Diseases in Philadelphia.
Center for Substance Abuse Treatment Howard Moss gave the plenary talk April 26 at the 2007 Joint Meeting on Adolescent Treatment Effectiveness in Washington, DC, sponsored by SAMHSA’s Center for Substance Abuse Treatment. The title of the presentation was “Diagnostic Controversies in Adolescent Alcohol Use Disorders.”
American Society of Addiction Medicine At the 38th Annual Medical Scientific Conference of the American Society of Addiction Medicine, Mark Willenbring gave a presentation at the opening plenary and a talk on “Clinical Management Strategies for Patients With Alcohol Dependence and Related Medical Illnesses” at an NIAAA symposium on Update on Medical Complications of Heavy Drinking. The meeting took place April 26-29 in Miami.
Congress on Prediabetes Dr. Kunos gave an invited talk on “Cardiovascular Effects of CB1 Receptor Blockade” at the 2nd International Congress on Prediabetes, April 27 in Barcelona, Spain.
Veterans Integrated Service Networks Dr. Willenbring gave a presentation on “How Can We Reduce the Public Health Burden of Heavy Drinking and Alcoholism?” at the Veterans Integrated Service Networks Mental Health Conference in Minneapolis, MN, May 1-4.
Inter-American Society of Hypertension Congress Dr. Kunos was chair of a symposium on Endocannabinoids as Therapeutic Targets in Cardiovascular Disease at the Inter-American Society of Hypertension Congress in Boca Raton, FL, May 9. He gave a talk on “Endocannabinoids and Hypertension.”
VA Medical Center On May 15, Sam Zakhari gave a presentation entitled “Alcohol and the Cardiovascular System: Sites and Insights” at the VA Medical Center, Washington, DC.
McGill University Dr. Kunos received the Nickerson Memorial Lecture Award at McGill University, Montreal. The May 20 lecture was entitled “Endocannabinoid Regulation of Appetite and Fat Metabolism.”
American Psychiatric Association Dr. Willenbring organized the NIAAA research track at the American Psychiatric Association meeting in San Diego, May 19-24. The research track included a workshop on Practical Pharmacotherapy for the Treatment of Alcohol Dependence and symposia on CRF-Antagonism for Treatment of Alcoholism and Affective Disorders and The COMBINE Trial: Treatment of Alcohol Dependence from Bench to Bedside.
University of Connecticut Dr. Kunos received the semi-annual Distinguished Faculty Lecture Award by the University of Connecticut in Farmington. The title of his talk, presented on May 22, was “The Role of the Endocannabinoid System in the Control of Energy Balance.”
G. Outreach
Leadership to Keep Children Alcohol Free In November of 2005 members of the National Association of Attorneys General (NAAGs) Committee on Youth Access to Alcohol held a meeting in Chicago with four companies that produce either distilled spirits or beer products. The NAAGs invited Leadership to Keep Children Alcohol Free to participate. Mary Easley, First Lady of North Carolina and Hope Taft, then First Lady of Ohio, represented the Leadership in their capacity as co-chairs. The goal of the meeting was to share information, have an open discussion of the companies’ marketing practices as they relate to underage drinking, and ask the companies to consider a proposal to reduce youth exposure by raising the standards for media placement. Beam Global Spirits & Wine Inc., the largest distilled spirits company based in the U.S., attended the meeting.
On Monday, May 7, Beam Global held a press conference ann