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NATIONAL ADVISORY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM June 6–7, 2012
The National Advisory Council on Alcohol Abuse and Alcoholism (NIAAA) convened for its 130th meeting at 5:30 p.m. on June 6, 2012, at the Fishers Lane Conference Center in Rockville, Maryland, in closed session for a review of grant applications and a MERIT Award extension. The meeting recessed at 7:00 p.m. Dr. Abraham Bautista, Director, Office of Extramural Activities, presided over the closed session, which, in accordance with the provisions of Sections 552b(C)(6), Title 5, U.S.C. and 10(d) of Public Law 92-463, excluded the public for the review, discussion, and evaluation of individual applications for Federal grant-in-aid funds. Dr. Kenneth Warren, Acting Director, NIAAA, convened the Council in open session on June 7, 2012, at 9:00 a.m.
Council Members Present:
Andrea Barthwell, M.D.
Linda L. Chezem, J.D.
Fulton T. Crews, Ph.D.
Suzanne M. de la Monte, M.P.H., M.D.
Marianne L. Fleury
Scott L. Friedman, M.D.
Andres G. Gil, Ph.D.
Kathleen Grant, Ph.D.
Andrew C. Heath, Ph.D.
John H. Krystal, M.D.
Craig McClain, M.D.
Edward P. Riley, Ph.D.
Linda P. Spear, Ph.D.
Gyongyi Szabo, M.D., Ph.D.
Ex Officio: Capt. Robert DeMartino, M.D., Department of Defense
Chairperson: Kenneth R. Warren, Ph.D.
Executive Secretary: Abraham P. Bautista, Ph.D.
Ralph Hingson, Sc.D., M.P.H., Robert Huebner, Ph.D., Antonio Noronha, Ph.D., Samir Zakhari, Ph.D.
Other Attendees at the Open Sessions
Approximately 40 observers attended the open session, including representatives from constituency groups, liaison organizations, NIAAA staff, and members of the general public.
Call to Order of the Open Session, June 7, 2012
Dr. Kenneth Warren called the open session of the 130th meeting of the Council to order at 9:00 a.m. on Thursday, June 7, 2012. He welcomed participants and introduced the Department of Defense’s (DoD) new liaison representative to the NIAAA Council, Dr. Robert DeMartino. Council members and NIAAA senior staff introduced themselves.
Dr. Warren highlighted key recent Institute activities, referring to the written Director’s Report:
- Legislation, budget, and policy. Under the Consolidated Appropriations Act for 2012, the National Institutes of Health (NIH) received $30.6 billion. NIAAA received $459.4 million, an increase of $1.5 million (0.3%) over Fiscal Year (FY) 2011; NIAAA has fared better than most agencies. NIAAA estimates that funds will support 659 Research Project Grant (RPG) awards in FY2012, including 156 competing awards. The FY2013 President’s proposed budget, released in February 2011, requests $30.6 billion for NIH and $457.9 million for NIAAA (down 0.4% from FY2012 for NIAAA). If Congress enacts this budget, NIAAA would support 653 RPG awards, including 156 competing grants with a success rate of 19%. Congressional passage of a final appropriation is not anticipated prior to the presidential election. NIAAA’s planning process is underway for submission of its FY2014 budget.
- Director’s activities. As part of a site visit to NIAAA by several research scientists from Anhui Medical University in the People’s Republic of China in April 2012, Dr. Warren and Professor Li Jun signed a letter of intent to cooperate in several areas of alcohol research, including epidemiology, prevention, pharmacotherapy, liver injury, health economics, and postdoctoral training. NIAAA engages in a number of collaborative activities with the People’s Republic of China. Dr. Warren also participated in a roundtable discussion on veterans’ behavioral health and the criminal justice system in May 2012. Representatives of federal agencies and elected state officials discussed behavioral health and legal issues associated with problems encountered by returning Iraq and Afghanistan veterans in the transition from DoD to the Department of Veterans Affairs (VA) health system. NIAAA supports some research grants that focus on returning veterans. In May 2012 Dr. Warren signed a letter of intent whereby Johns Hopkins School of Nursing will create an interactive online course based on NIAAA-developed curricula on the prevention and treatment of alcohol use disorders. The course will be made available to schools of nursing worldwide, and nurses can earn continuing education credits.
NIAAA staff honors and organization.
- The American Journal of Physiology–Heart and Circulatory Physiology has named Dr. Pal Pacher a Star Reviewer for 2011.
- Dr. Warren welcomed Ms. Erin Bryant, a new science writer and editor in the Communications and Public Liaison Branch, and Ms. Judit O’Connor, NIAAA’s new budget officer. Dr. R. Thomas Gentry will retire from NIAAA’s Division of Metabolism and Health Effects.
- NIAAA outreach activities. NIAAA hosted a research track at the May 2012 American Psychiatric Association meeting on integrating treatment for alcohol problems and co-occurring conditions in psychiatric care. Drs. Bankole Johnson and John Krystal presented major keynote addresses.
- Press release. Dr. Edward P. Riley gave the 4th Annual Jack Mendelson Honorary Lecture at NIH on April 19, 2012.
- Multimedia products. NIAAA has launched its redesigned website and, in June 2012, released a new issue of the NIAAA Spectrum. NIAAA’s peer-reviewed Alcohol Research & Health will bear a new name: Alcohol Research: Current Reviews. A new issue of Alcohol Alert appears online, Preventing Alcohol Abuse and Alcoholism: An Update. NIAAA’s popular seasonal fact sheet, “Parents: Help Your Teen Party Right at Graduation,” focuses on physiological effects of excessive drinking on the adolescent brain. Another fact sheet, “New Year, Old Myths, New Fatalities,” received the National Association of Government Communicators’ 2012 Blue Pencil Award.
- NIAAA/NIDA reorganization update. Dr. Lorraine Gunzerath discussed potential and ongoing activities related to the NIAAA/NIDA reorganization. In response to a Request for Information, NIAAA received 500 responses from members of most major professional organizations and others. Top responses urged the following: (1) Retain research on fetal alcohol syndrome (FAS) and other prenatal issues in the new Institute’s portfolio; (2) orient the budget to public health, with a third of funding each to smoking, alcohol, and drugs; (3) appoint a new director to prevent bias; (4) resist budget reductions; (5) retain specific organ research in the new Institute’s portfolio ( including FAS and HIV/AIDS); Another major, and controversial, topic related to the placement of the tobacco portfolio in NCI versus the new Institute. As well, a number of people responded who opposed a merger/reorganization though that issue was not included as an option in the published Request for Information (RFI).
Dr. Gunzerath described the draft portfolio distribution. If the published portfolio distribution were implemented based on the 2012 portfolio, the new Institute would include 68% NIDA grants and 25% NIAAA grants, with the majority of the remaining grant portfolio coming from the National Cancer Institute and the Heart Lung and Blood Institute. It would be expected that Council representation for the new Instiute would reflect the portfolio distribution—and a NIDA-related majority likely would influence future research directions.
Participants in a recent NIH webinar included alcohol industry representatives who later visited Dr. Lawrence Tabak to urge consideration of the economic effects of a merger and to study the health effects of alcohol consumption. NIH Director Francis Collins has asserted that the Institute focuses solely on the science. NIH has planned a series of meetings with additional stakeholders proposed by NIAAA, including the World Health Organization, National Highway Transportation Safety Administration, pharmaceutical companies, and others who use NIAAA’s research.
Release of the draft Scientific Plan will take place in the fall, followed by a public comment period. In December 2012 final recommendations to the NIH Director will be made, and in January/February recommendations for FY2013 would be incorporated in the President’s proposed 2014 budget. Portions of the Strategic Plan independent of reorganization would take place around that time.
Dr. John Krystal reported on the ongoing informal dialogue between the NIAAA and NIDA Councils on the impact of the proposed reorganization. Both Councils have concerns that their Institutes’ research related to neurodevelopmental effects of exposure to drugs of abuse, including FAS, will move to the National Institute on Child Health and Development (NICHD). The NIDA Council shares NIAAA’s concern that research on the toxic and medical consequences of alcohol and HIV, and the overlap with addiction, would move out of the new Institute. Parallel concerns exist about NIAAA’s research on alcohol’s effects on the liver and other organs. The NIDA Council raised concerns that a consolidation of NIH’s tobacco research portfolio not take place in the reorganization, and that the growing research portfolio on food addiction as contributor to obesity and on the nutritional value of alcohol may be jeopardized by a reorganization. The issue persists of determining the best forum for continued discourse between the NIDA and NIAAA Councils. Dr. Krystal stated that he and NIDA’s Dr. Eric Nestler, as private citizens, have submitted a joint editorial to Biological Psychiatry that addresses opportunities and concerns regarding the reorganization.
Discussion. Dr. Scott Friedman reported that the concerns of the liver research community remain strong. In response to a question from Dr. Fulton Crews, Dr. Gunzerath stated that NIAAA received input from diverse stakeholders that reflected research and economic activity in the community.
Extramural Advisory Board Report
Dr. Crews presented the Extramural Advisory Board’s recommendations of February 2012 for future research to address the acute clinical crisis of alcoholic hepatitis. Contrary to the common perception of alcoholic liver disease as a chronic, continuous progression to cirrhosis and possibly cancer, Dr. Crews explained that alcoholic hepatitis is an acute, fatal syndrome that involves unknown factors beyond excessive alcohol consumption, and little research has been conducted to date. The Board’s recommendations included the following:
1. Multicenter collaborative trials using common protocols, including biomarkers to address the spectrum of alcoholic hepatitis
a. Collect and bank genetic and other biological samples and consent for the following:
i. Translational studies of basic mechanisms
ii. Genetics, including pharmacogenomics
iv. Systems biology of the disease and of treatment response
b. Improve diagnostic definitions to distinguish alcoholic hepatitis from other clinical syndromes.
i. Relate to risk and outcomes
ii. Improve clarity of taxonomy, and
iii. Reduce problems with basic vs. clinical classification
iv. Aid in treatment decisions both short and long term
v. Conduct studies of gene expression, epigenetics, metabolism, inflammatory markers, gender, fibrosis, and the biome
2. Mechanisms of alcoholic hepatitis
a. Investigate mechanisms of alcoholic hepatitis:
i. Systems biology of multiorgan involvements
ii. Stem cell responses
iii. Cellular and proteomic markers
iv. Nutritional markers
vi. Gut biome
vii. Endogenous danger signaling molecules
b. Animal models that replicate alcoholic hepatitis are needed.
c. Markers of regeneration, fibrosis, and inflammation need to be linked to alcoholic hepatitis pathogenesis and prognosis.
Acceptance. The Council voted unanimously to accept the recommendations.
Presentation of Council Operating Procedures
Council members unanimously approved standard operating procedures for NIAAA staff actions regarding administrative supplements and time extensions that do not require Council review.
Consideration of the February 9, 2012, Meeting Minutes and Future Meeting Dates
Council members unanimously approved the minutes of the NIAAA Council meeting held on February 9, 2012. Future Council meetings will take place on September 19–20, 2012; February 6–7, June 12–13, and September 18–19, 2013; and February 5–6, June 4–5, and September 10–11, 2014.
Prenatal Alcohol, SIDS, and Stillbirth (PASS) Network
Dr. Amy Elliott, Director and Senior Scientist, PASS Network, described her network’s studies to determine the role of prenatal alcohol exposure in the risk for SIDS and other adverse pregnancy outcomes, especially stillbirth and FASD. The PASS Network in part is composed of the Northern Plains Comprehensive Clinical Site in South Dakota and a site associated with Stellenbosch University, South Africa, areas selected due to high rates of prenatal alcohol use. The blind longitudinal study incorporates collaborative, integrative research and has developed and implemented a joint common protocol.
Early studies implicated maternal alcohol use and smoking for adverse effects prenatally and in infancy. Autopsies on infant brains showed that brain stem abnormalities lead to an inability to awaken in a dangerous situation (low oxygen, for example). Links were found between prenatal alcohol exposure and stillbirth and SIDS, and researchers are working to determine warning signs and mechanisms during the fetal period and early infancy in order to prevent death, to understand the pathways for alcohol and smoking’s effects, and to develop effective interventions. PASS Network researchers investigated the role of the respiratory and autonomic control system prenatally and in infancy using new technology, and also investigated anomalies in the placenta possibly associated with specific physiological deficits.
These studies led to PASS’s preliminary hypothesis: Prenatal alcohol exposure increases the risk for SIDS and stillbirth and alcohol-related neurodevelopmental disorders. In 2006 researchers developed the full-scale hypothesis-testing protocol for implementation in the Northern Plans and South Africa. The study aims to enroll 12,192 mom-baby pairs for a prospective, community-based/participatory study. PASS ’s secondary hypothesis is: Fetal alcohol exposure, modified by genetics and environment, affects placental structure and the function and maturation of the central and autonomic nervous systems. Using a multidisciplinary approach, the main study protocol engages the entire cohort, and an embedded cohort representing about one third of enrollees participates in additional studies. The study follows women recruited early in pregnancy, at several points during their pregnancy, at delivery, and at 1 month and 12 months after delivery. Comprehensive, standardized data is collected and tracked on drinking patterns and fetal/infant development. The study has enrolled more than 7,800 women to date. A given woman keeps 87% of her appointments, and consent rates are high for use of tissues in research.
Dr. Elliott explained that the researchers seek to determine genetic and environment interactions that can influence prenatal alcohol toxicity, and they examine the effects of prenatal alcohol and related exposures (primarily smoking) on the placenta, brain development, physiological development, and neurobehavioral development. New knowledge is hoped to increase the effectiveness of intervention campaigns, to identify fetuses and infants potentially at risk for adverse outcomes, to inform strategies for better study of stillbirth and SIDS in high-risk communities, to generate novel hypotheses for mechanistic testing in experimental models, and to inform future studies on developmental origins of health and disease.
Discussion. Dr. Crews stated that tryptophan might elevate serotonin levels in the placenta and reverse deficits, and, similarly, when added to milk, might lower or resolve infants’ risk. Dr. Elliott confirmed Dr. Suzanne de la Monte’s observation that study samples would be “dirty” due to high comorbidity of smoking and alcohol use, but asserted that the large cohort in the longitudinal study would enable isolation of alcohol-only and other such samples. In response to Dr. de la Monte’s question about clues to dysmorphology phenotypes, Dr. Elliott stated that photos are taken of the entire cohort at 1 and 12 months for evaluation, looking for dysmorphic features. She hopes to follow the cohort in the longer term to identify features better. Dr. Riley commended the project, which will generate prospective demographic and environmental data to examine long-term consequences. Dr. Warren stated that the study is powered to reach significance with SIDS, the least frequent adverse outcome, and has potential to identify prenatally a large cohort of children with FASD. Dr. Elliott stated that the data include measures of maternal depression and anxiety, among others, in efforts to look at all issues. Dr. Warren noted that the study has added projects to it, including 3D cameras used in testing in South Africa. Dr. Craig McClain pointed out that large alterations exist in tryptophan metabolites in the serum or stool specimens of alcoholics, suggesting low serotonin as a biomarker for tryptophan metabolized over the alternative pathway, which causes toxic metabolites; metabolomics may help to address this hypothesis. Dr. Elliott responded that such approach would be a good supplement to the measurement of Doppler ultrasound to help determine how well the placenta functions. She responded to Dr. Kathleen Grant that while the study collects DNA on the mothers and offspring, but not fathers, in deference to cultural considerations in some communities, a follow-up study might incorporate the fathers. Dr. Grant suggested querying the serotonin system genomically, since many related serotonin genes, like the serotonin transporter and tryptophan hydroxylase, among others, have functional variants in the genes that might render infants more vulnerable to disturbances in the serotonin system. Dr. Elliott responded that with funding and appropriate approvals, the study group could look at copy number variants for various systems, and that genetics questions will be best addressed when fetal alcohol outcomes are completed. She replied to Dr. de la Monte that tissue samples have been banked for future use with de-identified datasets. Dr. Warren acknowledged Judge Linda Chezem’s contributions to the study.
Adolescents and Alcohol: What Do Basic Science Studies Tell Us?
Dr. Linda Spear, Developmental Exposure Alcohol Research Center, Binghamton University, described her work with a simple animal model of adolescence that considers issues of intake, alcohol sensitivity, and consequences of exposure, and described how that work may inform alcohol use by human adolescents. Adolescence, a highly conserved developmental transition from dependence to relative independence found across mammalian species, has common goals, similar biological and hormonal changes, growth spurts, and regionally specific brain transformations. It spans years in humans and months in rodents.
Studies show that sensation and novelty seeking in rats and humans rise in adolescence and then decline—in both species and genders, and in rats lacking gonads. Adolescent alcohol intake is greater than adult intake in both species, suggesting the presence of a biological component and not merely peer pressure or cultural norms, as is often assumed for humans. Adolescent rats respond with greater sensitivity than adults to socially facilitating and rewarding effects, but with lessened sensitivity to alcohol-induced intoxicating and aversive effects. Other work has shown that adolescent rats are more sensitive to ethanol-induced impairment in LTP and spatial memory tasks, and less sensitive to ethanol-induced aversive effects, social inhibition, sedation, motor impairment, analgesia, interoceptive cues, and hangover effects. Dr. Spear explained that prior stress exacerbates adolescent-typical responsiveness to ethanol, and that adolescent rats appear more sensitive to the low-dose social-facilitating effects but less sensitive to higher-dose social-inhibiting effects. It appears that adolescent-typical ethanol sensitivities result not just from pharmacokinetic influences. Because adolescents tend to metabolize alcohol faster than adults, blood alcohol levels are important. The adolescent brain appears to be differentially sensitive to alcohol.
Dr. Spear has investigated gonadal hormones and also neurotransmitter involvement, the glutamate and GABAA systems. New opiate receptors appear to be related to social-facilitating effects, whereas more underdeveloped kappa receptor systems may contribute to lessened sensitivity to other effects. Adolescents seem to show greater acute tolerance than adults to alcohol.
Compared to other drugs, adolescent rats typically show more sensitivity to rewarding effects of nicotine and cocaine/amphetamine and less sensitivity to aversive affects of alcohol, nicotine, and amphetamine. Adolescents appear to be less sensitive to the aversive effects of alcohol. This demonstrates a shift to rewarding and away from aversive effects of nicotine and amphetamine, and possibly to nondrug stimuli. In human and animal studies of taste reactivity to sucrose and quinine, mouth responses reveal that adolescents are more sensitive to a sweet taste or more aversive to quinine than adults.
Researchers cannot conduct studies to see how teenagers react to alcohol and have not determined adolescent-typical sensitivities, but the literature suggests that most young people drink for social purposes. In a 1983 study of moderate alcohol consumption, 8- to 15 year olds showed less behavioral change than expected for their blood alcohol levels, raising the question of whether insensitivity to alcohol intoxication among humans might permit or encourage heavier drinking. Low sensitivity to alcohol’s intoxicating effects is a known risk factor for problematic alcohol involvement and increases the risk of future alcoholism. Lowered sensitivity to alcohol is seen genetically in individuals with a positive family history of alcohol in human and in certain animal studies, developmentally in adolescence, and as a function of prior experiences/stressors—these factors in combination can promote high levels of adolescent alcohol use with potential to become problematic. A Collaborative Ethanol Group (CEG) field study of drinking by young people ages 18–23 found that during the course of an evening, participants averaged more than 7.5 drinks each and had blood ethanol concentrations in the drunken driving range.
Acute consequences of heavy adolescent alcohol use may include increased risk taking, alcohol overdose, and intoxication. Animal studies cannot study lethal dose changes by age, but the literature suggests that this is an issue. Chronic effects of heavy adolescent alcohol use may include increased susceptibility to alcohol use disorders and other neurobehavioral and cognitive consequences. The NIAAA-funded Neurobiology of Adolescent Drinking in Adulthood (NADIA) Consortium looks at effects of adolescent alcohol exposure that last into adulthood, including sleep arousal, hormonal stress axis issues, alterations in impulsivity and learning, and social anxiety and measures of anxiety. A current study reveals lasting effects on adult animals’ social behavior and sensitivity to alcohol after exposure to alcohol every day in adolescence, but Dr. Spear acknowledged the need for more study.
In summary, basic science studies have shown that adolescents exhibit attenuated sensitivity to many alcohol effects that could serve as cues to moderate drinking and greater sensitivity to ethanol-induced social facilitation, disruption in brain plasticity and memory, and rewarding effects. This developmental blending of enhanced and attenuated alcohol sensitivities may permit relatively high levels of alcohol intake, potentially leading to adverse consequences among at-risk adolescents during and outlasting adolescence.
Discussion. Dr. Spear responded to Dr. Krystal’s question that no simple mechanism differentiates between rewarding and intoxicating effects in adolescence, but the kappa, mu opiate, glutamate, dopamine, and perhaps GABAA systems appear to be involved. Dr. Grant noted that large individual differences exist between human and nonhuman primate populations. Dr. Spear stated that male rats like to drink in social groups, and around 30% become intoxicated while some are almost teetotalers. High levels of social behavior predict more social drinking, and a future study might look into how animals with high social behaviors respond to alcohol’s aversive effects. To Dr. Grant’s suggestion to schedule reinforcement of social access, Dr. Spear stated that that strategy might be more appropriate for primates, since isolate housing has altered much development in rats already. Dr. Crews observed that understanding has just begun of differences between the adolescent and adult brain, with huge decreases in gene expression between adolescence and adulthood. He stated that 30-year-old humans still show developmental synaptic remodeling. Ms. Mimi Fleury emphasized that not all adolescents are able to drink more, but those who can drink most have most vulnerability to harm from addiction. Dr. Spear concurred, noting the disturbing fact that young people do not recognize that a low level of response to alcohol is a risk factor. To a question from Dr. Sam Zakhari about adolescent behavior of rats genetically predisposed to drink excessively, Dr. Spear responded that a developmental study found a genetic association: Both P rats and Worcesters drink a lot during adolescence, but P rats (drinkers) stay high and Worcesters (nondrinkers) regain sobriety.
Council Round Table: Special Council Review (SCR)
Dr. Warren solicited comments from Council members regarding a new requirement for NIH Councils to give special review of applications from Principal Investigators who exceed the threshold of $1.5 million in total costs of NIH grant awards. Noting that the total cost of a grant includes both the direct cost of the research as well as the indirect institutional costs, Dr. Grant suggested requiring scrutiny for direct costs rather than total cost. She commented that since staff already conducts this type of review, the requirement formalizes the practice. Dr. Andrea Barthwell urged that NIH should emphasize to investigators that the requirement is not meant to discourage applications and should provide clear instructions. Similarly, NIH should clarify to review panels that their only responsibility is to determine scientific merit. Dr. Andres Gil pointed out that pending current applications in the current council cycle should not be included in the $1.5 M threshold.
Ex Officio Report: Department of Defense
Dr. Robert DeMartino, Chair, Department of Defense/VA Health Executive Committee on Psychological Health and Traumatic Brain Injury Work Group, described a variety of DoD activities. At the operational and clinical level, DoD is working to implement comprehensive, systematic assessment for at-risk alcohol use, including regular, routine use of screening instruments and brief interventions at multiple levels, and determining whether its systems of care for substance use disorders is sufficient, especially because service members resist revealing problems. Dr. DeMartino explained that DoD struggles with assessing and caring for its people in reasonable ways, while ensuring that their problems do not impact other service members, especially on combat missions. DoD and VA are concentrating collaboratively on activities to foster the transition from DoD to VA health care systems. Dr. DeMartino stated that the Institute of Medicine is completing a review of DoD’s policy and programs, and that DoD anticipates addressing additional gaps and incorporating the report’s guidance rapidly into policy and programs.
Discussion. Dr. Warren raised a question of how the VA and DoD address the issue of uneven geographical access to healthcare facilities. Dr. DeMartino responded that improving access to care constitutes an important part of DoD’s focus. Dr. Krystal pointed out that while the military has worked to recognize and destigmatize traumatic brain injury and post-traumatic stress disorder, alcohol abuse has been a more difficult issue to tackle because of its functional implications for other soldiers and greater difficulty in viewing it as a battle wound. Dr. DeMartino noted that the military recognizes the need for change in the military and national cultures, stating that the military has an opportunity to improve by communicating, showing by example, and inviting leadership into the discussion. The DoD’s policy work recognizes the biological bases for some illnesses and the need to merge health and mental health. Dr. Krystal suggested that alcohol’s role in military sexual trauma may represent a wedge issue. Dr. Barthwell observed that neither DoD nor VA offers access to private-sector care providers to their members’ prescription records, thus enabling significant redundancy in prescribing and likely contributing considerably to comorbidity of alcoholism and prescription drug abuse. Veterans’ care would improve through transparent prescription monitoring.
Time was set aside for public comment, but no one stepped forward to speak.
Dr. Warren adjourned the meeting at 12:20 p.m.
I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.
Kenneth R. Warren, Ph.D.
National Institute on Alcohol Abuse and Alcoholism
National Advisory Council on Alcohol Abuse and Alcoholism
Abraham P. Bautista, Ph.D.
Office of Extramural Activities
National Advisory Council on Alcohol Abuse and Alcoholism