DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
155th Meeting of the
NATIONAL ADVISORY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
September 10, 2020
The National Advisory Council on Alcohol Abuse and Alcoholism (NIAAA) convened for its 155th meeting at 1:01 p.m. on Thursday, September 10, 2020, via Webex videoconference and NIH Webcast. The Council met in closed session from 12:00 p.m. to 12:42 p.m. to review grant applications and cooperative agreements. Dr. Abraham Bautista, Director, Office of Extramural Activities, presided over the Council’s review 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. The closed session recessed at 12:42 p.m.
Council Members Present:
Louis E. Baxter, M.D.
Jill B. Becker, Ph.D.
Daniel J. Calac, M.D.
Christopher S. Carpenter, Ph.D.
Alex M. Dopico, M.D., Ph.D.
Robert J. Hitzemann, Ph.D.
Constance M. Horgan, Sc.D.
Beth Kane-Davidson, LCADC, LCPC
Charles H. Lang, Ph.D.
Mary E. Larimer, Ph.D.
Laura E. Nagy, Ph.D.
Laura Elena O’Dell, Ph.D.
Scott J. Russo, Ph.D.
Vijay H. Shah, M.D.
Susan M. Smith, Ph.D.
Edith Vioni Sullivan, Ph.D.
Col. Charles S. Milliken, M.D.
NIAAA Director and Chair: George F. Koob, Ph.D.
NIAAA Deputy Director: Patricia Powell, Ph.D.
Executive Secretary: Abraham P. Bautista, Ph.D.
Senior Staff: Vicki Buckley, M.B.A.; David Goldman, M.D.; Ralph Hingson, Sc.D.; M. Katherine Jung, Ph.D.; George Kunos, M.D., Ph.D.; Raye Litten, Ph.D.; Antonio Noronha, Ph.D.; and Bridget Williams-Simmons, Ph.D.
Other Attendees at the Open Session
Approximately 75 people viewed the NIH live webcast, including representatives from constituency groups, liaison organizations, NIAAA staff, and members of the general public.
Call to Order
NIAAA Director George Koob, Ph.D., called the open session of the Council meeting to order at 1:01 p.m. on Thursday, September 10, 2020. He introduced Council members and senior NIAAA staff via roll call.
Dr. Koob highlighted key recent NIAAA activities, referring to the written Director’s Report, which was distributed to Council members.
Staff Transitions: Dr. Koob announced the 2021 retirement of General Arthur T. Dean, Chairman and CEO of Community Anti-Drug Coalitions of America. A former member of the National Advisory Council on Alcohol Abuse and Alcoholism, General Dean was the recipient of NIAAA’s Senator Harold Hughes Memorial Award in 2016. Dr. Koob also announced the death of former Advisory Council member Joe L. Martinez, Ph.D., noting his distinguished career and commitment to diversity in neuroscience training.
Dr. Koob welcomed the following new NIAAA staff members: Jayme Gemmel, Intramural Section Chief, Administrative Services Branch; Jeremy Luk, Ph.D., licensed clinical psychologist, Office of the Clinical Director; Laura Manella, Ph.D., science writer/editor, Communications and Public Liaison Branch; and Angela Szwec, LATG, Animal Care and Use Committee Administrator in the Office of Laboratory Science, and Michele-Vera Yonga, RN, Nurse Practitioner, Laboratory of Neuroimaging, both within the Division of Intramural Clinical and Biological Research (DICBR). He also acknowledged the retirements of Joseph Hibbeln, M.D., Captain of the Commissioned Corps of the U.S. Public Health Service, after 28 years at NIAAA, and Soundar Regunathan, Ph.D., Program Officer in the Division of Neuroscience and Behavior (DNB). Finally, he noted that Corinde Wiers, Ph.D., Research Fellow, Laboratory of Neuroimaging, (DICBR), has accepted a tenure-track position at the University of Pennsylvania.
Fiscal Year 2020 Budget: The FY 2020 appropriation for NIAAA provided $545.4 million, a $19.8 million (3.8 percent) increase over the FY 2019 budget level. NIAAA estimates it will support 739 Research Project Grants (RPGs) in FY 2020. The FY 2021 budget is under development.
NIAAA Statement on Equity: Health disparities highlighted by the COVID-19 pandemic and recent instances of social injustice among African-Americans are a call to action for NIH and the entire scientific community. Addressing health disparities and diversity in biomedical research is a major NIAAA priority. Dr. Koob stated NIAAA is committed to significantly expanding health disparities research and ensuring that underserved communities will benefit from the work that it funds. He also noted that NIAAA is committed to increasing diversity in the scientific workforce across its intramural and extramural research programs and to addressing disparities in funding rates among grant applicants from underrepresented groups.
NIAAA is committed to diversifying the scientific workforce by promoting training, funding opportunities, and success for African Americans and other minorities facing disparities in funding rates and/or opportunities to pursue a successful research career.
Our commitment extends to our intramural and extramural research programs and spans the pipeline from early education to established scientists. We are also committed to significantly expanding health disparities research so that all members of society may benefit from the work that we fund.”
NIH is considering how best to begin redressing structural racism in the biomedical research enterprise. These steps could include listening, learning, and self-assessing through engagement with internal and external stakeholders and experts; improving diversity and inclusion in the NIH and extramural workforce and changing the culture throughout the biomedical enterprise; advancing health disparities research, including how structural racism affects health as well as interventions and implementation; and communicating findings and tracking results.
NIAAA is evaluating the following actions in support of this initiative: 1) Eliminate disparities in funding among grantees from underrepresented groups by increasing diverse representation in peer review panels; ensuring that diverse perspectives are reflected in post-review funding decisions; and increasing outreach to applicants from underrepresented groups; 2) Enhance training and career development opportunities for researchers from underrepresented groups by establishing guidance for NIAAA training and research centers and consortia to expand recruitment, training, mentoring, and significant leadership opportunities to underrepresented scientists; expanding diversity supplement program and career development awards; increasing recruitment and participation of underrepresented individuals in intramural research at all levels; and expanding use of existing mechanisms for early training opportunities for underrepresented minorities; 3) Expand health disparities research by supporting alcohol projects that incorporate analyses of social determinants of health disparities, such as systemic racism, to inform intervention development; increasing funding opportunities for research on alcohol-related health disparities; and applying health disparities research findings towards the development of novel basic research hypotheses in priority areas such as adversity and social variables; and 4) Ensure that NIAAA’s research and outreach benefits underserved communities by increasing the Institute’s outreach efforts to populations disproportionately affected by alcohol misuse; and encouraging similar efforts by NIAAA-funded research centers and consortia.
Impact of COVID-19 Pandemic on Alcohol Use and Treatment: Dr. Koob explained that the pandemic may prompt more people to drink alcohol and for those in recovery to relapse in order to cope with the stress and uncertainty resulting from social isolation. He also noted that physical distancing negatively impacts the provision of traditional in-person treatment and recovery services, although virtual meetings may provide an alternative. Alcohol use may also exacerbate the pandemic, as alcohol compromises immune function, increasing the risk and severity of lung infections. Chronic alcohol consumption increases the risk for acute respiratory distress syndrome (ARDS), with increased need for mechanical ventilation, prolonged intensive care unit stay, and higher incidence of mortality. Alcohol also produces behavioral disinhibition and can promote risky behavior with other people.
NIAAA Participation in NIH-wide COVID-19 Activities: Through its participation in the NIH Intramural Targeted Anti-COVID-19 (ITAC) program, NIAAA researchers Vijay Ramchandani, Ph.D., and Nancy Diazgranados, M.D., were awarded funding for their project “ COVID-19 Pandemic Impact on Alcohol (PIA) – A Natural History Study.” NIAAA is participating in two NIH Rapid Acceleration of Diagnostics (RADx) Programs: Underrepresented Populations (RADx-UP) that focuses on underserved and vulnerable populations disproportionately affected by the pandemic, and Radical (RADx-rad) that supports new, non-traditional approaches to address current gaps in COVID-19 testing and surveillance. In addition, NIAAA is represented on four Trans-NIH Working Groups: Social, Behavioral, and Economic Health Impacts of COVID-19; Pregnant and Lactating Women and Children; Bringing NIH Clinical Trial Networks Together; and Preclinical Therapeutic Discovery. NIAAA also participates in the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Initiative, a public-private partnership to develop a coordinated research strategy for prioritizing and speeding development of the most promising treatments and vaccines, and the NIH COVID-19 Candidate and Technologies Portal Review Group that performs initial triage for all applications submitted to the Portal for data on diagnostic, therapeutic, vaccine, and other candidates or technologies with near-term potential for testing against COVID-19.
COVID-19 Funding Opportunity Announcements (FOAs): Dr. Koob highlighted the following three FOAs in which NIAAA participates: Emergency Awards RADx-rad (multiple awards); Digital Healthcare Interventions to Address the Secondary Health Effects Related to Social, Behavioral, and Economic Impact of COVID-19 (PAR-20-243); and Community Interventions to Address the Consequences of the COVID-19 Pandemic among Health Disparity and Vulnerable Populations (PAR-20-237). He referred Council members to the written report for a complete list of COVID-19 Notices of Special Interest (NOSIs).
NIAAA FOAs: New NIAAA FOAs include Collaborative Partnership between Research Centers in Minority Institutions (RCMI) and Alcohol Research Centers (RFA-AA-20-010); Alcohol-HIV/AIDS Program Project Comorbidities, Coinfections, and Complications Research: Intervention and Cross-Cutting Foundational Research (RFA-AA-20-009); and the following NOSIs: Epidemiology and Prevention in Alcohol Research (NOT-AA-20-017); Secondary Analyses of Existing Alcohol Research Data (NOT-AA-20-018); and Alcohol and Aging (NOT-AA-20-019).
NIAAA Participation in NIH-wide FOAs: NIAAA is currently participating in over 20 FOAs and NOSIs, including the BRAIN Initiative: Data Archives for the BRAIN Initiative (RFA-MH-20-600); Theories, Models and Methods for Analysis of Complex Data from the Brain (RFA-EB-20-002); and Proof of Concept Development of Early Stage Next Generation Human Brain Imaging (RFA-EB-20-001); as well as Mechanism for Time-Sensitive Drug Abuse Research (PAR-19-064). A full listing may be found in the written Director’s Report.
What’s Ahead? Upcoming virtual events in 2020 include the Mendelson Honorary Lecture, September 22, featuring Sandra A. Brown, Ph.D., on "Discerning Risks and Effects of Alcohol in the Midst of Adolescent Development”; a Roundtable on NIAAA Definition of Recovery, September 30, about the development of NIAAA’s definition of recovery with reactions from nine recovery experts; and an Alcohol-Associated Liver Disease (ALD) and Alcohol Use Disorder (AUD) meeting, October 6, about improving clinical trial design and recruitment and retention of patients with AUD and/or ALD. Other upcoming virtual events include a webinar on Substance Abuse Prevention for Youth in Indigenous Communities on October 8 and the NIAAA 50th Anniversary Lecture Series on November 30 and December 1. Details will be available on the NIAAA website.
Research Highlights: Dr. Koob presented highlights of NIAAA-funded studies, including:
“Gestational Alcohol Exposure Disrupts Cognitive Function and Striatal Circuits in Adult Offspring” was published in Nature Communications (2020 May 22; 11(1):2555) by VC Cuzon Carlson, CM Gremel, and DM Lovinger. This study examined the lasting effects of gestational alcohol exposure on disrupted cognitive function (assessed via habit- vs goal-directed behavior) in adult mice. Compared to controls, mice exposed to alcohol during gestation (GEE) were more likely to rely on cognitively demanding goal-directed decision-making at the expense of more efficient, habit-guided decision-making. This behavior was linked to altered GABAergic and endocannabinoid activity in the dorsolateral striatum (DLS), a brain region involved in learning and habit formation. These results demonstrate a mechanism for GEE-related cognitive deficits and identify a potential target for therapeutic intervention.
“Circulating Extracellular Vesicles Carrying Sphingolipid Cargo for the Diagnosis and Dynamic Risk Profiling of Alcoholic Hepatitis” was published in Hepatology (2020, Apr 4, doi: 10.1002/hep.31256) by TS Sehrawat, JP Arab, M Liu, P Amrollahi, M Wan, J Fan, Y Nakao, E Pose, A Navarro-Corcuera, D Dasgupta, CY Liao, L He, AS Mauer, E Avitabile, M Ventura-Cots, RA Bataller, AJ Sanyal, NP Chalasani, JK Heimbach, KD Watt, GJ Gores, P Gines, PS Kamath, DA Simonetto, TY Hu, VH Shah, and H Malhi. This study demonstrated the utility of plasma extracellular vesicle (EV) concentration and sphingolipid cargo as diagnostic and prognostic biomarkers for alcoholic hepatitis (AH). EVs isolated from plasma samples from healthy controls, heavy drinkers, and patients with other forms of liver disease were compared. EV counts were correlated with disease severity and were significantly higher in AH subjects than heavy drinkers without liver disease, patients with alcoholic cirrhosis, and Model for End-Stage Liver Disease (MELD)-matched patients with end-stage liver diseases not attributable to alcohol. Higher EV count was also associated with higher 90-day mortality for AH patients, permitting dynamic risk profiling.
“Microglia Control Escalation of Drinking in Alcohol-dependent Mice: Genomic and Synaptic Drivers” was published in Biological Psychiatry (2020 May 19:S0006-3223(20)31598-5, doi: 10.1016/j.biopsych.2020.05.011) by AS Warden, SA Wolfe, S Khom, FP Varodayan, RR Patel, MQ Steinman, M Bajo, SE Montgomery, R Vlkolinsky, T Nadav, I Polis, AJ Roberts, RD Mayfield, RA Harris, and M Roberto. This study investigated the role of microglia, the primary immune cells in the brain, in the development of alcohol dependence using a well-established mouse model of moderate and excessive drinking. Microglia (MG) depletion prevented neuroimmune-induced escalation in drinking, blocked the inflammatory response to alcohol, and decreased anxiety-like behavior during withdrawal. Further analyses demonstrated a link between microglia depletion and reduced GABAergic and glutamatergic transmission in the central nucleus of the amygdala (CeA). These findings suggest that microglia may regulate dependence-induced changes in neuronal function and have a role in the development and progression of alcohol use disorder.
“Not All is Lost for Relapsers: Relapsers with Low WHO Risk Drinking Levels and Complete Abstainers Have Comparable Regional Gray Matter Volumes” was published in Alcoholism: Clinical and Experimental Research (2020; 44:1479-1487. doi: 10.1111/acer.14377) by DJ Meyerhoff and TC Durazzo. Abstinence following treatment for AUD may not be readily achievable for all individuals. World Health Organization risk drinking levels (WHO-RDL) are proposed as alternative clinical trial endpoints. Following AUD treatment, cortical and subcortical brain region volumes were assessed among three groups of patients: a group who maintained abstinence and two groups who relapsed to drinking (sorted by low vs higher WHO-RDL). Frontal gray matter volume was related to WHO-RDL, and “relapsers” with low WHO-RDL had frontal cortical brain volumes equivalent to those of complete abstainers after the same time period and larger than those of “relapsers” with higher WHO-RDL. These results suggest that WHO-RDL have meaningful structural neuroimaging correlates and that brain regional volumes are objective assessments that may help inform evidence-based criteria for success in AUD treatment or in clinical trials.
“Associations Between Medical Conditions and Alcohol Consumption Levels in an Adult Primary Care Population” was published in JAMA Network Open (2020 May 1;3(5):e204687. doi: 10.1001/jamanetworkopen.2020.4687) by SA Sterling, VA Palzes, Y Lu, AH Kline-Simon, S Parthasarathy, T Ross, J Elson, C Weisner, C Maxim, and FW Chi. Electronic health record data from a healthcare system that has integrated alcohol screening into routine primary care were analyzed to identify the associations between common medical conditions and different levels of alcohol use. Among nearly 900,000 patients who reported alcohol use, those with chronic liver disease, chronic obstructive pulmonary disorder, or hypertension had higher odds for exceeding both daily and weekly alcohol guidelines associated with risk for AUD. These results may aid primary care clinicians in specific disease management strategies targeted at particularly vulnerable patients.
“Healthcare Utilisation Prior to Suicide in Persons with Alcohol Use Disorders: National Cohort and Nested Case-Control Study” was published in the British Journal of Psychiatry (2020 Jun 25:1-7. doi: 10.1192/bjp.2020.122) by C Crump, AC Edwards, KS Kendler, J Sundquist, and K Sundquist. AUD is one of the strongest reported risk factors for suicidal behavior. This study examined healthcare utilization patterns prior to suicide in persons with AUD in a large population-based cohort followed from 2002 to 2015. Of the people with AUD who died by suicide, 39.7 percent had a healthcare encounter within two weeks and 75.6 percent had a healthcare encounter within three months prior to death, compared with 6.3 percent and 25.4 percent of controls, respectively. These results indicate that healthcare encounters at primary care and specialty outpatient clinics offer critical opportunities to identify active suicidality and intervene accordingly in patients with AUD.
Discussion: Louis Baxter, M.D., commented that he is very impressed and pleased that NIAAA is doing more than just making a statement about racial diversity and disparities by identifying concrete action steps. Vijay Shah, M.D., inquired about the likelihood that the current rules that have allowed telemedicine to flourish during the pandemic will be continued by the U.S. Department of Health and Human Services (HHS) in the future. Dr. Koob asked Patricia Powell, Ph.D., to follow up on the question. Edith Sullivan, Ph.D., praised the inclusion of the Meyerhoff and Durazzo article among the research highlights in Dr. Koob’s report because it documented that an alcohol consumption level short of absolute abstinence has structural ramifications for improvement of brain structure, a point argued by scientists for a long time. Dr. Koob responded that the field has to operationalize concepts such as recovery, however imperfectly, in order to move research forward.
Council Member Presentation: COVID-19 Fallout: Treatment Challenges from the Trenches
Dr. Koob introduced Beth Kane-Davidson, LCADC, LCPC, who directs the addiction treatment program at Suburban Hospital, Bethesda, MD. Ms. Kane-Davidson began her presentation in mask and face shield to demonstrate how patients experience treatment during the pandemic. She noted that COVID-19 has crippled the treatment systems that addiction professionals put into place.
Everyone has been impacted by COVID-19. There is a wide range of stressors associated with the virus itself, as well as stressors associated with closures/stay-at-home orders. More than one in four U.S. adults with no prior history of a mental health condition experienced mental distress during the early phase of the pandemic. Data about the impact of the pandemic on mental health and substance use is still emerging. A September 2020 report indicated that nearly one-quarter of U.S. adults are experiencing depression, nearly three times the pre-pandemic level. COVID-19 survivors report struggling with mental issues.
An August 2020 Morbidity and Mortality Weekly Report indicated that 40 percent of adults reported struggling with mental health or substance use issues in late June. Alcohol misuse could actually increase risk of mortality from COVID-19 because of immune function-related health effects. At this point, however, the extent to which alcohol use has changed as a result of the COVID-19 crisis is unclear. Market research indicates that the sale of alcohol is up: In late March, sales had increased as much as 54 percent, while in late April, online sales of alcohol had increased nearly 500 percent. Messaging about alcohol is also an issue. For example, there has been an explosion of jokes about increased drinking on social media. Individuals are also reporting that their drinking behaviors have changed. More research on alcohol use patterns during the pandemic is crucially needed.
Despite the fact that alcohol use already imposes a significant public health burden, less than 10 percent of the 15 million people in the United States with an AUD received treatment before the pandemic struck. COVID-19 magnified the challenges facing treatment programs: they were unsure how to help and faced a reduced patient census as more people waited for treatment or were afraid to enter a hospital for fear of infection. Further, drug rehabs around the country experienced flare-ups of the coronavirus or financial difficulties related to the pandemic. In addition, the closure of schools and offices also meant a loss of observable opportunities to identify teens or adults who may be experiencing substance use-related problems.
Treatment facilities faced challenges such as whether to stay open or close, switch to telemedicine, create virtual self-help groups, and find ways to keep both staff and patients safe. They had to consider issues such as patients with both mental health and substance use problems, risks of relapse, patients who were unfamiliar with online treatment, and how to obtain urine samples for drug testing. One big issue was loss of support; social isolation can be harmful for people in recovery. Suburban Hospital’s addiction treatment program decided to stay open, but needed to deal with physical set-up issues (i.e., maintaining the recommended distance between people), communication issues caused by masks that hide facial expressions, and outpatient issues, e.g., the use of masks and lack of waiting areas in lobbies. On April 7, the Maryland Department of Health issues COVID-19-related guidelines for American Society of Addiction Medicine (ASAM) Residential Substance Use Disorder (SUD) treatment, which helped, and then there were changes to laws and regulations that permitted and paid for tele-mental health services.
Telemedicine brought its own challenges, e.g., because of previous confidentiality considerations, Suburban initially had no cameras available for virtual services. Patients were able to easily “click off,” thereby cutting short opportunities for treatment professionals to overcome resistance. Some patients disliked or distrusted virtual meetings. However, telemedicine also provided opportunities for virtual self-help meetings, hybrid models of blended in-person and virtual services, and avenues for prevention.
Discussion: Dr. Koob asked if there are any new virtual techniques on the horizon that might transform treatment delivery. Ms. Kane-Davidson responded that while she knew of no transformative technologies, providers are experimenting with techniques such as polling patients during sessions to help them own the information and thinking about how to make a virtual session feel like an intimate experience. Dr. Koob asked Raye Litten, Ph.D., Acting Director, Division of Treatment and Recovery Research (DTRR) about NIAAA’s portfolio in this domain. Dr. Litten replied that DTRR has been striving to put existing behavioral therapies onto websites, smartphones, and other platforms to meet the needs of people in rural and other underserved areas. These might also be helpful in telemedicine, i.e., to provide specialized services virtually to a clinic that can’t support multiple highly-trained experts. Ms. Kane-Davidson endorsed this approach, noting that the field has been pushing to have telemedicine available for rural areas and those without transportation. Treatment professionals are hoping that telemedicine will remain part of their menu in the future, but also recognize that the practice of telemedicine needs to be designed in a way that engages patients. Dr. Powell commented that she had a visceral reaction to the image of Ms. Kane-Davidson in mask and shield because of the lack of facial expression; she wondered if treatment delivery by telemedicine works better because patients can see the counselor’s face and those of others. Ms. Kane-Davidson replied that it works well with those who have previously been in face-to-face treatment; for new patients who may be in flight mode, it’s easy to simply click off. She also noted that long-time AA members have not fully connected with virtual meetings. Col. Charles S. Milliken, M.D., reported that members of the military, who move around frequently, enjoy dropping in on virtual meetings in their previous communities where they feel comfortable, even while in a new location. He also noted that the Army can use Project ECHO in which a regional expert is available for consultation by a local clinic which may not have the expertise. Charles Lang, Ph.D. noted that many of the patients at his institution are homeless or indigent and don’t have the resources to engage in telehealth. His hospital has given such patients tablets so that they can take part. Another issue is that many patients eventually go to other states or countries and providers may not be allowed to do face-to-face telehealth across jurisdictional boundaries. Constance Horgan, Sc.D., inquired if there were documented differences in treatment outcomes between telehealth and in-person treatment; Ms. Kane-Davidson responded that this is an area where research is needed; she believes the hybrid approach is a good model. In the chatbox, Laura O’Dell, Ph.D., inquired about vulnerable populations, including older adults’ access to new technologies and if there are capabilities to translate materials into different languages on the online platform. Dr. Smith noted that many communities have poor Internet infrastructures that does not support video telehealth, especially communities with other disparities. Ms. Kane-Davidson responded that older patients are reluctant to come to an in-person group for fear of infection, yet are not comfortable with the technology used for virtual meetings, even though they have Internet access. Understanding how to reach this population and how to translate information via technology would be helpful in meeting currently unmet needs. Dr. Koob encouraged applications to address the issues discussed.
BRAIN Initiative Update
Dr. Koob introduced James Eberwine, Ph.D., who is NIAAA’s representative to the Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Multi-Council Working Group and a member of the Initiative’s Neuroethics Working Group. He also introduced co-presenter Changhai Cui, Ph.D., who has been tasked with translating what we have learned from the BRAIN Initiative to alcohol research, and Dr. Koob encourages to take advantages of advances made by the BRAIN Initiative.
Dr. Eberwine reported that John Ngai, Ph.D., formerly Coates Family Professor of Neuroscience, University of California Berkeley, has been appointed Director of the BRAIN Initiative. He has appointed Andrea Beckel-Mitchener, Ph.D., National Institute of Mental Health (NIMH) as Acting Deputy Director, and Greg Farber, Ph.D., (NIMH) and Ned Talley, Ph.D., National Institute of Neurological Disorders and Stroke (NINDS), as principals. Together, they make up the BRAIN Transition Team. The Initiative consists of six project teams, a coordinating team, review, outreach, and support personnel, all staffed by Institutes and Centers (ICs), including NIAAA.
The BRAIN Initiative Working Group 2.0, an Advisory Committee to the NIH Director, conducted a year-long review to prepare the Initiative for the final five years of its 10-year life. Its major findings were that the Initiative should stay on the productive path already underway, continuing support for technology development and targeted study of circuit components; add an emphasis on behavior paradigms and quantitative analysis, subcortical structures, and model organisms; consciously balance individual-investigator research with team science; and devote ample resources to large-scale transformative projects. The ACD Working Group on BRAIN 2.0 Neuroethics Working Subgroup (BNS) also conducted a review of neuroethics considerations. A neuroethics transformative project, Understanding the Bases of Consciousness: Intersection of Neuroscience and Neuroethics, was described in the BNS report. Consciousness is an area in which opinions abound, but science is scant.
To select BRAIN 2.0 transformative projects for funding, the Initiative began with 20 “Big Ideas” proposals received from BRAIN project teams and other staff. These were discussed with team leads at retreats on January 7 and February 3, 2020 that also included key proposal authors. There was a tentative merging of some concepts; proposers were asked to revise and submit final briefs based on these combinations. Finally, the BRAIN Transition Team evaluated the revised ideas in the context of BRAIN 2.0 report priorities, discussion at the “Big Ideas” team lead retreat; and the available BRAIN budget over the next five years. The goal in selecting projects is to build a “runway” to FY 2023 when funding jumps to $800 million for the year, per the 21st Century Cures Act.
The initial large-scale projects to be funded include: Organizing Resources for Brain Cell Type Access and Manipulation Across Species (cell type-specific armamentarium) which will develop tools for cell access in rodent and NHP brains, human cells and tissue with a long-term goal of achieving new therapeutic strategies for human brain disorders; Next-Generation Technologies for Brain Microconnectivity Analysis to develop a wiring diagram of the brain at multiple scales and species; and the Phase III Brain Cell Census, which will shift emphasis to construct a human brain cell atlas, building on the success of the Brain Initiative Cell Census Network (BICCN) mouse cell census.
In the second half of its lifecycle, BRAIN funding will ramp up and a large number of Requests for Applications (RFAs) are anticipated. The total 10-year Initiative is budgeted at $5.2 billion; only 30 percent has been spent through 2019, and funding remains steady at about $500 million per year.
Dr. Cui highlighted three alcohol investigators’ projects funded by the BRAIN Initiative between June 2019-September 2020. These include Shana Augustin, Ph.D., a postdoctoral fellow of NIAAA’s Intramural Program. Her research is to understand the mechanisms of neuromodulation by deep brain live imaging of cAMP and protein kinase A activities that underlie synaptic- and circuit-level mechanisms during learned behaviors; Zhiping Pang, Ph.D., Rutgers-Robert Wood Johnson Medical School, who is developing genetically-encoded detectors for neuropeptide release based on class B G-protein coupled peptide receptors; and Jun Ding, Ph.D., Stanford University, who works with colleagues developing new tools for long-term, non-invasive, in vivo monitoring of neuro lipids and neuropeptides in the brain during behavior. Hopefully, in the very near future these tools will be applied to alcohol-related studies.
Discussion: Dr. Koob reiterated the opportunity that BRAIN funding provides and encouraged applications from neuroscientists. Scott Russo, Ph.D., inquired about the funding mechanisms available, suggesting that the P30 mechanism would be valuable. Dr. Cui responded that various mechanisms used by the BRAIN Initiative may be found on the Initiative’s website; she noted that the U19 mechanism permits a group of investigators to come together, a feature of the P30. Dr. Russo asked if any of the U mechanisms supported dissemination of findings to the broader community; Dr. Cui noted that BRAIN Initiative has a Dissemination Team to help disseminate tools to the community. Drs. Eberwine and Koob both commented that the U mechanisms allow for investigators across multiple disciplines to work together and to disseminate their work. In the chat box, Dr. Shah asked if the integration of artificial intelligence (AI) with human intelligence was within the scope of the BRAIN Initiative. Dr. Eberwine replied that an expansion of AI was emphasized in both the BRAIN 2.0 and BNS recommendations.
NIAAA COVID-19 Initiatives and Activities
Dr. Koob introduced Kathy Jung, Ph.D., Director, Division of Metabolism and Health Effects (DMHE), who serves as NIAAA’s lead on COVID-19. Dr. Jung described NIH’s rapid stand-up and execution of initiatives to address COVID-19, as well as trans-NIH COVID-19 efforts that span three domains: seeking a vaccine, protecting the public by determining therapeutic agents, and detecting the virus. NIAAA is active on six of the seven trans-NIH working groups. Dr. Jung noted that NIH is putting a major emphasis on addressing the needs of underserved populations, and on the mental health aspects of the pandemic.
NIAAA has issued a Notice of Special Interest (NOSI) for Administrative and Competitive Revision Supplements on COVID-19 within NIAAA Mission (NOT-AA-20-011). NIAAA also has participated in other NIH COVID-19 NOSIs (see full list on NIAAA website); has developed resources to facilitate research on downstream public health effects of the COVID-19 pandemic. An example is that, the Alcohol Policy Information System (APIS) has been updated to include new information about state level alcohol-related COVID-19 policies. NIAAA also is supporting an intramural natural history study, COVID-19 Pandemic Impact on Alcohol.
Dr. Jung reviewed parallels in the health effects of alcohol and COVID-19 that Dr. Koob introduced in his Director’s Report. She noted that alcohol might influence COVID-19, but there is currently no hard evidence that alcohol contributes to susceptibility to COVID, impacts the progression and severity of the disease, or affects long-term outcomes. Providers should be aware of the possible contributing role that alcohol may play in the disease; additional evidence on alcohol’s impact may allow development of effective therapeutics.
Topics under NIAAA’s Notice of Special Interest (NOSI) for Administrative and Competitive Revision Supplements on COVID-19 within the NIAAA Mission (NOT-AA-20-011) include: What are the broad physiological and pathological mechanisms mediating the impact of alcohol use and misuse on SARS-CoV2 infection and COVID-19 progression and complications? What are the common mechanisms of alcohol-associated Acute Respiratory Distress Syndrome (ARDS) and COVID-19-related ARDS? Are there mechanistic synergies or distinctions that can be exploited to manage COVID-19 progression? Does COVID-19-related systemic inflammation accompanied by concomitant alcohol use exacerbate the neuroinflammation associated with AUD? Is SARS-CoV-2 neuroinvasive, similar to some other coronaviruses? How does alcohol impact the susceptibility and consequences of neurobiological manifestations of coronaviruses? In immune compromised persons, or persons with other underlying co-morbid conditions, what additional physiological factors mediate the impact of alcohol misuse on SARS-CoVo2 infection and COVID-19 progression and outcomes?
Social, Behavioral, and Economic Health Impacts of COVID-19
Dr. Koob introduced Laura Kwako, Ph.D., Health Scientist Administrator, DTRR, who described the work of the NIH Social, Behavioral, Economic (SBE) Working Group in which NIAAA is a partner IC. The Working Group has issued multiple funding opportunities. These include the following SBE Notices of Special Interest: Availability of Administrative Supplements and Urgent Competitive Revisions for Research on the 2019 Novel Coronavirus and the Behavioral and Social Sciences (NOT-OD-20-097); Guide Notice of Information Highlighting Harmonization and Data Sharing Expectations for Supplement and Revision Projects Addressing Social, Behavioral, Economic and Health Impacts of the COVID-19 Public Health Emergency (NOT-OD-20-118); Competitive and Administrative Supplements for Community Interventions to Reduce the Impact of COVID-19 on Health Disparity and Other Vulnerable Populations (NOT-MD-20-022); and Digital Healthcare Interventions to Address the Secondary Health Effects Related to Social, Behavioral, and Economic Impact of COVID-19 (NOT-MH-20-053). The following SBE program announcements with a focus on vulnerable and health disparate populations are also available: Community Interventions to Address the Consequences of the COVID-19 Pandemic Among Health Disparity and Vulnerable Populations (PAR-20-237) and Digital Healthcare Interventions to Address the Secondary Health Effects Related to Social, Behavioral, and Economic Impact of COVID-19 (PAR-20-243).
Uptake of COVID-19 Testing in Underserved Populations
Dr. Koob welcomed Judith Arroyo, Ph.D., Minority Health and Health Disparities Coordinator at NIAAA, who introduced the RADx Underrepresented Populations Project (RADx-UP), a series of interlinked community-based projects focused on implementation strategies to enable and enhance uptake of testing of COVID-19 in underserved, under-resourced, rural, and/or vulnerable populations. $500 million has been allocated to RADx-UP from the Office of the Director; all ICs are participating. The overarching goal is to understand the factors influencing the disproportionate burden of the pandemic on underserved and/or vulnerable populations so that interventions can be implemented to decrease these disparities. Topics addressed in NIAAA supplements may go beyond alcohol to consider what else is affecting testing in vulnerable communities. Emergency mechanisms are being utilized to encourage rapid scientific response and impact this year.
For RADx-UP, underserved populations include NIH-designated health disparity populations, i.e., racial/ethnic minorities, rural, socioeconomically disadvantaged, and sexual and gender minorities. It also includes COVID-19 medically and/or socially vulnerable populations: Those experiencing substance use disorders or serious mental illness; medical comorbidities – vulnerability enhanced, including HIV/AIDS; homelessness; crowded housing - shelters, residential treatment, multigenerational households; as well as those in the criminal or juvenile justice systems; older adults – community and nursing home; children and adolescents; those with disabilities, cognitive, or communication disorders;
pregnant and post-partum women; migrant and immigrant populations; and those living in communities exposed to high rates of air pollution or other toxic exposures.
RADx-UP Phase I will consist of four interactive two-year awards. These include issuance of an RFA for a Coordination and Data Collection Center (CDCC) award (U24) to provide overarching support and guidance on administration/logistics, testing technology, community and health system engagement and data collection, integration and sharing ($13,000,000 annual direct costs [DC]). Three Emergency Competitive Revisions/Administrative Supplements to existing awards have also been issued for Phase I: Limited Competition for Community-Engaged Research on COVID -19 Testing (NOT-OD-20-121), which involves large consortia, multi-site trials, centers, and networks with capacity, infrastructure, and good community relationships to field large-scale testing interventions ($3,500,000 DC for both years); Community-Engaged Research on COVID-19 Testing (NOT-OD-20-120), that extends the opportunity to smaller scale research awards, including smaller, defined underserved or vulnerable populations ($1,300,000 DC for both years); and Social, Ethical, Behavioral Implications (SEBI) Research (NOT-OD-20-119), where the focus is to understand the challenges and hurdles to testing uptake ($400,000 DC for each of two years).
RADx-UP requirements include documented community engagement and rigorous research broadly defined. There will be rapid internal review and funding turn around for two deadlines: August 7th for FY 2020 funding and Sept 8th for Calendar Year 2021. Three-quarters (75 percent) of funding must be expended in the first year in order to enhance testing ramp up. The pay plan will be based on merit plus geographic plus focus population distribution. The estimated number of awards pending includes: CDCC--1 award; large infrastructure (NOT-OD-20-121)--25 awards; smaller testing focus (NOT-OD-20-120)--30 awards; and SEBI (NOT-OD-20-19)--4 awards.
RADx-rad Initiative – Automatic Detection and Tracing
Dr. Cui described the Rapid Acceleration of Diagnostics – Radical (RADx-rad) program. The goal of RADx-rad is to support new, non-traditional approaches and new applications of existing tools that address gaps in COVID-19 testing and develop platforms that can be deployed in future outbreaks of COVID-19 and other, yet unknown, diseases. RADx-rad uses a range of mechanisms including intramural projects, contracts, cooperative agreements, Small Business Innovation Research/ Small Business Technology Transfer (SBIR/STTR) awards, RPGs, and competitive revisions to support 1-4 year awards. Awards will be made by end of calendar year 2020.
RADx-rad FOAs support a range of non-traditional approaches for COVID-19 testing and detection, e.g., community wastewater analysis and other surveillance methods to identify the virus and measure the spread of infection; novel analytical platforms, such as next generation sequencing, coupled with point-of-care, non-invasive sample collection; screening and home-based tests that detect in sensory or other functions to predict disease at early onset; integration of AI systems with novel biosensing or laboratory diagnostics with digital health technologies for screening, diagnosing, and monitoring COVID-19, and to predict disease severity; and automatic, real-time detection and tracing of SARS-COV-2 by integrating virus-sensing elements with touchscreen or other digital devices.
Dr. Cui focused on one of RADx-rad FOAs, Automatic Detection and Tracing of SARS-CoV-2 (RFA-OD-20-014), for which NIAAA is the lead IC. It aims to address one of the critical challenges of the COVID-19 pandemic: the lack of the early detection of SARS-CoV-2 virus. The goal of the RFA is to support proof-of-concept projects for automatic, real-time detection and tracing of SARS-COV-2 by integrating virus-sensing elements with touchscreen or other digital devices. Its objectives are to: Identify aptamers or other biorecognition elements that bind to SARS-CoV-2 or its signature molecules with high specificity and affinity; validate the functionality of aptamers or other biorecognition elements immobilized on the virus sensing and transduction material; establish and validate the transduction mechanism (electrochemical, optical, etc.) that can effectively convert virus binding to the signal that can be captured by a touchscreen or other digital device; and validate efficiency of detection for the intended use and establish sensitivity, cross reactivity, and the detection limit.
The budget for RFA-0D-20-014, Emergency Awards: Automatic Detection and Tracing of SARS-CoV-2 is $10 million. Applications are due September 15, 2020.
DMHE Concept Clearance
Dr. Koob introduced Gary Murray, Ph.D., DMHE, who presented a concept clearance on Mechanisms of Alcohol-associated Cancers. This is a reissue of an old RFA from 2017.
NIAAA’s mission is to support and conduct research on the impact of alcohol use on human health and well-being. With respect to cancer, NIAAA supports studies directed toward a better understanding of the risks associated with alcohol use and basic studies to identify plausible mechanisms for the development or exacerbation of cancer. Epidemiological and biological research has established that chronic or excessive alcohol consumption increases the risk of at least seven different cancers, including mouth and oropharyngeal, laryngeal, esophageal, female breast, colorectal, stomach, and liver cancer. The impact of the amount of alcohol consumed (dose) on relative risk for cancer varies by site. Alcohol-attributable cancer mortality in the U.S. remains a significant problem representing 2.7% of all cancer deaths and 0.5% of deaths from all causes. But epidemiology must be paired with basic studies that demonstrate plausible mechanisms at defensible (physiologically relevant) concentrations, i.e., to demonstrate a causal link between alcohol consumption and risk of cancer.
Thus, NIAAA is seeking investigator-initiated grant applications to investigate the cellular and molecular mechanisms underlying the carcinogenic effects of alcohol, especially in minorities and women; clarify the role of alcohol in the development of breast cancer; investigate the synergy between alcohol and multiple agents, especially viral hepatitis, in exacerbating liver cancer and smoking in upper aerodigestive tract (UADT) cancers; and characterize the effects of alcohol on cancer stem cells. These efforts may lead to improved therapeutic approaches and preventive strategies and provide guidance on safe levels of alcohol consumption. Further research is needed to clarify dose-response relationships between alcohol and cancer risk, especially at low doses, and to better understand genetic and epigenetic variation in alcohol-induced carcinogenesis.
Currently, NIAAA’s sponsored research interests include these topics, any of which could be addressed under the new announcement: Basic studies on metabolism of alcohol, acetaldehyde, retinoic acid and other retinoids, e.g., Oxidative Stress, DNA adduct formation, epigenetics, cell damage, the microbiome; alcohol and breast cancer, e.g., enhanced aggressiveness of breast cancer; alcohol and colorectal cancer, e.g., aldehyde dehydrogenase (ALDH) polymorphisms and colorectal cancer; alcohol and hepatocellular carcinoma (HCC), e.g., lipid metabolism, alcoholic fatty liver, and links to HCC and other cancers; alcohol and pancreatic cancer; alcohol-induced immunosuppression and cancer; alcohol and Non-Hodgkin's lymphoma (reduction in risk).
The previous funding mechanisms for Mechanisms of Alcohol-associated Cancers (PA-17-219) and (PA-17-220), expire in September. The National Cancer Institute issued a Notice of Special Interest: Alcohol and Cancer Control (NOT-CA-20-034), in which NIAAA participates. It addresses the behavioral aspects of alcohol-related cancer development.
Discussion: In the chat box, Dr. Smith stated that she was very pleased to see the interest in genetic and epigenetic interactions with alcohol-induced cancer risk. She suggested adding consideration of interactions with nutrients and dietary patterns, which are additional, strong modulators of cancer risk, and are shaped further by alcohol use. Dr. Murray responded affirmatively, noting NIAAA’s interest in factors, such as tobacco, that play a role interacting with alcohol to affect cancer risk. David Goldman, M.D., inquired if NIAAA is encouraging studies incorporating genotype, e.g., risk of breast cancer attributable to drinking could be multiplicative with breast cancer type 1 (BRCA1). Dr. Murray responded that there is a need for studies incorporating genetic analysis, as they may be able to tease out the differences between those who do and do not develop clinical disease, even in the presence of identical drinking patterns. Dr. Goldman commented that DMHE is likely to receive applications incorporating genotype and gene editing. Jill Becker, Ph.D., commented that this is a very important research initiative. Because women have greater alcohol-related side effects and because there are profound sex differences in many cancers, it will be important to address sex differences in the interaction between alcohol and cancer. Dr. Smith echoed Dr. Becker’s comments. Dr. Murray responded that this is a very important area and one that DMHE supports; he noted that it is currently unknown, for example if the role of alcohol is in the initiation of breast cancer or in propagation of the tumor. Dr. Becker agreed that much is unknown. She pointed out that it is difficult to understand sex differences when data are aggregated without regard to biological sex across all cancers. Women don’t get only breast, cervix, and endometrial cancers. Dr. Daniel Calac asked if there are any projects assessing the work with CRISPR technologies and with sex differences among cancers. Dr. Murray responded that he was not aware of the CRISPR technology to correct polymorphisms and improve outcomes.
Action: Dr. Smith endorsed the alcohol and cancer concept.
DTRR Concept Clearances
Two concept clearances from DTRR were presented to Council.
Health Services: Dr. Kwako presented a concept clearance for an RFA for health services. She pointed out that a significant gap exists between the need for treatment and the field’s ability to provide appropriate levels of care, especially among health disparate populations. Closing this divide calls for major advances in the field of health services. However, there was a significant decline in the number of applications coded for health services between 2014 and 2020. In 2020, health services applications are at their lowest level (19 received for FY2020).
Thus, DTRR seeks to expand the Division’s portfolio to advance five main areas in health services research: Increase accessibility to treatment; make treatment and the settings where patients receive them more appealing to increase access; address treatment costs to the patient; evaluate, disseminate, implement, and sustain evidence-based behavioral and pharmacological treatments across the full range of professional healthcare practices; and increase research on health disparities. This RFA will help to stimulate interest among researchers in health services and advance research into factors preventing individuals from seeking and receiving state of the art treatment interventions, with a special emphasis on health disparate and vulnerable populations.
Dr. Kwako reported that DTRR received a few advance comments from Council members. Dr. O’Dell suggested changing some of the verbiage, which DTRR is doing. Dr. O’Dell also encouraged DTRR to think about all the possible factors that affect disparities. Constance Horgan, Sc.D., noted the importance of individual patient needs, but recommended that system-level variables, such as accessibility and affordability, also be addressed. Dr. Kwako reported that Council feedback will be incorporated into the RFA.
Action: Dr. Horgan strongly endorsed the DTTR health services concept.
NOSI for DTRR: Dr. Koob introduced Raye Litten, Ph.D., Acting Director, DTRR. Dr. Litten introduced the proposed NOSI, which will replace the expired program announcement “Behavioral Treatment, Services, and Recovery Research.” The purpose is to advance research related to treatment and recovery, including health services research, translational research, and use of new technology-enhanced research, to help make treatment more accessible and effective for special emphasis and underserved populations. Anticipated outcomes are to bridge the gap between those who need treatment and those who receive treatment for alcohol misuse and AUD; make progress in implementing evidence-based behavioral and pharmacological treatments for AUD into clinical practice; improve continuing care treatment interventions that aim to support long-term recovery; and remove barriers that prevent special emphasis and underserved populations from seeking and receiving appropriate health care and implement effective treatments for this population in a variety of real world clinical settings.
Dr. Litten reviewed the following DTRR research areas. Health Services seeks to make treatment more accessible and appealing by reducing barriers, disseminate and implement evidence-based treatments in a wide range of healthcare practices, and make treatment more affordable. The Behavioral Therapies and Mechanisms of Behavioral Change (MOBC) program aims to evaluate evidence-based behavioral therapies in real world treatment settings, especially for culturally diverse and special emphasis and underserved populations, and disseminate into clinical practice findings from MOBC studies that have shown promise in enhancing the effectiveness of individual behavioral therapies. The Recovery program strives to encourage researchers to adopt NIAAA’s updated definition of recovery when designing new studies, explores mechanisms (neurobiological, psychological, environmental, social, cultural factors) that support recovery, utilizes large treatment data sets that have long-term treatment follow-ups, and establishes a registry to follow patients’ long-term recovery after receiving initial treatment. The Translational Research program seeks to apply key preclinical research findings) to develop more effective treatments and encourage the use of evidence-based interventions in routine clinical practice. The Innovative Technologies and Methods for AUD Treatment and Recovery program strives to use new technology to disseminate evidence-based behavioral treatments among hard-to-reach populations and to improve effectiveness of telemedicine, investigates new ways of capturing real-time data in clinical trials and treatment protocols, and explores new analytical methods for evaluating treatment and recovery. The DTRR Special Emphasis and Underserved Populations Program aims to remove barriers that prevent special emphasis and underserved populations from seeking and receiving appropriate health care, implements effective treatments that are tailored for these populations in diverse clinical settings, and determines how social/cultural factors influence treatment accessibility, effectiveness, and long-term recovery. Special emphasis and underserved populations include racial, ethnic, and sex/gender minorities, AUD patients with psychiatric and substance abuse comorbidity, women, adolescents and young adults, older adults, Fetal Alcohol Spectrum Disorder (FASD), and HIV/AIDS. < This section was all one sentence. I broke it up and added the word “program”.
Discussion: In the chatbox, Dr. Smith thanked Dr. Litten for including FASD as a Special Emphasis population, noting researchers believe they are at greater risk for AUD for diverse reasons, although hard evidence is lacking.
Action: Dr. Horgan endorsed the DTRR NOSI concept.
Charles Milliken, MD, COL(ret) US Army, reported on two developments in the military’s treatment of alcohol and substance use disorders. The first was the confidential voluntary care program for alcohol treatment instituted by the Army in MAR 2019 following recommendations from the Institute of Medicine (IOM) and a pilot test of the concept. By the end of 2019, there was a statistically significant reduction in emergency room visits related to alcohol. There is now an opportunity to expand the program to other service branches, which would substantially reduce the stigma around seeking treatment.
The second is the National Defense Authorization Act (NDAA) regulations for implementing and measuring Medication-Assisted Treatment (MAT) for AUD, which is not used frequently in the military health system. The model proposed to correct the probable deficit would be to appoint an ‘addiction medicine champion’ at each installation to facilitate MAT and outpatient ‘withdrawal management’ for the providers at that installation. Training for local ‘addiction medicine champions’ would be an issue; to address training, under consideration is adopting the Project Matching Alcoholism Treatments to Client Heterogeneity (MATCH) model which has been used by the DOD pain community and provides remote teaching and virtual mentoring regarding the treatment of pain and use of opioids.
Discussion: Dr. Koob seconded Col. Milliken’s enthusiasm for both new developments; he recommended that the Department of Defense (DoD) check the Veterans Health Administration (VA)’s formulary for MAT, which is up-to-date. Dr. Milliken responded that DoD and the VA use the same Clinical Practice Guideline which recommends the same five medications.
Consideration of NIAAA Council SOP, NCAA May 22, and CRAN May 13, 2020 Minutes/Future Meeting Dates
Council members voted unanimously to approve the Council Standard Operating Procedures (SOP) and minutes of the NIAAA Advisory Council meeting held on May 12, 2020, and the minutes of the Collaborative Research on Addiction at NIH (CRAN) meeting on May 13, 2020.
Dr. Bautista announced upcoming meeting dates for 2021-2024. In 2021, the Council will meet on February 4, May 11, and September 9; the CRAN Council will meet on May 12, 2021. In 2022, Council will meet on February 10, May 10 and September 8; the CRAN meeting will be on May 11. In 2023, Council will meet on February 9, May 9, and September 7; the CRAN Council will meet on May 10. In 2024, Council will meet on February 8, May 14, and September 12; the CRAN Council meeting will meet on May 15.
Dr. Koob adjourned the meeting at 5:30 p.m.
I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.
George F. Koob, 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