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First Joint Meeting of the National Advisory Council on Alcohol Abuse and Alcoholism and the National Advisory Council on Drug Abuse
NATIONAL ADVISORY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
AND THE NATIONAL ADVISORY COUNCIL ON DRUG ABUSE
The National Advisory Council on Alcohol Abuse and Alcoholism (NIAAA) and the National Advisory Council on Drug Abuse (NIDA) convened for their first joint meeting at 10:00 a.m. on September 12, 2011, at Building 1, National Institutes of Health, Bethesda, Maryland. Dr. Nora Volkow, Director, NIDA, and Dr. Kenneth Warren, Acting Director, NIAAA, presided over the meeting.
NIAAA Council Members Present:
Andrea G. Barthwell, M.D.
David W. Crabb, M.D.
Suzanne M. de la Monte, M.P.H., M.D.
Scott L. Friedman, M.D.
Andres G. Gil, Ph.D.
Kathleen Grant, Ph.D.
Deborah S. Hasin, Ph.D.
Andrew C. Heath, D.Phil.
John H. Krystal, M.D.
Edward P. Riley, Ph.D.
Linda P. Spear, Ph.D.
Gyongyi Szabo, M.D., Ph.D.
NIDA Council Members Present:
Francisco X. Castellanos, M.D.
Steven R. Childers, Ph.D.
Thomas J. Crowley, M.D.
Nabila El-Bassel, D.S.W.
Anita S. Everett, M.D.
Elizabeth F. Howell, M.D.
Thomas A. Kirk, Ph.D.
Caryn E. Lerman, Ph.D.
Linda Carol Mayes, M.D.
Eric J. Nestler, Ph.D., M.D.
James L. Sorensen, Ph.D.
Hazel H. Szeto, Ph.D., M.D.
Roger Dale Walker, M.D.
Steven M. Wolinsky, M.D.
Zubieta, Jon-Kar, Ph.D., M.D.
Nora Volkow, M.D.
Kenneth R. Warren, Ph.D.
NIAAA Executive Secretary: Abraham P. Bautista, Ph.D.
NIDA Executive Secretary: Teresa Levitin, Ph.D.
More than 40 observers attended the meeting, including NIAAA and NIDA staff, representatives of constituency groups and liaison organizations, and members of the general public.
Call to Order and Introductions
Dr. Nora Volkow, Director, NIDA, called the open session of the first joint meeting of the National Advisory Councils of NIAAA and NIDA to order at 10:00 a.m. on Monday, September 12, 2011. She and Dr. Kenneth Warren, Acting Director, NIAAA, welcomed participants, and Council members introduced themselves.
NIDA Portfolio Analysis
Dr. Volkow explained that, in fulfilling NIDA’s mission to bring the power of science to bear on the prevention and treatment of drug abuse and addiction, two factors drive NIDA’s priorities and funding: Scientific opportunities may lead to transformative prevention and treatment strategies, and the application of current evidence-based knowledge may immediately enhance practices in the prevention and treatment of substance abuse disorders. Dr. Volkow noted the challenge of understanding the interaction of drugs with the influences of the environment on brain development and genetics in determining who will be exposed, who will experiment, who will become addicted, and what changes in the brain will drive compulsive use of drugs.
Dr. Volkow summarized NIDA’s portfolio, of which basic and clinical neuroscience and behavioral research represent a significant portion; this research aims to increase understanding of the neurobiology of addiction and the effects of these patterns on behavior and the process of substance use, experimentation, abuse, and addiction. A large investment in epidemiology and in services and prevention research informs NIDA on targets for intervention and on strategies to tailor individual and community interventions. The portfolio of research on pharmacotherapies and medical consequences includes significant emphasis on HIV/AIDS. Smaller investments support NIDA’s Clinical Trials Network (CTN) and intramural research. NIDA’s priority areas include prevention research, treatment interventions, and HIV/AIDS research. Prevention research involves basic science, prevention, and services research, and encompasses genetics/epigenetics, development, environment, and comorbidity.
Science demonstrates that the period of greater vulnerability for drug and alcohol experimentation occurs during adolescence and early youth, irrespective of the drug. Most diagnoses of dependence occur between ages 18 and 23, after which the rate of diagnosis of dependency decreases dramatically. Prevention interventions during childhood and adolescence can have great impact on individuals, leading to the quest for better understanding of the dynamics that drive the periods of vulnerability; of changes in the brain in the transitions from childhood to adolescence and adolescence to adulthood; and of social factors that place adolescents and children at greater risk. Studies have generated knowledge about how changes in brain connectivity in the transition from adolescence to adulthood engenders greater vulnerability, and about the environmental factors that make the adolescent brain much more vulnerable to neuroplastic changes triggered by substances of abuse.
NIDA’s genetic studies aim to understand the factors behind vulnerability to substance abuse disorders and the neurobiology of the disorders, and to identify molecular targets for treatments. One highly replicated study found an area of chromosome 15 that contains the genes for three nicotine receptors associated with higher rates of nicotine dependence, which led to recognition of nicotine receptors that previously had not been considered in addictions and to the identification of the habenula as an area of the brain not previously implicated in addiction. More recent studies have connected these receptors with vulnerability for other types of drugs of abuse as well as pinpointed the habenula as a common neurobiological substrate underlying addiction processes. These findings have generated new ways to understand addictions and also have led to potential molecular targets. Genome association technology has enabled lower costs for the genome sequencing that will be the next step in genetic exploration. Dr. Volkow asserted that knowledge will remain incomplete without understanding how the genes associated with vulnerability for substance abuse disorders affect brain development, organization, function, response to the environment, and influence on normal or pathological behavior.
NIDA recognizes that multiple treatments are necessary to address drug addiction, including medications and behavioral interventions. Roadblocks to progress in the field that must be addressed involve minimal investment by pharmaceutical companies in medication development to treat addiction, erosion of the healthcare system’s involvement in screening and treatment of substance abuse disorders, and the fact that few individuals who need treatment for alcohol and drug abuse ever get it, and most who need it never recognize that need.
NIDA has created the CTN to revitalize the healthcare system and the Criminal Justice Drug Abuse Treatment Studies to implement evidence-based interventions in criminal justice systems. Dr. Volkow explained that NIDA invests $300 million on research related to HIV and substance use disorders, noting that substance use disorders are a main factor involved in the epidemic. Significant investments in NIDA’s Avant-Garde Award Program enable researchers in the HIV community to engage in seeking, testing, and early treatment with antiretroviral therapy (ART) of individuals with co-occurring substance abuse and HIV. Another area of significant NIDA investment recognizes that epigenetic processes are crucial for an HIV virus to enter a latency phase, which has hindered the ability to cure HIV without ART. The research aims to understand how reactivating the silenced HIV and minimizing the latency can treat the disorder. Drugs of abuse play an important role in modifying some epigenetic processes, and some overlap exists between epigenetic processes affected by HIV and by drug abuse. Dr. Volkow asserted that better understanding of that interaction will permit development of more targeted interventions.
NIAAA Portfolio Analysis
Dr. Kenneth Warren, Acting Director, NIAAA, stated that NIAAA’s mission is to understand how alcohol use impacts both normal and abnormal biological functions and behavior across the lifespan at all levels of drinking. NIAAA also studies alcohol-related diseases, including dependence; all organ pathologies that derive from alcohol; and the public health problems that result from both acute and chronic alcohol use, including poisoning, accidental injury, and accidental death. Dr. Warren explained that alcohol differs from most other drugs in that it is legal, widely used, easily obtainable, and part of the context of many ceremonial occasions and social gatherings. Most adult Americans (144 million people) use alcohol at various times of the year. Of these, 126 million have no alcohol use disorder and 85 million never exceed high-risk drinking levels. Fifty-one million drinkers who do not have alcohol use disorders occasionally exceed high-risk drinking limits, and 18 million Americans have an alcohol disorder.
Dr. Warren explained that harmful drinking is a leading risk factor for disease burden in the United States and the third leading cause of death. Two distinct patterns of drinking produce the most harm—binge drinking (resulting in unintentional death and injury, homicide, violence, suicide, and death) and heavy drinking (resulting in cirrhosis, other alcohol-related liver disorders, pancreatitis, cardiovascular disease, dementia, and alcohol dependence). In 2006 as part of its strategic plan, NIAAA introduced its life course perspective, visualized as a rainbow, where alcohol interacts with genes and the environment across the lifespan, producing different consequences at different stages. Themes that transcend the lifespan include metabolism, genetics, epidemiology, neurobiology, and health services research.
NIAAA’s wide-ranging extramural research portfolio represents 90% of NIAAA’s overall investment. The largest of NIAAA’s six major programs is neuroscience and behavior, followed by metabolism and health effects, treatment, prevention, epidemiology, and health services. NIAAA’s transdivisional research emphasis areas include, among others, underage drinking and fetal alcohol spectrum disorders.
Special initiatives housed in NIAAA’s Division of Neuroscience and Behavior include the long-running Collaborative Study on the Genetics of Alcoholism (COGA), whose primary goal is to find and understand genes that affect the risk for the development of alcoholism and related disorders. Other initiatives include Neurobiology of Adolescent Drinking in Adulthood (NADIA) and Integrative Neuroscience Initiative on Alcoholism (INIA), focused currently on confirming previously identified gene targets and identifying promising druggable targets, and on the role of stress. The new Human Adolescent Brain Initiative will focus on the impact of child and adolescent alcohol use on the developing brain. NIAAA’s high priority areas include alcohol and stress, alcohol-nicotine interactions, alcohol and neuroimmune function, pain and alcohol dependence, systems biology, and functional genomics.
NIAAA’s Division of Epidemiology and Prevention Research portfolio includes epidemiological investigations and investigations of the fetal effects of alcohol, prevention in adolescents, prevention consequences, HIV/AIDS, psychiatric comorbidities, and violence and sexual behavior. Unique to NIAAA is its significant investment in prevention policy research in such areas as zoning and DWI laws, and underage drinking policies, reflecting alcohol’s status as a legal substance. NIAAA’s Alcohol Policy Information System gathers states’ data and facilitates alcohol policy research.
The Division of Treatment and Recovery Research emphasizes research on health services, recovery, medications development, personalized medicine, behavioral therapies, and mechanisms of behavioral change. The NIAAA Clinical Investigations Group (NCIG) rapidly and efficiently tests compounds for efficacy and safety in treating alcohol use disorders, aided by 19 industry collaborations.
NIAAA’s Division of Metabolism and Health Effects portfolio investigates alcohol’s effects on a number of organs adversely affected by alcohol. Programs focus on fetal alcohol syndrome (FAS), the cardiovascular system, muscle and bone, the autoimmune system, and the liver and metabolism. A common element that affects all organs is the action of alcohol on underlying molecular mechanisms.
NIAAA also studies the beneficial effects of moderate drinking (fewer than two drinks daily), including decreased risk of coronary artery disease, congestive heart failure, ischemic stroke, type 2 diabetes and metabolic syndrome, osteoporosis, and dementia. As a result of alcohol research, Alda 1, an ALDH-2 activator, was developed as a preventive agent for myocardial infarction.
NIAAA’s FASD research portfolio addresses the leading preventable birth defects associated with cognitive impairment in the United States. FASD is considered a substance use issue because, given its high prevalence, reducing or eliminating alcohol exposure in pregnancy or by those at risk for pregnancy, represents a central issue to prevent FAS. Priority areas include changing social norms on drinking in pregnancy. NIAAA initiatives include CoFASD (epidemiologic active ascertainment in multi-communities across the U.S.), CIFASD (collaborative initiative on FASD), and PASS (Prenatal Alcohol SIDS and Stillbirth Network) (with the National Institute on Child Health and Human Development).
Dr. Warren discussed the possible fate of the diverse NIAAA portfolio in the new substance use and addiction disorders institute. He observed that the Scientific Management and Review Board voted to accept an option that states in part that the “new institute would integrate all relevant addiction research portfolios from NIAAA, NIDA and other institutes at NIH,” and that “non-addiction research portfolios currently held by NIAAA and NIDA would be transferred to other institutes as deemed appropriate.” Noting his added emphasis, Dr. Warren contrasted these statements with language regarding reassignment of certain aspects of nonaddiction research portfolios: “. . . research on alcohol liver disease could be reassigned to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) or research on Fetal Alcohol Spectrum Disorders could be reassigned to the National Institute of Child Health and Human Development.” Dr. Warren suggested the importance of questions regarding when alcohol research is not substance use research: When alcohol is consumed in pregnancy? When it involves alcohol metabolites? How will common mechanisms for alcohol (e.g., peripheral organ and brain) be addressed within NIH if dispersed across multiple Institutes and Centers, each with differing priorities?
Round Table Discussion
Dr. James Sorensen inquired how Council members can help guide the reorganization. Dr. Volkow responded that creation of the new institute has been delayed a year, giving the parties more time to maximize integration of the two fields and to maximize resource use and knowledge advancement. Dr. Warren observed that Council members have the wisdom to understand the science and to offer guidance as the issue progresses. Echoed by Dr. Elizabeth Howell, Dr. Dale Walker stated that the Councils should advocate for protecting both the researchers and patients involved in the Institutes’ portfolios. Dr. Howell cited the potential in a merger for unanticipated loss of projects, asserting that only addiction researchers have the requisite understanding of addictions and cautioning that spinning off HIV or FAS research would not turn out well. Dr. Edward Riley observed the inadvisability of separating etiology (e.g., FAS research on mothers) from outcomes (e.g., effects on offspring). Dr. Eric Nestler stated that concerns about the reorganization seem related more to process than the actual merger and asserted the need to focus on the process to get it right.
Noting the morbidity exacted on patients who use alcohol and the enormous cost of liver disease, Dr. Scott Friedman expressed concern about the likelihood that the liver portfolio would be diffused substantially by its transfer to NIDDK. Dr. Francisco Castellanos asserted that the importance of investigating the developmental framework within which addiction occurs, and the knowledge in NIDA and NIAAA about etiology, are compelling arguments for retaining certain bodies of work. Dr. Warren concurred that drawing artificial developmental boundaries makes no scientific sense. Dr. Gyongyi Szabo noted the similarity in the Institutes’ priorities and the potential for synergy, particularly in HIV/AIDS and the fetal effects of drug abuse. She predicted that sending portions of addiction research to other Institutes would impede scientific synergy, especially because new information in epigenetics and systems biology would be lost. She also expressed concern about creating a new entity in the current fiscal environment.
In response to a comment by Dr. Nestler, Dr. Warren advised that the new institute might house portfolios related to tobacco prevention that would mirror NIDA and NIAAA’s prevention activities and NIAAA’s policy research. He added that the NIH Substance Use and Addiction Task Force will decide on portfolio contents. Dr. Volkow stated that areas whose future location is uncertain include the effects of alcohol in the fetus, the liver and alcohol and injection drug use, and NCI’s policy issues.
Dr. Thomas Crowley observed that the new institute may help focus on the central question of how biology and environment combine to produce general vulnerability to substance use disorders. Dr. Kathleen Grant stated that advances in neuroscience beyond a certain point depend on understanding the entire organism as well as how excessive use of substances affects organs and impacts behavior, and she expressed concern for the vulnerability of that unique aspect of NIAAA’s portfolio. She also noted the importance of nicotine’s effects on breathing, heart rate, and stress response. In response, Dr. Volkow asserted the value of conceptualizing the notion of systems biology in a white paper that identifies the areas that the field considers to be in jeopardy and strategies to ensure their security.
Dr. Walker reminded Council members that NIDA and NIAAA were established because stigma impeded both individuals’ access to care and research to enable understanding of the phenomena. He suggested that the Councils develop a joint statement on the existing portfolio and on an ideal portfolio. Dr. Andrea Barthwell urged the two Institutes to consider strategies to overcome the inevitable problems that accompany reorganization, particularly the loss of scientific expertise, and to consider cross-Institute projects that could protect the Institutes’ science. Dr. Caryn Lerman stated that research in the tobacco field spreads over multiple Institutes, and strategies exist to reduce scientific fragmentation. She added that addiction science research could move from NCI to the new Institute.
NIH Director’s Report
Substance Use, Abuse, and Addiction Action Timeline
Dr. Lawrence Tabak, Principal Deputy Director, National Institutes of Health, presented an updated timeline for the reorganization process. The Substance Use, Abuse, and Addiction Task Force has been conducting an analysis of all FY 2010 funding mechanisms preparatory to creating an internally developed portfolio integration plan for a new Institute. Simultaneously with developing the portfolio integration plan, and with stakeholder input, NIH will develop a scientific strategic plan that reflects synergies resulting from creation of new Institute. In fall 2012 NIH plans to release both plans for public comment and then to refine the plans. By December 2012 final recommendations will be submitted to the NIH Director for approval and inclusion in the President’s FY 2014 budget. Dr. Tabak stated that at that point, NIH will begin to implement aspects of the scientific strategic plan that do not depend on formal reorganization. By October 2013, the National Institute on Substance Use and Addiction Disorders will be established.
Discussion. Drs. Anita Everett and Suzanne de la Monte inquired about the Councils’ role in the reorganization process. Dr. Tabak stated that Councils will receive the planning documents for their review and comment prior to public release. Scientific experts will develop the plans based on relevant Institutes’ strategic plans, new information since development of those plans, and especially what might be envisioned from synergies that would emerge from a single research entity.
Dr. Lerman inquired about strategies to ensure continuity during the transition. Dr. Tabak stated that NIH advises all stakeholders to continue with current plans and to conduct business as usual until actualization of the new entity. He stated that the science and the portfolio will drive personnel changes, and personnel issues regarding multitasking will be accommodated with compromise.
To Dr. Steven Childers’s question regarding a straw model, Dr. Tabak replied that NIH will consider input from all stakeholders following release of the plans, may use relevant Councils as an initial sounding board, and will make changes that make scientific sense. He noted that NIH made substantial changes based on stakeholder input to the plans for the National Center for Research Resources. Drs. Walker and Childers inquired about interactions between the two planning groups, perhaps with input from the Councils, to address early concerns. Dr. Tabak responded that the two groups will have contact with each other, and that NIH scientific leadership will drive the strategic planning process.
Dr. Deborah Hasin expressed concern about the reorganization being seen as an opportunity for economies that may diminish researchers’ interest in working in the addictions area. Dr. Tabak acknowledged broad concern about the current budget climate and reiterated a previous pledge that the resources set will not be diminished disproportionately.
NIH Diversity Programs
In a discussion of diversity among NIH researchers, Dr. Tabak asserted that NIH proactively supports a diverse biomedical research work force in order to continue to attract the best and brightest to biomedical research. Nevertheless, data documenting NIH’s efforts over 30 years reveal a less than impressive impact on achieving that goal. For example, 2008 data show that principal investigators on research project grants who are Black or African American, or of Hispanic or Latino origin, are severely under represented compared to the general population.
Dr. Tabak discussed several recent NIH-commissioned studies on workforce diversity. Ginther and colleagues in 2010 examined diversity in academic biomedicine. Pohlhaus and colleagues (2011) reported on gender differences and applicant success-in-funding rates for NIH extramural programs; no gender differences were detected for first applicants, but upon reapplication, a small, statistically significant, and persistent—but unexplained—gap was found between male and female applicants.
In a 2011 study published in Science, Ginther and colleagues concluded that Black and Asian applicants are significantly less likely to receive a Type 1 R01 award, and that differences in Asian applicant award rates relate to U.S. citizenship. Even after controlling for a range of factors, Black applicants were 10% less likely than white applicants to receive a Type 1 R01 award. Researchers also concluded that award probabilities correlate with NIH Funding Rank of the applicant’s institution. In each rank group, Black applicants have the lowest award probability, and only citations and prior review committee experience reduce those disparities. Both Black and Hispanic applicants are less likely to resubmit a revised application. Participation in NIH-supported training or career development programs has a positive effect on R01 award rates, but the advantage appears to help White applicants more than Black and Asian applicants.
Also in Science, NIH Director Francis Collins and Dr. Tabak outlined NIH’s commitment to a diverse biomedical workforce, additional NIH analyses to describe the problem, steps to seek out causes of success-rate differences, and action items to address those differences. Dr. Tabak asserted that NIH is committed to determining the causes of the differential success rates and to instituting effective interventions. NIH engages in a vigorous communication outreach to all stakeholders and has established an Early Career Reviewers program both to increase exposure of investigators from diverse institutions to the review process and to increase the diversity of review panels. NIH intends to conduct experiments on its review process to determine if bias exists and to assess whether the proportion of under-represented minority (URM) reviewers on a panel affects outcomes for URM applicants. Working with academic institutions, NIH will encourage creation or enhancement of pre-application mentoring programs for junior faculty. NIH has funded extramural grants designed to study interventions to strengthen the pipeline in a manner to help improve workforce diversity. Two high-level groups, the NIH Diversity Task Force and the new Advisory Committee to the Director Working Group on Diversity in the Biomedical Research Workforce, are working on the issue.
Discussion. Dr. Nabila El-Bassel inquired about NIH’s work with universities to increase the involvement of racial and ethnic minority investigators. Dr. Tabak responded that the disparity is generated during the peer review process, and that NIH’s current approach is to determine the root cause and redress it. Dr. Walker stated that American Indians typically are classified as “other” and emphasized the need to address the issue of Native researchers in the addictions field. Dr. Tabak responded that NIH leadership and members of the advisory committee are aware of this situation, which also applies to other minority subgroups. Dr. Everett stated that a new NIDA report on this issue may provide useful information.
Dr. Andres Gil suggested that NIH consider the effects of lack of early career mentorship, lack of opportunities to be in a network of individuals who provide mentoring, and isolation from the field’s top senior researchers. Dr. Tabak pointed out that the field of study may have an impact. African Americans disproportionally apply for grants in the areas of behavioral and social sciences, particularly health disparities, with a virtual absence of Black applicants in the basic sciences. In response to a question from Dr. Hasin, Dr. Tabak stated that the dataset for the 2011 Ginther study appears online.
Dr. Scott Friedman inquired about outreach to undergraduate students to motivate career choices in biomedical research. Dr. Tabak stated that NIH’s conundrum involves how far back in the pipeline NIH should extend its reach; if middle school-age students do not take pre-algebra, “the game is over.” He stated that NIH might work strategically in partnership with other agencies. Dr. Friedman suggested that data extractable at the university level might show whether the best and brightest of URMs choose biomedical research in the same proportion as law or other advanced studies. Dr. Tabak observed that in the 1970s, when medical schools were told to increase their enrollment, the rationale used was the need for more people to give back to communities. In response, the majority of African American physicians now practice in communities, and pursuing a research-based career is not a priority.
Round Table Discussion
Dr. Warren replied to Dr. Grant that no mission statement exists for the new Institute. Dr. Szabo inquired about the scientific leadership that will drive strategic planning. Dr. Warren stated that the strategic planning group, currently in formation, proposes to involve stakeholders from the external scientific community, including representatives from NCI’s tobacco program, NIAAA, NIDA, NIDDK’s obesity program, National Institute on Environmental Health Sciences, and National Institute on Mental Health. He speculated that they will first determine how to establish outreach to add additional external stakeholders to this activity. Although an internal NIH group will determine portfolio content, Dr. Warren anticipated that NIAAA and NIDA will be able to offer input. Dr. Volkow characterized the reorganization process as open and considered the delay in the timeline as a means to permit more outside communities to offer input. She asserted the need for the Councils to devise a viable strategic plan that acknowledges the fast-moving science and that projects the Institutes’ strengths into the future.
Dr. Volkow replied to Dr. Childers that NIAAA and NIDA intramural programs have made considerable progress in identifying collaborative opportunities independent of a new institute, including scientists already crossing institutional boundaries. For example, the two scientific directors plan to merge clinical programs across Institutes, including epigenetic resources and genetics/epigenetics. Dr. Warren concurred that the work to bridge the two Institutes is progressing well.
Dr. Friedman inquired about the usefulness of advice from NCI’s advisory council. Dr. Lerman responded that while no one currently on that council works with tobacco, staff at that Institute should be part of these conversations. Dr. Volkow added that an analysis of the NCI and NIDA portfolios revealed little overlap in grant funding. Both NIDA and NCI conduct prevention research, with greater investment by NCI. NCI has argued that prevention research targeted at preventing cancer should stay at NCI—but it is prevention against addiction and ultimately cancer. Dr. Warren observed that NCI’s tobacco prevention and policy portfolios more closely parallel NIAAA’s, in that both tobacco and alcohol are licit substances. He also noted that while NCI focuses on cancer prevention, NIAAA focuses on preventing inappropriate use of alcohol—a fine distinction.
Dr. Thomas Kirk inquired whether opportunities exist for innovation prior to the reorganization and what the relationship will be of the new Institute to a more integrated healthcare environment. Dr. Volkow replied that while she recently received an endorsement to launch a long-term innovative partnership based on scientific necessity, identification of individuals to fill key Institute positions will be a challenge. She and Dr. Warren observed that while healthcare reform will offer opportunities for screening and treatment of a large portion of the population, the infrastructure is not ready. Both Institutes currently engage in services research efforts. Dr. Volkow pointed to the Institutes’ significant partnership regarding both licit and illicit substances, an area where functional integration will occur in the future. Dr. Walker endorsed joint efforts by the NIDA and NIAAA Councils to influence progress in portfolio integration and strategic planning. Dr. Castellanos identified research on adolescent brain development as a prime opportunity for merging the Institutes’ interests.
Dr. Riley inquired about how other Institutes might handle portions of NIAAA or NIDA’s portfolio—for example, liver research—that might be added to their purview. Dr. Volkow acknowledged the value of the Councils jointly articulating such concrete issues and suggesting action plans to ensure a mechanism to evaluate the integrity of the science. Dr. Riley added that it makes sense to distribute the science on an etiological basis. Dr. Volkow stated her view that the issue of what makes scientific sense is distinct from evaluating and ensuring that a portfolio deemed, on the basis of scientific merit, to belong to another Institute does not suffer. Dr. Friedman asserted the need for assurance that if liver research were to be assigned to NIDDK that the portfolio would remain intact. Dr. Warren noted an earlier guarantee that portfolios would remain intact for a certain period of time, pointing out that implementing such a guarantee would pose a challenge and will warrant monitoring. Dr. Nestler suggested establishing a formal review process to ensure that synergies are attained and that research is not lost or given short shrift. Dr. Volkow endorsed that proposal as part of Councils’ advice.
Dr. Crowley suggested that the NIDA and NIAAA Councils advise the reorganization-related committees on strategies to capitalize on NIAAA’s NESARC and COGA, and NIDA’s CTN and Genetics Consortium. Dr. Volkow assured the Councils that NIDA and NIAAA currently work actively together in using CTN to extract alcohol data, in medications development trials to systematically monitor effects on drinking behavior, and in capitalizing on infrastructure to investigate comorbid conditions. NIDA has contributed funding for both NESARC and COGA, and considerable dialogue is ongoing.
Dr. Volkow discussed the need to integrate both Councils prior to 2014 to maximize interactions and identify opportunities. Dr. Howell endorsed holding another joint Council meeting. Dr. Warren stated that Council members can send their ideas to the Institute directors and the Council executive secretaries. Dr. Volkow suggested nominating individuals from both Councils to develop their viewpoints and present reports to each other’s councils, followed by a joint meeting in a year’s time. Dr. Grant suggested that each Council discuss the process to develop additional recommendations and useful steps to inform NIH leadership.
Dr. Warren adjourned the meeting at 1:20 p.m.
I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.
Kenneth R. Warren, Ph.D.
Acting Director, National Institute on Alcohol Abuse and Alcoholism
Chairperson, National Advisory Council on Alcohol Abuse and Alcoholism
Abraham P. Bautista, Ph.D.
Director, Office of Extramural Activities
Executive Secretary, National Advisory Council on Alcohol Abuse and Alcoholism
Nora Volkow, M.D.
Director, National Institute on Drug Abuse
Chairperson, National Advisory Council on Drug Abuse
Teresa Levitin, Ph.D.
Director, Office of Extramural Affairs
Executive Secretary, National Advisory Council on Drug Abuse