KF27 .A653 1985 Pt. 8 COMMITTEE ON APPROPRIATIONS JAMIE L. WHITTEN, Mississippi, Chairman EDWARD P. BOLAND, Massachusetts JOSEPH P. ADDABBO, New York TOM BEVILL, Alabama BILL CHAPPELL, JR., Florida BILL ALEXANDER, Arkansas JOHN P. MURTHA, Pennsylvania BOB TRAXLER, Michigan JOSEPH D. EARLY, Massachusetts LINDY (MRS. HALE) BOGGS, Louisiana MATTHEW F. MCHUGH, New York MARTIN OLAV SABO, Minnesota VIC FAZIO, California W. G. (BILL) HEFNER, North Carolina LES AUCOIN, Oregon DANIEL K. AKAKA, Hawaii WES WATKINS, Oklahoma WILLIAM H. GRAY III, Pennsylvania BERNARD J. DWYER, New Jersey BILL BONER, Tennessee STENY H. HOYER, Maryland BOB CARR, Michigan ROBERT J. MRAZEK, New York RICHARD J. DURBIN, Illinois SILVIO O. CONTE, Massachusetts ELDON RUDD, Arizona CARL D. PURSELL, Michigan TOM LOEFFLER, Texas JOHN EDWARD PORTER, Illinois FREDERICK G. MOHRMAN, Clerk and Staff Director DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1986 MONDAY, MAY 6, 1985. TESTIMONY OF MEMBERS OF CONGRESS AND OTHER ALCOHOL, DRUG ABUSE AND MENTAL HEALTH ALCOHOL RESEARCH CENTER, UNIVERSITY OF COLORADO WITNESS DR. RICHARD DEITRICH, SCIENTIFIC DIRECTOR Mr. NATCHER. Our first witness this afternoon is Dr. Richard Deitrich. Come around, Doctor. We will be pleased to hear from you. All of you ladies and gentlemen who will testify this afternoon will have 10 minutes. Mr. DEITRICH. My name is Richard Deitrich, Professor of Pharmacology and Scientific Director, Alcohol Research Center, and also the immediate past President of the Alcohol Research Center. I would like to thank the Committee on Appropriations for the opportunity to present testimony concerning the research program and funding of the National Institute on Alcohol Abuse and Alcoholism. It is appropriate to take a few minutes to review the history of alcohol research and its accomplishments to date, in order to better understand the opportunities for the future. As you are aware, the effort of the Federal Government in alcohol research is relatively recent. There was, however, a small research effort before that time. As has been pointed out by Dr. Dora Goldstein of Stanford University, we tend to forget that many of the significant advances in the treatment of alcoholism were made possible by research findings, especially if they were made many years ago. For example, it used to be relatively common that alcoholics would die with rum fits or delirium tremens. Research showed that this did not usually occur during drinking, but only upon cessation of drinking and was a result of withdrawal from alcohol. At that time, it was not certain that alcohol was addicting in the usual sense. (1) When I entered the Research Center some 20 years ago, this was a raging controversy, but knowledge of alcohol withdrawal led to vastly improved treatment and the saving of many lives. These advances were a direct result of research; clinical observations during the hundreds of years before had not supplied the answer. Subsequently, a multi-hospital study identified that the minor tranquilizers, benzodiazepines, as the best drugs for treatment of withdrawal; whereas, the major tranquilizers, commonly used in the treatment of psychoses, actually made things worse. Similarly, people died, not from the direct effects of alcohol, but from the low blood sugar, as a consequence of excessive consumption. From research findings, it was understood that alcohol can lower blood glucose in malnourished individuals, even those on a severe diet who were trying to lose weight, but raise it in well-fed individuals. Research has also provided the understanding that a very destructive syndrome associated with alcoholism, Wernicke's disease, which eventually causes permanent brain damage, was primarily a vitamin deficiency. The routine administration of Vitamin B-1 has greatly reduced if not eliminated this problem. More recently, the understanding that the propensity to this disease is genetically controlled is another research advance. The discovery from animal and human experimentation, that alcohol damages the liver, even in well-nourished individuals, is changing the thinking of a generation of physicians. The inappropriate use of fluid replacement in alcoholics is now thought to cause severe or fatal brain damage, central pontine myelinolysis. The correctness of this idea was shown by reproducing the condition in animals. More recently, the discovery of a genetic component is a familiar risk for human alcoholism, and the development of animal models for many actions of alcohol has pushed the field into the mainstream of biological research, in general. The establishment of NIAAA has spurred an increase in alcohol research, and certainly the Federal effort has increased from essentially nothing only a few years ago to a first-rate productive and visible research effort both in the intramural and extramural programs. However, the effort in proportion to the problem is badly out of balance. In 1980, the first Institute of Medicine report on alcohol research clearly documented that, based upon dollars per $1,000 of cost to the Nation, research dollars per death, or dollars per chronic case, alcohol research ranks far behind research on cancer or heart disease. For example, in 1978, the amount spent on research was $209 per case for cancer, but only $1 per case for alcoholism for research. The Institute of Medicine concluded at that time that "alcohol research is not funded at a level commensurate with the economic cost it imposes on society or at a level comparable to research funding for other major disorders." Again, in 1982 and in 1984, this view was reiterated by this prestigious group. Their recommendation for NIAAA is a research budget of $100 million in constant 1983 dollars. Please understand, I am not advocating that we reduce funding for other areas of re search, simply that the alcohol research be brought more into line with the problem that it creates. Thus, the request by the Administration of only $52.8 million for alcohol research is woefully inadequate. Even the amount of $68 million would not meet the goal, but would allow NIAAA to meet its present commitments and provide for essential growth. As it stands in fiscal year 1985, it has been necessary for NIAAA to cut the currently-funded RO-1 and Center grants. In our-Alcohol Research Center, this 10-percent cut has severely restricted a number of important projects. For example, we have a project to assess the genetic influence on the reaction of individuals to alcohol. This is an important study with regard to the basis of the genetic component in human alcoholism and, as a spinoff, it carries far-reaching consequences for solutions to drunk driving problems. However, we have never been able to fully fund that project, and this year, we have again been unable to proceed at the maximal pace possible. The Alcohol Research Centers have been funded at the fully-authorized level only once during the eight years that we have had our Center at the University of Colorado. In research institutions where a critical mass of high quality investigators are present, I believe that the Centers provide more research per dollar amount spent than can be achieved by any other mechanism. Funding cuts, directed at all NIAAA RO-1 and Center grants this year, seriously disrupt ongoing projects and, perhaps more importantly, inhibit the flow of new scientists into the system. These cuts are penny-wise but pound-foolish. I fully realize that the necessity of reducing the Federal budget deficit is uppermost in our minds as American citizens. However, even a small dent in the over $100 billion per year cost of alcoholism to our government and Nation would repay, many times over, the proportionately small amount of cost for alcohol research in the budget needed to accomplish this change. Thank you very much for your attention. [The statement of Mr. Deitrich follows:] Testimony of Dr. R.A. Deitrich Professor of Pharmacology and Scientific Director Alcohol Research Center University of Colorado Health Sciences Center 4200 East 9th Avenue Denver, CO 80262 I would like to thank the Committee on Appropriations for the opportunity to present testimony concerning the research program and funding of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). It is appropriate to take a few minutes to review the history of alcohol research and its accomplishments to date, in order to better understand the opportunities for the future. As you are aware, the effort of the Federal government in alcohol research is relatively recent. There was, however, a small research effort before that time. As has been pointed out by Dr. Dora Goldstein of Stanford University, we tend to forget that many of the significant advances in the treatment of alcoholism were made possible by research findings, especially if they were made many years ago. For example, it used to be relatively common that alcoholics would die with rum fits or delerium tremens. Research showed that this did not usually occur during drinking, but only upon cessation of drinking and was a result of withdrawal from alcohol. At that time, it was not certain that alcohol was addicting in the usual sense. alcohol withdrawal led to vastly improved treatment and the saving of many Knowledge of |