Statement for the Record
Mr. Chairman and Members of the Committee:
I am pleased to present the President's budget request for the National Institute on Drug Abuse for FY 2003, a sum of $967,898,000 which reflects an increase of $76,960,000 over the comparable Fiscal Year 2002 appropriation.
NIDA'S Strong Research Foundation
I feel very honored to be serving as the Acting Director of the National Institute on Drug Abuse (NIDA) at a time when new discoveries of significant promise are transforming our understanding of the brain and body and providing us with the knowledge we need to confront both the new and the old realities of the day.
Budget increases, visionary predecessors, and the unprecedented pace in neurobiology have allowed the National Institute on Drug Abuse to establish a strong research foundation from which to alleviate the complex public health problem of drug abuse and addiction. As the world's leading supporter of research on the health aspects of all drugs of abuse, including nicotine, NIDA addresses the most fundamental and essential questions about drug abuse and addiction, which range from understanding how drugs act on the brain; to identifying and minimizing the role that stress can play in drug use and relapse; to detecting and responding to emerging drug use trends such as "Ecstasy" and prescription drugs. This portfolio also continues to elucidate our understanding of drug abuse as a preventable behavior and drug addiction as a treatable disease.
Coupled with strong research is our ability to expand its dissemination to clinicians. Through coordinated dissemination and translational research efforts, NIDA ensures that even the most basic neurobiology discoveries systematically influence community prevention and treatment providers across the country so that our citizens can live healthier and more productive lives. For example, almost 1000 people from both rural and urban communities are participating in treatment protocols where they are receiving science-based drug addiction treatment and medical care through their participation in NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN). And even more citizens are stopping the initial use of drugs by participating in prevention programs that follow the science-based prevention principles identified and disseminated by NIDA. Much has been accomplished, but more remains to be done.
Drug Abuse is Costly at Many Levels
Directly or indirectly, every family and community is affected by drug abuse and addiction. We all have family members, friends, or acquaintances who abuse some substances. These drugs take a tremendous toll on our society; and they are costly at many levels. At the economic level, the cost of illegal drugs to our Nation was estimated by the White House Office of National Drug Control Strategy to be more than $161 billion in 2000. When one adds the cost of the Nation's deadliest addiction - use of tobacco products - the cost soars to nearly $300 billion each year.
Drug abuse is inextricably linked with the spread of infectious diseases such as HIV/AIDS, tuberculosis, and hepatitis C, and is also associated with domestic violence, child abuse, and other violent behavior. But because our research has shown that drug abuse is preventable and drug addiction is treatable, there is much reason for optimism.
Bringing a Multi-Disciplinary Approach to Drug Abuse Prevention Research Efforts
Researchers have learned much about why people use drugs and have identified many of the risk and protective factors that can influence drug use. In the past year, research has also revealed new insight into how to tailor anti-drug messages to sensation-seeking adolescents to actually reduce marijuana use, and taught us not to group together high risk youth for prevention interventions. Despite our progress, research gaps remain. For example, researchers are trying to determine what influences adolescent decision-making, especially decisions about drugs. What thoughts and emotions are going on at the precise moment an adolescent makes the initial and subsequent decisions to try or not to try drugs? These are questions that can not be answered by prevention researchers alone. A transdisciplinary and multi-pronged research approach that integrates all areas of science - basic behavioral, cognitive, developmental, social, neurobiological, and clinical - to develop innovative directions in drug abuse prevention research, is the underlying premise for NIDA's new National Drug Abuse Prevention Research Initiative. Testing the effectiveness of new and existing science based prevention approaches through multi-site trials conducted at the local community level will also be important in this endeavor.
Treating Addiction to Nicotine and Other Drugs of Abuse
Tobacco use remains one of the greatest risk factors for cancer. It is addiction to the drug, nicotine, that drives the continued use of tobacco in this country and abroad, despite the known negative consequences. Smoking cessation remains among the most successful and cost-effective approaches to reversing the tide of tobacco-related diseases, including cancer. New technologies and breakthroughs in neurobiology, such as the recent identification of the critical role that the gene tryptophan hydroxylase - an enzyme that produces the brain chemical messenger serotonin - plays in the initiation of smoking are providing new opportunities for NIDA and other NIH Institutes such as the National Cancer Institute to collaborate at the scientific and clinical levels. Developing novel and selective medications to better treat addiction to tobacco and other substances of abuse is of mutual interest to many in the private and public sectors. NIDA will continue to develop addiction treatments, especially treatments that are specifically tailored to adolescent populations, such as those being tested at our Teen Tobacco Treatment Research Center in NIDA's Intramural Research Program in Baltimore, MD.
Developing new and effective ways to treat all addictions continues to be a high NIDA priority. Both behavioral therapies, such as cognitive behavioral therapies that have been shown successful in reducing cocaine use, and pharmacological approaches, will continue to be supported by NIDA. NIDA's Medications Development Program is about to bring two anti-cocaine medications to Phase III Clinical Trials this year. Not only are the medications Selegeline and Disulfiram showing success in cocaine-addicted populations, but they show promise as potential treatments for methamphetamine addiction as well.
Expanding NIDA'S Clinical Trials Network
Recognizing that the path leading from new findings to changes in clinical practice can be lengthy, and that millions of people across the country are in need of quality drug abuse treatment, NIDA has established an infrastructure to more rapidly and systematically bring new treatments to those in need. When research-based treatments such as the behavioral therapy, motivation enhancement, and the pharmacological therapy, buprenorphine-assisted detoxification, are proven to work repeatedly in small controlled settings, they are developed into treatment protocols by researchers and practitioners and undergo rigorous multi-site trials to determine their effectiveness in community-based treatment settings. Currently, more than 15 treatment protocols are being tested or about to be tested in the established multi-site trials across the country. In FY 2003 NIDA plans to expand this infrastructure to ensure greater geographic distribution, and to reach underserved populations and regions underrepresented in the health care system, including individuals who have mental illnesses, those suffering from HIV/AIDS or other infectious diseases, adolescents who may be in need of drug treatment, and Hispanic and other minority populations.
AIDS and Other Medical Consequences
Considerable scientific progress has been made in understanding, preventing, and treating HIV/AIDS and other infections among drug users. For example, NIDA-supported researchers have made tremendous progress in our battle against the Hepatitis C Virus (HCV). HCV infection is a major public health problem with 60 percent of all new cases of acute HCV infection attributed to syringe and needle sharing. One of the most critical problems in controlling HCV is the variability of the virus with more than 9 distinct types of virus known. NIDA researchers identified an antibody that can block HCV from binding to the CD81 receptor that is found in both liver and B cells. This may prove to be a useful therapeutic target. An antibody proven to block this receptor would have the potential of blocking HCV infection or modulating early infections in exposed persons by interfering with the Hep C viral life.
Given that the epidemiological patterns of drug abuse and risk behaviors are constantly changing and new infections of HIV and other blood-borne and sexually transmitted infections continue to emerge and spread, NIDA is encouraging researchers to apply new findings to develop new and improved approaches to prevent the acquisition and ongoing transmission of these infections, as well as strategies to improve access to diagnostic screening and care.
Integrating Treatment Into The Criminal Justice System
Drug abuse treatment has been shown to reduce drug use and its related criminal behavior. The majority of individuals in prisons have a drug problem that requires treatment. For these reasons many different approaches for bringing treatments into the criminal justice system have been tried, including treatment as an alternative to prison, drug courts, drug abuse treatment in prison settings and treatment in community settings after release. Outcomes for each approach vary. NIDA is establishing a research infrastructure to test models at multi-sites to establish a more integrated approach to the treatment of incarcerated individuals with drug abuse or addictive disorders. The National Criminal Justice Drug Abuse Treatment Research System will serve as the vehicle for blending public health and public safety approaches.
Stress and How it Influences Drug Use
Particularly relevant in light of the events of September 11 is the role stress plays in drug use and addiction. We are expanding our research to better understand the role that stress plays in initiation, escalation and relapse to drug use so we can develop more effective ways to manage and treat stress. While we know that people take drugs initially to experience their rewarding and pleasurable effects, we also know that they relapse to taking drugs even after long periods of abstinence, for entirely different reasons. Stress is identified by most patients as the predominant factor to relapse. People prone to relapse also identify the triggers of environmental cues associated with previous drug use, and the drugs themselves. We are just beginning to appreciate that each of these triggers may involve brain circuitry different from that involved in the initiation of use and each operates on its own pathway. For example, (as seen in figure 1) stress-induced relapse appears to involve the hypothalamo-pituitary-adrenal axis to release stress hormones such as CRF from the brain and cortisol (steroid) from the adrenal glands. In contrast, cue-induced relapse appears to involve portions of the amygdala; and drug-induced relapses involves the mesolimbic circuitry. By more clearly defining the neural pathways that subserve each trigger for relapse, such as the activation of CRF in the brain, NIDA will be able to more strategically identify and develop prevention strategies, as well as new targets for addiction medications.
Government Performance and Results Act (GPRA)
The NIH budget request includes the performance information required by the Government Performance and Results Act (GPRA) of 1993. Prominent in the performance data is NIH's second annual performance report which compared our FY 2001 results to the goals in our FY 2001 performance plan.
The Formidable Force of Science
Continued progress can be expected in curtailing drug abuse and addiction if we continue to capitalize on the strong research foundation that NIDA has established. Research is critical to all of our Nation's endeavors and there is hope in knowing that new and growing public health needs such as Addiction, AIDS, Bioterrorism, and Cancer, and Diabetes, and others, are being tackled head on with the formidable force of science.
I would be pleased to respond to any questions. Thank you.