Experts Mull Impact of Proposed Single National Addictions Institute

Opponents of a proposed union between the National Institute on Drug Abuse (NIDA) and the smaller National Institute on Alcohol Abuse and Alcoholism (NIAAA) worry, in part, that combining these two National Institutes of Health (NIH) agencies as part of a proposed new, single national addictions institute could result in a lack of focus or funding for alcohol research. However, at least one researcher says the plan could actually result in more funding for alcohol-addiction research.

In late September, the NIH's Scientific Management Review Board (SMRB) voted 12-3 in favor of a recommendation from its Substance Use, Abuse and Addiction (SUAA) Workgroup to dissolve both NIAAA and NIDA and create a single institute on addictions. The SUAA was formed last summer to study the possibility of such a reorganization and issue recommendations.

The SMRB did not even call a vote on the SUAA's second option, which would have created a cross-NIH addiction initiative, but no new unified agency.

The plan endorsed by SMRB would consolidate all NIH addictions research — including hundreds of millions of dollars in nicotine-addiction grants now administered by the National Cancer Institute — under one roof, while shifting non-addiction related NIDA and NIAAA research to other agencies.

The proposal is now on the desk of NIH Director Francis S. Collins, M.D., Ph.D., for consideration. If Collins accepts the SMRB recommendation, it would still need to be approved by Department of Health and Human Services Secretary Kathleen Sebelius and receive no objections from Congress.

Once Congress is notified, it would take at least six months — and probably much longer — for the new institute to open its doors. It would also need a new director, since NIH has effectively ruled out having the current directors of NIDA or NIAAA taking the reins.

Members of NIDA's National Advisory Council on Drug Abuse voted unanimously in favor of the addictions institute, while NIAAA's National Advisory Council on Alcohol Abuse and Alcoholism unanimously endorsed the SMRB's non-merger option.

The Research Society on Alcoholism (RSA), the leading professional organization representing alcohol researchers, strongly opposed the dissolution of NIAAA and NIDA “as a matter of public health policy and on scientific grounds,” according to a Sept. 22 statement.

“An addictions institute, by its very nature (exclusive focus on addictions), would not serve as an encouraging environment for research on the vast array of significant public-health problems that are not, and will never evolve into, addictions,” according to RSA. “These public-health concerns include teenage drinking, drunk driving, and the many health effects of moderate alcohol use that impact the majority of those who consume alcoholic beverages, but are not addicted. Further, public-policy issues such as taxation, distribution and legal use of alcohol as a commodity will not be considered.”

RSA also took a dim view of the proposed “dismemberment of NIAAA’s integrated alcohol research portfolio,” which the group said would see studies on fetal alcohol  spectrum disorders shuffled off to the National Institute of Child Health and Development; alcoholic liver disease research sent to the National Institute of Diabetes and Digestive and Kidney Diseases, and investigations of alcoholic immune dysfunction shifted to the National Institute on Allergies and Infectious Diseases. “No single institute would be able to coordinate the interrelated effects of alcohol on different organ systems following this diaspora,” RSA asserted.

Like RSA, the National Association of Addiction Treatment Providers (NAATP) is on record opposing the addictions-institute plan, while other field organizations, like Community Anti-Drug Coalitions of America (CADCA), have chosen not to take a position. “We have a great partnership with both, and CADCA and its coalitions care deeply about both Institutes and their missions,” said CADCA Chairman and CEO Arthur Dean, who also sits on the NIAAA national advisory council.

David Rosenbloom, Ph.D., director of Join Together, said that a single NIH addictions institute could “yield important science and public-health benefits.”

“Many individuals with addiction use alcohol and tobacco and drugs at the same time,” said Rosenbloom. “A broad addiction institute may be better able to design and sponsor clinical, basic and health services research that matches this real-world reality instead of focusing on just one substance at a time.”

However, noted Rosenbloom, “There are very important negative health and social consequences from misuse of alcohol and drugs by individuals who may not meet the clinical definition of addiction. A new institute must also continue to support policy and clinical research on these issues.” Rosenbloom also called for the institute to boost health-services research, “because evidence-based treatments are often not implemented well, and we need to know how to make treatment more effective in real populations.”

Researchers who support the SMRB-endorsed plan, like Wake Forest University professor and NIDA advisory committee member Steven R. Childers, Ph.D., point to the “common science and mechanism of action in the brain” for alcohol and other drugs, noting, for example, that drugs like naltrexone, an opiate agonist, have also been found to be effective in treating alcoholism. “In today's research world, the argument that a merger would make collaboration better seems compelling,” said Childers.

The scientific case for uniting NIDA and NIAAA under a single addictions agency “seems so crystal-clear and obvious that the only thing that's surprising is that it has taken so long to do it,” added NIDA advisory council member Eric J. Nestler, Ph.D., M.D., chair of the neuroscience department at the Mount Sinai School of Medicine in New York.

Nestler, who said that having two separate research agencies only serves to validate the “erroneous and dangerous” notion — propagated by the alcohol industry, in particular — that alcohol is somehow different than cocaine, marijuana, heroin, or other drugs. “Alcoholism is a form of drug abuse,” he said. “To divide the two makes no sense.”

Nestler said that rather than putting NIAAA's $450 million annual budget for alcohol research at risk, creating a single, $1.5 billion (or so) addictions research institute would give the agency more leverage before Congress. He called objections to the merger “parochial” and predicted that the head of the new 'National Institute on Addictions' would face pressure to allocate more — not less — funding to research on the nation's number-one drug of abuse, alcohol.

“Maybe it's the people at NIDA who should be afraid,” he said.