Department of Health and Human Services
National Institutes of Health
National Institute on Drug Abuse
Minutes of the 69th Meeting of the National Advisory Council on Drug Abuse
May 19-20, 1998
The National Advisory Council on Drug Abuse convened its 69th meeting at 9:00
a.m. on May 19, 1998 in Conference Rooms E1 and E2, Natcher Building, National
Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland. Dr. Alan I. Leshner,
Director, NIDA, chaired the meeting. The meeting on May 19 was for the purpose
of reviewing applications for federal grant assistance and was open only to Council
members and federal employees. The meeting reconvened on May 20 at 9:00 a.m. and
was open to the public. The Council adjourned May 20 at 3:04 p.m.
Council Members Present:
Susan G. Amara, Ph.D.
Andrea G. Barthwell, M.D.
Gerald H. Friedland, M.D.
Morton E. Goldberg, D.Sc.
Reese T. Jones, M.D.
Nancy J. Kaufman, R.N., M.S.
George F. Koob, Ph.D.
G. Alan Marlatt, Ph.D.
Clyde B. McCoy, Ph.D.
Thomas A. McLellan, Ph.D.
June E. Osborn, M.D. (May 19 only)
Kathy Sanders-Phillips, Ph.D.
Catherine A. Stevens, J.D.
Lei Yu, Ph.D.
Col. Terry K. Schultz, M.D. (ex officio)
Richard Suchinsky, M.D. (ex officio)
Council Members Absent:
Hortensia D. Amaro, Ph.D.
Rand D. Conger, Ph.D.
Thomas A. Hedrick, Jr.
Linda S. Slattery
Council Chairs Present:
Alan I. Leshner, Ph.D.
Richard A. Millstein
Teresa Levitin, Ph.D.
Federal Employees Present:
National Institute on Drug Abuse
| Jane Acri, Ph.D.
Thomas Aigner, Ph.D.
Khursheed Asghar, Ph.D.
Jamie Biswas, Ph.D.
Jack Blaine, M.D.
Roger Brown, Ph.D.
Robert Caudle, Ph.D.
Nora Chiang, Ph.D.
Peter Cohen, M.D.
James Colliver, Ph.D.
Peter Delaney, D.S.W.
William C. Grace, Ph.D.
Arthur MacNeil Horton, Ed.D.
Coryl Jones, Ph.D.
Andrea Kopstein, M.P.H.
Teresa Lee, Ph.D.
Geraldine Lin, Ph.D.
Rita Liu, Ph.D.
Minda Lynch, Ph.D.
Jack Manischewitz, Ph.D.
|| Arnold Mills, M.S.
Kesinee Nimit, M.D.
Lisa Onken, Ph.D.
Nancy Pilotte, Ph.D.
Jonathan Pollock, Ph.D.
Elizabeth Rahdert, Ph.D.
Rao Rapaka, Ph.D.
Elizabeth Robertson, Ph.D.
David Shurtleff, Ph.D.
Hari Singh, Ph.D.
Karen Skinner, Ph.D.
Zili Sloboda, Sc.D.
Vincent Smeriglio, Ph.D.
Jack Stein, M.S.W.
Betty Tai, Ph.D.
Pushpa Thadani, Ph.D.
David Thomas, Ph.D.
Frank Vocci, Ph.D.
Naimah Weinberg, M.D.
Cora Lee Wetherington, Ph.D.
Stephen Zukin, M.D.
Other Federal Employees:
Karol Kumpfer, Ph.D. - Center for Substance Abuse Prevention
Marina Volkov, Ph.D. - Office of Behavioral and Social Sciences Research, NIH
Members of the Public Present:
Steven Stocker - ROW Sciences
Sloan Mahone - American Academy of Child & Adolescent Psychiatry
Pamela Moore - Capitol Publications
Linda R. Wolf Jones, D.S.W. - Therapeutic Communities of America
Linda Kaplan - National Association of Alcohol and Drug Abuse Counselors
Julie Shroyer - Capitol Associates
Lisa Putman - The Blue Sheet
Pat Kobor - American Psychological Association
Chuck Thomas - Marijuana Policy Project
Closed Portion of the Meeting - May 19, 1998
- Call to Order
This portion of the meeting was closed to the public in accordance with Sections
552b(c) (4) and 552b(c) (6), Title 5, U.S. Code and Section 10(d) of the Federal
Advisory Committee Act, as amended (5 U.S.C. Appendix 2).
Mr. Richard A. Millstein, Deputy Director, NIDA, called the meeting to order
and introduced new members, Dr. Andrea G. Barthwell and Dr. Gerald H. Friedland.
He then provided an overview of the agenda for the meeting. Dr. Teresa Levitin,
Executive Secretary, provided a summary of voting policies and procedures, detailed
instructions on Council review procedures, and reminders about NIH confidentiality
and conflict of interest policies.
- Application Reviews
The Council divided into two subcouncil committees for the purpose of expediting
application reviews and allowing for in-depth discussion as needed. Applications
from the Division of Basic Research and the Medications Development Division were
reviewed by a subcouncil committee chaired by Dr. Khursheed Asghar. Applications
from the Division of Clinical and Services Research, and the Division of Epidemiology
and Prevention Research were reviewed by a subcouncil committee chaired by Dr.
William C. Grace. Each subcouncil committee reviewed applications and made recommendations
for concurrence with the initial Scientific Review Group. These recommendations
were carried back to the full Council for approval.
Members absented themselves from subcouncil and full Council meetings during
discussion of, and voting on, applications from their own institutions or other
applications in which there was a conflict of interest, real or apparent. Requests
for administrative supplements were also reviewed. Conflict of interest statements
were signed by each member. Members were not required to leave if an application
in conflict with that member was acted upon en bloc.
For this Council, 528 applications, requesting $481,865,181 in Total Years
Direct Costs, went to review. Of these, 347 were scored by the Scientific Review
Groups, representing $69,463,800 in First Year Direct Costs and $297,519,144 in
Total Years Direct Costs. The full Council approved each subcouncil committee's
recommendations, including nine administrative supplements. One MERIT application
was approved for continuation.
Open Portion of the Meeting - May 20, 1998
- Call to Order
Dr. Alan I. Leshner called the open portion of the meeting to order and welcomed
the Council members, NIDA staff, and visitors. He reminded the Council and audience
that the meeting was open to the public in compliance with the Government in the
Sunshine Act and indicated that time would be provided for public comment. Dr.
Leshner welcomed the new members and expressed gratitude for their willingness
to serve. He noted that Dr. Terry Schultz is retiring from the Department of Defense
and will, therefore, no longer serve on Council. Dr. Leshner acknowledged Dr.
Schultz's years of service and thanked him for his work.
- Consideration of the Minutes of the 68th Council
The Minutes of the February 3-4, 1998 meeting were approved as written..
- Future Meeting Dates
Future meeting dates for Council were announced as follows:
September 15 - 16, 1998
February 2 - 3, 1999
May 25 - 26, 1999
September 14 - 15, 1999
February 8 - 9, 2000
May 16 - 17, 2000
September 12 - 13, 2000
- NIDA Director's Report
Dr. Leshner prefaced his report by noting some internal changes in NIDA. In
particular, the Office on AIDS and the Clinical Medicine Branch have been combined
to establish a Center on AIDS and Other Medical Consequences, to be headed by
Dr. Henry Francis. The establishment of this Center reflects NIDA's growing emphasis
on the medical sequelae of drug abuse.
Dr. Leshner indicated that the budget figures were unchanged since presented
to the Council in February. The FY 1998 budget remains $527.175 million, reflecting
a 7.6% increase over FY 1997 levels. The FY 1999 President's budget request reflects
an increase of 8.4% increase for NIH overall, with NIDA's allocation expected
to be $576.299 million, which is a 9.3% increase. Congress is continuing to deliberate
this budget, and outcomes of deliberations on tobacco legislation may have an
impact on the budget. However, both Congress and the Administration strongly support
Dr. Leshner reminded the Council that in FY 1998 NIDA benefitted from resources
provided outside the normal appropriation process. The Office of National Drug
Control Policy transferred $9.5 million for coordinating and overseeing the evaluation
of a national media campaign ($7 million) and for developing a new program of
research in media communications ($2.5 million). Also, Dr. Varmus transferred
$2 million for research on methamphetamine.
The Council was reminded that review integration is proceeding in three areas:
basic neuroscience, basic behavioral science, and HIV/AIDS. Neuroscience applications
will be reviewed in June under the new study sections, and the behavioral science
reviews under new study sections will occur in the June 1999 meetings. AIDS applications
will be reviewed in the new structures in July 1998. Dr. Leshner asked the Council
to help monitor the integration and to help develop a process for evaluation of
A committee dedicated to review of career development applications, such as
applications for fellowships, K awards, and training grants, has been developed
at NIDA. Council was also asked to help the Institute monitor that process.
Two NIH policies related to review were noted. First, there has been an issuance
around the inclusion of children in NIH sponsored research, and the inclusion
or exclusion of children must be justified for research applications. Second,
any application requesting more than $500,000 in direct costs for any year of
the project needs agreement before submission that the Institute will accept the
Shaping the Research Agenda
Dr. Leshner reported that NIDA is consolidating its existing Program Announcements
(PAs), and he reviewed the distinctions between a Program Announcement and a Request
for Applications (RFA). Further, NIDA and all NIH are working to establish methods
for "sunsetting" a PA after a specific period. These activities should
help clarify the Institute's research priorities.
A Program Announcement, "Role of Limbic System and Brain Ontogeny in Drug
Abuse," released in February, is noteworthy for attempting to stimulate research
in a developmental issue, that of limbic system functions and brain development.
A list of other announcements was provided to Council.
The Council members were referred to their information folders for a list of
recent meetings. Dr. Leshner noted in particular that NIDA was the lead among
NIH institutes in a recent meeting focusing on the glutamate system, "The
Glutamate Cascade: Common Pathways of Central Nervous System Disease States,"
held May 3-5. The American Society of Addiction Medicine and NIDA recently jointly
sponsored a symposium on treatment for adolescent drug abusers, and NIDA hosted
a meeting on stress, the CRF system, and drugs of abuse. The NIDA Office of Special
Populations organized and held two meetings in March, one for the African American
Researchers and Scholars Group and one for the Hispano/Latino Researchers and
Scholars Group. Council members were referred to the written Director's Report
for details and for information on other meetings.
Upcoming meetings on several topics were announced. "Addicted to Nicotine:
A National Research Forum" will be held in July. This national conference
is sponsored by NIDA and the Robert Wood Johnson Foundation in conjunction with
the National Cancer Institute and the Centers for Disease Control and Prevention.
An American Psychological Society miniconference entitled "Cognition and
Emotion: Applications to Drug Abuse" has been organized by NIDA staff and
will occur later in May.
Dr. Leshner informed the Council that, for the first time, the American Psychiatric
Association's annual meeting will include an organized research-based program
track on drug abuse and addiction. This collaborative effort of NIDA and the APA
should greatly stimulate psychiatrists' involvement in drug abuse research and
awareness of research findings.
Several activities are occurring to help disseminate the findings of NIDA research.
Dr. Leshner praised the leadership of Dr. June Osborn and her colleagues, Drs.
Lonnie Bristow and David Lewis, in organizing the Physician Leadership on National
Drug Control Policy effort. This is stimulating a fresh look at addiction from
a medical perspective, and there is involvement of luminaries from the field of
medicine that makes this effort of great significance. Dr. Leshner noted that
efforts related to nicotine have been highly visible. In addition to the upcoming
nicotine conference, he testified before the Senate Committee on Labor and Human
Resources to inform them about nicotine addiction. He also testified for a special
hearing of the Senate Appropriations Subcommittee.
The town meetings are continuing to occur and enjoy ever greater successes.
Approximately six hundred people attended the recent meeting in Boston, and one
is planned for Iowa in the fall. Simultaneously with the Iowa meeting, NIDA will
place science education materials developed through the NIDA Science Education
program into every middle school in the United States.
Treatment providers, policy makers, and researchers benefitted from their interactions
and attendance at the NIDA treatment conference held in April. Approximately 900
people attended. Another accomplishment, one that grew from Council discussions
about two years ago, was the development of a manual for assisting communities
evaluate the local context and local environment so that those communities can
successfully implement prevention programs, modifying them as needed to the local
needs. This manual, Assessing Drug Abuse within and across Communities, has been
very well received.
A methamphetamine research report has been released as part of the ongoing
research report series. A Practical Theorist report on drugs in the brain has
been released by the Community Anti-Drug Coalition of America (CADCA).
A depiction guide has been developed with the Entertainment Industries Council
in order to help those in the entertainment industry accurately depict drug abuse
and addiction in their products. Relatedly, NIDA, along with the Entertainment
Industries Council and the Robert Wood Johnson Foundation, held the second annual
Prism Awards. The Prism Award is given for accurate depictions of drug abuse and
addiction in the media. Over 350 people, more than expected, attended the award
ceremony, which attests to the impact NIDA can have by recognizing others' efforts
to reduce drug abuse. Finally, the Bill Moyers' series, "Close to Home: Moyers
on Addiction," was noted as a major accomplishment in disseminating information
about addiction, its consequences, and its presence across ethnic and cultural
groups. It was seen by approximately 12 million people.
- Report from the Director, Center for Substance Abuse Prevention - Dr. Karol
Dr. Leshner introduced Dr. Karol Kumpfer, who was recently appointed the Director
of the Center for Substance Abuse Prevention at the Substance Abuse and Mental
Health Services Administration. Dr. Kumpfer began her remarks by noting epidemiologic
and societal trends of concern to the drug abuse field. These include increases
in alcohol, tobacco, and drug use in youth; changes in demographics; reductions
in the "safety net" of Medicaid and Medicare; lack of support for substance
abuse treatment under managed care systems; corrections-based rather than medical
solutions to drug use; and cuts to CSAP discretionary grant programs. Citing her
experience as a state deputy director involved in substance abuse planning in
1982, Dr. Kumpfer outlined the challenges that local communities face in such
times of reduced budgets, especially if they do not have guidance and management
accountability. However, she noted that there were reasons for optimism despite
the current concerns. These reasons include a much better (than in 1982) understanding
of how to develop and implement effective prevention programs and increased collaboration
among federal agencies. Collaboration has also been strengthened at the state
and private sector level. Further, science is providing hope to parents by clarifying
that, while peer influence is important under some circumstances, parents also
have influence. A major remaining challenge is to help researchers disseminate
their results to those who need them.
Dr. Kumpfer presented her model of CSAP's role as a bridge from research to
practice. CSAP/SAMHSA can serve as a bridge by 1) field testing promising models;
2) facilitating adoption of best practices; 3) supporting infrastructure development;
and 4) promoting service availability. She also noted that CSAP has a budget line
apart from its block grants, the Knowledge Development and Application (KD&A)
activity. To illustrate, she gave three examples of CSAP programs to develop knowledge,
disseminate information, and develop the capacity to use information. She then
presented information on upcoming "KD&A" announcements and activities
Council members expressed support for Dr. Kumpfer's vision of CSAP's role and
expressed a desire for close collaboration between NIDA and CSAP as prevention
programs are implemented, evaluated, and "marketed" for dissemination. The potential
for using schools of public health to assist in CSAP's activities was also noted,
and Dr. Kumpfer informed Council of a faculty development program that would be
relevant for those in schools of public health.
- New and Proposed NIDA Initiatives and Council Suggestions - Dr. Alan I.
Dr. Leshner opened and led a discussion of scientific opportunities and priorities
for the Institute and noted that five areas in particular had been identified
and developed in consultation with Council and other sources. These priorities
are: (1) The Treatment Initiative, which includes medications and behavioral components;
(2) Children and Adolescents, with particular focus on the domains of prevention
and issues surrounding prenatal and developmental factors; (3) Vulnerability to
Addiction, which goes beyond examining determinants of use to examine genetic
and other determinants of addiction; (4) Methamphetamine Research, in order to
avert the growing crisis of methamphetamine use as it spreads eastward across
the nation; and (5) Combating Nicotine Addiction, which examines the nature of
addiction to nicotine and interventions for nicotine addiction.
Council commented that attention to marijuana was absent in the foregoing discussion,
and Dr. Leshner replied that NIDA already has a substantial investment in marijuana
research and solicited Council's further input on the issue. Dr. Leshner further
noted that the legislative authority for NIDA includes studies of the abusability
of marijuana but not studies of marijuana's indications for specific medical conditions.
These are within the purview of other institutes of the National Institutes of
Council supported the concept of a national clinical trial network for drug
abuse treatment interventions and suggested that a similar network for studying
prevention might be useful. Members also suggested topics that could be included
under the areas mentioned, such as prices and access as affecting vulnerability
to addiction or epidemiologic issues in methamphetamine research. Treatment in
children and adolescents was mentioned as a need, as was the treatment delivery
system and its need to be responsive to both drug abuse and HIV disease. Developing
therapeutics for HIV and ensuring their applicability to drug users was another
topic of interest to Council. International studies, continued work in basic neuroscience,
and collaboration around training issues (e.g., to support research training and
to ensure clinical training is based on scientific findings) were other needs
- New Center Program and Review Guidelines - Dr. Teresa Levitin
Dr. Levitin reported that the current guidelines for NIDA centers were established
in 1995 with the understanding that they would be re-examined after NIDA had some
experience in implementing them. An internal NIDA steering committee has met and
proposed some changes, but the basic parameters have not changed. NIDA centers
still represent the entire breadth of NIDA-supported science, and they are expected
to demonstrate superb centerness and stellar science. The new document clarifies
the meaning of "centerness" and makes clear the distinctions among types
of centers. The guidelines now incorporate the new review criteria, and procedural
and administrative changes have been included. The centers review committee will
meet three times annually, and a preliminary assessment of science will occur
at the first step of the two stage review.
Council asked about the number of NIDA centers and how that compares to other
NIH components. Dr. Leshner explained that NIDA has a smaller percent of its budget
dedicated to centers than the average NIH Institute. A discussion of several issues
related to centers ensued. These issues included renewability of centers, supplements,
and operationalization of "centerness." Council expressed a desire for data on
renewal rates for NIH and NIDA centers.
- Ethnic/Cultural Issues in Drug Addiction Treatment - Dr. Kathy Sanders-Phillips
Dr. Sanders-Phillips noted that she presented a workshop on ethnic and cultural
issues in drug treatment at NIDA's recent drug treatment conference, and this
workshop formed the basis for her comments. She presented an overview of the literature
on health interventions and drug treatment with minority populations, and she
presented data from her own research. Previous research has often ignored minority
populations and been limited by a failure to address the heterogeneity of minority
groups. Other methodological concerns (e.g., failure to establish service equality
among groups, failure to distinguish between cultural background and cultural
identity) were noted. Research has often been based in a deficit model, and sociocultural
factors have been addressed poorly - or not at all. Confounding issues, such as
poverty and attitude towards treatment, also are often not addressed. Factors
related to successful interventions with minorities were outlined, and suggestions
for future research directions were made.
Dr. Leshner and Council thanked Dr. Sanders-Phillips for her overview and discussed
the implications her comments would have for several NIDA initiatives, such as
the treatment network and research training, as well as for the way research applications
- Treatment Research Subcommittee Report - Dr. Alan Marlatt
Dr. Marlatt summarized the highlights of the recent NIDA treatment conference
(National Conference on Drug Addiction Treatment: From Research to Practice, April
8-9, 1998). He related that General McCaffrey's keynote address emphasizing that
research should inform public policy was well delivered and well received. Theory
and data were consistently integrated throughout the conference, and there was
evidence of integration of types of treatment so that different modalities were
combined to heighten treatment effectiveness over what would be expected from
a single modality intervention. Dr. Marlatt summarized several presentations.
He reported that a publication on principles of effective drug treatment is in
early stages of development as a result of the conference. Dr. Leshner thanked
Dr. Marlatt for his report and indicated interest in the treatment publication
- Children and Adolescents Subcommittee Report - Dr. Kathy Sanders-Phillips
Dr. Sanders-Phillips reported that the Children and Adolescents Subcommittee
members at their first meeting spent time in getting acquainted with each other
and learning about NIDA's activities around children and adolescents. Particular
items of discussion were the policy on inclusion of children in research, follow-up
of children prenatally exposed to drugs into their school ages, neuroimaging,
risk behaviors, and criminal justice concerns. They also discussed a need for
training minority researchers in child and adolescent research. Dr. Leshner thanked
Dr. Sanders-Phillips for her report.
- Council Comments
Future topics for Council meetings were raised. Topics of interest included
the proposed transfer of methadone from an FDA regulatory program to a CSAT certification
program. Council indicated that an update on that issue from CSAT would be useful.
An update on the development of new study sections was requested, and the point
was made that data on review groups' functioning would be helpful. A discussion
of the mission of the new NIDA Center on AIDS and Other Medical Consequences was
requested. A final area of interest was treatment in correctional settings.
- Public Comments
Mr. Chuck Thomas of the Marijuana Policy Project provided his perspective on
recent legislation before Congress and urged NIDA to increase marijuana's availability
for medical research.
Dr. Leshner adjourned the 69th meeting of the National Advisory Council on
Drug Abuse at 3:04 p.m.
I hereby certify that the foregoing minutes are accurate and complete.
|Alan L. Leshner, Ph.D.
National Advisory Council on Drug Abuse
|Teresa Levitin, Ph.D.
National Advisory Council on Drug Abuse
Note: Informational materials provided to the public at the open session of
the meeting may be obtained from the Executive Secretary.