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and to the needs of blacks, Hispanics, Native Americans and low-income


If we apply what we already know, we will see major

decreases in uncontrolled high blood pressure, high cholesterol,

stroke, and by

east and cervical cancer deaths by the Year 2000.

One of the hallmarks of the 1980's was the recognition that motor

vehicle fatalities, homicide, suicide, and other types of injury are

important priorities for the public health community, and that proven

public health interventions can be used to reduce their terrible toll

on our society.

One in four U.S. residents sustains injuries each


The total lifetime cost of injuries sustained in 1985 was $158


Over the last 5 years, we have delineated many of the causes

of injury, identified important risk factors such as alcohol use,


tested ways to prevent not only injuries but also the disability that

results from them.

Our task for the 1990's is to build the teams from

public health, transportation, law enforcement, and other fields that

are needed to achieve dramatic reductions in injuries and deaths due

to falls, drownings, motor vehicles, homicides, and suicides.

Occupational injuries occur at twice the rate of injuries in the

home, and farming is the second most dangerous occupation in the

country, after transportation workers.

The 9 million farm workers and

family members in the United States bear a disproportionate share of

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comprehensive national system to prevent farm-related injuries and

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In addition, CDC will sponsor a Surgeon General's

conference to exchange information, build consensus, and maximize

collaboration in this effort.

The Institute of Medicine report on The Future of Public Health

makes it clear that these are just a few of the challenges facing

public health during the next decade.

This report, published last

year, emphasizes the need to strengthen the ability of State and local

health departments to cope with this broad and complex array of

prevention issues.

A strong and efficient network of public health

agencies--Federal, State, and local, working with their private sector

partners--is the foundation for effective prevention programs in the


Developments in scientific technology and innovative applications

for disease prevention, and of course, our own talented and dedicated

workforce, make us very optimistic about CDC's ability to meet the

challenges of the 1990's. Mr. Chairman, with your support for this

budget request of $1,171,755,000, including $509.1 million for HIV

control, we will continue to provide leadership to the challenges of

preventing disease, injury, disability, and improving the quality of

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Nov. 1986-
Sept. 1987

Deputy Director (AIDS), Centers for Disease Control


Director, Center for Infectious Diseases, CDC


Assistant Director for Science, CDC


Director, Virology Division, Bureau of Laboratories, CDC


World Health Organization (WHO) Collaborating Center for

Influenza, Director; Honorary Fellow (WHO)


John Curtin School for Medical Research, the Australian

National University, Canberra, A.C.T., Australia


Chief, Respiratory Virology Unit, Bureau of Laboratories,



Supervisory Research Microbiologist, Respiratory Virology
Unit, CDC


Research Assistant, University of Maryland


Adjunct Associate Professor, Department of Parasitology and

Laboratory Practice, University of North Carolina, Chapel
Hill, 1985-present.

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Senator HARKIN. Dr. Goodwin with ADAMHA. Dr. Goodwin.

Dr. GOODWIN. I am pleased to be here. I would like to point out that the budget is outlined in the handouts that I think you have, that give the distributions by activity. We are proposing in ADAMHA a $2.8 billion request, which we think will permit us to address, in a balanced manner, the diverse missions for which ADAMHA is accountable. Our primary and defining mission is research on mental and addictive disorders, with very urgent responsibilities for prevention and for treatment improvement, particularly focused on drug abuse, and for accelerating the transfer of research base knowledge into front line clinical treatment.

We think that there is a real potential advantage in having these treatment improvement and prevention programs in an agency that has so strong a research base.

We also have an ongoing responsibility for the administration of the ADMS block grant, including some new accountability requirement that are built into it.

As Dr. Mason said, fully one-half of our budget is focused on drug abuse. We have seen, in this country, a gradual shift from drugs as a general problem of use to a problem of addiction; that is, general use going down, and the proportion of users who are addicted going up.

The complexity of this problem is daunting. The need for a sophisticated array of research and treatments, as well as translation of research into treatment, is really critical in this area.

Specifically, we intend to integrate the basic and clinical research on drug abuse with the state-of-the-art treatment approaches that will be managed through the Office for Treatment Improvement, a new component of ADAMHA.

There is considerable expansion of the block grant, as well as expansion of the categorical treatment programs in the budget_proposal before you. We are particularly proud to have Dr. Beny Primm, one of the leading drug treatment experts in the world, join us as the Director of the new Office for Treatment Improvement.

The ability of OTI to bring leadership to this area is reflected not only in the persona of a Dr. Primm, but also in its placement in an agency which also contains NIDA and the Office for Substance Abuse Prevention that is so credibly led by Dr. Elaine Johnson.

We are proud of our capacity to bridge from research into the practice, both in the treatment area and in the prevention area. And that bridge is bidirectional, because the demonstration programs give feedback to the researchers about what is most important to study; and the research is able to give feedback to the treatment and prevention systems to try to improve those systems to the state of the art.

This is a complex process, but we think having these programs all within the same umbrella agency will help us do this.

The block grant is increased to $1.3 billion in our request, as indicated in one of the handouts, and it provides funds for prevention and treatment on mental illness, alcoholism, and drug abuse.

I might point out that what is increasingly becoming the rule rather than the exception is comorbidity, that is, the coexistence of drug abuse, alcoholism, and mental illness. And indeed, the most treatment-resistant groups of each of these areas have more than one problem.

We have to be aware of this clinical reality of dual diagnosis when we plan treatment services, earmarks, and so forth.

The set-aside in the ADMS block grant is extremely important to us. We have only had this set-aside for a little more than a year, and it gives us the capacity to collect data that can provide valuable information about these programs. We have been without such information through the whole decade of the eighties.

These set-aside funds also allow us to provide technical assistance to help translate some of the research into practice, and to do a small amount of actual service system research, which fills the gap between university research and the world of clinical practice. ADAMHA also intends to request treatment plans from the States although we do not have the full congressional authority for the treatment plans yet. This should help to provide availability from the States.

Our budget for research, which has been the constant thread of the ADAMHA mission, is nearly $1 billion, and this includes $230 million for our very important basic and behavioral research on AIDS.

We actually want to express deep appreciation to Congress for your support of ADAMHA research over the past 8 years. That support has helped us close a gap between ADAMHA's funding levels and those of the general health research community that had developed in the seventies. Today ADAMHA is really in a position to take advantage of considerable advances in the basic brain sciences and behavioral sciences as they apply to the problems of mental illness, drug addiction, and alcoholism.

Our priority is to pick research projects that have the highest likelihood of long-term payoff and to support emerging areas, such as those elucidated in the NIMH Decade of the Brain and NIMH's new national plan for research on schizophrenia. Also a priority is our focus on childhood disorders. In relation to what Dr. Dowdle said about prevention, we have seen, that identifying and treating childhood mental disorders very early can have, an impact on subsequent adolescent drug and alcohol abuse. Existing data that treatment of childhood mental disorder can help in that arena.

Genetic studies continue to be very important. We are taking advantage of new advances to understand the genetics of severe substance abuse, particularly alcoholism. We also are proposing specific treatment-matching research in alcoholism. For far too long, the treatment system in alcoholism and drug abuse has been based on "seat of the pants" assumptions and professional impressions of what is right, rather than controlled research. We really have to expand our knowledge base as we expand our treatment system.

A high priority in NIDA is the expansion of a medication development program. The ability to treat addiction requires an approach to the chemical trap of addiction, as well as to the psychosocial traps of addiction. One cannot hope for the psychosocial approaches to work unless we can find some way chemically, with a medication, to dampen the craving that drives so many people out of the good treatment programs.


We will support treatment research demonstrations that will expand treatment and expand knowledge at the same time. With the treatment research demonstrations, we are indeed making optimal use of our resources.

I am pleased to have a chance to summarize this and, later on, hope to be able to answer some questions.

[The statement follows:

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