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.

PREPARED STATEMENT

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:]

STATEMENT OF DR. FREDERICK K. GOODWIN

I am pleased to appear before you to discuss the President's fiscal year 1991 budget request for the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA).

The request totals $2.8 billion, of which $1.3 billion is distributed directly to the States through block grants.

Another

$1.5 billion is requested to support research, treatment, and prevention activities focused on mental illness, alcoholism, and drug abuse; this amount includes $50 million for new grants in the "Community Partnership" drug abuse prevention program; $7 million for continuation of a rural mental health research initiative begun in 1990; and $72 million for programs targeted on the needs of homeless persons who suffer mental and addictive disorders. There is $1.4 billion in this budget for drug abuse, a 15 percent increase over last year. Also, the request includes $230 for ADAMHA's AIDS programs.

This budget will further our capacity, and that of the States and communities, to respond decisively and effectively to the evolving patterns and consequences of substance abuse in this country. Our request also anticipates the remarkable opportunities open to us to improve treatments for mental and addictive disorders on the basis of scientific findings regarding the fundamental biological and behavioral mechanisms involved in disorders which are estimated to cost the Nation $50 billion annually for clinical treatment and support services, and more than four times that amount in indirect costs associated with premature mortality, reduced productivity, crime, and social welfare programs.

We are pleased to report that our most recent data document a dramatic, continuing decline in the use of illegal drugs by the population-at-large. At the same time, we are very concerned by a parallel trend toward the increasingly pathological, addictive use of substances including crack, potent new designer drugs, and the combined use of alcohol and other drugs by a smaller number

of users, with consequences that constitute a national tragedy. While the destructive use of drugs is not limited to any subgroup of Americans, the severity of consequences is not distributed evenly. The toll of drug use among young male members of the Nation's urban underclass is unconscionable; the impact on the unborn children and infants of women of childbearing age--and, specifically, the recent phenomenon of "crack babies"--is heartbreaking; the effects of drugs on the one-insix persons who are mentally ill at any given time, or homeless, or who carry HIV, the AIDS virus, confound the already precarious situations of these specially vulnerable individuals.

The broad shift toward more dangerous patterns of drug use challenge us, as a Nation, to recognize that developing more effective treatments and strategies for preventing addiction requires a substantial and sustained research effort--and to realize that an integral part of that effort must entail a high priority on translating knowledge generated through research into improved treatment and prevention services.

A key element of ADAMHA's response to this challenge is an intensified commitment to our primary scientific mission--to generate new knowledge and to translate that knowledge into clinical practice. To that point, I would express appreciation to the members of Congress for your support, particularly over the past 7 to 8 years, of our research programs. Although the depth and quality of the knowledge base among and within the fields of mental illness, alcoholism, and drug abuse remains uneven, we are finding that advances in one field increasingly often inform the hypotheses and speed the pace of work in other fields. And, as sophisticated epidemiological research defines the frequency of comorbidity, or co-occurrence, of mental and addictive disorders, practical applications of such crossfertilization of the knowledge base are more apparent.

Recently, we created an Office for Treatment Improvement in the Office of the Administrator to advance ADAMHA's ongoing

national leadership initiatives to translate our knowledge base into improved treatment services. We are fortunate to have recruited Dr. Beny Primm, who is among the Nation's pre-eminent authorities on drug abuse treatment, to head the new OTI.

Under Dr. Primm's guidance, OTI extends to the clinical treatment arena the quality of dedicated expertise which ADAMHA currently possesses in the primary prevention sphere, embodied in the Office for Substance Abuse Prevention (OSAP). The OTI, I should note, also administers funds passed through ADAMHA in the form of the ADMS Block Grant and the Mental Health Services to the Homeless Block Grant, and monitors State accountability to its provisions.

The OTI and OSAP bridge the traditional research sector with the front lines of substance abuse treatment and prevention services, primarily through the application of new knowledge in the form of demonstration projects which apply research-based findings in large populations and which nourish research by identifying promising interventions which need further testing

and refinement.

Because ADAMHA's research institutes--the National

Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism--also support demonstration projects, let me anticipate questions that may arise regarding the division of responsibility between these two components of the Agency.

The demonstrations conducted by OSAP and OTI are designed to try out new approaches or methods that are based on state-ofthe-science knowledge and theories. If one views our strategy as a "crash program," these projects represent our effort to test, immediately and in real-world settings, the feasibility of new prevention and treatment service models. The evaluation built into each project is intended to answer the specific question of whether a given approach "works" here and now.

Demonstrations conducted by the Institutes, on the other hand, are intrinsically of a research nature. That is, while