these projects also are designed to translate "laboratory knowledge" into clinical uses, they involve rigorously matched controls for experimental variables in the new approach. Another key difference is that while OTI and OSAP demonstrations assess for project-specific effectiveness, the Institute's evaluations are designed to determine methodically if an approach that works in one setting can be applied with equal success to other settings and other populations. Both demonstration approaches expand our treatment and prevention capacity while they are expanding and enriching our knowledge base. An example is seen in the District of Columbia initiative, under which NIDA will conduct research, in specially funded treatment clinics, designed to develop and demonstrate new model programs effective in treating drug abuse and establish appropriate combinations of treatment methods and approaches. I should emphasize again that I am describing a two-way bridge, wherein research both informs and is informed by community experiences. I also want to emphasize our commitment to basic and clinical research which will benefit all persons who suffer alcoholism, drug abuse, and mental illness. As you are aware, President Bush last July signed into law the congressional resolution declaring January 1990 to mark the advent of the "Decade of the Brain." His proclamation recognizes the enormous potential of the brain sciences to advance our understanding of some of the most serious disorders threatening the physical and mental health of the Nation--schizophrenia, major depression, Alzheimer's disease, childhood disorders, and alcoholism and other drug disorders. Two new NIMH research strategies--the National Plan for Research on Schizophrenia and the Brain, and the National Plan for Research on Child and Adolescent Mental Disorders will serve as mileposts for our progress throughout this decade. Under the first of these initiatives, NIMH-funded studies recently have provided new insights into the basic genetic control and regulation of dopamine, a chemical messenger in the brain that is excessively active in schizophrenia. In ongoing work at the NIAAA; computerized tomography is being used to characterize the actual physical changes that occur in brains of alcoholics. CT scans of age-matched alcoholic subjects and nonalcoholic controls reveal substantial, atypicalfor-age damage in the brains of alcoholics, suggesting special susceptibility of the cortex to neurotoxic effects of alcohol. Thus, imaging technologies may be useful in the early diagnosis of alcoholism, and may lend themselves to the development of new treatment approaches for alcoholism. As our understanding of the biological bases and sequelae of drug addiction has deepened, the identification, development, and large-scale clinical trials of medications designed to act specifically on brain neurochemical systems that are linked to tolerance and craving for drugs has emerged as NIDA's number one priority. Crack cocaine is one of the most addictive substances yet known and, because of an uncontrollable craving for cocaine, abusers tend to strongly resist available treatments. Recent results of a NIDA-funded study indicate that the medication flupenthixol offers singular promise in treating crack dependence. Outpatients receiving this medication experienced a rapid, marked reduction in cocaine craving and use, as well as a lessening of cocaine withdrawal symptoms. We hope to replicate these encouraging preliminary findings in a larger, double-blind, placebo-controlled study now being developed. Finally, our budget request includes $12 million for the This final subsidy payment for Saint Elizabeths Hospital. subsidy is to assist the District of Columbia in assuming full operational responsibility for the hospital as authorized by Public Law 98-621. I will be pleased to answer any questions you may have. 26-182 0-90-14 BIOGRAPHY OF FREDERICK K. GOODWIN Frederick K. Goodwin, M.D., is Administrator of the Alcohol, Drug Abuse, and Mental Health Administration of the Department of Health and Human Services. ADAMHA is comprised of three research Institutes--the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the National Institute of Mental Health--and two offices charged with public health applications of research--the Office for Substance Abuse Prevention and the Office for Treatment Improvement. As Administrator, Dr. Goodwin directs federal efforts to contribute scientific solutions to the public health problems associated with mental illness, alcoholism, and drug abuse. He was appointed by President Reagan, confirmed by the U.S. Senate, and subsequently reappointed by President Bush. He is the first federal scientist to have risen through the ranks to attain this high post. A physician-scientist specializing in psychiatry and psychopharmacology, Dr. Goodwin served previously as Scientific Director of the National Institute of Mental Health (NIMH) and Director of NIMH's Intramural Research Program, the largest mental health and neuroscience research and research training program in the world. He joined the NIMH In 1965. Dr. Goodwin is an internationally recognized authority in the research and treatment of major depression and manic depressive illness. He was first to report the antidepressant effects of lithium in a controlled study, and was a leader in the development of safe, effective techniques utilizing cerebrospinal fluid to measure changes in brain chemistry. Although he has made seminal scientific contributions in diverse areas, his research is characterized by key constants: attentiveness to the interaction of biological and psychological factors in mental illness; a focus on longitudinal observation of patients' experiences over the course of Illness; and a commitment to scholarship. A graduate of Georgetown University, Dr. Goodwin received his M.D. from the St. Louis University, and completed his psychiatric residency at the University of North Carolina in Chapel Hill. Among his many professional affillations, he is a Member of the Institute of Medicine of the National Academy of Sciences. He serves on the editorial boards of key scientific journals, including the Archives of General Psychiatry, and is founder and coeditor-in-chief of Psychiatry Research. Dr. Goodwin is a recipient of the major research awards in his field: the Hofheimer Prize from the American Psychiatric Association, the A.E. Bennett Award from the Society of Biological Psychiatry, the Taylor Manor Award, the International Anna-Monika Prize for Research In Depression, and the Edward A. Strecker Award. In 1986, President Reagan conferred upon Dr. Goodwin the highest honor available to a member of the career Federal service: The Presidential Distinguished Executive Award. In 1989 he was the first recipient of a new award: Psychiatrist of the Year (Best Teacher in Psychiatry) from the Psychiatric Times. The author of more than 375 publications, Dr. Goodwin now has in press, with Oxford University Press, a comprehensive textbook on manic-depressive Illness, co-authored with Dr. Kay R. Jamison. He is one of five psychiatrists on the Current Contents' list of the most frequently cited scientists in the world, and one of 12 psychiatrists listed in the Best Doctors in the U.S. He is married to Rosemary Goodwin, a clinical social worker with expertise in alcohol and drug abuse treatment. They have three children. Senator HARKIN. Dr. Goodwin, thank you very much. I will have some questions about that. I remember you were in my office and we talked about this some time ago. We will see what progress has been made on those drugs. I know FDA has got some. They are under clearance process right now. Dr. GOODWIN. Yes; we are getting good cooperation from FDA and they are treating the drug abuse area more like they have been treating the AIDS area in terms of acceleration. Senator HARKIN. We discussed that. Dr. Harmon, the new Director of HRSA, welcome. HEALTH RESOURCES AND SERVICES ADMINISTRATION STATEMENT OF ROBERT HARMON Dr. HARMON. Thank you, Mr. Chairman. This is my second week on the job and as I left Missouri, where I was the State Health Director, I received a number of plaques and so forth. I told my colleagues: These plaques are fine; what I would really like is a house in Bethesda. [Laughter.] I do bring the State and local perspective. I also was a local health officer in Arizona previously, and I will be working closely with Dr. Mason and Dr. Sullivan to improve the working relationship of the Federal Government with the States and the localities. The 1991 budget for HRSA continues the agency's preeminent role in providing health care and education to the underserved, the disadvantaged, and minorities. This budget of $1.6 billion will meet our commitments through community and migrant health centers, maternal and child health block grant, treatment programs for persons with black lung, Hansen's disease, AIDS, and other conditions, support for health professions students and institutions, and a wide variety of other activities dealing with organ transplantation, vaccine injury compensation, health care services for the homeless, and the initiative to reduce infant mortality. I would like to direct your attention briefly to several new or expanded activities that we will be undertaking. We are seeking $107 million for the new minority health initiative, which includes expanded and revitalized programs on loan repayments and scholarships for service in underserved areas, a program to provide a full range of health care and social services in our public housing units, community-based recruitment of minorities and disadvantaged into health professions careers, and institutional support and faculty development to sustain minority enrollment levels at health professions schools. We are proposing $25 million as an increase in the MCH block grant for the one-stop shopping approach to provide health care, financial assistance, social services, and other community support to pregnant women and to children. We are also expanding the infant mortality prevention project in community health centers, at $4 million. We will continue HRSA's strong involvement in fighting the AIDS epidemic through grants in areas with a high incidence of AIDS, pediatric service demonstration projects, education and training centers to instruct health care providers in better AIDS treatment, grants to community and migrant health centers for treatment of HIV-infected persons, and renovation grants for facilities to deliver better intermediate and long-term care. PREPARED STATEMENT We will focus our health professions support on programs designed to assist the minority and disadvantaged students as a top priority. In 1991 HRSA will address many opportunities and numerous challenges. I believe the budget we are presenting to you will enable us to take advantage and meet those challenges. Thank you. [The statement follows:] STATEMENT OF DR. ROBERT HARMON I am pleased to appear before you today to discuss the fiscal year 1991 budget request for the Health Resources and Services Administration (HRSA). HRSA's clients are: O O O O O O 0 0 mothers and children, the homeless, the poor and disadvantaged, the medically underserved, migrant workers, health professions students, persons with AIDS, chronic lung disease and Hansen's disease, those in need of organ transplants, those who are too sick to leave their homes. HRSA programs span a wide range of activities. They: provide grants or support for personal health services In fiscal year 1991, we are requesting approximately $1.6 billion and 1,528 full-time-equivalent positions. Our partners in this effort are State and local health departments, universities, private non-profit organizations, and many other participants in our nation's public health system. Since 1982, when the HRSA was formed, its mission has continued to rapidly adapt to a changing environment. While our agency's essential focus has remained ensuring health services to persons who might not otherwise receive care, the agency has developed new and innovative approaches to providing that care. At the same time HRSA has accepted responsibility for new programs addressing current public health needs. Community Health Centers The FY 1991 request includes $438 million to continue support of approximately 550 grantees providing primary health care services to over 5 million medically underserved people. These underserved individuals include those without access to care because they lack insurance, live in communities without sufficient health resources, have health concerns not met by traditional medical care, or face other barriers to care. The request also includes funding to improve compensation packages for center physicians. Migrant Health Centers The FY 1991 request for Migrant Health Centers includes $48 million for the continued support of services to migrant and seasonal farmworkers and their families. Access to health care for this |