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Answer. It is difficult to estimate how much would be required to initiate screening in all communities suspected to be at risk for lead contamination. The Department's recently released Strategic Plan for the elimination of childhood lead poisoning states that the combined National costs of financial assistance to these States and communities with the highest priority of demonstrated significant childhood lead poisoning problems would be $ 25 million for prevention activities in the first year of a 20year effort involving a shared commitment of both public and private sectors to eliminate this disease. The portion of such funds involving increases of Federal assistance beyond the 92% increase proposed in the 1992 President's budget would require offsetting reductions of other programs within the domestic discretionary cap.

Question. Dr. Roper, is it your intention to continue the AIDS prevention cooperative agreements with the six cities?

Answer. CDC will continue to provide funds directly to the six cities (Chicago, Houston, Los Angeles, New York City, Philadelphia, and San Francisco) as directed by the Congress through the HIV/AIDS prevention cooperative agreements. In FY 1992, the funds currently awarded to the states and the six cities for counseling, testing, referral and partner notification (CTRPN) will be awarded through a formula grant for the early intervention services (EIS) cited in the Comprehensive AIDS Resources Emergency (CARE) Act of 1990. In FY 1992-1995, the six cities will continue to receive an amount for EIS which is equal to the amount they received for CTRPN in FY 1990.

SUBCOMMITTEE RECESS

Senator BUMPERS. Thank you very much. The subcommittee will stand in recess to reconvene at 2 p.m., when we will continue our hearings on the administration's budget request, including Alcohol, Drug Abuse, and Mental Health Administration, the Health Resources and Services Administration, and one related agency, the National Council on Disability.

[Whereupon, at 2:22 p.m., Tuesday, March 12, the subcommittee was recessed, to reconvene at 2 p.m., the same day.)

(AFTERNOON SESSION, 2 P.M., TUESDAY, MARCH 12, 1991) The subcommittee met at 2 p.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding.

Present: Senators Harkin, Bumpers, Cochran, Specter, and Gorton.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION

STATEMENT OF FREDERICK K. GOODWIN, M.D., ADMINISTRATOR
ACCOMPANIED BY:
ALAN I. LESHNER, PH.D., ACTING DIRECTOR, NATIONAL INSTI-

TUTE OF MENTAL HEALTH
CHARLES R. SCHUSTER, PH.D., DIRECTOR, NATIONAL INSTITUTE

ON DRUG ABUSE ENOCH GORDIS, M.D., DIRECTOR, NATIONAL INSTITUTE ON ALCO

HOL ABUSE AND ALCOHOLISM BENY J. PRIMM, M.D., DIRECTOR, OFFICE FOR TREATMENT IM.

PROVEMENT ELAINE M. JOHNSON, PH.D., DIRECTOR, OFFICE FOR SUBSTANCE

ABUSE AND PREVENTION STEPHEN W. LONG, DIRECTOR, DIVISION OF FINANCIAL MANAGE

MENT DENNIS WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, OF. FICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES

OPENING REMARKS OF SENATOR HARKIN

Senator HARKIN. Good afternoon. The Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will come to order.

And again, I apologize to Dr. Goodwin and the rest of you here for my delay. Actually, we were talking about appropriations matters, as a matter of fact, over at the caucus.

Today, the subcommittee's hearings on the administration's fiscal year 1992 budget request continue with the examination of the proposals for the Alcohol, Drug Abuse, and Mental Health Administration; the Health Resources and Services Administration; and the National Council on Disability, one of the related agencies funded by this subcommittee.

Our first witness is Dr. Frederick Goodwin, the Administrator of ADAMHA. For ADAMHA, the administration has requested $3 billion, $3.048 billion to be exact, an increase of $101 million over last year. ADAMHA research would rise $83 million or 8.4 percent over

This funding request supports the important research to fulfill the promise of the decade of the brain as well as essential research on alcohol and drug abuse. But the increases proposed for research

last year.

come at the expense of important service programs that are proposed for termination: Protection and advocacy for the mentally ill, clinically training of mental health professionals, and all homeless service demonstrations.

We have got to try to do better in these areas. The proposed budget would provide $99 million additional for capacity expansion for drug treatment. However, I am concerned that this proposal does not address alcohol, the Nation's worst drug problem.

I am concerned also that States would not share equally in the proposed increase. Providing funds for the ADMS block grant would accomplish this goal, but the administration has requested level funding

for this block grant. Dr. Goodwin, we are looking forward to hearing testimony on these and other programs in the budget. Your complete statement will be printed in the record.

At this point, I will leave it open for any opening remarks by Senator Specter, and I would recognize my distinguished colleague from Mississippi, Senator Cochran.

Senator COCHRAN. Mr. Chairman, thank you very much. Happy to be here with you today to hear the testimony of this panel of witnesses.

These agencies are very important in my State of Mississippi, and I hope by my presence here, to indicate that we want to work with them, to help make sure we deliver the services in an efficient way and in a sensitive way to the people for whom the benefits are designed to assist.

I do not have any formal statement, Mr. Chairman, but I do have some questions, and if I am not able to personally ask them of the witnesses, I would like for them to be submitted to the record, those that I am not able to propound in person.

Thank you very much.
Senator HARKIN. Thank you, Senator Cochran.

Dr. Goodwin, welcome again to the subcommittee and please proceed.

SUMMARY STATEMENT

Dr. GOODWIN. Thank you, Mr. Chairman, and Mr. Cochran as well.

I am pleased to be here to present our 1992 budget request. As you said, it is just a little over $3 billion, and it emphasizes the scientifically and clinically oriented task for which we feel our agency is uniquely qualified; that is, the conduct and the support of research on brain and behavioral mechanisms involved in the mental and addictive disorders, and the application of that research base knowledge to the improvement and expansion of treatment for those disorders, and to refine strategies for prevention.

Accordingly, 69 percent of our proposed budget, exclusive of our block grant, that is, the budget that we directly manage, is slated for research and research demonstrations.

I might add that we feel that research in our area is especially important because of the lack of legitimacy and stigmatization in these populations. If ever one needs data in order to establish legitimacy, establish a basis for equitable reimbursement for services, we feel very heavily the responsibility of making sure that what

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ever we do in the treatment and prevention area is as solidly based as possible since it is not as easily understood as areas in the general health arena.

We feel that our combined research and treatment and prevention activities can expand the Nation's treatment capacity even as we expand knowledge.

Under the request for research, the biggest increase is for the ADAMHA medication development program, that is 50 percent. This is an attempt to try to decrease the drug craving which drives so many people out of the important psychosocial rehabilitation aspects of drug treatment.

As our knowledge accumulates regarding the specific neurochemical abnormalities that can occur in the serious mental and addictive disorders, we can then make rational investments in medications that might help control that aspect of the problem in order to allow the psychosocial approaches to be more effective.

The request also permits us to implement a series of strategic research plans across all three Institutes that focus on new knowledge about brain and behavior and where that new knowledge is ready to be applied effectively to the public health needs, particularly in regard to children and adolescents, persons with very severe disorders requiring long-term care, and those disorders where we think we have a chance of making significant advances in early detection. One example of that would be the use of genetic markers for the more genetic forms of alcoholism.

Given the nature of the drug problem and its continued importance, both from a health perspective and a social perspective in our society, and even though there have been substantial advances in the mainstream of society, there is still a kind of persistence, perniciousness in several important segments of society.

Because of that importance, we note that over one-half of our total budget is still devoted to the antidrug abuse initiative. Indeed, with our new money, four out of five of our new dollars in the budget are devoted to antidrug spending.

The most important highlight of that, Senator Harkin already mentioned, is the $99 million proposal for the new capacity expansion program, which is designed to significantly close the gap between the current demand for drug abuse treatment services and the current national, that is, public and private treatment system.

This capacity expansion program will be based on demonstrated need. That is, an attempt to supplement the block grant by filling gaps, and it will raise the total number of 97,000 Federal slots to 106,000 and that should be capable of treating about 300,000 individuals.

Critical to our ultimate ability to translate our research knowledge into information useful to the public, both in terms of people being willing to use services appropriately and to support the research upon which they are based is our science education effort which I am highlighting here since it is a new component of our budget this year.

We are attempting to increase the relatively poor state of science education, particularly life science education in this country, particularly at the kindergarten to 12th grade level. This is a $2.4 million request for science education activities and associated public education about science.

We are very concerned that unless we do something in this arena, and this is particularly important for the minority populations, to get down into the education pipeline as early as we possibly can, our capacity to still have a vigorous research enterprise will be limited in future years. We are doing this project jointly with the NIH.

We also have an $8.8 million increase in funding for homeless programs, focused on a new homeless program that will provide the States with the information they need to design and configure services that are required by the homeless individuals, particularly that increasing portion of homeless individuals who have mental illness along with substance abuse.

PREPARED STATEMENT

That is the end of my statement, and I would now like to introduce the people who are here with me. On my far left is Dr. Elaine Johnson, the Director of our Office for Substance Abuse Prevention; Dr. Bob Schuster, the Director of the National Institute on Drug Abuse;

Stephen Long, who is the Director of our Budget Office; Dr. Beny Primm, who directs our Office for Treatment Improvement, which also manages our block grant; Dr. Alan Leshner, who is the Acting Director of the National Institute of Mental Health; Dr. Enoch Gordis, who is the Director of the National Institute on Alcoholism and Alcohol Abuse; and Dennis Williams, who is from the Budget Office in the Department.

[The statement follows:]

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