The

Other highlights of the request that I will mention briefly include an $8.8 million increase in funding for homeless persons with mental and addictive disorders, bringing the total in this area to $89 million. Administration is proposing a government-wide consolidation of all McKinney Demonstration programs in the Department of Housing and Urban development to allow for more efficient and effective management. In FY 1992, the ADAMHA budget also includes a new $20 million homeless research program that will generate knowledge needed by the States to help this population. We propose to phase out two NIMH programs for which States have the authority and expertise to continue--Clinical Training and Protection and Advocacy. And, consistent with the statutory agreement (P.L. 98-621) transferring Saint Elizabeths Hospital to the District of Columbia, no additional subsidy is authorized for the Hospital.

I will be pleased to answer any questions you may have.

BIOGRAPHICAL SKETCH OF DR. 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 of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism--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 is the Government's top psychiatrist, directing 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 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 for measuring changes in brain chemistry. Although he made seminal scientific contributions in diverse areas including drug addiction and alcoholism, his research is characterized by key constants: attentiveness to the interaction of biological and psychological factors in mental and addictive disorders; 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 took his psychiatric residency at the University of North Carolina in Chapel Hill. Among many professional affiliations, 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 Psychiatric Times. In 1990, he received the Service to Science award from the National Association for Biomedical Research, and the Public Service Award from the Federation of American Societies for Experimental Biology (FASEB). He is the first recipient of the Fawcett Humanitarian Award of the National Depressive and Manic-Depressive Association. The author of more than 375 publications, Dr. Goodwin recently completed, in collaboration with Kay R. Jamison, Ph.D., a comprehensive textbook on manic-depressive illness (Oxford University Press, 1990), recently designated as the Best Medical Book of 1990, by the Association of American Publishers. 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.

38-711 0-91-18

a/ Includes $31 Million in obligational Authority for funds transferred from the Office of National Drug Control Policy Special Forfeiture Fund

NATIONAL DRUG STRATEGY

Senator HARKIN. Dr. Goodwin, thank you very much for your opening statement

Senator COCHRAN. I do not have any questions, Mr. Chairman. Senator HARKIN. Dr. Goodwin, your Department released a report last November on the economic costs of alcohol and drug abuse which estimates that alcohol abuse cost this Nation $86 billion in 1988 and drug abuse cost $58 billion.

In 1985, the most recent year for which we have data, alcohol abuse caused 94,768 deaths. Drug abuse caused 6,118 deaths. In terms of lost productivity, alcohol abuse cost $24 billion, drug abuse $2.6 billion.

Alcohol is our Nation's No. 1 drug of abuse and top public health problem, yet the budget proposes not a single penny more for the ADMS block grant than we provided in fiscal year 1991.

Given that alcohol abuse is the most prevalent and costliest drug to society, how should the national drug strategy address this issue?

And I guess I want to say also, is the $99 million proposed for capacity expansion to be directed to alcohol, drugs, or both?

Dr. GOODWIN. Well, it will be directed to drugs, but because of the co-morbidity of drugs and alcohol, it is more the rule than the exception that a very large portion of those people will also be alcohol abusers.

I can also point out that we have recent data that the early onset of drug abuse substantially increases by a factor of fourfold to fivefold your risk of becoming an alcoholic later on.

So, in effect, the drug abuse problem is helping to fuel the alcohol problem and make it worse and more intractable.

Senator HARKIN. So it is really going for drugs, but you say there is some coincidental

Dr. GOODWIN. Particularly among the young.

Senator HARKIN. Use of that money for alcohol.

Dr. GOODWIN. It is virtually unheard of to see a pure alcohol abuser or alcohol addicted young person. Among young people today, the coexistence of these disorders is much more the rule than it is the exception, and we know that the early onset of drug abuse can substantially worsen the later expression of the alcohol disorder.

Senator HARKIN. The other part of my question was, how should the national drug strategy address the issue of alcohol?

Dr. GOODWIN. To the extent that the national drug strategy was in response to the drug problem as having special relationships to crime, special relationships to AIDS through HIV intravenous transmission, special relationships to crack babies, a variety of social problems that are serious halo effects of the drug problem which are not halo effects of the alcohol problem to the same extent that we understand the social and public health implications behind the emphasis on drugs. From a public health point of view, we certainly agree that alcohol is a very serious problem, even by itself, without the co-morbidity. Alcohol has an enormous impact on health.

For example, of the $15 billion in direct costs associated with alcohol, only about 20 percent of that goes to the treatment of the addiction itself. The rest goes to the medical consequences of alcoholism.

In the general health arena, alcohol has a major consequence. We do think that many of the treatment dollars in the block grant do end up benefiting those with alcohol along with drugs because of the co-morbidity.

SUBSTANCE ABUSE MORTALITY

Senator HARKIN. It says here you have 94,000 deaths attributable to alcohol and 6,000 attributed to other drug abuse.

Dr. GOODWIN. Yes.

Senator HARKIN. Is it fair to say that alcohol is, you use the word, major? It is beyond that. I mean, it dwarfs the problems caused by other drug abuse.

I am wondering if we are really putting everything we need into alcohol abuse. I have been told time and time again that the-what is the word that is used, gateway drug or the gateway to drugs, is alcohol. It starts with alcohol among young people.

If they do not start on drugs first, they start with alcohol. Maybe that is what you mean by co-morbidity.

Dr. GOODWIN. Well, the problem is that alcohol consumption by the young, at least experimental drinking is so ubiquitous that it is virtually everybody so that, of course, everybody who ends up on drugs will have used alcohol.

But since that is such a common-that is, the use of alcohol among the young is so common from our high school surveys that it is difficult to really call that a gateway drug.

If you look at a more careful longitudinal analysis, actually what we find is that drugs can be gateways to more serious problems with alcohol just as alcohol can be a gateway to drugs. In fact, they sort of wash out.

But let me speak to the issue of 90,000 versus 6,000. I agree that there are certainly more deaths due to alcohol than there are due to drugs. On the other hand, the deaths due to drugs usually occur to young people.

So that the years of life-it is the same argument that we have about AIDS and why AIDS is to important-the years of productive life lost are substantially greater with a young cocaine overdose in a high school or college kid, compared to cirrhosis of the liver that may tragically shave off several years at the terminal end of life. And that is not to trivialize the alcohol problem at all, it is just that the comparison of the numbers dead need to take into account the age at which these people are dying.

Senator HARKIN. I think that makes sense. I understand that.

Dr. GOODWIN. And of course, the HIV connection is a very important one that Dr. Primm could speak to. Drug abuse is now the fastest growing reason for AIDS; that is, the AIDS population that is increasing most rapidly and is causing the spread into the heterosexual population and into women and children is principally related to injection drug abuse or the sexual partners of injection drug users, so we almost have to consider the AIDS epidemic as part of a burden on us in relation to the drug war.