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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.


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

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 mil

lion 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.


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:]


Mr. Chairman and Members of the Subcommittee:

I am pleased to appear before you to discuss the President's fiscal year 1992 budget request for the Alcohol, Drug Abuse, and Mental Health

Administration (ADAMHA).

As the principal source of support for the scientific study of disorders that each year cost our Nation more than $66 billion in direct clinical care costs, ADAMHA's core program 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. In addition, ADAMHA encompasses two Offices--for Substance Abuse Prevention (OSAP), and for Treatment Improvement (OTI)--charged with ensuring that research-based information is introduced in a timely manner into clinical and public health practice. That is, while the task of the institutes is to support controlled research and research demonstration programs, principal responsibilities of OTI and OSAP are to apply research-based knowledge in actual practice settings, to conduct field evaluations of the effectiveness of a given intervention, and to identify and systematically refer to the institutes researchable questions that arise in the "real world" of service delivery.

These core ADAMHA-conducted programs will account for $1.8 billion, or 60% of our total 1992 budget request of $3.1 billion. The other major component of the request is the ADMS Block Grant, which we propose to maintain at its current level of $1.3 billion in 1992.

Of those programs conducted by ADAMHA, basic and clinical research, research demonstrations, and the research portion of the Block Grant setaside account for the predominant share--69.2%--of ADAMHA's budget (Figure 1). An increase of more than $81 million will bring the research total to $1.3 billion in 1992.

The request expands or maintains most activities, again with an emphasis on initiatives launched or accelerated in recent years to capitalize on gains in our knowledge of the brain and behavior. Significant among these is ADAMHA's medications development program, which will increase by 50% to $68.3 million in 1992, an increase that will permit us to build on a new partnership between ADAMHA and the pharmaceutical industry.

A factor critical in the ultimate yield of biomedical research will be a citizenry able to understand and act on new research findings that have a bearing on health and healthy behavior. In the interest of enhancing public awareness of the benefits that derive from the conduct of science, ADAMHA is. requesting $2.4 million in 1992 for science education programs to be directed at children in grades K through 12. This program will be sponsored jointly by the NIH.

The primary thrust of ADAMHA's programs is to elucidate fundamental processes involved in brain and behavioral disorders and to integrate that information into new and enhanced treatments and preventive strategies. Given this orientation toward research, the recently passed legislation establishing the Senior Biomedical Research Service program should enhance the Federal government's ability to attract and retain the best and brightest biomedical and behavioral scientists.

In order to ensure that the wealth of new information that is being accumulated about the basic workings of the brain and substrates of behavior will be linked effectively to public health needs, the NIMH has developed a series of strategic plans for research. The plans address opportunities and needs in areas ranging from neuroscience, to schizophrenia and the brain, to child and adolescent disorders, to research on the services required by patients with severe mental disorders.

Looking again at the total ADAMHA request for 1992, one sees that fully 48%, or $1.5 billion, will continue and expand anti-drug abuse initiatives (Figure 2). With an agency-wide increase of 4.5% over current year funding, more than four out of five new dollars in the budget proposal--$107.2 million-will be devoted to new anti-drug spending, with emphasis on research and treatment programs. In 1992, much of this growth will occur in programs managed by ADAMHA's Office for Treatment Improvement, which has focused on drug abuse treatment issues since its creation last year.

Slated initiatives include a new $99 million program that will expand effective drug treatment services as a means of closing the gap between demand for drug abuse treatment services and current national treatment capacity. These Capacity Expansion Program (CEP) grants will increase the total number of federally-funded treatment slots to 106,500, capable of providing drug

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