« PreviousContinue »
abuse treatment services next year to nearly 300,000 persons. Of the $99 million, $68 million is requested in budget authority from this subcommittee, and $31 million will be transferred to ADAMHA from the Office of National Drug Control Policy's Special Forfeiture Fund.
Members of the subcommittee likely are aware of the very encouraging trends evident in the most recent results of the National Household Survey on Drug Use and the annual High School Senior survey. I suspect, too, that some of you may be concerned about apparent disparities between these promising survey results on the one hand and, on the other, the deaths, hospitalizations, crime, and other tragic consequences of drug use-particularly among young Black males, among the families of drug users who are put at high risk for AIDS, and in infants who are born addicted.
We are confident that the declines in drug use that we are reporting are real and quite significant from a public health perspective. Incremental annual declines in most categories of drug use are cumulatively convincing-in 1982, for example, 66% of all High School seniors had some illicit drug taking experience. By 1990, fewer than half of all seniors reported any lifetime drug use--that is a reduction of one fourth. Even more meaningful clinically are the drops we're seeing in past year use of drugs, between the year of "peak" use and 1990's rates. At 32.5%, "past year" use of any illicit drug in 1990 is down by 40% since the peak year 1979, when over half of all seniors reported use. Past year cocaine use dropped by nearly two-thirds since 1985; crack is down by a half since 1986; and marijuana is down by half since 1979.
These trends are the cutting edge of the future; conversely, the excessive morbidity and mortality that we are seeing today in many cities are inevitable shadows of the past. For the addicts and victims of drug abuse for whom primary prevention is not an appropriate response, as well as for persons with alcohol disorders and serious mental illnesses, research on fundamental mechanisms of brain and behavior, and an array of effective treatments are needed urgently. Let me offer highlights of our progress toward these ends. Concerned by reports that infants whose mothers used cocaine during pregnancy have abnormal breathing patterns and may be at increased risk of sudden infant death syndrome (SIDS), NIDA investigators ascertained that
infants and children with apnea have high levels of endogenous opioid peptide beta-endorphin in their cerebrospinal fluid that might be involved in SIDS and in the respiratory difficulties associated with the apnea of infancy. In evaluations of a potential therapy using an opioid antagonist, naltrexone, no abnormal respiratory events occurred following naltrexone therapy. The therapy's potential needs to be evaluated in cocaine babies who have respiratory difficulties during infancy.
In research demonstrations designed to study and change high-risk behaviors of intravenous drug users (IVDUs) and their sexual partners, NIDA investigators found that, over six months, educational outreach resulted in decreased frequency of drug injection in 49- to 75% of users and cessation of all IV use in 16 to 47%. These and other high risk behavior changes strongly. support the effectiveness of outreach to IVDUS.
NIMH intramural scientists using positron emission brain imaging techniques (PET scans) found specific abnormalities in adults who had a childhood history of attention-deficit hyperactivity disorder (ADHD). Affecting 3 to 5 percent of the Nation's youth under 13, ADHD is a risk factor for juvenile delinquency and, for many, lifelong problems. Findings that a significant number of children with ADHD have a parent with the condition indicate that the disorder is a distinct, often inherited, neurological problem rather than a result of poor parenting or character weakness.
NIMH investigators found that cocaine use, independent of any other drug use, is an exceptionally strong risk factor for attempted suicide. Analyses of data from NIMH's Epidemiologic Catchment Area study of the mental health of Americans identified a major depressive episode, active alcohol abuse/dependence, and separation or divorce as additional strong risk factors that have a cumulative effect on the probability of attempted suicide.
An apparent marker of and possible contributor to the occurrence of AIDS dementia has been identified by NIMH investigators. Quinolinic acid, a metabolite of the naturally occurring brain amino acid tryptophan, is normally present in the brain in low levels, but the high concentrations typically seen in HIV-infected patients can cause convulsions and damage to brain tissue. Animal studies have shown that in monkeys infected with simian immunodeficiency virus (SIV), which resembles HIV infection, the key enzyme
responsible for the production of quinolinic acid is elevated up to 6800% over Quinolinic acid levels diminish markedly
uninfected control animals.
following AZT treatment.
Recently analyzed data from the ECA study show the median age of onset for several forms of major mental illness, including depression and manicdepression, are considerably younger than previously known. Men and women were two to three times more likely to develop major depression between the ages of 15 and 19 than after the age of 19. Median age of onset for manicdepression (bipolar disorder) is 19 years; for phobia, 13 years, and for substance abuse disorders, the late teens.
In addition to highlighting the urgency of early prevention, identification and treatment, these findings will add impetus to research on the comorbidity, or co-occurrence, of mental and addictive disorders. An analysis conducted last year of data on the prevalence of mental disorders and substance abuse among the adult U.S. population indicate that 30% of adults who have ever had a mental disorder also have had a diagnosable alcohol and/or durg abuse disorder during their lives. More than half (53%) of adults who have had drug abuse disorders have had one or more mental disorders. And 37% of adults who ever have been alcohol abusers have had one or more mental disorders. The findings underscore the importance for health care providers to be alert to the need to treat more than one problem and, from a scientific perspective, raise intriguing questions regarding the etiologic mechanisms underlying these high rates of comorbidity.
NIAAA investigators last year clarified why women are more susceptible than men to such effects of alcohol as blood alcohol concentrations and liver disease. Although the liver is the primary site of alcohol elimination, oxidation of ethanol by alcohol dehydrogenase in the gastric mucosa also contributes to the removal of alcohol. This "first-pass" metabolism of ethanol occurs to a lesser extent in women than in men, and is virtually nonexistent in alcoholic women. These findings, which help clarify many previous apparently contradictory results on sex-related differences in blood ethanol concentrations, are one reflection of ADAMHA's concern with women's health
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. The 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.