Centers for Disease Control
Advisory and Assistance Services

The

The Centers for Disease Control (CDC) utilizes advisory and assistance services to enhance our efforts in the prevention and control of disease. services are used to prevent unnecessary disease, disability, and death by expanding our knowledge in disease control and environmental and occupational safety and health.

Advisory and assistance services are used by all program entities at CDC. Many studies and analyses, such as the Task Force on Pneumoconosis, the Immunization Management Seminar, and the Assessment of HIV, are necessary to prevent and control disease outbreaks. The dissemination and exchange of information with the advisory committees, such as the Immunization Practice Advisory Committee and the Mine Health Research Advisory Committee has given CDC a broader base of knowledge in disease control and environmental and occupational safety and health.

Appropriate use of advisory and assistance services is assured through internal reviews that are in place throughout the procurement, contracting, and personnel appointment process.

WEDNESDAY, MARCH 21, 1990.

ALCOHOL, DRUG ABUSE AND MENTAL HEALTH

ADMINISTRATION

WITNESSES

FREDERICK K. GOODWIN, M.D., ADMINISTRATOR

ENOCH GORDIS, M.D., DIRECTOR, NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

LEWIS JUDD, M.D., DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH

ELAINE JOHNSON, DIRECTOR, OFFICE FOR SUBSTANCE ABUSE PREVENTION

STEPHEN W. LONG, DIRECTOR, DIVISION OF FINANCIAL MANAGEMENT BENY PRIMM, M.D., DIRECTOR, OFFICE FOR TREATMENT IMPROVEMENT CHARLES R. SCHUSTER, PH.D., DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE

DENNIS P. WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, DHHS ALAN LESHNER, DEPUTY DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH

Mr. NATCHER. At this time we take up the budget request for fiscal year 1991 for the Alcohol, Drug Abuse and Mental Health Administration. We have before the committee Dr. Frederick K. Goodwin.

Dr. Goodwin, as the Administrator, would you first tell us who you have with you at the table?

Dr. GOODWIN. Yes, Mr. Chairman. Mr. Dennis Williams, Deputy Assistant Secretary for Budget will be joining us. He has not arrived yet.

On the far right is Dr. Enoch Gordis, Director, National Institute on Alcohol Abuse and Alchoholism; Dr. Lewis Judd, Director, National Institute on Mental Health; Dr. Beny Primm, Director, Office for Treatment Improvement; Mr. Steve Long, who is the Budget Officer for ADAMHA; Dr. Charles Schuster, Director, National Institute on Drug Abuse; and Dr. Elaine Johnson, Director, Office for Substance Abuse Prevention.

Mr. NATCHER. Thank you. We will be pleased to hear from you. Dr. GOODWIN. I am pleased to be here to discuss our 1991 budget request, which totals $2,800,000,000. We feel this will allow us to deal with the diverse areas this agency is accountable for, some of the most important public health issues in our country.

Our primary and defining mission is the conduct and support of specific research on the mental and addictive disorders. That program responsibility is tightly linked to our responsibilities for prevention and the improvement of treatment. Those two programs, prevention and treatment improvement, are focused on drug abuse in particular.

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It is important to us to be able to transfer our research-based knowledge into front line clinical practice and the service systems. We have considerably enhanced capacity to do that through the new leverage we have over the block grants.

DRUG ABUSE

One half of our budget, $1,400,000,000, as you can see in the handouts we have given the committee, is devoted to drug abuse issues. We intend to pursue the Federal response to the drug abuse crisis by a close integration of our basic and clinical research with our research demonstrations and finally with the block grant. We see this as a continuum of function.

I will get back to the research in a minute, which is our most important issue. First I wanted to talk about the expansion of the block grant. We will be describing that. The expansion is in the Office of Treatment Improvement. Dr. Primm is here to answer questions about that very important component of ADAMHA.

The leadership that is reflected in our recruitment of Dr. Primm is also reflected in Dr. Elaine Johnson, who came to OSAP from the National Institute of Drug Abuse with a long career touching on research in drug abuse. That has allowed her to be alert to the potential for linkage between OSAP and NIDA. We see OTI and OSAP as an important bridge between the research community and substance abuse prevention and treatment.

The bridge goes two ways, not only to generate hypotheses for research but to sharpen the research focus, that is to give the researchers some sense of where the gaps are in knowledge out in the field, and also of course for the prevention and treatment of this disorder through prudent programs, wherever possible based on what is known from the research base.

BLOCK GRANT

The block grant will total $1,300,000,000 in the President's request. This is the second year of an increase, the biggest increase of course coming from 1989 to 1990.

It is very important that the block grant programs recognize the high frequency of comorbidity, the coexistence of mental and addictive disorders. Comorbidity is more the rule than the exception. We intend through block grants to provide assistance and emphasize the importance of converging treatment of substance abuse with treatment of mental illness across the spectrum.

One thing that will allow us to assess that issue and others is the set-aside from the block grant, which as you know was legislated by Congress two years ago, and that has enabled us to begin data collection activities, technical assistance activities and service systems research which are very important components in closing the gap between university-based research and the real world of practice and prevention. Most of that set-aside—which will, by the way, equal in our proposal 5.7 percent of the block grant-the bulk of that will be in data collection. The next largest component is services research and the smallest component is technical assistance.