Senator ADAMS. Without objection, the written testimony will appear in full in the record as though given.

Dr. SABSHIN. Thank you, sir.

Senator ADAMS. I have just one question, Doctor. How well do you think the ADAMHA and especially the NIMH is doing in getting information out to practicing mental health professionals? I know we have made some enormous advances, and you have testified to them very eloquently. Are these results and suggested changes in practice being made available to the people working in the field? I am just asking that as to what kind of a transmission system we have, or is it all right?

Dr. SABSHIN. It is all right, but it can be improved, sir. There are a variety of things that need to be done to get the new diagnostic techniques, the new therapeutic practices out to the field. A number of organizations in the mental health field in addiction have national congresses. Just 10 days from now we are going to have a meeting with 15,000 people present in which we are going to make every effort to disseminate the information better. That needs to be done throughout the year.

So you have highlighted an important problem. We certainly are working hard to get the new information out so that the public, the patients, potential patients and their families can benefit from the new treatments.

Senator ADAMS. Thank you very much, Doctor, for your excellent testimony. We appreciated it.

Dr. SABSHIN. Thank you,

sir.

STATEMENT OF DR. MARIAN W. FISCHMAN, DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES, JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE, ON BEHALF OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION

Senator ADAMS. Our next witness is Dr. Marian Fischman, American Psychological Association.

Dr. Fischman, welcome to the committee. We are pleased to hear your testimony.

Dr. FISCHMAN. Thank you, sir. I am pleased to testify in behalf of the American Psychological Association on appropriations for the Department of Health and Human Services and the Office of Educational Research and Improvement. My written testimony includes the APA budget recommendations.

Senator ADAMS. Without objection, your written statement will appear in full as though given at this point in the record.

Dr. FISCHMAN. Thank you, sir.

To summarize a few, APA recommends $9.77 billion for NIH for fiscal year 1992, urging that research funds for health and behavior be increased. We particularly support additional funding for the NICHD in the areas of research on injury prevention and child

care.

APA recommends $10 million for individual investigator awards at OERI. We must make a commitment to adequately fund the research component of our education investment if we are to meet the educational needs of our children.

APA recommends $585.9 million for research at NIMH, $330 million for research at NIDA, and $180 million for research at NIAAA.

Mental illness and substance abuse disorders exact a terrible toll on this country both economically and in terms of human suffering. Research into effective prevention and treatment simply must be a national priority. APA urges continued support for the NIMH and NIAAA Homelessness Research Demonstrations and increased funding for AIDS primary prevention research and services.

As a professor in the department of psychiatry and behavioral sciences at Johns Hopkins Medical School and an active researcher in the area of substance abuse for more than 20 years, I want to stress that stable, steady funding for research must be maintained. The President's budget, however, would result in decreases in the number of new and competing renewal grants at NIMH and NIDA and only small increases in NIAAA, lower than in fiscal year 1990. Research support has cycled over the years, and such instability is both wasteful and inefficient. Productive findings, whether in the area of schizophrenia, the opiate receptor, or better prevention approaches for drug abuse and alcoholism, come out of consistent and focused study. We are very concerned about the negative effects that these decreases will have both for our ability to advance knowledge and our ability to attract young investigators to the field.

PREPARED STATEMENT

The President's budget for the ADAMHA Institute slates increases primarily for medication development programs. While APA supports this initiative, it is important to understand that magic bullets will not be developed. Medication interventions for the range of behavioral problems that are the focus of these institutes are unlikely to be effective unless integrated into more comprehensive psychosocial treatments. It is critical that research into their development be supported.

Thank you for the opportunity to testify today. [The statement follows:]

STATEMENT OF MARIAN W. FISCHMAN

I am pleased to testify today, on behalf of the American Psychological Association (APA), on the subject of Fiscal Year 1992 appropriations for the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA), the National Institutes of Health (NIH), and other agencies of the Department of Human Services.

Alcohol Drug Abuse and Mental Health Administration (ADAMHA)

APA recommends funding of $1.254 billion for research and research training at the Alcohol Drug Abuse and Mental Health Administration. Mental Illness and substance abuse disorders exact a substantial toll on this country, both economically and In terms of human suffering. Clearly, research to discover effective means of preventing and treating these problems must be a national priority. It is critical that stable. steady. Increases in the extramural research budgets for Investigator Inititated grants_ at the ADAMHA Institutes be maintained. The President's budget, however, would result In decreases In the number of new and competing grants at NIMH and NIDA. Although additional grants could be funded at NIAAA, the number of grants supported would still be far lower than the number supported In Fiscal Year 1990.

APA recommends $585,9 million for research at the National Institute of Mental Health. Millions of Americans suffer from mental health problems that are largely behavioral in nature. These mental disorders account for $129.3 billion in economic costs, mostly because of lost productivity. Research on the prevention, etiology, and treatment of mental disorders can provide us with Information critical for alleviating this burden.

We applaud the efforts of NIMH to develop a National Plan to improve_Care_for_ Severe Mental Disorders. Appiled research In the areas of clinical services and service systems is critically needed for understanding the most effective ways of deliver Ing effective services to persons with severe mental disorders. However. NIMH should also expand its funding of prevention-related and behavioral research -- as they have repeatedly been urged to do by Congress so mental disorders may be better understood and more effectively addressed.

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APA recommends $330,0 million for research at the National Institute on Drug Abuse. Mounting concern over Increased substance abuse in this country has increased public awareness and concern about problems related to drug abuse, and the need for more research to discover the underlying mechanisms of drug abuse, more effective treatments, and effective approaches for prevention.

The medications development program at NIDA is an ambitious effort to develop new pharmacologic Interventions for drug abuse. These new approaches will not, however, be effective without Integration Into more comprehensive treatment; there is also a need for new and better treatment models that utilize pharmacotheraples. It is critical_that_ research on more comprehensive treatment approaches Involving psychosocial therapies proceed concurrently with the development of new medications. This will lead to the development of effective treatment models that Integrate pharmacological and psychosocial theraples for drug abuse treatment.

I would like to make special mention of the basic research being done on the blological and chemical bases of drug addiction. The development of effective drug treatment programs crucial in the battle against drug abuse depends on the results of this research. The use of animal models in this research is vital, and the amount of money spent on these studies Is minuscule compared to that spent on treatment overall for drug abuse In this country.

APA recommends $180.0 million for research at the National Institute on Alcohol Abuse and Alcoholism. Alcohol abuse is a widespread problem arising from a complex Interplay of biological, psychological, and environmental factors; it is responsible for significantly greater economic costs than drug abuse, and affects many more people. It Is Imperative that adequate research dollars be provided for research on alcohol abuse and alcoholism. Research on behavioral factors is particularly Important for developing effective prevention and treatment Interventions. Even for those who may be genetically predisposed toward alcoholism, we now know that other psychological and environmental factors contribute heavily to this complex disorder. Behavioral prevention research In the area of alcohol abuse is needed, especially with minorities, adolescents, and women.

APA recommends $2.9 billion dollars for AIDS research and services funding for. $1 billion more than the President's request. Primary prevention of the spread of HIV remains the best public health strategy for stemming the tide of this horrible disease. We need to have a better understanding of the most effective Interventions to change high risk sexual and drug using behaviors. This proposed funding Increase is directed at research and services related to primary prevention of viral transmission, and health care. Included in the request is $324 million for ADAMHA's core AIDS activities, a 33% Increase over the President's request. Additional funding would support NIDA's outreach programs to IV drug users, and NIMH's randomized field trials of preventions Interventions, as well as other critical efforts. ADAMHA also has a critical role to play In conducting training of mental health providers on the mental health aspects of HIV Infection, and Initiating mental health services research related to HIV Infection.

APA recommends $14.4 million for the NIMH Homelessness Research Demonstration Program. and $17.7 million for the NIAAA Homelessness Research Demonstration Program. The Administration proposes to eliminate authorities for the NIMH and NIAAA Homelessness Research Demonstration Programs, replacing them with a new $20 million Health and Human Services Consolidated Homeless Research Program to be administered by NIMH under existing authorities. To date, $44 million has already been invested in these programs; an investment that could be lost if currently funded projects lose their third and final year of funding. Without this funding, the research demonstration projects would be unable to complete date collection, analysis and reporting. Thus, no Information regarding the effectiveness of those Interventions would be generated. The loss of critical data would leave substantial knowledge gaps in this area. We urge the Commision to continue funding for those important programs.

APA recommends $47.6 million for NIMH. $7.9 for NIDA. and $7.0 for NIAAA for research training. The success of research Initiatives at ADAMHA depends upon a steady Infusion of new scientists to pursue research careers in the area of mental health. Wo recommend a significant increase in research training funds for areas of critical concern. Including prevention, applied services research, severe mental illness, the neurosciences, and other behavioral research. Thus, we are perplexed that although the Administration has identified the need for a pool of well-trained Investigators to address Important ADAMHA Initiatives, they propose no Increases in the number of funded research traineeships.

APA recommanda $26 million for NIMH clinical training programs. APA also proposes an additional $3 million for programs at NIDA and NIAAA to ensure that alcohol and drug abuse education becomes an integral part of the training resolved by all health and mental health professionals. NIMH clinical training projects are designed to ensure the placement of mental health professionals in underserved areas of the country, and to Improve the quality of training provided to those professionals. The programs train providers to provide services to the most underserved groups. This year, the Administration proposes eliminating NIMH Clinical Training programs. We believe. however, that these programs are providing a vital function of ensuring a supply of trained professionals to provide services to priority populations.

National Institutes of Health (NIH)

APA recommends $9.77 billion for the National Institutes of Health for Fiscal Year 1992. We are deeply concerned about the level of research funding proposed in the President's budget. NIH is able to fund only about 25% of approved applications on average; several Institutes have an even lower success rate. APA supports the recommendation by the Ad Hoc Group for Medical Research Funding of $9.77 billion for Fiscal Year 1992. This appropriation would provide funding for approximately one third of approved, peer-reviewed grants at study-section recommended levels.

APA has long urged that NIH funds for health and behavior research be Increased. This research relates to the most urgent health problems of our nation, since seven of the ten major causes of death--such as unintentional Injuries, heart disease, and cancer--are behavioral In origin. Human beings do not always make optimal choices In connection with their health; some of the most difficult problems--stopping smoking, or sticking to a healthful diet--are the health behaviors that are most costly to our nation.

APA supports a large Increase in funding for the National Institute of Child Health and Human Development (NICHD). The healthy development of children, and prevention of childhood disorders, require intensified research efforts and additional funds. In particular, we support an additional $500.000 for the injury prevention research_program at NICHD and a total of $9 million in spending for NICHD's multisite national child caro study and for additional research projects on child care. APA supports the Frlands of NICHD's request for $702 million for Fiscal Year 1992. or $181.4 million above the President's budget. APA also supports Increased research at the National Institute on Aging on long-term care and and the burdens of caregiving. We urge $5 million above the President's budget for long-term care research. and an additional $2.5 million for human factors research related to aging; neither of these areas has received the attention that its promise merits.

Centers for Disease Control National Institute for Occupational Safety and Health (NIOSH)

APA recommends $128 million for the National Institute for Occupational Safety and Health (NIOSH). a 37 percent increase over the agency's current budget and an amount that will allow expansion of Initiatives focused on workplace stress. The President's budget contains no additional funding for any NIOSH activities. Estimated annual costs for psychologically disabled workers are in excess of $15 billion in disability payouts and lost wages alone, and occupational stress claims are accelerating faster than any other type of worker Illness compensation claim. APA has joined with NIOSH to promote further research and training directed toward Identifying risk factors and workers at risk for job stress, understanding the consequences of Job stress, and Identifying stress control measures. Increased funding is needed for NIOSH to address critical research areas, such as risk factors for stress, consequences of stress, and control of

Job stress, and to expand professional training opportunities to Increase the number of professionals trained to address these needs.

Office of Educational Research and Improvement (QERI)

Achieving

APA recommends $10 million for lodividual Investigator research at OERI. the national educational goals established by the National Governors Association In 1990 such as ensuring that by the year 2000 all children will start school ready to learn, that U.S. students will be first In the world in science and mathematics achievement, and that students will be competent in challenging subjects will depend on finding solutions to questions and problems into which we have invested little research. For example, researchers are now struggling to discover how children normally learn and process Information--Information that is critical for understanding how children may become competent In math and science.

Out of a total $29 billion national budget, the education research budget of $74.3 million equals an Investment of only two tenths of one percent, and the percentage of the budget dedicated to the Individual Investigator is minuscule. Certainly, In a nation as rich in resources as ours, even In tough economic times, we can make a commitment to adequately fund the research component of our education Investment. Without an adequate research base, we are simply left to trial and error for Improving the educational system.

OERI simply doesn't have the needed resources to adequately fund Individual Investigators conducting education research. Approximately $2 million is requested by the Administration for Individual Investigator research awards; doubling the funding available for these awards In Fiscal Year 1991. However, this level of funding for Individual Investigator awards is still woefully Inadequate. APA recommends that the Individual Investigator research amount be Increased to a level of $10 million. This will help to foster Interest In the field and promote and recruit researchers, Including minority researchers, Into the field.

Thank you for the opportunity to present the views of the American Psychological Association on these Important Issues. We appreciate your past support for these agencles, and urge additional support for Fiscal Year 1992.

Senator ADAMS. Thank you, Dr. Fischman. You have indicated that psychotherapy is necessary with drugs to treat addiction. Do you have or would you wish to state-and you can do this in written form for the record if you prefer-what you believe are the most promising areas of behavior research you would like to see NIMH support?

Dr. FISCHMAN. Well, I would both like to submit written testimony but also to give you an idea of what I mean.

These addictive behaviors, these mental illnesses are basically behavioral problems. People take drugs. Drug taking is a behavior. Whatever else we do, we have to figure out how to prevent this chronic relapsing, behavioral problem. It is only by understanding the behavior and understanding how we can shape and modify that behavior that we can begin to understand how to treat. We can give people medication, we can help them stop taking the drug. We can help them come into treatment, but once they are in treatment we have to know how to change that behavior.

Senator ADAMS. Thank you very much, Doctor, for your testimony.

Dr. FISCHMAN. Thank you, sir.

STATEMENT OF DR. DAVID H. VAN THIEL, MEDICAL DIRECTOR, TRANSPLANTATION, DEPARTMENT OF SURGERY, UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE, PITTSBURGH, PA

ACCOMPANIED BY DR. TIN-KAI LI

Senator ADAMS. Our next witness is Dr. David Van Thiel and Dr. Tin-Kai Li, Research Society on Alcoholism.

I do not want to take away from anyone, but I notice that we have Dr. Perrine here of the Vermont Alcohol Research Center.