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budget, research findings in the 1980's have significantly impacted on health care costs related to the treatment of alcohol withdrawal, while providing a more informed view of the problems of prevention stemming from advances in research in human genetic. In the 1990's, research on the genetics of alcohol-related genetic organ pathologies as well as research focusing on alcohol's effects on brain function (offering real possibilities for more effective prevention and the development of new pharmacological treatments), offer real hope of further reductions in the costs of health care related to alcoholism. The Research Society on Alcoholism believes strongly that alcoholism research should be a substantial part of the national strategy on substance abuse and dependence.

Senator ADAMS. Thank you, Doctor.

Dr. Li, did you have anything further you wish to state?

Dr. LI. No, Senator.

STATEMENT OF DR. M.W. BUD PERRINE, DIRECTOR AND SENIOR SCIENTIST, VERMONT ALCOHOL RESEARCH CENTER OF THE HUMAN ECOLOGY INSTITUTE

Senator ADAMS. Dr. Perrine, we are pleased to hear from you at this time. If I mispronounced your name, I apologize.

Dr. PERRINE. No, Senator. You are one of few who pronounced it the first time correctly. I am very grateful.

I would like to endorse what Dr. Van Thiel has just presented. I would also respectfully submit that my written testimony be accepted for the record.

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

Dr. PERRINE. My name is Bud Perrine. I am a member of the Research Society on Alcoholism. I am director of the Vermont Alcohol Research Center, and I would like to speak today about one aspect of a focus of our research that goes back many years; in fact, about as long as the agency, the National Institute on Alcohol Abuse and Alcoholism. It has to do with the problem of death on the highway contributed to by alcohol.

We are still losing about half of our highway fatalities in alcoholinvolved crashes. Currently that works out to be about one death in an alcohol-involved crash every 22 minutes or one injury every minute. This is a very serious public safety and public health problem.

I was recently lecturing on the topic and mentioned that this is a relatively constant factor. We are losing about one-half of our individuals on the highway in alcohol-involved crashes. That amount is 25 percent of the total of approximately 100,000 lives lost each year from alcohol-involved causes, so it is the largest single cause of alcohol-involved deaths in the country.

I was asked at the end of the lecture, well, after 20 plus years now of federally funded research, much of which has come through the auspices of this committee, why are we making no progress, or are we making any progress? So the nasty question was, what do you have to show for 20 years of research in the area of drinking and driving? I found that a very challenging question.

We can answer a qualified yes, we have made progress. There has been a reduction which can be attributed to the research findings which have been made available to the decisionmakers and to the committees such as this one and the corresponding committee on the House. Let me give just one example as the focus for my remarks. That is, the change in the blood alcohol concentration

standard which is recommended by the Federal Government for implementation by the States.

Some 20 years ago before the Federal agencies were formed, NIAAA and the National Highway Traffic Safety Administration, most of the States who had any standard at all had 0.15 percent blood alcohol concentration, which is about the same as if a 180pound man drank 71⁄2 12-ounce beers in 1 hour on an empty stomach he would reach 0.15.

With the increase in interest in this area and with the beginnings of systematic research in the area, it was discovered that that was much too high a level. Both from field research and also from laboratory research on the effects of alcohol, the level from Federal recommendations was dropped to 0.10. That is only five drinks in 1 hour for a 180-pound man, which is still far too high. Back in the Commercial Motor Vehicle Safety Act of 1986 from Senator Danforth's committee, a study committee from the National Academy of Science was requested to investigate the problem. I had the privilege of chairing that committee, and we submitted a report on commercial motor vehicle operators, "Zero Alcohol and Other Options", a transportation research board publication. which I commend, in which we recommended there be zero alcohol level for commercial motor vehicle operators because it was the work place, and in terms of impairment that the level should be no higher than 0.04, which is still the equivalent of two drinks, two beers, for this 180-pound man.

The next year the Congress passed a followup bill which required further study for all drivers. I am serving on that committee and can report that in all probability we will be recommending 0.08, which is still high based on laboratory experiments which show that as little as one drink can significantly influence the performance on various cognitive functions.

So we see that the research which has been carried out both in the field and in the laboratory has provided the ammunition, if you will, the scientific evidence which has led in turn to the ability of policymakers to lower the limit.

Now what does that mean? That means that in the 1980's, at least, there has been approximately a 20-percent proportional decrease in alcohol-involved fatalities. Part of that is attributable to the research findings which have been funded through the activities of the subcommittee, through the NIAAA, and have led to these results.

PREPARED STATEMENT

The new wave is interdisciplinary, multisite research on this topic which involves psychiatry, neurology, electrophysiology, psychology, my own field of performance, and genetics. We currently have such a program under way funded by the National Institute on Alcohol Abuse and Alcoholism, and we are looking forward to reporting back to you all in a few years on the results of that, the main point being we need the stability, predictability. Instead of the roller coaster or elevator of Federal funding up and down, we need to attract the younger individuals who are the brightest and the best and can become involved in a problem which they see in their daily lives is taking some of their friends and relatives.

Thank you very much, sir.

[The statement follows:]

STATEMENT OF M.W. BUD PERRINE

Mr. Chairman and members of the subcommittee, thank you for the opportunity to appear before you today and to present testimony concerning alcohol abuse research and funding. My name is Bud Perrine, and I am Director of the Vermont Alcohol Research Center located in Colchester, Vermont.

The Vermont Alcohol Research Center is a not-for-profit organization and receives the majority of its funding from research grants awarded by the National Institute on Alcohol Abuse and Alcoholism. Alcohol is the common element in all current research projects which are all related at some level to drinking and driving. These projects fall into one of three general types: field studies, surveys, or experimental lab studies. The field studies involve extensive personal interviews with convicted drunken drivers in California and Maryland, and with subjects recruited both at roadside in Ohio and at bars in Vermont. The survey research involves randomdigit-dialing telephone recruiting, as well as telephone and personal interviews with the general driving population and the nocturnal driving population, especially female and older drinking drivers. The experimental studies are designed to investigate the characteristics of alcohol tolerance in human subjects from psychobiological perspective, that is, at both psychosocial and biomedical levels. Regarding my relevant professional activities, the National Academy of Sciences invited me a few years ago to serve as Chairman of the Congressionally-mandated study committee to recommend national policy on a statutory blood alcohol concentration limit for commercial motor vehicle operators. More recently, the National Highway Transportation Administration has invited me to serve as a member of an expert advisory panel for a Congressionally-mandated study to determine the appropriate blood alcohol concentration limit for all drivers. In addition, I am a chartered member of the Advisory Committee on Alcohol, Other Drugs, and Transportation formed by the Transportation Research Board of the National Research Council, National Academy of Sciences.

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Alcohol abuse costs this nation dearly. The annual loss of about 95,000 lives from alcohol abuse represents losing the equivalent each year of all the residents of a medium-size city, such as Sioux City, Iowa. Alcohol abuse also costs us more than $115 billion each year; if those dollars could be saved and aggregated, we would not need a Gramm-Rudman-Hollings Bill to fight the national deficit. And all this damage stems from the behavior of citizens who voluntarily drink beverage alcohol, which is legally and readily available throughout our nation, from the most urban to the most rural areas.

We need to know much more about the specific actions of alcohol on the body, on the mind, and on behavior to begin developing and implementing effective and selective prevention measures that will permit the continued voluntary pleasures for so many, yet will avoid the consequent misery for others. To these ends, scientific inquiry and research are absolutely necessary; the National Institute on Alcohol Abuse and Alcoholism is the specific federal agency officially charged with that mission (among others) when it was established just 20 years ago.

Drunken driving is a major public health problem. Almost 45,000 individuals are killed each year on U.S. highways and roads. Approximately half of these, or 23,000 deaths, result from alcohol-involved crashes. That is comparable to losing everyone living in a community about the size of Muscatine, Iowa, each year.

The detailed data behind this statistic are revealing and important: 52 percent of those who die in alcohol-involved crashes are the alcohol-impaired drivers themselves, and another 11 percent are drinking pedestrians. Of the remaining victims, 20 percent are passengers in the drinking driver's vehicle, whereas 17 percent are drivers, non-drinking pedestrians, or passengers who were not in the drinking driver's vehicle. Thus, we lose some 4,000 innocent people to alcohol violence on the highways each year-this is roughly comparable to losing all 11 members of your favorite football team-each and every day of the year-at the hands of drunken drivers. Any one of us here in this room or anywhere else in this nation could be killed by the random terrorism of a drunken driver crashing into us as we innocently use the highways or sidewalks throughout America.

The drunken driving problem is exceedingly complex. It cannot be solved with slogans (for example, "Friends don't let friends drive drunk", "Stop drunk driving", etc.). It cannot be solved by the prohibition of alcohol, as in the Great Experiment. Our major hope is based on achieving the three goals of science: increased understanding of the phenomenon, leading to increased prediction regarding the phenomenon, leading in turn to increased control of the problem. The key to under

standing the first link in this chain-is high quality research focused on drinking drivers.

Research on drunken driving is making progress. The rate has been quite slow, however, due in part to the extraordinary complexity of the phenomena and in part to the lack of predictable research funding that would in turn facilitate a coordinated systematic approach to the problem. Let me address the complexity issue first and the funding issue later.

Almost every American uses the highways, either as a driver or as a passenger. Most of us also use the sidewalks or roadsides as pedestrians or cyclists. Just in terms of the sheer number of drivers in America, the magnitude and complexity of this problem area are overwhelming. The vast majority of Americans also drink alcoholic beverages. A large proportion of Americans do both: they drive after drinking; some do so after 1 or 2 drinks, some after 5 or 6 drinks, and-incredibly-some drive after 10, 20, or even 30 drinks. Consequently, there is a very wide range of behavior and thus an enormous number of possibly relevant variables and contribut ing factors in this problem area.

We have already established the importance of age differences; for example, alcohol-involved crashes are the leading cause of death for teenager's (ages 15-19); and even though they cannot drink legally, the fatal crash rate of young drivers is three times that of older drivers when alcohol is involved. Thus, experience with driving, experience with drinking, and experience with driving after drinking are all possible components in understanding such age differences. Other factors possibly associated with different crash rates among drinking drivers might well be differences in attitudes, differences in personality, differential sensitivity to alcohol actions on behavior, as well as even genetic predispositions to be able to tolerate alcohol effects. Recent research on some of these variables has been useful in differentiating among broad types of drinking drivers. Thus, further research along these lines should be productive in increased refinement and differentiation among high-risk versus medium-risk versus low-risk drinking drivers.

The great complexity of research on this real-world problem causes it to be costly. However, we need a higher not a lower level of funding to assure continued progress and to develop effective means for selectively targeted prevention. The complex object of study is embedded in two of our most frequent activities, namely, driving and drinking. Valid conclusions about the interaction between these two frequent activities cannot be obtained by studying them in isolation or just in the laboratory. Rather, it is necessary to go out of the university, to go out into the field, to observe and interview drinking drivers, and to work with the police and others involved with this problem in the real world.

The contributing factors and significant variables must be teased out painstakingly from the complexity of the whole problem. Furthermore, the more complex the phenomenon, then the larger the number of subjects needed for adequate differentiation and for statistical significance. Field research that addresses a major public health problem of this magnitude is much more costly than laboratory research on isolated variables (e.g., alcohol effects upon reaction time in a psychomotor task). Any attempt to force cost containment on such field research would thus be both stifling and counterproductive. Ultimately, the nature of the problem drives the nature of the research-and that should in turn determine the nature of the costs.

If the fiscal year 1992 research appropriation for the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is not increased substantially, funds available for real-world field studies concerning drinking and driving will not be adequate to support meaningful research on this problem. If the appropriation is as restricted as in the President's request, the already small number of grants and specialists in this crucial public health research area will diminish further. Unfortunately, there are currently so few really dedicated and talented scientists in this area that we cannot afford to lose a single one. On the contrary, we desperately need to attract more new research talent to the alcohol abuse area in general and the drinking-anddriving area in particular.

To provide research continuity and program predictability, we must also resist cutting the NIAAA research appropriation in subsequent years. Rather than reducing, we should be building; and we should be training new researchers in this important public health problem area.

Adoption of the resident's budget would permit NIAAA to fund only 127 new and competing grants; it would also require cuts in continuation grants and reductions in new and competing grants. In the process, it would greatly reduce the flexibility the NIAAA needs in funding grants of varying magnitudes of cost.

In particular, I most strongly endorse the call by the Research Society on Alcoholism for a $35 million increase in NIAAA's budget for research and research training.

In conclusion, the costs of research on drunken driving and other alcohol abuse are extremely small relative to the potential savings in lives, suffering, and dollars, especially when compared to the costs of other federal expenditures, many of which do not have a similar potential for such savings. In view of the increased competition for decreasing federal funds, some criteria should be available to aid in reaching rational decisions on the relative priorities for appropriations. Very compelling criteria for this purpose would be the potential number of American lives saved, the number of injuries prevented, and the number of dollars thus spared. Research on alcohol abuse in general and on drinking and driving in particular clearly meets these criteria. The potential for both human and economic savings in this major public health problem area is enormous.

Senator ADAMS. Thank you very much, Doctor. I have just one question that any of the panel can comment on. It goes to the basic difficult question that you were asked by your class. We have an interest in clinical research and the kind of field studies that you mentioned. Do you think that NIAAA has the right balance between basic and applied research at the present time? If not, can you suggest if a correction should be made and, if so, what type of a correction it should be?

The reason I ask that question is that I am a former Secretary of Transportation and very familiar with NHTSA. Your figures are absolutely right. I am also convinced and understand the effects that alcohol has as a drug. It has become a socially acceptable drug for centuries. I know not why or where it got started, but it has. We, therefore, are dealing with should we be doing what you just suggested, which is trying to have a public campaign to show the killing effects on the highway, in other words clinical research tests, or is there any hope or should we be putting more money into basic cause of alcoholism and attempts to cure at that point? I know there is some genetic writing going on at the present time, but if either or both of you can comment on that, I would be pleased to hear it.

Please go ahead first, Doctor. Then I will go to Dr. Perrine.

Dr. VAN THIEL. I think that the major issue is not how to direct the funds, because I think NIAAA has done a superb job of using the funds that have been made available to it to accomplish each of the goals that you have identified.

I think that the important issue is to continue the funding. The NIAAA did reasonably well when the War on Drugs Program was initiated, but when those funds were withdrawn or not continued it has fallen considerably behind the NIH, such that the NIH had a 15-percent increase in budget and NIAAA had only a 5-percent increase.

I think it is impossible to have any really good ongoing programs with declines in budgets and with failure to support it. So I would recommend that you increase the budget to the $205 million and trust, because the NIAAA has done well, that it will distribute the moneys as is most appropriate.

Senator ADAMS. Doctor?

Dr. PERRINE. I concur with Dr. Van Thiel.

I would simply like to add to that. Since there is no single approach which is going to solve this complex problem which results from the combination of two things that Americans do very frequently and with great pleasure, driving and drinking, we need the genetic approach. That is the new approach. We also need the applied approach, which is public awareness.

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