Alcohol Abuse and Alcoholism recently developed a new method which appears capable of identifying alcoholism early in its development on the basis of statistical comparisons of blood samples. Grantees of the National Institute on Drug Abuse have continued their pioneering investigations of endorphins, which are naturally occuring opiate-like chemicals in the brain. This research may make possible someday the development of a Salk-like vaccine for the treatment and prevention of drug abuse. Other investigators working with support from the National Institute on Drug Abuse have developed, and are now field testing, a kit for measuring marijuana metabolites in urine. This may make it possible to detect whether a person is driving under the influence of this drug. Dramatic advances also have been made in "mapping" brain functions. By using a new technique developed by the National Institute of Mental Health, scientists have been able to trace metabolism of deoxyglucose inside the brain. This is a giant step forward in that it appears to have enormous potential for assessing the effects of various treatment agents. This would lay the ground work for reducing the number of people affected by major mental illnessess such as depression and schizophrenia. Newly developed treatment techniques have allowed a reduction in the size of the population institutionalized because of such disorders in the United States from close to 600,000 in 1955 to approximately 150,000 in 1981. American corporations have utilized knowledge from ADM research in their development of occupational alcoholism programs. In the past ten years, the number of major American corporations with such programs has risen from a little more than 20 percent of the Fortune 500 corporations to well over 50 percent in 1979. Our ability to provide effective treatment for alcohol, drug abuse, and mental health problems, depends heavily upon a steady flow of new knowledge, their causes, and the best possible therapeutic approaches. In terms of both economics and ultimate results, we believe that a strong research program is the best investment that can be made in promoting our primary goals. In other areas, our treatment programs are now providing services to over 4 million persons throughout the nation. We have established valuable management linkages with the States first through our State-wide service grants in drug abuse, and, more recently, with the alcoholism services development program, which is developing as the conduit for our alcoholism treatment funds. In mental health, we have been in the process of implementing the newly enacted Mental Health Systems Act, which promotes increased ties with State and local agencies as well as improves our general responsiveness to the mental health service needs of the nation. This new services program emphasizes provision of community mental health services which are truly comprehensive, organized to achieve maximum flexibility and accountability, and fully coordinated with local health and related social support services. Priority target populations are the chronically mentally ill, the elderly, severely mentally disturbed children and adolescents, and other underserved segments of our population. The goal of better mental health care for these groups is achieved through several targeted funding mechanisms, and through continued support for general mental health treatment programs in communities. Pilot programs addressing needs of the chronically mentally ill have been very successful, and the fact that a number of States have invested many times the federal contribution reinforces our belief that real benefits can be gained from this program. My last area of emphasis is the alcoholism service initiative launched in 1980. The initiative, based on recommendations of a special task force conducted by the Department, has focused on six areas of special need: women, youth, domestic violence, the fetal alcohol syndrome, occupational alcoholism programs and the Department's Employee Assistance Program. Considering the pervasive problem of alcohol abuse in our society and the past relative lack of federal resources devoted to this problem, we believe that a targeted effort such as this is the best way to address it. All indices of disease incidence and cost versus resources expended addressing it indicate that alcoholism is the most neglected disease in our society. Finally, Mr. Chairman, I would like to turn to our role in developing and promulgating regulations, an area that I understand is of special interest to the Committee. ADAMHA is not a regulatory agency, per se. Most regulations developed by the agency are required to clarify and implement our grant and contract programs, as required by authorizing legislation or the Adminstrative Procedure Act. Our responsiblilities in this area are to develop the implementing regulations consistent with Administration policy and the intent of Congress, request and analyze public input, and publish the final regulations in the Federal Register and the Code of Federal Regulations. As a rule, ADAMHA regulations do not impact upon the general public. They have the most direct application for agency grantees and contractors, and comments on proposed regulations are received primarily from current or prospective funding recipients. Enforcement of grant guidelines and regulations is part of the ongoing program management carried out by project and grants management officers on a day-to-day basis. The character of this enforcement is to assure that grantees are expending Federal funds in conformance with the purpose for which they were appropriated. Only one set of our regulations impacts upon programs other than those directly supported by the agency. Patient confidentiality regulations restrict disclosure and use of alcohol, and drug abuse patient records maintained in connection with treatment programs which receive Federal funds directly or indirectly. With respect to both these as well as other ADAMHA regulations, the additional cost they impose upon the private sector is minimal. ADAMHA will spend approximately $344,000 in 1981 to develop program regulations. These figures represent the cost of devoting 9.4 workyears of effort to assuring that regulations are in place for all programs, especially those newly authorized by the Mental Health Systems Act. ADAMHA's responsibility for promulgating regulations is limited to providing printing and publication costs, estimated to be $115,000 in 1981. We would be pleased to answer any of the questions the Committee may have. |