of users, with consequences that constitute a national tragedy. While the destructive use of drugs is not limited to any

subgroup of Americans, the severity of consequences is not

distributed evenly. The toll of drug use among young male members of the Nation's urban underclass is unconscionable; the impact on the unborn children and infants of women of childbearing age--and, specifically, the recent phenomenon of "crack babies"--is heartbreaking; the effects of drugs on the one-insix persons who are mentally ill at any given time, or homeless, or who carry HIV, the AIDS virus, confound the already precarious situations of these specially vulnerable individuals.

The broad shift toward more dangerous patterns of drug use challenge us, as a Nation, to recognize that developing more effective treatments and strategies for preventing addiction requires a substantial and sustained research effort--and to realize that an integral part of that effort must entail a high priority on translating knowledge generated through research into improved treatment and prevention services.

A key element of ADAMHA's response to this challenge is an intensified commitment to our primary scientific mission--to generate new knowledge and to translate that knowledge into clinical practice. To that point, I would express appreciation to the members of Congress for your support, particularly over the past 7 to 8 years, of our research programs. Although the depth and quality of the knowledge base among and within the fields of mental illness, alcoholism, and drug abuse remains uneven, we are finding that advances in one field increasingly often inform the hypotheses and speed the pace of work in other fields. And, as sophisticated epidemiological research defines the frequency of comorbidity, or co-occurrence, of mental and addictive disorders, practical applications of such crossfertilization of the knowledge base are more apparent.

Recently, we created an Office for Treatment Improvement in the Office of the Administrator to advance ADAMHA's ongoing

national leadership initiatives to translate our knowledge base into improved treatment services. We are fortunate to have recruited Dr. Beny Primm, who is among the Nation's pre-eminent authorities on drug abuse treatment, to head the new OTI.

Under Dr. Primm's guidance, OTI extends to the clinical treatment arena the quality of dedicated expertise which ADAMHA currently possesses in the primary prevention sphere, embodied in the Office for Substance Abuse Prevention (OSAP). The OTI, I should note, also administers funds passed through ADAMHA in the form of the ADMS Block Grant and the Mental Health Services to the Homeless Block Grant, and monitors State accountability to its provisions.

The OTI and OSAP bridge the traditional research sector with the front lines of substance abuse treatment and prevention services, primarily through the application of new knowledge in the form of demonstration projects which apply research-based findings in large populations and which nourish research by identifying promising interventions which need further testing

and refinement.

Because ADAMHA's research institutes--the National

Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism--also support demonstration projects, let me anticipate questions that may arise regarding the division of responsibility between these two components of the Agency.

The demonstrations conducted by OSAP and OTI are designed to try out new approaches or methods that are based on state-ofthe-science knowledge and theories. If one views our strategy as a "crash program," these projects represent our effort to test, immediately and in real-world settings, the feasibility of new prevention and treatment service models. The evaluation built into each project is intended to answer the specific question of whether a given approach "works" here and now.

Demonstrations conducted by the Institutes, on the other hand, are intrinsically of a research nature. That is, while

these projects also are designed to translate "laboratory knowledge" into clinical uses, they involve rigorously matched controls for experimental variables in the new approach.

Another

key difference is that while OTI and OSAP demonstrations assess for project-specific effectiveness, the Institute's evaluations are designed to determine methodically if an approach that works in one setting can be applied with equal success to other settings and other populations.

Both demonstration approaches expand our treatment and prevention capacity while they are expanding and enriching our knowledge base. An example is seen in the District of Columbia initiative, under which NIDA will conduct research, in specially funded treatment clinics, designed to develop and demonstrate new model programs effective in treating drug abuse and establish appropriate combinations of treatment methods and approaches.

I should emphasize again that I am describing a two-way bridge, wherein research both informs and is informed by community experiences.

I also want to emphasize our commitment to basic and clinical research which will benefit all persons who suffer alcoholism, drug abuse, and mental illness. As you are aware, President Bush last July signed into law the congressional resolution declaring January 1990 to mark the advent of the "Decade of the Brain." His proclamation recognizes the enormous potential of the brain sciences to advance our understanding of some of the most serious disorders threatening the physical and mental health of the Nation--schizophrenia, major depression, Alzheimer's disease, childhood disorders, and alcoholism and other drug disorders.

Two new NIMH research strategies--the National Plan for Research on Schizophrenia and the Brain, and the National Plan for Research on Child and Adolescent Mental Disorders will serve as mileposts for our progress throughout this decade. Under the first of these initiatives, NIMH-funded studies recently have

provided new insights into the basic genetic control and

regulation of dopamine, a chemical messenger in the brain that is excessively active in schizophrenia.

In ongoing work at the NIAAA, computerized tomography is being used to characterize the actual physical changes that occur in brains of alcoholics. CT scans of age-matched alcoholic subjects and nonalcoholic controls reveal substantial, atypicalfor-age damage in the brains of alcoholics, suggesting special susceptibility of the cortex to neurotoxic effects of alcohol. Thus, imaging technologies may be useful in the early diagnosis of alcoholism, and may lend themselves to the development of new treatment approaches for alcoholism.

As our understanding of the biological bases and sequelae of drug addiction has deepened, the identification, development, and large-scale clinical trials of medications designed to act specifically on brain neurochemical systems that are linked to tolerance and craving for drugs has emerged as NIDA's number one priority. Crack cocaine is one of the most addictive substances yet known and, because of an uncontrollable craving for cocaine, abusers tend to strongly resist available treatments. Recent results of a NIDA-funded study indicate that the medication flupenthixol offers singular promise in treating crack dependence. Outpatients receiving this medication experienced a rapid, marked reduction in cocaine craving and use, as well as a lessening of cocaine withdrawal symptoms. We hope to replicate these encouraging preliminary findings in a larger, double-blind, placebo-controlled study now being developed.

Finally, our budget request includes $12 million for the

This

final subsidy payment for Saint Elizabeths Hospital. subsidy is to assist the District of Columbia in assuming full operational responsibility for the hospital as authorized by

Public Law 98-621.

I will be pleased to answer any questions you may have.

26-182 0-90-14

BIOGRAPHY OF 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 on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the National Institute of Mental Health--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 directs 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 the 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 utilizing cerebrospinal fluid to measure changes in brain chemistry. Although he has made seminal scientific contributions in diverse areas, his research is characterized by key constants: attentiveness to the interaction of biological and psychological factors in mental illness; 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 completed his psychiatric residency at the University of North Carolina in Chapel Hill. Among his 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 the Psychiatric Times.

The author of more than 375 publications, Dr. Goodwin now has in press, with Oxford University Press, a comprehensive textbook on manic-depressive illness, co-authored with Dr. Kay R. Jamison. 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.

Senator HARKIN. Dr. Goodwin, thank you very much. I will have some questions about that. I remember you were in my office and we talked about this some time ago.

We will see what progress has been made on those drugs. I know FDA has got some. They are under clearance process right now.

Dr. GOODWIN. Yes; we are getting good cooperation from FDA and they are treating the drug abuse area more like they have been treating the AIDS area in terms of acceleration.

Senator HARKIN. We discussed that.

Dr. Harmon, the new Director of HRSA, welcome.