Question: If you were asked to reduce your spending level, what areas could you recommend for cuts? Answer: The recommendation would depend on the size of the reduction under consideration. Expenses incurred by the Office of the Director are for personnel and the operating costs needed to support personnel in the performance of their duties. It is possible that a modest reduction in the level of spending could be accomplished through cutbacks to operating monies, such as travel, training, equipment rental, etc., without necessitating a simultaneous reduction in personnel. However, a reduction of more significant proportions would entail cutbacks to both personnel and support costs. CLINICAL INVESTIGATORS Question: late last year the Committee urged the Director to establish an NIH-wide program on clinical investigation training to redress the shortage of clinical investigators. What have you done in response to the Committee's request? Answer: An NIH report on this subject has been prepared for the Committee. The report, "Assuring the Supply of Clinical Investi.gators," summarizes the activities of the NIH Coordination Committee on Manpower, with respect to the examination of all programs for research manpower development and the establishment of modifications and innovations to assure an adequate supply of clinical investiga tors. Question: How bad is the shortage of clinical investigators? Answer: The NIH observed the decline in absolute numbers of postdoctoral fellows holding clinical degrees until 1976. In 1970, of 7,246 postdoctoral fellows, 4,659 held clinical degrees; in 1975, the number of postdoctoral fellows had decreased to 5,680 with 2,698 holding doctoral degrees. In 1976, there were 1,950 clinical postdoctoral fellows in training, a pool that has remained relatively constant in number since that time. Therefore, although the percentage of individuals in clinical postdoctoral training continues to show a modest decline, the absolute numbers of clinical postdoctoral fellows has remained relatively constant since 1976 at an average of 1,900 per year. In addition, the NIH Advanced Development Programs continue to attract physicians into research careers. BROADENING ADVISORY GROUPS Question: Late last year the Committee renewed its request to NIH to provide more slots for nurses and other health professionals on various advisory boards, peer review groups and study sections. What have you done in response to the Committee's request? Answer: The steps the NIH has taken to broaden membership on various advisory boards, peer review groups and study sections are outlined in a report of February 1981, to the Senate Committee on Appropriations. That report, "NIH Advisory Boards, Peer Review Groups, and Study Sections" reads, on page 3, as follows: SOURCES OF MEMBERSHIP Decisions regarding the types of expertise needed to fulfill the review and advisory functions of each committee are made by the Director of the NIH component using the committee in consultation with the Committee's executive secretary Appropriate nominees are then identified by NIH staff through such means as contacts with former committee members and scientific colleagues; professional societies, foundations, and associations (for example, the Arthritis Foundation, the Council of Primary Health Care Practitioners, the American Society of Respiratory Therapists, the American Black Nurses Association, and the American Association of Hospital Pharmacists); and the recently established NIH Consultant File. The computerized Consultant File is a compilation of names of people who responded to announcements published by the NIH in the NIH Guide to Grants and Contracts, the Federal Register, and widely read scientific journals. The announcements requested names of individuals who wished to be considered for membership on NIH committees and for other peer review activities. The Consultant File, to be expanded and updated periodically, may be searched by field of expertise, name, geographic area, or female or minority status. It currently contains some 8,000 names. Curricula vitae and bibliographies are also available. ALLIED HEALTH PROFESSIONALS Allied health professionals play an important role in the NIH review and advisory process. We believe that this field is well represented: 24% of the membership on NIH advisory councils and boards, and about 12.5% of the total 2007 current members on all NIH public advisory committees. As vacancies occur and as needs for advice evolve, the NIH will continue to call upon allied health experts to meet the obligations of committees at both the initial review and the council levels. These individuals round out the perspectives of the wide range of experts needed to carefully assess the merit of research grant applications and contract proposals and to provide advice on program and policy issues. BUILDINGS AND FACILITIES Question: You are requesting $6.7 million for renovations to the Clinical Center at NIH. How much of this amount pertains to meeting life safety code requirements and how much falls into the general area of cosmetic improvement? Answer: About 75% of the FY 1982 Clinical Center Modernization program involves life safety work and the remainder is work to correct functional obsolescence. In the process of altering and/or replacing work now in place to achieve the above objectives, some cosmetic improvements will result. Question: What accounts for the $1.7 million decrease from the Fiscal 1981 Level? Answer: A portion of the decrease is attributable to the smaller amount requested this year for Clinical Center modernization ($0.27 million below that in FY 1981). The principal decrease results from the fact that this year no funds are requested for the nine-year` Last year project to renovate six of the older laboratory buildings. $1.5 million was appropriated for the initial phase--moving occupants from Building 8 and design of renovations for that building. Question: Why are you requesting an extra $330,000 in Fiscal 1982 for Repairs and Improvements? Answer: The increase of $330,000 in Fiscal 1982 for Repairs and Improvements reflects a ten percent increase over the 1981 level. Funding in the amount of $3,250,000 has been appropriated for this account for the past four years (FY 1978 through FY 1981). In this four-year period, the Engineering News Record Construction Cost index has increased 31 percent. SUBCOMMITTEE RECESS Senator EAGLETON. The subcommittee will stand in recess until 2 p.m. today when we will meet again in this room and hear budget requests for the Alcohol, Drug Abuse, and Mental Health Administration. [Whereupon, at 12:20 p.m., Thursday, February 19, the subcommittee was recessed, to reconvene at 2 p.m. this same day.] (AFTERNOON SESSION, 2:05 P.M., THURSDAY, FEBRUARY 19, 1981) ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION STATEMENT OF ROBERT L. TRACHTENBERG, ACTING ADMINISTRATOR ACCOMPANIED BY: JOHN R. DE LUCA, DIRECTOR, NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM WILLIAM POLLIN, DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE KENT L. AUGUSTSON, DIRECTOR, DIVISION OF FINANCIAL MANAGE- ITTEILAG, ACTING DEPUTY ASSISTANT SECRETARY, SUBCOMMITTEE PROCEDURE Senator RUDMAN [presiding]. Good afternoon. We are going to hear this afternoon from Robert Trachtenberg, who is the Acting Administrator for the Alcohol, Drug Abuse, and Mental Health Administration and, I also believe, Aaron Liberman, Associate Superintendent of St. Elizabeths. I want to welcome you all here. You all look remarkably well. Nobody looks too shellshocked after last night. I would like to invite you or anyone in the hearing room who wishes to remove their jacket and be more comfortable to feel free to do so. I expect I might well do that before too long myself, so if anyone here cares to, feel free to. I wonder, if you might, Mr. Trachtenberg, introduce the members of your panel to us this afternoon? PREPARED STATEMENT Your prepared statement will be inserted in the record at this point. [The statement follows:] (789) STATEMENT OF ROBERT L. TRACHTENBERG It is a pleasure for me to have the opportunity to appear before this Subcommittee, pending appointment of a new agency Administrator, to discuss the programs of the Alcohol, Drug Abuse, and Mental Health Administration. The Directors of the three Institutes which comprise our agency are with me to participate in answering the Committee's questions. Mr. Chairman, let me state at the outset, that we are very optimistic regarding the significant progress we have made in efforts to understand and treat alcoholism, drug abuse, and mental illness. These problems today place an immense human and dollar burden on the people of our country. To cite only a few statistics on the extent of these problems: O Some 10 million adult Americans are estimated to suffer from alcoholism. More than 3 million young people also experience alcohol problems. In one survey of 10th-12th graders, 31 percent reported being drunk at least 6 times a year. Unfortunately, only 15 percent of those who need help with alcohol problems are receiving adequate care. O We believe there are up to 450,000 heroin users in the U.S. Other drug abuse problems also continue: Some 23 million of our citizens are marijuana users, and approximately 15 million report having tried cocaine. Mental disorders will affect 15 percent of the U.S. population --or 34 million persons--during the course of a year. While we are making advances, there are still more patients in hospitals receiving treatment for mental problems than for any other illness. As the Committee can realize, in financial terms such problems collectively exert a tremendous drain on the Nation's economy annually. The cost to society of alcohol, drug abuse, and mental health (ADM) disorders has been documented by many major studies and was estimated at over $120 billion in 1977. Alcohol abuse accounted for about $53 billion; drug abuse, about $15 billion; and mental illness, about $53 billion. These are conservative estimates of measurable economic costs only. About $85 billion of the total cost is due to lost productivity resulting from premature mortality, excess morbidity, and reduced job efficiency. Industry spokesmen agree that ADM disorders cost American industry billions of dollars each year. General Motors, for example, announced recently that absenteeism costs that company alone more than one billion dollars per year, of which ADM costs are a major portion, adding hundreds of dollars to the cost of producing each automobile. ADM problems are also a major problem in the military. A recent Department of Defense study found that 21 percent of personnel studied reported significantly impaired work performance from drug use; almost half of that 21 percent reported serious work impairment of 40 or more days in a single year. Notwithstanding the size and scope of the problems, our progress to date encourages us to believe that ADAMHA programs can continue to help reduce the cost in human suffering as well as the economic consequences associated with these disorders. The contributions that ADAMHA funded research has made to our understanding of the causes, treatment, and prevention of ADM disorders have been and promise continue to be substantial. ADAMHA funds about 80 percent of all the ADM research in the Nation, including problems in such key areas as schizophrenia, depression, alcoholism and drug abuse. This research has led to major biomedical and behavioral treatment interventions. For example, scientists at the National Institute on to |