ritious diet, can cause cirrhosis, which is a frequently fatal disease that requires lengthy and recurring hospitalizations. This work has importance both for alerting physicians to the critical role of alcohol, regardless of nutrition, in the development of cirrhosis, and as a basis for the development of an effective treatment for this disorder, which was the seventh leading cause of death in 1975 but for which there is now no effective therapy. Plans are now being implemented for the establishment of a clinical research program in the NIH Clinical Center and the adjoining Ambulatory Care Research Facility (ACRF). This effort, which complies with Congressional directives on this issue, is the result of several years' discussions and is considered extremely important by the Institute. Space and utilization plans for this program have been developed, and renovations are scheduled to begin in FY 1981 and to be completed in March 1982. Funds for this purpose were transferred to NIH in FY 1979 and FY 1980 and are included in the appropriation for FY 1981. The NIAAA clinical research space will consist of the 3B North wing of the Clinical Center for a clinical ward, and 2500 square feet of space in laboratory and animal areas on the 3rd floor of the ACRF for use as support laboratory facilities. Architectural plans developed with NIH and its contractor provide for the clinical ward to include space for 10 beds as well as space for examining rooms, physiological and electrographic testing, therapy and counseling, nursing station and minimal office space for on-duty clinical staff. Designs for the laboratory and animal facilities include 12 modules to be used for cell cultures, phosphorous, iodine, carbon isotope studies, and clinical biochemistry, as well as space for animal facilities. Because of the wide range of physiological functions and health problems that are affected by alcohol consumption, and the need for improved techniques for the early identification and treatment of individuals with alcoholism or other alcohol-derived health problems, studies conducted in the clinical research program will be oriented toward the development and testing of improved diagnostic and therapeutic techniques. In preparation for this program, collaborative efforts have been carried out with NIH Institutes which will provide the preliminary base for the clinical research program and will be expanded with the availability of NIAAA clinical bed space for studies of the importance to the Institute. The development of a strong clinical research base on the NIH campus, therefore, will broaden the alcohol research capacity by allowing the Institute to take advantage of the vast array of scientific talent and facilities at the NIH while still providing distinct advantages to the treatment and prevention programs of the Alcohol field. The National Institute on Drug Abuse reports that there is an intensive effort on the part of drug companies to develop new benzodiazepines (e.g.,"tranquilizers") which are longer acting, more like sedatives, or ahorter acting. The market of the 1980's will be flooded with new compounds of this class yet very little is known about their possibility for abuse or long-term effects. In FY 1982, NIDA will begin a program to analyze these drugs to determine their abuse liability, drug interactions, behavioral effects, and health hazards. One of the latest "street drugs" is alpha-methyl-fentanyl, often mis labled "China White." This drug, suspected in a number of deaths in California, is not yet "scheduled," and is, therefore, still legally available. It is both cheap and easy to synthesize from readily available precursors. In FY 1982, NIDA intends to conduct the appropriate animal studies to enable us to render assistance to DEA and make recommendations relative to scheduling decisions. We will also study the metabolism of this and related compounds in humans, assuming that it can be done safely. This should enable the development of a test whereby emergency room personnel can identify the drug on admission of persons in dire need of treatment. Newly published research findings indicate close connections between neurohormones in the hypothalmus and reinforcement and memory. In FY 1982, NIDA will conduct the basic studies of these substances to determine their possible role in producing psychological "highs" and the development of tolerance to drugs which can be thought of as a type of memory. NIDA will explore the use of technology, particularly the PETT (position emission transaxial tomography) scanning technique for study of regional activity in the brain and distribution of drugs in subjects who have not abused the drug and in individuals who are tolerant to the drug or in withdrawal. It was The latest "fashion" in drug use is to smoke the drug. know that heroin and cocaine could be used in this manner but now even valium is being smoked. Street wisdom declares that this gives the individual a more intense effect, a "higher high." There is a need for study of this new phenomenon, smoke analysis and investigation of the pharmakinetics of such drug abuse. Review of physician prescription practice statistics indicates a dramatic rise in the use of tranquilizers other than valium. Of particular interest is atavan which is rapidly replacing valium as the tranquilizer/hypnotic of choice. NIDA will attempt to study the patterns of sedative-hypnotics and tranquilizers and the nature and extent of such use. Increasing concern has been expressed with regard to mounting drug abuse in occupational settings. While employee assistance programs abound, there is virtually no study examining the efficacy of different strategies for recruiting individuals into those programs. More significantly, there is no data with regard to the efficacy of employee assistance or substance abuse programs as they affect drug abusers specifically. Efforts are needed to clarify numbers of persons in need of employee assistance as a consequence of substance abuse, the types of workplaces most likely to show such problems, and, most significantly, the effect of different employee assistance/substance abuse programs and models on worker performance and industrial productivity. There now exists a body of data pointing to the general effectiveness of selected drug abuse treatment forms, e.g., methadone maintenance, outpatient drug-free treatment, and therapeutic community treatment. Each of these forms contain within them a number of individual treatment and rehabilitation services. There is a continuing need to understand the ways in which treatment programming can be made more effective through the emphasizing of certain initiatives and deemphasizing of others. In short, there is need to separate treatment programs into their component parts, e.g., counseling, family therapy, vocational rehabilitation, etc., in order to explore the real efficacy of each and thereby increase the cost effectiveness of drug abuse treatment overall. As a part of that activity, it will be necessary to explore the relationship between treatment outcome and drug abuse client characteristics at intake with a particular emphasis on client diagnosis. In so far as diagnosis suggests the extent and nature of client adjustment problems, it gives promise of aiding significantly in the determination of treatment components approriate to client need. Thus, the relationship of treatment components to refinement of service delivery strategies. The major portion of The National Institute of Mental Health's initiatives will relate to its research program. An initiative in childhood depression will be directed toward increasing knowledge of the origin, prevalence, and diagnostic criteria relating to childhood mental illness. Special attention will be given to the development of Research projects will be supported for the purpose of NIMH research will seek further understanding of genetic A major research priority will continue to be the diagnosis NATIONAL INSTITUTE OF MENTAL HEALTH STATEMENT OF DR. HERBERT PARDES, DIRECTOR ACCOMPANIED BY: DR. WILLIAM F. DOBBS, SUPERINTENDENT, ST. ELIZABETHS HOSPITAL DR. AARON LIBERMAN, ASSOCIATE SUPERINTENDENT FOR ADMINISTRATION, ST. ELIZABETHS HOSPITAL JAMES E. PITTMAN, EXECUTIVE OFFICER PERCY E. GOODY, BUDGET OFFICER ANTHONY ITTEILAG, ACTING DEPUTY ASSISTANT SECRETARY, BUDGET, DEPARTMENT OF HEALTH AND HUMAN SERVICES PREPARED STATEMENT Senator RUDMAN. We're going to move on to St. Elizabeths testimony. I'm going to declare a 5-minute recess here while we stretch and gather ourselves together. [A brief recess was taken.] Senator RUDMAN. Back on the record. Let's reconvene the hearing. Dr. Pardes, I will let you proceed on the St. Elizabeths portion of this hearing. Dr. PARDES. Thank you, Senator. In addition to the people you have already met. let me introduce Mr. James Pittman on my right, the Executive Officer. Senator RUDMAN. Your name again, sir? Mr. PITTMAN. James Pittman. Dr. PARDES. On my left, Dr. William Dobbs, the new Superintendent of St. Elizabeths Hospital. On his left Dr. Aaron Liberman, who is the Executive Administrator of St. Elizabeths Hospital, and on his left, the NIMH Budget Officer, Mr. Ed Goody. In the interest of time, I would be happy to just condense my opening statement. Senator RUDMAN. I would like you to do that, if you would. Then we will have it incorporated into the record. Why don't you proceed on that basis. [The statement follows:] (919) STATEMENT OF DR. HERBERT PARDES It is a pleasure to have the opportunity to appear before you to discuss the programs of Saint Elizabeths Hospital. When we appeared before this Committee last year, we reported on a variety of activities which were then underway to revitalize the Hospital. Thanks to the efforts of Hospital staff, I am pleased to say that substantial progress has been made in several areas. APPOINTMENT OF NEW SUPERINTENDENT Earlier this year, I was pleased to announce the appointment of Dr. William Dobbs as Superintendent of Saint Elizabeths Hosptial. Dr. Dobbs, who served as Acting Superintendent from December 1979 to his appointment as Superintendent is a graduate of Emory University Medical School and is board certified in psychiatry and neurology. During a twenty-nine year career in the Washington area and Saint Elizabeths Hospital, Dr. Dobbs has served as a director of several clinical divisions as well as director of training. The Hospital is indeed fortunate to be led by this man of distinguished professional achievement and personal character. MAINTENANCE OF ACCREDITATION Saint Elizabeths Hospital was surveyed by the Joint Commission on Accreditation of Hospitals in June 1979. Subsequently, the Adult Psychiatric Programs, the Alcoholism Program and Child and Adolescent Program were granted one year accreditation. The Area D Community Mental Health Center was granted a two year accreditation in 1978. The Hospital was re-surveyed during August 1980 and was again granted a one year certification. At the same time, the Joint Commission took the unusual step of sending a commendation letter to the Superintendent citing the considerable progress made by the Hospital in achieving accreditation since 1975. During the month of January, the Area D Community Mental Health Center was re-surveyed. Although the Center will not be notified formally of the Joint Commission's decision for several months, comments made by the surveyors at the summation conference were favorable and supportive. Thus, the Hospital has succeeded in maintaining its accredited status through this second series of surveys. It is our feeling that the Hospital is achieving a level of excellence which will assure the continuing availability of high quality services to its patients. OUTPLACEMENT OF PATIENTS Another area of accomplishment relates to the final submission of a joint plan by the District of Columbia Government and HHS for implementation of the Dixon Plan. The Dixon Plan is the outgrowth of a lawsuit, which has resulted in the submission of a formal planning effort with the District of Columbia, to deinstitutionalize several hundred Saint Elizabeths Hospital patients in the least restrictive environment possible. The management and |