House Appropriations Subcommittee on Labor-HHS and Education Holds Hearing on President’s Budget Request for SAMHSA, NIDA, NIAAA and NIMH;
Directors of Each Agency Testify

On Thursday, March 1, 2007, the House Appropriations Subcommittee responsible for funding programs within the Departments of Labor, Health and Human Services and Education convened a hearing to discuss the FY 2008 budget request for each of the key federal agencies responsible for administering drug and alcohol and mental health prevention, treatment, education and research programs.  The witnesses representing each of the agencies were:  Terry Cline, Ph.D., Administrator of the Substance Abuse and Mental Health Services Administration; Nora Volkow, M.D., Director of the National Institute on Drug Abuse, T.K. Li, M.D., Director of the National Institute on Alcohol Abuse and Alcoholism; and Thomas Insel, M.D., Director of the National Institute of Mental Health.

Chairman of the Full House Appropriations Committee and the Subcommittee on Labor-HHS, Congressman David Obey (D-WI), chaired the hearing.  Other Committee members in attendance included Subcommittee Ranking Member Representative James Walsh (R-NY), and Representatives Jesse L. Jackson, Jr. (D-IL), Patrick J. Kennedy (D-RI), Lucille Roybal-Allard (D-CA), Tom Udall (D-NM), Michael Honda (CA),  Tim Ryan (D-OH), John E. Peterson (R-PA), and Dennis R. Rehberg (R-MT). 

Substance Abuse and Mental Health Services Administration

Dr. Cline began his testimony by stating that despite the President’s request to cut the budget of SAMHSA by $159 million from the FY 2007 continuing resolution funding level which would represent a five percent overall reduction for SAMHSA, an aggressive agenda has been set for the upcoming year.  According to Dr. Cline’s remarks the focus of SAMHSA’s budget is on service delivery programs, such as the Mental Health and Substance Abuse Block and Formula Grants; resources will also be invested in program priority areas of children’s mental health services, suicide prevention, school violence prevention, prevention and treatment of Post-Traumatic Stress Disorder, the Screening, Brief Intervention, Referral, and Treatment (SBIRT) program, HIV/AIDS and criminal and juvenile justice.  In regards to expanding substance abuse treatment capacity, Dr. Cline articulated that the FY 2008 budget enhances accountability and improved performance outcomes by requiring States to report on the Community Mental Health Services (MHBG) and Substance Abuse Prevention and Treatment (SAPT) Block grant funds; States reporting on the SAPT Block Grant National Outcomes (NOMS) could receive an increase to their State allocation if some States do not report. 

Dr. Cline testified that SAMHSA continues to expand treatment capacity through the Access to Recovery (ATR) program and provides increases for screening of drug addiction and treatment for those involved with the criminal justice system.  Despite a cut of $36.4 million to the Center for Substance Abuse Prevention, Dr. Cline stated that the budget will continue to fully support the prevention activities of SAMHSA, including the Minority HIV/AIDS and Substance Abuse Prevention Grants, the Fetal Alcohol Spectrum Disorder Center for Excellence, and the Strategic Prevention Framework grant program.  Citing the progress that has been made in reducing youth drug use in America Dr. Cline also stated that SAMHSA will continue to focus energy and take a leadership role in the prevention of underage drinking; alcohol remains the drug of choice among adolescents and Dr. Cline acknowledged that more progress needs to be made in reducing underage drinking rates.                

National Institute on Drug Abuse

Dr. Volkow began her remarks by highlighting the results of NIDA’s latest Monitoring the Future survey which show a 23 percent decline over the last five years in any past-month illicit drug use by students in the 8th, 10th and 12th grade combined.  Despite progress with rates of youth drug use, Dr. Volkow cited concern with misuse of prescription medications which has produced steep increases in abuse-related emergency room admissions; additionally, use of prescription medications, along with over the counter drugs (cough medicine), account for five of the top six drug abuse categories reported by 12th graders.  Prevention was emphasized as critical and Dr. Volkow explained that NIDA continues to focus on adolescence, because that is typically when drug abuse and addiction begin.  Since addiction results from a complex interaction of drugs, genes and environmental and developmental factors, NIDA has also made the study of these interactions a priority.  NIDA’s treatment research identifying the brain circuits that underlie addiction, such as craving, euphoria, and inhibitory control have opened the door to different treatment approaches, including the possibility of using neurofeedback, where patients learn to regulate specific regions in their brains by getting feedback from real-time brain images.  Dr. Volkow also cited progress in the development of addiction medications, as well as immunotherapeutic strategies, which are based on the development of vaccines to generate antibodies to the drug that block its entry into the brain and thereby interfere with its effects.    

Dr. Volkow emphasized one of NIDA’s major objectives of translating research into practice by highlighting its Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) initiative; this initiative is aimed at bringing new treatment models into the criminal justice system to improve outcomes for individuals with drug histories.  Dr. Volkow also spoke about the Drug Abuse Treatment Clinical Trial Networks (CTN) which brings evidenced-based treatments to community settings, and the establishment of four Centers of Excellence for Drug Abuse Information, in collaboration with the American Medical Association.  Another area of priority, according to Dr. Volkow’s testimony, is HIV/AIDS where NIDA is supporting preclinical and clinical studies that examine the interactions between: drugs of abuse and HIV medication, HIV and the plasticity (relative to changes that lead to addiction), and HIV and neurotoxicity (with regard to the adverse drug effects that result in conditions such as dementia and Parkinsonian symptoms); NIDA is also supporting research to make testing more acceptable in communities nationwide.

National Institute on Alcohol Abuse and Alcoholism

Dr Li’s testimony began with a reminder about the seriousness of excessive alcohol use which costs the Unites States an estimated $185 billion annually and is ranked by the Centers for Disease Control and Prevention as the third leading cause of preventable death in the United States.  Dr. Li articulated NIAAA’s strong research and prevention focus on pregnant women, children and adolescents, including the agency’s work on the interplay between hormones, brain development, and alcohol use.  Dr. Li also spoke about the work of the Interagency Coordinating Committee for the Prevention of Underage Drinking and the forthcoming Surgeon General’s Call to Action on underage drinking.  In addition to recent research findings that will improve the diagnoses of alcohol dependence, NIAAA is supporting research to improve treatment options, including identifying the next generation of medications, and understanding how individuals change harmful drinking patterns. In particular, Dr. Li emphasized that success can only be achieved if individuals have access to treatment and that coverage of mental health and drug and alcohol addiction services would allow a greater proportion of individuals to receive the care they need. 

National Institute on Mental Health

Dr. Insel began his remarks by summarizing how research has transformed the understanding of mental disorders by defining mental disorders as brain disorders that begin early in life; mental disorders along with addictive disorders are the most common chronic illnesses of young people in the United States.  NIMH’s efforts have focused on predicting who is at risk for developing disease; pre-empting the disease process; personalizing interventions; and ensuring that clinical research involves participation from the diversity of people and settings involved in health care. Dr. Insel indicated that NIMH plans to expand its efforts in treatment development, with an enhanced focus on medications that reverse the cognitive deficits in schizophrenia, additional studies of novel antidepressants, and new efforts in autism, anxiety disorders, and eating disorders.  Dr. Insel emphasized NIMH’s collaboration with SAMHSA’s Center for Mental Health Services (CMHS) on the Mental Health Transformation State Incentive Grant program.               

Members’ Remarks

Subcommittee Ranking Member Congressman James Walsh (R-NY) began his opening remarks by stating his concern with how the agencies are addressing the mental health issues of active duty troops and veterans. Rep. Walsh also stated that building a foundation for research is good, but only if it translates into practice, and that he would like to hear more about the agencies’ efforts to turn research into practice.  Chairman Obey (D-WI) began by expressing his frustration with the belief that level funding means that there will not be cuts, when in fact, it does not take into account inflation and population growth; Obey stated “we are headed in the wrong direction” with the Administration’s budget request and asked the witnesses to explain the challenges that level funding would create for their agencies.  Dr. Cline responded by highlighting the efforts of SAMHSA to develop a comprehensive data strategy, which will help translate data into outcomes to better show results; additionally, he emphasized the continued importance of investing in prevention.  Dr. Volkow discussed the difficulty of bringing medications into medical practice, in part due to the lack of involvement of the pharmaceutical industry in this particular area of medication development, and also stated that clinical trials are delayed because of budget shortfalls.    Dr. Li articulated that it is a struggle to change the culture of binge drinking in youth and that it remains important to identify those who are at high risk for alcohol dependence, both of which are priority areas of NIAAA. 

Congresswoman Roybal-Allard (D-CA) and Congressman John Peterson (R-PA) both remarked that they are concerned about underage drinking.  Rep. Peterson asked why there is not more information made available to young people about the damage excessive drinking can cause to the brain while it is in development.  Dr. Cline confirmed that alcohol is the number one drug of choice for young people and that SAMHSA is investing resources in its Strategic Prevention Framework to combat underage drinking as well as focusing on the environmental factors such as schools, parents and peers that prevent underage drinking. 

Congressman Ryan (D-OH) offered his support for after school programs that prevent alcohol and drug use and keep youth involved in activities during that vulnerable time period.  Rep. Ryan asked the witnesses about what efforts are being undertaken to study stress and the role it plays as a trigger for alcohol and drug use and mental health conditions.  Dr. Volkow responded that stress is one of the most important environmental factors that contribute to drug use and poverty, that many prevention interventions work and that it is critical that such effective interventions are applied in communities. 

Congressman Kennedy (D-RI) expressed his disappointment with the cuts proposed in the FY 2008 budget request by stating it is a departure from reality and that it will result in shifting costs to other systems, including the criminal justice system, which is also receiving significant cuts in the FY 2008 budget request.  Rep. Kennedy inquired as to how treatment of co-occurring disorders could be best administered in order to eliminate bureaucratic waste of resources and stated his position that the mental health and substance abuse block grants should be integrated.  Dr. Cline responded by stating that SAMHSA is working on a number of best practices in the area of co-occurring disorders as well as supporting policy academies for information sharing.  Additionally, Dr. Cline highlighted the flexibility that currently exists within SAMSHA to administer programs for co-occurring populations. 

For more information on the House Appropriations Committee and the Appropriations process, including how to submit written testimony for the record, please visit: http://www.appropriations.house.gov/.