GOVERNMENT RELATIONS UPDATE
NIH moves toward creation of a new addictions institute
On November 18, 2010, Francis Collins, the Director of the National Institutes of Health, announced that NIH would proceed with a reorganization of substance use, abuse, and addiction research funding by creating a single Institute that would include the major portfolios of the National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA), as well as possibly components of other Institutes’ portfolios.
Many details of the reorganization remain to be worked out, but it can be expected that it will have a significant impact on the funding and direction not only of research surrounding substance use but also of mental health research and behavioral and neuroscience research broadly. This article provides an overview of how the reorganization process has proceeded thus far, what will happen next, and what role the American Psychological Association and other scientific organizations play in it.
As reported previously in PSA, the first meeting of the NIH Scientific Management Review Board (SMRB) was held in April of 2009. The SMRB was established to provide greater oversight of the organizational structure and allocation of resources across the 27 Institutes and Centers within NIH. At that meeting, the Board decided to take up three tasks and assigned each of them to individual Working Groups (PDF, 46 KB), including one group looking at organizational change in general and another group examining the NIH clinical center.
But the group that garnered the most attention was the Substance Use, Abuse, and Addiction (SUAA) Working Group, which was charged with determining what organizational change, if any, could optimize the support of substance use, abuse, and addiction research at NIH. Central to that discussion was the possible merger of NIDA and NIAAA, an idea that has circulated informally within NIH for many years. The SUAA Working Group was comprised of ten members, including both outside scientists and NIH officials, and was chaired by William Roper, Dean of the School of Medicine at the University of North Carolina.
The APA provided input to this process in August, 2009, through a letter (PDF, 41 KB) from Steve Breckler, Executive Director for Science, to the SMRB Chair. This letter requested that the SUAA Working Group consider several critical issues, including the distribution of tobacco/nicotine research across NIH, the integration of research that deals with comorbid mental health conditions, and where to house research on other compulsive disorders.
In a series of meetings in September and October, 2009, the SUAA Working Group heard presentations from a variety of stakeholders. On September 1, Kenneth Warren, Acting Director of NIAAA, and Nora Volkow, Director of NIDA, provided overviews of the NIAAA (PDF, 4 MB) and NIDA (PDF, 2 MB) portfolios. Psychological science was well represented at a September 23 scientific forum, with presentations by psychologists Mark Goldman (PDF, 716 KB), Thomas Greenfield, Stephanie O’Malley (PDF 204 KB), and Linda Porrino (PDF, 304 KB). At its October 14 (PDF, 52 KB) meeting, the SUAA Working Group heard from representatives of the judicial system, academia, and industry.
Additional SUAA Working Group meetings were held through 2010 to gain perspectives from representatives of the Substance Abuse and Mental Health Services Administration, the former Alcohol, Drug and Mental Health Administration, the White House Office of National Drug Control Policy, as well as former NIDA and NIAAA Directors.
What Kind of Reorganization?
As deliberations continued, it was clear that the Working Group was considering a full range of reorganization options from the minimalist (e.g., establishing a joint advisory council to oversee separate Institutes) to a full merger of NIDA and NIAAA.
After receiving briefings on February 3, 2010, from Working Group Chair William Roper, the Advisory Councils of both NIDA and NIAAA considered the options. The NIDA Advisory Council voted to support a merger, while the NIAAA Advisory Council issued a resolution (PDF, 26 KB) favoring retention of separate Institutes.
At the SMRB’s meeting on March 10, 2010 (its first meeting with then new NIH Director Collins), Roper reported that the SUAA Working Group was in “agreement that the status quo is not ideal for fulfilling the NIH mission and optimizing research into substance use, abuse and addiction” and that it was “eager to improve how NIH manages research into substance use, abuse and addiction.” However, the group had not come to agreement about how best to proceed. According to Roper, the majority favored a functional reorganization, such that NIDA and NIAAA remained separate entities but related research programs across the two Institutes were managed in an integrated fashion. The minority view was that a structural reorganization was needed, involving a merger of NIDA and NIAAA into a single Institute focused on alcohol and drug abuse and addiction.
On May 18, the SMRB met to review the recommendations of the SUAA Working Group. Several panels (PDF, 77 KB) representing a variety of perspectives including those of community stakeholders, early stage investigators, NIH grantees, and the current Directors of NIDA and NIAAA weighed in on the issue of a functional versus structural reorganization. It was reported at this meeting that five members of the Working Group favored a functional reorganization and three favored a structural merger. The Working Group continued its discussions following this meeting in preparation for developing a final report and recommendations.
This final report (PDF, 1 MB) of the SUAA Working Group was received by the SMRB at its meeting on September 15, 2010. Roper provided a summary that included the news that, with further deliberation, opinion in the Working Group had shifted such that members had become evenly split in their support of a functional versus structural reorganization.
Following discussion, the SMRB voted to recommend a structural reorganization option to the NIH Director. The SMRB proposed that a new Institute be established that would include research on use, abuse, and addiction involving alcohol, tobacco, and other substances, as well as compulsive behaviors. Although the final SUAA report included a findings section on comorbidity, neither the Working Group nor the SMRB specified how research on mental health disorders that are comorbid with substance use should be accommodated in a proposed reorganization.
The NIH Director Decides
NIH Director Collins announced on November 18 that he agreed with the SMRB recommendation and would proceed with a structural reorganization of substance use, abuse, and addiction research. He designated Lawrence Tabak, NIH Deputy Director, and Stephen Katz, Director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), to serve as co-chairs of an internal SUAA Task Force that would develop detailed plans for the reorganization.
In addition to the co-chairs, the SUAA Task Force includes representatives from the National Human Genome Research Institute; National Institute on Deafness and Other Communication Disorders; National Institute of Biomedical Imaging and Bioengineering; National Heart, Lung, and Blood Institute; and NIAMS. The staff were reportedly selected from Institutes that would not be seen as biasing the outcome of the reorganization. The task force will be informed by content experts selected by the Directors of NIDA, NIAAA, National Cancer Institute, National Institute of Mental Health, National Institute of Child Health and Human Development, and National Institute of Diabetes and Digestive and Kidney Diseases.
According to Tabak, “Our charge will be to perform an analysis to identify SUAA-plus activities across the NIH for possible inclusion in a new SUAA IC [Institute/Center] and SUAA-minus activities within NIAAA and NIDA that could potentially be moved to other relevant ICs.”
Although no specific implementation timeline has been released, Collins has said he expects a detailed reorganization plan from the task force by the summer of 2011. And at a meeting of the Advisory Committee to the Director on December 9, Tabak stated that he anticipated that a new Institute would be in place by 2013. He also said that there will be opportunities for external stakeholder input and review and that comments may be submitted to the new Feedback NIH website.
NIH observers have noted that one implication of a merger is that it could open the way for further reorganization. Since current law limits the number of Institutes and Centers to 27, a merger creates space for a new Institute or Center to be established.
APA has been working with the College on Problems of Drug Dependence (CPDD), Research Society on Alcoholism (RSA), Society for Research on Nicotine and Tobacco (SRNT), and Society of Behavioral Medicine (SBM) to provide substantive input to the reorganization process. That effort led to a letter (PDF, 188 KB) to Director Collins, endorsed by 47 scientific and professional groups, offering assistance as the reorganization moves forward and proposing several points of consensus to be used as reorganization principles. The perspectives of psychologists were represented as well in letters sent individually by CPDD (PDF, 171 KB), SRNT (PDF, 2 MB), and SBM (PDF, 148 KB), and by a coalition of groups (PDF, 187 KB) led by The Campaign for Tobacco Free Kids. APA and its partners will continue to monitor and provide input to the reorganization process.
Geoff Mumford is Associate Executive Director for Government Relations in the APA Science Directorate.