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Understanding Alcohol

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Appendix I

More About the National Institutes of Health

Begun as a one-room Laboratory of Hygiene in 1887, the National Institutes of Health today is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States.

What Is the NIH Mission and Organization?

The NIH mission is to uncover new knowledge that will lead to better health for everyone. NIH works toward that mission by

NIH is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health and Human Services. NIH’s institutes and centers encompass 75 buildings on more than 300 acres in Bethesda, Md. The NIH budget has grown from about $300 in 1887 to more than $23.5 billion in 2002.

What Is the Goal of NIH Research?

Simply described, the goal of NIH research is to acquire new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.

How Does NIH Help Scientists Reach This Goal?

Approximately 82 percent of the investment is made through grants and contracts supporting research and training in more than 2,000 research institutions throughout the United States and abroad. In fact, NIH grantees are located in every state in the country. These grants and contracts make up the NIH Extramural Research Program.

Approximately 10 percent of the budget goes to NIH’s Intramural Research Programs, the more than 2,000 projects conducted mainly in its own laboratories.

The Intramural Research Programs are central to the NIH scientific effort. First-rate intramural scientists collaborate with one another regardless of institute affiliation or scientific discipline and have the intellectual freedom to pursue their research leads in NIH’s own laboratories. These explorations range from basic biology, to behavioral research, to studies on treatment of major diseases. NIH scientists conduct their research in laboratories located on the NIH campus in Bethesda and in several field units across the country and abroad.

NIH Research Grants

Final decisions about funding extramural research are made at NIH headquarters. But long before this happens, the process begins with an idea that an individual scientist describes in a written application for a research grant.

The project might be small, or it might involve millions of dollars. The project might become useful immediately as a diagnostic test or new treatment, or it might involve studies of basic biological processes whose practical value may not be apparent for many years.

Peer Review

Each research grant application undergoes a peer-review process.

A panel of scientific experts, primarily from outside the government, who are active and productive researchers in the biomedical sciences, first evaluates the scientific merit of the application. Then, a national advisory council or board, composed of eminent scientists as well as public members who are interested in health issues or the biomedical sciences, determines the project’s overall merit and priority in advancing the research agenda of the particular NIH funding institute.

Altogether, about 38,500 research and training applications are reviewed annually through the NIH peer-review system. At any given time, NIH supports 35,000 grants in universities, medical schools, and other research and research training institutions both nationally and internationally.

Who Are the Scientists NIH Supports?

Scientific progress depends mainly on the scientist. About 50,000 principal investigators—working in every state and in several foreign countries, from every specialty in medicine, every medical discipline, and at every major university and medical school—receive NIH extramural funding to explore unknown areas of medical science.

Supporting and conducting NIH’s extramural and intramural programs are about 15,600 employees, more than 4,000 of whom hold professional or research doctorate degrees. The NIH staff includes intramural scientists, physicians, dentists, veterinarians, nurses, and laboratory, administrative, and support personnel, plus an ever-changing array of research scientists in training.

The NIH Nobelists

The roster of those who have conducted NIH research or who have received NIH support over the years includes the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won Nobel Prizes for achievements as diverse as deciphering the genetic code and identifying the causes of hepatitis.

Five Nobelists made their prize-winning discoveries in NIH laboratories. You can learn more about Nobelists who have received NIH support at http://www.nih.gov/about/almanac/nobel/index.htm.

What Impact Has NIH Had in the Health of the Nation?

NIH research has played a major role in making possible the following achievements of the last few decades:

NIH Research in the 21st Century

NIH has enabled scientists to learn much since its humble beginnings. But many discoveries remain to be made:

These are some of the areas where NIH’s investment in health research promises to yield the greatest good for the greatest number of people.

For more about NIH, visit its Web site at http://www.nih.gov.

Appendix II

More About the National Institute on Alcohol Abuse and Alcoholism and Its Science Education Program

The Public Health Problem of Alcohol

In 1970, the U.S. Congress recognized that alcohol is the number one drug of abuse in our nation and created the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as the principal federal focus for research to address this public health problem. Today, as one of the research institutes of the National Institutes of Health (NIH), NIAAA manages about 90 percent of the nation’s investment in research aimed at developing, through science, the knowledge of that problem, whom it affects, and how, as the basis for more effective treatment and prevention methodologies.

What is the scope of the problem? Approximately 1 million youth, ages 12–17, are consuming alcohol. Nearly 14 million American adults develop problems from drinking. Death can be, and too often is, the ultimate consequence. About 100,000 deaths each year are due to alcohol abuse and alcoholism. Short of death, specific problems include health deterioration such as damage to the brain, liver, gastrointestinal tract, and heart; injuries such as automobile crashes and household accidents; domestic and other forms of violence; neglect of work and family; and costs to society associated with police, courts, jails, and unemployment.

It has been estimated that every dollar invested in treatment yields seven dollars in savings in healthcare costs and lost-productivity costs from job absenteeism, injuries, and poor work performance. Specific benefits of adolescent treatment include better psychological adjustment and improved school performance after treatment, less heavy drinking, less use of other drugs, and less criminal involvement.

Thirty Years of Research Progress

NIAAA’s 30 years of attention to the science of alcohol-use problems has produced results. For example, it is now clear that a portion of the risk for developing alcoholism is the result of genetics, and scientists are making progress in finding the genes that influence vulnerability to alcoholism. We also have learned many of the ways alcohol affects the brain. Alcohol neuroscience research has already provided the basis for new medications to treat alcoholism. We have begun to understand more about the risks—and benefits—to health that result from alcohol use and how to treat alcohol-related health conditions, including the damage caused to major body organs by excessive alcohol use. Alcohol researchers have defined populations at risk and have developed and tested programs that have proved successful in reducing alcohol-related problems in schools and communities. In fact, research findings from NIAAA-supported investigators have provided the basis for changes in policy and legislation that have saved many lives. These include raising the minimum legal drinking age to 21 and establishing 0.08 percent as the legal blood alcohol limit for driving. A growing body of research on improving treatment effectiveness has resulted in, among other things, improved diagnostic systems and methods of screening and assessment.

NIAAA Overview

NIAAA supports research principally through extramural grants awarded to scientists at leading U.S. academic and research institutions and through research conducted by NIAAA’s own intramural staff scientists. Findings from these research areas are made available and accessible through a variety of dissemination activities, including the Institute’s science education program. Research and dissemination activities are summarized below.

Extramural Research

Genetics: NIAAA supports research aimed at discovering the genes that predispose individuals to alcoholism and the environmental factors that influence the development of alcohol dependency in susceptible individuals. Areas of genetics research include

Alcohol and the Brain: Many of the behaviors associated with alcohol-use problems are the result of alcohol’s effects on the brain. NIAAA-supported research is designed to learn how these effects influence the development of alcohol abuse and alcoholism. Molecular biology and genetic techniques, including the use of transgenic animals, are becoming an integral part of this research. In addition, noninvasive imaging technologies are used in animal and human studies to identify neural circuits influenced by alcohol.

Medications Development: NIAAA is strongly committed to developing medications to diminish alcoholics’ craving for alcohol, safely detoxify dependent individuals who are entering treatment, and reduce risk of relapse. Naltrexone—the first medication approved as a safe and effective adjunct to psychosocial treatment for alcoholism since 1949—was developed from neuroscience research. It is an opiod antagonist. Findings from neuroscience and from genetics point to promising targets for the future development of additional pharmacological interventions.

Prevention: NIAAA-supported prevention research is aimed at developing effective measures to reduce alcohol-related problems, including studies of alcohol-related intentional and unintentional injury, alcohol-related violence, alcohol in the workplace, drinking and driving deterrence, and the relationship between simply the availability of alcohol and incidence of alcohol-related problems. New methodologies permit prevention researchers to target high-risk neighborhoods within larger cities.

Treatment: NIAAA supports a range of treatment (clinical) studies, including trials of newly developed treatment therapies, treatment-matching studies that look at the relationship between patient characteristics and type of treatment, and behavioral-pharmacological treatment approaches.

Epidemiology: Alcohol epidemiology provides the foundation for monitoring the health of a population, as distinguished from an individual’s health; developing and evaluating alcohol prevention and treatment services; and establishing alcohol-related social policies. NIAAA-supported epidemiology research examines the context, volume, and specific drinking patterns that lead to particular alcohol-related problems. Epidemiology research also studies the impact of gender, race and ethnicity, and other sociodemographic factors on alcohol use and abuse. Genetic, environmental, and other factors that influence alcohol-related injury or disease occurrence in a defined population are also topics of epidemiology research.

Intramural Research

NIAAA intramural scientists focus on unique research opportunities that require intensive, long-term commitment, together with flexibility to adjust research priorities quickly in response to new findings. Because clinical and laboratory studies occur side-by-side in the intramural program, new findings from basic research may be transferred readily for appropriate testing and application. Conversely, clinical hypotheses may, in turn, be posited to lab scientists. Areas of intramural study include

An 11-bed inpatient alcohol ward and a large outpatient program are located at the National Institutes of Health Clinical Center in Bethesda, Md., in close proximity to NIAAA laboratories where basic research is conducted. Coordinated interaction between these facilities is essential in pursuing the goals of the intramural research program.

Research Dissemination

NIAAA shares findings from alcohol research with healthcare practitioners, policymakers, social service program providers, and others, including the general public through publications. These include scientific and clinical journals and monographs and general and specialized manuals, clinical bulletins, brochures, and pamphlets. Research findings are also shared through three on-line database services sponsored by the Institute: Quick Facts, an epidemiological database; ETOH (chemical name for alcohol), an alcohol-related bibliographic reference database; and the NIAAA clinical trials database. Publications, reports, and database services are accessible online at http://www.niaaa.nih.gov. This website can also be a valuable resource for teachers.

The NIAAA Science Education Program

Dissemination of research findings through science curricula in our nation’s schools is part of the continuing commitment of NIAAA to make the science of alcohol problems both accessible and understandable to the public. Although many youth receive information about alcohol use as part of a health education or physical education curriculum, NIAAA believes that understanding the science involved in developing this information is important to the choices that students will make about drinking. Alcohol use is part of the American culture, and most adults who drink do so with a minimum of risk. Thus, despite what young people are taught in health education or physical education about the potential for alcohol use to cause them problems, many nevertheless take drinking for granted—a common “rite of passage” for American youth, especially boys. However, being told in a health education class that alcohol use by underage drinkers can cause cognitive damage is very different from learning the science behind this finding. Moreover, “telling” is not always “teaching.” The critical-thinking skills involved in the methodology of doing science are learned in science education. Critical thinking is an invaluable asset in personal decision making.

The NIAAA science education program, of which this curriculum is one product, is designed to support teachers in their efforts to help students enjoy the process of discovery and to appreciate how medical science generally, and alcohol science specifically, addresses public health issues and, in so doing, positively affects their lives and that of their families.

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