by Bob CurleyThe influential National Academy of Sciences (NAS) has recommended merging the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), saying that research on alcohol and other drugs frequently overlaps and that arguments against a merger are "primarily nonscientific."
The two leading addiction-research agencies "have overlapping missions and substantive foci and would work more effectively together than apart," according to a report from the NAS's National Research Council. The recommendation comes as part of a comprehensive review of the National Institutes of Health (NIH), and is just one of two mergers suggested by the Committee on the Organizational Structure of the National Institutes of Health.
The committee's report, "Enhancing the Vitality of the National Institutes of Health: Organizational Changes to Meet New Challenges," suggests that Congress or the NIH launch an evaluation of the proposed NIDA/NIAAA merger and assess support for combining the institutes. A spokesperson for NIH said that the recommendation was under review, but that no action has yet been taken in response to the report.
Over the years, the report noted, members of Congress and the research community have questioned the decision to create separate research institutes to examine alcohol and other drugs -- a decision that dates back to the early 1970s, when NIDA and NIAAA were established as part of the National Institute of Mental Health.
"Prevention and treatment approaches are fundamentally similar for alcohol abuse and abuse of other substances," the report said. The NAS also quoted a Feb. 26, 2003 editorial in the Journal of the American Medical Association by current NIAAA Director T.K. Li and the then acting director of NIDA, Glen Hanson, discussing the overlap between alcohol and other drug research.
"There is a strong association among the use of tobacco, illicit drugs, and the abuse of alcohol," wrote Hanson and Li. "In addition, there is a similarity of biological and social-risk factors underlying vulnerability to all of these substances, including genetic and environmental factors. Lastly, there are overlapping mechanisms thought to underlie how these substances influence the brain. Hence, it would be desirable from a public-health perspective to address all substances of abuse when opportunities arise."
The NAS report also contends that separation of the institutes has led to the segregation of the alcohol and other drug research communities, and balkanized research studies. "Few studies investigate alcohol and other substances of abuse at the same time, even though few drug addicts abuse only one substance," according to the report. "And the exclusive focus of the two institutes has meant that some addictions, e.g., gambling and food addictions, have received virtually no scientific attention."
A Drug, and a Food
While Li and the recently appointed director of NIDA, Nora Volkow, remain officially mum on the merger proposal, former NIDA Director Alan Leshner, M.D., said that, "On substantive grounds, it seems to make sense."
Leshner, now the CEO of the American Association for the Advancement of Science, said he would like to see the agencies brought together as a National Institute on Addiction. "From the point of view of an individual suffering from obesity because of compulsive eating, I think those people have as much right to benefit from science as anyone else," he said.
Having a separate institute studying alcohol "may bring more attention to it, but I think the crossover argument speaks for itself," added Leshner.
But Leshner's former counterpart, longtime NIAAA director Enoch Gordis, M.D., said that even as an independent agency NIAAA has not received funding proportional to alcohol's impact on society. Gordis said that alcohol research could easily be subsumed in a combined agency by research on illicit drugs, which already gets the lion's share of public and legislative attention and money. "The attention to alcohol would be downplayed," he predicted.
Gordis agreed that there are some areas of research overlap between alcohol and other drugs -- "there's no question of that," he said -- but argued that there are important differences, as well.
"Alcohol is a drug, but it's also a food," noted Gordis. "There are whole areas of physiology that don't apply to other drugs." Unlike most other drugs, for example, "alcohol in its chemically pure form is a toxin," and consumption can lead to a wide range of health problems, he said.
Psychosocially, alcohol also demands a different response because it is a legal product that is taxed and also creates jobs and generates revenues, he added. "Therefore the control of its noxious social effects are in a very different manner altogether than illicit drugs," Gordis said.
The alcohol industry makes many of the same arguments against a NIDA/NIAAA merger, although for somewhat different reasons. "We've always been opposed to linking alcohol with illicit drugs," said Jeff Becker, president of the Beer Institute. "Alcohol is a legal product, and it would be inappropriate to link them in any substantive way."
Becker echoes Gordis' worries about losing NIAAA's distinct focus. "Our concern is that the focus may shift to drugs rather than alcohol," he said. (Says Gordis: "There are things that the industry does that I don't like, but on this I agree with them.")
But the NAS report largely dismisses such concerns. "In the Committee's view, substantive arguments against merger are not convincing," the report stated. "One suggests that alcohol requires a separate institute because it is unique in affecting every cell in the body; but other abused drugs studied by NIDA, such as inhalants, also affect all cells."
"Another argument is that alcohol is unique among abused substances because it is legal, at least for adults, and thus everything surrounding the drug is unique," according to the report. "On the other hand, NIDA supports a large amount of research on nicotine addiction, and smoking is also legal for adults."
A merger of NIDA and NIAAA, the report concludes, "would seem to offer many advantages, scientifically and with respect to improved health, and should be studied carefully."
The NAS has had its say; now its up to Congress or the leadership of NIDA and NIAAA to decide if their recommendations bear further scrutiny. Standing in the way of further study of a merger will be opposition from members of Congress allied with the alcohol industry; resistance from inside the bureaucracy, where change to the status quo is rarely welcomed; and plain old inertia. "Nothing happens until somebody decides to recommend it as an action item," said Leshner.
COMMENTS ON THIS ARTICLE: