Why can’t we all just get along?
A long time ago, an intrepid institutional director named Francis Collins promised his minions (as former NIH director Harold Varmus had promised his) that he would unite the nation’s two mighty addiction research bodies, The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), for the greater good of the entire kingdom—researchers and taxpayers alike.
Hasn't happened yet.
Existing within the large institutional framework of the National Institutes of Health (NIH), the two agencies overlap sufficiently to make them prime candidates for a consolidation. Advocates of the merger, most of them advocates for NIDA, also suggest that the research itself will improve as a result of a decrease in “overlapping missions.”
However, as I wrote in 2010, the NIAAA has a long list of reasons why the merger—which looks, from the NIAAA point of view, more like an acquisition—is a bad idea. Alcohol use disorders are different than other drug addictions, researchers at NIAAA commonly propose. The genetics of alcoholism differs from the genetics of drug addiction, they say, and most people with “alcohol use disorders” don’t abuse other drugs. Furthermore, alcohol damages the brain and other organs in a consistent pattern “best suited to a single alcohol institute,” according to the NIAAA’s acting director.
At this stage, NIAAA’s heel dragging is patently obvious. The agency has always been the weaker sister in the addiction research family. With only half of NIDA’s billion-dollar budget, NIAAA deals strictly with alcohol research, even if the NIAAA has at times seemed unsure of what constitutes its main area of study—alcohol the addictive drug, or alcohol the healthy beverage. The merger would represent a recognition that alcohol is just another drug, albeit a legal one.
In a recent issue of Addiction Professional, Alison Knopf writes that “the alcoholism research field, which believes it would lose out under such a definition, is still fighting the reorganization. And some openly question whether the ‘merger’ ever will come to pass at all.”
Among the many unanswered questions are these, says Knopf: "The current portfolios for AIDS, fetal alcohol syndrome (FAS), liver disease and smoking—where the most money is at the two institutes—may or may not stay within the new institute. Also unknown to many is whether the new institute will cover all addictions (including those such as food and gambling) or will be devoted to the health effects of alcohol and drugs only."
The dark mutterings among alcohol researchers get even more specific in Knopf’s article. In one scenario, Fetal Alcohol Syndrome (FAS) “would go to the National Institute of Child Health and Development, liver disease and the entire organ damage portfolio would go to the National Institute of Diabetes & Digestive & Kidney Diseases, and cancer-related research would go to the National Cancer Institute (NCI). What would happen to drunk driving research is still unknown.”
Furthermore, “NIDA is worried about losing its AIDS funding, because it represents one-third of the institute’s budget.”
The NIH Substance Use, Abuse, and Addiction (SUAA) task force continues to wrestle with the question, which was originally to be decided by the end of the year. In the end, Knopf writes, one persistent rumor has stayed alive: The notion that “the alcohol beverage industry is lobbying Kentucky politicians, including U.S. Rep. Hal Rogers, chairman of the House Appropriations Committee, to keep the institutes separate because it doesn’t want alcohol to be associated with cocaine.”
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