Minutes of the 135th Meeting of the NATIONAL ADVISORY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
Minutes of the 135th Meeting of the
NATIONAL ADVISORY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
February 4–5, 2014
The National Advisory Council on Alcohol Abuse and Alcoholism (NIAAA) convened for its 135th meeting at 5:00 p.m. on February 4, 2014, in Fishers Lane, NIAAA, Rockville Maryland. The Council met in closed session for a review of grant applications and a Merit Award extension. The meeting recessed at 5:50 p.m. Dr. Abraham Bautista, Director, Office of Extramural Activities presided over the closed session, which, in accordance with the provisions of Sections 552b(C)(6), Title 5, U.S.C. and 10(d) of Public Law 92-463, excluded the public for the review, discussion, and evaluation of individual applications for Federal grant-in-aid funds. Dr. George Koob, Director, NIAAA, reconvened the Council in open session on February 5, 2014, at 2:00 p.m . in Wilson Hall, Building One, National Institutes of Health, Bethesda Maryland.
Council Members Present:
Carol A. Casey, Ph.D.
Linda L. Chezem, J.D.
Fulton T. Crews, Ph.D.
Suzanne M. de la Monte, M.P.H., M.D.
Marianne L. Fleury, B.S.
Andres G. Gil, Ph.D.
Paul J. Gruenewald, Ph.D.
Sarah N. Mattson-Weller, Ph.D.
Craig J. McClain, M.D.
Robert O. Messing, M.D.
Patricia E. Molina, M.D., Ph.D.
Adolf Pfefferbaum, M.D.
Rajita Sinha, Ph.D.
Department of Defense (ex officio): COL Charles Milliken, M.D.
NIAAA Director and Acting Chair: George Koob, Ph.D.
NIAAA Deputy Director: Kenneth R. Warren, Ph.D.
Executive Secretary: Abraham P. Bautista, Ph.D.
Senior Staff:
Vivian Faden, Ph.D.; Ralph Hingson, Sc.D., M.P.H.; Robert Huebner, Ph.D.; George Kunos, Ph.D.; Keith Lamirande; Gary Murray, Ph.D.; Antonio Noronha, Ph.D.
Other Attendees at the Open Sessions:
Approximately 50 observers attended the open session, including representatives from constituency groups, liaison organizations, NIAAA staff, and members of the general public.
Call to Order and Introductions
NIAAA Deputy Director Kenneth R. Warren introduced the permanent NIAAA Director, Dr. George Koob, for whom a detailed biography appears in the February 2014 NIAAA Director’s Report. Dr. Koob called the open session of the Council meeting to order at 2:05 p.m. on Wednesday, February 5, 2014.
Director’s Report
Dr. Koob highlighted key recent Institute activities, referring to the written Director’s Report.
• NIAAA budget. In Fiscal Year (FY) 2013, Congress appropriated $443.4 million for NIAAA. NIAAA awarded 648 research project grants (RPGs) including 166 competing awards, corresponding to a success rate of 20%. Support for other key extramural funding mechanisms included 18 research centers, 135 other research grants, 270 full-time training positions, and research and development contracts amounting to $37.6 million. Following a lengthy continuing resolution, the President signed the Consolidated Appropriations Act on January 17, 2014. NIH received $29.9 billion for FY 2014, an increase of $1 billion over the FY 2013 post-sequestration level. The FY 2014 appropriation for NIAAA amounts to $444.9 million, an increase of $11.5 million (2.7%) over the previous year. NIAAA expects to support 652 RPGs in FY 2014, including 175 competing awards. In the future Dr. Koob anticipates awarding more RPGs, which he considers the basic foundation of the Institute’s extramural program. Preliminary FY 2015 budget work has begun in preparation for presentation of the President’s budget request to Congress on March 3, 2014.
• NIAAA staff transitions. New NIAAA staff members include Dr. Nancy Diazgranados, who joins the Section of Clinical Assessment and Treatment Evaluation as a staff clinician. Ms. Bonnie Ellis joins the Administrative Services Branch as a section chief, administrative officer.
• Honors and awards. The NIH Asian Pacific Islander American Organization awarded its 2013 Leadership Excellence Award to Dr. Abraham Bautista. Dr. Ralph Hingson received the University of Pittsburg Legacy Laureate Award. Dr. Lorenzo Leggio was appointed editor-in-chief of Alcohol and Alcoholism. He, together with Fatemah Akhlaghi, received a National Center for Advancing Translational Science (NCATS) grant award. Dr. Leggio and Dr. Mary Lee received an award for a translational project to investigate the effects of oxytocin in alcoholism. Dr. Cheryl Marietta has won an NIH Mission First, Safety Always grant. Council member Dr. Patricia Molina was recently elected as the President of the American Physiological Society.
• 2013 NIAAA Current Research Advances. Dr. Koob highlighted aspects of NIAAA’s recent research. Studies by the Division of Intramural Clinical and Biological Research show that chronic intermittent ethanol exposure facilitates forms of rewarded learning known to be mediated by the dorso-laterial striatum that suggests the possible route by which alcohol abuse may prime striatal circuits to acquire information about reward-related stimuli and set the stage for stimulus-controlled behaviors.
An intramural group has developed and patented a new class of dual-action drug, which, in addition to blocking cannabinoid receptors 1(CB1R) outside the brain, also inhibits inducible nitric oxide synthase (iNOS) or activates 5-adenosine monophosphate-activated protein kinase (AMPK). The prototype CB1R/iNOS dual inhibitor displayed improved anti-fibrotic activity over single target compounds in a mouse model of liver fibrosis.
Another study has revealed that loss of metabotropic glutamate receptor 2 escalates alcohol consumption in rats; doing the opposite may decrease alcohol intake.
A study involving convergent translation evidence of a role for anandamide in amygdala-mediated fear extinction, threat processing, and stress reactivity shows that increasing tissue levels of endogenous anandamide in the amygdala reduces fear reactions in mice by facilitating the extinction of learned fear. In parallel brain-imaging studies, people who carry a low-expressing variant of the fatty acid amide hydrolase (FAAH) gene exhibit faster habituation in the amygdala reactivity to threat. Dr. Koob stated that NIAAA will encourage this type of cross disciplinary/preclinical-clinical research approach.
Dr. Koob highlighted the Division of Metabolism and Health Effects’ research on the role of FoxO3a in alcohol-induced autophagy and hepatotoxicity Research shows that the combination of hepatitis C and alcohol inactivates the transcription factor FoxO3a, which causes decreased expression target genes and increased liver injury. Absence of FoxO3a may explain the progression of alcoholic liver disease to a more severe clinical phenotype in a small minority of heavy drinkers. Modulation of this pathway is a potential therapeutic approach for the hepatitis C virus and alcohol-induced liver injury. Research on rhesus macaques shows a variable immune response in heavy versus moderate drinking as a possible explanation for moderate drinking’s health benefit in reducing the risk of cold and other viral infections.
Studies in the Division of Treatment and Recovery Research present hard data that show placebo-effect variations in clinical trials for alcohol dependence, but a negative correlation with treatment-effect size.
A randomized controlled trial (RCT) study that integrated primary medical care with addiction treatment shows that individuals with substance abuse–related medical conditions benefit from integrated treatment, a potentially cost-effective approach. A double-blind, placebo-controlled trial shows that varenicline significantly reduces alcohol consumption and craving; it represents a potential target for future medications for alcoholism and perhaps in smoking cessation. An RCT shows that gabapentin was effective in treating alcohol dependence and relapse-related symptoms of insomnia, dysphoria and craving with a favorable safety profile. The researcher is pursuing FDA approval for gabapentin for the treatment of alcoholism.
Division of Neuroscience and Behavior research shows that modifying glutamatergic function can change how rodents drink. Another study shows that disruption of alcohol-related memories by mammalian target of rapamycin complex 1 (mTORC-1) inhibition prevents relapse, a model with possible direct human relevance. Mouse research on fetal alcohol spectrum disorder (FASD) shows that prenatal ethanol exposure disrupts intercortical circuitry. An imaging study in recovering alcoholic men reveals that a selective insular deficit contributes to compromised salience network connectivity deficits, which may relate to inhibitory control.
The Division of Epidemiology and Prevention Research shows, in a review of research findings since 2007 on underage drinking, an analysis of related traffic fatality trends and new research on social determinants, consequences, and preventive interventions. An upcoming article on trends in extreme binge drinking among U.S. high school seniors reveals that the percentage of high school seniors who binge drink fell, but the percentage of people who take 15 drinks over 4 hours have not. A large national survey shows that Americans have poorer diets on drinking days than nondrinking days. A study of psychophysiological responses to stress following alcohol intake in social drinkers at risk of hazardous drinking found differences in the subjective effects of ethanol between high- and low-risk drinkers.
Dr. Koob encouraged consideration of interactions between NIAAA Divisions.
Addiction and Alcoholism
In describing Dr. Koob’s views on addiction and alcoholism, and having worked on both alcohol and substances of abuse throughout his career, he presented his conceptual framework for stages of the addiction cycle: binge/intoxication stage, withdrawal/negative effect stage, and preoccupation/anticipation (or craving) stage. The addiction cycle involves elements of impulse control disorders, with excitement, impulsivity, and activation (but little regret or self-reproach), as well as compulsive disorders, whose obsessions engender stress, anxiety, and repetitive behaviors. Dr. Koob also explained his view of positive and negative reinforcement, where in positive reinforcement presentation of a stimulus (drug) increases the probability of a response (nondependent drug-taking paradigms). However, in negative reinforcement removal of an aversive stimulus (such as the dysphoria of drug withdrawal) increases the probability of a response (such as dependence-induced drug taking). Dr. Koob asserted that negative reinforcement, a key part of addiction, often is neglected. He acknowledged the important roles of dopamine and opioid peptides in the nucleus accumbens in the binge intoxication stage of the addiction cycle and the frontal cortex glutamatergic systems in preoccupation-anticipation (“craving”) stage of the addiction cycle, but noted that stress transmitters and circuits during the withdrawal/negative affect stage play a key role in motivation for alcohol and drug seeking. Dr. Koob concluded that addiction is an incentive salience disorder, a reward deficit disorder, a stress surfeit disorder (perhaps in parallel), and an executive function disorder (perhaps in parallel or perhaps at the start).
Dr. Koob illustrated this point by describing a study by Gunduz-Cinar and colleagues (Molecular Psychiatry 2013; 18:813-823) where they demonstrate that animals trained in a conditioned-fear paradigm showed, during extinction of that fear, an increase in anandamide in the amygdala suggesting a compensatory anti-stress response. A FAAH inhibitor also globally raised anandamide levels. The investigators also looked at humans and found a distribution of individuals with different alleles for FAAH activity. AA carriers who have less FAAH activity, and presumably have more brain anandamide were less reactive to stress reactivity. When they are exposed to fearful stimulus, they had much faster habituation to the stimulus. Therefore, in animals that show better extinction to a fearful stimulus, and possibly in humans in conditions associated with posttraumatic stress disorder (PTSD), anandamide activation may protect them. This suggests a target for potential treatment and facilitation of a behavioral treatment such as cognitive behavioral therapy with a re-exposure paradigm used for the treatment of PTSD; and that a FAAH inhibitor might boost behavioral treatment and increase its efficacy and speed, and consolidate it longer.
Dr. Koob enumerated his goals for NIAAA and invited Council members’ comments: understand the unique molecular-cellular actions of low intoxicating doses of alcohol; understand the neuroplasticity of neurocircuits that drive excessive drinking and alcoholism; develop evidence-based prevention and treatment for excessive drinking and alcoholism across the developmental spectrum; understand the role of alcohol in organ pathology, and develop effective prevention and treatment strategies for such pathology; increase understanding of the epidemiology and underpinnings of underage drinking, and how problems of drinking by young people can be addressed effectively; develop improved approaches to deliver health services for alcohol disorders; promote and recruit young investigators to the alcohol field, and promote and recruit women with parity for pay, and promote and recruit minorities to the alcohol field.
Discussion. To Dr. Patricia Molina’s query about HIV/AIDS, Dr. Koob agreed that NIAAA considers HIV/AIDS to be a priority, and he proposed to work on the issue in concert with NIDA.
Hughes Award Presentation
Dr. Warren presented the 2014 NIAAA Senator Harold Hughes Memorial Award to Mr. Tom Donaldson, president, National Organization on Fetal Alcohol Syndrome (NOFAS). Named in honor of U.S. Senator Harold Hughes, the award recognizes the contributions of a non-researcher whose work helps to translate alcohol research into practice in alcohol prevention, treatment, and policy-making. Dr. Warren stated that since 2002 Mr. Donaldson has led NOFAS, which raises awareness of the public, the medical professions, and legislators that FASD is the leading known cause of developmental disability and birth defects, and the leading cause of learning disabilities in the United States. Mr. Donaldson accepted the award, noting that NOFAS stands by a strong and independent NIAAA. He stated that as a nonprofit public advocacy organization, NOFAS’s messages and activities are informed by NIAAA-inspired published research. Mr. Donaldson observed the significant impact of Sen. Hughes’s aim to make the issue of alcohol abuse and alcoholism a matter of public health and scientific pursuit.
Consideration of the September 12–13, 2013, Meeting Minutes and Future Meeting Dates
Council members unanimously approved the minutes of the NIAAA Council meeting held on September 12–13, 2013. NIAAA plans future Council meetings for June 4–5 and September 10–11, 2014. In 2015 the Joint Council meeting with NIDA and the National Cancer Institute will take place on February 4, and the NIAAA Council will meet February 4–5, June 10–11, and September 16–17. In 2016 the Joint Council meeting will take place on February 3, and the NIAAA Council will meet February 3–4, June 8–9, and September 14–15.
NIAAA Advisory Council’s Functional Integration Workgroup Report
Dr. John Krystal, Chair, Psychiatry Department, Yale University, reported on the work of the Functional Integration Workgroup, successor to the Extramural Advisory Board, which had provided input to NIAAA Council on concept proposals and recommended research directions. Dr. Krystal stated that the workgroup met twice in 2013, with some sessions attended only by NIAAA representatives and others with National Institute on Drug Abuse (NIDA) and/or National Cancer Institute (NCI) Tobacco Division representatives. The next workgroup meeting will take place in April 2014.
Dr. Krystal explained that synergies in the functional integration of NIAAA, NIDA, and NCI’s Tobacco Division are to be achieved through collaboration rather than structural integration; that the nature, scope, and priorities are to be developed together; and that consolidation opportunities may arise. Critical questions for NIAAA involve how NIAAA/NIDA collaboration can advance the greater societal good (e.g., common aims, greater efficiency); and how collaboration can advance the aims of NIAAA as the steward of the nation’s research on alcohol.
At the November workgroup meeting, NIAAA representatives discussed initiating awards for personalized treatment and mobile technologies, and conducting health services research. Broader group discussions revealed a striking breadth of integrated research opportunities related to comorbidity, including such opportunities as neurobiology (molecular, cellular, systems development, cognitive, and social, and the need for biomarkers and unique treatments, and for deeper understanding of pathophysiology of alcohol and other substance and medical disorders); basic mechanisms of medical risk (for example, inflammation and oncogenesis, including the interaction of smoking and drinking in cancer risk); behavioral processes, including the need for novel assessments to address complexities and unique types of experimental analyses and treatment); and social mechanisms (including the unique epidemiological studies to obtain data to drive research on comorbidity issues).
Another theme that the workgroup discussed was to provide more investment in support of basic research on the scientific underpinnings of addiction, as opposed to addiction per se. Other priorities include the genetics and epigenetics of complex behaviors; basic behavioral mechanisms of behavior change; basic mechanisms of brain development (e.g., fetal, adolescence, elders, and times of vulnerability); basic mechanisms of cellular injury and repair in the brain, liver, and lung; development of new treatment technologies and approaches, such as transcranial brain stimulation and mobile applications and Web-based interventions that can serve as prevention and treatment multipliers in multiple settings, and create cost-efficiencies; and research training and approaches to research career development.
Dr. Krystal explained that current CRAN notice of funding opportunities (NOFO) include administrative supplements and competitive revision applications to promote research on new and/or under-recognized opportunities to address polysubstance use and comorbidity.
Discussion. Dr. Koob observed that functional integration is on the right track. He urged Council members to publicize the availability of the current NOFOs. Dr. Krystal noted that with greater lead time, people will consider how to take advantage of the opportunities. Dr. Bautista noted that the administrative supplement received a good response, but the competitive revisions may not have done as well because those applications are subject to peer review. Dr. Judy Arroyo, NIAAA, suggested issuing an R21 or R01 announcement for secondary analyses of existing data sets. Dr. Krystal responded that workgroup discussions on low-hanging fruit included reanalysis of existing data or of secondary analyses. Dr. Koob suggested issuing a CRAN application related to opioid-alcohol interaction.
NIH-Industry Partnership for Therapeutics Development
Dr. Christine Colvis, National Center for Advancing Translational Sciences (NCATS), described NCATS’ new NIH/industry partnership program to discover new therapeutic uses for existing molecules and bring therapeutics into use sooner. NCATS focuses on technologies, approaches, and strategies to help stages of translation from basic science findings to the point of community treatment. Eight pharmaceutical companies have participated to date in the therapeutics development program, launched in May 2012, which is designed to explore repurposing and repositioning investigational drug compounds by leveraging companies’ assets and harnessing the intellectual power in the research community.
Dr. Colvis explained the process for the initiative’s pilot. NIH provided template research agreements, composed in collaboration with the pharmaceutical companies; issued NOFOs to academic investigators; and conducted peer reviews of the applications. Companies provided preclinical and clinical compounds and placebos at no cost along with significant in-kind support. The companies were expected to interact with investigators and provide regulatory advice, their experience, and their data. NIH entered into a memorandum of understanding with each of its corporate partners, each of which proposed a Phase IIa trial. The companies contributed a total of 58 agents that previously had not been approved.
In pre-applications, investigators indicated a specific area of medical need, identified an appropriate investigational team, and described a scientific rationale that linked a compound’s mechanism of action with a disease. Researchers submitted nearly 160 pre-applications in response to the NOFO, a robust response. For compounds that received 5 or more applications (this occurred for 16 compounds), the applications covered at least 3 different indications in all cases but one. Following NCATS’ peer review, top-tier applicants made contact with companies. Each company received at least one application for an indication it had not considered previously, and ultimately the investigator and company would decide whether or not to move forward. Template collaborative research agreements played a significant role in expediting the process.
NCATS made nine awards in June 2013 totaling $12.7 million for the first year. The projects addressed Alzheimer's disease, alcoholism, smoking cessation, schizophrenia (two applications), peripheral artery disease, lymphangioleiomyomatosis, Duchene muscular dystrophy, and calcific aortic valve stenosis. For example, intramural investigator Dr. Lorenzo Leggio, along with extramural scientist Dr. Fatemah Akhlaghi, are investigating whether antagonism of the ghrelin receptor (GHS-R1a) might be a novel treatment for alcoholism. These studies are conducted at NIH (NIAAA/NIDA/Clinical Center), University of Rhode Island and Pfizer. The Intramural Program at NIAAA and NIDA supports Dr. Leggio. NCATS provides funds to the extramural segment at the University of Rhode Island, while Pfizer provides the drug, ghrelin receptor inverse agonist, competitive antagonist, which was originally indicated for type II diabetes. A smoking cessation project, whose primary investigators are Drs. Darlene Brunzell and Ken Perkins, was based on strong data to support the linkage to alpha7, a compound Janssen had already tested on patients with schizophrenia. NCATS’ two NOFOs attracted studies at all levels: some starting with pre-clinical, some with Phase I, and some with Phase II.
Feedback was solicited from the academic side and pharmaceutical companies, which indicated that the template agreement and the two-tiered selection process for applications worked well. The two-tiered process involved first the submission of a pre-application (X02). Approved pre-applicants are advised to get in touch with pharmaceutical companies for the submission of the grant application. Last year, the 11 week-time period for this process was too short to put together a collaborative research agreement, grant application and for the pharmaceutical companies to provide their new ideas to the applicants. Strong enthusiasm was expressed for another initiative, and in January 2014 NCATS issued a notice to pharmaceutical companies that had not participated in the program to solicit compounds for inclusion in another funding opportunity.
Discussion. In response to Dr. Reilly’s question about the Common Fund’s Library of Integrated Network-based Cellular Signatures (LINCS) program, Dr. Colvis stated that in the future NCATS might consider coordinating this program with the LINCS program, which repurposes and identifies new mechanisms for Food and Drug Administration– (FDA) approved drugs. Though many people have raised the question of whether people could screen for the 58 compounds, NCATS does not have them; the strategy may be explored with pharmaceutical companies in the future. She emphasized the advantage of the participating companies’ disclosure of a great amount of information in the context of a highly competitive environment. In response to a question from Dr. Craig McClain regarding new corporate participants, Dr. Colvis stated that companies must make at least three compounds available to the investigators.
NIH Council of Councils Update
Dr. Craig McClain, NIAAA’s representative to NIH’s Council of Councils, described the work of that body. A typical agenda includes special topics of interests and NIH updates from its chair, Dr. James Anderson, and NIH Director Dr. Francis Collins. NIH Institute Directors also offer updates, and Council members review applications and discuss Common Fund initiatives.
NIH spends about $1 billion yearly on research cores, but there are no centralized directories, best business practices, or sustainability plan and thus duplications of effort become apparent. To help fix this situation in part, Institutes can use existing cores. At this meeting, Dr. Collins suggested that peer review could be like a jury duty, with everyone in the pool and individuals serving when called. Other issues discussed included electronic data used to identify research trends; PIONEER-type awards to promote investment in the investigator; use of biosketches that identify each author’s contribution to a publication; concerns with reproducibility and novelty of published studies; declining research budgets and loss of international “market share”; large investments in HIV/AIDS research by each Institute; FDA/NIH partnership on tobacco research; the BRAIN Initiative; the CRAN; and the Common Fund.
Dr. McClain emphasized the importance of NIAAA investigators understanding the Common Fund, which aims to impact large targets quickly and facilitate applications for R21 or R01 grants or infrastructure development. Common Fund projects have a short time frame (5 to 10 years), and projects are meant to be catalytic, synergistic, and trans-NIH. Phase II Common Fund planning programs for 2013 included basic science (glycomics), citizen science, 3D nucleome, and physical activity benefits mechanisms.
Discussion. Dr. Warren stated that although Common Fund programs remain a priority, they did not move forward in FY 2013 due to sequestration. New programs are being added and are under discussion.
Department of Defense Ex-Officio Council Member Report
COL Charles Milliken, newly appointed Ex-Officio Council Member from the Department of Defense (DoD), described recent activities based on a 2012 Institute of Medicine report and a 2013 DoD response. The DoD’s Health-Related Behavior Survey revealed that the armed services are populated predominantly by young males who experience high levels of heavy drinking and binge drinking. Army researchers find that combat exposure increases PTSD, depression, and alcohol consumption; half of individuals with PTSD have alcohol problems. Moreover, many individuals whose symptoms do not reach the level of PTSD use alcohol as self-medication for sleeplessness, and in many instances such use may result in the development of problems. DoD screens periodically after a service member returns home for alcohol along with PTSD and depression. COL Milliken also mentioned that a 2007 DoD report showed soldiers were willing to endorse alcohol use problems, along with PTSD and depression. However, only 1% of individuals with referrals enter substance abuse clinics typically located in communities, while 30% enter mental health treatment centers within DoD’s medical services. In the military system, COL Milliken explained, commanders need to know everything about their soldiers, but a balance is necessary; the Army has tried to make its existing clinics more attractive by permitting confidentiality for an individual in the absence of adverse legal evidence, and DoD is considering broadening that program to other services. The goal is to encourage early treatment help service members avoid harming their careers. Career soldiers are more fearful about their careers than younger solders, but success rates are good for the younger group.
DoD has adopted SBIRT (Screening, Brief Intervention, and Referral to Treatment) geared to alcohol in screening settings. Annual screenings are conducted in primary care clinics. DoD is rolling out a program to place a mental health provider in all primary care clinics with 3,000 patients to address alcohol and mental health problems in one to four SBIRT-type sessions. In addition, the Army is working to initiate automated screening in its clinics for PTSD and depression, and tentatively for alcohol as well, though the process has been interrupted by the transition of the primary care system to patient-centered medical homes. Automated screening will generate more frequent alcohol screening.
Discussion. Dr. Koob suggested that a future Council meeting feature a presentation on the relationship between PTSD and alcohol. COL Milliken responded to Dr. Sarah Mattson-Weller that clinical observations reveal that young women are more willing to say “I feel distressed, I need to see someone,” and access a mental health clinic, while young males are not in touch with distress but go out drinking—and then are brought into treatment services.
Public Comment
Ms. Mary Kelly, Substance Abuse Librarians and Information Specialists Association, called attention to the association’s Internet Archiving Project, which helps digitize holdings of libraries that are reconfigured or closed.
Dr. Sarah Cavanaugh, Physicians Committee for Responsible Medicine, urged NIAAA to broaden its prevention, education, and treatment research efforts for excessive alcohol use. She raised questions about the usefulness of large expenditures on research using animal models and the ethical ramifications of using animals in research on a uniquely human disease.
Adjournment
The meeting adjourned at 4:45 p.m.
s/s
George Koob, Ph.D.
Director
National Institute on Alcohol Abuse and Alcoholism
and
Acting Chairperson
National Advisory Council on Alcohol Abuse and Alcoholism
s/s
Abraham P. Bautista, Ph.D.
Director, Office of Extramural Activities
National Institute on Alcohol Abuse and Alcoholism
and
Executive Secretary
National Advisory Council on Alcohol Abuse and Alcoholism