National Advisory Council Meeting - September 16-17, 2009

Summary of the 122nd Meeting

September 16-17, 2009

The National Advisory Council on Alcohol Abuse and Alcoholism (NIAAA) convened for its 122nd meeting at 5:30 p.m. on September 16, 2009, at the Fishers Lane Conference Center in Rockville, Maryland, in a closed session.   Dr. Abraham Bautista presided over the closed review of grant applications and Merit Award nominations.   Dr. Kenneth Warren, Acting Director, NIAAA, presided over the Council’s open session on September 17, 2009.   In accordance with the provisions of Sections 552b(C)(6), Title 5, U.S.C. and 10(d) of Public Law 92-463, the session on September 16, 2009, was closed to the public for the review, discussion, and evaluation of individual applications for Federal grant-in-aid funds.

Council Members Present:

Michael E. Charness, M.D.
David W. Crabb, M.D.
Gen. Arthur T. Dean
Cindy L. Ehlers, Ph.D.
Scott L. Friedman, M.D.
R. Adron Harris, Ph.D.
Deborah S. Hasin, Ph.D.
Andrew C. Heath, D.Phil.
Vimal Kishore, Ph.D.
Lynell W. Klassen, M.D.
John H. Krystal, M.D.
Peter M. Monti, Ph.D.
Larry I. Palmer, LL.B.
Edward P. Riley, Ph.D.
Linda P. Spear, Ph.D.

Ex-officio: John P. Allen, Ph.D., M.P.A.

Chairperson: Kenneth R. Warren, Ph.D.

Executive Secretary: Abraham P. Bautista, Ph.D.

Senior Staff:

Vivian B. Faden, Ph.D., Ralph W. Hingson, Sc.D., M.P.H., Robin Kawazoe, Antonio Noronha, Ph.D., Howard B. Moss, M.D., Mark Willenbring, M.D., Samir Zakhari, Ph.D.

Other Attendees on September 17, 2009

Approximately 75 additional observers attended the open session, including representatives from constituency groups, liaison organizations, NIAAA staff, and members of the general public.

Call to Order of the Closed Session, September 16, 2009

Dr. Abraham Bautista called the closed session of the 122nd meeting of the Council to order at 5:30 p.m. on Wednesday, September 16, 2009, for consideration of grant applications and MERIT Award nominations.  He reviewed procedures and reminded Council members of regulations pertaining to conflict of interest and confidentiality.  Members absented themselves from the discussion and evaluation of applications from their own institutions and in situations involving any real, apparent, or potential conflict of interest.  Council members then considered nominations for the MERIT Award.  The closed session adjourned at 6:30 p.m.  

Call to Order and Introductions, September 17, 2009

Dr. Kenneth Warren called the open session to order on September 17, 2009, at 9:00 a.m. and welcomed participants.   Council members and NIAAA senior staff introduced themselves.

Director’s Report

Dr. Warren highlighted key recent Institute activities, referring to the written report:

• Legislation, budget, and policy.   NIAAA currently is awarding the last of the many FY 2009 grants.  Appropriations for the year totaled $450.2 million, an increase of 2.7% over the FY 2008 budget, enhanced by an additional 2-year appropriation of $113.9 million under the American Recovery and Reinvestment Act (ARRA).  Approximately 40% of ARRA funds are to support R01 and R21 grants, and about 28% of the funds will support Challenge Grants and Grand Opportunities Grants.  Additional funds will support other existing programs and faculty recruitment grants (P30).  Both the House and Senate have passed NIH appropriations bills for FY 2010.  The House version provides $31.259 billion—$941 million more than FY 2009 and $500 million more than the President’s request of $30.759 billion, of which NIAAA would receive $466.3 million.  The Senate passed the President’s budget, but members took issue with a prescriptive provision regarding specific research.   Congress will reconcile differences between the bills in conference.  To initiate the FY 2011 budget process, NIAAA planned soon to submit materials to the Department.  
• Director’s activities.   Dr. Warren signed a letter of intent with NIAAA’s Polish counterpart, following a series of activities in Poland in September 2009 to determine whether to add that country to the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD). Dr. Warren and Ms. Peggy Murray also participated in the International Symposium on FASD in Berlin, where they met with key staff at the German Ministry of Health.   Ms. Murray explained that Poland has the desire and funds to engage in research, and noted that German officials asked NIAAA to send them rationale and information on the advantages of a separate alcohol research establishment.
• Honors.   Dr. Warren announced that Dr. Patricia Powell received the Martin K. Trusty Excellence Award in Management; Dr. Judith Arroyo and Ms. Robin Kawazoe received NIH Director’s Awards for their contributions to the first NIH Summit on the science of eliminating health disparities; Dr. Samir Zakhari received both a certificate of appreciation from the HHS Secretary for serving as an Executive Review Board member for the Senior Executive Service Candidate Development Program and an NIH Director’s Award in Science for leadership in promoting the advancement of emerging scientific areas in alcohol research; and Dr. Antonio Noronha received the annual Research Society on Alcoholism (RSA) Seixas Award.  
• NIAAA staff and organization.   New appointments to NIAAA include William Dunty, Ph.D., program director, Division of Metabolism and Health Effects; Pamela Anderson, Management Analyst- Administrative Fellows Program, Ethics and Management Branch; Ms. Jenna Adamczyk, research assistant, Division of Treatment and Recovery Research; and Mark Siegal, NIAAA Web manager, Communications and Public Liaison Branch.   Dr. Warren announced the imminent retirement of Dr. Mark Willenbring, Director, Division of Treatment and Recovery Research.
• Multimedia products from NIAAA.   Dr. Warren announced that NIAAA has launched the new NIAAA Spectrum, and both Alcohol Research & Health and Alcohol Alert recently published new issues.   He reported that NIAAA has received many repeat bulk orders for the Rethinking Drinking brochure and stated that the University of Missouri’s Rethinking Drinking Web site is being integrated into two separate Screening, Brief Intervention, Referral, and Treatment (SBIRT) grants.
• Outreach.   NIAAA hosted Jeter’s Leaders awards, a high school program that emphasizes leadership training, peer education, healthy lifestyles, and alcohol education.   NIAAA is partnering with the Centers for Disease Control (CDC) to promote college alcohol-reduction strategies; the two agencies signed a Memorandum of Understanding to collaborate on evaluation of marketing strategies.   Dr. Warren highlighted NIAAA’s health disparities outreach efforts, including meetings of the National Hispanic Youth Initiative, National Institute of Mental Health Summer Research Institute, and the Association of American Indian Physicians.  
• News media interactions.   A Time magazine article quoted Dr. Willenbring at length, and Dr. Ralph Hingson gave numerous media interviews on college drinking.

Dr. Warren stated that in September 2009, he and Dr. Howard Moss presented at a closed meeting of the Scientific Management Review Board (SMRB), which is looking at the NIH structure regarding NIAAA and NIDA; the NIDA director made a separate presentation to the panel.   The Board’s Substance Use and Abuse Working Group will hold additional meetings at which several Council members plan to speak.   The Board’s Web site is http://smrb.od.nih.gov/.   

Shortly after his arrival, NIH’s new director, Dr. Francis Collins, hosted a stakeholders meeting with scientific organizations.   Dr. Monti reported that Dr. Collins suggested that NIH pay greater attention to issues surrounding healthcare reform.   Dr. Collins also stated that existing Institutes must accommodate disease categories that may not be well represented at present.

Extramural Advisory Board Report on Stress and Alcohol Relapse

Dr. Linda P. Spear, Psychology Professor, Binghamton University—SUNY, presented recommendations from the June 2009 meeting of the Extramural Advisory Board (EAB) on stress and alcohol relapse.  She offered a brief overview of the science underpinning the EAB’s recommendations.  The Board had based their deliberations on background material prepared by NIAAA’s Division of Neuroscience and Behavior, which examined such topics as stress- and alcohol-sensitive neural circuits, psychological factors and neuroimaging, autonomic nervous system and interoceptive cues, racial and ethnic factors, behavioral mechanisms, and medications.  The EAB recommended the following:

1.      Characterize the phenomenology of the course of alcohol dependence, maintenance, abstinence, and stress, as related to the dynamics of relapse and stress-related relapse.  Resolve critical issues of time-course of dependency, abstinence, and relapse, with consideration of transient vs. progressive vs. persistent effects of stress on relapse; explore the use of animal studies for modeling critical components of stress/relapse interactions; understand the relationship between dependence severity and stress-induced relapse; distinguish factors that cause relapse (e.g., stress, anxiety, negative affect); investigate the cumulative effects of adversity/chronic stress (history and type of stress) on relapse propensity, including consideration of developmental timing of stress (prenatal, adolescent, aging), critical periods, gene/development interactions, and different stressor models (e.g., PTSD, HIV, high crime, poverty).

2.      Use multifactorial measures in animal models to study processes contributing to stress-induced relapse across the lifespan.  Investigate models of “relapse”-increased responding to cues and/or changes in drinking patterns; determine endophenotypes and intermediate adaptations associated with stress and relapse that can be examined in humans and animals.  Assess the role of genetics in animal models of stress-induced relapse; focus on behavioral processes (e.g., explicit and implicit learning response inhibition), and development of translational models of behavioral indexes of stress-related relapse; consider the impact of developmental exposure to stressors and chronic repeated stressors on later drinking; examine interoceptive cues that may serve as cues to trigger relapse; and explore neuroimaging as a means to promote translational studies.

3.      Utilize multifactorial human models to study stress-induced relapse across the lifespan, examining stress-related comorbidities (e.g., mood, anxiety, other substance abuse); interoceptive cues (e.g., heart rate, respiration, and other autonomic responses) that are highly sensitive to learning history, are associated with alcohol and stress, and that may serve as cues to trigger relapse; resilience mechanisms, pathways leading to positive and negative outcomes, and how behavioral and biological measures return to normal vs. permanent changes; and groups of individuals at high vs. low risk of relapse, to answer questions of the role of biological vs. environmental factors in individual variance, differences between alcoholics who bottom out and relapse vs. those who do not, stress-relevant protective vs. vulnerability factors in abstinence/relapse, and the value of secondary analyses of NESARC data.

4.      Characterize the interaction between stressors and alcohol on biological processes, including structural (e.g., dendritic spines, circuitry), chemical (e.g., transmitter, immune, neuromodulators, neurosteroids), neural/glial, and genetic (e.g., gene expression/function “epigenetics,” histone and DNA modification, noncoding RNAs) measures. Of particular interest is the overlay of both stress- and EtOH-sensitive brain circuits (e.g., better understanding of prefrontal cortical-limbic interactions).

5.      Identify stress-related markers predictive of relapse.  Consider both peripheral and central markers in males and females, human and animal models, with an emphasis on determining predictability (human studies) and causality (animal studies).   Of particular interest are endophenotypes and intermediate adaptations that can be measured in animals and humans (e.g., PPI, behavior, sleep, withdrawal indexes, endocrine, autonomic, neuroimmune measures), and markers that predict relapse and stress-induced relapse (e.g., genetic, epigenetic, molecular/cellular/proteomic, neural circuits, stress-related physiology [ANS, HPA], cognitive, pharmacological, behavioral, social, cultural, ethnicity, gender).

6.      Characterize the spectrum of reversible biological responses to mild stress and pathological (irreversible) responses to severe and prolonged stress, and how they relate to alcohol dependence.  Include the spectrum from reversible effects of modest exposures on brain signaling events and circuits to toxic effects on some of the same signaling events and neural circuits.  

7.      Develop medications for relapse prevention.  Explore potential pharmacotherapies for comorbid disorders and stress (e.g., anxiety, depression, PTSD) as potential drugs to treat stress-induced relapse; integrate genetic/epigenetic/behavioral/neuroimmune responses to define new therapeutic targets and patient subgroups; and develop medications to enhance behavioral therapies directed at relapse prevention.

Discussion.   Dr. John Krystal urged NIAAA to maintain its high priority on such mechanisms as the Clinical Trials Network to test drugs and introduce new treatments for people.  Dr. Warren responded that Dr. Collins has committed to pharmacotherapy development and can be expected to support NIAAA in this regard.  Dr. Warren noted that the “Green Sheet,” which monitors FDA-related activities, reveals that many companies are working on potential medications for alcohol.  Dr. Krystal noted that traditional grant mechanisms do not facilitate the required creative collaboration among government, academia, and drug companies.  He noted that novel medications that address alcohol use in the context of stress may be emphasized.  Dr. Moss described NIAAA’s strong medications development program, whereby NIAAA works with industry collaboratively and with technical support to bring into the pipeline therapeutics for alcohol use disorders.  Dr. Krystal observed that no new grants were awarded for human testing of a new drug.  Dr. Willenbring concurred that considering a typical R01 mechanism does not lend itself to drug development, NIAAA has implemented a contract mechanism.  Pharmaceutical companies show increasing interest in alcohol use medications and recognize the large untapped market.  He asserted the need to bolster the addiction specialty sector to support general practitioners in initiating treatment for dependence, and noted the emerging importance of behavioral change mechanisms and other approaches that move beyond persuasion and education.  

Concurrence. The National Advisory Council concurred unanimously with the EAB recommendations.

NIAAA Spectrum : New NIAAA Webzine

Dr. Vivian Faden, Acting Director, Office of Science Policy and Communications, NIAAA, introduced NIAAA Spectrum, the new NIAAA webzine.  The Web publication features brief and engaging articles, short news updates, and colorful graphics (including “charticles”) on NIAAA and alcohol research, targeted for use by a wide audience.  The webzine will be archived, and readers can forward it to others.  NIAAA will save printing costs, and the material can be updated easily.  To be published initially three times a year, the webzine will be distributed to NIAAA’s mailing lists and be made available in pdf file format.

Discussion.   Council members commented on the publication’s attractiveness.  Dr. Scott Friedman suggested promoting the webzine’s priority in Web searches and assessing the impact of the publication and each article.  Dr. Faden stated that the Web manager will address such issues.  Professor Palmer recognized the importance of placing this authoritative resource on the Internet.  Dr. Hasin suggested expanding the mailing list to researchers beyond the circle of NIAAA grantees.  Dr. Faden solicited suggestions for possible audiences to help inform a dissemination plan.  Dr. Spear pointed out that a Google search on the title elicited considerable information on FASD, but Dr. Charness noted that indexing is needed. Dr. Crabb also pointed out that most people will not search for “NIAAA Spectrum.”  Dr. Friedman suggested that the webzine audience might include university and high school health offices and high school nurses.

Genetic Factors in Risk for Alcohol Dependence in a Native American Indian group
 
Dr. Cindy L. Ehlers, Professor, Department of Molecular and Integrative Neurosciences, Scripps Research Institute, stated that alcoholism is the most urgent health problem facing Native Americans.  Dr. Ehlers for many years has studied a group of Native Americans. Dr. Ehlers stated that her longitudinal and cross-sectional studies seek to identify key environmental and genetic risk factors for alcohol in this population group using a variety of techniques with children, adolescents, and adults.  
 
Dr. Ehlers’s study found that degree of cultural affiliation, poverty, employment, divorce, and religion had no impact on rates of alcohol dependence in this population.
 
In a population with high rates of alcohol dependence, it is important to identify which phenotypes are associated with genes that might underlie the disorder. The National Longitudinal Alcohol Epidemiologic Study (NLAES) and National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) show that age of onset of drinking influences whether one becomes alcohol dependent, and those who begin at age 15 are especially more at risk than those who delay. While NLAES data show that of people in the general population who begin drinking before age 13, 10% will become alcohol dependent the rates are much higher in this population group offering a point of prevention in this population. Native Americans in this population group also report more serious life events associated with alcohol dependence, including more health problems than reported in the Collaborative Study on the Genetics of Alcoholism (COGA) study.  
 
In this Indian population major depression is lower than in the National Comorbidity Study (NCS) suggesting that it may not be a common cause of Alcohol dependence. Dr. Ehlers also found much lower rates of anxiety disorders than in the NCS and higher rates of antisocial personality disorder and conduct disorder than in the COGA study.  She also found increased rates of stimulant and marijuana dependence.  
 
Dr. Ehlers also investigated, for the first time, the level of response to alcohol. Investigators gave specific alcohol doses to a matched group of tribal individuals who were positive or negative for family history of alcohol dependence; no differences were seen in blood alcohol levels or flushing reaction. They found an extremely low level of response to alcohol and fewer EEG signs of intoxication, and Indian men with higher degrees of Native American ancestry had lowest levels of response to alcohol. This important endophenotype in this population appears to put them at risk.  
 
Dr. Ehlers derived the heritability information on several alcohol related phenotypes, and conducted a linkage mapping that indicated evidence that a region on a chromosome may harbor genes involved in the phenotype of interest. Some elements of alcoholism diagnosis are heritable, such as tolerance and withdrawal, frequency of drinking, binge drinking, cravings, and severity of drinking. Some phenotypes related to alcohol dependence are also more heritable, including any drug dependence, antisocial personality disorder (ASPD), and body mass index (BMI).  Dr. Ehlers has identified promising locations for the alcohol-problems phenotype, drinking-dependence phenotypes, and withdrawal, some of which have been confirmed or were initially found in other population samples, representing consensus about areas harboring genes for alcohol dependence.  In looking at tobacco use and drinking severity, an area on chromosome 4 is likely to be important for both.  In looking at SNPs, some highly significant associations with some genes were found.
 
It has been suggested that neurobiological mechanisms that underlie appetitive drives and instincts to consume food and beverages may become dysregulated during the process of drug exposure.  A promising area of the genome appears to be associated with craving in this Indian population.   Different areas on the genome harbor genes for alcohol dependence vs. other drug dependence.  Dr. Ehlers found an area on the genome that might harbor overlapping genes for BMI and for drug dependence, and also for other phenotypes such as ASPD. Evidence has been found for association with CNR1, OPRM1, and ADH with impulsivity, level of response to alcohol, and drinking severity phenotype.
 
Discussion.  To a question from Dr. Scott Friedman, Dr. Ehlers responded that rates of alcohol dependence and BMI are extremely high in Native Americans, aboriginal Australians, Maori, and Pacific Islanders.  Dr. Andrew Heath noted the difficulty in obtaining approval for genetic research on Australian aboriginals. Dr. Zakhari commented on the value of comparing residents on reservations with and without liver cirrhosis for prevalence of depression, because people with primary biliary cirrhosis have depression. Dr. Ehlers acknowledged the necessity to look at medical comorbidity.  She stated that few people in her sample have depression, but data may be available from the Indian Health Service.  Dr. Moss noted the importance of Dr. Ehler’s independent confirmation of Schuckit’s hypothesis about level of response.  He inquired whether markers exist for the promising high-risk phenotype, other than the genetic and response markers associated with administering ethanol, that may offer opportunities for indicated and selected intervention.  Dr. Ehlers stated that she has not looked at other biochemical markers, which would be important to do.  Using electrophysiology, investigators found an association with EEG gamma activity and alcohol depression in this population, and have identified genome locations for the EEG phenotypes in this population. In response to a question from Dr. Heath, Dr. Ehlers noted the need for sensitivity in addressing the issue of trauma and abuse in this population.  Dr. Ehlers responded to Dr. Willenbring that she compared her data on alcohol insensitivity with Schuckit’s data on Caucasians. Dr. Noronha inquired about the correlation of alcohol clearance rates within the population and associations with ADH1A and -1B.  Dr. Ehlers stated that although she found no great differences in alcohol elimination rates associated with Native American heritage or family history, more data have become available from Howard Edenberg’s work on SNP genotyping across ADH that will enable subsequent investigation.

Brief Alcohol Interventions: Efficacy, Mechanisms, and Cost-Effectiveness

Dr. Peter M. Monti, Director, Center for Alcohol and Addiction Studies, Brown University, presented evidence that youthful drinking is a major problem.   Data show that early age of onset of drinking relates to dependence, suicide, violent behavior, dating violence, and other serious problems, including motor vehicle crashes.   Data also show that brief interventions decrease future health problems and injury, and Dr. Monti’s work with screening and brief interventions (SBI) in emergency departments (EDs) is at the forefront of thinking in the treatment of alcohol.   EDs treat many individuals who lack healthcare coverage, and brief interventions are expected to make a great impact.

In the first of six studies, Dr. Monti stated that Brown’s Center for Alcohol and Addiction Studies give teens in EDs the opportunity to explore their drinking.   Motivational interviewing (MI) provides individuals with feedback, comparing level and consequences of their drinking compared to standard, age-matched groups; elicits goals teens may have for changing their behavior; helps them to envision the future with and without change; helps identify barriers and discuss potentially useful strategies; and summarizes the conversation.   MI is brief, appropriate for several levels of readiness for change, proven effective with adults, and useful to capitalize on a “teachable moment.” Its principles involve expressing empathy, developing discrepancy, avoiding argumentation, rolling with resistance, and supporting self-efficacy.  

Dr. Monti’s studies used two-group designs, with an assessment, random assignment according to positive blood alcohol level and/or AUDIT score to the intervention or standard care, with follow-up to 12 months.   The first study of 18 and 19 year olds found no difference between the MI and standard care groups: all drank less at 3-month follow up and some returned to drinking at 12 months.   But investigators identified encouraging findings in “harm-reduction effects” that included fewer alcohol-related problems and motor vehicle violations in the MI group, which held up to 12 months and 6-12 months, respectively.   A similar study of 13 to 17 year olds found reduced drinking, but no harm-reduction effects.   In both studies, teens reduced alcohol use regardless of the intervention; their emergencies appeared to enhance their motivation to change.   The next study added a more stringent control group, which received feedback absent any psychotherapeutic intervention, using the same research methodology.   The study found that MI made a difference in terms of drinking behavior out to 12 months.   In terms of alcohol status, MI worked best in alcohol-positive and AUDIT-negative teens.

An ongoing study used standard MI in the trauma unit or ED and included significant others during the interview, a construct based on the behavioral couples literature, community reinforcement approach, and social support literature.   The significant other—a partner, family member, or friend—provided perspective on the person’s drinking, general and specific support for changes the patient wanted to make, and participated throughout the session, especially during discussion of pros and cons, feedback, and the change plan.   Dr. Monti noted the labor-intensive work necessary to pare down the sample to individuals with suitable significant others as well as the difficulty of the design for a brief intervention.   Most patients were male; most chose females as significant others; and most patients were AUDIT-positive and alcohol-negative.   Acuity of the trauma appears to affect drinking outcomes and alcohol-related consequences, with patients recruited from trauma units doing better than patients from EDs.   In addition, following people on a monthly basis has generated high participation rates.   The investigators are considering mediators and moderators of efficacy, in that the nature of the relationship makes a difference.

Dr. Monti stated that the work has generated strong overall evidence of efficacy, despite some conflicting findings, and that patient characteristics are important to understand findings.   Using audiotapes from all sessions, the group is conducting an analysis of what predicts change talk, which appears to be the degree to which the therapist affirms and engages in complex reflection; negative change talk can be predicted by confrontation and extreme structure.   A manuscript is in press at Addiction that looks at mechanisms of change.

Another manuscript at Addiction describes moderators and mediators of treatment effects that isolate the feedback component.  Sophisticated moderation analyses found potential moderators to include alcohol status at time of the event; if a patient were positive for alcohol, one treatment or another made no difference, while just coming to the ED accounted for the variance.   If they were negative for alcohol, patients in MI did much better than those in the feedback-only group.   Another potential moderator of intervention effects is attribution for alcohol, which is the extent to which the patient can identify with the risks and benefits of drinking.   Patients’ baseline readiness also appears to be a predictor; individuals not ready for the treatment did better if they received the full intervention.   Dr. Monti asserted that baseline characteristics are relevant for efficacy of a brief intervention and might provide an empirical basis for development of practice guidelines.   Additionally, alcohol status may be helpful in developing more cost-effective intervention in ED contexts.  

Dr. Monti described the steps undertaken in current cost-effectiveness analyses.   He reported that the standard care condition costs $59 per patient.   Screening ED patient records for MI costs $122, while proactive screening by interviewing ED personnel is only slightly more expensive, at $125 per patient.  

Results show MI to be more favorable across all outcomes and somewhat better for men than women.   Sensitivity analyses were robust in terms of variability in parameter estimates.   Dr. Monti asserted that MI is a good societal investment compared to other medical interventions.   Future directions include developing better outcome measures for alcohol-related harm, risky behaviors, and alcohol use and misuse; identifying active ingredients of treatment; focus on mediators/moderators; and incorporating process measures into treatment.   More impactful and acceptable interventions are needed for younger teens, and it is important to consider the auto as a unit of analysis to reach young people in the car who were not drinking.   More cost-effectiveness studies are warranted, and it appears that EDs and trauma units are good venues for multiple risk behaviors.   Dr. Monti expressed the value of looking at the relationship between alcohol and sexual risk.

Discussion.   Dr. Monti responded to a question from Dr. John Allen that a fine-grained process analysis will be conducted to see if therapists diverged in their approach based on patients’ response.   Dr. Allen noted that therapists’ approaches have implications for selecting counselors.   Dr. Moss inquired about small-to-moderate effect sizes, and Dr. Monti responded that effects are better for alcohol-related consequences.   He is now tweaking treatment toward drinking per se.   In response to a second question, Dr. Monti stated that policies to implement SBI for multiple risks are far ahead of the data.   He currently is conducting a pilot study in EDs on multiple-risk behaviors.   To Dr. Crabb, Dr. Monti replied that the effect on significant others’ drinking behavior is not yet known, due to difficulties in tracking them.   Dr. Monti responded to Dr. Kishore that he has not yet conducted patient treatment matching.   Dr. Spear inquired why MI was less effective with younger adolescents; Dr. Monti asserted the importance of intervening with families of 13 to 17 year olds, acknowledging the difficulty in enlisting parents for the experiment.   Dr. Monti explained that the significant-other study involved low recruitment levels, while the refusal rate in other studies reflected parents not wanting to get involved. Dr. Willenbring stated that in terms of cost efficacy, in the real world one must factor in the people who are ineligible for randomized controlled trials for generalizability.   Treatment effectiveness trials are needed to look at real-world conditions.  

Consideration of the June 10–11, 2009, Minutes and Future Meeting Dates

Council members voted to approve the minutes of the Council meeting of June 10–11, 2009.   Upcoming Council meetings will take place on February 3–4, 2010, June 9–10, 2010, September 22–23, 2010; February 16–17, 2011, June 8–9, 2011, and September 14–15, 2011; February 8–9, 2012, June 6–7, 2012, and September 19–20, 2012.

Public Comment

Time was allocated for public comment, but no one came forward to speak.

Adjournment

Dr. Warren adjourned the meeting at 12:45 p.m.

CERTIFICATION

I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.

/s/

Kenneth R. Warren, Ph.D.
Acting Director
National Institute on Alcohol Abuse and Alcoholism
and
Chairperson
National Advisory Council on Alcohol Abuse and Alcoholism

/s/

Abraham P. Bautista, Ph.D.
Director
Office of Extramural Activities
and
Executive Secretary
National Advisory Council on Alcohol Abuse and Alcoholism