NIAAA Director's Report on Institute Activities to 118th Advisory Council Meeting

Thursday, June 5, 2008

CONTENT:

A. Legislation, Budget, and Policy

B. Director’s Activities

C. NIAAA Staff and Organization

D. Research Priority Emphasis and Core Support Teams

E. NIAAA Research Programs

F. Scientific Meetings

G. Outreach

H. Multi-Media Products from NIAAA

A. Legislation, Budget, and Policy

Federal Employee Health Coverage for Substance Abuse Services  In the Office of Personnel Management’s annual call for benefit and rate proposals from Federal Employees Health Benefits (FEHB) Program carriers i n March, the agency called the attention of FEHB carriers to new Current Procedural Terminology (CPT®) codes for screening and short-term intervention for alcohol and substance abuse.  CPT® codes, issued by the American Medical Association (AMA), are used by physicians to report and bill health insurance plans for their services.  The Centers for Medicare and Medicaid Services adopted screening and brief intervention codes in January 2007, while the AMA’s addition of two CPT® codes became effective in January 2008.  The OPM letter to carriers stated that “ All carriers should be aware of these new codes to update their systems so that they can more efficiently provide benefits for these types of services.”  OPM stated at least 70 percent of enrollees participate in FEHB plans which will recognize the codes for their claims processing systems when services are delivered by a medical professional. The new coverage will reimburse doctors who screen their patients for a full spectrum of substance use behaviors, including alcohol, illicit drugs, and prescription drug abuse/addiction, and provide appropriate intervention.

NIAAA Budget

FY 2008 Appropriation  On Wednesday, December 26, 2007, after four continuing resolutions, President Bush signed Public Law 110-161 (Consolidated Appropriations Act, 2008) providing an appropriation for NIH.  Under the 2008 appropriation NIAAA’s budget is $436.3 million, an increase of 0.2 million above the FY 2007 appropriation.  A summary of the FY 2008 appropriation is below.

FY 2009 President’s Request  The FY 2009 budget request for NIAAA is $436.7 million, including HIV/AIDS, an increase of $0.4 million and 0.1 percent over the FY 2008 appropriation.  The budget request for HIV/AIDS research is $27.0 million.  The following highlight some of the major components of the FY 2009 budget request:

Research Project Grants  Under the President’s Request, the institute plans to support approximately 191 competing research project grants (RPGs) which would equal an approximately 26.5 percent success rate for competing RPGs.  The FY 2009 request holds the average cost of competing RPGs at the FY 2008 level.  There will be no inflationary increases for direct, recurring costs in non-competing continuation RPGs.

Alcohol Research Centers  The centers program budget will support 17 research centers at $27.3 million.

Other Research  $12 million is provided to support 86 research career awards in FY 2009.  Cooperative agreements will be funded at $8.7 million.

Research Training  Research training is provided $11.3 million for 287 pre- and post-doctoral trainees in full-time training positions, which is flat with FY 2008.  Stipend levels for pre- and post-doctoral NRSA trainees will increase 1 percent in FY 2009 but there will be no other increases for tuition or training related expenses. 

Research and Development Contracts  Research and development contracts are provided $34.4 million.

Intramural Research Program  $47.6 million has been allocated to maintain the intramural research program’s overall level of effort for FY 2009.

Research, Management and Support  Research, management, and support (RMS) activities are provided $26.0 million for FY 2009.

Below is a summary of the FY 2009 President’s budget request (dollars in thousands):                                               

Budget Hearings  The NIAAA FY 2009 President’s budget request was presented March 5 before the House Appropriations Subcommittee.  The House hearing schedule followed the format that has been used over the past several years whereby there is an overview hearing followed by a “theme” hearing combining the institute directors of specific institutes/centers requested to attend the hearing.  Dr. Zerhouni was the main presenter at the March 5 House overview hearing.  NIAAA was not asked to participate in a “theme” hearing. 

The Senate Appropriations Subcommittee, originally scheduled to meet April 23 ^rd, was rescheduled for April 30 ^th and subsequently cancelled.  There has been no tentative date set for a future hearing.

B. Director’s Activities

Community Anti-Drug Coalitions of America  On February 13, Dr. Li gave a plenary address at the 18 ^th Annual Leadership Forum of the Community Anti-Drug Coalitions of America (CADCA).  Participants at the meeting, which took place in Washington, D.C., included community anti-drug coalitions from around the country, addiction treatment professionals, researchers, educators, law enforcement professionals, faith-based leaders, government leaders, and youth.  Participants had an opportunity to hear overviews from experts on key substance abuse issues.  Dr. Li’s talk was entitled “Partnering to Prevent and Reduce Underage Drinking and Related Problems.”  Other NIAAA participants included Ralph Hingson, who gave a presentation on prevention of college age and underage drinking; and Dennis Twombly, who gave a workshop presentation on how alcohol affects the adolescent brain.  Acting Surgeon General Steven K. Galson discussed the Surgeon General's Call to Action on Underage Drinking.  

Li gave a seminar to the Duke University Medical Center Department of Psychiatry and the Central Nervous System Division of the Duke Clinical Research Institute in Durham, NC, on March 7.  His presentation was entitled “Recent Advances in Understanding Alcoholism: Diagnosis, Treatment, and Prevention.”

Alcohol and Stress: A Framework for Future Treatment Strategies  NIAAA joined an international group of organizations to sponsor a meeting on Alcohol and Stress: A Framework for Future Treatment Strategies, held in Volterra, Italy, May 6 to 8.  Dr. Li gave the introduction to the meeting; Markus Heilig, Antonio Noronha, and Sam Zakhari also participated, co-chairing symposia, and making presentations.  

C. NIAAA Staff and Organization

Among the doctorate level staff in the extramural program, the turnover rate over the past two years has varied from 7 to 9 percent. 

Staff Departures

Ricardo Brown, Ph.D.  Ricardo Brown left the Division of Metabolism and Health Effects (DMHE) in April to join HowardUniversity as associate vice president for research and professor of physiology and biophysics with tenure in the College of Medicine.  Dr. Brown joined NIAAA in July 2002, after nearly 15 years as an independent investigator.  He also served as Professor and Chairman of the Department of Biology at MorganStateUniversity in Baltimore, Maryland.  In DMHE, he managed the institute’s cardiovascular research and endocrine portfolios.  In addition, over the past 2 years he served as NIAAA’s Coordinator for Minority Health and Health Disparities.  While at NIAAA, Dr. Brown received the NIH Director’s Award as a member of the group that developed the Trans-NIH Type 1 Diabetes Research Strategic Plan (2006) and NIAAA’s EEO Award (2006) in recognition for his community service activities.

Vishnu Purohit, Ph.D.  Vishnu Purohit has left NIAAA to join the National Institute on Drug Abuse as a program director in the Chemistry and Physiological Systems Research Branch of the Division of Basic Neuroscience and Behavioral Research.  Dr. Purohit came to NIAAA in 1991 from the Food and Drug Administration.  At NIAAA, Dr. Purohit was a program director in DMHE, administering a portfolio in the areas of alcoholic liver disease, pancreatitis, cancer, and osteoporosis.  He was the NIAAA representative on many trans-NIH committees, including the Digestive Diseases Interagency Coordinating Committee, Nutrition Coordinating Committee, Dietary Supplement Working Group, Federal Working Group on Bone Diseases, and Cancer Research Portfolio Group.

Jose Velazquez, Ph.D.   Jose Velazquez has accepted a position as director of the Cell Biology Program in the Division of Aging Biology at the National Institute on Aging.  He joined NIAAA 5 years ago and served as chief of what was then the Genetics and Proteomics Research Branch in the Division of Basic Research, team leader for the Technology and Analysis Team, and most recently program director for functional genomics in DMHE.  During his tenure at NIAAA, Dr. Velazquez helped develop research programs in the areas of biomarker discovery, epigenetics, proteomics, mitochondrial function, and metabolomics.

Tina Vanderveen, Ph.D.  Office of Extramural Activities (OEA) Director Tina Vanderveen retired in March after serving in many capacities at NIAAA.  Dr. Vanderveen was recruited to NIAAA in 1978 from the NIH institute that is now NIDDK.  Prior to arriving at NIH she had a 14-year career as a medical nutrition officer in the United States Air Force.  She served in many positions in her long career at NIAAA, including chief of the former Psychosocial Research Branch in what was then the Division of Extramural Research, director of NIAAA’s centers program, deputy director as well as acting director of the former Division of Basic Research, and deputy director of the then Office of Collaborative Research.  She was named OEA director in 2005.  Dr. Vanderveen briefly interrupted her NIAAA career to serve as a special assistant for AIDS in the National Institute on Drug Abuse’s Division of Clinical Research, returning to NIAAA in 1989. 

New Appointments

Judith Arroyo, Ph.D.  Judith Arroyo has been named Minority Health and Health Disparities Coordinator for NIAAA.  Dr. Arroyo came to NIAAA in 2003 from the Center on Substance Abuse, Alcoholism, and Addictions at the University of New Mexico.  She has worked nationally and internationally on Hispanic use of alcohol and other substances, and served as the first chairperson of the US/Mexican Border Governor’s Conference Substance Abuse Commission.  The minority health coordinator provides leadership and guidance to NIAAA staff on all aspects of extramural activities related to minority health and health disparities. In addition to working in this capacity, she will continue her role as a program director in the Division of Epidemiology and Prevention Research (DEPR). 

Zhigang (Peter) Gao, M.D.   Zhigang (Peter) Gao joined DMHE as a program director in March.  Dr. Gao earned his M.D. degree from the HenanMedicalUniversity, Zhengzhou, China, and an M.S. in pharmacology from Henan Institute of Medical Sciences. He also has an M.B.A. from the Carey Business School of Johns Hopkins University.  He was a postdoctoral fellow at Johns Hopkins and subsequently joined the faculty of the medical school.  Dr. Gao comes to NIAAA from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) where he was a senior research fellow.  His research has been focused on human hematopoietic stem cells, bone marrow derived stem cells, hemoglobin, and vector development for gene therapy.  His specific areas of expertise also include chemotherapeutic drug studies and animal models for oncology research.  Dr. Gao served as an associate editor for the journal Discovery Medicine from 1999-2003. 

Patricia Powell, Ph.D.  Patricia Powell has been named chief of NIAAA’s Science Policy Branch (SPB).  Dr. Powell had been acting chief of SPB since 2006.  She came to NIAAA in 2001 as an American Association for the Advancement of Science/NIH Science Policy Fellow and then joined the NIAAA staff as a health science administrator with the then Office of Scientific Affairs. Dr. Powell began working with the Leadership to Keep Children Alcohol Free in 2003 and served as one of NIAAA’s representatives to the Office of the Surgeon General for the development of the Call to Action to Prevent and Reduce Underage Drinking.

Honors

Robert B. Huebner, Ph.D.  Bob Huebner has been selected as a recipient of the 2008 American Psychological Association (APA) Meritorious Research Service Commendation.  This commendation recognizes outstanding contributions to psychological science through service within the federal government and other organizations in program development and research facilitation.  Dr. Huebner’s award recognizes significant contributions to the advancement of psychological science in promoting and supporting important research at NIAAA and NIH in the areas of problem drinking, treatment, and recovery, and the search for mechanisms of behavior change.  Dr. Huebner will receive personal congratulations from the president of APA at the December 2008 meeting of APA’s Board of Directors in Washington, DC. 

Ralph Hingson, Ph.D.  The American Society of Addiction Medicine (ASAM) has named Ralph Hingson the recipient of its R. Brinkley Smithers Distinguished Scientist Lecture and Award.  The citation notes Dr. Hingson’s “innovative analytic and public policy strategies resulting in fundamental advances in prevention science and public policy concerning the use of alcohol and its harmful consequences in many dimensions of our society, especially in the pursuit to keep our youth and highways safer.”  The award was presented during the ASAM annual medical-scientific conference in Toronto, Canada, April 11 to 13; Dr. Hingson’s award lecture was entitled “Magnitude and Prevention of College Age and Underage Drinking Problems.”  

Kenneth R. Warren, Ph.D .  Kenneth Warren, NIAAA’s Deputy Director, was the recipient of the Excellence Award from the National Organization on Fetal Alcohol Syndrome (NOFAS) at the organization’s Leadership Awards Benefit on May 14.  The award cites Dr. Warren for “pioneering FASD research and distinguished contributions” toward understanding and addressing the fetal alcohol syndrome and fetal alcohol spectrum disorders.  As reported in the February 2008 director’s report to the council, Dr. Warren’s name was added to the NOFAS Linda and Tom Daschle Hall of Fame in November, 2007.  Dr. Warren developed NIAAA’s FAS research program over 30 years ago and has been active in FASD activities throughout his career, including serving as the current chair of the government-wide Interagency Coordinating Committee on FAS.

D. Research Priority Emphasis and Core Support Teams

Update on Teams  When NIAAA established transdisciplinary research teams in 2003,  the teams’ structure was intended to be flexible, allowing changes to be implemented as scientific opportunities arise and fields of science mature.  NIAAA senior management and staff recently reexamined and updated the structure of the teams, changing the designation of some teams to “working groups” or “coordinating committees.”

• A team explores an area to develop a long-range vision, and it develops and opens a new frontier for alcohol investigation.  In pursuit of these goals, the team may organize conferences and even issue RFAs for exploratory grants. 

• A working group has a more intermediate agenda, and it fosters trans-divisional activities focusing on oversight of the program initiatives implemented by the teams and expanding on those activities, also using the tools of discussions, workshops, RFAs, and program announcements.

• A coordinating committee will address ongoing trans-divisional activities of the institute that do not have a clear endpoint.

Briefly, the changes and recommendations for the teams include the following: 

• T he Gene and Environment (GxE) team will continue.  The Research Resources and Technologies will be combined with efforts in systems biology to create an Informatics and Computational/Systems Biology Team.

• The Mechanisms of Alcohol Action and Injury Team has been successful in implementing important new programs for the institute, including new projects in metabolomics and epigenetics, among others; also, major efforts that involve NIAAA in metabolomics and proteomics have been undertaken in the past few years within the Roadmap.  This team will be discontinued.

• The Centers and Training Team continues to serve a critical function within the operations of the Institute and will continue as a team.

• The  Mechanisms of Behavior Change, Underage, and Medications Development Teams will continue but with the designation working groups.

• Newly created are working groups on Biomarkers, and Fetal Alcohol Spectrum Disorders.

• Coordinating committees on AIDS, international research, and health disparities and minority health have been created.

Supplement on Underage Drinking Published in Pediatrics  An April 2008 supplement of Pediatrics presents seven papers developed by the members of the NIAAA Team on Underage Drinking Prevention and the steering committee of experts assembled to advise the institute on this initiative.  The supplement offers reviews and analyses of current research on biological, behavioral, and environmental changes during childhood and adolescence that foster the initiation, maintenance, and acceleration of illegal use of alcohol by underage youth. NIAAA staff Vivian Faden, Margaret Mattson, Howard Moss, Ralph Hingson, and Cherry Lowman were coauthors for articles in the supplement.

E. NIAAA Research Programs

RFAs and PAs 

NIAAA has received, or is expecting, applications in response to the following recently issued requests for applications (RFAs) and program announcements (PAs):  

• RFA AA-08-007 (R01) and 008 (R21)  Behavioral Mechanisms in the Transition to Habitual Alcohol Seeking and Drinking

• RFA AA-08-009 (R01) and 010 (R21) Alcohol Tolerance: Contribution to Consumption

• RFA AA-08-011 (R01) and 012 (R21) International Research on Venue-Based Interventions for HIV/AIDS and Alcohol Use    

• RFA AA-08-013 (R01) and 014 (R21) Alcohol, AIDS, and Liver Disease: Preventable Side-effects of Antiretroviral Therapy

• PAR 08-004 (U01) International Research Collaboration on Alcohol and Alcoholism

Based on the DEPR strategic plan reviewed by the Council in February 2007, four program announcements have been posted, including the following: 

• Epidemiology and Prevention in Alcohol Research

• Research on Alcohol-Related Public Policies such as Those Detailed the Alcohol Policy Information System (APIS)

• Screening and Brief Alcohol Interventions in Underage and Young Adult Populations

• Nutrition and Alcohol-Related Health Outcomes 

 To date, over 30 applications have been received in response to the announcements. 

Publications by Extramural Staff

An NIAAA-sponsored supplement to Alcoholism: Clinical and Experimental Research (ACER) specifically devoted to mechanisms of behavior change was recently published.  This supplement to ACER was entitled “The Search for Mechanisms of Behavior Change in Evidence-Based Behavioral Treatments for Alcohol Use Disorders” (Vol. 31, No. S3).  The supplement is based on the proceedings of a pre-conference satellite meeting that took place at the June 2005 meeting of the Research Society on Alcoholism.  The guest editors for the supplement were Robert Huebner and J. Scott Tonigan of the University of New Mexico.

In an analysis of a survey of infant feeding practices, Rosalind Breslow and coauthors found that a substantial percentage of breastfeeding women consumed alcohol.  The authors conclude that there is a need for nationally representative data on alcohol consumption and alcohol-related feeding practices among breastfeeding women.  (Breslow, R.A., Falk, D.E., Fein, S.B., and Grummer-Strawn, L.M.  Alcohol consumption among breastfeeding women.  Breastfeeding Medicine 2:152-157, 2007) 

Q. Max Guo and Samir Zakhari wrote the overview article that opens the most recent issue of Alcohol Research & Health on systems biology.   (Q. Max Guo and Samir Zakhari, Systems Biology and Its Relevance to Alcohol Research.  Alcohol Research & Health 31:5-10, 2008-05-21) 

Research Reports

The following items represent examples of the breadth and quality of research supported by NIAAA. 

Stress-Signaling Target for Alcohol Dependence  Relapse to drinking after periods of sobriety is a defining characteristic of alcoholism and is often triggered by stress.  In preclinical and clinical studies, scientists in NIAAA’s intramural program and collaborating centers found that a brain molecule known as the neurokinin 1 receptor, or NK1R, appears to be a central actor in stress-related drinking.  Previous studies have shown that a brain chemical known as substance P (SP) is released in response to stress, produces symptoms of anxiety, and binds preferentially to NK1R.  In this study, the researchers first demonstrated that NK1R plays an integral role in alcohol consumption in animals.  Mice that were genetically engineered to lack NK1 receptors consumed much less alcohol than did normal mice with fully functional NK1R.  Subsequently, in a small clinical study, the researchers showed that an experimental compound designed to block NK1 receptors reduced alcohol craving and improved overall wellbeing among recently detoxified alcohol-dependent individuals who had high levels of anxiety.  Using functional brain imaging, the researchers also showed that the exaggerated sensitivity to negative stimuli seen in alcoholics was dampened with the medication, while the lack of responses to pleasurable stimuli was restored.  Compounds that block NK1R may have considerable potential for treating alcoholism, and potentially other addictions.  (George, D.T., Gilman, J., Hersh, J., Thorsell, A., Herion, D., Geyer, C., Peng, X., Kielbasa, W., Rawlings, R., Brandt, J.E., Gehlert, D.R., Tauscher, J.T., Hunt, S.P., Hommer, D., and Heilig, M.  Science 319:1536-1539, 2008)

Drinking and Mortality  How much and how often people drink—not just the average amount of alcohol they consume over time—independently influence the risk of death from several causes.  Scientists in NIAAA and the National Cancer Institute examined data from a nationwide health survey conducted in 1988.  Almost half of the nearly 44,000 people who participated in the survey identified themselves as current drinkers who had at least 12 drinks of alcohol during the previous year.  By the end of 2002, more than 2,500 of these individuals had died. The researchers found that, in men, frequency and quantity of alcohol consumption had opposite effects on cardiovascular mortality.  The greater the amount of alcohol that men consumed on drinking days, the greater was their risk for death from cardiovascular disease.  For example, men who had five or more drinks on drinking days had a 30 percent greater risk for cardiovascular mortality than men who had just one drink per drinking day.  Alcohol quantity was also associated with increased mortality from cancer among men.  Frequency of drinking, on the other hand, was associated with decreased risk for death from cardiovascular disease among men.  Among women, frequent drinking was associated with a significantly increased risk of cancer, while increased quantity was associated with risk for mortality from all causes.  The researchers conclude that, for drinkers who are not alcohol dependent, “alcohol quantity and frequency might be thought of as modifiable risk factors for mortality.”  ( Breslow, R.A. and Graubard, B.I. Alcoholism: Clinical and Experimental Research 32:513-521, 2008)

Epigenetic Effects Involved in Withdrawal Anxiety  Chronic exposure to alcohol changes brain function in ways that, with continued heavy drinking, set the stage for addiction.  Research suggests that alcohol exposure can change gene activity; this study looked at whether an effect by alcohol on genetic material could play a role in withdrawal-related anxiety.  The investigators found that alcohol can cause specific epigenetic changes to genetic material—that is, changes that do not affect the DNA sequence, but alter elements of the genetic material’s structure and as a result change gene activity.  Epigenetic changes were associated with the levels of anxiety of rats that were first maintained on a liquid diet with alcohol, and then denied alcohol.  One type of change noted was the addition or removal of specific chemical groups (acetyl groups) to and from a protein (histone) that forms part of the structure of the DNA chain.  These scientists found evidence that the removal of acetyl groups from histones in the DNA complex was associated with anxiety brought on by alcohol withdrawal.  The changes took place in a part of the brain (the amygdala) implicated in anxiety and alcohol-drinking behaviors.  By blocking the enzyme that removes the acetyl groups, the researchers prevented the development of alcohol withdrawal-related anxiety.  The researchers also investigated the potential role played by these types of changes in the anxiety-reducing effect that occurs with exposure to low levels of alcohol.  Rats injected with a one-time dose of alcohol exhibited less anxiety than control animals.  The changes at the gene level seen with low dose alcohol were the opposite of those seen in withdrawal—an increase in the addition of acetyl groups to histone rather than a decrease.  This study both demonstrates how epigenetic changes can be involved in alcohol-related behavior, and suggests that these mechanisms might serve as the basis for new treatments.  ( Pandey, S.C., Ugale, R., Zhang, H., Tang, L., and Prakash, A.The Journal of Neuroscience 28:3729-3737, 2008)

Gene Variant Predicts Medication Response  Drinking alcohol increases the release of endogenous opioids, compounds that originate in the body and promote a sense of pleasure or well-being.  The drug naltrexone blocks brain receptors for endogenous opioids, reducing alcohol’s pleasurable effects, making it easier for patients to remain abstinent or stop quickly in the event of a slip.  According to an analysis of participants in the 2001-2004 COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) Study, among patients taking naltrexone, those with a specific variant of an opioid receptor gene ( OPRM1) drank less and experienced better overall clinical outcomes than patients without the variant.  About 87 percent of patients with the variant who received naltrexone experienced good outcomes, compared with about 49 percent of those who received a placebo.  About 55 percent of patients without the variant experienced a good outcome regardless of whether they received naltrexone or placebo.  Good outcome was defined as abstinence or moderate drinking without related problems.  In addition to naltrexone or placebo, all patients received medical management and some also received a combined behavioral intervention.  The researchers found that, compared with patients who do not carry the variant, white variant carriers who received naltrexone fared substantially better than other groups on all measures, including almost a 6 times greater likelihood of good clinical outcome. Extending the clinical outcome measure to variant carriers of all ethnicities reduced the benefit to just over a 3 times greater likelihood of good outcome. The researchers found no gene-medication interaction in patients who received specialized alcohol counseling, leading to them to conclude that genotyping for the variant may be most useful when naltrexone is used without intensive counseling.  (Anton, R.F., Oroszi, G., O’Malley, S., Couper, D., Swift, R., Pettinati, H., and Goldman, D.Archives of General Psychiatry 65:135-144, 2008)

Drinking Experience Predicts Drug-Related Risk  Research suggests that among people who drink, those who begin drinking at very young ages are at higher risk of future problems with alcohol.  This study analyzed data from the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey, a national survey involving interviews with 42,862 respondents age 18 and older.  The analysis looked at whether, among all drinkers, those who began drinking at an early age, or experienced dependence, were more likely to subsequently use drugs or develop drug dependence.  The study also looked at whether, among drinkers who used drugs, these two factors—early onset of drinking, and dependence—predicted driving under the influence of drugs and involvement in motor-vehicle crashes because of drugs.  Among all drinkers, those who began drinking at the youngest ages were also at the highest risk of using drugs and experiencing drug dependence.  Independent of early drinking onset, alcohol dependence was also associated with increased risk of drug use.  Among those who both drank and used drugs, early alcohol use was also associated with higher rates of driving under the influence of drugs, and being involved in motor vehicle crashes because of drugs.  The authors conclude that the prevention of early alcohol and dependence treatment plays a part in the prevention of drug use and drug-related crashes. (Hingson, R.W., Heeren, T., and Edwards, E.M. Journal of Studies on Alcohol and Drugs 69:192-201, 2008)

Gene Variants Affect Stress Responses  The extent to which someone is emotionally resilient in the face of stress is a product of both genes and experience.  Resilience influences vulnerability to psychiatric disorders, including addictions.  In this work, intramural scientists collaborating with scientists at other centers found that gene variants that affect the expression of the signaling molecule neuropeptide Y (NPY) altered brain responses to stress and emotion in human subjects.  Previous research had found that NPY’s release reduces anxiety.  Using functional brain imaging, these investigators found that individuals with the gene variant that yielded the lowest level of NPY reacted with heightened emotionality to images of threatening facial expressions. People with the low level NPY variant were also found to have a diminished ability to tolerate moderate levels of sustained muscular pain.  In a preliminary finding, the low level NPY gene variant was found to be more common than other variants among a small sample of individuals with anxiety disorders.  Finally, low level NYP expression was linked to high levels of trait anxiety—an indication of an individual’s level of anxiety under normal circumstances.  These findings provide an illustration of how genetics underlie individual variation in resiliency to stress.  (Zhou, Z., Zhu, G., Hariri, A.R., Enoch, M.-A., Scott, D., Sinha, R., Virkkunen, M., Mash, D.C., Lipsky, R.H., Hu, X.-Z., Hodgkinson, C.A., Xu, K., Buzas, B., Yuan, Q., Shen, P.-H., Ferrell, R.E., Manuck, S.B., Brown, S.M., Hauger, R.L., Stohler, C.S., Zubieta, J.-K., and Goldman, D.  Nature 452:997-1001, 2008)

COGA Finds Additional Genes Associated with Alcohol Dependence  Genetic factors have been shown to play an important role in the development of alcohol dependence. Several genes, including GABRA2, ADH4 and CHRM2, have been found to be associated with alcohol dependence in the Collaborative Study on the Genetics of Alcoholism (COGA); these associations have been replicated in multiple independent studies.  In recent COGA studies, four additional genes have been associated with the risk for alcohol dependence:

• TACR3, the gene for tachykinin receptor 3.  Tachykinins are neuropeptides; the receptor encoded by this gene plays an important role in the response to ethanol and cocaine.  Variations in the TACR3 gene have been strongly associated with severe alcohol dependence as well as cocaine dependence.  (Foroud, T., Wetherill, L.F., Kramer, J., Tischfield, J.A., Nurnberger, J.I. Jr., Schuckit, M.A., Xuei, X., Edenberg, H.J.  Alcoholism: Clinical and Experimental Res earch.  Epub ahead of print, doi: 10.1111/j.1530-0277.2008.00663.x)

• OPRK , a gene that encodes the κ-opioid receptor.  A variant in a regulatory stretch of the gene reduces transcription of the gene by half and is significantly associated with alcohol dependence. (Edenberg, H.J., Wang, J., Tian,H., Pochareddy, S., Xuei, X., Wetherill, L., Goate, A., Hinrichs, T., Kuperman, S., Nurnberger, J.I. Jr., Schuckit, M., Tischfield, J.A., Foroud, T. Human Molecular Genetics. Epub ahead of print, doi:10.1093/hmg/ddn068)

• ACN9, a novel gene that was originally identified in yeast. Variations within or near the ACN9 gene have been associated with alcohol dependence; it may be involved in alcohol metabolic pathways.  (Dick, D.M., Aliev, F., Wang, J.C., Saccone, S., Hinrichs, A., Bertelsen, S., Budde, J., Saccone, N., Foroud, T., Nurnberger, J. Jr., Xuei, X., Conneally, P.M., Schuckit, M., Almasy, L., Crowe, R., Kuperman, S., Kramer, J., Tischfield, J.A., Hesselbrock, V., Edenberg, H.J., Porjesz, B., Rice, J.P., Bierut, L., Goate, A.. Biological Psychiatry. Epub ahead of print,doi10.1016/j.biopsych.2007.11.005)

• NFKB1 , a gene that encodes the transcription factor NF-kB. Variations in the NFKB1 gene are associated with risk for alcohol dependence, particularly with the age of onset.  (Edenberg, H.J., Xuei, X., Wetherill, L.F., Bierut, L., Bucholz, K., Dick, D.M., Hesselbrock, V., Kuperman, S., Porjesz, B., Schuckit, M.A., Tischfield, J.A., Almasy, L.A., Nurnberger, J.I., Jr., Foroud, T . Human Molecular Genetics 17:963-70, 2008)

While replication and functional studies are needed, the identification of these new genes has significant implications for potential therapeutic targets for the treatment of alcohol dependence. 

Naltrexone and Opioid Receptors  Opioid receptors in the brain are involved in the rewarding effects of alcohol; by blocking opioid receptors, the drug naltrexone reduces alcohol’s pleasurable effects.  Meta-analyses of naltrexone indicate that the FDA-recommended dose of 50 mg can reduce drinking and relapse in some, but not all, individuals with alcohol dependence.  This study used positron emission tomography (PET) to investigate the binding of naltrexone to two opioid receptors, mu and delta, thought to be important to alcohol’s rewarding effects.  The study, conducted with recently abstinent alcohol subjects, found that the 50 mg dose of naltrexone resulted in nearly complete inhibition of the mu-opioid receptor, with little variation among subjects. Inhibition of delta-opioid receptors was only partial, with a mean of 21 percent, and the level of blockade varied among individuals. The authors suggest that the variability in naltrexone’s effects on delta-opioid receptors may contribute to the inconsistency of the drug’s effectiveness.  (Weerts, E.M., Kim, Y.K., Wand, G.S., Dannals, R.F., Lee, J.S., Frost, J.J., and McCaul, M.E.Neuropsychopharmacology 33:653-665, 2008)

Endocannabinoids in the Development of Fatty Liver  Fatty liver, the first stage in the development of alcohol-related liver disease, can progress with continued drinking to hepatitis and cirrhosis.  Previous research on fatty liver has suggested the involvement of the endocannabinoid signaling system, so named because the receptors with which endocannabinoids interact are also the targets for the active ingredients of marijuana.  In mice fed alcohol chronically, endocannabinoid levels increase, and the animals develop fatty liver.  In this intramural work, fatty liver failed to develop in mice fed alcohol when they were also given an agent (rimonabant) that blocked the cannabinoid receptor CB ₁.  Alcohol-fed “knockout” mice in which the CB ₁ receptor was inactivated also failed to develop fatty liver; knockout mice that lacked CB ₁ only in hepatocytes (a class of liver cells) similarly failed to develop fatty liver, indicating that alcohol causes fatty liver via these hepatic receptors.  This work also identified a specific type of liver cell—the hepatic stellate cell—as the source of the endocannabinoid that activates CB ₁ receptors in hepatocytes, driving the development of fatty liver.  Knowledge of the molecular sequence of events that underlies alcohol’s ability to damage the liver could lead to means of slowing the progress of the disease in affected individuals.  (Jeong, W.-i., Osei-Hyiaman, D., Park, O., Liu, J., Bátkai, S., Mukhopadehyay, P., Horiguchi, N., Harvey-White, J., Marsicano, G., Lutz, B., Gao, B., and Kunos, G.  Cell 7:1-9, 2008)

Infant Attachment and Opioid Receptors  Endogenous opioids—substances that are present naturally in the brain and have opiate-like effects—are among the neurotransmitters that play a role in the brain’s reward system, motivating animals to behave in ways that promote survival.  Research suggests that signaling by endogenous opioids is involved in the sense of comfort that an infant feels in contact with its mother.  This collaborative study involving scientists at NIAAA and other centers found that infant rhesus macaques with a variation in the gene for an opioid receptor (the mu-opioid receptor) that conveys a gain of function in the receptor showed higher levels of attachment to their mothers than infants with the more common allele, or gene variant.  The opioid receptors encoded by the gain-of-function allele coupled with greater affinity to the endogenous opioid β-endorphin.  One of the ways the increased attachment manifested itself was in the level of distress of the infants when separated from their mothers during weaning.  Previous research has suggested that rhesus monkeys with the variant allele in the mu-opioid gene have a higher preference for alcohol.  The authors suggest that common neurobiological systems may underlie such behavioral variations as differences in attachment behavior among individuals and problems with alcohol and other drugs.  (Barr, C.S., Schwandt, M.L., Lindell, S.G., Higley, J.D., Maestripieri, D., Goldman, D., Suomi, S.J., and Heilig, M. Proceedings of the National Academy of Sciences of the United States 105:5277-5281, 2008)

Neurocircuitry in Children of Alcoholics  Despite the increased risk of dependence in children of alcoholic parents, most people with a family history of alcoholism do not develop the disease.  This study used functional magnetic resonance imaging (fMRI) in an attempt to identify and characterize activation patterns in the brains of children of alcoholics (COAs) that would help explain why some COAs develop problems with alcohol and others do not.  Investigators obtained fMRI images of three groups of young people:  11 COAs with no history of problem drinking (resilient), 11 COAs with such a history (vulnerable), and 6 with no family history and no history of problem drinking (control).  The young people were shown words with a range of emotional content during imaging.  In the resilient COAs, fMRI imaging revealed activation patterns (in response to the words displayed) of brain areas involved in the monitoring of emotional stimuli; however, these young people did not suppress emotional reactions, in contrast to vulnerable COAs, whose brain activation patterns suggested that they were limiting emotional responses.  Differences in patterns among the three groups suggest that vulnerability and resilience are based in different brain pathways.  An understanding of these processes could help in the design of treatment and prevention strategies.  (Heitzeg, M.M., Nigg, J.T., Yau, W.-Y.W., Zubieta, J.-K., and Zucker, R.A.  Alcoholism: Clinical and Experimental Research 32:414-426, 2008)

Prenatal Alcohol Disrupts Cell Adhesion  Adhesion molecules are components of cells that enable them to adhere to other cells.  Adhesion molecules are important in embryonic development as they help shape the orderly aggregation of cells into tissues.  One of the ways prenatal alcohol exposure can harm a developing fetus is by disruption of the cell adhesion molecule L1.  Investigators in this study identified a binding site for alcohol on the L1 molecule.  The location of the binding site suggests that alcohol may impair the function of L1 by disrupting how it folds into a three-dimensional shape, which is critical to its function. The site is close to points in the molecule at which genetic changes are known to cause neurological abnormalities.  Information on the nature of alcohol’s effects on L1 may provide a basis for the development of compounds to block prenatal damage by alcohol.  (Arevalo, E., Shanmugasundararaj, S., Wildemeyer, M.F., Dou, X., Chen, S., Charness, M.E., and Miller, K.W.Proceedings of the NationalAcademy of Sciences of the U.S.A.105:371-375, 2008)

Zinc Supplementation Enhances Liver Regeneration  Zinc deficiency is a known feature of alcoholic liver disease (ALD). Absorption of zinc from the intestines is reduced in ALD, while urinary excretion of zinc is increased.  This study reports that in mice with ALD as a result of 6 months of an alcohol-containing diet, zinc supplementation enhanced liver regeneration.  One of the mechanisms for zinc’s effect was an increase in levels of hepatocyte nuclear factor-4alpha (HNF-4α), a transcription factor that has been shown to be important in the expression of genes in liver cells.  Inducing zinc deficiency in cultured cells derived from the liver resulted in lower levels of cell proliferation and of a variety of proteins that promote cell proliferation, as well as HNF-4α. The work suggests that HNF-4α is a key regulator of liver cell growth; the removal of zinc, which forms part of the structure of this molecule, impairs its function and the ability of the liver to regenerate.  The authors conclude that dietary zinc supplementation might be of benefit in ALD.  (Kang, X., Song, Z., McClain, C.J., Kang, Y.J., and Zhou, Z. The American Journal of Pathology172:916-925, 2008)

F. Scientific Meetings

Transportation Research Board  On January 15, Ralph Hingson gave a presentation on comprehensive community interventions to reduce alcohol problems among youth at the annual meeting of the Transportation Research Board of the National Academies, held in Washington, DC. 

Joint Meeting on Adolescent Treatment Effectiveness  Vivian Faden gave a plenary presentation entitled “Epidemiological and Developmental Perspectives on Alcohol Use and Alcohol Use Disorders in Adolescents and Young Adults” at the Joint Meeting on Adolescent Treatment Effectiveness (JMATE) held in Washington, DC, March 25 to 27.  Sponsors of JMATE include NIAAA and other government agencies and private organizations concerned with adolescent health. 

Symposium on Food Addiction  Ivana Grakalic co-organized the symposium entitled “Food Addiction” held on April 8 at the Experimental Biology (EB) 2008 meeting in San Diego, CA. The EB meetings bring together seven different scientific societies; NIAAA and NIDA jointly sponsored the symposium on food addiction.  The symposium brought together leading experts in addiction to discuss the controversial topic of food addiction.  Like drug and alcohol addiction, eating disorders are characterized by binging and craving.  In light of the significant comorbidity between eating disorders and substance abuse, as well as the emergence of animal models of binge eating and binge alcohol drinking, this symposium served as an opportunity to stimulate further research in this area. 

Stem Cell Research Symposium  Sam Zakhari and Lesley Stuart from the National Institute of Neurological Disorders and Stroke co-chaired an NIH symposium at the NIH campus in  Bethesda May 6 on Stem Cell Research:  New Directions for Research in Regenerative Medicine. 

Society for Prevention Research  Marcia Scott gave a presentation entitled “Context and Beyond: NIH Priorities for Prevention Research” at the annual meeting of the Society for Prevention Research, held in San Francisco, CA, May 28 to 30. 

Addiction Treatment Presentations  Mark Willenbring made presentations at or participated in numerous scientific meetings since the previous council.  Presentations focused on medications development and advances, health services research, and diagnosis, treatment, and recovery.  In addition to meetings of State practitioners in New York and Minnesota, meetings included the First Annual Symposium of Addiction Medicine in San Jose, Costa Rica, sponsored in part by the Asociación Centro de Rehabilitación para el Adicto in San Jose; the Forensic Mental Health Association 2008 Conference, Seaside, CA; the American Society of Addiction Medicine 39 ^th Annual Medical-Scientific Conference in Toronto, Ontario, April 10 to 13; an Addiction Recovery Symposium in Philadelphia May 1 and 2 sponsored by the Institute for Research, Education, and Training in Addictions; and the American Psychiatric Association 2008 Annual Meeting in Washington DC May 3 to 8. 

Symposium on Alcoholic Liver and Pancreatic Diseases  DMHE has received a $20,000 funding award from NIH’s Office of Rare Diseases to support the Third International Symposium on Alcoholic Liver and Pancreatic Diseases (ALPD) that will be held on 17-18 July, 2008 in Bilbao, Spain.

G. Outreach 

Leadership to Keep Children Alcohol Free  In January, Jane Beshear, First Lady of Kentucky, joined the Leadership; in February, Ginger Beebe, First Lady of Arkansas, and Jessica Doyle, First Lady of Wisconsin, became members.

Rear Admiral Steven K. Galson, M.D., M.P.H., the Acting U.S. Surgeon General, continued his outreach on behalf of the Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking, speaking at events in three Leadership states.  On April 14, at the invitation of Nebraska First Lady Sally Ganem, he spoke in Lincoln, Nebraska, and the next day at University of Nebraska at Omaha.  On February 27, he joined Ohio First Lady Frances Strickland and Angela Cornelius, director of the Ohio Department of Alcohol and Drug Addiction Services, and presented the Call to Action to Ohio college and university presidents and other members of the Ohio College Initiative to Reduce High Risk Drinking, a program of the Drug-Free Action Alliance.  With Wyoming First Lady Nancy Freudenthal, he kicked off the nationwide Town Hall meetings with a meeting March 24 in Riverton, Wyoming. (The nationwide series of Town Hall meetings is sponsored by the Substance Abuse and Mental Health Services Administration [SAMHSA].) The Wyoming First Lady’s Initiative to Reduce Childhood Drinking (WFLI) hosted the Town Hall, in conjunction with the Wyoming Department of Health.

The following are examples of recent regional activities of Leadership members: 

• Hawaii Lieutenant Governor James R. “Duke” Aiona, Jr., Leadership co-chair, announced in April that Hawaii has formed a public-private partnership with Mothers Against Drunk Driving (MADD) to combat underage drinking. MADD-Hawaii launched a statewide radio campaign to raise awareness of the issue, alerting parents to the “use and lose” law that allows the State to suspend or delay a driver’s license for anyone under age 21 who buys, possesses, transports, or consumes alcohol.  The Lt. Governor also announced that the State will use a Strategic Prevention Framework – State Incentive Grant from SAMHSA to prevent and reduce underage drinking.

• Lt. Governor Aiona led a roundtable discussion in Washington, D.C. in February at a Leadership Foundation meeting to encourage other States to join the U.S. Surgeon General's Call to Action To Prevent and Reduce Underage Drinking .

• Kentucky First Lady Jane Beshear will partner with the Kentucky State Police to serve as spokesperson for the State’s Enforcing Underage Drinking Laws program.  Mrs. Beshear recorded underage drinking public service announcements that will began airing on radio in April. In addition, Mrs. Beshear will participate in public events advocating the prevention of underage drinking.

• North Dakota First Lady Mikey Hoeven will serve as a member of the Governor’s new Prevention Advisory Council on Drugs and Alcohol. The council will explore the interrelationship between substance abuse prevention, education, and enforcement programs; address traffic safety issues including driving under the influence of drugs and/or alcohol; and develop policies that promote safe, stable families and communities.

Leadership Foundation  Vivian Faden gave an update on NIAAA’s Underage Drinking Research Initiative at a luncheon February 11 in Washington, DC, for the Leadership to Keep Children Alcohol Free Foundation . 

News Media Contacts  Mark Willenbring gave interviews for coverage of alcohol-related issues for numerous news media outlets including CNN, on alcohol treatment; Russian news agency ITAR-TASS, on how Alcoholics Anonymous is regarded by scientists; the journal Science on research on new pharmacological treatments for alcohol dependence, the Washington Post; cable channelVH1; and satellite radio outlet ReachMD, on the video education program on NIAAA’s Clinician’s Guide. 

On May 24 ^th, Q. Max Guo participated in a Voice of America Health Forum radio/TV show on alcohol abuse and alcoholism.  The show ran live in China. 

Fifth Annual North Dakota Alcohol Forum  Mariela Shirley gave a talk on “Screening and Prevention of Underage and College Drinking Problems” at the Fifth Annual North Dakota Alcohol Forum sponsored by the ND Department of Transportation.  The meeting took place in Bismarck, ND, February 20. 

State Alcohol Policy Boards  Ralph Hingson gave presentations to agencies in California and Pennsylvania concerned with alcohol policy.  On January 29 he gave a plenary presentation on the DEPR’s strategic plan at the National Alcohol Policy 14 Conference, held in San Diego, CA, and sponsored by the California Council on Alcohol Policy.  On April 10, he was a keynote speaker at the Pennsylvania Liquor Control Board Conference on Connections: Linking Communities of Concern to Reduce Underage and High Risk Drinking. His talk was entitled “Magnitude and Prevention of College Age and Underage Drinking Problems.”  The meeting took place in New Cumberland, PA. 

Science Outreach to Students  NIAAA staff organized and participated in a series of spring activities aimed at exposing young students to science. 

• Brain Awareness Week  NIH and the National Museum of Health and Medicine (NMHM) hosted more than 250 middle-school students and their teachers at the annual Brain Awareness Week activities, March 10 to 14.  The Dana Alliance for Brain Initiatives organizes Brain Awareness Week; NIH is one of numerous partners in the effort.  NIAAA and other NIH institutes with neuroscience-related programs presented a series of hands-on demonstrations and exhibits, which included Dennis Twombly’s Drunken Brain Exhibit on alcohol actions in the brain.  The 2-day program was launched with a Washington, DC Brain Awareness Week proclamation by Mayor Adrian Fenty.  

• National Brain Bee  On March 14, NIH hosted nearly 40 high school winners of the 2008 USA National Brain Bee competition at the National Library of Medicine.  Co-sponsored by the University of Maryland and the Society for Neuroscience, the 2-day competition covered topics such as memory, sensation, emotions, intellect, brain imaging, neuroscience research, and dysfunctions such as stroke, epilepsy, Alzheimer's disease, and autism. Dennis Twombly and other NIH scientists gave talks to the students; Dr. Twombly gave an overview of research programs at NIH and discussed alcohol effects in the brain and the unique vulnerability of adolescents to alcohol.  The high school students then participated in several rounds of questions as the final portion of the competition.  More information is available at ( http://www.internationalbrainbee.com/).

• NIAAA Take Your Child to Work Day  Through collaboration between the intramural and extramural programs, NIAAA launched a new set of satellite activities as part of the NIH Take Your Child to Work Day on April 24.  NIH parents registered 61 children for 14 different presentations and lab demonstrations.  The activities were organized by Dennis Twombly, Nardos Fessaha, and Tina Lancaster.  Hosting the presentations were NIAAA staff Lee Chedester, Fumihito Ono, and Dr. Twombly, along with Roger Sorensen (NIDA), and Archie Fobbs ( NationalMuseum of Health & Medicine). 

• Jeter’s Leaders Youth Foundation returns to NIAAA   Following successful visits in 2003 and 2007 by students in the “Jeter’s Leaders” program, the Communications and Public Liaison Branch CPLB recently hosted the largest contingent yet from this New York City-based leadership program. “Jeter’s Leaders” is part of the Turn 2 Foundation, founded by baseball star Derek Jeter, which focuses on peer education, leadership skills, and healthy alcohol-free lifestyles.  The Foundation asked NIAAA to host not only a new group of students for a visit with NIAAA, but a returning class to learn about other research at NIH.  CPLB worked with the NIH Director’s Office to accommodate both groups.  For the 2008 visit, new students had a tour of the NIHAnimalCenter in Poolesville tour and participated in Drunken Brain and Fatal Vision activities with Dennis Twombly and Fred Donodeo and in a Q & A session with NIAAA clinical director Markus Heilig.  Returning students visited with Clinical Center Director John Gallin and NIDDK director Griffin Rodgers, saw a demonstration of NIDDK’s metabolic research pod, and toured the National Library of Medicine’s forensic exhibit.  The visit also included a lunch with former presidential management interns originally from New York City to discuss educational and career opportunities at NIH for minority students.  Building on these successful events, CPLB will continue to explore educational and outreach opportunities with the Turn 2 Foundation. 

Community Anti-Drug Coalitions of America  In the February 29 issue of Coalitions Online, CADCA’s online newsletter,  Ricardo Brown was featured in an interview on minority disparities in alcohol use and treatment.  The article is available on CADCA's website, http://cadca.org/CoalitionsOnline/article.asp?id=1787.  Coalitions Online reaches more than 13,000 subscribers each month, most of whom are involved in community coalitions to prevent alcohol and other drug abuse. 

H. Multi-Media Products from NIAAA

Alcohol Research & Health  An issue of Alcohol Research & Health on systems biology was printed and distributed.  Sam Zakhari and Q. Max Guo were scientific review editors for this issue.  On April 29, the editorial advisory board of the journal met to discuss journal content and format and plan future issues. 

Alcohol Alerts  An Alcohol Alert that summarizes NIAAA’s strategic plan for 2008 to 2013 was published in January. 

NIAAA Newsletter  In April, CPLB issued the Spring 2008 edition of the NIAAA Newsletter. This issue featured stories on the new free online video training for the Clinician’s Guide, updates to the Alcohol Information Policy System (APIS), an NIH video on YouTube with an interview with DTRR director Mark Willenbring, and a summary of the Spring Conference Series Spotlighting Mechanisms of Behavior Change.

Clinician’s Guide Online Training  NIAAA’s new, online, interactive video training program for continuing education credit was posted on Medscape.com® on April 8.  In the first five weeks, some 4,225 physicians and nurses have completed the course for credit. Based on NIAAA’s Clinician’s Guide, the course features four 10-minute, realistic video case scenarios that demonstrate evidence-based techniques for identifying and managing the care of patients who drink too much. Each case is led by an expert clinician who offers insights and engages viewers in considering different strategies for treatment and follow-up. The program applies state-of-the-art e-learning technology with interactive exercises designed to engage adult learners.

NIAAA’s partnership with Medscape® has been a rewarding two-way venture. The company seeks solid content from reputable, non-commercial sources, and has not charged NIAAA to post our courses or provide credit. Last year, our text-based edition of the Guide course was one of the top activities ever posted on Medscape®.

For promotion, Medscape® publicized the new video case studies course via email newsletter to thousands of clinicians in April, and plans followup publicity in the weeks ahead. In addition, our contacts in the American Medical Association provided a free, full-page color advertisement for this program in JAMA.  We are staging an extensive second wave of promotion via email announcements to health professional schools, medical societies, professional associations, HMOs, and other organizations that will reach clinicians in training and in practice.

To present the course and some “before you begin” instructions clearly, we designed a new, attractive “gateway” page on the NIAAA website. The page currently links to two versions of the program—a standard one and a closed-caption one for the hearing impaired. In addition, we are developing an HTML-based program that is compatible with screen readers used by the visually impaired. 

NIAAA Explores Electronic Promotion of The Cool Spot CPLB recently began a pilot project to evaluate the effectiveness of web-based banner advertising.  Two separate banner ads promoting The Cool Spot website for youth were created for parents and teachers. With input from educators and parents, the ads were placed on a number of sites frequented by each group. A benefit of banner ads is that they offer a direct link to the website being advertised, which facilitates evaluation.  This pilot will be evaluated, in part, according to the web traffic generated by each ad.  Although the analysis is continuing, early results suggest that two PBS websites, PBS Teachers (www.pbsteacher.org) and PBS Parents (www.pbsparents.org), are effect outlets for this type of promotion.

NIAAA Video Conference Series on NIAAA’s Web Site  The first webinar presentation in the NIAAA Video Conference Series has been archived on the NIAAA Web site.  Mark Willenbring’s presentation,  Alcoholism Isn’t What It Used to Be: New Research on the Nature and Diagnosis of Alcohol Use Disorders, can now be viewed online.