Reflections on the Scheduled NIAAA/NIDA Merger, Part 1

Editor’s Note: Ready or not – and like it or not! — the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) are scheduled for merger in less than 18 months.  Points contributing editor Ron Roizen offers a two-part post on the history of the two institutes, the recent push toward merger, and the merger’s possible effects.  This signal change in the organization of federally funded alcohol and drug research in the U.S. compels the attention of readers from across Points’ spectrum of history, policy, and advocacy.  In addition to welcoming comments, we invite research and policy professionals with an interest in post-length comments on the merger– or on Roizen’s take on the merger–  to contact Managing Editor Trysh Travis (ttravis@ufl.edu) to discuss future stints as guest bloggers.

The planned decommissioning of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) and the creation of a new National Institutes of Health (NIH) institute to take their places, now scheduled for launch in October, 2013 (FY2014), are notable developments in the history of the federal role in the application of science to alcohol- and drug-related public problems in the U.S.  The push for merger of these two formerly separate public problem domains is by no means new.  Sociologist David J. Pittman published an article titled, “The Rush To Combine: Sociological Dissimilarities of Alcoholism and Drug Abuse,” nearly a half-century ago, criticizing what he regarded as the contemporary trend toward conflation.(1)  Pittman’s 1967 article appeared of course before either NIAAA, created in 1970, or NIDA, created in 1973, had arrived on the scene.

Despite their surface similarities, the two institutes grew out of quite different cultural and political circumstances.  NIAAA’s creation was the product of a constituency-driven movement to modernize American attitudes toward alcoholism and, beyond that, to enhance the nation’s awareness of and substantially enlarge its response capacity with respect to a massive putative “hidden alcoholism” problem lurking unrecognized in our population.(2)  The testimonies of Alcoholics Anonymous’s (AA) William Griffith Wilson,(3) National Council on Alcoholism’s (NCA) Mrs. Marty Mann, and actress Mercedes McCambridge highlighted the 1969 hearings of the Senate Special Subcommittee on Alcoholism and Narcotics, chaired by Senator Harold Hughes, which in turn lead to NIAAA’s creation.(4)

According to Nancy Olson’s account, R. Brinkley Smithers and Thomas P. Pike – the latter, an early member of AA, vice chair of the board of the Fluor Corporation, and an influential Republican who also offered testimony at the Hughes hearings – played key roles in convincing President Richard M. Nixon to sign the “Hughes Act” creating NIAAA, despite veto recommendations from some influential members of Nixon’s administration.(5) NIDA’s creation, in 1973, on the other hand, grew out of palpable public anxiety regarding the diffusion of illicit drug use in the 1960s, worry about the potential consequences of continuing heroin use by military personnel returning from wartime Vietnam, and disenchantment with the nation’s predominantly criminal justice response to drug problems to date.(6) Reform-minded members of the medical and legal professions also played key roles in the creation of the alcohol and drug institutes.  Both institutes banked on the promise of modern science to improve knowledge and strengthen social responses to their respective problem domains.  But the meaning and relevance of science’s authority and prospects differed for each.  On the alcohol side, NIAAA’s creation represented a crowning achievement for the modern alcoholism movement, now lending the prestige and resources of a freestanding federal agency to alcoholism’s disease status and its importance as a public health problem.  On the drug side, NIDA’s creation was intended to buttress mainstream society’s claims regarding the evils of illicit drugs, affirm the importance of maintaining an official tabu on drug use, and, at the same time, advance the prospects for effective treatment for drug use victims.  The passage of time showed that neither NIAAA nor NIDA stuck entirely faithfully to the scripts suggested by these founding intentions, although neither institute may be said to have abandoned these scripts either.

NIAAA’s creation, incidentally, also arguably reflected generational change and historical forgetting in relation to the alcohol question in then-recent American history.  Had claims the nation harbored a massive hidden alcoholism problem been advanced in, say, the 1940s or 1950s, many Americans who had experienced the tumultuous Prohibition-and-Repeal era might have regarded that contention as suspiciously too alarmist and by extension too “dry.” The memory of the ill-fated “Noble Experiment” would have been still too fresh.  By 1970, however, American society’s cultural brake on problem enhancing rhetoric about alcohol problems had been loosened.(7)  I remember quite well, for example, the insistent clamoring, in the late 1960s and early 1970s, for impressive prevalence estimates for alcoholism, giving rise to national alcoholism prevalence numbers ranging anywhere from four, five or six million, to nine million,(8) to 13 million,(9) to 18 million.(10)

In 1966, following a recommendation by the Cooperative Commission for the Study of Alcoholism, a National Center for Prevention and Treatment of Alcoholism was launched within the National Institute of Mental Health (NIMH).  NIAAA’s subsequent creation in December, 1970, greatly expanded the federal investment in alcohol-related endeavors over that represented by the earlier NIMH center.  Yet NIAAA, and later NIDA, would remain under NIMH’s organizational umbrella – with the associated tacit implication that alcoholism was properly classified as a mental illness – until the creation of the Alcohol, Drugs, and Mental Health Administration (ADAMHA) in 1973.  With ADAMHA’s creation, NIAAA, NIDA, and NIMH became organizationally co-equal entities, though they remained unequal in terms of customary funding levels.  The so-called “Gardner Report,”(11) which was instrumental in the creation of ADAMHA, recommended separate institutes for alcohol and drugs.  The report’s authors, according to one account, “perceived a need for continued visibility and leadership, especially in the areas of drug abuse and alcohol abuse….”(12)

Carolyn L. Wiener’s sociological analysis of NIAAA’s institutional development stressed the new agency’s efforts, inter alia, to establish turf rights, develop constituencies, and maintain a separate identity.(13)  Yet, pressure to conflate alcohol and drug activities into a single institution soon followed NIAAA’s creation.  In December, 1976, Nevada Senator Paul Laxalt sent NIAAA Director Ernest Noble a letter suggesting NIAAA should merge with NIDA.  Laxalt put forward a plan to create a single National Institute on Substance Abuse; backers for Laxalt’s plan included Senators Hubert Humphrey, Richard Schweiker, and Strom Thurmond.  Noble and the NIAAA Advisory Council successfully resisted Laxalt’s proposal.(14)  Regarding the Laxalt episode, NIAAA Advisory Council member Edwin J. McClendon commented that alcoholism was beginning to be recognized as a health problem while drug abuse was still “heavily cast in the criminal justice climate.”  McClendon continued:  “And we sure don’t want the alcohol problem cast back in that when we fought for half a century to get it out of there.”(15)  Another threat to NIAAA’s, NIDA’s, and NIMH’s autonomy soon followed.  Gerald L. Klerman, appointed ADAMHA’s administrator in June, 1977, put forth a plan to centralize the initial grant review process at the ADAMHA level, thus depriving the individual institutes of control over that important function.(16)  The alcohol constituency again circled the wagons and defeated Klerman’s plan.(17)  Similarly, in September, 1977, Peter Bourne, recently appointed director of President Jimmy Carter’s recently created Office of Drug Abuse Policy, advanced the idea of an NIAAA-NIDA merger, suggesting, in part, “…it would increase the status and clout of the two separate efforts in the federal government, perhaps to the benefit of both of them.”(18)  Once again, alcoholism interests recoiled at the idea, but the issue subsided when Bourne left his post under a cloud in July, 1978.(19)  Neither identification with nor linkage to mental illness or drug addiction struck the fancy of NIAAA’s powerful constituencies, which included well-prepped members of the U.S. Congress.  Merger of NIAAA and NIDA continued to represent a topical possibility however in the 1980s and 1990s.  “Over the years, there has been recurring interest in why the two institutes that focus on substance abuse and addiction are separate,” noted a 2003 National Academy of Sciences (NAS) report.(20)

Part 2 here.

Acknowledgment:

Thanks are owed Kaye Fillmore, William L. White, and Loran Archer for comments on an earlier draft.  I also thank Marc Schuckit for suggesting I should write something on the merger.

Notes:

(1)    David J. Pittman, British Journal of Addiction 62:337-343, 1967.  Incidentally, I began a previous discussion of merger, prepared back in 1993, by making reference to the same Pittman paper (see http://www.roizen.com/ron/merger.htm).

(2)    See, e.g., Gordon McKay Stevenson, Jr., “The Emergence of Non-Skid-Row Alcoholism as a ‘Public’ Problem,” Temple Law Quarterly 45(4):529-584, (Summer) 1972.

(3)    Identified in the record only as “Bill W.” to preserve anonymity.

(4)    Available online at: http://babel.hathitrust.org/cgi/pt?id=uc1.b4193168;page=root;view=image;size=100;seq=8;num=ii, accessed March 2, 2012

(5)    Nancy Olson, With a Lot of Help from Our Friends: The Politics of Alcoholism, New York, Lincoln [NE], Shanghai: Writers Club Press, 2003, Kindle edition, slider at 1831-1840.

(6)    See David F. Musto, “Drug abuse research in historical perspective,” Appendix B (pp. 284-294) in Committee on Opportunities in Drug Abuse Research, Division of Neuroscience and Behavioral Health, Institute of Medicine, Pathways of Addiction: Opportunities in Drug Abuse Research, Washington, D.C.: National Academy Press, 1996 and David T. Courtwright, “NIDA, This is Your Life,” Drug and Alcohol Dependence 107:116–118, 2010.

(7)    Ron Roizen, “How does the nation’s ‘alcohol problem’ change from era to era? Stalking the social logic of problem-definition transformations since Repeal,” pp. 61-87 in Sarah Tracy and Caroline Acker (eds.), Altering the American Consciousness: Essays on the History of Alcohol and Drug Use in the United States, 1800-2000, Amherst: University of Massachusetts Press, 2004.

(8)    Re Don Cahalan’s reluctant role in creating this estimate, see Deborah M. Barnes, “Drugs: Running the Numbers,” Science, New Series, Vol. 240, No. 4860 (Jun. 24, 1988), pp. 1729-1731.

(9)    Nancy Olson, Ibid., Kindle edition, slider at 825-836, credits her own offhand remark to Senator Hughes as one source for a 13 million estimate at this time.

(10) On 18 million, see Joseph R. Gusfield, The Culture of Public Problems, Chicago: University of Chicago Press, 1981, p. 60.  There is an interesting history of alcohol science paper to be written on how the then-contemporary preoccupation with prevalence estimation ultimately deflated.  By 1980, sociologist Robin Room was suggesting that the number of high-problem-score alcoholics in the U.S. population was arguably roughly equivalent to the reported number of alcoholics already in some kind of treatment – or about one million (see Room, “Treatment-Seeking Populations and Larger Realities,” Ch. 13, pp. 205-224 in Griffith Edwards and Marcus Grant [eds.], Alcoholism Treatment in Transition, London: Croom Helm, 1980, see p. 212).

(11) E. A. Gardner, Final Report of the Mental Health Task Force (Washington D.C.: Department of Health and Human Services, 1973).

(12) Quoted in:  Committee on Co-Administration of Service and Research Programs of the National Institutes of Health, the Alcohol, Drug Abuse, and Mental Health Administration, and Related Agencies, Institute of Medicine, Research and Service Programs in the PHS: Challenges in Organization, 1991, p. 32.

(13) Carolyn L. Wiener, The Politics of Alcoholism: Building an Arena Around a Social Problem, New Brunswick, NJ: Transaction, 1981.

(14) On the Laxalt episode, see Wiener, Ibid., pp. 142-143 and Olson, Ibid., Kindle edition, slider at 3859-3869.

(15) The Alcoholism Report, 5(5):2, December 24, 1976, p. 2.

(16) On the Klerman episode, see Olson, Ibid., Ch. 28, “The Klerman Controversies.”

(17) NIAAA and the other institutes’ initial review processes were eventually centralized in the 1990s when ADAMHA was abolished and the research functions of the three institutes were placed under the NIH umbrella.

(18) In Olson, Ibid., Kindle edition, slider at 3953.

(19) See Olson, Ibid., Kindle edition, slider at 3967.

(20) National Academy of Science, Enhancing the Vitality of the National Institutes of Health: Organizational Change to Meet New Challenges, Washington, D.C.: National Academies Press, 2003, p. 72.