and was informed not only by science, but also by the existing commitment base (the amount of money already committed to multi-year projects), administration policy, congressional earmarks, and the prioritization process within the specific institute. Budget decisions also were influenced by historical budget trends and the consideration of balance between mechanisms (extramural, intramural, grants, contracts, research project grants, and center grants), and the balance between AIDS and other research. Unlike other PHS organizations, the ADAMHA institutes also had to consider the balance between research and services.

The AIDS budgets from the various institutes were reviewed by the administrator of ADAMHA with the help of an analyst in the planning office. The administrator, with advice from the senior staff, would decide on an overall budget request (AIDS and non-AIDS) to submit to the Public Health Service.

The ADAMHA budget process recognized that the agency was unique in its mix of research and services programs, and the budget attempted to implement the concept of an integrated ADAMHA mission, where progress depended on linking research and services with national leadership and advocacy on substance abuse and mental health issues. This concern fundamentally differed from budgetary concerns at NIH, where there was little worry about the level of services budgets and programs in other agencies (such as Health Resources Services Administration or Centers for Disease Control and Prevention).

Historically, within ADAMHA, the three institutes approached planning and budgeting for AIDS in very different ways. NIAAA developed its overall research budget and then determined what portion was related to AIDS research. NIDA, with a large investment in AIDS research but without a formal organizational structure for AIDS programs, developed its AIDS and non-AIDS budgets jointly. NIMH, with a formal Office on AIDS Programs, developed an AIDS budget separately from its non-AIDS budget and then put the two together to develop an overall NIMH budget. The manner in which HHS treated AIDS funding, either as part of various agency budgets or as a separate entity, also affected how the institutes structured and developed their budgets.

In 1991 the budget process at NIAAA, NIDA, and NIMH became more complicated with the uncertainty about whether or not the institutes would be moved from ADAMHA to NIH. Even after the decision to reorganize was made, the institutes still were involved in implementing the FY 1992 budget as part of ADAMHA. Also, until the fall of 1992, they were developing and presenting



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