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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

This study was supported under a grant from the W.M. Keck Foundation of Los Angeles. The views presented are those of the Institute of Medicine Committee to Identify Strategies to Raise the Profile of Substance Abuse and Alcoholism Research and are not necessarily those of the funding organization.

Library of Congress Catalog Card No. 97-69691

International Standard Book Number 0-309-06401-5

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

Cover: The cover of this report includes a circular motif, called a mandala, that was designed by Leigh Coriale of the National Academy Press. The term mandala comes from Sanskrit, and such motifs are prominent among many of the world's religions. In psychology, mandalas were studied and used most extensively by the psychiatrist Carl Jung, who viewed mandalas as abstract representations of the totality of the conscious and unconscious. Universal elements of the unconscious, or archetypes, were important in Jung's theory of individual psychological development and manifestations, but also were evident in symbols, myths, legends, and rituals. Color reprints of some of Jung's patient's mandalas are contained in R.F.C. Hull's English translation of Jung's book, The Archetypes and the Collective Unconscious (Second Edition, Tenth Printing; Princeton, NJ: Princeton University Press, 1990).

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