issues. Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention (1979), for example, contains an example of fruitful collaboration between the Division of Mental Health and Behavioral Medicine and the Division of Health Promotion and Disease Prevention that resulted in the chapter “Strategies for the Prevention of Mental Disorders. ” This chapter secured a place for these “forgotten” disorders among the preventable medical diseases and conditions to be tackled as part of the newly emerging set of federal initiatives directed toward the goal “Health for All by the Year 2000.”

PREVENTION AND TREATMENT OF SUBSTANCE ABUSE

The Institute's reports on drug and alcohol abuse have resulted in greater support of research in those previously neglected fields and have brought conceptual clarity to the complex issues of effective treatment for these chronic, relapsing health problems.

The report Alcoholism, Alcohol Abuse and Related Problems: Opportunities for Research (1980) is another example of fruitful collaboration with the Division of Health Promotion and Disease Prevention. This report became a benchmark in the history of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NIAAA research budget ($22.2 million) was quite small in relation to the large burden of illness created by the problem of alcohol abuse. The report evaluated the current state of knowledge about alcohol and surveyed available research technologies. It identified several important, specific, and feasible directions for research: the metabolic pathways for alcohol in humans; the physiological effects of these metabolites; and the role of genetic factors in influencing individual responses to alcohol. In addition, it highlighted the promising emergent research on the effects of alcoholism on brain function. These recommendations resulted in increased attention to the problem, and NIAAA's research budget grew to $71.2 million by 1987. Another IOM study, Causes and Consequences of Alcohol Problems: An Agenda for Research, released in 1987, reassessed the achievements in alcohol research and offered directions for the future. By 1993, NIAAA's research budget approached $163 million.

Service issues were addressed in the report Broadening the Base of Treatment for Alcohol Problems released in 1990. This committee found that for alcohol, unlike drug abuse, the largest source of treatment financing is from private insurance. There was an intense review of the literature related to alcohol treatment in the areas of patient matching; outcomes; comprehensive treatment settings; needs of special populations; cost-effectiveness; and the impacts of financing policies. Recommendations for improving treatment



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