The NIAAA-NIDA Merger: Comments from the Field I

Editor’s Note: Following up on Ron Roizen’s two-part think-piece on the NIAAA and NIDA merger, we offer the comments of Paul M. Roman, Regents Professor of Sociology at the University of Georgia and Director of their Center for Research on Behavioral Health and Human Service Delivery in the Owens Institute for Behavioral Research.  Roman currently studies organizational change and innovation adoption in the delivery of treatment for substance use disorders. Earlier in his career he conducted extensive research on the adoption and implementation of employee substance abuse and assistance programs in the workplace.

Decommissioning
(Chitttagong, Bangladesh)

Ron Roizen offers us a great contribution about the merger of NIAAA and NIDA. There is a remarkable amount of history and organizational process embedded in this event, which may provide some surprises as it unfolds.  I want to add some reflections, largely from the perspective of someone with active research grants from both NIDA and NIAAA that I hope can be continued beyond their current funding, but also from that of someone who “was there at the founding” of NIAAA.   In Ron’s piece,  I am initially struck by the vision of the two Institutes, like ships, being “decommissioned” although I guess the metaphor fails when we consider their being taken out to sea and sunk.

From my own perspective, my expectation of the merger has consistently been of a bigger and more visible NIDA with NIAAA tagged on as a division, and perhaps another division  that would include tobacco, depending on where that goes.  If  indeed we see a truly new organization, that will be striking.  For Points readers’ socio-historical skills, these developments are a challenge for close observation and recording.  I would add a prediction that for the first 5 years or so, there will be scrupulous and highly visible attention to alcohol research project support, simply because of the kinds of doubts that I (and most others, including Roizen) have expressed about NIAAA’s mission being lost in the woodwork.

Because it was a big deal to Selden Bacon, the dean and founder of alcohol sociology, and he’s not here to add his comments, I would note that the “hidden alcoholic” idea probably had its first empirical genesis in a little study reported by Bacon (with his student Bob Straus) in the Quarterly Journal of Studies on Alcohol in 1951. This widely-ignored manuscript on “social stability among alcoholics,” using data on diagnosed alcoholics from some part of the then-new Connecticut treatment system, revealed the middle-class-ness of the clients and, at least in this setting, undermined the notion of the dominance of the “Skid Row” types.  The influence of this piece is hard to track, if there was any influence, and in this regard Bacon is part of the pantheon that includes Leif Erikson discovering America.

The one bit of fact that is not quite captured in Ron’s piece is that the research review process for NIDA grants, kept exclusively “in-house” for nearly 40 years of NIDA’s existence, has been totally handed over to NIH to conduct through its centralized Center for Scientific Review.  This was achieved about three or four years ago, with very little resistance.  It means that no longer will most of the NIDA applications be reviewed by committees made up exclusively of drug research scientists.  This move from “segregated review” was understood to be primarily the action of NIDA Director Nora Volkow, who was said to assert that the science underlying NIDA applications should be able to compete in the big NIH arena where all applications are more or less reviewed together.  Curiously, however, NIAAA still maintains its “in-house” review of research grant applications.

Is drug science more advanced than alcohol science?  Will this change before, during, or after the merger? How will this affect alcohol science?   “Segregated review” should stimulate a raft of questions from the perspective of the sociology of science about disciplinary maturity, standards of scientific investigation and  the status of “paradigms,” effectively described for the “drug side” in Roizen’s piece.

Separate (But Equal!) Paths to Review

From my observations, the general scuttlebutt is that NIDA grantees commonly complain that this “new” integrated system works against them while NIDA staff insist that hard evidence shows that the “new” centralized review is actually improving funding opportunities or at least maintaining the status quo.  This is very difficult to analyze as budgets and opportunities for funding plunge downward.  However, referring back to Ron’s piece, the late Gerry Klerman’s wishes for centralized review of grants rather than “in-house” reviews have more or less come true, given that the volume of applications to NIDA is much larger than those to NIAAA.  And, to repeat, the resistance to this change was very minimal, the resisters of course being the somewhat mysterious drug research constituency than Ron does not discuss in detail.

I wish I had the skills to add to Ron’s piece in terms of the history of the “drug” constituency.  I am yet to find anywhere a detailed statement on the birth of NIDA or even much about the actors involved, whereas parallel history about NIAAA’s conception and birth is as thick as sausage gravy.  NIDA seems to have popped out by some different hydroponic (I love that image) mechanism.  But evidence of constituency pressure, or even of the existence of a constituency, seems hard to find.  From what little is written, it almost seems that its emergence was a result of a need for symmetry, like having a plant-holder on each side of the front door.   But my myopia may be due to my overly long identification with the alcohol side, which is checkered by early memories of a genuine repulsion among alcohol people of the idea of mingling or collaborating with the “drug people.”  Goffman’s concept of “courtesy stigma” definitely applies.

Arrival of the Drug People

Drug people’s presence at sociology meetings seemed to lead to boring preoccupations with criminal activity that seemed to have little originality, and huge social distance between the researchers and the subjects.  Alcohol researchers seemed to like their subjects more, and certainly did not hesitate to replicate portions of their behavior.  These attitudes toward sociologists studying drugs was pure prejudice on my part as well as that of  my alcohol-research-loving peers, but definitely the result of fairly intense socialization, particularly through the remarkably tight membership of  the Committee on Drinking Behavior of the Society for the Study of Social Problems, once a renegade organization from the staid and social-problem-hating American Sociological Association.

Since the founding of NIDA, a strong constituency group has emerged among NIDA-funded researchers, which needs no explanation.  Numerous amongst us became “crossovers” and the resistance to drug-oriented research diminished…..what a surprise, ha ha.  This allegiance on the part of many researchers to “both sides of the fence” may add to Ron’s explanation for the relatively easy flow of this merger process.

I think the worriers, including Dave Pittman (whose essay on “The Rush to Combine” is definitely worth a read), were right that the “merger” with drugs would prove detrimental to the alcohol side, a position that Ron documents well.  Contributing to this in a dramatic way was the florid revitalization of the War on Drugs by Reagan and his spouse in the mid-1980s, which by implication created another hidden group, this time terrifying, namely hidden drug users in the workplace, who still are pursued by very well paid collectors and testers of urine. Youthful drug use throughout all social classes has also preserved this fear-driven stereotype.  In terms of the alcohol constituency, what I would (likely unoriginally) call “spillover stigma” served to drive part of this group back into the closet, and perhaps to throw in another metaphor, to “declaw” the aggressiveness of the alcohol constituency.

Hearken back to the NCA “coming out party” at the Washington Shoreham Hotel in 1976 where 48 prominent recovering alcoholics identified themselves, dressed in formal wear in a crowded and darkened ballroom.

Washington Shoreham: Wasn't that a Time?

For me, it is hard to mentally re-populate that group with prominent new people of today who are open and well known in the context of their recovery.  The leaders who “come out” are rare indeed today, and seem restricted to the grounds of the curious “recovery movement” which, through its very gentle rhetoric, cannot even be considered as paralleling the activities of people like Hughes, McCambridge, Smithers, Kemper, Ford, and Pike, but who, on the other hand, may be having influence through such legislation as the Wellstone-Domenici Parity Act.  But high visibility is no longer part of the action.  Going back to the late 80s and early 90s, a cynical view is that the War on Drugs (which could be said to have been followed by a smaller war on substance abuse treatment) paralleled those historical events where it’s clear that the leader is about to be captured or to die: the alcohol constituency scattered into the woods and largely stayed there.

One last point.  It is said that the new Institute may be the second largest of the 26 NIH Institutes in terms of funding, right after cancer.  I’m not sure if this assertion assumes that a load of money for tobacco will be transferred to the new Institute from the NCI.  Regardless, it seems amazing how much this future fact seems out of step with public sentiment.  While polls certainly show a significant amount of public support for treatment, such support is also there for punishment.  And while the public surely worries about drugs, it is not their number two priority in terms of seeking medical care.

One thought on “The NIAAA-NIDA Merger: Comments from the Field I

  1. Hi Paul,
    Thanks for your insider’s perspective on the history of NIDA/ NIAAA (I love the image of the alcohol constituency scattering into the metaphorical woods). I did wonder: do you have any thoughts on SAMSHA? How does that agency fit into this story? I’m always interested in learning more about how and why the split between treatment and research went down.

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