Addiction Research Institutes Face Prospect for Cuts in 2021 Budget

At a time when addiction research is being highly valued for expanding knowledge about today's preferred treatments while working toward more effective solutions for tomorrow, proposed budget cuts for the two addiction-focused institutes under the National Institutes of Health (NIH) are generating widespread concern.

President Trump's proposed budget for fiscal year 2021, released earlier this month, calls for a substantial cut of more than $49 million in funding for the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Funding for NIAAA would decline from around $546.7 million in the current fiscal year to $497.3 million in the budget year that begins Oct. 1.

The budget for the National Institute on Drug Abuse (NIDA) would decrease from just under $1.46 billion to just over $1.43 billion, a significantly smaller decrease than the proposal for NIAAA but still a decline of nearly $26 million.

Both institutes have seen steady increases to their overall funding levels over the past few fiscal years.

“Recommended cuts to NIDA—while we are seeing increases in methamphetamine and cocaine use around the country—are not wise,” Andrew Kessler, JD, founder and principal of behavioral health consultant Slingshot Solutions, tells Addiction Professional. “Yet even more perplexing are the cuts to NIAAA.”

Kessler adds, “Alcoholism remains a major public health problem in the United States, larger than even the opioid epidemic. To suggest the agency take on a cut of almost 10% of its budget is shortsighted, and ignores the damage done to society by alcohol abuse.”

Kessler cites results from a study published this month in JAMA Network Open as an example of the widespread impact alcohol abuse continues to have. The analysis of trends in alcohol-induced mortality rates from 2000-2016 shows increases among all ethnic groups for the 2013-2016 period, and finds particularly steep increases among young adults—perhaps signaling major future increases in alcohol-related disease. Authors of the study wrote that their findings “document an urgent public health crisis calling for concerted public health action.”

Relevant to the states

Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), tells Addiction Professional that substance abuse agencies in state government rely on information generated by the NIH institutes “almost on a daily basis.”

Initiatives under NIDA's Clinical Trials Network offer ongoing reports on developments in treatment, Morrison says. The work of the institutes is looked to for identifying potentially game-changing advances in treatment.

“Folks want medications now for stimulants,” Morrison says of the lack of an approved medication treatment for stimulant use disorder at a time when methamphetamine use is reaching crisis proportions in some communities.

Several other institutes under NIH cross over into topics relevant to alcohol and drug treatment, but the work of NIDA and NIAAA carries great resonance for the field's stakeholders.

This is certainly not the first time in the institutes' history that advocates have encountered proposed budget cuts—in some cases, eventually seeing a return to level funding or even some budget increases. The national election this fall likely will add another layer of complexity to a federal budget process with no certain outcome for the addiction research effort.