Circulating Now welcomes guest bloggers Laura C. Manella and Gregory K. Roa from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to celebrate the 50 year anniversary of the NIH institute, which supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems.
On New Year’s Eve fifty years ago, President Richard Nixon signed the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970. This legislation was also known as the Hughes Act for Senator Harold Hughes, who was in recovery from alcohol use disorder (AUD) and a champion of alcohol research.
The U.S. has a complex history with the use and abuse of alcohol. Early debates involved the medicinal properties of alcohol and the negative behaviors associated with excessive alcohol use. Dr. Benjamin Rush, a prominent physician and signer of the Declaration of Independence, spoke out about the dangers of misuse, publishing An inquiry into the effects of ardent spirits upon the human body and mind: with an account of the means of preventing, and of the remedies for curing them in 1811.
However, the general view that excess alcohol consumption and intoxication represented a personal moral failure persisted through the Temperance Era of the mid- to late-19th century, giving way to efforts to implement anti-alcohol legislation. This movement ushered in America’s national experiment with Prohibition from (1919 to 1933).
Following the repeal of Prohibition, advances in medical science in the 20th century helped to develop an understanding of the disease theory of alcoholism—now referred to as alcohol use disorder, or AUD. Additional factors gave credence to the idea that recovery from AUD was possible—the acceptance of the effectiveness of mutual support groups like Alcoholics Anonymous (founded 1935), and the successful introduction in the 1940s of the medication disulfiram, which received approval by the U.S. Food and Drug Administration (FDA) as a treatment for AUD in 1951.
Grass-roots efforts were integral in the call for federal resources to investigate alcohol problems by harnessing modern biomedical research.
The Hughes Act of 1970 authorized a comprehensive federal program to address the prevention and treatment of alcohol-related problems. This legislation established the National Institute on Alcohol Abuse and Alcoholism (NIAAA), drawing attention to alcohol misuse as a major public health issue.
NIAAA was first established as a component of the National Institute of Mental Health (NIMH), while NIMH was part of the U.S. Public Health Service’s Health Services and Mental Health Administration. In 1974, NIAAA became an independent Institute within the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). In 1992, the ADAMHA Reorganization Act established the research component of NIAAA as an institute within the National Institutes of Health, where it remains today.
The NIAAA’s launch was a major step in solidifying the reframing America’s understanding of AUD as a preventable and treatable medical disorder. Thanks to the research supported by the NIAAA, AUD is recognized as a spectrum disorder, ranging from mild to severe, that varies across the lifespan and by the individual.
The NIAAA’s establishment set the stage for broadening the scope of alcohol research to many critical areas, reflecting alcohol’s far-reaching effects. For example, soon after its creationgroundbreaking reports by NIAAA-funded scientists about “fetal alcohol syndrome,” demonstrated alcohol’s negative effects on prenatal development. The NIAAA quickly marshalled resources, funding new grants to better understand the birth defects associated with prenatal alcohol exposure. We now know that prenatal alcohol exposure can result in a wide range of lifelong effects called fetal alcohol spectrum disorders (FASD). This research informed a U.S. Surgeon General’s advisory about drinking during pregnancy in 1981 and legislation in 1988 which required that alcohol beverage containers be labeled with a warning from the Surgeon General about the risk of prenatal alcohol exposure.
By 1976, NIAAA’s portfolio of investigator-initiated research had grown, and to further strengthen the alcohol research enterprise, Congress passed a law to establish the National Alcohol Research Centers Program. The goal was to provide stable, long-term support for alcohol research and serve as a platform for research training and dissemination. The Centers represent the depth and breadth of alcohol research and have made significant contributions towards our understanding of the causes, consequences, diagnosis, prevention, and treatment of alcohol-related problems.
NIAAA continued to build on the success of its extramural and intramural research programs, establishing initiatives to integrate alcohol research across promising areas. One such initiative, the Integrative Neuroscience Initiative on Alcoholism (INIA), was launched in 2001 to foster translational, multidisciplinary, collaborative research on the brain mechanisms involved in excessive alcohol use and their relationships with AUD, stress, and anxiety. INIA was one of the NIH’s first U01-supported research consortium programs. The NIAAA’s extensive research program in neuroscience has demonstrated that alcohol affects the brain in many ways and that lasting changes in the brain caused by alcohol misuse perpetuate AUD and make individuals vulnerable to relapse.
Throughout its history, the NIAAA has been integral in raising awareness about the impact of alcohol misuse on health and providing resources based on evidence-based, NIAAA-supported research. These outreach efforts include the development of resources for health professionals as well as consumer-oriented public service announcements and consumer health messages. They also include the development of websites and materials such as Rethinking DrinkingSM, which helps individuals assess their drinking habits; the NIAAA Alcohol Treatment Navigator®, which helps adults recognize and find quality alcohol treatment near them; and the College Alcohol Intervention Matrix (CollegeAIM), which helps colleges and universities identify effective alcohol interventions for their campuses.
Beginning in 1974, the NIAAA curated and produced peer-reviewed publications that cover important research advances in the field of alcohol use and health. The original journal, Alcohol Health and Research World, was written in an accessible style and supported a broad audience of scientists and clinicians. These publications have been digitized and are available on Internet Archive in the SALIS Collection. Today, its successor, Alcohol Research: Current Reviews, continues to produce scientific review articles on topics spanning neuroscience and behavior, organ damage and other health effects, epidemiology and prevention, and treatment and recovery.
In addition, NIAAA-supported research provided much of the scientific foundation of two landmark U.S. Surgeon General reports: The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking (2007) and Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (2016), the first reports focused on alcohol and other substance misuse.
The NIAAA’s rich research legacy of generating and disseminating evidence-based information to improve the diagnosis, prevention, and treatment of alcohol-related problems across the lifespan endures today.
The National Library of Medicine holds a wide variety of materials related to the medical and social history of alcohol. Start exploring with a result of over 5000 digitized materials related to the search term alcohol abuse in the NLM Digital Collections.
Laura C. Manella and Gregory K. Roa are members of the Communications and Public Liaison Branch at the National Institute on Alcohol Abuse and Alcoholism