Proceeding along the path of a structural reorganization needs to deliver on the promise that such a union would bring about scientific opportunities and public health benefits that could otherwise not have been achieved. Now is the time for more analytic thinking and a strategic approach that threads an accurate path to progress and incorporates most of the important needs of both institutes. Increased synergies of focus, operations, programs, procedures, scientific approaches, and collaborations on a level that hitherto has not been achieved are essential to surpass the status quo, enhance the public good, and advance the prevention and treatment of alcohol, drug, and behavioral addictions.
For a new structural reorganization to succeed, all operations of both abolished institutes would need to be integrated seamlessly and relevant activities at other institutes would need to be incorporated; this includes both infrastructure and personnel. Not merging the infrastructure of both institutes would create silos of people and resources within a much larger organization through which differences would be difficult or nearly impossible to resolve, and collaborations less likely to occur, thereby negating important advantages of a union. A poorly integrated institute would be ungovernable as a united whole and unable to address a clear set of missions, objectives, and priorities.
To succeed, a new single and larger institute for alcohol and drug use, abuse, and addiction would also require an enormous amount of cooperation from other institutes since the portfolios of research in the areas of alcohol, tobacco, and other drug abuse should logically be transferred to the new institute. The larger an administrative structure is, the more complex it would be to administer, and the greater would be the need for sophisticated administrative structures and skills. Thus, in the near term, a structural reorganization would be less efficient and more costly than the individual institutes are currently. Only with careful strategic planning would it be possible to increase efficiency and reduce costs over time.
NIAAA and NIDA do not have overlapping infrastructures. Indeed, the intramural laboratories of the institutes are located in different parts of Maryland (at least 30 miles apart)—Rockville and Bethesda for NIAAA and Baltimore for NIDA. To organize them efficiently into one operation would require the focus and expansion of one of these sites. Presently, the United States federal government faces a challenging financial climate and likely a flat NIH budget or even a loss. Even if the long-term costs were reduced, additional funds would be required in the short term to avoid compromising the ongoing research of all the institutes involved. It is unclear that additional funds would be appropriated to fund a consolidated infrastructure of the two institutes. Are there plans within the NIH to use Office of the Director resources to achieve an efficient structural integration, with the promise of a greater scientific and public health yield in the future? Surely, the funds cannot come solely from the existing institutes, as this would disrupt grant funding and be counterproductive to scientific progress. If the Secretary of Health and Human Services approves a structural reorganization, then additional funds will be needed from the Office of the Director or the Common Fund.
An efficient structural reorganization will require the development of a financial plan to streamline staff and existing operations. Hence, this financial planning must start soon. The new institute for substance use, abuse, and addiction will have to draw on programs with funding from other NIH institutes that have alcohol and drug addiction-related portfolios, such as the National Institute of Mental Health (NIMH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Child Health and Human Development (NICHD), National Cancer Institute (NCI), and National Heart, Lung, and Blood Institute (NHLBI). These other institutes from which programs are drawn would, naturally, need to contract in size to remain efficient. Indeed, this new institute for alcohol and drug use, abuse, and addiction could potentially become one of the largest groupings within NIH, with antecedent costs.
An important recipe for a proposed structural reorganization to succeed would be to extend the functional union based on the foundation of the established history of successful collaborative ventures between NIAAA and NIDA. For example, in FY 2008, NIAAA and NIDA co-funded 13 grants, including collaborative studies on the genetics of alcoholism and the National Epidemiologic Survey on Alcohol and Related Conditions, and have collaborated on NIDA’s Clinical Trials Network (SUAA Working Group, 2010
). Further collaborations to ensure appropriate scientific prioritization should, therefore, be encouraged and would not require any new money being invested by NIH or the federal government. Demonstrated success of this type of functional reorganization should be required before a more complete and costly structural reorganization is allowed to take place. Over time, those areas of overlap and synergy would be identified to eliminate redundancy and optimize collaboration.
According to the plan recently outlined by Dr. Collins, the newly created Substance Use, Abuse, and Addiction Task Force will provide its recommendations about which programs should be moved to the proposed new institute by the summer of 2011. Thereafter, a transition team will be formed to develop the structure of the new institute and a search will be conducted for a director, with the goal of launching the new entity by October 2012. If the move toward a structural reorganization is to be considered as a process that will be unveiled slowly and progressively, with gradual integration of two disparate cultures, an alternate approach would be to begin by intensifying and strengthening present functional collaborations through an NIAAA-NIDA Joint Task Force.
There is certainly no crisis—the sine qua non
for a structural change to an institute or institutes within NIH. Indeed, the SUAA Working Group report (SUAA Working Group, 2010
) states, “…the SUAA Working Group unanimously agreed that there are no existing organizational impediments significantly hindering NIH’s conduct of SUAA research.” Yet, the debate about the potential reorganization to fuse the objectives of NIAAA and NIDA seems to have created a mood of crisis that has led to polarized opinions. A gradual and progressive plan for integration could provide time for careful thought and planning, and defuse this sense of crisis.
A reasonable approach would begin with the NIH Director determining a specific percentage of resources from each institute to be committed for collaborative research agendas modeled on the same governance and operational structures that are currently used by the Neuroscience Blueprint and the Basic Behavioral Research Operations Network. This arrangement would provide an increasingly integrated functional reorganization. In this way, a clearer road map can be developed that provides for a process of due diligence and critical information gathering to understand the practical needs and challenges of developing an informed organizational approach. Predetermined milestones can then be used to evaluate progress and adjust course as needed to ensure a viable plan that fuses the optimal functions of NIAAA and NIDA as well as incorporating other relevant research.