After two years of study and what was considered to be a fait-accompli, the merger of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was suddenly called off last month. In a November 16 announcement, National Institutes of Health (NIH) director Francis S. Collins, M.D., Ph.D., said that the two institutes would be on a course of “functional integration” instead of “structural integration.” There will be no new single institute, as the Scientific Management Review Board (SMRB) had recommended (see ADAW, Dec. 6, 2010).

But functional integration means that NIDA and NIAAA will have to collaborate, according to NIH.

The Research Society on Alcoholism (RSoA) applauded the decision — the alcoholism research community had felt overshadowed by the NIDA drug budget. For their part, drug researchers had supported the merger, partly because it’s impossible to separate alcohol and drugs, they said.

And in fact, the widespread feeling was that pushback from the alcohol research community is what prevented the merger from going forward.

“My reaction to the cancellation of the merger was one of sadness, because for one more time, politics has trumped science,” said Charles P. O’Brien, M.D., Ph.D., Kenneth Appel Professor in the Department of Psychiatry at the University of Pennsylvania. “I was there, and I heard everyone who was so strongly and emotionally against the merger,” he told ADAW. “Scientifically, the merger made sense,” he said.

O’Brien cited his own work with naltrexone, originally a medication to treat opioid addiction and then to treat alcoholism. “That went unnoticed for years because the alcohol field didn’t want to respect the fact that a heroin drug was effective in alcoholism,” he said.

“I don’t see any scientific group that was against the merger on the basis of science,” said O’Brien. “You can’t do drug research without also studying alcohol — they are both addictions.”

Andrew Kessler, principal with treatment and prevention lobbying firm Slingshot Solutions, agrees. “The reason I thought this merger would work is because it’s one disease,” he told ADAW. “The disease of addiction would have benefited by everyone working on it,” he said. “It’s not alcohol vs. drug. We’re all fighting the same disease in different forms.”

Recovery researcher Alexandre Laudet, Ph.D., senior staff with National Development and Research Institutes in New York City (NDRI), said it makes sense to examine alcohol as part of addiction.” When you ask people what their first substance was, a lot of the time people will say it’s alcohol,” she told ADAW. But she agreed that the cultures can be different, making the analogy of the vast cultural differences between Alcoholics Anonymous and Narcotics Anonymous.

For instance, Laudet noted that NIAAA historically has been more recovery oriented (e.g., funding research on 12-step) than NIDA. She went on to observe that that researchers and NIH reviewers themselves had adopted a “silo mentality” and felt that a NIDA-funded researcher would not be viewed as competitive for NIAAA funding, noting that when she first joined NDRI in 1994, NIDA was the “go to” institute for research funding.

No more ‘business as usual’

Still, it was not politics or economics, but science that was the driving force behind Collins’ decision, said Lawrence A. Tabak, D.D.S., Ph.D., principal deputy director of NIH and the government’s official spokesman on the merger cancellation (neither NIDA nor NIAAA would allow employees to be interviewed on this topic). In addition, although Collins, in his November 16 statement, cited “budget uncertainties” as a reason for the decision not to merge, Tabak soft-pedaled this as a reason.

Throughout the proceedings of the past two years, NIH officials had repeatedly said that the decision to merge would be dictated by scientific and public health concerns, not financial ones, and Tabak said this is still correct. “I think Dr. Collins decided that we can accomplish what we need to scientifically using the functional approach,” Tabak told ADAW.

And just because there is no merger doesn’t mean that things will go back to the way they were, Tabak said. “More than two years ago, the SMRB overwhelmingly said ‘You don’t want to continue business as usual,’” he said. “After two years of intense study and observation, we know we can achieve the same scientific goals with a functional merger.”

The portfolios themselves may not undergo dramatic changes. Tabak added that there was a discussion of a subset of existing grants going from the NCI to the new institute – “to be precise, to the institute that had not yet been formed, not to NIDA,” he said.

On the table for functional integration is a collaboration among all relevant researchers, said Tabak. “They will continue to write their grants to NIH, and NIH through its receipt and referral system will assign them to the appropriate institute.”

The alcohol research industry considers the merger cancellation a victory for its efforts, according to RSoA. “I wouldn’t characterize this as either a victory or a loss,” said Tabak. But he does think that more collaboration will benefit everyone. “As the community gains a better understanding of the new potential opportunities by having all the relative institutes work together, they will see that this is a win for the field,” he said. The NIH Common Fund will require that research be done in a more collaborative way, he said.

Positive results?

And the process, fraught as it was with emotion and paranoia, had positive results, said Tabak. “We are now confident, based on what we’ve learned about the respective portfolios and how the groups have been working together, about collaboration.”

Tabak told ADAW he did not know the cost of the NIDA-NIAAA merger process. But it was not a fruitless effort, he said. “It was fruitful. We learned about the science, where the commonalities are, and we learned an enormous amount about the gaps.” The procedure was “a very good use of time and energy,” he said.

Kessler agreed with Tabak. “You’ll never get me to say that this money was wasted in terms of examining the efficiency of the institutes,” he told ADAW.

People who disagree with Tabak do not speak on the record, out of fear of losing their jobs. But many people in the field disagree with his assessment. “I don’t think any good came out of this — it only heightened antagonisms that were already existing between the two institutes,” said one NIH insider.

Asked whether NIH is doing anything to smooth over the anguish of the past few years, starting with the private plea by Enoch Gordis, M.D., former longtime NIAAA director in December of 2009, to the NIH: “This is clearly not a time to bury the NIAAA… I ask this committee and the NIH: please don’t take the sign off the door” (see ADAW, Sept. 27, 2010), Tabak said it’s not necessary, dismissing the passions now “past tense.” Within NIH, the new opportunities for collaboration are already being realized, he said citing the dual NIDA/NIAAA role of Markus Heilig, M.D., Ph.D., who is now clinical director for both institutes.

As for a permanent director of NIAAA (there has only been an acting director), Tabak said NIH will initiate a search process.

‘Conspiracy’ theories?

The backstory of the merger process — aside from the passion of the alcohol field — is rife with “conspiracy” theories, some of which may well contain half- or full-truths. Alcohol researchers went to the alcohol beverage industry and induced its lobbyists to go to Congress to put pressure on NIH to cancel the merger (because the industry did not want to be lumped in with zero-tolerance illegal drugs). Lung cancer researchers supported by the NCI didn’t want to see their grants move to the new institute. NIH was threatened that it would lose NCATs if it supported the new institute. Personalities — the high-profile NIDA director Nora Volkow, M.D., popularly thought to be in line for the top position of the new institute, vs. the quiet and scholarly acting director of NIAAA Kenneth R. Warren, Ph.D. — were also thought to play a part.

Whatever went on behind the scenes, the announcement, which came out the Friday before Thanksgiving, was a “total shock,” said Kessler, who has followed the merger process closely. “When this announcement came out, many of us were expecting instead an announcement about the research portfolio for the new institute, and very excited about it,” he told ADAW. “So for Dr. Collins to call off the merger and go forward with a functional merger rather than an institutional merger is very very surprising. The fact that the SMRB was so overwhelmingly in favor of it, and the fact that Dr. Collins and Dr. Tabak dedicated so much time, money, and resources, makes the decision in the end all the more puzzling.”