Patricia Molina, MD, PhD: Good morning. My name is Patricia Molina. As a vice chair of the NHSN, I would like to welcome you to the 2008 NHSN conference entitled Community, Behavioral, and Molecular Sciences in Addictive Disorders.

I'm pleased to announce that this year we have the highest number of registrants, a total of 182.

We have members and participants representing not only various institutions across the US and Puerto Rico, but we also have several countries being represented, including Argentina, Brazil, Canada, Chile, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Peru, and Spain. A todos ustedes los que estÃ?n aquÃ? presenten les extendemos la mÃ?s cordial bienvenida.

Esperamos que esto sea una oportunidad para establecer nuevas relaciones, desarrollar nuevas amistades y de aprender aspectos que nos ayuden en sus trabajos en sus respectivos paÃ?ses.

In addition, this year we have several organizations that have partnered with NHSN and its mission and that have been instrumental in the success of this conference. These are the NIH, particularly NIDA, CSAT and SAMHSA, RECIA, which is a newly formed network of investigators in Latin America, and REDLA. Several of the leaders that have facilitated the participation of these entities honor us with their presence, either this morning, or will honor us with their presence throughout the duration of the conference.

I would like to take a few minutes to mention their names. Some of them are here right now. Some of them you will see wandering in and out throughout the next two days. Mr. Tom Brown, Deputy Director of the US Department of State, Dr. Westley Clark, Director of Center for Substance Abuse Treatment (SAMHSA), Dr. Kyu Rhee, Director of the Office of Innovation and Program Coordination from the National Center on Minority Health and Health Disparities, Dr. Elena Rios, President and CEO of the National Hispanic Medical Association, Dr. Lula Beatty, Director for Special Populations Office (NIDA). Dr. William Turner, a Robert Wood Johnson Health Policy Fellow from the Office of Senator Barack Obama, and Senior Enrique Gabriel Bravo Mena president of "Red Iberoamericana" de ONGs [organizaciones no gubernamentales] que Trabajan en Drogodependencias.

Three years ago, I was at the center of a natural disaster that cost our city, institution, and laboratories millions of dollars, years of work, and most importantly, livelihood of many residents of the Gulf Coast. This year, our colleagues in Texas were affected by Hurricane Ike. As before, we extend our best wishes for a rapid recovery, and open our laboratories and homes to those that may still be in need.

The success of a conference of this magnitude is not possible without the tremendous behind the scenes work that takes place during the previous 350 days of the conference. Many members of the NHSN have been working incredibly hard to bring together this conference and provide a stimulating environment.

I would like to take a few minutes to recognize two individuals that have worked day and night to make sure that things go smoothly. These are Sheila Kaupert and Jane Brooks, from the national office. I know that they're not in the room right now, but when you get a chance, please take three seconds of your time to thank them for all their hard work. Together they have done a tremendous job, and I would like for us to recognize their contributions as you meet them out in the registration booth.

However, the science and the strategic planning to organize the conference has been led by three members of our network. These are our conference chairs, Dr. Bill Vega, and Dr. Antonio Cepeda, and their co chair, Dr. Willy [Guillermo] Prado, who have worked hard to put together this conference program.

I would like to introduce to you Bill Vega so that he can open the conference for you.

William "Bill" Vega, PhD: Good morning. Bienvenidos. Thank you for coming to the National Hispanic Science Network Conference 2008. We're very pleased to present a challenging and information rich conference that covers diverse topics of interest to our investigators.

It has been a great deal of effort from many people to assemble this conference with a great deal of dedication required. And I believe that the end product reflects the maturity of our organization at this point in its development, and the quality of our support staff and other professionals who worked on the conference planning committee who gave generously of their limited time to this endeavor.

It takes a lot of work, a lot of time away from other very important topics and all of our lives to really work on this. And I must say, we've had a very dedicated crew, many of whom have worked year after year on the conference planning committee.

I especially want to thank Jane Brooks again for her exceptional support in managing the planning process and all its details, entanglements, and surprises. She was very cool under fire, and we had many fires in the development of this conference.

I also want to thank Jose Szapocznik for his able and energetic assistance in handling all the myriad last minute details that always come up in a conference of this scope and when immediate action was required and I was not available.

Most of all, I want to welcome you and really hope that your time at this conference will be of maximum benefit because we know your time is precious as well.

Now I would like to introduce Antonio Cepeda who coordinates the international program of the National Hispanic Science Network.

Antonio Cepeda-Benito, PhD: Buenos dÃ?as.

Es un gr�n placer para mi estar aqui otra ves, en Washington DC, donde se celebr� la primera reunion de NHSN, hace unos� unos siete anos, si. I'm so happy to be here again. This is an organization that has been great to me, and I have grown with it.

Patricia already named all the countries that are represented in our meeting, and we could do the same with the states of our country and the list will go and on. So we are a very diverse group of individuals in many ways.

And so we are all many disciplines represented here, and I think that's one of the strengths that we have. So I'm very happy to be here again.

One of the things that I wanted to sort of remind you of is that Steve Gust, who is the Director of the International part of NIDA office [NIDA International Program Director], that's what they call it, the international office, he has been very generous to us for the past four years in providing support for international researchers to come to this conference, and I wanted to recognize him for that.

And also the NHSN, the steering committee, because they also support many international researchers coming to this conference in the form of they are speakers and they get kind of funding that is essential for them to have to be able to attend.

So thank you to all of you, and I hope you have a great conference.

I just have one little announcement to make. Tomorrow during the international, we have three international speakers talking. There will be a free lunch. And if you want to stay for the lunch, then I encourage you to sign up from where you signed up today for the conference. Thanks.

Patricia Molina: The work of the NHSN is conducted under the auspices of NIDA with the collaboration of an increasing number of entities as we continue to grow. Endeavors such as the NHSN need the support and encouragement not only of its members, but also importantly from those leaders at NIH involved in development of initiatives to improve the health of Hispanics at large.

It is my pleasure to introduce to you Dr. Lula Beatty, Director of the Special Populations Office, Office of the Director at the National Institute on Drug Abuse. Dr. Beatty's responsibilities include developing racial ethnic minority research and health disparities programs as well as initiatives to encourage the increased participation of underrepresented scholars in drug abuse and addiction research and monitoring NIDA support of racial-ethnic minority and health disparities research.

Programs in her office include the diversity supplement program, the research development seminar series, a historically black college and universities initiative, an African American initiative on HIV and criminal justice, and a Southern Africa Initiative.

Before joining NIDA, she was Director of Research at the Institute for Urban Affairs and Research at Howard University. We have asked her to address our conference participants and reaffirm her support for our network. Please help me welcome Dr. Lula Beatty.

Lula Beatty, PhD: Thank you, thank you. It's a pleasure to be here. And I guess I'll do the first thing first, which is she asked me to reaffirm our support. It is reaffirmed.

Patricia Molina: Thank you. And I have a lot of witnesses looking.

Lula Beatty: So now I'm just going to make some thank yous. I'd like to start as you do with some thank yous.

I want to thank the NHSN for the work that they've been doing over the years and for putting together this meeting and providing opportunities for people to come together to talk about research and how to improve research for their communities, and also how to become more involved in conducting some of that research.

I want to thank my Deputy Director, Tim Condon, our Director, Nora Volkow, for the support that they've provided to the office over the years and for their commitment to continuing to provide support to us.

And I also want to thank all of you. I've talked to some of you. I've known some of you through some of our programs, and so I'm really glad to see your continued involvement in doing research and your continued efforts to get research funded through NIDA and NIH, since that's one of our major issues.

And I want to thank the NIDA staff. I see a lot of NIDA staff here. And out office works primarily, we have a small office, some dynamic people in the office, but we count and depend a great deal on our colleagues and the divisions where our scientific programs sit. So I want to thank all of them for their continued support to this initiative and to our office over the years.

And then I want to give a special thanks to the Special Population staff and the Program Officer who works very closely in starting and working with you, and that's Ana Anders, who's sitting in the front row. So, Ana, if you could stand again.

Okay. And so I'm just going to give you just a few more comments. The Special Populations office has been around for about 16 or 17 years now, and it was started basically to try to address two goals.

And the first is that NIDA was concerned about the qualitative research and the amount of research that we had that was really looking at the issues of racial ethnic minority populations which has been brought now to health disparities populations which includes underserved and some rural populations. But that was the beginning of the office.

We wanted research that really looked in the communities at what the issues were within particular communities and making sure that our measures, the approaches, the ethics, everything was as it should be in order to get data that could be good data, appropriate data that could be used to inform prevention and treatment programs and services.

The other was that we were concerned about the number of researchers we had from those communities who are doing research, and we wanted to develop programs to increase that number. And that has been difficult, but we've had some success.

I attended a meeting on enhancing diversity in science in February, and Dr. Kington, who is our Deputy Director, for NIH wide Deputy Director, and he gave some fairly sobering statistics on the number of researchers for the groups.

And for Hispanic population, NIH wide, the best numbers they have is something like maybe 3.4, 3.5% funded investigators. For African American investigators, it's somewhere around maybe 2%, a little under 2%.

Now the good news is that might be a little bit better than it was a few years ago. But the sobering news is that there is still work to be done to bring new researchers in, but also to work to try to retain the investigators that we have so that people aren't just coming in and cycling out. So that's the challenge that all of us are facing and that we're needing all of you to kind of work with us about.

I wanted to describe a couple of programs that have already been mentioned, and I'm describing them because I think most of you know if you're working with the NHSN, they know these programs. But I want to say because they are still programs that we have that we are still supporting.

One is the Diversity Supplement program. It used to be called the Minority Supplement program.

You'll hear diversity a lot because we can't really say minority too much anymore for some of our programs. But it's the Diversity Supplement program that supports people from high school up to investigator level. So it gives you a chance to work with a funded investigator. And for those of you who might be in graduate school or undergraduate school, it also provides a stipend and some tuition remission. So please call our office if you're interested in that.

Over the last year since we've been keeping records in that program, we've supported about 500 people under that program; about 30 to 40% of those have been labeled Hispanic students.

We have a summer research with NIDA program which supports undergraduates and high school students because we're trying to reach a younger people to at least get them interested in science. Flair Lindsey in our office runs that program. It's actually an offshoot of the Diversity Supplement program. We've supported about 700 to 800 or so students over the last maybe ten years in that program, and about the same percentage, 25, maybe 30 to 40%, have been from the Hispanic population.

What's interesting and the good news also about these programs is we actually have more investigators who are wanting people than we have money to support. So what that shows is, one, we do need money, but also that there are people who are willing to serve as mentors and are open to those opportunities.

We have a MIDARP program [see footer]. I think some of you have been funded under MIDARP program which is the Minority Institutions Drug Abuse Research Program. That is now being reissued. It is being reviewed now at NIH. It will not be called the MIDARP. It's going to be called -- we had a really hard time coming up with a substitute name to try to put diversity in place of minority, so Diversity Institutions. And we've gotten a great deal of work specific to populations from that program.

The other thing is a seminar series. We have a seminar series where we bring people in to talk about their concept paper, and we will work with them on their research ideas, bring in extramural scientists as well as NIDA staff to look at it, give you feedback on it, and to bring you back a second time to undergo a mock review.

And then the expert work groups. We have some racial ethnic minority work groups, African American, Asia and Pacific Islander, American Indian, and Alaska Native. And the NHSN is part of that that whole network of people looking specifically at the concerns of their populations.

There are a number of common kinds of concerns, under representation of scientists, some concerns about the cultural appropriateness perhaps of some of the design. But there are still some unique aspects to each of those groups, and that's why we keep them separately, but we always try to bring them together to talk about these joint concerns.

So in the last two days I've been meeting with the joint work groups, including NHSN representatives and the other groups. So they've had some mutual talks, and hopefully there will be ways that you can think about collaborating and networking across those groups, and those other groups do mentoring. They have different ways of going about it, perhaps. But everybody is looking to mentoring and trying to bring people into the field.

Just a couple of other things is that I just want to kind of end on, we've had some success. I've talked about some of the successes, the number of people we have supported. And we count the NHSN as a great success in demonstrating that if you really focus on a population and give some sustained support to it over time, that we can start seeing new publications. We can start seeing new researchers. So we count that as a great success.

And some of the other programs we talked about, we've tried to bring people in and that even if you're a member of the NHSN to become active in participating and making use of some of the other programs. And I think that you've done that very well.

There are a couple of things that's coming out of our office. We have a resource guide that we're working on that's really going to talk about racial-ethnic work that we've conducted over the last eight - ten years.

And this will be a place where we're going to put some of the resources, describe some of the programs, but actually give kind of a bibliography with some selected annotations on what we have, what has been discovered or published from some of the NIDA research that really focused on racial ethnic minority populations. And so that's in draft form. And we asked each of the work groups yesterday to look over that to give us comments on that.

In addition to that, we're hoping to put up a health disparities web site with some of that information, and then some other issues around health disparities that should be showing up. So we're hoping to complete that within the next year.

We still got a lot to do, and the need is still great. And I think you mentioned earlier we're in a time where we're experiencing so many natural and human made disasters. And we can only speculate what that will do in terms of drug use and addiction and where people will be with that.

We do know in our work that while use, sometimes drug use is about the same or maybe even lower in some racial ethnic populations, that no matter the population, the consequences of use is much greater, much more severe within racial-ethnic minority populations.

So when we hit, even if we have low use, in terms of some of our outcomes are really severe, and we really have to pay attention to that. Some of those things that we all know about are HIV, the criminal justice issues, and in some populations, suicide, not even talking about some of the other medical conditions.

So we have to continue our work. You have to continue. Progress is there and it looks small, but we have to take these little small steps. And I think that we can take these small steps together.

We're looking for you on suggestions on how we can do what we do better. What we can do that we might need to stop doing or new things that we need to continue to do. So I know that through Ana you will let us know that, but please feel free to call me or any of the other staff with any suggestions or recommendations on how it is that we can start working together better, but how it is that we can continue to address this important need and to anticipate the needs within our communities.

And I think that that's all I wanted to say. This may be more for me than for you, but to say stay motivated, stay focused. It's hard budget times, but we have great commitment from people and we want to ensure that that continues.

So enjoy the meeting, and again, our doors and our phones and our e mails are always open to you.

So now I have another really pleasant task, and that is that I've been told that I can introduce the next speaker. So it is my pleasure to introduce Wes Clark. When I started at NIDA, Wes was on council, and I just remember how in comparison to council now, those council meetings were just so dynamic, in part, due to him and the questions and the issues he's raised.

If any of you know him or you see his bio, he's well credentialed, very accomplished, MD, JD, MPH, and some other degrees that I don't even know what they stand for. So we know that he has great accomplishments. We know that he's really smart.

But the thing that I really admire most about him is that his commitment and his energy, his ability to get people together and involved and invested in these interests that we have that are in common.

So please welcome Dr. H. Westley Clark who's Director of the Center for Substance Abuse Treatment under the Substance Abuse and Mental Health Services Administration.

H. Westley Clark, MD, JD, MPH: Thank you, Lula. Thank you for the kind words.

And it's indeed a pleasure to be here again. I was most recently at the Latino Behavioral Health Institute in LA in September addressing some of the more pragmatic and practical issues, and I know some of you were there, but your focus is on research. And it's important that the research enterprise helps serve as a backdrop to the clinicians and those interested in the clinical aspects of substance abuse treatment.

We are in a time of change as Lula suggested. Institute directors are changing. The administration is changing. The seasons are changing. The budget is changing. The money is changing. The Census Bureau says the population is changing. By 2031, one in every five US citizens will be 65 and older. By 2042, the minority populations together, collectively, are expected to be the majority in the United States. By 2050, if immigration patterns continue to hold, the Hispanic population is expected to be 30% of the US population, or over 130 million individuals.

So this is going to be change in that by 2050, 62% of the children will be minorities, up from 44% in 2008. So you will have great opportunities, and there will be great need for the work that you do.

Whether it's basic science, whether it's social science, whether it's epidemiology, the needs will be fairly transparent. Politically there are also other changes going on.

For us at SAMHSA, it means that we will be rethinking our programs and initiatives to meet the needs of the changing populations and priorities, but in order to have evidence based practices, we need to work with you. Dr. Volkow, Lula, Wilson Compton, Ana, others will help facilitate that.

But at the end of the day, it's up to you, and that's why as Lula pointed out, it's critical that we stop or block or slow the revolving door where researchers come in, they work a couple of years, and then they wander off into the hinterlands. That's problematic.

You can't have evidence based practices without evidence. So we can't change practices without that evidence.

So it's appropriate that we consider all of these changes during National Hispanic Heritage Month, which is where we are.

Our mission at the Center for Substance Abuse Treatment is to improve the health of the nation by bringing effective alcohol and drug treatment to every community. Again, that's why we need your help. To do that, we need to be aware of the unique needs of each community and support programs that meet those needs in a culturally competent and responsive way.

According to the 2007 National Survey on Drug Use and Health, 42% of the respondents who consider themselves Hispanic or Latino drank alcohol within the past month. That ranked the Hispanics or Latinos third among ethnic groups included in that survey following whites and American Indians and Alaska Natives.

Of that 42%, roughly 18% were binge drinkers, that's five or more drinks on a single occasion. Another 5.5% were heavy drinkers.

The Hispanic and Latino population compared more favorably to other racial groups regarding illicit drug use. According to our survey, 6.6% of the respondents who considered themselves Hispanic or Latinos admitted to using illicit drugs in the past month, and this placed Hispanics and Latinos at the second lowest ethnic group with only Asians reporting a lower percent.

Well compared to 2007 data with 2006, we saw some changes among Hispanics with regard to illicit drugs use. However, when we compared past years' substance dependence of abuse, there were these definite decreases, not a lot.

Illicit drug use decreased from 3.4% in '06, to 2.5% in '07. Alcohol decreased from 8.5% in '06 to 7% in '07. And both alcohol and drug use combined decreased from 10% to 8.3%. And these aren't huge changes, but they are changes. People are making progress, and we need to redouble our efforts with regard to prevention and treatment.

14% of the admissions to treatment facilities in '06 were Hispanic or Latinos according to our treatment episode data set. That 14% equaled 250,000 admissions. These are not unique patients. These are admissions, so there are some people who repeat.

In 2007, we look at the number of people who met criteria for needing treatment. There were 2.9 million Latino or Hispanics who needed treatment for illicit drug or alcohol use, but only 177,000 actually received treatment in a specialty facility out of that 2.9 million.

Consequently, around 2.7 million didn't receive treatment. That means 94% of Hispanic Latinos who needed treatment didn't get that.

People have many reasons for not seeking treatment. Some can't afford it. Some don't have health coverage, and others don't have a way to get to treatment. Still others worry about the stigma associated with seeking treatment for substance abuse disorders.

However, 40% of respondents said that they didn't seek treatment because they could either handle their problem on their own or they didn't want to stop using.

Think about it. We need to figure out how to get people into treatment, and this is where cultural competence, cultural awareness of diversity becomes critical.

94% of Hispanics and Latinos are not getting the treatment they need, and almost half of that just didn't want to make an effort. And this is not peculiar to Hispanic Latinos. We are really putting the light on those people who perceive no need for treatment because that's the overwhelming majority of individuals. If we can't address that, then we can't reduce the social consequences with alcohol and drug use.

We need to reach those 2.7 million people. We are trying at CSAT, through 209 programs that provide services which include Hispanic Latino populations. We have programs that range from treatment drugs courts where 45% of the population served is Hispanic.

We have our screening brief intervention referral to treatment program that serves the population that includes 29% Hispanic Latinos. Our HIV portfolio includes 27% Hispanic Latinos, and we have other programs such treatment services for homeless, access to recovery that also serve Hispanic Latino population.

In addition, our Addiction Technology Transfer Center: we have Fafi in the audience, and she is the director of one of our programs that's CSAT-funded, grants developing the Hispanic initiative to meet the needs of Hispanic serving providers and clients who require better resources created specifically for this population.

But you can't change practices without evidence base. We can't change practices without the awareness, the sensitivity, things that work. That's your job is to help us compile the things that work so that we can translate that into practice. We need to change the behavior of practitioners, but we need to have something to inform those practitioners.

So we are in a time of change. And the National Hispanic Heritage Month reminds that us that effectively addressing the needs of the Hispanic Latino population is going to be essential. It's going to be our continued commitment just as Lula is vouching for NIDA's continued commitment.

As long as I'm at SAMHSA, the Director of CSAT, I have a continued commitment. And we are actively promoting the need of the Latino Hispanic communities. I'll continue to do that.

Money may get tight, so I'll just have to figure out how to squeeze money from a stone. But if I can do it, Yvette Torres will help me figure out how to achieve it. So we want you to continue to collaborate with us. Our administrator left, as Dr. Zerhouni for NIH left.

We've got an acting administrator, so we'll be waiting to see which of the two candidates wins. Our only hope is that whoever wins continues to focus on alcohol and drug treatment and continues to support research.

So we need to work collaboratively to do that. And then we'll get the bureaucracy to respond, but the bureaucracy can't work without you. So thank you, thank you for being here.

Patricia Molina: Thank you very much. So we've heard it now. The vivid support that we have both from NIDA and CSAT, SAMHSA to continue our work.