With the inauguration of President Barack Obama, the rhetoric of change echoes through the corridors of power in the nation’s capital.  Nowhere is it more urgent or important to convert that rhetoric into reality than in the area of substance abuse and addiction.  And nowhere would the return on investment of public funds be higher.

Just as the financial regulatory structure of the past is no longer able to protect the public interest in sound financial institutions and practices, so the government structure and policies relating to tobacco, alcohol and illegal and prescription drug abuse and addiction have proved incapable of protecting our children and their families from the ravages of substance abuse and addiction.

Take research.  The National Institutes of Health spend almost $15 billion on research for cancer, strokes, cardiovascular and respiratory diseases and AIDS.  But they spend less than $2 billion on substance abuse and addiction, the largest single cause and exacerbator of those cripplers and killers.

The organization of the federal research institutes — separate ones for Drug Abuse (NIDA, for illegal drugs and nicotine) and for Alcohol Abuse and Addiction (NIAAA for beer, wine and distilled spirits) — ignores the science of the disease of addiction.  For years CASA and others have demonstrated the tight statistical relationship of these substances — the greater likelihood that cigarette smokers and drinkers will use marijuana, and that marijuana users will get into drugs like methamphetamines, cocaine and heroin.  Now we have scientific evidence that these substances affect dopamine levels in the brain through similar pathways.  The recent findings of neurological science, and NIDA Director Nora Volkow’s work with brain imaging, reveal the similar impact of these substances on the brain.  All science and logic cries out to combine the current separate institutes into a single National Institute on Substance Abuse and Addiction.

To effect this change, the Obama administration will have to take on lobbyists for the alcohol industry (which doesn’t like being associated with other drugs) and for illegal drug researchers (who fear such a merger will reduce resources available to them since the alcohol industry has been able to hold down the NIAAA budget to half that of NIDA).

Take prevention of illegal drug use.  When Richard Nixon first declared war on drugs, he allocated 60 percent of the funds for prevention and treatment, 40 percent for interdiction and related criminal activity.  Today that original allocation has been flipped on its head.  It’s time to return to the original Nixon allocation.  Demand is the driving force in U.S. drug use: though only 4 percent of the world’s population, Americans consume two-thirds of the world’s illegal drugs.

Take prevention of smoking and alcohol abuse and addiction. Precise figures are hard to come by, but a low estimate finds that almost a third of the nation’s health care bill is attributable to use and abuse of those legal drugs, as are more than half a million premature deaths (400,000 plus from smoking and 100,000 from alcohol abuse).

Here there is a quick fix to reduce use of these substances: higher taxes to increase the price.  Research and experience has repeatedly shown that higher excise taxes on cigarettes and alcoholic beverages reduces use and abuse, especially by the teens that the nicotine pushers regard as replacements for adults who die or quit and underage drinkers targeted by alcohol merchants.  New York City and state taxes, which brought the cost of a pack of cigarettes in New York City to more than eight dollars, have prompted a sharp drop in smoking, particularly among public high school students.  When Alaska increased taxes on alcoholic beverages in 1983 and 2002, researchers found an immediate and sustained reduction in deaths from alcohol-related diseases.  As they put it in the American Journal of Public Health, “Taxing alcoholic beverages is an effective public health strategy for reducing the burden of alcohol-related disease.”

Pick up your pen, open your e-mail and write your congressman and the new president to tell them: Those of us combating substance abuse and addiction are entitled to our share of the change you promised to bring to Washington.  Act now to battle the nation’s number-one disease: create and adequately fund a National Institute on Substance Abuse and Addiction, rebalance the allocation of resources between demand reduction and interdiction aimed at illegal drug use, and reduce smoking and alcohol abuse and underage drinking by increasing the cost of cigarettes and alcohol through higher excise taxes on these legal drugs.

*Joseph A. Califano, Jr., is Chairman and President of The National Center on Addiction and Substance Abuse (CASA) at Columbia University and a former U.S. Secretary of Health, Education, and Welfare.  To comment on this article visit http://chairmanscorner.casacolumbia.org/