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Alcohol and Health. Fifth Special Report to the US Congress

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Alcohol and Health. Fifth Special Report to the US Congress DOCUMENT RESUME ED 254 813 CG 018 100 TITLE Alcohol and Health. Fifth Special Report to the U.S. Congress from the Secretary of Health and Human Services. INSTITUTION National Inst. on Alcohol Abuse and Alcoholism (DHHS), Rockville, Md. REPORT NO DHHS-(ADM)-64-1291 PUB DATE Dec 83 NOTE 170p. AVAILABLE FROM Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402. PUB TYPE Information Analyses (070) EDRS PRICE MF01/PC07 Plus Postage. DESCRIPTORS *Alcoholism; Drinking; Etiology; Health; Heredity; *Physical Health; Pregnancy; *Prevention; Social Problems; Traffic Accidents ABSTRACT This report is divided into an overview of alcohol and health, and eight chapters which deal with various aspects of alcohol use and abuse. The epidemiology e. alcohol abuse and alcoholism is discussed. Data are presented on self-reported consumption of alcohol among youths and adults; alcohol consumption during pregnancy; alcohol-related hospitalizations and mortality; alcohol problems in veterans and native Americans; and alcohol-related traffic fatalities. Early and recent studies on the heritability of alcoholism are reviewed, the environmental-genetic influences on alcoholism are considered, and human and animal studies on the genetic factors in physiological responses to alcohol are explained. In a discussion of psychobiological effects of alcohol, cognitive and neurophysiological effects, neuropathologic illnesses, electrophysiology, and neural and biochemical effects are considered, and theories of the effects of alcohol are reviewed. The medical consequences of alcohol are discussed in terms of alcohol and the digestive system, the liver, muscle systems, blood disorders, kidney disease, pulmonary disease, the endocrine system, and alcohol and cancer. The effects of alcohol on pregnancy outcome are discussed. Adverse social consequences of alcohol use and abuse are described, including alcohol-related accidents, crime, domestic problems, and suicide. Treatment trends in research and practice are discussed and preventive efforts are reviewed. (NRB) *********************************************************************** * Reproductions supplied by EDRS are the best that can be made * * from the original document. * *********************************************************************** FIFTH SPECIAL REPORT TO THE U.S. CONGRESS ON ALCOHOL AND HEALTH FROM THE SECRETARY OF HEALTH AND HUMAN SERVICES DECEMBER 1983 U.S. DEPATI f MENT OF EDUCATION NATIONAL INSTITUTE OF EDUCATION [DUCA IONAt, III` flitt,FSINIORMATION n'r; ,r;41( /1( I h.'. OOPOf . 1.,iroo Oil lle.0(I as I orqdnirdfion or.11,,,it.mi It tt pie fn uniptove 0 O.OloOof 1100 O Poi,.of ',Wis..' 01,ttitoti MIS if0f.0 $(11.11l dq ,01 Itri 0., 1,1%> I.. NIE CO 0 DE Pat tMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol prim Abuse and Mental Health Admtntstrabon National Institute on Alcohol Abuse and Alcoholism 5600 Fishers Lane Rockville. Maryland 20851 This publicationmay be reproduced in any quantity desired.It is in the public domain and no permission is required.Citation of the source Is appreciated.(NIAAA) DHHS Publication No. (ADM) 84-1291 Printed 1984 For sale by the Superintendent of Documents, U.S.Government Printingonto Washington, D.C, 20402 Contents Page Foreword Preface vi vii Acknowledgments Contributors vii Reviewers viii Introduction x Alcohol and Health An Overview xiii Defining Alcoholism and Heavy Drinking xiii Alcoholism and Heredity xiii Alcohol and the Brain xv Other Health Hazards xvi Adverse Social Consequences xviii Treatment Trends xx Prevention xiii Future Directions xxiii Chapter I. Epidemiology of Alcohol Abuse andAlcoholism 1 Consumption of Alcoholic Beverages Measured byAlcohol Sales 1 Surveys of Self-Reported Consumption Among Adults 2 Surveys of Alcohol Consumption Among Youthand Young Adults 3 Surveys of Alcohol Consumption During Pregnancy 5 Alcohol-Related Mortality Attributed to Alcoholism,Alcoholic Psychosis, and Liver Cirrhosis 6 Alcohol-Related Causes of Hospitalization 7 Alcohol-Related Problems in Veterans 8 Alcohol-Related Problems Among Native Americans 8 Alcohol-Related Motor Vehicle Fatalities 9 Summary 11 References 13 Chapter II. Genetics and Alcoholism 15 Heritability of Alcoholism--Early Studies 15 Heritability of Alcoholism -- Recent Studies 16 Environmental-Genetic Influence on Alcoholism 17 Genetic Factors in Physiological Responses toAlcohol 19 Potential Mechanisms of Genetic Influence 21 Summary 22 References 22 Chapter III. Psychobiological Effects of Alcohol 25 Cognitive and Neurophysiological Effects 25 Neuropathologic Illnesses 28 Electrophysiology 30 Neural and Biochemical Effects 31 Theories of Alcohol's Effects Summary 37 References 39 39 Chapter IV. Medical Consequences of Alcohol 45 Alcohol and the DigestiveSystem Alcohol and the Liver 45 Alcohol and Muscle Systems 48 Alcohol and Blood Disorders 51 Alcohol and Kidney Disease 53 54 Alcohol and Pulmonary Disease 54 Alcohol and the Endocrine System Alcohol and Cancer 55 59 Summary References 59 60 Chapter V. The Effects of Alcoholon Pregnancy Outcome Historical Perspective 69 69 Fetal Alcohol Syndrome andAlcohol-Related Birth Effects Prevalence 70 70 Problems with Human Fetal AlcoholStudies Animal Models 71 71 Specific Adverse Pregnancy Outcomes 72 Alcohol Use, Abuse, and Dependence and Pregnancy 75 Implications of Current Knowledge--Frontiers Summary 77 References 78 79 Chapter VI. Adverse Social Consequences of Alcohol Use and Alcoholism 83 Alcohol and Accidents Alcohol and Crime 83 87 Alcohol and the Family Alcohol and Suicide 89 92 Economic Costs of Alcohol Abuse 93 Summary 95 References 96 Chapter VII. Treatment: Emerging Trends in Research and Practice 100 Recent Advances in Diagnosis and Nomenclature 100 Screening and Early Detection of Alcoholism 104 Alcoholism Treatment: Programsand Therapeutic Approaches Therapeutic Approaches 105 109 Factors Affecting Treatment Outcome 113 Emerging Trends and Future Directions 115 Summary References 116 117 Chapter VIII. Prevention: A Broad Perspective Current Perspectives 122 122 Education, Information, and Training Law and Regulation 123 Current Activities 130 Summary 133 136 References 137 Index 142 5 iv Foreword As thisreport so amply documents, the Interest to a few dedicated men and women price of alcohol abuse to the American people themselves often recovering alcoholics. Rppallingly high. And that price Is paid by Treatment now involves many thousands in the all of us. The cost to our economy has been helping professions as well. In industry, many, estimated at over $49 billion each year. But perhaps most, companies are coming to rec- the dollar cost is only the beginning. The cost ognize that losing a valued employee to alco- in human pain and misery, disease, and death holism Is costly--and that making provision for isstill more staggering. Accidents on our treatment just makes good business sense. streets andhighwaysclaimabout50,000 Many health insuranceplans are providing Americans' lives each year--leaving another benefits to treat alcoholismItself as they 150,000 permanently disabled. Half of those discover It costs much less in the long run than tragedies are alcohol related. Alcohol's role in treating its chronic health consequences. disrupting family life is less easily document- Perhaps the most encouraging sign Is the ed, but few doubt that it is significant. One in increasing awareness Americans are develop- three Americans surveyed last year felt that ing that we ourselves have a primary respon- alcohol caused problems in his or her family. sibility for preserving our well-being by prac- Fortunately,thislong-neglectedproblem ticing better health habits--including modera- has now become of increasing concern to many tion in alcohol consumption. Americans. As a result of citizen action, drunk This report deserves to be widely read--and driving, once largely ignored, is now being its implicationsthoughtfully considered. taken seriously. More and more States are Through our combined efforts, we can sharply enacting tougher laws to discourage driving reduce alcohol abuse and its devastating con- after drinking. Treating alcoholics once was of sequences. Margaret M. Heckler Secretary of Health and Human Services December 1983 6 v Preface Thishas been a centuryofimpressive Implicated in a wide range of other illnesses as achievement In public health. The &hien'. of well. vaccines against such diseases as stud! 'pox, As this and previous Alcohol and Health diphtheria, and polio and their widespread ap- reports indicate, the increased Federal role. in plication have virtually eliminated those once this area has markedly altered an earlier pes- dreaded Illnesses. Tuberculosis, the cause of simistic outlook with respect to treating those one In eight deaths In 1900, is now uncommon dependent on alcohol. We no longer believe and still more rarely 'fatal. Antibiotics have that the alcoholic must reach the late stages made most infectious diseases easily curable. of the Illness before he or she can benefit But the devastation of one disease has not yet from help. On the contrary, as in other ill- been significantly eroded. It plays a role in 10 nesses, there is good evidence that the earlier percent of all deaths in the United States. In treatment begins, the greater is the likelihood some segments of the population, it produces of successful recovery. still higher mortality. It is the principal cause Alcoholresearchhasprovideduswith of deaths through accidents among those aged greater
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