Report on Alcohol & Health

Ninth Special Report on Alcohol and Health Marks Research Gains

Secretary of Health and Human Services Donna E. Shalala announces
the availability of the Ninth Special Report to the U.S. Congress on
Alcohol and Health, the latest in a series of triennial reports begun
in 1970. The report highlights recent research on the effects of
alcohol use, abuse, and dependence on individuals and society, new
knowledge about the mechanisms of those effects, and progress since
1992 in developing interventions to prevent and treat alcohol
damage.

“About 14 million Americans, almost 10 percent of adults, meet
diagnostic criteria for alcohol abuse and alcoholism,” writes Secretary
Shalala in the foreword. While the proportion of adults with these
medical disorders has been similar each time that problem prevalence
surveys have been conducted, other epidemiologic measures show change:
Abstention has increased and heavy drinking has decreased among U.S.
adults. Per capita alcohol consumption, which peaked during the 1980s,
in 1993 reached the lowest level since 1964. Increased health concerns,
less tolerant attitudes toward drinking, and increased social and legal
sanctions against drinking and driving are possible reasons for these
changes, the report suggests.

Drinking patterns and problem prevalence vary substantially by
gender, age, ethnicity, and among discrete subgroups of these broad
classifications. As in past reports, the rate of alcohol abuse and
alcoholism among men is almost three times that for women. Separate
analyses show that, although per capita consumption since 1980 has
declined less markedly among women, men continue to drink more and
report more alcohol-related problems than women. Heavy drinking,
alcohol abuse, and alcoholism are most prevalent among 18- through
29-year-olds of both genders and least prevalent among persons aged 60
and older. Although heavy drinking and monthly and daily alcohol use
among high school seniors have declined since the 1980s, the decline is
less among college-bound seniors, and binge drinking is a widespread
problem on college campuses.

Alcohol-related morbidity and mortality remain significant problems.
As many as 44 percent of more than 40,000 traffic crash fatalities each
year involve alcohol and, although such crashes are decreasing, young
drivers continue to be over-represented in drinking driving deaths.
Liver cirrhosis, on the decline since 1973, remains the 11th leading
cause of death, and heavy drinking contributes to other leading
killers: heart disease, stroke, and certain cancers.

The population distribution of alcohol disorders and other alcohol
damage provides clues for understanding how that damage can be mediated
by individual attributes and environmental influences. The Ninth
Special Report describes these interactions in eleven chapters on
genetic, psychological, and sociocultural influences on alcohol use and
abuse; actions of alcohol on the brain; neurobehavioral effects of
alcohol consumption; effects on health and body systems; effects on
fetal and postnatal development; effects on behavior and safety, the
economic aspects of alcohol use and related problems, prevention;
treatment; and health services research. Produced by the National
Institutes of Healthks National Institute on Alcohol Abuse and
Alcoholism with guidance from a distinguished editorial advisory board
and contributions from some of the worldks foremost alcohol
researchers, the 450-page referenced volume is a resource for
researchers, treatment and prevention practitioners, and policy
makers.

Across the alcohol research spectrum, the report documents new gains
from the 25-year Federal investment in alcohol research. Since the
previous report, geneticists using animal models have identified
several quantitative traits including alcohol preference, alcohol
sensitivity, and severity of withdrawal that are believed to underlie a
drinkerks response to alcohol. Systematic efforts are underway in large
human populations with high alcoholism prevalence to detect and map the
specific genes involved in alcoholism susceptibility, determine how
gender and other factors modify that susceptibility, and identify the
biological and psychological factors that influence the relationship
between primary gene products and drinking behavior.

“The alcohol field is uniquely poised to take full advantage of the
tools and techniques of todayks science to fully explore biobehavioral
linkages,” says National Institutes of Health Director Harold Varmus,
M.D., in the report preface.” This exploration will add significantly
to our overall understanding of other diseases where biology and
behavior are so closely intertwined.”

The relationship of the brain to behavior is the focus of
neuroscience research, where scientists are characterizing the many
cellular and molecular mechanisms by which alcohol produces immediate
and long-term changes in CNS activity. Unlike other psychotropic drugs
that work through a single receptor, alcohol affects many cellular
sites and processes including neurotransmitter receptors, cell
membranes, intracellular mechanisms, and gene expression to produce
intoxication, tolerance, dependence, and withdrawalpall behaviors
potentially mediated by pharmacologic agents. In addition to
naltrexone, the anticraving medication approved in 1994 for use in
alcoholism treatment, NIAAA researchers are evaluating other
anticraving medications, detoxification agents, alcohol-sensitizing
agents, and medications for use in patients with coexisting psychiatric
disorders. Effectively combining behavioral and pharmacologic therapies
for different patient types is a focus of current research.

The Ninth Special Report introduces several new applications for
alcohol research, including the recently tested and proved AMPS
program, a resistance education program for high-risk 6th grade
students that demonstrated positive results through grade 12, and
Project Northland, a community-based intervention that reduced the
onset of alcohol use, drinking prevalence, and the combination of
cigarette and alcohol use among 6th, 7th, and 8th grade students.
Researchers also demonstrated that reduced blood alcohol level laws for
young drivers reduce single-vehicle nighttime crashes, with the
greatest effect achieved by zero tolerance laws. According to NIAAA
Director Enoch Gordis, M.D., “Our researchers are conducting controlled
trials in prevention and have shown not only that social and regulatory
policies can be researched but that the application of research
findings to policy can save lives.”

Recently validated research applications for clinical practice
include behavioral therapies to prevent relapse and brief interventions
for use by primary care professionals to help nondependent problem
drinkers curtail drinking. NIAAAks health services research program
also aims to improve the accessibility, quality, effectiveness, and
cost-effectiveness of prevention and treatment.

Bound copies are available for $11 by written request to:

NIAAA
P.O. Box 10686
Rockville, Maryland 20849-0686