A rather large study funded by NIDA was the Perinatal 20 demonstration project assessing prevention of substance abuse during pregnancy. Although the major purpose was to look at the abuse of illegal substances, some data were collected on alcohol use, as well. CDC's role is to collect data to define the scope of the problem; support the development and evaluation of FAS prevention projects; and build state capacity for coordinated, state-based FAS surveillance and prevention programs CDC submission to IOM committee.
An Introduction to Alcoholism
At this time, no agency has been able to support research on the clinical aspects of FAS, on the medical treatment of children with FAS, or on the education and remediation of these children. The demonstration grant program focuses on the development of innovative, community-based models of drug prevention, education, and treatment, targeting pregnant and postpartum women and their infants National Center for Education in Maternal and Child Health, It has funded demonstration projects.
The most common drug addressed was cocaine, followed by alcohol and polydrug use. Because demonstration projects are rigorously evaluated only infrequently, the nature, utility, and transferability of their findings are difficult to assess. The five treatment programs that serve Native American women include comprehensive services specific to FAS. In recognition of the seriousness of this problem, which affects both the health and the societal functioning of many Americans, several times in the past few years, members of Congress have introduced legislation related to FAS see Table The bills have focused largely on creating an interagency task force on FAS and increasing resources for prevention programs and prevention research.
These bills, with one exception, have never been passed. The National Institute. Authorize services for the prevention, intervention, treatment and aftercare of American Indian and Alaskan Native children and their families at risk for FAS and fetal alcohol effect FAE. Authorization of grants to Native American tribes for training, prevention, and intervention programs.
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Provide for an increase in the amount of federal funds expended to conduct research on alcohol abuse and alcoholism among women. Develop a plan to disseminate diagnostic criteria to health care and social services providers. SAMHSA to support, conduct, and evaluate training programs for professionals; and prevention and education programs for the public. Organize a program of basic research on services and effective prevention, treatment and intervention for pregnant alcohol-dependent women and those with FAS or FAE [Originally introduced as S. Establish a program for the conduct and support of research and training and the dissemination of health information about the cause, diagnosis, prevention and treatment of FAS and related conditions.
Develop uniform criteria for the collection and reporting of data on FAS and related conditions. This report is in response to that mandate. Committee expertise included pediatrics, developmental psychology and neurology, obstetrics, nosology, teratology, epidemiology, sociology, substance abuse prevention and treatment, and psychiatry. The charge to the committee was to improve the understanding of available research knowledge and experience on:.
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- What is an alcoholic? How to treat alcoholism.
As part of its work, the committee assessed and reviewed U. Department of Health and Human Services agency research on the topic and provided guidance for the future. The committee understood its charge to focus on the effects of exposure to large amounts of alcohol, that is, on FAS and what had historically been called fetal alcohol effects FAE. The committee studied data on the relation between low or moderate levels of prenatal alcohol exposure and more subtle psychologic, educational, developmental, and behavioral abnormalities associated with such exposure, but given the currently available data it was unable to conclude that these subtle abnormalities do or do not represent a distinct clinical entity.
Thus, the committee concluded that it was inappropriate to develop diagnostic criteria or establish incidence or prevalence estimates for this putative condition. However, some discussion of these data is warranted. Large prospective studies conducted in several U. These statistical associations are typically weak and the estimated average effects are usually small, so these results seem to have little clinical significance for individual children Day et al. The population implications, in theory, can be important for the following reasons.
First, one interpretation of these results is that the small shift in the average behavioral, educational, and psychological scores in children prenatally exposed to low levels of alcohol theoretically may translate into increases in the. Second, these weak population results could also suggest that prenatal exposure to low levels of alcohol occasionally but only rarely lead to behavioral, educational, and psychological effects in an individual that do have clinical significance.
The clinical significance of small population effects on an individual has not been demonstrated empirically for low-level prenatal alcohol exposure. Finally, these population effects suggest at least a teratologic potential for low-level prenatal alcohol exposure and can provide directions for further research.
It is also possible that these effects are spurious, given the difficulties of excluding confounding variables such as stress or nutrition by history alone. Given the current state of our knowledge it is impossible to conclude whether low-level alcohol intake in pregnancy has clinically significant deleterious effects on the individual or not. The committee is cognizant of the grave concern of many pregnant or preconceptional women and their partners about possible effects of less than heavy consumption of alcohol, and it is also aware that this issue has been and will continue to be debated in the lay press.
The committee hopes its report will clarify research questions and design issues for further work in this area. The lack of diagnostic criteria for or more definitive statements regarding possible effects of low to moderate exposure to alcohol should not be interpreted as contradictory to the Surgeon General's warning against drinking alcohol during pregnancy.
This will be discussed in more detail in Chapter 7. The committee did not establish precise lower limits of alcohol exposure associated with significantly increased risk of FAS. Some researchers have attempted such calculations, but the committee felt that it is premature to make such a statement.
Maternal factors such as parity, age, history of heavy drinking, and general health status all influence how much alcohol exposure is necessary for FAS. The level of alcohol exposure is generally very high and likely found in only a small percentage of women who drink while pregnant. Recent data suggest that although approximately 40 percent of all women in the United States are abstinent Wilsnack et al. The committee did not establish an incidence or prevalence rate for FAS in the general U.
Rather, the committee reviewed estimates from the scientific literature. The difficulties in determining the extent of the problem are discussed in this report. Clinical experience has accumulated with helping pregnant alcoholic women to decrease their drinking and with helping children with FAS to learn and perform more like unaffected children Kleinfeld and Wescott, However, most of this rich clinical literature derives from anecdote and uncontrolled.
Therefore, the committee has focused its efforts on reviewing and commenting on the knowledge and experience base that derives from research. The committee felt it more important to discuss gaps in the knowledge base about FAS and to indicate possible directions for new research endeavors that may ultimately lead to the prevention of what some call the only percent preventable birth defect.
The committee met four times for a total of 10 days, reviewed the published literature, and requested and analyzed information from researchers in the field and from relevant USPHS agencies regarding past and future research efforts in this area. Such information included but was not limited to program budgets an d grant and contract abstracts. A major source of information about past work in the area is the published literature.
The Causes That Lead Teenagers to Drug and Alcohol Abuse
Much has been written recently about FAS and related disorders. The Secretary of Health and Human Services submits a special report to Congress every three years on the current state of knowledge about alcohol and health U. These reports contain superlative reviews of the current state of the published scientific literature on FAS research. Rather than duplicate those efforts, the committee briefly reviews the established scientific literature on FAS where needed and the reader is referred to the sources cited above for background or more extensive information.
As such, this report is relatively brief.
Alcohol abuse - Wikipedia
The experimental literature regarding FAS can be complicated. Research in teratology can be intricate and complex. The report lays out some of the basic principles of teratology and how they apply to the study of alcohol and FAS, particularly with animal models, in Chapter 2. Studies in animals are compelling in the context of the human situation. FAS is important because it is a condition caused by human behavior that affects human health and behavior.
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The committee has tried to paint a portrait of the wide-ranging human dilemmas involving. FAS through vignettes in Chapter 3. These are intended to illustrate the scope and impact of FAS more fully than any individual chapter could. To address the many issues raised by FAS, such as ascertaining its prevalence and assessing therapeutic or prevention interventions, it is essential to maintain well-defined diagnostic criteria. In Chapter 4, the committee has elaborated the principles of setting diagnostic criteria and has presented revised FAS diagnostic criteria, which it recommends for general usage.
The diagnostic criteria are essential for surveillance and epidemiologic research on FAS. Current challenges in epidemiology and surveillance of FAS are discussed in Chapter 5. Chapter 6 provides an overview of the epidemiology of women's drinking, an understanding of which is crucial for FAS prevention efforts. Chapter 7 discusses FAS prevention, including treatment for maternal alcohol abuse, while Chapter 8 lays the foundation for research in treatment of the child and the adult with FAS. Chapter 9 consists of a brief summary statement and recommendation concerning the integrative nature of FAS diagnosis, surveillance, prevention, and treatment, and how that impacts on research and treatment challenges.
Before going further, some clarification of terms is warranted.