CHAPTER 1. EPIDEMIOLOGY OF ALCOHOL USE AND ALCOHOL-RELATED CONSEQUENCES Figure 1A. Apparent per capita alcohol consumption (all beverages), 1977-1989 1B. Apparent per capita alcohol consumption by beverage types, 1977–1989. . Percentage of change in apparent per capita alcohol consumption from 1978 to Relationship between death rate from vehicular accidents per 100 million vehicle- kilometers and adult alcohol consumption in liters per capita per year Distributions of deaths by age and sex for different drinking levels. The GABAA receptor, a membrane protein whose function is altered by alcohol Axial computerized tomographic and magnetic resonance images of the brains of a 36-year-old alcoholic patient and a 36-year-old healthy nonalcoholic Mean daily alcohol consumption (grams of alcohol per kilogram of body weight) by groups of seven selectively bred alcohol-preferring rats and alcohol- CHAPTER 7. BIOCHEMICAL EFFECTS OF ALCOHOL METABOLISM Figure 1. Ethanol metabolism in the liver cells of alcohol-naive individuals CHAPTER 9. EFFECTS OF ALCOHOL ON FETAL AND POSTNATAL DEVELOPMENT Figure 1. Children with FAS have characteristic facial features. . CHAPTER 1. EPIDEMIOLOGY OF ALCOHOL USE AND ALCOHOL-RELATED CONSEQUENCES An overview of key national surveys assessing alcohol effects, consumption, related Estimates of apparent per capita alcohol consumption by State: 1989. . . Prevalence of abstinence and drinking levels among males by selected socio- Alcohol problems-social and other consequences: Drinkers with current problems Alcohol abuse or dependence in the past year, by age, sex, and ethnicity: Data from ECA (DSM-III) and 1988 NHIS (DSM-III-R), in percentages Lifetime comorbidity of alcoholism and psychiatric disorders per 100 respondents Lifetime psychiatric diagnoses per 100 addiction treatment patients by current sub- Percent change in North Carolina driving-while-intoxicated arrest rates, alcohol-related crash rates, and single-vehicle nighttime crash rates, by age and CHAPTER 13. SCREENING AND BRIEF INTERVENTION Table 1. Examples of instruments used for screening alcohol use disorders. FOREWORD O ver the past several decades, we Americans have enjoyed significant improvements in our health as a result of advances made by medical research. Diseases and disorders that once brought certain death or lifelong debility have yielded to researchers' pursuit of causes and consequences. In the coming years, we can expect that our Nation's continuing commitment to medical research will help us live increasingly healthier lives. As can be seen in this Eighth Special Report to the U.S. Congress on Alcohol and Health, one area that continues to make solid progress is research on alcohol abuse and alcoholism. The report describes advances in knowledge that have been made since the publication of the Seventh Special Report in 1990advances that will help us understand how alcohol acts on the human body at the most basic biological level; advances that will help us discover how best to design programs to prevent alcohol abuse; advances that will help us solve everyday clinical problems; and, most important, advances that will ensure that progress in preventing and treating alcohol-related problems will be sustained into the next century and beyond. Among the advances described in this report are those related to vulnerability to alcoholism. Our increasing understanding of how genetic influences can contribute to the potential for developing alcoholism and of how genes and the environment interact to increase vulnerability to alcohol-related problems will help us recognize persons at high risk for alcoholism, implement intervention strategies at an early stage, and develop new treatments for alcohol-related problems. Also, exciting work is discussed in the chapter on neuroscience. This research is critical to understanding changes in the brain's sensitivity to alcohol and the development of physical dependence, as well as understanding how alcohol interacts with the central and peripheral nervous systems to produce intoxicating, behavioral, and neurotoxic effects. Using increasingly sophisticated technologies such as imaging, alcohol scientists are increasing our understanding of how the brain works in general and how addiction develops in particular. From this research will come new pharmacologic treatments that could, among other things, interrupt the craving for alcohol that often contributes to relapse. The Eighth Special Report documents the progress in our understanding of how alcohol affects the organs and systems of the human body. It also describes the important knowledge we have gained (1) on the effects of alcohol on the developing fetus and on children who were prenatally exposed to alcohol; (2) on technologies that have been developed to test the effectiveness of community-based prevention programs as well as those targeted at specific population groups; (3) on findings related to public policies, such as health warning labels and drinking and driving measures; and (4) on progress made toward ensuring that the assessment, diagnostic, and treatment tools used by practitioners in the alcohol field have undergone the same rigorous review of their effectiveness as those available for other major illnesses. The tremendous gains in knowledge documented in this report show without a doubt that medical research will continue to bring hope to the millions of Americans affected by alcohol abuse and alcoholism. We can be confident that, like other diseases that once caused widespread pain and suffering, alcohol abuse and alcoholism will one day yield to the preventive and treatment measures derived from today's scientific discoveries. Donna E. Shalala Health and Human Services |