DOCUMENT RESUME ED 095 469 CG 009 180 AUTHOR Keller, Mark, Ed. TITLE Alcohol and Health; New Knowledge. INSTITUTION National Inst. of Alcohol Abuse and Alcoholism (NIMM), Rockville, Md. PUB DATE Jun 74 NOTE 242p. AVAILABLE PROM National Clearinghouse for Alcohol Information, Box 2345, Rockville, Maryland 20852; U.S. Government Printing Office, Washington, D.C. 20402 (Stock No. 1724-00399; $2.55) EDRS PRICE MF-$0.75 HC-$11.40 PLUS POSTAGE DESCRIPTORS *Alcohol Education; *Alcoholism; Conference Reports; *Federal Government; *Guidelines; Information Dissemination; *Program Descriptions; Scientific Research ABStRACT This second report to the Congress of the United States on Alcohol and Health concentrates on highlighting certain advances in knowledge gained about uses and misuses of alcohol in the last few years. It floes not attempt to address all aspects of knowledge, and deliberately bypasses those areas in which new information may be developing but has not yet reached a sufficiently reportable level. This report offers: an authoritative guide to (1) understanding what scientists and scholars are currently studying and reporting, (2) a picture of current realities, and (3) a basis for thinking about problems related to alcohol and their possible solution. This publication is not an authoritative guide for solving moral issues which belong in the realm of personal decision. Emphasis is given to the important and expanding role of the National Institute on Alcohol Abuse and Alcoholism, and its progress toward "programs for people." The legislative mandate for the states to produce a working, viable plan for the provision of alcoholism services has now been implemented in every state of the union, and this mandate is viewed as the most significant progress made in recent years to provide effective, quality treatment to every alcoholic person who needs it. (Author/PC) S DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE U. Public Health Service Second Special Report to the U.S. Congress on A" CC.1.70 Preprint Editior. June 1974 031* vS DE PAO TMENT OF r4E Al TM F OUCAtiQNi WE IF ARE AI NATION E OF U N U ? ASTTI ?N Wav .1 I F 1 Morris E. Chafetz. M.O. Chairman of the Task Force Editorial Staff: Mark Keller Editor Associate Editors D. Promisel, L. Splecler, L. Light, M. M. Davies U DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service .49 Alcohol. Drug Abuse, and Mental Health Administration National Institcs on Alcohol Abuse and Alcoholism I tine 5brin F : !IF,r ROCkvplit. Maryland 20[352 *tokffs Errata Sheet \s° instead of L. Spiegler Title Page, Editorial Staff, L. 2: D. Spiealer p. 34, L. 4: delete of (12) p. 37, Para. 1, L. 5: (11) instead (10) instead of (11) Para. 3, L. 3: p. 44, Para. 1. L. 5: insert (4) (11) instead of (12) p. 45, L. 5: Paza. 1, L. 4: (10) instead of (11) (11) instead of (12) 3, L. 4; Para. (11, p. 99) instead of (12. p. 99) L. 8: (11, p. 444) instead of (12, p. 444) L. 10: p. 98, Para. 1, L. 6: (18) instead of (11) (15) instead of (9) Para. 6, L. 2: (10) instead of (6) L. 3: instead of (5) L. f: (9) (2) instead of (15) p. 99, L. 2: (18) instead of (11) L. 8: 13) instead of Para. 1, L. 10: (2, 7) (3, 20) instead of (12, 13) 3, L. 1: Para. (19, instead of (4) L. 14: (5) instead of (8) Para. 4, L. 2: (14) 20) instead of (12, p. 100, Para. 1, L. 5: (19, 13) instead of (13) Para. 2, L. 6: (20) Para. 3, L. 2. instead of (8) (14) instead of (3) L. 5: (4) (17) instead of (10) L. 101 (12) instead of (9) Para. 4, L. 2: (21) instead of (14) L. 11: (20) instead of (13) L. 14: (22) instead of (17) p. 101, L. 6: (8) instead of (18) Para. 1, L. 6: (6, 16) instead of (19, 20) Pars. 2, L. 5: (11) instead of (21) L. 6: (23) instead of (22) L. 1: L. 31: (24) instead of (23) p. 102, ref. (1:0 Lieber instead of Libor ref. (1:) Lundquist instead of Lunanist p. 110, Para. 1, L. 4: (16) instead of (17) (35) instead of (38) L. 4: (33) instead of (35) L. 5: (29) instead of (31) L. 5: (29) instead of (31) Pcgra. 5, L. 3: p. 111, In the key, L. 4: 20-49 os. instead of 20-9 or. Longevity instead of Logevity p. 123, ref. (24) L. 10: p. 124, Para. 1, L. 8: eliminate 'and Huxley' (16) instead of (17) L. 14: (10. 12) instead of (10, 13) L. (7, 18) instead of (7, 19) Para. 4, L. 2: p. 125, Para. 1, L. (2) instead of fl. 12) 3: (13) instead of (14) p. 125, Para. 1, L. 4: (3, 19) instead of (3,20) 7: L. (17) instead of (18) 9: L. insert after potassium ions: into cells Pars. 4, 2: L. insert (0, 15) L. 2: insert (1, 14) L. 5: (33) instead of (20) p. 129, Para. 1, L. 8: (22, 23, 4, 33) instead of (36, 23, 4, 28) Para. 2, 4: L. (5) instead of (10) lit L. (23) instead of (41) p. 132, Para. 1, L. 8: (4) instead of ( ,4). p. 138, Para. 5, L. 9: instead of 100 mg/100 t1. p. 141, Para. 1, L. 3: 0.10 percent of psychodrama. p. 145, Para. 2, L. 10: psychodrama instead 'oriented". Para. 4, L. 5: insert "a community, after comma preceding p. 148, Para. 5: delete line E. enlisted p. 149, Para. 5, L. 9: enlisted instead of p. 199, Para. 4, L. 7: (25) instead of (24) p. 200, Para. 1, L. 4: insert (1) p. 203, Para. 5, L. 3: insert (11) p. 204, Para. 6, L. 20: (16) instead of (9) (18) instead of (17) p. 205, Para. 3, L. f: p. 209, Para. 6, L. 1: delete fifth word CONTENTS IVAILABIE COO BESI Foreword vi Members of the Task Ff,rce LX Preface xi Findings xiii Recommendations xvii Introduction 1 Alcohol l'se and Misuse by Adults and Youth I. 37 Alcohol and Older Persons II. 49 Economic Costs of Alcohol-Related Problems III. 61 Heredity and Congenital Effects Alcoholl:m: IV. Some Health CrTisequences of Alcohol Use V. 69 Alcohol and Cancer 1. 91 Alcohol and the Heart 2. Alcohol and Liver Disorders ......... 98 . . . 1. 104 Alcohol and Moitality 4. 124 Alcohol and the Central Nervous System 5. 127 Alcohol and Highway Safety VI. 145 Trends in Treatment of Alcoholism VII. 169 Problem Drinkers on the Joh VIII. 183 Alconcliq:p and Health Insurance IX. '197 The Enhancement of Health X. Appeorlix: Prevention of Alconolism in the United States 215 Utilizing Cultural and Educational Forces Preprint Edition --- June 1974 nITARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Srrvice Abuse, and Mental Health Administration Alcohol, l!rut National Institute on Alcohol Abuse and Alcoholism 0,00.t ttS FOREWORD abuse and alcoholism any years aao when alcohol There was a ta-e not As a Nation, we turned our backs on were not considclee important problems. Both as a government official and what we now terunnize as a serious problem. longer ignoring the un- are pleased to say that Americans are no a citizen, I misuse of alcohol. fortunate conseouences that result from the Alcohol and Health. This ::econd Special Report to the U.S. Congress on few years,marks another step foclssina on new knowledge developed in the past I am concerned misuse of alcohol. forward in our understanding of the use and I am reassured that the the extensii,e use of alcohol by young people. The Re rt has adverse effects. majority of Americans consume alcohol with no touching on many aspects of e ucation implications throurhout our Department, and welfare as well as health. inaugurated an educational program he have in the past several years and thus designed to reduce the aiming at the prevention of alcohol misuse t, Activities described in this, incidence of nnw cases of alcoholism. for the treatment of alcoholism, promise such as encouraging insurance payments We also plan to for those who already have this illness. new lines of help before the public an awareness of continue our study and research, and to keep this proble. approaches to alcohol and alcoholism, In this new report, we recommend new involving the partnership of emphasizing tarti67:1774 actions and programs We need to seek out the causes of this private enterprise and citizen croups. minority of alcohol consumers, and to search illness that de-ielops in a sizeatle tools We also need to develop wore effective out measures o' rreventinq it. constructively coping with this health and for preventine' alcoholism and for . social problem. Caspar W. Weinberger Secretary of Health, Education, and Welfare vi MEMBERS OF THE TASK FORCE Morris E. Chafetz, P.D. (Chairman) Director, NIAAA John A. Deering (Executive Secretary and Staff Director) Associate Director, NIAAA Norbert Barry, iii, Ph.D. F. Barris Montague Thoras Parford, Ph.S. Professor Research Psychologist Public Realth Specialist Department of Pharmacology National Institute on National Institute on School of Pharmacy Alcohol Abuse and Alcohol Abuse and University of Pittsburgh Alcoholism Alcoholism Ralph E. Berry, Jr., Ph.D. Marc }ertsman, P.D. t. Mansell Pattison, M.D. Associate Professor Executive Assistant Associate Professor and of Economics to the Director Vice-Chairman School of Public Health National Institute on Department of Psychiatry Harvard University Alcohol Abuse and and Human Behavior klcoholism University of California Kenneth L. Eaton Irvine, Calif. Deputy Director Jimmie Holland, le.D. National Institute on Department of Psychiatry M. W. Perrin., Ph.D. Alcohol Abuse and Montefiore Hospital and Professor of Psychology Alcoholism Medical Center University of Vermont Bronx, Mew York Donald W. Goodwin, M.D. Paul M. Roman, Ph.D. Department of Psychiatry Mark Keller, Editor Associate Professor of Washington University Quarterly Journal of Sociology and Epidemi- School of Medicine Studies on Alcohol ology Tulane University Center of Alenhell Studies Putaers University Pobin Room, Ph.D. Richard L. Veech, M.D., Ph.D. Special Research Group Chief, Laboratory of Alcohol University of California Research. School of Public Health National Institute on Alcohol Berkeley, Cali!. Abuse and Alcoholism 0° M vii ('it I StSi OTHER CONTRIPVTOPS Charles S. Lieber, M.D. N. P. Dituzio, Ph.D. David J. Armor, Ph.D. Professor of Medicine Rand Corporation Professor and Chairman Dept. of Physiology Mount Sinai School Santa Monica, Calif. of Medicine Tulane University Frank Baker, Ph.D. Brian L. Mishara, Ph.D. Department of Psychiatry Richard Driver, Ph.D. Socio-Technical Systems The Laboratory of Com- Associate Professor Associates, Inc. munity Psychiatry The Center of Alcohol Poston, Mass. Harvard Medical School Studies Rutgers University C. S. Muir, M.O. David Berenson, M.D. Chief, Epidemiology and Research Psychiatrist Rashi Feln, Ph.D. Piostatistics National Institute on Professor of the Eco- Alcohol Abuse and International Agency for nomics of Medicine Alcoholism Harvard Medical School Research on Cancer Lyon, Trance Howard T. Mane, Ph.D. Paul J. Feldstein, Ph.D. Professor of Special Fdu- Hans Popper, M.D. Professor Fogarty Scholar School of Public Health cation and Psychology Fogarty International University of Pittsburgh and Dept. of Economics Center University of Michigan National Institutes of James Boland Louise A. Johnson, Ph.D. Health Policy Analysis. Inc. Assistant Professor Boston, Mills. David M. Promisel, Ph.D. Mount Sinai School of Research Specialist Medicine C. Nicholas Braucht, Ph. D. National Institute on Assistant Professor of AlCohol Abuse and Robert Kastenbaum, Ph.D. Psychology Alcoholism Department of Psychology University of Denver Boston Harbor Campus Danielle Spiegler University of Mass. John M. Chat:lama, M.D. Psychologist Professor of Epidemiology James Kissho National Institute on University of California Alcohol Abuse and Deputy Director School of Public Health Alcoholism Division of Special Treat- Los Angeles ment and Rehabilitation Programs National Institute on Alcohol Abuse ane Alcoholism Betty M. Ullman, Ph.D. Leland F. Towle, Manaerer Center for Research in Pettit!' Services Pesearch Stanford Research Institute Diseases of the Heart, Menlo Park, Calif. Circulation, and Related Disorders University of Mohican is IrFFACF Alcoholisr Are alcohol al -use is one of our most serious healt1, problems. Although the use of elcuholic heverages is harmless to most people and apparently beneficial for sore, alcoholisr is an illness that plagues sore any tiren that number when one considers 9 million ArericanF directly, and the effects on farther and ethers. it is an illness, as this Pe rt demon- strates, that can engender other serious eiseases--such as card omyopathy, cancer, cirrhosisand cell shorten the lifespan of its victims by many years. And yet, it did not become a national health priority until a few years ago. The National Tnstitute on ticohol Abuse anc' Alcoholism was created in 1970 as a result of this awareness and leads Federal efforts in this area. It has since that tire ineeigurated new programs ranging from treatment in poverty and industrial settings. to state formula grants, to community assistance, as well as a nurber o* other services, research, arc' trainine functions. These programs have stimulated a risine tide of interest and concern for alcoholic people. But it is not enough, and we cannot rest complacent when there is so much more to be done. How does such an outstardine an0 clearly fundamental need fit into an The solution is that the treatment of overall national health strategy? alcoholic people and the prevention of alcoholism ultimately rust be assumed by the same people who are treating every other kind of illness in our health Physicians, nurses, social workers, profession- care and huran service systems. als of all kinds, and others involved in and committed to health care must all assure their proper responsibility for alcoholic people in exactly the same way A major they would take care of a person with any other kind of illness. accomplishment in this direction was achieved with the recent signing by the President of a comp :ehensive alcoholism and alcohol abuse act, Public Law 93- 282,' which prohibi;:s hospitals receiving Federal funds from discriminating in any way in the admission of matients suffering from alcoholism. I am also encouraeee by the crowing recognition both inside and outside the health care system of the importance of alcohol misuse and alcoholism. Recently, two separate Presidential Commissions The National Commission on Marihuana ane Drug Abuse and the President's Science Advisory Committeeissued The rain common finding was reports on drug abuse and chemicals, respectively. that the problems of alcohol overshadow thy importance of any other kind of drug. It is fitting, then, that the new. Alcohol and Health Peport should appear This Pe ort brines tovether under one cover a comprehensive at this time. review of the new direct ons that art being taken to understand and to deal with alcohol misuse and alcoholism, and underscores our contention that the time has core to bring the treatrent of alcoholism into the mainstream of our Nation's health care system. Charles; C. Edwards, M.L. Assistant Fcretary for Pealth Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and rehabilitation Act mmenerenta of 1974. xi 008XF. C.06 felte.0 FIVDINCS Alcoholisr an alcohol abuse continue to occur at high incidence rates within the American society. The proportion of American youth who drink has teen increasing so that. curronth, it is almost universal. The highest scores on an index of possi- ble problem-drinking behaviors were recorded in the youngest age group for which data are available, the 18-20 year olds. The public suffers from much ignorance concerning alcohol and from ambiva- lent feelings toward it. worse yet, heavier drinkers know less about alcohol than do lighter drinkers or abstainers. In general. American atti- tudes about drinking are marked by confusion and dissent. The economic cost assOciatet with misuse of alcohol is estimated at S25 billion a year. The U.S. system of alcohol controls is a chaotic relic. It provides little support in mitigating alcohol problems and may induce a counterproductive ambivalence among the public. The excessive use of alcohol, especially when combined with tobacco, has Non-white men appear been implicated in the development of certain cancers. to be especially susceptible. Heavy drinking during pregnancy can adversely affect the offspring of alco- The significance cf heredity in alcoholism is as yet un- holic mothers. resolved. The development of a new animal model of liver cirrhosis gives promise of resolving the problem of cause in one of the severest damages suffered by alcoholic people, and may contribute to more effective treatment, and pre- vention. In some cases, Moderate consumption of alcohol is generally not harmful. or such as among the elderly, it may have beneficial physical, social psychological effects. The non-excessive use of alcohol does not appear to adversely affect the over-all rortality rate or the mortality from a specific major cause of In fact, the mortality of drinkers is lower death, coronary heart disease. than that of abstainers and ex-drinkers. How alcohol intoxicates and how alcohol addiction develops are outstanding fundamental questions that require intensive research in several disci- plines. Alcoholism is a treatable illness, but different treatments are required by Increasirgly, individual treatment needs can be different individuals. determined or the basis cf valid studies or clinical experience.