CG 009 180 National Inst. of Alcohol Abuse and Alcoholism

235 Pages·2011·9.35 MB·English

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
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ASTTI ?N
Wav
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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
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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.