CRS Report for Congress Congressional Research Service The Library of Congress 91-680 SPR Alcohol Use and Abuse by Women Edith Fairman Cooper Analyst in Social Science Science Policy Research Division September 13, 1991 FETAL ALCOHOL SYNDROME (FAS) Some infants of heavy drinking mothers are inflicted with lifetime physical damage that is 100 percent preventable. The term, fetal alcohol syndrome (FAS), is used to describe physical irregularities observed in infants at birth that usually indicate alcohol exposure from maternal consumption during pregnancy. FAS is an international problem that shows no racial boundaries. In 1973, the term, fetal alcohol syndrome, was coined by Kenneth L. Jones and David W. Smith, two pediatric dysmorphologists, (-36) who rediscovered the tell-tale signs of alcohol exposure in infants at birth and notable in early childhood. The effect of maternal consumption of alcohol on birth weight and the development of children was noted in the 1700s, when there was a "gin epidemic" in England. In 1714, about two million gallons of gin were reportedly consumed in England. By 1750, the annual alcohol consumption rate had grown to 11 million gallons. A letter was written to Parliament voicing concerns about the gin problem and stating that, "too often the cause of weak, feeble, and distempered children, who must be, instead of an advantage and strength, [become] a charge to their country." -37 "Medically," it has been reported, "there was very little appreciation of alcohol's influence on the conceptus during the gin epidemic. -38 By the middle of the 19th century, Dr; E. Lanceraux, a French physician, seemed to have described some of the significant characteristics of FAS when he stated: As an infant he dies of convulsions or other nervous disorders; if he lives, he becomes idiotic or imbecile, and in adult life bears the special characteristics: the head is small..., his physiognomy vacant [peculiar facial features], a nervous susceptibility more or less accentuated, a state of nervousness bordering on hysteria, convulsions, epilepsy...are the sorrowful inheritance,...a great number of individuals given to drink bequeath their children (Lanceraux, 1865; quoted by Gustafson, 1885). -39 Near the end of the 19th century, many epidemiologists began to examine this issue and such studies continued into the early 20th century. Animal research brought the issue scientific status as it proved potential harm existed from prenatal alcohol exposure. By the 1920s, with the coming of the Prohibition era, the issues of prenatal alcohol exposure and birth defects were virtually ignored in both England and in the United States. -40 In 1940, such research began once more, and some scientists used animal study findings to ridicule pre-Prohibition concerns, arguing that prenatal exposure to alcohol might contribute to behavioral abnormalities, but they were most likely the results of postnatal home and social conditions. By the 1960s, a large amount of medical literature condoned moderate alcohol use during pregnancy, doubting any relationship with birth defects other than an hereditary basis until the thalidomide tragedy. -41 With the exception of French researchers, who reported that children of alcoholic parents (-42) experienced high incidences of delayed growth and development and medical disorders, most of the world's researchers expressed no concern about alcohol ingestion and birth defects. French researchers, however, spelled out all the characteristics that became known as FAS. -43 In 1973, Drs. Kenneth Jones and David Smith noted unusual physical features and a failure to thrive in infants of alcoholic mothers at the Harborview Hospital in Seattle, Washington, brought to their attention by a pediatric resident, Dr. C. Ulleland. Later, after identifying other similar infants, they sought the assistance of a child psychologist who diagnosed various levels of mental anomalies, as well, in these infants. Drs. Jones and Smith later published their findings in the medical journal, Lancet. In a subsequent Lancet publication that year, they formally used the term, fetal alcohol syndrome. -44 Prevalence Although exact prevalence and incidence data are not available for FAS at this time, it has been estimated that prevalence (based on nationwide and European studies) ranges from one to three cases per 1,000 live births, and a worldwide incidence (based on 20 studies from Australia, Europe, and North America) of 1.9 cases of FAS per 1,000 live births. -45 Investigators have found that, worldwide, "FAS outranks Down's syndrome and spina bifida in prevalence and is now the leading known cause of mental retardation. -46 One study found the average IQ of FAS patients to be 66. -47 Fetal Alcohol Effects (FAE) Fetal alcohol effects is a term referring to birth defects in infants who are prenatally exposed to alcohol that are not as severe as those required for an FAS diagnosis. Although FAS is now believed by many researchers to be the most severe outcome of in utero alcohol exposure, FAE, in many respects, can be as debilitating. In addition, it is more widespread within the general U.S. population. -56 According to one expert, among the general U.S. population, the incidence of FAE is estimated to be three times greater than for FAS. In the alcohol-abusing population, the FAE incidence was found to be nearly four times greater. -57 The major characteristics of FAE are retarded growth, abnormalities in form and structure of the fetus, and damage to the central nervous system. There are even occurrences where FAE have resulted in death. -58 In relatively mild cases, it has been observed that, a child might have FAE who has continuing trouble mastering the multiplication tables, has difficulty grasping how to tell time, persistently rocks the head and body, is clumsy, has difficulties with peers, exhibits poor judgment, and repeats behaviors that have previously shown bad results. -59 These actions, when occurring alone, or if one or two occur at the same time, might well be experiences in the normal development of a child. Various clusters of these actions grouped together might be the result of any number of things other than maternal alcohol abuse. However, when physical and behavioral abnormalities "more or less coalesce into a repeated, cumulative set of fixed actions or signs, the alarm bell sounds." FAS or FAE might be the reluctant conclusion. -60 Fetal Alcohol Syndrome High-Risk Factors By no means do all women who drink alcohol excessively during pregnancy deliver an infant suffering from FAS or even FAE. -62 According to the Seventh Special Report to the U.S. Congress on Alcohol and Health, "far fewer cases of FAS and FAE have been reported relative to the frequency of abusive drinking in pregnant women." Only 50 percent of offspring of alcohol-abusing women showed any adverse effects that could be attributed to prenatal alcohol exposure. May found that the FAS rate among Plains Indians is one birth in 97, about one percent of all babies born. Among Pueblo and Navaho tribes, the rate is one infant out of 749 born, which is about 0.13 percent of all infant births. The low FAS incidence among these latter Indian tribes may reflect the fact that women who drink alcohol reportedly are ostracized. -78 It has been noted that the risk of FAS is seven times higher for African American infants than for white infants who receive the same amount of in utero alcohol exposure. -87 ALCOHOL TREATMENT FOR WOMEN In traditional substance abuse treatment centers in the United States, women represent 25.4 percent of alcoholism clients. Nationwide, the ratio of women alcoholics to male alcoholics (30 percent and 70 percent, respectively), is slightly higher than for female and male alcoholics in treatment. -105 One of the reasons that has been suggested for this difference is that many women drinkers may pursue other avenues of treatment, such as personal physicians, or psychiatric services. -106 Treatment outcomes also tended to differ between men and women. A comparative study found that a higher percentage of women than men who completed treatment abstained from further alcohol use. The type of treatment facility utilized seemed to have influenced this result. It was discovered that women had higher abstinence rates if treated in a medically oriented alcoholism facility, while men experienced higher abstinence rates if treated in a peer group-oriented facility. Some experts believe that separate treatment facilities for women might better meet their needs. The study found, however, that "treatment outcome was better for women treated in a facility with a smaller proportion of female clients and better for men in a facility with a larger proportion of female clients." The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has concluded, therefore, that evidence has not been found which indicates that women fare better with separate treatment opportunities. -107 NOTES 36. Dysmorphologists are experts in dysmorphology, which is the study of abnormal development of tissue forms. (Illustrated Stedman's Medical Dictionary, 24th ed., 1982. p. 433. 37. Abel, Ernest L. Fetal Alcohol Syndrome. Oradell, New Jersey, Medical Economics Books, 1990. p. 4. 38. Ibid., p. 5. 39. Ibid., p. 6. 40. Warren, Kenneth R., and Richard J. Bast. Alcohol-Related Birth Defects: An Update. Public Health Reports, v. 103, no. 6, Nov./Dec. 1988. p. 639. 41. Abel, Fetal Alcohol Syndrome, p. 8. 42. Out of 69 families studied by French researchers, in 29 of them, both parents were alcoholic, in 26 families, only the mother was alcoholic, in the remaining 15 families, only the father was alcoholic, and children were born with high incidences of delayed growth and developmental and medical problems. 43. Abel, Fetal Alcohol Syndrome, p. 9. 44. Ibid., p. 10. 45. Ibid., p. 27. 46. Warren and Bast, Alcohol-Related Birth Defects, p. 638. 47. Weeks, Maureen (for Sen. Johne Binkley). Economic Impact of Fetal Alcohol Syndrome in Alaska. Senate Advisory Council. Alaska State Legislature. Juneau, Alaska, Feb. 1989. p. 2. 56. Dorris, Michael. The Broken Cord. New York, Harper and Row Publishers, 1989. p. 153. 57. U.S. Dept. of Health and Human Services. Public Health Service. Alcohol, Drug Abuse, and Mental Health Admin. National Institute on Alcohol Abuse and Alcoholism. Seventh Special Report to the U.S. Congress on Alcohol and Health. Secretary of Health and Human Services. Rockville, MD, Jan. 1990. p. 140. 58. U.S. Dept. of Health and Human Services. Public Health Service. Indian Health Service. Alcoholism/Substance Abuse Program Branch. IHS Alcoholism/Substance Abuse Prevention Initiative: Background, Plenary Session, and Action Plan. Craig Vanderwagen, Russell D. Mason, and Tom Choken Owan [eds.] Rockville, Md., 1986. p. 18. 59. Dorris, The Broken Cord, p. 154. 60. Ibid., p. 154-155. 61. U.S. Dept. of Health and Human Services, IHS Alcoholism/Substance Abuse Prevention Initiative, p. 17. 62. U.S. Dept. of Health and Human Services, Seventh Special Report to the U.S. Congress on Alcohol and Health, p. 140. CRS-15 77. Roberts, Shauna S. Indians Battle Fetal Alcohol Syndrome, p. 36. 78. Ibid. 87. Taha-Cisse, Ashaki H., Issues for African American Women, p. 55. 105. National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert, p. 3. 106. Ibid. 107. Ibid.
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