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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