Secretary of Health and Human Services Donna E. Shalala has announced the availability of the 10th Special Report to the U.S. Congress on Alcohol and Health, produced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The report highlights recent research advances on the causes, consequences, treatment, and prevention of alcohol addiction (alcoholism) and alcohol abuse.
The 492-page report, available in print and on the internet, documents the scope of alcohol’s impact on society. The effects range from violence to traffic crashes to lost productivity to illness and premature death—all of which, combined, cost our nation an estimated $184.6 billion per year. The report also conveys the rapid progress of research into the genetic and environmental factors that can lead to alcohol addiction. Scientists are using these insights to develop and test new ways of preventing and treating this disease. "Alcohol problems can yield to scientific investigation and medical intervention in the same way as other health conditions," writes DHHS Secretary Donna Shalala in the foreword.
The new report presents advances in alcohol research since 1997, when the last edition of Alcohol and Health was published. "This report reflects the tremendous growth in the scope of alcohol research," according to NIAAA Director Enoch Gordis, M.D. Contemporary alcohol research spans all life stages—from prenatal alcohol exposure to drinking problems in the elderly—and applies the latest methods of basic, epidemiological, clinical, behavioral, and social sciences research, often in multidisciplinary collaborations. The following research areas are among those detailed in the 10 th Report :
Genetics of alcoholism. Two studies have found evidence of genes on specific chromosomes influencing susceptibility to alcoholism. The ongoing Collaborative Study on the Genetics of Alcoholism (COGA), which involves 987 individuals from high-risk families, reported suggestive evidence of genes on chromosomes 1 and 7 involved in alcoholism. An early report from the study also reported weaker evidence of such a gene on chromosome 2. Another study from NIAAA’s Laboratory of Neurogenetics, based on 152 members of a southwestern Native American tribe, reported suggestive evidence for a gene influencing susceptibility to alcoholism on chromosome 11. Both studies reported finding evidence of a gene that was protective against alcoholism in a region of chromosome 4.
Heavy drinking during pregnancy and fetal brain development. Applying advances in neuroimaging and cellular and molecular biology, alcohol researchers are gaining an increasingly clear picture of the physical nature of alcohol-induced damage to the developing brain and the mechanisms that cause the damage. Imaging studies have demonstrated structural abnormalities in certain brain regions, whereas other regions seem to be spared. Research also shows that a number of deficits in cognitive and motor functions are linked to prenatal alcohol exposure, while other functions appear to remain intact. These studies, as well as basic research on the mechanisms of prenatal alcohol damage, support the notion that alcohol has specific, rather than global, effects on the developing brain.
Preventing underage drinking. One major study, the Community Trials Project, found that sales clerks in alcoholic beverage outlets were half as likely to sell alcohol to minors in communities with programs that trained clerks, enforced underage sales laws, and raised awareness of increased enforcement through the media. Another large study, Project Northland, showed that a multi-year program involving schools, parents, peers, policy-makers, and businesses can effectively reduce underage drinking—if the intervention begins before adolescents begin to use alcohol. The 10th Report also describes the search for the roots of alcohol problems in adolescence and later life stages, through multidisciplinary research on social, cultural, psychological, and biological influences.
Reducing alcohol-related traffic crashes. The 10 th Report presents many studies on the effectiveness of laws, public policies, community programs, and individual actions to deter drunk driving. A number of studies have focused on State laws that make it a criminal offense to drive with a blood alcohol concentration (BAC) over a certain limit, which in most States is 0.10 percent. New research shows that States that reduce the legal BAC limit to 0.08 percent experience a significant drop in fatal crashes related to alcohol, and that this decrease is distinct from the effects of other drunk driving measures.
Chronic alcohol use and the brain. Studies in animal models are revealing how changes in the brain from chronic alcohol consumption underlie such features of alcoholism as tolerance (lowered sensitivity to the intoxicating effects of alcohol), withdrawal, and craving. This work is helping scientists understand the biological basis for the motivation to drink too much and the mechanisms through which alcohol causes lasting damage to the brain in some individuals who consume alcohol heavily.
Damage to body organs. Research on how alcohol damages body organs is providing information that may be used in developing novel treatments. For example, a variety of evidence suggests that liver damage results from changes in immune function, suggesting the potential of immune-based treatments.
Helping patients to reduce alcohol use and related problems. When patients are found to be at-risk or problem drinkers, but not alcohol dependent, health care providers can significantly reduce alcohol use and related problems by providing a quick form of counseling called "brief intervention." Research shows that brief interventions delivered in primary care settings can decrease alcohol use for at least a year in persons who drink above recommended limits.
Medications for treating alcoholism. Advances in neuroscience have paved the way for medications that operate at the molecular level of brain processes that influence alcohol addiction. Studies show that the medication naltrexone and a similar compound, nalmefene, help reduce the chance of heavy drinking when abstinent individuals relapse; that a medication called acamprosate may prevent relapse; and that when patients with co-existing depression take antidepressants, their alcoholism treatment outcomes improve.
The report contains eight chapters: (1) Drinking Over the Life Span: Issues of Biology, Behavior and Risk, (2) Alcohol and the Brain: Neuroscience and Neurobehavior, (3) Genetic and Psychosocial Influences, (4) Medical Consequences, (5) Prenatal Exposure to Alcohol, (6) Economic and Health Services Perspectives, (7) Prevention, and (8) Treatment. Each chapter is divided into two to six subsections that can be downloaded individually in PDF format from the NIAAA website ( http://www.niaaa.nih.gov/). Bound copies of the entire 492-page report can also be ordered by writing to: National Institute on Alcohol Abuse and Alcoholism, Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849-0686.
The NIAAA produced the 10 th Special Report to the U.S. Congress on Alcohol and Health with guidance from a distinguished editorial advisory board and contributions from some of the world’s leading alcohol researchers. A component of the National Institutes of Health, NIAAA funds more than 90 percent of the alcohol abuse and alcohol addiction (alcoholism) research in the United States.