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OCR for page 104
~ ~ . Alcohol and Drug Abuse
Experts who testified about the Year 2000 Health
Objectives identified the use and misuse of alcohol
and drugs as a major national problem. Substance
abuse affects overall health status, contributing to
intentional and unintentional injuries, heart disease,
cancer, cirrhosis, AIDS, fetal and infant death, and
many other health problems. Its direct and indirect
mortality, morbidity, and impact on health care costs
are tremendous, according to testifiers. Furthermore,
the broad array of licit and illicit drugs now available
carries a range of social costs that extend well beyond
those suffered by the users themselves.
A total of 32 individuals focused their testimony on
issues relating to the use and misuse of alcohol and
other drugs, another 24 made major statements on
these issues, and many others addressed them as part
of their testimony on other subjects. Testifiers
agreed, in general, that the nation has made progress
on the 1990 Objectives but that, as William Wallace
of the New Hampshire Division of Public Health
Services says, "we have only scratched the surface."
(#430) The National Association of State Boards of
Education (NASBE) adds that upon reviewing the
current status of the national health objectives for
1990 it is apparent "that our country still has far to
go in some significant areas related to the misuse of
alcohol and drugs." (~573)
Many testifiers advocate continuing and strengthen-
ing the objectives on alcohol and other drug use,
including setting additional targeted reductions. In
the words of Bob Dickson of the Texas Commission
on Alcohol and Drug Abuse, "We must emphasize
chemical dependency's significance as a major nation-
wide health concern." He also stresses the need to
focus much energy on preventing the disease. That
means not only finding "genetic markers to warn
susceptible individuals, but also changing attitudes in
a societr that still glorifies drinking. (#312,}
Along with other witnesses, Al Wright of the Los
Angeles County Department of Health Services calls
for strong health protection measures to fight alcohol
and drug abuse. (#229) Marilyn Aguirre-Molina and
Christine Lubinski, speaking for the National Council
on Alcoholism (NCA), say that an assertive public
p,; -fly, systematic and coordinated educational
a loaches, and other interventions are required.
. ruse alcohol control measures can be used to limit
104 Healthy People 2000: Citizens Chart the Course
consumption, the control of alcohol availability is a
public health issue.1 The NCA strongly urges The
inclusion of economic incentives and other policy
initiatives in the form of process objectives to facili-
tate the achievement of a number of outcome objec-
tives. This can best be accomplished through the
cooperation of the public, voluntary, and private
sectors to advance the formulation of such policies
and to advocate for their enactment." Issues that the
NCA believes should be addressed include increased
prices through tax policy and health and safety
warning labels. (#467)
Anne Windle of the Department of Addiction,
Victim, and Mental Health SeIvices of the Montgo-
me~y County Government in Maryland, acknowledges
that substance abuse is an emotional issue. Many of
the potential solutions are highly political and have
serious implications for this society. She adds that a
national dialogue is needed to openly consider all
options. "We must address the enormous financial
incentives at every level of the drug trade. And we
must acknowledge the societal realities that exclude
some segments of our society from participating in
means of earning a legal and acceptable living," she
says. (#616)
Donald Gragg of the Southern California Perma-
nente Medical Group suggests that "much of the
progress made on the 1990 Objectives seems to be a
result of a slight shift in societal attitudes particularly
with regard to the acceptability of drinking and dnvi-
ng (and the use of illicit drugs). It is imperative that
a major thrust be made to continue and accelerate
this shift in societal values during the next decade,
with special focus on adolescents and young adults."
(~282)
Many testifiers focused their comments on several
particular areas of concern surrounding alcohol and
drug abuse. By far, the two most commonly discussed
areas were problems associated with alcohol and the
issue of substance abuse among adolescents. Many
other witnesses addressed the special substance abuse
problems in minority populations. These three areas
are discussed in detail below.
Although not addressed in great detail, other topics
were discussed that testifiers felt needed attention in
the Year 20~)0 Health Objectives: substance abuse
during pregnancy, especially the risk of fetal alcohol
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syndrome; cocaine, "crack," and heroin; and AIDS
among intravenous drug users. Robert Welch and
Robert Sokol of Wayne State University and the
Hutzel Hospital in Detroit explain that even though
nationwide efforts appear to have increased awareness
of the adverse effect of alcohol consumption during
pregnancy, "a segment of intractable, heavy drinkers
who are unable to modify their behaviors still exists.
With respect to cocaine, Welch and Sokol report that
there is little mention of this drug in the 1990 Objec-
tives and emphasize that since their publication,
cocaine has "become more readily available and easier
to take in the form of 'crack'." (#421J Finally,
heroin is identified as important, not only because of
the deleterious effects of addiction, but also because
of perinatal AIDS.
Patrick O'Malley and Lloyd Johnston of the
Universitr of Michigan recommend, and others agree,
that because of AIDS, reducing the prevalence of
intravenous drug use should be a very important
objective. (#419J The issue of AIDS is covered
further in Chapter 19.
ALCOHOL PROBLEMS
Many witnesses testified about the problems caused by
alcohol. Dave Anderson of the American Automobile
Association, for instance, reports that about half of all
highway fatalities-26,000 of the s2,000 deaths per
yea~are alcohol related.2 (#008) Harold Jordan of
Meharry Medical College adds that 18 million adults
currently experience problems as a result of alcohol,
and of these, 11 million suffer from the disease of
alcoholism. The direct and indirect costs of alcohol-
ism amounted to $117 billion in 1983, according to
Jordan. (#254)
To deal with the problem, Wallace calls for more
attention to the causative agent itself and would
eventually like to see an alcohol-free society. Short
of that, he recommends warnings on alcoholic
beverage containers similar to those on tobacco
products; a ban on radio and television advertising of
alcoholic beverages; an increase in taxes on alcoholic
beverages to be used for alcohol-related programs;
and a Major and massive" educational effort aimed at
health professionals, the schools, and the public.
(#430J
The NCA recommends the enactment of com-
prehensive legislation that requires education and
training for servers of alcoholic beverages, third-party
liability laws, and zoning ordinances specifying the
location and density of alcohol gullets, with considera
tion of their proximity to public and private transpor-
tation. (#467)
Linda Grant of the Washington State Association
of Alcoholism and Addictions Programs says that "the
information we have today is not the same as the
information that was available when the objectives for
1990 were drawn up." For example, there is much
evidence on the heavy genetic role of alcoholism.
Thus, she says, drug abuse and alcoholism may require
different approaches. (#692)
In addition, the NCA believes that the term Abuse"
should not be used in discussions of alcoholism. The
term is vague, and no clear-cut line exists between use
and abuse; it should be replaced, when warranted,
with the word "problem." Along with others, the
NCA agrees that the title of any chapter or section
on alcoholism should convey a broad approach to the
problem, that is, the objectives must focus on issues
resulting from, as well as factors related to, its use.
(~467)
ADOLESCENT SUBSTANCE ABUSE
According to Wayne Teague of the Alabama Depart-
ment of Education, The most serious threat to the
health and well-being of our children is drug abuse."
f#675) Elaine Hill and Casey Clark of the University
of Colorado Health Sciences Center add that Ha recent
national survey, the National High School Seniors
Survey conducted in 1986, demonstrated that 92
percent of high school seniors had used alcohol, 15
percent had tried cocaine, 10 percent had used some
hallucinogen, 1 percent heroin, 17 percent inhalants,
and 50.2 percent reported using marijuana.n3 It
appears that alcohol use continues to predominate
over illicit drugs, and that cocaine and crack have
replaced heroin. Statistics also clearly indicate, they
say, that children are now using drugs at younger
ages.4 (#577) According to the American School
Health Association (ASHA), adolescents involved in
substance abuse are at high risk for many health
problems, such as lack of physical endurance and
respiratory problems. Furthermore, quoting Brenda
Wagner, ASHA writes:
One of the greatest concerns of professionals
working with adolescents involved in substance
abuse is the delay of accomplishing the adoles
cent tasks necessary to reach emotional maturity.
It is difficult to adequately accomplish these
tasks if one's perception of self, time, and
sequence is distorted or if one's interest and
Alcohol and Drug Abuse 105
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ability in evaluative thinking is impaired.5
(~5)
Michael Jarrett of the South Carolina Department
of Health and Environmental Control points out a
problem with the 1990 objectives that address adoles-
cent substance abuse, which must be corrected for the
year 2000. "The problems and preventions needed for
these age groups are quite different, and the 1990
objectives do not address rather significant problem
areas. For example, the targeted ages in the plan are
often too late to begin efforts to measure and reduce
the problem." (~108)
Claire Brindis and Phillip Lee of the University of
California, San Francisco foresee problems in reaching
this group with interventions because "no one ap-
proach will respond to the various segments of the
adolescent population and the different needs of new
immigrants, refugees, the middle class, and the poor."
To combat the problem, they suggest that "a diversity
of programs under the umbrella of a common goal
may be an effective way of responding to the needs of
different individuals and groups in the community.
For example, drug education programs directed at
high school students may be more effective if
programs also are available for parents and pre-high
school students." (#027J Yet strategies for reaching
youth must not rely solely on formal educational
programs, according to Gragg. To be effective, they
must also use everyday television, music, and other
media. (#282)
To deal with the problem of substance abuse in
adolescents, the ASHA calls for prevention inte~ven-
tions that "combine and coordinate multiple forces of
the community with those of the school." (~005)
Teague says that parents, school officials, and com-
munity leaders all must commit to the task. (#675)
Health care professionals, including physicians, nurses,
pharmacists, and dentists, need to be educated about
the prevalence and availability of alcohol and illegal
drugs to school age children, as well, add Hill and
Clark. They also suggest that other states follow
Colorado and legislate drug education in kindergarten
through high school classes. (#577J
The NASBE calls for an even more comprehensive
strategy in efforts to reach young people.
Health risk behaviors overlap and, equally
important, are associated with low academic
achievement, school failure, and dropout. For
this reason, society cannot afford to address
health problems piecemeal through discrete
106 Healthy People 2000: Citizens Chart the Course
programs aimed at reducing substance abuse,
teenage pregnancy, AIDS, and other issues.
Rather, they must see these problems as part of
a more general, at-risk syndrome that requires
a comprehensive approach, including school and
community.
To this end, the NASBE advocates the active involve-
ment of parents, peers, law enforcement agencies,
social service agencies, health care givers, the
churches, business, industry, and the media in any
programs aimed at adolescents. In addition, the
NASBE says that education programs must be de-
signed to alter knowledge, attitudes, and most impor-
tant, behavior. "Mere public awareness of the risks
associated with drinking is not sufficient. Knowledge
must be transferred Into changed attitudes and
changed behavior." (#573)
"Risk-taking adolescents do not believe that it is
harmful, or that the risks outweigh the thrills in the
areas of driving, drinking, drugs, and sex," says
Herbert Rader of the Salvation Army in New York.
Thus, it is also important that youth activities be
organized to enhance self-esteem, promote new skills
acquisition, and promote life skills that encourage
healthy behaviors, as do the youth programs of the
Salvation Army. (#432)
The NCA calls for legislation mandating equal time
for health and safety messages to counterbalance
alcohol ads on radio and television. (~467) Gragg
suggests that by the year 2000, 75 percent of the
references to alcohol or drugs in television, drama,
hum, and popular music reflect negative connotations
about the use of these substances. (~282) Preven-
tion strategy for the nation must send the message
that "it's all right not to drink" and that the abuse of
alcohol is unacceptable behavior, according to
Jacqueline Morrison of Wayne State University.
(#723J
SUBSTANCE ABUSE BY MINORITY GROUPS
Given the differences between ethnic and racial
minorities and the rest of the population in the rates
of alcohol morbidity and mortality, the NCA suggests
the "development of sub-objectives with specific
targets for minority populations." (~467) Mario
Orlandi of the American Health Foundation in New
York adds that "ethnic variability presents a dilemma
to health planners who are responsible for developing
substance abuse prevention initiatives." Programs, he
continues, must have not only demonstrated eff~ca~
OCR for page 107
but also cultural relevance for particular minority or
ethnic groups and subgroups. (#167)
Blacks
Morrison, who also represented the National Black
Alcoholism Council, calls alcoholism The number one
public health problem in the Black community, as it
is related to cancer, vehicle accidents, domestic
violence, homicide, school dropout, hypertension, fetal
alcohol syndrome,n and many other problems.
Morrison calls for more culturally sensitive individual
and communin,r-level alcoholism awareness and
education programs. She also calls for more attention
to programs for children of alcoholics. In addition,
Morrison calls for more data on Blacks and alcohol-
related driving accidents and for public information
and educational programs targeted to the Black
community. (~723)
Hispanics
According to Sylvia Andrew of Our Lady of the Lake
University In San Antonio, Texas, alcohol and drug
abuse are problems among Me~ncan-American youth
as well. In terms of prevention, attention should be
given to the overaccessibility of alcohol in barrios.
(#495J
Ricardo Jasso of Nosotros Human Services Deve-
lopment in San Antonio calls attention to the prob-
lem of inhalant abuse among Mexican-Americans. To
deal with the problem, Nosotros is developing a com-
prehensive continuum of programs, including counsel-
ing for individuals, groups, and families, as well as
psychiatric assessments; alternative activities; chemical
abuse education, general educational programs, and
job skill training; job placement programs; social
services and referrals; and residential treatment
programs for teenagers. (#494)
Native Americans
JoAnn Kauffman of the Seattle Indian Health Board
reports that many deaths among Native Americans 45
years old or younger are alcohol related.6 A large
part of the Native American adolescent suicide
problem, discussed in greater detail in Chapters 6 and
16, is alcohol related.
Currently there are not adequate resources to
treat Indian alcoholism or substance abuse.
There are even fewer resources available to
meet the treatment needs of children of
alcoholics. The multi-generational cycle of
family dysfunction perpetuates alcoholism,
violence, sexual abuse and self-destructive be-
haviors. To break the cycle requires breaking
through family and community denial, and
striving for cultural revitalization and adequately
trained treatment providers. (#696)
The Indigent, Homeless, and Disadvantaged
The terrible toll exacted by substance abuse, as seen
in the breakdown of personal health and the breakup
of families and neighborhoods, is even more
pronounced among the disadvantaged. Rader reports
that a major expansion of drug detoxification and
rehabilitation programs, including adequate residential
facilities, is needed for the large number of
intravenous (IV) drug abusers who would be willing
to come off the street. "Some recent surveys suggest
that many IV drug abusers on the streets of New
York would voluntarily enter residential drug treat-
ment programs if they were available," says Rader.
(~432)
Programs are successful, Rader explains, because
something has been kindled within a person.
Attainment of this change of outlook, which
results in a dramatic change in behavior, seems
to create a contagious hope within others. The
answer to a great deal of drug abuse is not
education alone or provision of clean needles or
addressing chemical dependency only, but pro-
viding emergency shelter, secure safe houses,
psychosocial support and counselling, health
care, education and training for living, camps
away from the streets, community centers where
opportunity for personal achievement, self-
esteem, and respect for others are developed,
employment counselling, etc. (#432J
IMPLEMENT. ATION
A variety of strategies were proposed for achieving
the year 2000 alcohol and drug objectives. Dickson
calls for a strong and focused attack on substance
abuse.
It is time for the chemical dependency field, and
the general public, to turn from the "drug-of-
the-month~ hysteria of the media, place our
country's manpower and resources into the fray,
Alcohol and Drug Abuse 107
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and begin a major offensive against substance
abuse. Everything that we have gained could
well be lost if we once more are forced to
endure the perception that chemical dependency
is a weakness, a sign of moral deficiency, rather
than a treatable neuro-chemical disease. Our
progress depends on the final answering of this
question that, indeed, it is a disease. (#312)
The NCA views "a policy to substantially increase the
tax rates among alcoholic beverages" as an important
element in a successful implementation strategy.
Tax rates among beverage classes should be
equalized by alcohol content. Such a move
would, in and of itself, raise four billion dollars
and serve to undermine public perceptions that
beer and wine are more ~moderate" alcoholic
beverages. (~467)
The worksite has great potential for combatting
alcohol and drug problems, according to Dickson:
"Random drug screening, to create a drug free work-
place, coupled with an EAP (employee assistance
program) is the most effective method so far for
dealing with chemical dependency. (#312)
Many testifiers were concerned with uniformity in
data collection. The NCA strongly recommends, and
others agree, that the Year 2000 Health Objectives
also include a process objective for implementing and
monitoring an improved and coordinated information
REFERENCES
system within and between federal, state, or local
governments and the private sector, and for both
health and human services information. This would
be based on the concept of uniform minimum data
sets and would include greater precision and
standardization in the definition of terms that describe
drinking and levels of problem use. (~467J
Accurate surveillance of alcohol problems among
minority groups also requires the implementation of
a uniform demographic information collecting system,
the NCA adds. It recommends that in addition to
collecting data on age and gender, a uniform racial
and ethnic identifier be included on all pertinent
records. (#467)
Although prevention and treatment of both alcohol
and drug problems, as well as data collection and
surveillance, will be critical to the achievement of the
year 2000 alcohol and drug objectives, society must
Understand that factors of public policy, urban
economics, family life, and education are among the
risk factors for both these problems," states James
Sail of the Detroit Department of Health. Putting it
into an even broader framework, he adds that "while
disease-specific objectives and monitoring of health
status will continue to be legitimate, we are acting on
the assumption that, at least among the urban under-
class, the following health areas share a common
group of underlying risk factors: sexually transmitted
diseases, maternal and infant health, teenage pregnan-
py, internal injuries, stress-related mental illness, and
alcohol and drug abuse." (~389)
1. Bruun K, Edwards G. Lumio M, et al.: Alcohol control policies in public health perspective. Finnish
Foundation for Alcohol Studies, vol. 25. WHO and Addiction Research Foundation, 1975
2. U.S. Department of Transportation, National Highway Traffic Safety Administration: Fatal Accident
Reporting System 1988. A Review of Information on Fatal Traffic Crashes in the United States in 1988 (DOT
Publication No. HS 807 507), 1989
3. Bachman JO, Johnston LD, O'Malley PM: Monitoring the Future: Questionnaire Responses from the
Nation's High School Seniors, 1986. Ann Arbor: Institute for Social Research, University of Michigan, 1988
4. Ibid.
5. Wagner BJ: Intervening with the adolescent involved in substance abuse. J Sch Health 54(7):244-246, 1984
6. U.S. Department of Health and Human Services: Report of the Secretary's Task Force on Black and
Minority Health. Washington, D.C.: U.S. Government Printing Office, 1987
108 Healthy People 2000: Citizens Chart the Course
OCR for page 109
TESTIFIERS CITED IN CHAPTER 11
005 Allensworth, Diane; American School Health Association
008 Anderson, Dave; American Automobile Association
027 Brindis, Claire and Lee, Phillip; University of California, San Francisco
108 Jarrett, Michael; South Carolina Department of Health and Environmental Control
167 Orlandi, Mario; American Health Foundation
229 Wright, Al; County of Los Angeles Department of Health Services
254 Jordan, Harold; Meharry Medical College
282 Gragg, Donald; Southern California Permanente Medical Group
312 Dickson, Bob; Texas Commission on Alcohol and Drug Abuse
389 Sail, James; Detroit Department of Health
419 O'Malley, Patrick and Johnston, Lloyd; University of Michigan
421 Welch, Robert and Sokol, Robert; Wayne State University/Hutzel Hospital (Detroit)
430 Wallace, Jr., William; New Hampshire Division of Public Health Services
432 Rader, Herbert; The Salvation Army in the United States
467 Aguirre-Molina, Marilyn and Lubinski, Christine; National Council on Alcoholism
494 Jasso, Ricardo; Nosotros Human Services Development (San Antonio)
495 Andrew, Sylvia; Our Lady of the Lake University of San Antonio
573 Wilhoit, Gene; National Association of State Boards of Education
577 Hill, Elaine and Clark, Casey; University of Colorado Health Sciences Center
616 Windle, Anne; American Public Health Association, Public Health Education Section
675 Teague, Wayne; Alabama Department of Education
692 Grant, Linda; Washington State Association of Alcoholism and Addictions Programs
696 Kauffman, JoAnn; Seattle Indian Health Board
723 Morrison, Jacqueline; Wayne State University
Alcohol and Drug Abuse 109
Representative terms from entire chapter:
drug abuse
