cause of mental retardation (American Academy of Pediatrics, 1993; Bagheri et al., 1998; IOM, 1996). Sustained heavy alcohol consumption worsens the outcome for patients with hepatitis C (NIH, 1997a; USDHHS, 2000) and increases the risk for cirrhosis and other liver disorders (Saadatamand et al., 1997; USDHHS, 2000). Cirrhosis, primarily attributable to heavy drinking, is one of the 10 leading causes of death in the United States (Bureau of the Census, 1997; Hasin et al., 1990; Popham et al., 1984; Saadatamand et al., 1997; Schmidt, 1980).

Progress has been made in reducing the rate of alcohol-related driving fatalities, but it is still a serious problem. Overall, the rate of alcohol-related driving fatalities declined from 9.8 deaths per 100,000 people in 1987 to 6.5 per 100,000 in 1996 (USDHHS, 2000). It is estimated that even at current rates, 3 out of every 10 Americans will be involved in an alcohol-related crash sometime during their lives. The populations of greatest concern for alcohol-related driving fatalities include Native Americans and those between the ages of 15 and 24. In 1994, the alcohol involvement rate in fatal traffic crashes for American Indian and Alaska Native males was 4 times higher (28 per 100,000 population) than for the general population, and, for 15- to 24-year olds, the rate was almost 13 per 100,000 population (USDHHS, 2000).

The consequences of excessive alcohol consumption extend beyond death rates. Alcohol consumption also contributes to risk of injury. In addition to injuries and deaths from traffic accidents, a significant proportion of injuries and deaths from falls, fires, and drowning has been linked with use of alcohol (Saadatamand et al., 1997; USDHHS, 2000). Alcohol consumption contributes to destruction of personal and social relationships (Brookoff et al., 1997); it is a factor in homicide, suicide, marital violence, and child abuse (Roizen, 1993; USDHHS, 2000); and it contributes to high-risk sexual behavior (Strunin and Hingson, 1992, 1993; USDHHS, 2000).

Positive Health Effects

In contrast with those harmful effects, however, evidence is overwhelming of a beneficial effect of moderate consumption of alcohol (1–2 drinks per day) on reducing risk of coronary heart disease and thrombotic stroke. Light-to-moderate drinking can have beneficial effects on the heart, especially among people at greatest risk for heart attacks, including men over age 45 and women after menopause (USDHHS, 2000; Zakhari,



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