Public Health Programs and Practices

gress on Alcohol and Heaith shows declines in per capita alcohol consumption and liver cirrnosis deaths, as well as increased abstention and decreased heavy drinking across a broad range of age, sex, and demographic groups in the United States. The report, prepared by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), details recent scientific progress in understanding, preventing, and treating alcoholism and alcohol abuse and their consequences. NIAAA estimates that more than 15 million Americans ages 18 and older meet standard diagnostic criteria for alcohol abuse or alcoholism. In addition, many others are involved in alcohol-related traffic crashes or suffer from injuries and other problems associated with single drinking incidents. Alcohol also is a substantial factor in a wide range of safety and behavioral problems, including domestic and criminal violence and high-risk sexual behaviors. The report says raising the minimum drinking age has contributed to reduced fatal traffic crashes among persons younger than age 21. In particular, alcohol-related fatal crashes decreased between 1982 and 1989 by 47 percent among drivers ages 16-18 and 33 percent among drivers ages 18-20. Despite the older legal drinking age, alcohol remains the most frequently used drug among U.S. high school seniors. The report also shows that estimated rates of alcohol abuse and alcoholism in young women are converging with rates for young men. NIAAA Director Enoch Gordis, MD, said, "Heavy drinking has been linked with hypertension, weakened heart muscle, and arrhythmias; and chronic alcohol abuse with adverse effects on immune, endocrine, and reproductive functions, among other consequences." Moderate drinking may reduce risk for coronary heart disease, but moderate use also has been associated with added risk of hemorrhagic stroke, motor vehicle crashes, and adverse drug interactions. Alcoholism treatment research, conducted with increasingly sophisticated study designs, has documented promising psychological and pharmacological interventions. In recent studies, researchers identified pharmacological agents that appear to reduce alcohol craving and relapse in alcoholism treatment patients. "The ultimate success of treatment efforts lies in uncovering the mechanisms involved in craving, impaired control, and other disease features of alcoholism," Gordis said. In this pursuit, scientists are exploiting new tools in molecular biology, genetics, and neuroscience, including advanced biochemical tests, gene mapping, and a variety of brain imaging technologies.