Public Policy Office Response to WHO "Health Problems Related to Alcohol Consumption" Survey

Alcohol consumption can also alter neuronal function, resulting in cognitive deficits and neuroadaptations that contribute to the behavioral changes observed with alcoholism (tolerance, sensitization, loss of control, dependence, withdrawal, and relapse).

Please enter your organization's views on the magnitude of health problems related to alcohol consumption:

There is overwhelming evidence that excessive, long-term alcohol consumption can cause a variety of adverse health effects across many major organ systems, including brain damage. Alcohol consumption can also alter neuronal function, resulting in cognitive deficits and neuroadaptations that contribute to the behavioral changes observed with alcoholism (tolerance, sensitization, loss of control, dependence, withdrawal, and relapse).

Fortunately, a number of governmental agencies fund the collection of epidemiologic and longitudinal data enabling scientists to track patterns of alcohol-related problems. The CDC and your own institution recently came to similar conclusions about the toll taken by alcohol misuse. According to the CDC, excessive alcohol consumption is the number-three cause of preventable death in the United States. The WHO also ranks alcohol third among preventable risk factors for premature death in developed nations.

Alcohol also contributes significantly to mortality from a wide range of acute and chronic injuries and diseases. In the U.S. alone, tens of thousands of people die each year from unintentional injuries (i.e., motor vehicle and fall injuries), as well as from intentional injuries (i.e., suicide and homicide), while under the influence of alcohol. Tens of thousands more die from chronic conditions, most notable of which are alcoholic liver disease and liver cirrhosis.

Alcohol abuse and dependence commonly occur in individuals who suffer from mood, anxiety, and personality disorders, as well as the effects of other drugs of abuse. Patients suffering co-morbid disorders often have poorer treatment outcomes and are more likely to drop out of treatment. The high co-morbidity between alcohol and tobacco dependence poses special problems. Alcoholics smoke heavily, are more addicted to nicotine, and are less successful at quitting smoking, which puts them at greater risk for certain cancers and cardiovascular diseases. In fact, fifty to ninety percent of alcoholics smoke, which is a rate three times higher than that of the population as a whole.

Please enter your organization's opinions on effective interventions to reduce health problems related to alcohol consumption:

During the past decade, advances have been made in behavioral interventions for alcoholism treatment. These interventions include motivational enhancement therapy, brief interventions, behavioral couple?s therapy, twelve-step facilitation therapy, and the community reinforcement approach. Although these interventions are effective in reducing or preventing drinking, limited information is known about how and why these treatments are effective. Understanding the mechanisms of action of an intervention involves identifying the active processes and/or components of treatments and how they result in positive outcomes. Such knowledge should ensure that interventions can be made more effective for the greatest numbers of patients under diverse conditions. Specification of the critical, active components of treatments might allow existing interventions to be modified in a manner which enhances these components, as well as modifying or eliminating the ingredients of the treatment that yield less positive effects. Further, understanding efficacy elements across alcohol interventions may facilitate development of new treatments with greater efficacy than existing ones.

Efforts to develop medications for alcohol use disorders have expanded rapidly in recent years. Three agents -- disulfiram, naltrexone, and acamprosate -- are now approved for use in the U.S. and many other countries. However, some patients do not respond to these medications, and their effectiveness among individuals with psychiatric/medical/substance abuse comorbidities, adolescents, minority groups, and other special populations remains uncertain. Therefore, developing new medications in conjunction with psychosocial therapies is an important step toward improving treatment outcomes for all individuals with alcohol use disorders.

Because researchers and practitioners are becoming more sensitive to the chronicity of alcohol disorders and related medical consequences, questions of how to integrate new and effective strategies for treating substance abuse over time and across multiple settings are becoming as important as knowing what works with which aspect of the disorder -- with whom, under what conditions, and at what cost.

Additional comments:

Alcohol is the drug of choice among youth. Data from the 2005 Monitoring the Future (MTF), an annual survey of U.S. youth, show that more than three-fourths of 12th graders, nearly two-thirds of 10th graders, and more than two-fifths of 8th graders have consumed alcohol at some point in their lives. And when youth drink, they tend to drink heavily.

Recognizing that underage drinking is such a serious public health problem for our youth, APA appreciates the fact that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has made it a research priority for the Institute and has intensified its research, evaluation, and outreach efforts. An important impetus for NIAAA?s initiative was epidemiologic findings that indicated that the kind of serious drinking problems previously associated with middle adulthood often begin to emerge during adolescence and young adulthood. NIAAA is now committed to investigating alcohol-related problems in a developmental context as psychological and neurobiological research suggest that adolescence may be a period of particular vulnerability to the effects of alcohol.

It is not clear whether early use of alcohol actually causes alcohol dependence or whether it simply indicates an existing vulnerability to alcohol use disorders. Some evidence indicates that genetic, physiologic, and psychological factors may contribute to the relationship between early drinking and subsequent alcoholism. Clearly, a developmental approach will be necessary to fully elucidate the scientific basis of these phenomena and to prevent and successfully treat the causes, problems, and consequences associated with underage drinking. Many scientific psychologists have contributed to the existing body of research on the prevention, etiology, and treatment of alcohol dependence and will keep doing so as developmental science continues to inform both the understanding of the origins of underage drinking and strategic planning to reduce the adverse outcomes that result from underage drinking.