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called Prevention Plus, based on these conferences, is now available for use

in schools and communities.

Its purpose is to marshal the school and

canmunity resources to develop more comprehensive prevention programs.

In March of this year, Secretary Dole, Governor Volpe and I had the

opportunity to participate in the first national conference for youth on

teenage drinking and driving.

The conference was held in Chevy Chase,

Maryland at the National 4-H Center and was attended by nearly 400 bright,

energetic young people from every State and Territory. These young people joined together dedicated to eliminating drunk driving among their peers. Their sincerity, enthusiasm, and determination, give one faith in the future.

Right now, these young people who met in Chevy Chase are mounting

anti-drinking and driving campaigns base on positive peer pressure.


effort focuses on using young people to persuade other young people that

drinking and driving is not acceptable and can be deadly. Since this

conference, 34 States have reported starting new anti-drinking and driving


Next April, I intend to convene the Second Annual Conference for

Youth on Drinking and Driving to continue this initiative.


In addition to these conferences, this past spring we sponsored a special art

exhibit for young people which featured works depicting teenage drinking and


I am also pleased that this Fall we are helping to organize 15 more

conferences which will help communities assess the need for treatment

programs, for students who encounter problems associated with the use of

alcohol and drugs. When someone's drinking gets out of hand, do parents know

where to turn?

Do children? Do friends? These meetings will provide

answers, explain what treatment may consist of, and show

when trouble

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All of these actions are part of a Secretarial initiative of high personal

priority and are aimed at getting the appropriate message to our young people.

Additionally, in recent years, largely in response to growing public concern,

many States have moved to raise the minimum age for possession, purchase, and

consumption of alcoholic beverages.

Evidence is accumulating which indicates

that raising the legal drinking age significantly reduces alcohol-related

motor vehicle accident involvement among this age group.

However, while I

believe that this can be an effective measure to reduce the tragic toll of

alcohol-related motor vehicle accidents among young people, at the same

time, I believe that this is an appropriate matter for the States to consider

rather than be mandated at the Federal level as proposed in H.R. 3870.

It is my belief that the actions of the Federal, State, and local Governments,

as well as citizens groups, including groups such as Student Aganist Drunk

Driving (SADD) and Mothers Aganist Drunk Driving (MADD), can have a positive

impact on this tragic problem.



Fall 1980


levels of .10 percent or more, a rate of 11.5

per 100,000 population. • In 1975, the costs of alcohol problems were

estimated to be $43 billion in lost production, health and medical services, accidents, crime

and other social consequences. • The Fetal Alcohol Syndrome is estimated to

cause some 1,400 to 2,000 birth defects an

nually. OTHER DRUGS • The vast majority of users of “other drugs” are

marijuana users, but the category is not limited

to this group.

1. Nature and Extent of the Problem

A major objective of the drug and alcohol prevention policy is to reduce the adverse social and health consequences associated with the misuse of these substances, especially among adolescents, young adults, pregnant women and the elderly.

Alcohol and other drug problems have pervasive effects: biological, psychological and social consequences for the abuser; psychological and social effects on family members and others; increased risk of injury and death to self, family members and others (especially by accidents, fires or violence); and derivative social and economic consequences for society at large. Destructive drug and alcohol use shares many similarities with tobacco use and may respond to some of the same prevention strategies (see Smoking and Health).

Per capita alcohol consumption and use of other drugs for non-medical purposes decreases with older age groups, but the use of drugs for medical purposes, both over-the-counter and prescription drugs, increases.* Since the aging process is accompanied by physiologic changes that after the body's response to both food and drugs, practices of self-medication, over-prescribing and the concurrent use of two or more drugs can create serious health problems for the elderly. Concurrent misuse of alcohol and drugs consumed for either non-medical or medical

purposes increases risks to health and complicates the delivery and financing of preventive and treatment measures from both private and public sources. *NOTE: For purposes of this report, the term “use of other drugs” refers to self-reported use of lici: or illicit drugs for non-medical or self-defined purposes. It does not include inappropriate use of drugs consumed for medical purposes, nor the use of alcohol or tobacco. These are discussed separately. e Health implications

• In 1975, an estimated 36,000 deaths from cir-

rhosis, alcoholism or alcoholic psychosis could

be directly attributed to alcohol use. • In 1975, an additional 51,000 fatalities could be

indirecuy attributed to alcohol use. • Alcohol has been identified as a risk factor for

cancers of the oral cavity, esophagus and liver. • lo 1977, about 45 percent of all motor vehicle

fatalities involved drivers with blood alcohol

• The social cost of drug abuse, including law

enforcement, has been estimated to be at least $10 billion per year, a figure which may be an underestimate considering the difficulties of measuring the aggregate health and social con

sequences of those behaviors. • Between May 1976 and April 1977, there were

an estimated 7,000 to 8,000 deaths and an estimated 275,000 to 300,000 medical emergencies

related to misuse of drugs. • An undetermined portion of deaths and medical

emergencies relate to drug use for suicide and attempted suicide (see Control of Stress and Violent Behavior) and may be very difficult to

prevent. • Barbiturates were the class of drugs mentioned

most frequently by medical examiners in connection with drug-related deaths reported to the Drug Abuse Warning Network between May 1977 and April 1978 (2 percent of drugs men

tioned). • Tranquilizers were the class of drugs mentioned

most frequently by emergency rooms during the

same period (24 percent of drugs mentioned). ? The proportion of barbiturate and tranquilizer

misuse that is deliberate and the proportion that ris accidental is not known.

DRUGS USED FOR MEDICAL PURPOSES • Use of high estrogen content oral contraceptives

by women smokers increases risks of coronary and cerebrovascular disease.

See Family Planning • People over 65 years of age, 11 percent of the

population, use more drugs and for longer periods of time than any other age group, ac.

counting for 30 percent of all medicines con

sumed. • The risk of adverse drug reactions in elderly

patients is almost twice that in patients between

30 and 40 years of age. • Between 70 and 80 percent of reactions are pre

dictable and preventable. • Between 0.3 and 1.0 percent of the nation's total

35.5 million hospital admissions each year are

due to adverse drug reactions. • Improper use of drugs forces curtailment of

normal activities, or contributes to such curtailment, in an unknown proportion of the disabled population.

b. Status and trends

• An estimated 10 percent of the adult population

18 years and over are frequent heavy drinkers
(5 or more drinks per occasion at least once

per week). • Most problems indirectly attributable to alcohol

(homicides, car crashes) have the highest rates

among young adult males ages 18 to 24 years. • National surveys indicate no changes in peak

quantity consumed by teenagers 12 to 17 (five or more beers at a time) or in regularity of

their drinking, between 1974 and 1978. • Alcoholism mortality rates (2 per 100,000) and

alcoholic psychosis rates (1 per 100,000) show

little overall increase between 1950 and 1975. • Based on survey reports and tax-paid with

drawals, per capita consumption of absolute alcohol did not change significantly during the years 1971 to 1976. More recent data indicate that per capital consumption began to increase again after 1976, from 2.7 gallons to 2.82 gallons of absolute alcohol per capita in 1978. Whether the increase will continue is not yet

known. OTHER DRUGS • A dramatic decline in level of heroin-related

medical problem indicators was seen from 1976

to 1977, suggesting a decline in heroin use. • The proportion of adolescents (12 to 17 years

old) reporting current use of marijuana has been rising continuously for the last decade and has increased significantly from 6 percent in

1971 to 16 percent in 1977. • The proportion of young adults (18 to 25 years

old) reporting that they had ever used marijuana rose from 39 percent in 1971 to 60 percent in

1977. • It has been estimated that there are approxi

mately 2,500,000 persons (roughly 2 percent of the population age 18 and over) having serious

drug problems. • Epidemiological evidence suggests that the use

of alcohol, tobacco and marijuana by adolescents is associated.

• Barbiturate-related mortality accounted for less

than 1,300 deaths in 1976.
. 2. Prevention/Promotion Measures
a. Potential measures
• Education and information measures include:

general public information campaigns, and
programs targeted to children and youth and
to specific at-risk populations, with specific
messages to facilitate problem recognition or
reinforce desired behavior;
programs targeted at a wide array of service
professions concerning the recognition of,
and responses to, alcohol and other drug
information on medicine labels on drug/
drug, drug/food and drug/alcohol interac-
tions, with practical guidance on avoiding
clinically significant interactions;
school and community-based health educa-
tion programs, some using peer leaders and
special education programs emphasizing ef-
fective risk-management skills and alterna-
tives to drug and alcohol use;
education of physicians, nursing home staff
and patients about hazards surrounding the
misuse of tranquilizers, hypnotics and other
classes of prescription and nonprescription
easily understandable information available
to patients taking drugs for medical pur-

• Service measures include:

programs which offer general social support
(youth centers, recreation programs) and
thereby provide alternatives to drug and
alcohol use;
outreach and early intervention services at
the worksite and in community settings for
persons whose behavior indicates that they
are at-risk for the development of alcohol
or other drug problems;
anticipatory guidance, identification of chil-

dren at high risk of alcoholism;
- a broad range of treatment services in em-

ployee assistance programs, in general
health care delivery settings and in special-
ized alcohol and drug facilities;
counseling by pharmacists to older people
taking drugs for medical purposes;
maintenance of computerized drug profiles;
hotlines and drug information centers people
can use to learn about drug effects and

• Technologic measures include:

product safety changes which reduce the risk
of injury and death in places associated with
use of alcohol and other drugs (e.g., airbags

in motor vehicles and improved fireproofing
in residences);
modification to alcoholic beverages them-
selves (e.g., reduction of alcohol content,

reduction or elimination of nitrosamines); - efforts by community institutions to modify

social settings and contexts to reduce the risk associated with intoxication and to alter social reaction to some types of drinking or

drug-using behavior.
• Legislative and regulatory measures include:

regulating the conditions of availability of
alcoholic beverages (i.e., zoning regulations
regarding hours of sale, Dumbers of outlets
and numbers of licenses);
enforcing minimum drinking age laws and
employing legal disincentives to discourage
the dispensing of alcohol to obviously intoxi-
cated persons;
enforcing laws prohibiting driving while in-
toxicated by alcohol or drugs and initiating
stronger legal disincentives;
controlling advertising of alcoholic bever-
enforcing laws related to production, distri-
bution and use of "other drugs” that are
proscribed except for medical and scientific
purposes; special law enforcement agencies
are responsible for enforcing such prohibi-
tions and violations are punishable by crim-
inal sanctions;
regulation of conditions under which these
substances are available for authorized uses,
such as measures relating to scheduling of
"controlled substances' and limitations on
periodic re-examination of sanctions to en-
sure correspondence to the degree of severity
of the health and social problems associated
with the overuse of each particular sub-
stance or drug;
patient labeling for certain prescription drugs

(estrogens, progestins); - drug information for patients in nursing

hones and in other long-term care facilities. • Economic measures include: - excise taxes on alcoholic beverages and

other means of affecting the price of alcohol; -tax incentives or disincentives to control

levels of advertising expenditures for alco

holic beverages. b. Relative strength of the measures • Systematic evaluation of the effects of education

and yearly intervention programs targeted at children and youth and populations at special

risk is at an early stage. • Regulatory measures have been the Nation's

primary tool of drug abuse prevention during most of the 20th century. There is much debate

about the overall cost-benefit assessment of the current prohibitions. From a more limited per. spective, however, some recent trends tend to support claims that regulatory approaches have

had an impact on the extent of drug use. • Heroin addiction in this country has been de

clining in recent years, coincident with reduced supplies on the illegal market and the extensive availability of treatment services. Late in 1979, however, the supply and incidence of heroin use increased in several Eastern cities. Also, barbiturate-related mortality has been declining steadily as a result of increased legal controls, greater physician awareness of the most efficacious uses of these drugs, and improved public awareness of the hazards associated with the use of barbiturates in combination with other

depressants. • Mass media campaigns that have focused public .

attention upon alcohol use and abuse may have contributed to a period of relative stability in alcohol consumption during the seventies (although economic conditions were also a likely significant factor). Alcohol problems, as noted by several indicators (cirrhosis mortality rate decline, survey data on alcohol consumption among youth and adults), appear also to have leveled off during this period of apparent stability. While direct causal attribution is not possible, the creation of a National alcoholism treatment network and early intervention services in the workplace probably played a role in the

stabilization of cirrhosis deaths. • Alcoholic beverage regulation has not tradition

ally been focused on public health considerauons, but data concerning the impact of regulatory initiatives on tobacco smoking may be transferable to the alcohol area. Research here and in other countries suggests that the availability of alcohol may affect the level and type of alcohol problems, particularly physical health problems consequent to long-term excessive drinking. Consumption, in turn, has been linked fairly conclusively to the relative price of alcohol, and less conclusively to such factors as the legal purchase age, number and dispersion of retail on-premise and off-premise outlets, and hours of sale. Also “Dram Shop" laws can offer powerful incentives for alcoholic beverage licensees to try to reduce the likelihood of intoxica

tion among their patrons. • In general, alcohol and drug education programs

can increase information levels and modify attitudes. Their effect on drinking or drug-using behavior has not yet been demonstrated conclusively, although recent studies have yielded en

couraging preliminary findings. „3. Specific Objectives for 1990

Improved health status
a. By 1990, fatalities from motor vehicle accidents


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