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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
community 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
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
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.
PROMOTING HEALTH/PREVENTING DISEASE
OBJECTIVES FOR THE NATION
MISUSE OF ALCOHOL AND DRUGS
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 licit 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.
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. • 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 cris 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
rhosis, alcoholism or alcoholic psychosis could
be directly attributed to alcohol use. • In 1975, an additional 51,000 fatalities could be
indirectly attributed to alcohol use. • Alcohol has been identified as a risk factor for
cancers of the oral cavity, esophagus and liver. • In 1977, about 45 percent of all motor vehicle
fatalities involved drivers with blood alcohol
population, use more drugs and for longer periods of time than any other age group, ac
counting for 30 percent of all medicines consumed. • 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.
35.5 million hospital admissions each year are
18 years and over are frequent heavy drinkers
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 1990 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.
DRUGS USED FOR MEDICAL PURPOSES
than 1,300 deaths in 1976.
general public information campaigns, and
programs which offer general social support
dren at high risk of alcoholism; - a broad range of treatment services in em
ployee assistance programs, in general
product safety changes which reduce the risk of injury and death in places associated with use of alcohol and other drugs (e.g., airbags hones and in other long-term care facilities. • Economic measures include: - excise taxes on alcoholic beverages and
in motor vehicles and improved fireproofing
in residences); - modification to alcoholic beverages them
selves (eg, 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
alcobolic beverages (i.e., zoning regulations
stronger legal disincentives; - controlling advertising of alcoholic bever
inal sanctions; - regulation of conditions under which these
substances are available for authorized uses,
(estrogens, progestins); - drug information for patients in nursing
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 perspective, 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.
ally been focused on public health considera-
couraging preliminary findings. ,3. Specific Objectives for 1990
Improved health status