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• 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-

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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 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.

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

• 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

• 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 adoles-
cents is associated.

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, numbers 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

homes 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 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, barbituratc-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 bave 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 considera-
tions, but data concerning the impact of regula-
tory initiatives on tobacco smoking may be
transferable to the alcohol area. Research here
and in other countries suggests that the avail-
ability 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 alco-
hol, 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 licen-
sees 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 conclu-
sively, 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

involving drivers with blood alcohol levels of .10 percent or more should be reduced to less than 9.5 per 100,000 population per year. (In

1977, there were 11.5 per 100,000 population.) b. By 1990, fatalities from other (non-motor ve

hicle) accidents, indirectly attributable to alcohol use, e.g., falls, fires, drownings, ski mobile, aircraft) should be reduced to 5 per 100,000 population per year. (In 1975, there were 7 per

100,000 population.) c. By 1990, the cirrhosis mortality rate should be

reduced to 12 per 100,000 per year. (In 1978,

the rate was 13.8 per 100,000 per year.) *d. By 1990, the incidence of infants born with the

Fetal Alcohol Syndrome should be reduced by
25 percent. (In 1977, the rate was 1° per 2,000
births, or approximately 1,650 cases.)
*NOTE: Same objective as for Pregnancy and

Infant Health.
e. By 1990, other drug-related mortality should be

reduced to 2 per 100,000 per year. (In 1978,

the rate was about 2.8 per 100,000.) f. By 1990, adverse reactions from medical drug

use that are sufficiently severe to require hospital admission should be reduced to 25 percent fewer such admissions per year. (In 1979, estimates range from approximately 105,000 to

350,000 admissions per year.) • Reduced risk factors g. By 1990, per capita consumption of alcohol

should not exceed current levels. (In 1978, about 2.82 gallons of absolute alcohol were consumed per year per person age 14 years and

h. By 1990, the proportion of adolescents 12 to 17

years old who abstain from using alcohol or
other drugs should not fall below 1977 levels.
(In 1977, the proportion of abstainers was:
46 percent for alcohol; for other drugs, ranging
from 89 percent for marijuana to 99.9 percent
for heroin.*)
*NOTE: A person is defined as not using alcohol
or other drugs if he or she has never used the
substance or if the last use of the substance

was more than one month earlier.
i. By 1990, the proportion of adolescents 14 to 17

years old who report acute drinking-related
problems during the past year should be reduced
to below 17 percent.* (In 1978, it was estimated
to be 19 percent based on 1974 survey data.)
*NOTE: Acute drinking-related problems have
been defined as problems such as episodes of
drunkenness, driving while intoxicated, or
drinking-related problems with school authori-

j. By 1990, the proportion of problem drinkers

among all adults aged 18 and over should be

reduced to 8 percent. (In 1979, it was about 10

k. By 1990, the proportion of young adults 18 to 25

years old reporting frequent use of other drugs
should not exceed 1977 levels. (In 1977, it was
less than one percent for drugs other than mari-
juana and 19 percent for marijuana.*)
*NOTE: "Frequent use of other drugs” means
the non-medical use of any specific drug op 5

or more days during the previous month.
1. By 1990, the proportion of adolescents 12 to 17

years old reporting frequent use of other drugs should not exceed 1977 levels. (In 1977, it was less than 1 percent for drugs other than mari

juana and 9 percent for marijuana.) • Increased public/professional awareness m. By 1990, the proportion of women of childbear

ing age aware of risks associated with pregnancy and drinking, in particular, the Fetal Alcohol Syndrome, should be greater than 90 percent.

(lo 1979, it was 73 percent.) A. By 1990, the proportion of adults who are

aware of the added risk of head and neck cancers for people with excessive alcohol consumption should exceed 75 percent. (Baseline data

unavailable.) 0. By 1990, 80 percent of high school seniors

should state that they perceive great risk associated with frequent regular cigarette smoking, marijuana use, barbiturate use or alcohol intoxication. (In 1979, 63 percent of high school seniors perceived "great risk” to be associated with 1 or 2 packs of cigarettes smoked daily, 42 percent with regular marijuana use, 72 percent with regular barbiturate use, and only 35 percent with having 5 or more drinks per occasion

once or twice each weekend.) p. By

1990, pharmacists filling prescriptions should routinely counsel patients on the proper use of drugs designated as high priority by the FDA, with particular attention to prescriptions for pediatric and geriatric patients and to the problems of drinking alcoholic beverages while taking certain prescription drugs. (Baseline

data unavailable.) • Improved services/protection 9. By 1990, the proportion of workers in major

firms whose employers provide a substance abuse prevention and referral program (employee assistance) should be greater than 70 percent. (In 1976, 50 percent of a sample of the Fortune 500 firms offered some type of

employee assistance program.) r. By 1990, standard medical and pharmaceutical

practice should include drug profiles on 90 percent of adults covered under the Medicare program, and on 75 percent of other patients with acute and chronic illnesses being cared for in

all private and organized medical settings.

(Baseline data unavailable.) • Improved surveillance/cvaluation systems s. By 1990, a comprehensive data capability

should be established to monitor and evaluate the status and impact of misuse of alcohol and drugs on: health status; motor vehicle accidents; accidental injuries in addition to those from motor vehicles; interpersonal aggression and violence; sexual assault; vandalism and property damage; pregnancy outcomes; and emotional and physical development of infants

and children. 4. Principal Assumptions

• The Federal emphasis on research and technical

assistance will continue, with primary reliance on State and local governments and the voluntary sector for delivery of alcohol and drug abuse preven

tion services. • Rc rces and services devoted by State and local

governments, and voluntary groups, for drug and alcohol prevention programs and services will ex

pand. • Federal funding for research and evaluation in drug

and alcohol prevention will modestly increase, with special attention to the priority areas reflected in

the proposed objectives, • Federal information initiatives will continue to

sensitize the public to the adverse social and health consequences of heavy or frequent use of alcohol

and other drugs. • Strong and varied initiatives both public and pri

vate, wili scek to minimize use of tobacco, alcohol and other drugs by children and adolescents-including coordinated efforts with alcohol producers, distributors, retailers and State alcohol control com

missions. • The allocation of resources by alcohol producers,

distributors and retailers to the marketing, promotion and distribution of alcoholic beverages will

probably increase. • No dramatic shift in tax or regulatory policies to

ward availability and consumption of alcoholic beverages will occur, unless consumption trends

require reconsideration. • There will be no dramatic or permanent shift in the

availability of controlled substances outside legiti

mate medical and scientific channels. • The trend will continue toward hodifi

the criminal law and its less punitive administration in cases involving arrests for personal possession of

marijuana and other drugs.
5. Data Sources
a. To National level only
• Health Interview Survey (HIS). Accidental in-

juries, disability, use of hospital, medical and
other services, and other health-related topics.

DHHS-National Center for Health Statistics
(NCHS). NCHS Vital and Health Statistics,
Series 10, selected reports, and Advance Data,
selecied reports. Continuing household inter-

view survey; National probability samples. • Health Examination Survey (HES) and the

Health and Nutrition Examination Survey (HANES). Alcohol and drug related conditions. DHHS-NCHS. Vital and Health Statistics, Series 11, selected reports. Periodic surveys; National probability samples; data obtained

from physician's examinations. • National Hospital Discharge Survey (HDS).

Utilization of hospital services related to misuse of alcohol and drugs. DHHS-NCHS Vital and Health Statistics, Series 13. Continuing; Na

tional probability sample, short stay hospitals. • National Ambulatory Medical Care Survey

(NAMCS). Alcohol and drug related patientphysician encounters. DHHS-NCHS. NCHS Viral and Health Statistics, Series 13. Continuing survey; National probability sample, office

based physicians. • The lifestyle and values of youth. Non-medical

use of substances in 12 categories including marijuana, barbiturates, cocaine, prescription drugs, alcohol, cigarettes. DHHS-NIDA. Drugs in the Class of (survey year date), Behaviors, Attitudes and Recent National Trends, series Number 20. Annual surveys since 1975 of high school seniors in a National sample of public

and private schools. • The National Survey on Drug Abuse. Estimates

of the levels of illicit and legal drug use in the United States: marijuana-hashish, cocaine, hallucinogens, heroin and other opiates; summary of data on use of inhalants, alcohol, cigarettes and the non-medical use of psychotherapeutic drugs legally prescribed. DHHS-NIDA. Highlights from the National Survey on Drug Abuse, 1977. Continuing survey since 1971; National

sample. • Drug Abuse Warning Network (DAWN). Drug

abuse encountered in emergency rooms and medical examination offices. DHHS-NIDA and the Drug Enforcement Administration. Quarterly reports of provisional data Series G, NIDA. Continuing survey in 26 standard metro

palitan statistical areas. • National Prescription Audit (NPA). Drug sales,

including barbiturates, tranquilizers; source of prescription; payment status, provider type. IMS America, Lid., Ambler, Pennsylvania. IMS reports. Continuing audit of pharmacies on IMS

panel. Third Special Report to the U.S. Congress on

Alcohol and Health, June 1978. Subsequent reports will be available approximately every

three years.

6. To State and/or local level
• National Vital Registration System

Mortality. Deaths by cause (including alco-
hol and drug related), by age, sex and race,
DHHS-NCHS. NCHS Vital Statistics of the
United States, Vol II, and NCHS Monthly
Vital Statistics Reports. Continuing report-
ing from States; National full count. (Many

Slates issue earlier reports.) • Hospitalized illness discharge abstract systems.

Professional Activities Study (PAS). Patients in short stay hospitals; patient characteristics, alcohol and drug related diagnoses, procedures performed, length of stays. Commission on Professional and Hospital Activities, Ann Arbor, Michigan. Annual reports and tapes. Continuous reporting from 1900 CPHA member hospitals; not a probability sample, extent of hospital participation var

ies by State. – Medicare hospital patient reporting system

(MEDPAR). Characteristics of Medicare
patients, diagnosis, procedures. DHHS-

Health Care Financing Administration,
Office of Research, Demonstration and Sta-
tistics (ORDS). Periodic reports. Continu-
ing reporting from hospital claim data; 20
percent sample.
Other hospital discharge systems as locally

• Area Resource File (ARF). Demographic,

bealth facility and manpower data at State and county level from various sources. DHHSHealth Resources Administration Area Resource File: A Manpower Planning and Research Tool, DHHS-HRA-80-4, Oct. 79. One

time compilation. • Annual Census of State and County Mental

Hospitals. Resident patients and new admissions to mental institutions; costs, diagnoses of alcohol psychoses. DHHS-ADAMHA, National Institute of Mental Health (NIMH). Mental Health Statistical Notes, selected issues; special reports and tabulations furnished to the Center for Disease Control. Continuing reporting; National full count of patients in State and county mental hospitals.

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