On the Trail of Fetal Alcohol Syndrome

 2000.  Tenth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA.  Pages 282-338.

 FAS-foreningen was founded in August, 2000 in Sweden by Katarina Wittgard.  It started with a network in 1999 with the support of Dr. Marita Aronson, one of the foremost researchers on FASD in Europe.

 The revison to the fourth editon of the Diagnostic and Statisitcal Manual of Mental Disorders (DSM-IV-R) is published by the American Psychiatric Association.

 2001.  The SAMHSA FASD Center for Excellence was initiated.  The U.S. Congress authorized the Center in Section 519D of the Children's Health Act of 2000, which included six mandates (Section b of 42 USC 290bb-25d or Public Law 106-310). The mandates focus on exploring innovative service delivery strategies, developing comprehensive systems of care for FASD prevention and treatment, training service system staff, families, and individuals with an FASD, and preventing alcohol use among women of childbearing age.

Term "Fetal Alcohol Spectrum Disorders" comes into use.

Craig Lesley writes Storm Riders, a fictionalized account of his adopted son who has FAS.  Picodor Pubishers.

 2002.  FASworld Deutschland was founded on September 7, 2002 by Ann Gibson. 

FAS Stichting Nederlands was officially founded on 23 September 2002.

Dr. Nancy Day of the University of Pittsburgh finds that as little as one drink a day can cause physical deficits.  (Study in the journal Alcoholism:   Clinical and Experimental Research.)  Report in Reuters News Service, October 17, 2002.

 2003.  CalFAS (California FAS) was founded by Diane Kerchener. It started through a meeting with SAMHSA, who encouraged CA's three state representatives, Diane Kerchner, Kathy Page and Michael Monti along with NOFAS to start a state organization.

 2004.  NIAAA National Advisory Council approves the definition of binge drinking as 4 or more drinks for a female and 5 or more for a male.

 April, 2004 the National Institutes of Health (NIH), the Centers for Disease Control (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), along with the National Organization on FEtal Alcohol Syndrome and other experts in the field developed the following definition of Fetal Alcohol Spectrum Disorders.  " Fetal Alcohol Spectrum Disorders (FASD) is an umbrellla term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy.  These effects may include physical, mental, behavioral and/or learning disabilites with possible lifelong implications.  The term FASD is not intended for use as a clinical diagnosis." 

Damaged Angels by Bonnie Buxton.  The second internationally distributed book on FASD and its effectson a Canadian family.  It was first published in Canada and soon to be published in the United States in May of 2005.

Dr. John W. Olney of Washington University in St. Louis says even two drinks during pregnancy can cause neurological damage.  (From a presentation to the American Association for the Advancement of Science.)  (Reported in the Associated Press, February 14, 2004.)

 Fetal Alcohol Syndrome:  Guidelines for Referral and Diagnosis.  Published by the National Center on Birth Defects and DevelopmentalDisabilities, Centers for Disease Control and Prevention, Department of Health and Human Services.  The latest update on diagnostic criteria.

 May 10th, 2004, six Japanese brewers voluntarily place warning labels on their products.  According to the newspaper article, Japan joined Brazil. South Korea, and the United States in the use of warning labels for drinking during pregnancy.

The World Health Organization Global Status Report on Alcohol  mentions  the effects of prenatal alcohol exposure in one paragraph.

 2005. Sandy's Law.  February 1, 2005, the Province of Ontario, Canada's Liquor Licence Act requires certain premises to post signs warning women that drinking alcohol during pregnancy can cause Fetal Alcohol Spectrum Disorder.  It must be prominently displayed in all locations where beverage alcohol is sold or where customers brew their own wine or beer for take home consumption. Failure to comply with the signage requirements is an offence under the Liquor Licence Act.
    The following types of premises must post the warning sign:
Restaurants and bars licensed to sell beverage alcohol (wine, beer and spirits), LCBO stores and other retail stores authorized to sell beverage alcohol (i.e., The Beer Store, and wine, beer and spirits manufacturers’ stores) and Licensed brew-on-premise facilities."   

U.S. Surgeon Generals's Advisory of February 21st, 2005 updates the 1981 Surgeon General's Advisory that suggested pregnant women "limit" the amount of alcohol they drink now changes to "abstain".  In addition, studies indicate that a baby could be affected by alcohol consumption within the earliest weeks after conception, even before a woman knows that she is pregnant.  For that reason, the Surgeon General is recommending that women who may become pregnant also abstain from alcohol.
        Based on the current, best science available we now know the following:

- Alcohol consumed during pregnancy increases the risk of alcohol related
birth defects, including growth deficiencies, facial abnormalities, central
nervous system impairment, behavioral disorders, and intellectual
development.
- No amount of alcohol consumption can be considered safe during pregnancy.
- Alcohol can damage a fetus at any stage of pregnancy.  Damage can occur in
the earliest weeks of pregnancy, even before a woman knows that she is
pregnant.
- The cognitive deficits and behavioral problems resulting from prenatal
alcohol exposure are lifelong.
- Alcohol-related birth defects are completely preventable.

For these reasons:
1. A pregnant woman should not drink alcohol during pregnancy.
2. A pregnant woman who has already consumed alcohol during her pregnancy
should stop in order to minimize further risk.
3. A woman who is considering becoming pregnant should abstain from alcohol.4. Recognizing that nearly half of all births in the United States are
unplanned, women of child-bearing age should consult their physician and
take steps to reduce the possibility of prenatal alcohol exposure.
5. Health professionals should inquire routinely about alcohol consumption
by women of childbearing age, inform them of the risks of alcohol
consumption during pregnancy, and advise them not to drink alcoholic
beverages during pregnancy.
    In the United States, FAS is the leading preventable birth defect with associated mental and behavioral impairment.  There are many individuals exposed to prenatal alcohol who, while not exhibiting all of the characteristic features of FAS, do manifest lifelong neurocognitive and behavioral problems arising from this early alcohol exposure.  In the United States, the prevalence of FAS is between 0.5 to 2 cases per 1,000 births.  It is estimated that for every child born with FAS, three additional children are born who may not have the physical characteristics of FAS but still experience neurobehavioral deficits resulting from prenatal alcohol
exposure that affect learning and behavior.
    The outcomes attributable to prenatal alcohol exposure for the children of  women whose alcohol consumption averages seven to 14 drinks per week include deficits in growth, behavior, and neurocognition such as problems in arithmetic, language and memory; visual-spatial abilities; attention; and deficits in speed of information processing.  Patterns of exposure known to place a fetus at greatest risk include binge drinking, defined as having five or more drinks at one time and drinking seven or more drinks per week.
    Despitepublic health advisories and subsequent efforts to disseminate this information, including a Surgeon General's advisory in 1981, recent data indicate that significant numbers of women continue to drink during pregnancy, many in a high-risk manner that places the fetus at risk for a broad range of problems arising from prenatal alcohol exposure including fetal alcohol syndrome.  For example, data suggest that rates of binge drinking and drinking seven or more drinks per week among both pregnant women and non-pregnant women of childbearing age have not declined in recent years.  Many women who know they are pregnant report drinking at these levels.
    In addition, recent analysis of obstetrical textbooks suggests that physicians may not be receiving adequate instruction in the dangers of prenatal alcohol exposure. The American College of Obstetricians and Gynecologists advises against drinking at all during pregnancy.  Nevertheless, only 24 percent of obstetrical textbooks published since 1990 recommended abstinence during pregnancy, despite 30 years of research since the first publications proposed a link between alcohol exposure and birth defects.  Scientific evidence amassed in these decades has fortified the rationale for the original advisory against alcohol consumption during pregnancy.  Continuing research has generated a wealth of new knowledge on the nature of fetal alcohol-induced injury, the underlying mechanisms of damage, concurrent risk factors, and the clinical distinction of alcohol-related deficits from other disorders.
    Alcohol-related birth defects are completely preventable.  A number of resources are available to assist healthcare and social services professionals in advising their patients to reduce and refrain from alcohol in pregnancy.  These resources include the National Institute on Alcohol Abuse and Alcoholism, NIH ( www.niaaa.nih.gov ), the Centers for Disease Control and Prevention ( www.cdc.gov/ncbddd/fas/ ), and the Substance Abuse and Mental Health Services Administration ( www.fasdcenter.samhsa.gov/ ).

  Stout, Martha.  The Sociopath Next Door.  In an interview on NBC Saturday Today Show, she states, "Most sociopaths are not violent."  "They are often have a failure to plan."  "They can be charming."

        Russell, Elizabeth.   Alcohol and Pregnancy:  A Mother's Responsible Disturbance.  (2005)  Burleigh, Australia:  Zeus Publications.  One of the only non-fiction books written by an Australian birth mother about her struggles to advocate for her two sons. Discusses legal issues and residential alternatives. 

  2006.  The Merck Manual:  Eighteenth Edition.  Will not be online until August of 2006.  Two paragraphs are devoted to Fetal Alcohol Syndrome.
  Section 18:  Gynecology and Obstetrics, mentions "...increased risk of spontaneous abortion... fetal growth restriction...facial and cariovascular defects and neurologic dysfunction."  "It isa leading cause ofmental retardation and can cause neonatal death due to failure to thrive."
  Section 19:  Pediatrics, mentions, "...a constellation of physical and cognitive abnormalities."  "After birth, cognitive deficits become more apparent."  "The most serious manifestation is severe mental retardation..."  "...lesser degrees of alcohol use cause less severe manifestations..."

         The descriptions of the Antisocial and Histronic Personality Disorders (Section 15) are essentiallythe same.
 Antisocial:  "...callous disregard for the rights and feelings of others."  "...frustrated easily and tolerate frustration poorly."  "...act of conflicts impulsively and irresponsibly, sometimes with hostility and violence."  "They usually fail to anticipate the consequences of their behaviors and typically do not feel remorse or guilt afterward."  "...glibly rationalizing their behaviors or blaming it on others."  "Dishonestly and deceit permeate their relationships."  "Punishment rarely modifies their behavior or improves their judgment." 
 Histronic:  "...conspicuous attention seeking."  "...frequently evoke sympatheticor erotic attention."  "Relationships are often easily established and overly sexualized but tend to be superficial and transient."

FASD Center for Excellence produces a report on the economic costs of FAS(D) which estimated the lifetime cost at $3.5 million.  Costs of lost opportunities for caretakers and the person with FAS(D) are undeterminable but might be an extra $1.5 million.

  On October 25th, 2006, the European Union Strategy to Reduce Alcohol-Related Harm very briefly addressed Foetal Alcohol Disdorders on page 8 of the strategy...
http://ec.europa.eu/health/ph_determinants/life_style/alcohol/documents/alcohol_com_625_en.pdf

On November 20th, 2006 France requires warning labels on alcoholic beverages.

2007.  January 31st, 2007:  Diane Black of the Netherlands appears before the European Parliment during a seminar on European Alcohol Policies.  Dr. Black makes a speech on Prenatal Acohol Exposure in Brussels, Belgium.

 April, 2007.  ADHD and Fetal Alcohol Spectrum Disorders (FASD) edited by Dr. Kieran O'Malley is published.  One of the few textbooks that discuss the adult with FASD, epigenetics, similarities between the ADHD and FASD diagnoses, medications, dual diagnoses,  social communication, sexually inappropriate behavior and the judicial system.

  May 24th, 2007:    http://www.svd.se/dynamiskt/inrikes/did_15531275.asp.  [Non-professional translation]  "Cuba brought down Sweden at the WHO" Svenska Dagbladet, published 24 May 2007. Geneva.
    A Swedish resolution for a global strategy against alcohol has ended in a fiasco at WHO's World Health Assembly in Geneva.  In spite of support from many countries, Sweden failed yesterday to push through a resolution after opposition from alcohol-producing lands, with Cuba foremost.
    The Swedish alcohol initiative had been discussed at the WHO meeting and caused
turbulence.  From the beginning 40 countries stood behind the Swedish resolution that WHO should develop a "global strategy to diminish harmful alcohol use".  Sweden got support from the Moslem world and from many European and African countries.Swedish public health minister Maria Larsson said last week that "alcohol is an increasing problem in the world, and especially in Europe increasing heavy drinking among youth can be noted".
    But then came increasing opposition from Caribbean countries such as Cuba, the
Dominican Republic and Jamaica.  Many western countries were also unhappy thatSwedenbased its resolution on a report on the world's alcohol problems that had not been published in its entirety; only a three-page summary.  Consensus was lacking for the resolution to be accepted.
    It ended up that Cuba defeated the resolution which the Swedish public health minister had proudly introduced to the WHA the previous week.  The alcohol question has now been pushed off to the future.
    The question will next be taken up at the WHO's Executive Board meeting in
January 2008, where no less that six different proposals will be further discussed. The Caribbean lands are worried that alcohol restrictions will have effects on their production and trade in rum, where sugar production also plays a role.  In recent years restrictions have come from WHO onboth sugar and tobacco; two important commodities in these lands.  Now they feel that alcohol also is threatened. 
         Many nongovernmental organizations regretted that there will not be a global strategy against alcohol.

May 25th, 2007.  The United Kingdom recommends no alcohol during pregnancy or conception.  [Personal communication from Gloria Armstead (www.FASAware.co.UK) in the UK.]

       
    July 16th, 2007.  Swedish brewers including Carlsberg A/S's Swedish unit and Spendrups Bryggeri AB will put information labels on beer to highlight that consumption of alcoholic beverages may be inappropriate under certain conditions.

The Swedish Brewers Association has recommended to its members to put texts on beer with an alcohol percentage of more than 2.25 per cent, the association said in a statement Friday. Carlsberg, Spendrups and Kopparbergs Bryggeri AB agreed to follow the proposal.

  September, 2007.  South Africa institutes health warnings on labels of alcoholic beverages.

2008.    From The Local, a Swedish newspaper <http://www.thelocal.se/article.php?ID=12002&print=true> 
    WHO adopts Swedish alcohol resolution
    Published: 25 May 08 12:05 CET
               Online: http://www.thelocal.se/12002/

    The World Heath Organisation (WHO) has adopted a Sweden-backed global alcohol resolution at its annual World Health Assembly which was concluded in Geneva on Saturday.
Victory for Sweden in EU beer row (8 Apr 08) The resolution means that the WHO will develop a global strategy as part of its battle against health problems such as smoking and obesity.
    The WHO, in a press release summarizing the results of the assembly, recognized that work needed to be intensified to "curb the harmful use of alcohol" which is the fifth leading risk factor for death and disability in the world.
    Sweden has pushed hard for the development of a global strategy and has received the backing of its Scandinavian neighbours in lobbying for the adoption of a 'Swedish' view on alcohol policy.  The resolution brought by Sweden and the other Nordic countries at the World Health Assembly in 2007 failed in the face of opposition from Cuba, a significant alcohol producer.
    The resolution was this year presented by Rwanda with the support of several other African countries. Sweden had underlined its express support for the resolution.
    Sweden's public health minster, Maria Larsson, emphasised the importance of the alcohol issue to the WHO in several meetings and in her speech to the assembly.  "The so-called non-infectious diseases, such as injuries resulting from alcohol abuse, account for 60 percent of the world's illnesses, according to WHO statistics. To work against the abuse of alcohol is an investment for better health in the whole world," said Maria Larsson in a government press release.  "I am very happy that the WHO has now decided to work more intensively against the abuse of alcohol. The resolution that Sweden has worked with, and which has now been passed, becomes an important tool in this work."
    The WHO reports that work on the strategy will begin immediately and member states will be consulted during the drafting process over the coming two years. The resolution calls on the Director-General to consult with intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways to contribute to reducing the harmful effects of alcohol.
    Concrete measures can be expected to include a raft of recommendations for the marketing of alcohol, anti-drinking campaigns, licensing regulations and pricing.

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