June 2000

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

National Institutes of Health

National Institute on Alcohol Abuse and Alcoholism

From the Secretary of Health and Human Services

HIGHLIGHTS FROM CURRENT RESEARCH

10th 

Alcohol and Health

Special Report to the U.S. Congress on
i

Table of Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii

Chapter 1: Drinking Over the Life Span: Issues of 

Biology, Behavior, and Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Measuring the Health Risks and Benefits of Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Risks and Benefits of Alcohol Consumption: Physical Health . . . . . . . . . . . . . . .4

Psychosocial Consequences and Cognitive Effects . . . . . . . . . . . . . . . . . . . . . . .11

Effects on Society of Alcohol Use: Injuries and Violence . . . . . . . . . . . . . . . . . .12

Assessing Risks and Benefits: Mortality, Morbidity, and Disability . . . . . . . . . . .13

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Alcohol Involvement Over the Life Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Understanding the Age Progression of Alcohol Involvement in 

Childhood and Later Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Developmental Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Social Contexts and Drinking Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Changes in Patterns of Drinking Behavior as a Function of Social Change . . . . .40

Development and Drinking Behavior: Dynamic Models of 

Stability and Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Alcohol and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

Individual-Level Studies: Drinking by Offenders . . . . . . . . . . . . . . . . . . . . . . .55

Individual-Level Studies: Drinking by Victims . . . . . . . . . . . . . . . . . . . . . . . . .58

Environmental Influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Theoretical Developments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
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Tenth Special Report to Congress on Alcohol and Health

Chapter 2: Alcohol and the Brain: Neuroscience and Neurobehavior . . . . . . . . . . . . . . . . . .67

Setting the Stage: The Structure and Function of Neurons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Structure and Function of Neurons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

Communication Within and Between Neurons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Neurotransmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

From Cell Membrane to Nucleus: The Effects of Alcohol on Brain Neurons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

Alcohol’s Effect on Synaptic Transmission During Acute Exposure . . . . . . . . . . . . . . . . . . . . . . . . . .78

Alcohol’s Effects on Protein Phosphorylation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Long-Term Exposure to Alcohol: Gene Expression, Protein Phosphorylation, 

and Protein Localization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85

Acute Actions of Alcohol on the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89

Measuring Alcohol’s Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89

Alcohol and Ion Channels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90

Alcohol and Neurotransmitter Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

Neurobiological and Neurobehavioral Mechanisms of Chronic Alcohol Drinking . . . . . . . . . . . . . . . . . . . . . . . . .107

Reinforcement and Reward in Chronic Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107

Insights Into Features of Alcoholism From Animal Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108

Alcoholism and the Neural Structures of Reward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113

Neurochemical and Molecular Adaptations to Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115

Alcoholism: Lasting Changes in the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 

The Neurotoxicity of Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134

Neuropathologic Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134

Morphological Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135

Functional Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138

Mechanisms of Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142

Genetic Studies of Alcohol’s Actions on the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147

Development of Animal Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147

Investigation of Candidate Genes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149

Immediate Early Genes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
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iii

Chapter 3: Genetic and Psychosocial Influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159

Animal Genetic Studies on Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160

Quantitative Trait Loci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160

Creating Rodent Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161

Quantitative Trait Loci Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166

Recent Progress in the Genetics of Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169

Findings From Twin/Family Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169

Findings From Genetic Linkage Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173

Findings From Genetic Association Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177

Psychosocial Factors in Alcohol Use and Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181

Family History of Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181

Developmental Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186

Motivation To Drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187

The Role of Cognition: Beliefs About Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191

Chapter 4: Medical Consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197

Alcohol-Induced Liver Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198

Alcoholic Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198

Preventing Liver Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202

Nutritional Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202

Other Liver Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207

Alcohol and the Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214

Alcohol and Diseases Related to the Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214

Diseases Related to Immunodeficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214

Diseases Related to Autoimmunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215

The Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216

Changes in the Immune System of Alcoholics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217

Experimental Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219

Current Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222

Therapeutic Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226 
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Alcohol’s Effects on the Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240

The Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240

The Vascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248

Alcohol and Women: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253

Health Consequences of Alcohol for Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253

Physiologic Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254

Liver Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256

Alcohol and the Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258

Research Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258

Alcohol-Induced Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259

Alcohol-Induced Osteopenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260

Bone Histomorphometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261

Potential Mechanisms of Alcohol-Induced Bone Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .266

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .266

Alcohol and Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .273 

Age, Genetics, and Other Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .274

Menopausal Status and Hormones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .274

Mechanisms of Alcohol-Related Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .277

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .278 

Chapter 5: Prenatal Exposure to Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283

Prenatal Alcohol Exposure: Effects on Brain Structure and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .285

Diagnosing the Effects of Prenatal Alcohol Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .285

Neuroimaging: Precise Pictures of Structural Damage to the Brain . . . . . . . . . . . . . . . . . . . . . . . .287

Physical Measures of Altered Brain Function: Cry Patterns and EEG’s . . . . . . . . . . . . . . . . . . . . . .289

Effects on Cognitive and Motor Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290

Effects on Mental Health and Psychosocial Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .295

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .296
Table of Contents

v

Underlying Mechanisms of Alcohol-Induced Damage to the Fetus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .300

Challenges to FAS Research: Multiple Mechanisms, Sites of Action, and Risk Factors . . . . . . . . . .301

Candidate Mechanisms for Central Nervous System Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . .302

Candidate Mechanisms for Craniofacial Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .309

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310

Issues in Fetal Alcohol Syndrome Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .323

Reviews of Prevention Programs and Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .323

Methodological and Evaluation Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325

Reaching to All, Regardless of Risk: Universal Prevention Approaches . . . . . . . . . . . . . . . . . . . . . .326

Targeting Those at Increased Risk: Selective Prevention Approaches . . . . . . . . . . . . . . . . . . . . . . .327

Helping Those at Highest Risk: Indicated Prevention Approaches . . . . . . . . . . . . . . . . . . . . . . . . .329

International Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .331

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .332

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .332

Chapter 6: Economic and Health Services Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . .339

Effects of Changes in Alcohol Prices and Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .341

Public Policies and Alcohol Prices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .341

Alcohol Prices, Taxes, and Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .342

Alcohol Taxes and Traffic Fatalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .346

Alcohol Demand and Marijuana Demand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .348

Benefits and Costs of Taxation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .349

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .351

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .352 

Cost Research on Alcoholism Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355

Past Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355

Recent Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .356

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361
vi

Tenth Special Report to Congress on Alcohol and Health

The Economic Costs of Alcohol Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .364 

Distribution of the Burden of Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .365

Components of the Costs of Alcohol Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .366

Limitations and Caveats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .369

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .370

Chapter 7: Prevention Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .373

Reducing Alcohol-Impaired Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .375

Recent Trends in Alcohol-Related Traffic Fatalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .377

Legislative Efforts To Reduce Alcohol-Impaired Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .378

Enforcement of Impaired-Driving Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .386

Comprehensive Community Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .386

Alcohol Control Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .387

Individual Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .389

Safety Belt Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .390

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .391

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .391

Community-Based Prevention Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .397

Community Prevention for Heart Disease and Health Promotion: A Precedent . . . . . . . . . . . . . . .397

Methodological Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .398

Recent Research Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .399

Commentary and Future Research Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .405

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408

Alcohol Advertising: What Are the Effects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .412

Background: The Frequency and Content of Advertising Messages . . . . . . . . . . . . . . . . . . . . . . . .413

Does Alcohol Advertising Affect Drinking or Drinking Problems? . . . . . . . . . . . . . . . . . . . . . . . . .414

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .422

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .423
Table of Contents

vii

Chapter 8: Treatment Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .427

Screening and Brief Intervention for Alcohol Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .429

Screening for Alcohol Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .429

Brief Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .432

Areas for Future Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .437

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .439

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .439

Treatment of Alcohol Dependence With Psychological Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .444

Client-Treatment Matching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .444

Professional Treatment Modeled on the 12 Steps of Alcoholics Anonymous . . . . . . . . . . . . . . . . . .445

Supportive Ancillary Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .446

Intensity of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .448

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .448

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .449

Treatment of Alcohol Dependence With Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .451

Medications for Alcohol Dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .452

Medications for Patients With Both Alcoholism and Depression . . . . . . . . . . . . . . . . . . . . . . . . . .457

In Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .458

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .458

Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .463

ix

Foreword

I am pleased to present the Tenth Special Report on Alcohol and Health to the U.S.

Congress, and through them to the American people.

Alcohol problems, both those of individuals and those that affect society at large,

continue to impose a staggering burden on our Nation. Domestic violence, child

abuse, fires and other accidents, falls, rape, and other crimes against individuals such 

as robbery and assault—all are linked to alcohol misuse. Alcohol misuse also is

implicated in diseases such as cancer, liver disease, and heart disease. Although often

not aware of it, everyone shares a portion of this burden. For example, an estimated

20 to 40 percent of patients in large urban hospitals are there because of illnesses that

have been caused or made worse by their drinking. This means that out of every 100

patients in such hospitals, almost half may be there because of their alcohol use. Each

of us shares the price of these illnesses through rising health care costs. Because one 

in four children under the age of 18 lives in a household with one or more family

members who are alcohol dependent or who abuse alcohol, our Nation will continue

to be robbed of its future. As these children grow up, they too will be at risk for

continuing the cycle of alcohol abuse and dependence that has plagued too many 

of our citizens for too long.

As overwhelming as these facts are, the real tragedy is that many people do not yet

understand that alcohol problems can yield to scientific investigation and medical

intervention in the same way as other health conditions, and in many cases more

successfully.

The research findings presented in the Tenth Special Report to the U.S. Congress on

Alcohol and Health clearly demonstrate that continued support for alcohol research,

and the use of findings from research in prevention and clinical applications, offer the

best hope for reducing the costs we all pay for alcohol problems. I commend it to

your attention.

Donna E. Shalala

Secretary

U.S. Department of Health and Human Services

xi

Preface

During the latter half of the twentieth century, we witnessed an unparalleled era of

progress in medical science. Among other important scientific advances, we discovered

the genetic code and are well on our way toward mapping the entire human genome,

we began to explore how our brains work in concert with other body systems to

promote or to impede health, and we developed increasingly sophisticated medical

devices and technologies that allow us to look at the actual functioning of the myriad

systems that make up human beings.

The Tenth Special Report to the U.S. Congress on Alcohol and Health presents significant

new scientific findings about alcohol abuse and alcoholism since the last Special

Report, issued in 1997. These findings clearly demonstrate that alcohol investigators

working in fields as diverse as epidemiology, genetics, neuroscience, toxicology, prevention, and treatment are using the very latest tools and techniques of science to expand

our knowledge of how to prevent, reduce, and treat alcohol problems. Because alcohol

use problems exact such a personal, social, and economic toll on the American

people—an estimated 100,000 lives and $184.6 billion annually—the scientific

progress described in the Tenth Special Report is heartening.

As important as this progress is for those whose lives have been affected by alcohol 

use, I believe that the Tenth Special Report serves a greater purpose. Science does 

not happen in a vacuum. Rather, it is a cumulative process that builds upon the

knowledge developed by many scientists working in many different areas of investigation. Therefore, what is discovered about one disease or health condition may very

well provide important clues about other diseases and conditions, clues that will help

in the development of medications, treatments, and preventive approaches that can 

be widely applied. Because alcohol affects virtually all body systems and because

alcohol use problems affect all levels of human interaction, the alcohol research field

represents, in many respects, a microcosm of science in its entirety. Thus, the findings

described in the Tenth Special Report about genetics, neural circuitry, the effect of the

environment on gene expression, fetal development, cognition, psychological therapies,

prevention and education, and treatment contribute significantly to the knowledge we

need to solve not only the problems associated with alcohol abuse and alcoholism, but

also the problems of human biology and behavior in general.

I would like to commend the scientists who participated in the development of the

Tenth Special Report and the staff of the National Institute on Alcohol Abuse and

Alcoholism for their efforts to bring this important information to the attention of 

the U.S. Congress and the American people.

Ruth Kirschstein, M.D.

Acting Director

National Institutes of Health

xiii

Introduction

The first Special Report on Alcohol and Health was presented to the U.S. Congress in

1971. In that report, and in each subsequent one, the National Institute on Alcohol

Abuse and Alcoholism (NIAAA) summarized for the Congress—and the American

people—the cumulative body of alcohol research findings in each area of investigation.

For this, our 10th edition of the Special Report, we found ourselves in a pleasant, if

somewhat daunting, position. The breadth and scope of alcohol research has grown so

tremendously that summarizing the total body of alcohol research in one document is

no longer manageable; so we have chosen to present the findings from alcohol research

in a new way—to summarize what is known in a particular area and to describe in

greater detail significant research findings that have been reported since the Ninth

Special Report. And, in the best tradition of the Special Reports on Alcohol and Health,

this 10th edition continues to provide both extensive information on alcohol use

problems and ample cause for hope that we are well on the way to preventing and

effectively treating them.

Alcohol is widely used in our society. Most individuals who use alcohol drink in ways

that do not increase risk for alcohol use problems. Some, however, drink in ways or 

at times during their life course that increase risk to themselves or others. Still others

who use alcohol may derive a health benefit from its use. Defining precisely who is 

at risk for alcohol use problems and assessing the risks versus benefits of alcohol use 

are the first steps toward providing accurate public health information and designing

effective interventions to reduce alcohol use problems. The Tenth Special Report

presents important new findings about biological and behavioral factors that affect 

the risks and benefits of drinking over the life span.

Perhaps the single greatest influence on the scope and direction of alcohol research 

has been the finding that a portion of the vulnerability to alcoholism is genetic. This

finding, more than any other, helped to establish the biological basis of alcoholism. 

It also provided the basis—and justification—for much of the progress in genetics,

neuroscience, and neurobehavior described in the Tenth Special Report. Today we

know that approximately 50 to 60 percent of the risk for developing alcoholism is

genetic. Genes direct the synthesis of proteins, and it is the proteins that drive and

regulate critical chemical reactions throughout the human body. Genetics, therefore,

affects virtually every facet of alcohol research, from neuroscience to Fetal Alcohol

Syndrome. It is clear from the findings presented in the Tenth Special Report that

although much remains to be discovered, progress has been made toward understanding how genes are involved in the etiology of alcohol use problems, including

how genes interact with other genes and with the environment to produce disease.

The progress made in the neurosciences over the last two decades has been spectacular.

Alcohol investigators have taken full advantage of this progress by applying neuroscience techniques to the study of alcohol use problems. As a result, our understanding of the neural processes that underlie alcohol-seeking behavior and of how

alcohol’s actions in the brain are related to the phenomenon of addiction has grown

dramatically. Recent progress in neuroscience research described in the Tenth Special
xiv

Tenth Special Report to Congress on Alcohol and Health

Report has yielded information critical to

characterizing some of the cellular and molecular

processes involved in alcohol use and has helped

associate these processes with the behavioral and

physiologic manifestations of alcohol use and

abuse. One important tool used in both genetics

and neurobehavioral research is the animal model.

Alcohol scientists have applied molecular biology

techniques to develop a number of important

animal models that allow the study of the 

genes associated with traits that might influence

alcohol-related behaviors. Findings from studies

using both vertebrate and nonvertebrate animal

models and other study results concerning the

etiology of alcohol use problems are discussed 

in the Tenth Special Report.

Although the toxicology of alcohol—how alcohol

damages the body—was one of the first areas in

alcohol research to be studied, the acceptance of

the biological foundations of alcoholism and the

subsequent increase in alcohol-related biological

research helped to focus scientific attention on the

mechanisms by which this damage occurs. As

described in several chapters of the Tenth Special

Report, alcohol research scientists have uncovered

new information about the kinds of damage that

alcohol exposure can cause to the brain, both

during prenatal development and later in life, 

and to other major body organs. More important, there is a very good accounting of the

progress that alcohol scientists have made toward

understanding how this damage occurs. It is

knowing the “how” that has the potential to

produce therapeutic interventions to limit or

ameliorate many of the alcohol-related health

consequences.

Limited in the past, research on prevention

is coming into its own. The findings from

prevention research applied to various public

policies already have been shown to save lives.

New approaches to school-based and community

prevention are demonstrating that well-planned

prevention programs based on rigorously studied

and validated models can reduce the magnitude

and extent of our Nation’s alcohol-related problems. Prevention research is also examining the

role that advertising plays with respect to alcohol

use and abuse.

The main goal of alcoholism treatment is to help

alcoholics maintain sobriety. The Tenth Special

Report highlights the progress that has been made

toward developing both behavioral strategies and

medications to help achieve this goal. Some of

the most compelling questions about treatment

have to do with factors that help to make treatment services effective. Some studies have 

shown significant reductions in drinking following treatment with extensively tested and refined

behavioral therapies. Other strategies, involving

brief interventions in primary care settings, have

proved to be effective in reducing alcohol consumption in persons drinking at levels associated

with negative health consequences. Because many

individuals continue to experience problems with

alcohol after treatment, there is a need to further

improve treatment efficacy.

One of the principal payoffs of biological research

in genetics and neuroscience is the potential for

developing medications to treat a variety of

alcohol use problems. Neuroscience research

already has provided the groundwork for new

medications for treating alcoholism. Researchers

now are looking for new medications that target

the mechanisms of the addiction itself, such as

drugs that interfere with the reward properties 

of alcohol or craving, which are thought to be

major factors in relapse. It is likely that no one

medication will be effective for everyone nor that

there will be the proverbial “silver bullet” of

pharmacotherapies for alcoholism. Just as there

are different types of medications with different

mechanisms of action to treat complex diseases

like diabetes, it is likely that there will be a range

of medications, coupled with verbal therapies,

available to clinicians.

Last, like everyone else during this ending of one

century and beginning of a new century, I would

like to share my thoughts on where we are

heading in alcohol research. Finding the genes

for alcoholism is probably one of the most important goals in alcohol research. However, it is the
Introduction

xv

beginning of the story rather than the end. For

this information to be of practical use, we must

understand how biology and behavior interact to

produce disease. There is a welcome trend in the

alcohol field toward reciprocal work between the

biological and behavioral sciences. The potential

success of this type of collaboration has been well

demonstrated by major research efforts such as

the Collaborative Study on the Genetics of

Alcoholism, which involved both biological and

behavioral science and scientific principles. Other

examples of this type of work can be found in

research on the effects of alcohol on the fetus,

where there are excellent behavioral studies of

children with Fetal Alcohol Syndrome and other

alcohol-related birth defects as well as detailed

information from imaging studies about the

tremendous structural changes in the brains of

children exposed to alcohol in the womb. We

also are learning about the proper connectivity

among neurons. In this work it appears that

alcohol actually prevents the appropriate

expression of certain genes.

The trend toward studying the whole human

animal, not just its genetic or neural parts, will

continue to be advanced, I believe, by a rejection

of the “reductionist” view, which seeks to define

humankind in terms of its genes, and acceptance

of the tenet that genes are not (or even mostly)

destiny, just as humankind is not just the sum 

of its neurons and circuits.

That we are continuing to expand our knowledge

of alcohol use problems is clear from the material

presented in this Special Report. The scientists,

and the NIAAA staff who have worked so diligently to present the Tenth Special Report to the

Congress, have my thanks for their efforts. The

task now for each of us who is concerned about

the impact of alcohol abuse and alcoholism on

our society is to accelerate the pace of research

that has enabled us to come this far to ensure 

that the new millennium brings new successes.

Enoch Gordis, M.D.

Director

National Institute on

Alcohol Abuse and Alcoholism

xvii

Acknowledgments

Mary Jane Ashley, M.D.

Department of Public Health Sciences

Faculty of Medicine

University of Toronto

Addiction Research Foundation

Mental Health Services Corporation 

of Ontario

Toronto, Ontario, Canada

Gregory Bloss, M.A.

Division of Biometry and Epidemiology

National Institute on Alcohol Abuse 

and Alcoholism

Bethesda, Maryland

Susan J. Bondy, Ph.D.

Department of Public Health Sciences

Faculty of Medicine

University of Toronto

Addiction Research Foundation

Mental Health Services Corporation 

of Ontario

Toronto, Ontario, Canada

Laurie A. Chassin, Ph.D.

Department of Psychology

Arizona State University

Tempe, Arizona

Robert T. Cook, M.D., Ph.D.

Pathology and Laboratory Medicine

VA Medical Center and University 

of Iowa

Iowa City, Iowa

John Crabbe, Ph.D.

Portland Alcohol Research Center

Department of Behavioral Neuroscience

Oregon Health Sciences University

Portland, Oregon

Fulton T. Crews, Ph.D.

Center for Alcohol Studies

University of North Carolina School 

of Medicine

Chapel Hill, North Carolina

Vincent M. Figueredo, M.D.

Division of Cardiology

Lovelace Medical Center

Albuquerque, New Mexico

Michael F. Fleming, M.D., M.P.H.

Center for Addiction Research 

and Education

University of Wisconsin

Madison, Wisconsin

Michael T. French, Ph.D.

Health Services Research Center and

Department of Economics

University of Miami

Miami, Florida

Charles R. Goodlett, Ph.D.

Department of Psychology

Indiana University-Purdue University

at Indianapolis

Indianapolis, Indiana

Joel W. Grube, Ph.D.

Prevention Research Center

Berkeley, California

Henrick J. Harwood

The Lewin Group

Falls Church, Virginia

Brenda Hewitt

Office of the Director

National Institute on Alcohol Abuse 

and Alcoholism

Bethesda, Maryland

Michael E. Hilton, Ph.D.

Health Services Research Program

Division of Clinical and Prevention 

Research

National Institute on Alcohol Abuse 

and Alcoholism

Bethesda, Maryland

Ralph Hingson, Sc.D.

Social and Behavioral Sciences 

Department

Boston University School of Public Health

Boston, Massachusetts

Constance Horgan, Ph.D.

Institute for Health Policy

Heller School

Brandeis University

Waltham, Massachusetts

Contributors
xviii

Tenth Special Report to Congress on Alcohol and Health

Jan M. Howard, Ph.D.

Prevention Research Branch

Division of Clinical and Prevention Research

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland

Thomas E. Johnson, Ph.D.

Institute for Behavioral Genetics

University of Colorado at Boulder

Boulder, Colorado

Robert W. Karp, Ph.D.

Genetics, Neuroscience, and Behavior 

Research Branch

Division of Basic Research

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland

Donald S. Kenkel, Ph.D.

Department of Policy Analysis and Management

Cornell University

Ithaca, New York

Robert F. Klein, M.D.

Endocrinology and Metabolism Section

VA Medical Center

Portland, Oregon

George Koob, Ph.D.

Department of Neuropharmacology

The Scripps Research Institute

La Jolla, California

Mary Jo Larson, Ph.D.

New England Research Institutes, Inc.

Watertown, Massachusetts

David M. Lovinger, Ph.D.

Departments of Molecular Physiology and

Biophysics and of Pharmacology

Vanderbilt University School of Medicine

Nashville, Tennessee

Susan E. Martin, Ph.D. 

Violence, Trauma, and Unintentional Injury 

Prevention Research Branch 

Division of Clinical and Prevention Research

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland

Barbara J. Mason, Ph.D.

Department of Psychiatry and Behavioral Sciences

University of Miami School of Medicine

Miami, Florida

Sarah N. Mattson, Ph.D.

Center for Behavioral Teratology

San Diego State University

San Diego, California

Philip A. May, Ph.D.

Center on Alcoholism, Substance Abuse 

and Addictions

University of New Mexico

Albuquerque, New Mexico

Craig J. McClain, M.D.

Clinical Research Center

Division of Digestive Diseases and Nutrition

University of Kentucky Medical Center and 

Lexington VA Medical Center

Lexington, Kentucky

Esteban Mezey, M.D.

Division of Gastroenterology

Department of Medicine

The Johns Hopkins University

Baltimore, Maryland

Robert Nash Parker, Ph.D.

Robert Presley Center for Crime and Justice Studies

Department of Sociology

University of California

Riverside, California

Jurgen T. Rehm, Ph.D.

Fachhochschule Hamburg

Hamburg, Germany

Addiction Research Foundation

Mental Health Services Corporation of Ontario

Toronto, Ontario, Canada

Robert G. Rychtarik, Ph.D.

Research Institute on Addictions

Buffalo, New York

Robert F. Saltz, Ph.D.

Prevention Research Center

Berkeley, California

Keith W. Singletary, Ph.D.

Department of Food Science and Human Nutrition

University of Illinois, Urbana-Champaign

Urbana, Illinois

Barbara Smothers, Ph.D.

Epidemiology Branch

Division of Biometry and Epidemiology

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland
Acknowledgments

xix

Bryon H. Adinoff, M.D.

VA Medical Center

Dallas, Texas

Efrain Azmitia, Ph.D.

Biology Department

New York University

New York, New York

Thomas Babor, Ph.D.

Department of Psychiatry

University of Connecticut Health Center

Farmington, Connecticut

Monte Bissell, M.D.

Division of Gastroenterology

University of California at San Francisco

San Francisco, California

James D. Beard, Ph.D.

Department of Physiology

College of Medicine

The University of Tennessee-Memphis

Memphis, Tennessee

Howard T. Blane, Ph.D.

Research Institute on Addictions

Buffalo, New York

Gregory Bloss, M.A.

Division of Biometry and Epidemiology

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland

Ann May Diehl, M.D.

School of Medicine

Johns Hopkins University

Baltimore, Maryland

Bruce C. Dudek, Ph.D.

Department of Psychology

University of Albany, State University of New York

Albany, New York

Constance Horgan, Ph.D.

Institute for Health Policy

Heller School

Brandeis University

Waltham, Massachusetts

Stephanie S. O’Malley, Ph.D.

Department of Psychiatry

Substance Abuse Treatment Unit

Yale University School of Medicine

New Haven, Connecticut

Edward P. Riley, Ph.D.

Center for Behavioral Teratology

Department of Psychology

San Diego State University

San Diego, California

Kenneth J. Sher, Ph.D.

Department of Psychology

University of Missouri

Columbia, Missouri

Boris Tabakoff, Ph.D.

Department of Pharmacology

University of Colorado School of Medicine

Denver, Colorado

Sharon C. Wilsnack, Ph.D.

Department of Neuroscience

University of North Dakota

Grand Forks, North Dakota

Ellen Stewart, B.A.

New England Research Institutes, Inc.

Watertown, Massachusetts

John J. Woodward, Ph.D.

Department of Pharmacology and Toxicology

Medical College of Virginia Campus

Virginia Commonwealth University

Richmond, Virginia

Robert A. Zucker, Ph.D.

Department of Psychiatry and Psychology

Alcohol Research Center and Substance 

Abuse Division

University of Michigan

Ann Arbor, Michigan

Editorial Advisory Board

Peer Reviewers
xx

Tenth Special Report to Congress on Alcohol and Health

Raul Caetano, M.D., Ph.D.

Alcohol Research Group

Berkeley, California

Frank J. Chaloupka, Ph.D.

Department of Economics

University of Illinois at Chicago

Chicago, Illinois

Michael C. Costanza, Ph.D.

Medical Biostatistics

University of Vermont

Burlington, Vermont

Nancy L. Day, Ph.D.

Western Psychiatric Institute and Clinic

Pittsburgh, Pennsylvania

Robert Foss, Ph.D.

Highway Safety Research Center

University of North Carolina

Chapel Hill, North Carolina

Susan Gapstur, Ph.D

Department of Preventive Medicine

Northwestern University Medical School

Chicago, Illinois

Louis Gliksman, Ph.D.

Addiction Research Foundation

Toronto, Ontario, Canada

Rueben A. Gonzales, Ph.D.

Division of Pharmacology

College of Pharmacy

University of Texas

Austin, Texas

Stanley S. Greenberg, Ph.D.

Section of Cardiopulmonary Research

Louisiana State University Medical Center

New Orleans, Louisiana

Janet R. Hankin, Ph.D.

Department of Sociology

Wayne State University

Detroit, Michigan

R. Adron Harris, Ph.D.

Department of Pharmacology

University of Colorado Health Sciences Center

Denver, Colorado

Andrew C. Heath, D.Phil.

Department of Psychiatry

Washington University School of Medicine

St. Louis, Missouri

Robert J. Hitzemann, Ph.D.

Department of Psychiatry

State University of New York at Stony Brook

Stony Brook, New York

Harold D. Holder, Ph.D.

Prevention Research Center

Berkeley, California

Yedy Israel, Ph.D.

Department of Pathology

Jefferson Medical College

Philadelphia, Pennsylvania

Joseph L. Jacobson, Ph.D.

Department of Psychology

Wayne State University

Detroit, Michigan

Glenda Kaufman Kantor, Ph.D.

Family Research Laboratory

University of New Hampshire

Durham, New Hampshire

Lee Ann Kaskutas, Dr.P.H.

Alcohol Research Group

Berkeley, California

Karen Kopera-Frye, Ph.D.

Department of Psychology

University of Akron

Canton, Ohio

George Kunos, M.D., Ph.D.

Department of Pharmacology and Toxicology

Medical College of Virginia

Virginia Commonwealth University

Richmond, Virginia

Francine E. Lancaster, Ph.D.

Biology Department

Texas Woman’s University

Denton, Texas

Richard Longabaugh, Ed.D.

Center for Alcohol and Addiction Studies

Brown University

Providence, Rhode Island

Bryan Luce, Ph.D., M.B.A.

MEDTAP International, Inc.

Bethesda, Maryland

David MacKinnon, Ph.D.

Department of Psychology

Arizona State University

Tempe, Arizona
Acknowledgments

xxi

Stephen A. Maisto, Ph.D. 

Department of Psychology

Syracuse University

Syracuse, New York

William J. McBride, Ph.D.

Department of Psychiatry

Indiana University School of Medicine

Institute of Psychiatric Research

Indianapolis, Indiana

Matthew McGue, Ph.D

Department of Psychology

University of Minnesota

Minneapolis, Minnesota

Gary G. Meadows, Ph.D.

Department of Pharmaceutical Sciences

College of Pharmacy

Washington State University

Pullman, Washington

Lorraine Midanik, Ph.D.

School of Social Welfare

University of California at Berkeley

Berkeley, California

Brenda A. Miller, Ph.D.

Research Institute on Addictions

Buffalo, New York

Michael J. Moore, Ph.D.

Fuqua School of Business

Duke University

Durham, North Carolina

A. Leslie Morrow, Ph.D.

Department of Psychiatry

University of North Carolina School of Medicine

Chapel Hill, North Carolina

M. W. Perrine, Ph.D.

Vermont Alcohol Research Center

South Burlington, Vermont

Horace Mitchell Perry III, M.D.

Division of Geriatrics

St. Louis University Health Sciences Center

St. Louis, Missouri

Tamara J. Phillips, Ph.D.

Research Division

VA Medical Center

Portland, Oregon

Christopher J. Ruhm, Ph.D.

Department of Economics

University of North Carolina at Greensboro

Greensboro, North Carolina

Marcia Russell, Ph.D.

Research Institute on Addictions

Buffalo, New York

Herman H. Samson, Ph.D.

Department of Physiology and Pharmacology

Bowman Gray School of Medicine

Winston-Salem, North Carolina

Michael A. Sayette, Ph.D.

Department of Psychology

University of Pittsburgh

Pittsburgh, Pennsylvania

Edward M. Sellers, M.D., Ph.D.

Pharmacology/Dependence Research Unit

Women’s College Hospital

Toronto, Ontario, Canada

Don Shepard, Ph.D.

Brandeis University 

Waltham, Massachusetts

Jody L. Sindelar, Ph.D.

Department of Epidemiology and Public Health

Yale University

New Haven, Connecticut

Michael D. Slater, Ph.D.

Department of Technical Journalism

Colorado State University

Fort Collins, Colorado

Alan W. Stacy, Ph.D.

Institute for Prevention Research

University of Southern California

Los Angeles, California

Kathleen K. Sulik, Ph.D.

Department of Cell Biology and Anatomy

University of North Carolina

Chapel Hill, North Carolina

Gyongyi Szabo, M.D., Ph.D.

Department of Medicine

University of Massachusetts Medical Center

Worcester, Massachusetts

Ronald G. Thurman, Ph.D.

Laboratory of Hepatobiology and Toxicology

Department of Pharmacology

University of North Carolina School of Medicine

Chapel Hill, North Carolina

Maharaj K. Ticku, Ph.D.

Department of Pharmacology

University of Texas Health Sciences Center

San Antonio, Texas
xxii

Tenth Special Report to Congress on Alcohol and Health

Steven N. Treistman, Ph.D.

Department of Pharmacology

University of Massachusetts Medical Center 

Worcester, Massachusetts

Russell T. Turner, Ph.D.

Department of Orthopedics

Mayo Foundation Rochester

Rochester, Minnesota

Carl Waltenbaugh, Ph.D.

Department of Microbiology/Immunology

Northwestern University Medical School

Chicago, Illinois

Friedbert Weiss, Ph.D.

Department of Neuropharmacology

Scripps Research Institute

La Jolla, California

James R. West, Ph.D.

Department of Anatomy and Neurobiology

College of Medicine

Texas A&M University Health Sciences Center

National Institute on Alcoholism and 

Alcohol Abuse Staff

Office of Scientific Affairs

Charlotte Armstrong, Project Officer 

Maureen B. Gardner, Project Officer 

Michael Eckardt, Ph.D. 

Diane W. Miller, M.P.A.

Kenneth R. Warren, Ph.D. 

Contractor Staff

Palladian Partners

Cate Timmerman

Trudy Barnes

Elizabeth Hess, E.L.S.

Catherine Rankin

Peter Taylor

Market Experts

Karen McGuinness

Maureen Berg

Kristen Dill

Editing, Production, and Project Management

Many NIAAA scientific staff members contributed their time and expertise to ensure the accuracy of this report.

These include individuals who wrote sections of the report and are listed as contributors. In addition, the following

NIAAA staff members are due particular thanks for the extent of the effort they devoted to reviewing manuscripts and

providing guidance on the content: Mary Dufour, M.D., M.P.H., Kenneth R. Warren, Ph.D., Gregory Bloss, M.A.,

Susan Farrell, Ph.D., Laurie Foudin, Ph.D., Richard Fuller, M.D., Jan Howard, Ph.D., Robert Huebner, Ph.D.,

Antonio Noronha, Ph.D., Vishnudutt Purohit, Ph.D., Barbara Smothers, Ph.D., and Samir Zakhari, Ph.D.