This Is Your Child's Brain on Alcohol

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BY MARY JANE ROTHERAM-BORUS AND MARK TOMLINSON SEPTEMBER 12, 2014

IDEAS

Mary Jane Rotheram-Borus is a professor of psychology and the director of the UCLA Global Center for Children and Families.
Mark Tomlinson is a professor of psychology at Stellenbosch University in South Africa.

Social scientists have calculated that detrimental effects of alcohol cost the U.S. some $223.5 billion a year. We’re talking health issues such as liver disease, impaired driving, lost work due to hangovers, and emergency room visits. Alcohol costs substantially more to Americans than the harmful effects of illicit drug use ($151.4 billion) or tobacco ($167.8 billion).

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But there’s a more disturbing cost that you might be surprised to learn about that’s not even factored into those staggering numbers: fetal alcohol spectrum disorders, the conditions that can result when a mother drinks during pregnancy. (When all of the disorders are present, in their most severe forms, we call it fetal alcohol syndrome.) According to the U.S. Centers for Disease Control and Prevention, almost all of these children will have mental health problems as adults and 82 percent will not live independently. During adolescence, they also face an increased risk of drug and alcohol addiction. As a result, the lifetime cost of providing services to just one person with fetal alcohol spectrum disorder in 2002 was about $2 million. And 40,000 children are born each year in the U.S. with the disorders.

While both of us will have a beer or glass of wine with friends, neither Mary Jane nor Mark’s wife had a drink of alcohol while pregnant. Our friends and our doctors, along with casual reading on the subject, had impressed on us the serious risks and we decided it was not worth it. Only about 12.2 percent of pregnant women drink in the United States; however, in low- and middle-income countries about double that number of women will drink during pregnancy.

The two of us really saw the visceral impact of fetal alcohol spectrum disorders when we started working on improving mothers’ and children’s lives in South Africa. Fetal alcohol spectrum disorder affects as many as one in 10 children entering first grade in South Africa, the highest reported rate in the world.


Up until the 1990s, black South Africans were partially paid for their work in fields with a “DOP” or portion of wine. Drinking alcohol continues to be a part of the daily fabric of life in the townships—including brewing (and drinking) beer or spirits at home and visiting local bars known as shebeens. Alcohol is directly related to the high unemployment rates, especially for men in the townships—up to half of the young men are un- or under-employed over their lifetime.

The impacts of a mother drinking during pregnancy are not seen immediately. Brain damage slowly shows itself when the baby is small and fails to grow, speech comes late, colors are not learned by kindergarten, and school becomes a daily challenge. As we walked through informal settlements in Cape Town and Worcester—shacks without running water or flush toilets—we saw stunted and malnourished children playing outside all day long, many with the telltale signs of the disorder. Their faces feature foreshortened chins, thin upper lips, a flat mid face, short nose, and low nasal bridge. We couldn’t help but think ahead to the problems these children will have in school and their increased likelihood for dropping out. Their futures evaporated before they had a chance to grow, because of what their mothers knowingly or unknowingly drank before they were even born.

About one in four pregnant women in South Africa drink alcohol before recognizing she is pregnant and, without intervention, women who drank before realizing they were pregnant drank much more throughout their pregnancy. Even though there has lately been much chatter about how the occasional glass of wine with dinner should be OK, there really is no known “safe” amount of alcohol to drink during pregnancy. There is also no known safe period to drink during pregnancy. Binge drinking is by far the worst thing to do while pregnant—large doses (even if infrequent) are far worse than a small amount of alcohol routinely. Unfortunately, among alcohol drinkers in America, one in four binge drink, typically on weekends. This includes women who knowingly or unknowingly binge drink while pregnant.

The variations in how and when people drink may be the reason we have not been able to eliminate the negative consequences of alcohol during pregnancy. While access to drugs is often limited in many parts of the world, alcohol is almost universally available, especially in low-income countries because it can be manufactured locally. Brief, one-time counseling sessions that focus on the vulnerability of a fetus during pregnancy can help mothers understand the risks and reduce their drinking while pregnant. At sessions we offered to expectant mothers in South Africa, the influence of alcohol on a developing brain is starkly demonstrated by cracking an egg in alcohol at room temperature—the egg poaches. A child’s brain is fried when alcohol is circulating through its body. However, most women worldwide do not have access to these interventions. Compounding the problem: local healers throughout the world often use alcohol-laced remedies to help their clients relax. Pregnant women are often encouraged to take brews that include alcohol.

Here in the U.S., alcohol is embedded in almost all of our social rituals. Mary Jane’s parents in Los Angeles never drank, but they always had liquor to offer friends who came over for dinner. She does not know a male colleague who does not fancy himself a wine connoisseur and has been flabbergasted at the amount of money peers will spend on bottles of wine. Christmas, Yom Kippur, football tailgate parties, and practically all developmental milestones (graduations, child births, deaths) are marked with alcohol.

Given that alcohol permeates our lives—and every individual responds differently to alcohol—we have a responsibility to support one another and create a culture where “yes” is not the expected answer to, “Do you want a drink?” Genetic influence when it comes to alcohol abuse is real and scary. Some people are able to drink and never develop an addiction, while for others alcohol is a daily craving that is difficult to control. Previous attempts at controlling alcohol use that frame it as a question of willpower didn’t work. We need a more community-level approaches with policies like the ones we already have with the minimum age of drinking, restriction of bars in the proximity of schools, demonstration of a legal I.D. in order to purchase alcohol, and punishment of bar owners who continue to serve intoxicated customers.

National rates of tobacco smoking decreased as a result of structural and policy changes, including higher tobacco taxes, bans on smoking in restaurants and workplaces, and limits to the ability to when and where tobacco can be bought. Alcohol use could be similarly regulated—through higher alcohol taxes, continued limits on buying liquor based on the time of day or day of the week, and limiting alcohol at sports events, especially collegiate sports, or at educational events and professional conferences. Changing social rituals – such as bringing alcohol to parties, celebrating major achievements with champagne, marking the end of a work week with getting drunk- will take much longer to shift. Perhaps we could bring premium fruit juices to dinner parties instead.

In the next year, another 40,000 infants will be born with fetal alcohol spectrum disorders in the U.S. Following on the heels of Fetal Alcohol Spectrum Disorder Awareness Day earlier this month, we encourage you make a personal pledge to watch out for yourself, your friends, and people you encounter casually who may be at risk of creating a child with the disorder. The price to our children, our families, and our future is too high.

Mary Jane Rotheram-Borus is a professor of psychology and the director of the UCLA Global Center for Children and Families. Mark Tomlinson is a professor of psychology at Stellenbosch University in South Africa. They wrote this piece for Zocalo Public Square.

Contact us at editors@time.com.

Foetal Alcohol Spectrum Disorder – 'It Can Only Take One Drink'

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CAPS Hauraki service manager Jenny Curry, left, with Alcohol Healthwatch health promotion advisor Christine Rogan.

CAPS Hauraki service manager Jenny Curry, left, with Alcohol Healthwatch health promotion advisor Christine Rogan.

It can only take one or two drinks to damage an unborn baby's brain.

That's the message CAPS Hauraki wants to get across to young women in an effort to reduce the high rates of foetal alcohol spectrum disorder [FASD] in children.

CAPS Hauraki hosted Alcohol Healthwatch health promotion advisor Christine Rogan in Thames on November 22 to talk about FASD.

CAPS Hauraki service manager Jenny Curry said it didn't take much alcohol to damage a baby's brain.

"You can't afford to take the risk, you're basically poisoning the foetus, ethyl alcohol is a poison - it can be one or two drinks," she said.

"We need to raise awareness of it so that when people encounter it, they know how to deal with it. If you're aware, you tell your friend when you're out at the pub, 'don't drink if you're pregnant or if you're thinking about getting pregnant'."

The Ministry of Health estimates more than 50 per cent of New Zealand pregnancies are exposed to alcohol, which is 30,000 babies. FASD is a medical disorder with neuro-behavioural symptoms.

Those with FASD have learning and memory problems, boundary problems, empathy deficit, and excessive demand for attention, extreme emotional responses, poor understanding of social cues and clinically significant inappropriate interactions.

Rogan said children with FASD had a hidden brain injury.

"It's a neuro-developmental disorder or disability, but it's hidden, and so often what we see in our schools, social services and our communities generally is a hidden disability," she said.

"All we see is behaviour, and if you're just responding to behaviour, you think it's just naughtiness, in actual fact it's in the brain, it's the way in which the brain has been damaged by alcohol.

"So it's a very hidden thing to try and prevent and to address."

The aim of the seminar was to teach communities how to be aware of FASD, how to reach families who might be affected and to distribute information, she said.

"They need help and support. It's a very difficult thing to manage if you don't know what it is that you're dealing with," she said.

"Understanding foetal alcohol spectrum disorder is really important in order to address it properly and appropriately, and that takes a whole community."

Rogan said the authority was concerned about heavy drinking among young women.

"Heavy drinking is very normalised, and that is leading our young women to drink more heavily," she said.

"We have a concerning calamity happening there because that's at peak fertility years as well."

Teresa Ramsey 15:08, Nov 24 2017