Family Stories

COALITION 21

Guam Families Share Their Stories on Alcohol Related Events

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ALEX MONTAGUE,
MARCI'S GRANDDAUGHTER AND DRUNK DRIVING SURVIVOR
Even though I was only six years old at the time, I vividly remember the day my grandmother told me my mother was dead. In fact, I remember that day regularly. I remember that the morning before she died, she was so excited because she couldn't wait to give birth to Casey. That morning, she did my hair in this twirly thing that I like; whenever I do my hair like that, I think of her.

Alex Montague
Lisa Montague with her daughter, Alex
I also remember the smell of her perfume. When I smell something like it, I get a feeling, like a reminder, that she's there. I remember the funeral clearly too. I don't think I understood very well what the funeral was, but I looked around and saw people crying, and then they opened up the casket. I went up to go see my mother and touched her hair and looked at her.

I used to have nightmares about other people in my family dying. Now I'm 13 and I have dreams about what it would have been like if my mom hadn't died. Once I dreamed I was getting ready for prom with my mom. I don't think I will ever be healed from this. My mother was killed and she'll never be back.

Emergency medical technician (EMT) Pam Giese of Suring, Wisconsin, never knows how many alcohol-related traffic crashes she'll see in a day, for it is her job to rescue the dying, whether they are the drunk drivers or the innocent victims of the crash. It is job she cannot forget about at the end of the day.

PAM GIESE
EMERGENCY MEDICAL TECHNICIAN
When you arrive at a crash scene, all you see are the mangled cars, all you hear is the deafening silence. When you get out of the ambulance, you hear the screaming and moaning. Approaching the vehicle, you just have to block out your fear and anger. The fear of what you're going to find, like children. I'm always afraid I'll find children. The anger that the crash involved alcohol.

I remember one call where we had a 21-year-old who crashed coming home from a bar; it was his birthday. I had to take care of him while he was pinned in his vehicle, in critical condition. The driver of the other car was dead; his wife and kids were also in the car. I was so angry with the drunk driver, but I had to put my feelings aside. I jumped into the car with him and kept him alive while they cut him out of the car -- I had to keep him conscious so that he would breathe.

Repeatedly I said, "Come on, you can do it." Meanwhile, there are beer cans all over the car and it reeks of alcohol. But he has parents too, and he has to be saved like any other injured person. Last winter, a young man on leave from the service drove home from a bar, crashed in front of his parents' house and rolled into their lake. I had to tell his mother he was dead at the scene. She went crazy screaming and yelling, she was beside herself with grief. I can remember her howling -- she sounded like a wounded animal. I've never heard such a horrific sound.You never forget it; you can't ever really forget any of it.

When I leave a bad crash scene, I sometimes cry all night long. I cry from the helplessness, the feeling that I can't do anything to make things better. In a year, I personally see about 60 drunk driving traffic crashes. We save the lives of maybe an eighth of the victims -- if we can get to them in time. Most of the time they are fatalities.

I have a lot of nightmares. Over the years you get to the point where you block it out because you have to, or you take a short break from the ambulance corps. You try to weigh the good and the bad, and when I get close to quitting, I say to myself that if my family needed to be rescued from a drunk driving crash, I'd want somebody to be there.

If victims are fortunate enough to have been rescued by EMTs like Pam Giese, they are rushed to emergency rooms where they are treated by specialists like Dr. Marc Pollack, Board Certified in Emergency Medicine in York, Pennsylvania.

DR. MARC POLLACK
EMERGENCY MEDICINE PHYSICIAN
I've been practicing medicine for 20 years and I treat a lot of alcohol abusers -- as either the victims themselves or as the people who have caused a crash. Every now and then, both the offender and the victim are being treated near each other in the emergency department, and that can be unbelievably difficult.

Intoxicated people are always difficult patients. They don't want to cooperate with tests and X-rays, and they're the highest risk patients because if they leave, they leave impaired, putting others at risk.

The staff, at some level, has anger and disdain toward the intoxicated patient. You can't communicate with them, they want to leave, and they try to hit the doctors and nurses.

Around 10 p.m., the number of patients we see where alcohol was involved noticeably increases. By 2 a.m., it is almost half the emergency department. It's frightening. The average person driving around at midnight doesn't realize how many intoxicated people are on the road.

The case I remember most was 12 years ago; I remember it exactly. A drunk driver hit a car of teenagers head-on -- two were killed, three were injured. The driver came into the hospital drunk and screaming that he needed immediate attention; he had minor injuries. All the time he was demanding medical attention he knew he had caused a serious crash. He simply did not care. It sent a shudder through the whole staff.

The hardest thing about my job is telling parents that their child is dead from a car crash. You can't sugarcoat it. You go into a private room and tell the parents that their child has died. There is tremendous denial. They often say things like, "No, she has a broken leg." You have to use the word dead -- noeuphemisms like "passed on" or "went to heaven." You have to break the barrier of denial; you have to use the word dead. Then you have to show them their dead child.

It's especially hard for us when a child dies in the emergencydepartment. It changes the mood in the entire staff for the whole day. When an older person dies of natural causes, it is, of course, sad for the families; but everyone has to die at some point. When you see an 18-year-old die, it's almost always because of a crash. The feeling stays with you -- it's so sad, you can't get rid of it. You go into the lounge and you'll see nurses crying for half an hour or more. You just can't cut your emotions off.

People everywhere are losing their mothers, fathers, sons, daughters, friends and co-workers to drunk driving crashes. As a police officer regularly called to the scene of these crashes, Chief Kurt Muhle of Tekamah, Nebraska, has grown all too accustomed to dealing with
drunken drivers.

KURT MUHLE
POLICE OFFICER
Everyone thinks this kind of thing happens to everyone else. Those who are intoxicated feel invincible, so their common sense goes out the window. Everyone thinks everything will be OK.

But it is not.

I've been in public safety for 10 years and I've seen almost a hundred alcohol-related crashes. You just never forget them. The worst, in October 1998, had three fatalities -- a father, his eight-year-old son and the 24-year-old intoxicated driver of the car that hit them head-on. It was utterly devastating. I cannot begin to describe what I saw that night. It's been a little over two years and the memories are as if it happened yesterday -- every minute detail. I still wake up in the middle of the night feeling like I'm at the scene of the crash. My mind is out there on the side of the road, I can't sleep, my body is sweating and I'm bawling.

From the point of view of an officer, I tell people that if they could see what I see -- the devastation, the wreckage -- they wouldn't even think of drinking and driving. It's really hard for me to deal with knowing that the people I see were alive a few hours earlier and there I stand seeing how they died so violently. The blood, gore, victims ripped to pieces all because of somebody's stupid decision to drink and drive. It is unbearable.

Jay Bond is now 54 years old and still living in Texas, where a drunken driver killed his girlfriend, Sandra Tomlinson, in 1995. That year, Sandra was one of the 17,247 people in the United States who were killed in an alcohol-related traffic crash.

JAY BOND
DRUNK DRIVING SURVIVOR

Jay Bond and Sandra Tomlinson in 1994, a year prior to her death.
On June 25, 1995, at about 8:30 p.m., I got home and the message light on my answering machine was blinking. When I returned the call, my friend said, "I've got something to tell you and you'd better sit down." It never crossed my mind that he had such serious news. I was totally unprepared for him to tell me that a drunk driver had killed Sandra while she was riding her bicycle. My entire body went numb, I asked him to repeat himself. It was hard to breathe and I couldn't think.

Out on probation for a previous driving while intoxicated (DWI) conviction, Grant Warren had begun drinking that morning. That afternoon, he was driving with an infant and two other adults in the car and with a blood alcohol concentration (BAC) of up to .25 percent -- over twice the legal limit in Texas in 1995. He recklessly attempted to pass another vehicle by driving on the shoulder of the highway, exactly where Sandra was cycling. Sandra was killed instantly.

Understanding -- getting the fact that someone died -- takes a long time. It takes a long time for you to quit looking for someone to come in the door, call you on the phone, or do anything that they did when they were alive.

Seven months after killing Sandra, Warren got a 20-year prison sentence for intoxicated manslaughter and using his car as a deadly weapon. It's still not enough. I got a lifetime sentence. Sandra got the death sentence.

I'm still angry about it, but getting better. There are still moments that leave me stunned, the memories of Sandra and of the things we did, and thoughts of the things we might have done. It is an unbelievably overwhelming sadness and feeling of loss.

Healing is a lifetime process, but the fact of the loss will never change. The pain of it will always be there. To me, it boils down to the fact that someone chose between alcohol and Sandra's life. It was a conscious choice that led to Sandra's death. It equates the death of Sandra to a drink.Losing someone to a drunk driver and the pain of that loss -- I wouldn't wish that even on Grant Warren.

Thanks to prosecuting attorney Richard Alpert in Fort Worth, Texas, many of these drunk driving killers are convicted and sentenced to prison. Richard Alpert prosecuted Grant Warren, the drunk driver who killed Sandra Tomlinson. It was the first conviction under the new Texas law, which increased the punishment range for such crimes to 20 years in prison.

RICHARD ALPERT
PROSECUTING ATTORNEY
After dealing with DWI and intoxication manslaughter cases for the past 10 years, I've come to assume that everyone on the road after 10 p.m. is a potential drunk driver. I know that the number of people arrested for DWI goes up 40 percent after 10 p.m., so unless it's an emergency, I try not to be on the road between 10 p.m. and 4 a.m. These are random killings, and that makes it so much worse for victims' families. People who are killed by drunk drivers are victims of a horrible game of chance -- a minute here, a minute there, and the crash wouldn't have happened.

I've tried a lot of intentional murder cases, and there seems to be a deeper type of pain that is unique to DWI victims. Their loved ones were killed because someone was out having a good time. They feel that their lives have been cheapened by the random manner of their death. In my opinion, the people who kill others because they're drunk are more culpable than other killers because they're totally indifferent to the consequences of their actions and they have no respect for anyone else's life.

Drunk drivers are more selfish than the average criminal, for their pleasure is more important to them than other people's lives. They may be sorry later; they may shed tears in court -- perhaps for themselves, perhaps for the damage they have caused -- but they were too selfish to care when it mattered. Victims of drunk drivers are sacrificed on an altar of criminal indifference and it's a crime, unlike many, that's completely preventable.

The violence of a drunk driving crash is a leading cause of traumatic brain injury. If victims survive the crash, the ambulance ride and the treatment in the emergency department, they are often comatose and sent to the intensive care units, where occupational therapists like Becky Kligerman in Albany, New York, help them recover.

BECKY KLIGERMAN
OCCUPATIONAL THERAPIST
I see a large number of drunk driving survivors in my line of work. Trauma to the brain from a car crash, especially one from a high-speed collision, often leaves the victim comatose with significant swelling around and injury to the brain. Once you have a brain injury, you are never the same person again. It is really hard for therapists to see the pain that families feel when their loved ones awaken as somebody else, someone almost unrecognizable. The families tell me how someone used to be before the crash -- not just physically, but also emotionally, mentally and spiritually. When I meet them in recovery, they are someone completely different. It takes a long time for people to come to terms with this.

When the fortunate ones wake up, their memory is often impaired, emotions are out of proportion to the situation, they do things out of character or inappropriate, or they regress to childlike behavior because they have difficulty processing what's going on in their environment. Motor functions, cognition and the ability to do even the most basic activities are difficult. Activities like eating, putting on clothing and brushing their teeth may have to be taught all over again. In some cases, one side of their body may be partially or fully paralyzed. Or they may have cognitive deficits that are forever changed, so their personality might be different. A person who was outgoing and social might become withdrawn, quiet and angry. When the personality is different, that's the hardest part for the families.

Deputy Sheriff Robert Johnston knows all too well the physical and emotional pain of recovery from an alcohol-related crash. After barely surviving a traumatic crash, enduring surgeries, losing half of his left leg and undergoing physical therapy, Sheriff Johnston had to begin rebuilding his life and career.

ROBERT JOHNSTON
DRUNK DRIVING SURVIVOR AND DEPUTY SHERIFF
The night of August 10, 1994, I was on my way home after working a fatal traffic investigation. Miles from my house, a drunk driver in a one-ton truck sideswiped my motorcycle.With a broken arm, punctured lung and severed foot, I was pronounced dead on arrival at the hospital.

Robert Johnston All I remember is hearing the wind and then seeing the lights of the operating room. I thought I had been shot in the line of duty. After being in a coma for several days, I awoke to find that 16 pins were holding my arm together and that nine inches below my left knee needed to be amputated. When they took my leg off, the physical pain was excruciating.

It was a nightmare. It was horrible. All I thought about was that this was the end of my career. Who ever heard of a disabled police officer? Three months later, I was back at work on light duty; within a year I was back on full duty. The misery of the first year of recovery was unbearable -- physically and emotionally -- and the psychological obstacles are enormous.

I lived in constant, agonizing pain; but I made up my mind that failure was not an option. I took it one day at a time.

My crowning achievement came when I was transferred to a new office and a deputy saw me in the locker room and said, "My God, I've known you a year and I didn't realize you only had one leg." That was exactly what I wanted, for my fellow officers to think of and see me as any other officer. In that moment, I realized I was no longer handicapped.

The drunk driver was never prosecuted. Living in a very rural area, it took 40 minutes for emergency personnel to arrive. By then, the driver's BAC tested within the legal limit. To add insult to injury, he filed a lawsuit against me claiming that I was drunk, driving recklessly and hit him. I was awarded $800,000 in the lawsuit; he declared bankruptcy and disappeared.

I do everything I can as a traffic policeman to stop drunk drivers. My own experience has given me an intense insight. I've arrested almost 200 drunk drivers, and we've started a DWI patrol in our substation with the sole purpose to hunt down and arrest drunk drivers. It's working. We average two arrests a night, and that's with only one officer working that specific assignment.

Drunk driving is truly a victims crime. Every time you get on the road, you're rolling the dice. The statistics are horrifying and they're real. I know it from both sides of the hospital bed. As a traffic homicide officer, I look into the faces of victims and I can see their pain; as a victim, I can feel their loss and I know what I must do as an investigator. I realize that all of it can be avoided -- all of it. That fact enrages me.

The drunk drivers who killed Marci Solway's daughter and grandchildren and Jay Bond's girlfriend and who injured Officer Johnston are not alone. Millions of other DWI offenders drink and drive regularly, thinking nothing of wielding their two-ton weapons. Nearly nine out of 10 of those in jail for DWI have previously been sentenced to probation, jail or prison for other DWI offenses. And these are just the ones who have been caught; millions more put lives in jeopardy every day.

The monetary cost to society of impaired driving is staggering. It is estimated that alcohol-related crashes and the death, pain and suffering they inflict cost this country approximately $110 billion per year. If a drunk driver hits you or someone you know, medical bills will average $79,000. And don't expect justice. More than 80 percent of impaired drivers are not held responsible for their crime. If they are convicted, the median term imposed is six months.

Whether you are a drunk driving victim or not, the issue of impaired driving is clearly everyone's problem. It touches many lives in many different ways, and it leaves an indelible mark. So what can be done about this menace to society?

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Measures of Alcohol Consumption and Alcohol�Related Health Effects from Excessive Consumption

Current Drinking

Current drinkers are those who consume alcohol-containing beverages.

In 2002, 54.9% of U.S adults (18 years and older) reported drinking at least one drink in the past month. The prevalence of past-month alcohol consumption was higher for men (62.4%) than for women (47.9%) (SAMSHA, NSDUH, 2002).

Binge Drinking

Binge drinking is generally defined as having 5 or more drinks on one occasion, meaning in a row or within a short period of time (Naimi, 2003). However, among women, binge drinking is often defined as having 4 or more drinks on one occasion (NIAAA, 2004) (Wechsler, 1998). This lower cut-point is used for women because women are generally of smaller stature than men, and absorb and metabolize alcohol differently than men.

About 1 in 3 adult drinkers in the United States report past-month binge drinking, and this ratio has changed very little since the mid-1980s (Serdula, 2004).

In 2001, there were approximately 1.5 billion episodes of binge drinking in the U.S. Binge drinking rates were highest among those aged 18 to 25 years; however, 70% of binge drinking episodes occurred among those aged 26 years and older (Naimi, 2003).

Binge drinkers were 14 times more likely to report alcohol-impaired driving than non-binge drinkers (Naimi, 2003).

Binge drinking is associated with a number of adverse health effects, including unintentional injuries (e.g., motor vehicle crashes, falls, burns, drownings, and hypothermia); violence (homicide, suicide, child abuse, domestic violence); sudden infant death syndrome; alcohol poisoning; hypertension; myocardial infarction; gastritis; pancreatitis; sexually transmitted diseases; meningitis; and poor control of diabetes (Naimi, 2003).

Heavy Drinking

Heavy drinking is consuming alcohol in excess of 1 drink per day on average for women and greater than 2 drinks per day on average for men (NIAAA, 2004).

In 2002, 5.9% of U.S. adults reported heavy drinking in the past 30 days; the prevalence of heavy drinking was greater for men (7.1%) than for women (4.5%) (CDC, BRFSS, 2002).

Heavy drinking is associated with a number of chronic health conditions, including chronic liver disease and cirrhosis, gastrointestinal cancers, heart disease, stroke, pancreatitis, depression, and a variety of social problems (Naimi, 2003).

Alcohol Dependence

A person is defined as being dependent on alcohol if he or she reports three or more of the following symptoms in the past year (DSM-IV, 1994).

Tolerance (e.g., needing more alcohol to become intoxicated).
Withdrawal
Alcohol use for longer periods than intended.
Desire and/or unsuccessful efforts to cut down or control alcohol use.
Considerable time spent obtaining or using alcohol, or recovering from its effects.
Important social, work, or recreational activities given up because of use.
Continued use of alcohol despite knowledge of problems caused by or aggravated by use.

In 2002, 3.7% of past-year drinkers were alcohol-dependent (SAMSHA, NSDUH, 2002).

Underage Drinking

As of 1988, all states prohibit the purchase of alcohol by youth under the age of 21 years. Consequently, underage drinking is defined as consuming alcohol prior to the minimum legal drinking age of 21 years.

In 2003, 44.9% of 9th through 12th graders reported drinking alcohol on one or more of the past 30 days; prevalence of current drinking was higher for females (45.8%) than among males (43.8%) (CDC, YRBS, 2003).

In 2003, 28.3% of 9th through 12th graders reported binge drinking (having five or more drinks of alcohol in a row or within a couple of hours) at least once during the past 30 days. The prevalence of binge drinking was higher for males (29%) than among females (27.5%) (CDC, YRBS, 2003).

Alcohol use is a leading risk factor in the three leading causes of death among youth: unintentional injuries (including motor vehicle crashes and drownings); suicides; and homicides. Other adverse consequences of underage drinking include risky sexual behavior and poor school performance (CDC, YRBS, 2001).

Zero tolerance laws, which make it illegal for youth under age 21 years to drive with any measurable amount of alcohol in their system (i.e., with a blood alcohol concentration (BAC) =0.02 g/dL), have reduced traffic fatalities among 18 to 20 year olds by 13% and saved an estimated 21,887 lives from 1975 through 2002 (NHTSA, 1997).

Alcohol Use and Women�s Health

For women of childbearing age, the consequences of excessive alcohol consumption, particularly binge drinking, includes unintentional injuries, domestic violence, risky sexual behavior and sexually transmitted diseases, unintended pregnancy, and alcohol-exposed pregnancies.

In 2001, 11.8% of women aged 18 to 44 years reported consuming alcohol within the past month, and 11% reported binge drinking (5 or more drinks on any one occasion) (Naimi, 2003).

Women with unintended pregnancies were 60% more likely to binge drink during the three months before conception than women with intended pregnancies (Naimi, 2003).

Alcohol-Impaired Driving

In 2002, 2.2% of U.S. adults reported alcohol-impaired driving in the past 30 days (CDC, BRFSS, 2003).

In 1993, there were approximately 123 million episodes of alcohol-impaired driving in the United States. (Liu, 1997).

In 2001, there were approximately 1.4 million arrests for driving under the influence of alcohol or narcotics. This is an arrest rate of 1 of every 137 licensed drivers in the United States. (NHTSA, 2003).

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Alcohol-Related Health Effects from Excessive Alcohol Consumption

Total Deaths due to Alcohol

In 2000, there were approximately 85,000 deaths attributable to either excessive or risky drinking in the U.S., making alcohol the third leading actual cause of death (Mokdad, 2004).

Alcohol-related deaths in the United States vary considerably by state, and are directly related to the amount of alcohol consumed and the pattern of alcohol use.

Alcohol Motor Vehicle Crash Deaths

In 2002, 17,419 people in the United States died in alcohol-related motor vehicle crashes, accounting for 41% of all traffic-related deaths (NHTSA, 2003).

In 1995, 36% of all crash fatalities among youth aged 15 to 20 years were alcohol-related (Samber, 1997; NHTSA, 1997).

From 1997 through 2002, 2,355 children died in alcohol-related motor vehicle crashes; 1,588 (68%) of these children were riding with a drinking driver (CDC, MMWR, 2004).

Alcohol and Unintentional Injuries

Alcohol-related unintentional injuries and deaths include motor vehicle crashes, drownings, falls, hypothermia, burns, suicides, and homicides.

Approximately 31.1% of those who die from unintentional, non-traffic injuries in the United States have a blood alcohol concentration of 0.10 g/dL or greater (Smith, 1999).

Patients treated in an emergency department (ED) for an unintentional injury are 13.5 times more likely to have consumed 5 or more alcohol-containing beverages within 6 hours of their injury compared to age and sex matched community controls (Vinson, 2003).

Alcohol and Violence

In 1997, about 40% of all crimes (violent and non-violent) were committed under the influence of alcohol (Bureau of Justice Statistics, 1998).

In 1997, 40% of convicted rape and sexual assault offenders said that they were drinking at the time of their crime (Greenfield, 2000).

Approximately 72% of rapes reported on college campuses occur when victims are so intoxicated they are unable to consent or refuse (Wecshler, 2004).

Two-thirds of victims of intimate partner violence reported that alcohol was involved in the incident (Bureau of Justice Statistics, 1998).

Nearly one-half of the cases of child abuse and neglect are associated with parental alcohol or drug abuse (Grant, 2000).

Approximately 23% of suicide deaths are attributable to alcohol (Smith, 1999).

Alcohol and Pregnancy

Adverse health effects that are associated with alcohol-exposed pregnancies include miscarriage, premature delivery, low birth weight, sudden infant death syndrome, and prenatal alcohol-related conditions (e.g., fetal alcohol syndrome and alcohol-related neurodevelopmental disorders).

In 1999, 12.8% of women aged 18 to 44 years reported any alcohol use (at least one drink) during pregnancy, and 2.7% reported binge drinking (5 or more drinks on any one occasion) (MMWR, 2002).

Alcohol-related neurodevelopmental disorder and alcohol-related birth defects are believed to occur approximately three times as often as Fetal Alcohol Syndrome (FAS) (CDC, NCBDD/FAS, 2004).

Fetal Alcohol Syndrome is one of the leading causes of mental retardation, and is directly attributable to drinking during pregnancy. FAS is characterized by growth retardation, facial abnormalities, and central nervous system dysfunction (i.e., learning disabilities and lower IQ), as well as behavioral problems.

The incidence of FAS in the United States ranges from 0.2 to 1.5 per 1,000 live births http://www.cdc.gov/ncbddd/fas (CDC, NCBDD/FAS, 2004).

Any maternal alcohol use in the periconceptional period (i.e., during the three months before pregnancy or during the first trimester) is associated with a six-fold increased risk of SIDS (Iyasu, 2002).

Binge drinking (five or more drinks at a time) during a mother's first trimester of pregnancy is associated with an eight-fold increase in the odds that the infant will die of SIDS (Iyasu, 2002).

Alcohol and Sexually Transmitted Disease

Alcohol use by young adults is associated with earlier initiation of sexual activity, unprotected sexual intercourse, multiple partners and an increased risk for sexually transmitted diseases.

Among teens aged 14 to 18, 20% of those who reported drinking before age 14 also reported being sexually active compared to 7% of those who did not report drinking before this age (The National Center on Addiction and Substance Abuse, 1999).

In 1998, an estimated 400,000 college students between the ages of 18 and 24 had unprotected sex after drinking, and an estimated 100,000 had sex when they were so intoxicated they were unable to consent (Hingson, 2002).

Among adults aged 18 to 30, binge drinkers were twice as likely as those who did not binge drink to have had two or more sex partners (Leigh, 1994).

People who abuse alcohol are more likely to engage in risky behaviors, such as having unprotected sex, having more sex partners, and using intravenous drugs. In a single act of unprotected sex with an infected partner, a teenage woman has a 1% risk of acquiring HIV, a 30 % risk of getting genital herpes, and a 50% chance of contracting gonorrhea (Alan Guttmacher Institute, 1994).

Hepatitis C and Chronic Liver Disease

Alcohol consumption can exacerbate the HCV infection and accelerate disease progression to cirrhosis. Alcohol may also exacerbate the side effects of antiviral treatment for HCV infection, impairing the body�s response to the virus (Larrea, 1998).

In 2003, there were 12,207 deaths from alcohol-related chronic liver disease (CLD). Approximately 75% of those deaths occurred among men (CDC, NCHS, 2003).

Approximately 40% of the deaths from unspecified liver disease in the United States are attributable to heavy alcohol consumption (Parrish, 1993).

Alcohol and Cancer

Alcohol-related cancers include oral-pharyngeal, esophagus (squamous cell type), prostate, liver, and breast. In general, the risk of cancer increases with increasing amounts of alcohol.

Excessive drinkers are 3 times more likely to develop liver cancer than non-drinkers (English & Holman, 1995).

Excessive drinkers are 4 times more likely to develop esophageal cancer than non-drinkers (English & Holman, 1995).

Oral cancers are six times more common in heavy alcohol users than in non-alcohol users (American Cancer Society, 2002).

Compared to non-drinkers, women who consume an average of 1 alcoholic drink per day increase their risk of breast cancer by approximately 7%. Women who consume an average of 2 to 5 drinks per day increase their risk of developing breast cancer by approximately 50% compared to that of non-drinkers (American Cancer Society, 2002).

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Effective Prevention Strategies for Alcohol-Related Health Problems

Alcohol Taxes

A 10% increase on the tax for alcohol containing beverages could reduce the number of binge drinking episodes per month by 8% (Sloan, 1995).

For every 1% increase in the price of beer, the traffic fatality rate declines by 0.9% (Ruhm, 1996).

A 25% increase in the 1992 federal beer tax would have reduced work-loss days from non-fatal workplace accidents by 4.6 million and lost productivity by $491 million (Oshfeldt, 1997).

Raising state beer tax from 10� per case to $1 per case would increase the probability of graduating from college by 6.3% (Cook, 1993).

Minimum Legal Drinking Age Laws

All states and the District of Columbia have enforced 21-year-old minimum drinking age laws. In 2002, an estimated 917 lives saved in traffic crashes as a result of the age 21 minimum drinking age laws (NHTSA, 2002).

Increasing the minimum drinking age from 18 to 21 has reduced both drinking and traffic crashes among youth by 10 to 15% (O�Malley & Wagenaar, 1991).

Comprehensive Community Programs

Comprehensive community-based programs have reduced past month alcohol consumption among underage youth by 7% (Wagenaar, 2000).

Intervention Training Programs for Servers

Server training programs have reduced alcohol sales by 11.5% and sales to pseudo-intoxicated buyers by 46% (Toomey, 2001).

Server training programs have reduced single vehicle nighttime injury crashes by 23% (Holder, 1994).

Screening and Brief Intervention

Brief physician advice to reduce alcohol consumption has reduced the number of binge drinking episodes in the past 30 days more than 40% (Fleming, 1997).

The U.S. Preventive Services Task Force (USPSTF) recommends regular screening in primary care practices for alcohol misuse among adults and pregnant women (AHRQ, 2003).

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References

The Alan Guttmacher Institute, Teen sex and pregnancy. Available at http://agi usa.org/pubs/19/1999* Accessed March 18, 2004.

American Cancer Society Fact sheet Available at http://www.cancer.org/downloads/PRO/alcohol.pdf* (PDF�164K) Accessed March 18, 2004.

American Cancer Society. Detailed guide: oral cavity and oropharyngeal cancer available at http://www.cancer.org* Accessed March 18, 2004.

American Cancer Society: Detailed Guide: Breast Cancer. Available at http://www.cancer.org* Accessed March 18, 2004.

Centers for Disease Control and Prevention (CDC). Alcohol consumption among pregnant and childbearing-aged women United States, 1991-1999. Morb Mortal Wkly Rep 2002;51:273-6.

Centers for Disease Control and Prevention (CDC). Alcohol Related Disease Impact Software data. Atlanta (GA): Department of Health and Human Services 2003.

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