“I am adopted and my mom died so no one will ever know when or how much or how often my mom drank. I just know I have to live with it,” Liz Kulp said in The Best I Can Be: Living with Fetal Alcohol Syndrome or Effects. The Best I Can Be, a book written by her adopted mother Jodee Kulp, details Liz’s struggle against the brain and metabolic damage she suffered as the result of her birth mother’s drinking. According to the National Organization of Fetal Alcohol Syndrome (NOFAS), in the United States as many as twelve thousand infants are born each year with Fetal Alcohol Syndrome (FAS), a set of physical, mental, and neurobehavioral birth defects characterized by facial abnormalities and growth retardation. Three times as many babies have Alcohol-Related Neurodevelopment Disorder (ARND)—functional or mental impairment without facial abnormalities or growth problems— or Alcohol-Related Birth Defects (ARBD), which include malformations in the skeletal and major organ systems. Experts from NOFAS argue that FAS/ARND/ARBD affect more newborns every year than Down syndrome, cystic fibrosis, spina bifida, and sudden infant death syndrome combined. Together, FAS/ARND/ARBD comprise the leading known cause of mental retardation in the United States and affect every racial and ethnic group. These alcohol-caused syndromes present stark evidence of the devastation alcohol can cause and point to some of the medical and legal issues surrounding alcohol use.
People born with FAS/ARND/ARBD will spend their lives trying to overcome various difficulties in visual, auditory, language, and tactile processing. Like Liz, they will always have fine and gross motor skill problems and face challenges in their social and behavioral development. For example, Liz struggles daily with language because parts of her brain that process sounds into words and words into language were damaged by alcohol before she was born. The hugs and snuggles most children cherish were repugnant to Liz as an infant and young child—alcohol-caused brain damage retarded her ability to process tactile sensations. She was almost ten years old before she really enjoyed a hug.
The economic and emotional costs to individuals suffering from FAS/ARND/ARBD and their families is obvious, but the syndromes’ costs to society are incalculable as well. The Office of National Drug Control Policy estimates the 1992 cost to U.S. taxpayers for medical and specialized care for children born with FAS/ARND/ARBD was $1.9 billion. Many of these children will require a lifetime of custodial care. Ironically, while devastatingly irreversible, the damage done to a fetus by alcohol is totally preventable. Jodee Kulp notes that FAS “is 100 percent preventable and our number one cause of birth defects, yet as a culture we ignore it.”
Scientists have known for many years that alcohol is a teratogen, a substance known to be harmful to human development. When a pregnant woman drinks, alcohol enters her bloodstream and then goes through blood vessels in the placenta to her growing baby’s blood supply. Alcohol use can interfere with healthy development of the fetus and cause FAS/ARND/ARBD. Some scientists argue that it is not so much the total amount of alcohol consumed over time but rather a high number of drinks consumed at one time— binge drinking—that puts the fetus at greatest risk. Since there is no known safe amount of alcohol that can be imbibed during pregnancy, the simplest method of preventing FAS/ARND/ARBD is for women to avoid alcohol completely during all phases of pregnancy. In fact, that is what most doctors recommend. Enoch Gordis, director of the National Institute for Alcohol Abuse and Alcoholism contends, “Until such safe dose, if it exists, can be determined, the only responsible advice to women who wish to become pregnant and to those who are pregnant is to avoid alcohol use entirely.”
The Department of Health and Human Services has long recognized that alcohol-caused fetal injuries are a serious public health problem. Since 1981 the surgeon general has recommended abstinence during pregnancy and required that all alcoholic beverages be clearly labeled with a warning outlining the risk of alcohol to fetal development. Establishments selling alcoholic beverages are required to post the same message on signs in plain view. Moreover, the federal government provides prenatal programs, public service announcements, health articles, and brochures advising abstinence during pregnancy. State and local agencies, as well, fund programs that target specific groups known to be at higher risk than the general population, such as women who reside in communities with heavy per capita alcohol use.
However, results of a study published in the January 2003 issue of the journal Alcoholism: Clinical and Experimental Research, indicate that many women continue to drink throughout their pregnancies even though they have been advised of the danger. One of the researchers who conducted the study, Heather A. Flynn of the University of Michigan Medical School, concluded, “Despite increasing public awareness of the harmful effects of drinking during pregnancy, many women consume alcohol in varying degrees while pregnant.”
There is no cure for FAS/ARND/ARBD—prevention through abstinence and early identification of affected individuals offer the most viable solutions for this horrific alcohol-caused problem. The younger that children can be diagnosed (Liz Kulp was twelve-and-a-half before her FAS diagnosis was confirmed) and offered social support, special education, behavioral and cognitive therapy, and appropriate medication, the greater their chances of ultimately functioning at a higher level. Jodee Kulp concludes, “[Liz and I] believe that we can make a significant impact on society if we help persons with FAS become the best they can be . . . our prison system, homeless shelters and institutions should not be the structured environment they live their adult lives in.”
The potential for prenatal injury is just one of the com- plex problems surrounding the use of alcohol in American society. Authors in Alcohol: Opposing Viewpoints explore other alcohol-related issues in the following chapters: Is Alcohol Use Beneficial to Human Health? What Are the Causes of Alcohol Abuse? How Should Alcoholism Be Treated? What Measures Should Be Taken to Reduce Alcohol-Related Problems? While recent scientific discoveries have added to the layperson’s knowledge about alcohol and its effect on the human body, no one has yet resolved the many medical and legal issues surrounding this ancient beverage.