1. FETAL ALCOHOL SPECTRUM DISORDERS The Basics

2. DEFINITION OF ALCOHOLISM  PRIMARY  DISEASE  OFTEN PROGRESSIVE AND FATAL  IMPAIRED CONTROL  PREOCCUPATION  ADVERSE CONSEQUENCES  DENIAL

3. ALCOHOL USE IN TEENS 50.9% of Americans aged 12 or older reported being current drinkers of alcohol in a 2006 survey, with youths aged 12 to 17 alcohol use being 16.6% Among youths aged 12 to 17 in 2006 who were heavy drinkers, 56.7% were also current illicit drug users Among youth aged 12 to 17 the percentage of males who were current drinkers(16.3%) was similar to the rate for females(17.0%)

4. Scope of alcohol use in teens 26.9% of eighth-graders reported past year use of alcohol 6.4% of eighth-graders reported binge drinking 14.7% of 10 th graders reported binge drinking 21.6% of 12 th graders reported binge drinking National Institute of Drug Abuse “Monitoring the Future” 2011

5. Drinking Levels among High School Students 42% drank some amount of alcohol 21.6% binge drank 10% drove after drinking alcohol 28% rode with a driver who had been drinking alcohol CDC 2006-2011 – Youth Risk Survey

6. Why Teens are at Risk

7. Why Teens Are at Risk People who begin drinking at a young age also may drink heavily during stressful events later in life. NIAA recent study found an interaction between an early age of first drink and drinking patterns later in adulthood. People with an earlier age of first drink had: More frequent & higher consumption levels than those who began drinking at a later age.

8. Teen Brain on a Binge Binge drinking may have lasting effects on a still- developing brain of a teen. Recent study-long after hangover wears off—binge drinking impairs the spatial working memory - ability to perceive the space around you, to remember & work with this information to perform a task e.g. using a map, playing sports, driving a car and other measures of attention. Girls appear especially vulnerable.

9. Alcohol-More Effects on Teen Brain Even though adolescents might appear physically grown up, their brains are continuing to significantly develop & mature, especially in frontal brain, associated with higher-level thoughts, like planning & organizations. Heavy alcohol use could interrupt normal brain cell growth during adolescence and could interfere with teens’ ability to perform in school and sports & could have long-lasting effects, even months after teens use.

10. ADOLESCENT PREGNANCY Adolescents are more likely to engage in high risk behaviors, such as unprotected sex, when they are under the influence of alcohol or drugs. 50% of teens say drinking and drugs are the main reasons teens don’t use contraception when they have sex. (National Campaign to Prevent Teen Pregnancy) Students are 2-3 times more likely to be sexually active if they drank frequently, smoked cigarettes or smoked marijuana.(Family Planning Perspectives)

11. Fetal Alcohol Spectrum Disorders (FASD) Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy May include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications Not a diagnosis

12. Terminology Fetal alcohol syndrome Term first used in 1973 by Drs. Smith and Jones at the University of Washington One of the diagnoses used to describe birth defects caused by alcohol use while pregnant A medical diagnosis (760.71) in the International Classification of Diseases (ICD)

13. Terminology pregnanc y + Alcohol May result in Fetal alcohol effects (FAE) Alcohol-related birth defects (ARBD) Alcohol-related neurodevelopmental disorder (ARND) Partial FAS (pFAS)

14. Reprinted with permission, Streissguth A.P., & Little, R.E.

16. FASD Facts: 100% PREVENTABLE Leading known cause of preventable mental retardation Not caused on purpose Can occur anywhere and anytime pregnant women drink Not caused by biologic father’s alcohol use Not a new disorder

17. Cause of FASD The sole cause of FASD is women drinking alcoholic beverages during pregnancy. Alcohol is a teratogen. “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” —IOM Report to Congress, 1996.

18. FASD and Alcohol All alcoholic beverages are harmful. Binge drinking is especially harmful. There is no proven safe amount of alcohol use during pregnancy.

19. PARTNERS Men’s patterns of substance use typically are not targeted by public health campaigns and their levels of binge drinking, daily smoking and marijuana use remained fairly stable before, during and after pregnancy

20. EFFECTS OF ALCOHOL Weeks 1 – 8: Nervous system damage Days 15 – 25: Brain Damage Third week after conception: Highest risk of producing FAS, including facial abnormalities Third month: Rapid growth period During this entire trimester, structural damage can occur

21. SECOND TRIMESTER (3 RD TO 6 TH MONTH) Organs vulnerable to functional defects, especially: CNS Eyes Teeth Period of rapid growth occurs in 3 rd month and continues until after birth

22. THIRD TRIMESTER (6 TH through 9 th month) Rapid growth continues Immune system develops Risk of birth defects and damage to the developing brain

23. Fetal development chart

24. HOW DOES ALCOHOL CAUSE BRAIN DAMAGE Excessive cell death Reduced cell proliferation Migrational errors in brain development Inhibition of nerve growth factor Disruption of neurotransmitters

25. FAS and the Brain Permission to use photo on file.

26. FAS and the Brain ABC A B C A. Magnetic resonance imaging showing the side view of a 14- year-old control subject with a normal corpus callosum; B. 12- year-old with FAS and a thin corpus callosum; C. 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum. Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

29. BEHAVORIAL EFFECTS FOLLOWING PRENATAL ALCOHOL EXPOSURE Hyperactivity, reactivity Attention deficit disorders, distractibility Lack of inhibition Mental retardation, learning difficulties Perseveration

30. BEHAVIORS, CONTINUED Feeding difficulties Gait abnormalities Poor fine/gross motor skills Developmental delays (motor, social, language) Hearing abnormalities

31. LIFE LONG EFFECTS Children with FASD face many challenges and frustrations Infants and toddlers have developmental problems and delays. They may have poor muscle tone, be extremely irritable, abnormal sleep/wake cycles, disordered attachment, and feeding difficulties

32. LIFE LONG EFFECTS In toddlers there may be language delays, head banging, delayed motor skills, hyperactivity, cognitive delays and mental retardation In preschoolers, hyperactivity short attention span, aggressiveness, poor articulation and slow vocabulary development

33. LIFE LONG EFFECTS Children of school age will have many challenges throughout their school years They may look different and act different than their peers, which effects self esteem and social interactions

34. LIFE LONG EFFECTS The symptoms often seen are poor memory, attention deficits, learning disabilities, language problems, poor impulse control, increased aggressiveness and poor judgment FASD is often undiagnosed and the child will have continuing difficulties

35. General Issues With FASD Often undiagnosed among persons without FAS facial features More difficulties seen in those without FAS facial features and with higher IQs Adaptive functioning more impaired than intelligence

36. Systems of Care

37. Economic Costs of FAS/FASD FASD cost the United States more than $6 billion in 2004. The average lifetime cost for each child with FAS is $2 million. $1.6 million for medical care services $0.4 million for loss of productivity Lupton, Burd, and Harwood (2004) Increased costs

38. IMPORTANT Early evaluation and proper diagnosis will enable interventions that will enhance the quality of life for those effected by prenatal exposure

39. PREVENTION Understand that there is no safe amount of alcohol use during pregnancy Both fathers and mothers need to look at their smoking, drinking and substance use