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Ask the Expert

FASD: The Current Relevance of an Age-Old Problem - March 2014

Callie Gass
Project Director, SAMHSA FASD Center for Excellence

As March is Intellectual and Development Disabilities Awareness Month, I wanted to talk about the leading preventable cause of intellectual disability, in the U.S. and around the world – alcohol use in pregnancy.

A pregnant woman’s use of alcohol can have adverse effects on her child. People have witnessed this phenomenon at least since biblical times. In 1973, doctors described a specific set of severe alcohol-related birth defects that they labeled Fetal Alcohol Syndrome (FAS). Since that time, further research has brought greater understanding of the full range of physical, intellectual, developmental, and behavioral problems that prenatal alcohol exposure can cause, leading to the coining of the umbrella term Fetal Alcohol Spectrum Disorders (FASD). For as long as we have known about the problem, it remains relevant today.

The FASD Center for Excellence, an initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA), strives to increase the awareness of the adverse effects of maternal alcohol use. Our goal is to reduce, and if possible eliminate, FASD. We have a long way to go. In our January column, we reported that almost one in five pregnant women admit drinking at least some alcohol in their first trimester, a time when many women may not know they are pregnant. Our February column discussed an informal poll in which 60% of respondents indicated they thought alcohol use in pregnancy was OK. The incidence of FASD is estimated to be around one to three percent of births in the U.S., and many experts believe it may be much higher. The effects of FASD last a lifetime.

As stated in the International Charter on Prevention of Fetal Alcohol Spectrum Disorder, published this month in the prominent journal Lancet Global Health, “No known amount of alcohol is safe for a growing embryo and fetus.” The Charter calls for increased government action “to raise awareness of fetal alcohol spectrum disorder and the risks of alcohol use during pregnancy.”

I cannot emphasize this enough – we know that FASD is completely preventable.

Q and A

What are some of the birth defects caused by alcohol?

Alcohol is a known teratogen, meaning that it is a substance that can cause abnormal development in a growing fetus. Infants affected by alcohol exposure in the womb may have obvious skeletal anomalies such as a small head or poorly formed limbs. Many are born small for their gestational age, a result of fetal growth restriction. They may also have defects in the formation of major organs such as the heart, eyes, or the brain.

What other types of problems are associated with FASD?

Alcohol can disrupt the development of the brain and many of the problems it causes are subtle. As a result, FASD encompasses a wide range of memory, developmental, behavioral, and cognitive deficits that become more apparent as the individual grows and matures. These deficits can lead to issues with learning and school performance, along with difficulties in social skills, life skills, and employment. In addition, research has shown that individuals affected by FASD are at high risk for alcohol and other substance abuse, homelessness, encounters with the law, and suicide attempts. With its prevalence and its potential for lifelong disabilities, FASD is a significant public health concern.

How is SAMHSA addressing FASD?

SAMHSA is the federal agency charged with improving public health by addressing problems related to substance abuse and mental health. SAMHSA’s strategic initiatives center on prevention and treatment. At the SAMHSA FASD Center, we advance prevention efforts by increasing public awareness of the risks of alcohol use in pregnancy. We disseminate information and provide training on effective prevention interventions. For individuals with an FASD, we promote modifications in treatment to help reduce their risk of future substance use disorders as well as homelessness and suicide.

Treatment is also part of the core SAMHSA mission. Responding to the FASD Center’s mandate to improve FASD treatment and SAMHSA’s strategic initiatives to address trauma and justice, public awareness and support, and health care reform, we have supported efforts to strengthen and maintain recovery for birth mothers and others with substance use and mental health disorders. We have worked to implement evidence-based practices for the prevention of alcohol exposed pregnancies into existing systems of care. We have also been on the cutting edge in developing new screening tools to identify FASD and exploring modifications to the treatment of substance use disorders to meet the needs of individuals with an FASD and their families.

In the 12-plus years of our existence we have made progress against FASD through information campaigns, workforce development, state capacity building, and piloting prevention and treatment programs. We develop and distribute free educational materials in print and through our website. Our experts serve as a resource for families, communities and tribal entities, state and local governments, and clinicians seeking training and support services.

What are the costs associated with FASD?

Estimates of the cost of FASD are difficult to make. One study of children enrolled in Medicaid found that costs for a child with an FASD were up to nine times higher than for an unaffected child. The overall annual cost of FAS alone to the U.S. healthcare system was estimated at $5 billion in 2004, creating significant strain on limited social and health resources.

What can we do about FASD?

Prevention is the key. The International Charter calls for “a consistent, evidence-based message about prevention.” We have been aware of the problem of fetal alcohol exposure for ages. Preventing FASD remains a current and on-going concern.

FASD occurs in all segments of society. Thus, prevention strategies must be broad-based, consistent, and sustained.

The SAMHSA FASD Center is working toward eliminating FASD through the development and delivery of effective, low-cost interventions to prevent alcohol consumption during pregnancy that reach across all populations. In the meantime, we are committed to finding better ways to increase public awareness of the risks of alcohol use in pregnancy, and to treat individuals who are affected by the intellectual and developmental disabilities associated with FASD.

About the Expert

Callie Gass has been the Project Director for the SAMHSA FASD Center for Excellence since 2002. Ms. Gass has an extensive background in public health, with more than 20 years of experience managing substance abuse prevention and treatment programs. Prior to her work with the FASD Center for Excellence, Ms. Gass was Director of Programs and Partnerships for the National AIDS Fund, a position that entailed the direct management of several federally funded projects. Ms. Gass has also held various positions with the Northern Virginia Regional Council, supervising programs in homelessness, HIV/AIDS, housing, childcare, and youth services.

Reference: Jonsson E, Salmon A, Warren KR. (2014). The international charter on prevention of fetal alcohol spectrum disorder. The Lancet Global Health, 2(3), e135 - e137. doi:10.1016/S2214-109X(13)70173-6

DISCLAIMER: The views, opinions, and content of this column are those of the authors/experts and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.