Global Prevalence of Prenatal Alcohol Exposure – A Call to Action

Let’s congratulate and commend Tracey W Tsang and Elizabeth J Elliott on their important publication of “High global prevalence of alcohol use during pregnancy and fetal alcohol syndrome indicates need for urgent action” in The Lancet, [http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30008-6/fulltext].  This publication mirrors the historical, epidemiological, and societal implications presented in my book, “The Silent Epidemic:  A Child Psychiatrist’s Journey beyond Death Row – Understanding, Treating and Preventing Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure” [www.prenatalalcoholexposure.com]; as well as a an international book chapter in Fetal Alcohol Spectrum Disorders in Adults: Ethical and Legal Perspectives [https://link.springer.com/chapter/10.1007/978-3-319-20866-4_3].  The authors clearly call for global paradigm shifts in public perception of alcohol’s effects on society – through advocacy efforts, the media, the alcohol industry, advertising and public policy.
 
I have just returned from Vilnius and Alytus, Lithuania where I gave two lectures daily for three days to large audiences of clinicians, social workers, public health professionals and policy makers (as well as the entire class of first year medical students at the Medical University of Vilnius) about this topic.  Here is a video of the talk at the Ministry of Health to a multidisciplinary group of professionals in the Center for Mental Health [https://www.youtube.com/watch?v=ZNc_RL5Z5Vo].  The introductions were given by the Director of Mental Health for the Ministry of Health who spoke about the epidemic created by alcohol abuse during the former Soviet occupation of the Baltic country.  I was moved and impressed by the city of Alytus’s efforts to end the mass institutionalization of children from alcoholic families, opting instead to offer the entire family therapeutic care with farming families where they are allowed to live in a safe, agrarian setting while learning adaptive functioning skills and vocational skills as well as parenting training.  [My trip was sponsored by a nonprofit family foundation dedicated to improving the lives of Lithuanian children.]
 
In my humble opinion, a medical journal as world renown as The Lancet taking on this issue will surely help awaken others to the devastation on developing brains caused by our western society’s social drug of choice: alcohol.  Just as the British Parliament took on the Gin epidemic in the 1750s, so too can our modern societies choose to urge doctors to encourage their patients (both male and female) to contracept if using alcohol.  After all, these problems occur as early as the 3rd week post conception – well before many know they are pregnant.  Methylation effects to sperm DNA occur up to three months prior to conception, and are transmitted through histone modifications for generations, resulting in familial anxiety, depression, addictive disorders, obesity, and a plethora of other conditions hidden within our tightly wound genome. 
There is no excuse that alcohol is allowed to cause 1 in 20 American children to be born with preventable neurodevelopmental deficits, deformities, and lifelong lost potential.  If the solvent ethanol was as important to mankind as a life-saving antitumor medication, it would not be allowed to cause 1 in 1,000 babies to be born each year with brain damage and birth defects.  We prescribe contraceptives and pregnancy testing to all patients receiving pharmaceuticals that have any potential for causing negative reproductive outcomes.  Just as condoms are promoted for HIV prevention, let’s agree that alcohol and unprotected sex don’t mix and promote contraception and preconception health for alcohol consumers. [https://www.cdc.gov/ncbddd/fasd/alcohol-use.html].   
In the spirit of prevention, identification, and treatment – Kudos to Drs. Tsang, Elliott, Horton and The Lancet.  Perhaps one day you all will be granted well-deserved knighthood!

Taking Farm Animal Therapy to Lithuania

Last fall, I was honored to have a pediatrician and her husband, a neurologist, from Lithuania visit Dream Catcher Farm to learn more about our therapeutic farm animal sanctuary for children with Fetal Alcohol Spectrum Disorder (FASD) / Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE).  They spoke about their challenging work moving Lithuanian children from orphanages into foster care homes in the community.  Unfortunately, many foster families are unable to care for the children who have short attention spans, are impulsive, are triggered into “fight or flight” (emotional reactivity) very easily, are sensitive to ordinary environmental stimuli and have difficulty learning new information.   As a result, many children are returned to the orphanages. After I explained the 4 domain model of working with these children and told them about a novel program for women and their dependent children in North Carolina, they returned to Lithuania with renewed hope for families suffering from alcohol abuse.  Little did I know they would be sending me to Lithuania this fall to help build a farm program.

Parenting children with FASD/ND-PAE can be frustrating, overwhelming, and nearly impossible for those who are not trained to understand that these children can’t follow directions, and perform daily activities without continuous reminders and prompting.  They also have difficulty attuning to parents and caregivers because of wiring differences. It turns out that children respond well to and are eager to learn how to care for animals.  Farm animal therapy incorporates gentle stroking, petting, cuddling, and grooming animals in addition to feeding and watering them daily.  Hand raised animals like mine are eager to be touched, nurtured, and cared for and seek people out rather than running away.  For this reason, children are drawn to the gentle goats, rescue pig, and barn cats at Dream Catcher Farm.

On their return to Lithuania, the visiting physicians said, “We have children and we have animals.”  Yet what the idea they developed was to put the entire family on a farm with a farming family who would give the parents meaning and purpose living a substance free life, allowing the children to remain in their family of origin.  I feel blessed though maybe a little naive that  my farm may inspire others like it to help children with prenatal alcohol exposure and their families live happier, healthier lives.

http://www.hpenews.com/life/former-archdale-resident-expands-work-with-children-prenatally-exposed-to/article_21a9e4b2-8bf6-11e7-9200-6f73d686f4eb.html?utm_medium=social&utm_source=twitter&utm_campaign=user-share

Media Responsibility for Prevention

When I wrote my book, The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row, I naively thought that I could stem the tide of public awareness about alcohol use during childbearing years – helping unknowing young women understand the importance of contraception if using alcohol.  Articles like this one recently in the Washington Post are a big reason people are missing the message that a lot of damage happens to babies before you find out you’re pregnant.   And alcohol doesn’t just cause Fetal Alcohol Syndrome! https://www.washingtonpost.com/opinions/five-myths-about-pregnancy/2017/05/12/7cf6e12a-3666-11e7-b373-418f6849a004_story.html?nid&utm_term=.fddddfca9788#comments

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Ilustration by Angele Mele, Coverart for The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row.

I can’t help but wonder what responsibility the media has for creating the confusion and societal ambivalence about alcohol use during reproductive years.  Like some other drugs, alcohol is a neuroteratogen – a chemical solvent that causes birth defects of the brain and nervous system.  Yes, it’s a solvent.  Like household cleaning supplies, dry cleaning solution, gasoline, paint thinner, and rubbing alcohol.  Alcohol kills the tiny cells migrating out of the neural tube as early as the 3rd week after conception – well before most women know they are pregnant.

In my book, I indicate the role of the alcohol industry, the medical community, and the government in preventing brain damage caused by our social drug of choice in 1 in 20 American children.  The article in the Post reminds me of the media forces keeping the waters muddy about use of alcohol for women who are pregnant or planning pregnancy.  So much more can and should be done to help them as well, as women who are sexually active and using alcohol but not preventing pregnancy.

One risk of the “Five Myths” article and the book is that women will become confused by the stance that a little alcohol is okay. What is a little alcohol to one woman is a long island iced tea to another (equivalent of 6 shots). As a board certified child/adolescent and adult psychiatrist, I see patients adopted from foster care in the U.S., Eastern Europe, South/Central America, China, and Southeast Asia with a range of neurodevelopmental problems (learning, attention, memory, anxiety/arousal, mood, sensory, motor, social/communication, etc.) stemming from prenatal alcohol exposure. Psychiatrists see these patients, not obstetricians. The condition is called “Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure” (ND-PAE, ICD-10 code F88).

Most people know that alcohol abuse during pregnancy can cause “The Fetal Alcohol Syndrome” (FAS). What is less known is that as little as 4-5 servings of alcohol mistimed in the late 3rd week post conception is enough to cause the full FAS. Most women don’t know they are pregnant then. Our genetics, health factors, nutrition status, and other lifestyle behaviors can protect us and our babies or make the situation worse. We also know that a man’s sperm DNA is methylated by alcohol consumed up to 3 months prior to conception (it takes 3 months for sperm to develop from the earliest stages to “fertile”). Methylation of DNA has been linked to a variety of mental health, learning, medical, and other conditions.

I am a believer in educating alcohol consumers about the risks of unintentional prenatal alcohol exposure before knowing you are pregnant and to use contraception (prevent pregnancy) if using alcohol. Preconception health is the best way to prevent ND-PAE. I believe it’s time for the alcohol industry to be held accountable that our social drug of choice (alcohol) has caused brain damage in 1 in 20 U.S. children (CDC, 2015).

For more information about Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure, check out my book at www.prenatalalcoholexposure.com.

Guest of Potomac-Bethesda Rotary

brian-feldman-susan-rich-bob-fuhrman-aruna-miller-091516-dsc_0635

Pictured from left to right: Senator Brian Feldman, Susan Rich, Bob Fuhrman – Rotary Pres., and Representative Aruna Miller.

It was a remarkable honor to speak last night to the prestigious group of service-oriented citizen members of the Potomac-Bethesda Rotary Club.  As a public health entrepreneur, I’m grateful to have the support of State Senator Brian Feldman and District 15 Representative Aruna Miller, who attended the Rotary club dinner presentation about my new book – The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row.*   Sharing my journey with these remarkable legislators and the imminent Rotary scholars and community leaders was truly humbling.

My main points were to let them know much about the public health warnings and efforts leading up to Prohibition, and the reasons why our society seems deaf to the damage caused to our future generations from a chemical so ubiquitous as alcohol.  None of the Rotarians knew that as little as 4-5 standard servings of beer, wine or liquor exquisitely timed late in the 3rd week post conception can cause the Fetal Alcohol Syndrome (FAS), or that only 10-15% of children with effects of prenatal alcohol exposure have the identifiable facial characteristics.  They also didn’t know that a Long Island Iced Tea contains nearly 1.5 times the amount of alcohol (6 shots, no tea) to cause FAS.  Since 50% of U.S. pregnancies are unplanned and 13.5% of childbearing age women drink alcohol, we have an epidemic (1 in 20) of affected school-aged children in this country.

They were  dismayed that future generations could be impacted by a process known as “methylation” – the addition of “CH3-switches” placed on DNA’s histone proteins to interfere with the process of translation of the DNA/RNA into protein.  Not only is a child’s neuronal wiring affected by a mother drinking alcohol (i.e., killing the progenitor brain cells that will form important structures of the midline especially), the child’s gonads are affected (their “germ cells” – eggs and sperm) by effects of methylation.  This process affects future generations – even if the mother does not drink.  Since it takes 3 months for the process of spermatogenesis (sperm development) in the male, his use of alcohol can also potentially “methylate” his sperm DNA.   These permanent switches created by preconceptional alcohol exposure are transmitted for generations into the future. Thus, conditions such as alcoholism, chemical dependency, anxiety disorders, and neurodevelopmental disorders are carried down generation after generation – silently within the replication process of DNA.

The fact that most people don’t know that their children and grandchildren may be affected by their inebriated sperm is a problem our society should begin to face. The Better Safe Than Sorry Project, as well at the CDC and the US Surgeon General, recommend for alcohol consumers to avoid alcohol if pregnant or planning pregnancy (for males, this should be 3 months prior to conception); and to avoid pregnancy (i.e., contracept) until they are ready to abstain from alcohol.

In an effort to stem the tide of unintentional prenatal alcohol exposure (and prior to pregnancy recognition), we are hoping to work with the state legislature this fall on a state bill to require “point of purchase” messaging where alcohol is sold.  Forty-one states already have such signage, indicating that those who are pregnant or planning to be should avoid alcohol.  I would hope that we Marylanders would go one step further with an additional statement – “Alcohol consumers should avoid pregnancy (i.e., contracept), since problems can occur with exposure before knowing one is pregnant.”

Remember – alcohol and unprotected sex don’t mix!

*http://www.lulu.com/spotlight/TheSilentEpidemic; http://www.PrenatalAlcoholExposure.com.

We welcome comments from readers about this blog, as well as any others.

Housing for individuals affected by Prenatal Alcohol Exposure

Since I moved to the Washington, D.C. area in 2001, I have wanted to develop a community for individuals affected by prenatal alcohol exposure – also known as Fetal Alcohol Spectrum Disorder (FASD).  Two years ago, I founded 7th Generation Foundation, Inc. in order to begin the development process, including identifying a property to relocate my private practice and have a “home base” for 7th Generation to live and grow.  We now have Dream Catcher Farm in Potomac, a therapeutic farm animal sanctuary where children, adolescents and adults with effects of prenatal alcohol exposure can be evaluated, treated, and receive vocational skills while interacting with gentle farm animals.  While Dream Catcher Farm is still evolving, our board is on its way toward establishing a therapeutic community for young women affected within the womb by our social drug of choice, alcohol.

This article from Canada makes it clear that we are on the right track.  Individuals with FASD require supportive, safe, affordable housing with the opportunity to assist with job training and coaching, life skills, time management, organization, household responsibilities, grocery shopping, and other daily living skills that many of us take for granted.  Looking forward to an article like this being posted one day about the therapeutic community we will build!

Edmonton housing for people with fetal alcohol spectrum disorders first of its kind in Canada

 

Why is there no accountability for prenatal alcohol exposure in alcohol industry advertising?

The lobby of the alcohol industry is as silently powerful as the seductive influence of its subliminal advertising.  Sexy, gorgeous young people posing with our social drug of choice (AKA alcohol) flood the airways, print media and television as though beckoning peers to ‘take this drink so you can be beautiful and sensual, too.’  Such ad campaigns are aimed toward libidinal, primal drives to encourage intercourse – with consumers disinhibited to the point that anyone is a potential mate.  Even a 5th grader knows that a provocative marketing strategy to recruit childbearing age alcohol consumers through basic drive mechanisms (i.e., libidinal disinhibition) is unethical.  Like my then 10 year old daughter said to me on seeing one of these commercials, “Mommy, look.  Those people are drinking alcohol on TV and being all sexy.  They’re going to make a baby with Fetal Alcohol Syndrome.” She was right.
Alcohol advertising directed at reproductive age individuals should include warnings that contraceptives are necessary to prevent alcohol-related birth defects, neurodevelopmental issues, and other reproductive health problems that can happen as early as the first three weeks after conception – well before most pregnancies are recognized.  On average, 50% of US pregnancies are unplanned and nearly 15% of American women binge drink between the ages of 18 to 44.  A binge episode is considered at least 4 to 5 servings of alcohol.  For many college students, that’s a light weight pre-game amount.  For some, 12 servings is a small amount to drink over the course of a weekend night.  As little as 4-5 servings of beer, wine or liquor is enough to cause the full blown fetal alcohol syndrome (FAS) if perfectly timed in the late 3rd week post conception.  That’s when even those sexy models in the alcohol ads are unaware they may be pregnant.
Why is this one industry immune to the disastrous consequences caused by its product?”  After all, the entire over-the-counter pharmaceutical  industry was transformed by the “Tylenol” crisis of the 1980s when a consumer (not even the manufacturer) tampered with the product leading to several deaths.  Since 1973 when Drs. Ken Jones and David Smith first coined the term “FAS,” over 1.6 million people have been born with this preventable condition…and countless others lost to miscarriage, still birth, sudden infant death syndrome, and birth defects such as anencephaly and spina bifida.  Yet why does the burden, blame and shame rest with the mother?  What about the mothers in my psychiatric practice whose children have ND-PAE because they drank before pregnancy recognition?  Shouldn’t we be shaming the fathers too for causing their sperm DNA to be  methylated by alcohol during the 3 months prior to conception?
In honor of FASD Awareness Day, check out the website for my new book: https://www.prenatalalcoholexposure.com The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row. #Epidemic #NeurodevelopmentalDisorders #PrenatalAlcoholExposure #BiggerthanZika!

FASD – Condition affects one baby born each day – and is more common than autism — Edmonton and area Fetal Alcohol Network Society

MOTHERS-to-be are being warned about the incurable condition that strikes one baby born each day in the North-East. More than 300 babies born in the region every year suffering from Foetal Alcohol Spectrum Disorder (FASD). Source: http://www.thenorthernecho.co.uk/news/14709699. Condition_affects_one_baby_born_each_day_____and_is_more_common_than_autism_/ A pregnant woman with a glass of wine The condition is more common than autism, spina bifida […]

via FASD – Condition affects one baby born each day – and is more common than autism — Edmonton and area Fetal Alcohol Network Society