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

ND-PAE/FASD Hidden between the lines of Prominent Research Findings

Results of a new study (see below) point to symptoms of prenatal alcohol exposure contributing to alcohol use by age 18. Of the 34 “risk factors” identified, early dating (i.e., sexual promiscuity), more externalizing behaviors (acting out, impulsivity, hyperactivity, aggression, disruptive behaviors), worse executive functioning (working memory, attention, processing speed), and thinner cortices (smaller white matter compared to gray matter in the “neocortex”), and less brain activation in diffusely distributed regions of the brain (also seen on qEEG and fMRI in affected individuals). In the FASD world, we have known for decades that individuals prenatally exposed to alcohol have much higher risk of alcohol use behaviors by their adolescent years.

The authors of the study concluded the following: “The results provide evidence that multimodal neuroimaging data, as well as neuropsychological testing, can be used to generate predictions of future behaviors.”  To me, it’s interesting that the same highly expensive neurocognitive and neuroimaging studies are useful to predict prenatal alcohol exposure, yet the surest way to prevent it is to have alcohol consumers use reliable contraception.

I believe we as a society should do more to ensure that men and women stay away from alcohol during reproductive years unless they are using birth control. Alcohol use by males affects sperm development up to 3 months prior to conception and as many as 75% of children with effects of “prenatal alcohol use” is due to the father drinking prior to conception.  The point at which our offspring are most vulnerable is the time in which most people are unaware they may cause harm to their future child.  There is no safe amount of alcohol if you are having unprotected sex.

Pass on the word: If you are using alcohol, prevent pregnancy (i.e., contracept). If you are already pregnant or planning a pregnancy, stop using alcohol (beer, wine, and liquor).




Prevention of The Silent Epidemic of Prenatal Alcohol Exposure

People have called my perspective courageous, zealous, and maverick in The Silent Epidemic (http://www.lulu.com/spotlight/TheSilentEpidemic).  The purpose of writing the book was to educate policy makers, legislators, physicians, parents, educators and the public at large about the leading preventable cause of birth defects and neurodevelopmental problems – prenatal alcohol exposure.  The children and families in my practice who are most affected by ND-PAE have heartbreaking stories, overwhelming responsibilities of adopting more than one child with this neurodevelopmental condition, and even being forced to “rehome” – send their children to live elsewhere.  And the situation is continuing to be hidden under the bleary-eyed veil of the oldest intoxicant known to man.

If 1 in 20 American children have this preventable form of brain damage, shouldn’t we aim
as a society to counter it on the level of efforts to erradicate cancer or polio?  Actually, it is much easier than either. A pharmaceutical company would be require a childbearing age woman using a chemotherapy agent or radiation treatment to be on two forms of reliable contraception as a fail safe measure to prevent birth defects, and to take a routine pregnancy test each time she returns for her treatments.  A young woman on retinoic acid derivatives in face creams and acne medications would have the same prevention plan.  In order to truly prevent ND-PAE, we must begin preconceptionally – avoiding alcohol if planning a pregnancy AND using contraception if using alcohol.
I have a number of upcoming speaking engagements about this issue in the upcoming weeks to educate and inform.  If you would like to host a book reading or presentation at your Rotary Club, school board, town hall meeting, or other event, please contact Donna at drrichadm@gmail.com or 301-251-1190.

Alcohol Embryopathy

Letter to the Washington Post Editor submitted 1/25/16 by Susan D. Rich, MD, MPH, DFAPA:

An article on January 18, 2016 in the Washington Post’s Health and Science section, “This mother drank while pregnant. Here’s what her daughter’s like at 43,” features a courageous mother, Kathy Mitchell, and her daughter Karli who should be applauded for their tireless efforts to raise awareness about this prevalent and preventable condition.  Over the past 22-25+ years, Kathy and Karli have done great work to raise awareness about FAS. Kathy is the renown spokesperson for and Vice President of the National Organization on Fetal Alcohol Syndrome.  Karli has worked diligently as a volunteer in the office, stuffing envelopes, creating artwork for their logos, and providing an optimistic outlook with her beautiful smile that lights up a room. She won the Presidential Points of Light Award for her volunteerism. Their story is depicted in my 2001 Documentary: Dispelling Myths about Alcohol-related Birth Defects:  http://www.susanrich.info/psychoffice/patient_myths.html.  

Unfortunately, the article perpetuates the myth that intellectual disability and other neurodevelopmental problems only occur in heavy drinkers and that effects of prenatal alcohol exposure are relatively uncommon.  Alcohol can cause a range of neurodevelopmental disorders – actually nearly every neurodevelopmental disorder of childhood can be caused by alcohol.  Here’s a chapter I co-authored in an International book on autism: http://www.intechopen.com/…/clinical-implications-of-a-link….  We’ve known since 1981 about an important “missing link” about prenatal alcohol exposure (from a seminal paper published by Dr. Kathleen K. Sulik at the University of North Carolina)  that neurodevelopmental disorders (brain damage) associated with prenatal alcohol exposure (ND-PAE) can happen with as little as 4-5 servings of alcohol in one “binge” episode as early as the 3rd week post conception.  This is actually the period of embryonic development, not fetal development.  So, the real term for babies with the facial features and severe deficits associated with prenatal alcohol exposure is “alcohol embryopathy.”

With 13.5% of childbearing age women binge drinking and 50% of pregnancies unplanned, inadvertent prenatal alcohol exposure before a woman knows she is pregnant means that not only alcoholic women are having babies with FAS.  In truth, not all affected children have the tell-tell signs of characteristic facial features, severe intellectual disability and growth deficiency like Karli.  As a child/adolescent and adult psychiatrist, I see first-hand the mood dysregulation, sensory and motor disorders, ADHD and executive functioning problems, and social communication delays caused by prenatal alcohol exposure. According to the Centers for Disease Control and Prevention, we have an epidemic of 1 in 20 school age American children with preventable brain damage caused by prenatal alcohol exposure.  Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE), the topic of my upcoming book – “The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row,” may be among the most significant public health crises since polio.

For 23 years, I have asked this simple question:  Why has the alcohol industry not been held accountable for a failure to warn about this prevalent and preventable condition?  A small label on their products indicating risk for birth defects in pregnant women is too little too late in my opinion – since much damage has already occurred before a woman knows she is pregnant.  Pharmaceutical manufacturers, the tobacco industry, and other corporate megaliths have been called out for harm caused by their products.  Attorney Laura Riley and I recently addressed this question in a chapter in an international book on Legal/Ethical issues in FASD http://www.springer.com/us/book/9783319208657   Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure: Consumer Protection and the Industry’s Duty to Warn [Rich, Susan D. ​ and Riley, Laura J​.  Pages 39-47​;  ​Fetal Alcohol Spectrum Disorders in Adults: Ethical and Legal Perspectives. An overview on FASD for professionals. Editors: Nelson, Monty, Trussler, Marguerite (Eds.)].  My blog attempts to address the missing link by recommending that alcohol users prevent pregnancy not just stopping drinking after pregnancy recognition.  See http://www.bettersafethansorryproject.com.


Remember – if you drink alcohol and are of childbearing potential, avoid pregnancy (i.e., contracept or avoid sex). If you are pregnant or planning pregnancy, avoid alcohol.  The Centers for Disease Control and Prevention are now promoting our message – It’s better to be safe than sorry – alcohol and unprotected sex don’t mix!!! http://www.cdc.gov/media/releases/2016/p0202-alcohol-exposed-pregnancy.html.


FASD Awareness Day – Millions Who Recognize FASD March

We are living in an epidemic of “Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure” (ND-PAE) – the medical diagnosis for the range of social/communication, cognitive, motor/sensory, and mood/anxiety issues caused by our social drug of choice.  It is vastly misunderstood by the public since many of the children are inadequately diagnosed and improperly treated.  The condition is known more widely as Fetal Alcohol Spectrum Disorder (FASD).

In in recognition of FASD Awareness Day, I would like to encourage people who care about the minds of children to walk on Washington, DC – the “Millions who Recognize FASD” March.  If each year, 40,000 new babies are born with this preventable form of brain damage in this country, 1 in 20 school aged children have this condition, and it’s been over 40 years since it was identified, there are now more than 1.6 million people with brain damage that could have been prevented since we found out about this problem in 1973. We now know that it can happen with as few as 4-5 servings of alcohol (less than a Long Island Iced Tea) in the 3rd week of pregnancy.  With 13.5% of women binge drinking and 50% of pregnancies unplanned, we have an epidemic of FASD.

These children are being born in many cases to women who already have the disorder themselves and/or are unable to take care of the children.  In my practice, I have a number of children adopted from foster care where there are 9+ children, all in Child Protective Services – rotating between foster care placements until they are finally adopted by unsuspecting parents who are ill-informed of the issues and ill-equipped to handle the multiple, complex neurodevelopmental needs.  In a sense, the middle class families who adopt the children become their “social services agency” – providing educational opportunities, comprehensive mental health and medical care, and a nurturing home that is better than they would have had otherwise.  Unfortunately, many of the children have scars from their early childhood experiences – being locked in closets, left at home unattended without food, or shuffled between extended family members where they are sometimes abused.

In 1995, a rural area of North Carolina, I asked the question to women coming into a halfway house for pregnant women – “Why do you keep coming back?  Why has our program not helped?  Why do you return every two years with another alcohol and substance exposed infant?”  They said, “Because the government keeps taking them away from me.”  At that point, we decided to shift the tide in this epidemic.  There we developed a 24-unit transitional housing community where women in recovery can live and parent their own children with supportive services provided in an on site community building we built from the ground up in 2 years with $1.8M.  It opened my second year of medical school.  The women sign as a part of their lease agreement that they will be working or in school, participate with parenting classes on site, and undergo routine alcohol and drug screening.  In exchange, they are able to receive counseling, parenting support, transportation, housing vouchers, and many other supports to raise their children in their own apartments.  The courts reunite the women with their children from foster care so they can parent the children more effectively themselves.

It is time for the alcohol industry to be accountable for causing brain damage in children – our nation’s most valuable resource.  Each year, the combined income from the sales of alcohol – beer, wine and liquor – is $227 billion.  The average cost in 2003 to care for children with full Fetal Alcohol Syndrome was estimated at $5.4, which does not account for the children with brain damage that do not have the facial features.  It also does not account for the productive years of life lost, the family crises and dysfunction that ensues in taking care of these children, and the cost of criminal justice issues that can arise.  That means we can at increase the figure by 3-4 fold to account for the range of children, adolescents, and adults with this  to $16.2 – $21.6 million.

It is time to shift the tide in this public health crisis.  This is a call to action for families and individuals struggling with this disorder to join with me for a walk on Washington, DC, if not this year, then next year.  Let’s bring awareness to the need for supportive services for children with this disorder; for mothers stuck in a cycle of poverty, homelessness, and alcohol/other drug abuse; and for society to understand that it’s social drug of choice is stripping the minds of children, silently within the womb, before we even know they exist.  We need to hold the alcohol industry accountable for its product – not just putting a small, discrete label on the bottles or giving a few dollars to a national organization for a cocktail hour at a fundraising event.  We need funding for services and programs – in the educational system, the medical community, the justice system, and nonprofit sector to identify, treat, and prevent this condition.

The children are our future and we must begin today stemming the tide of this preventable epidemic caused by prenatal alcohol exposure.