Prevention of The Silent Epidemic of Prenatal Alcohol Exposure

People have called my perspective courageous, zealous, and maverick in The Silent Epidemic (  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 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:  

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:…/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   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


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!!!


BSTS Talk Show – Interview with FASworld’s Brian Philcox and Bonnie Buxton

The BSTS team was joined by the lovely Brian Philcox and Bonnie Buxton this past month. Bonnie is the author of the novel Damaged Angels, a heartbreaking story of raising their adopted daughter with ND-PAE, the new DSM 5 diagnostic term for FASD. Brian and Bonnie are founders of FASworld, a nonprofit based out of Toronto, Canada dedicated to raising awareness of FASD. Learn more about their efforts on their website:

Conversation included our recent trip to APA’s 168th Annual Meeting in Toronto, where Brian and Bonnie spoke as panelists at our symposium about their experiences raising their daughter and the aims of FASworld. Watch the video below to hear more about the prevention efforts and awareness campaigns focused on ND-PAE.

It Takes Two

Last summer Dr. Rich interviewed Intern Sydnie Butin and her friend Jacob Rosen. Jacob gave his opinions on a male’s role in preventing ND-PAE. It takes two to make a baby, so it takes two to prevent your baby from brain damage.

APA 18th Annual Meeting – ND-PAE: Society’s Preventable Mental Health Epidemic

On May 20th, Dr. Susan Rich presented at the American Psychiatric Association’s 168th Annual Meeting in Toronto, Canada. The Symposium was entitled Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure: Society Preventable Mental Health Epidemic. Her presentation, The Hidden Cost of ND-PAE, focused on the history of ND-PAE, the damaging effects of this disorder, and her treatment method for those diagnosed.

She was followed by Dr. Scott Parnell, with his presentation entitled: Exposure to Ethanol During Early Gestation. Here, Dr. Parnell focused on the biological damages that happen to fetuses neurodevelopmentally during their gestation development, honing in on his own studies completed with mice.

Following Dr. Parnell was BSTS Intern Sydnie Butin, who presented Better Safe than Sorry: A Tipping Point. Sydnie focused on our campaign, and the dangers associated with college students drinking at binge rates.

The symposium closed with a panel discussion with Bonnie Buxton, Brian Philcox, and BSTS Intern Lauren Grenier. Bonnie, author of Damaged Angels, spoke about her experience raising an adopted daughter with ND-PAE. Brian spoke in a larger scope about FASworld, Bonnie and Brian’s non-profit to raise awareness and support for ND-PAE. Finally, Lauren spoke on her own experience interning at a Residential Treatment Center, and how recently learning about this epidemic has shaped her understanding of services in place for these individuals.

To view this symposium, please visit the link below.