Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

National Medical Leaders Meeting

Thursday, February 12, 2004
Washington, D.C.

"Prevention and Treatment of Alcohol Abuse: Vision and Strategies"

Thanks for that terrific introduction, Dr. Runge. (Dr. Jeffrey Runge, Administrator, National Highway Traffic Safety Administration)

Dr. Runge has done a great job of describing the problem of impaired driving. I’d like to back up for a few minutes and describe for you the fundamental larger problem in our country: that of alcohol abuse and alcohol dependency, which can lead to impaired driving and a variety of other psychological, social and health problems.

The great American writer F. Scott Fitzgerald, himself an alcoholic, said this of his addiction: "First you take a drink, then the drink takes a drink, then the drink takes you."

Alcohol dependency and alcohol abuse

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2001 National Household Survey on Drug Abuse estimates that 16.6 million Americans 12 or older — 7.3% of our population — are dependent upon or abuse either alcohol or illicit drugs.

Drug and alcohol abuse and dependence affect individuals of all ages, from all geographic areas, and all ethnicities, education and employment levels.

No one is immune, and we cannot assume that any particular patient is not alcohol dependent when we see him or her in an emergency room, or any other clinical setting.

For example, alcohol-related consequences of heavy drinking — depression, heart failure, and frequent falls — can be mistaken for medical or psychiatric conditions common among the elderly.

We need to continue to educate all people about the risks of alcohol dependency. I'm convinced many people — young people especially — think they are immune.

HHS Secretary Tommy Thompson has charged me with improving health literacy in America, and nowhere is this more important than in the area of substance abuse.

Rates for illicit drug and alcohol dependence and abuse are highest among American Indians/Alaska Natives at 12.6 percent; followed by Hispanics (7.8 percent); Caucasians (7.5 percent); Blacks (6.2 percent); and Asians, Native Hawaiians, or other Pacific Islanders (3.7 and 4.9 percent, respectively).

Dependency on alcohol is exhibited by the following symptoms: Craving alcohol; an inability to stop drinking once one has started; a physical dependence, as evidenced by withdrawal symptoms experienced once drinking is stopped, and a high tolerance for the substance.

Those who abuse alcohol are a slightly different category, including those who are dependent on it, as well as others who might not have produced the effects I described that would result in them being diagnosed with alcohol dependence, but who may drink too much, too often, or in situations that increase the risk of harm.

What are the public health effects of alcohol abuse?

Science has proven that the abuse of alcohol and alcohol dependency can adversely affect physical and mental health, both in the individual who drinks, and those around them.

• Accidents — Alcohol-related motor vehicle crashes kill someone every 30 minutes and injure someone every 2 minutes. 41% of all traffic-related deaths are alcohol related. Americans self-report 120 million episodes of alcohol impaired driving each year! 17,419 of those episodes resulted in death in 2002. While we’ve made significant progress since the 1980's in reducing drunk driving, the number of alcohol-related fatalities is again trending upwards.
• Violence — Perpetrators of family violence are often using alcohol or drugs when they lash out at their victims.
• Increase in birth defects — Alcohol can have a number of harmful effects on a baby: including mental retardation, learning and behavioral problems.
• Co-morbities of depression, other mental health disorders — People who use or abuse alcohol often suffer from depression or other mental illness. 37% of those who are dependent upon alcohol have a co-occuring mental disorder.
• Reduced quality of life: inability to meet work, school or family responsibilities — Most adults — about 75% — with substance dependence or abuse are employed full or part time. But they are not completely functional, and often lose work time to alcohol-related illness.
• Drinking-related medical conditions — Those who are alcohol dependent run a higher risk of liver disease, and various forms of cancer, including breast cancer. They are also more likely to be injured by falling.

We can all quote numbers and statistics until we’ve completely lost track.  But those numbers signify real lives and real families.   These people are our sons and daughters, our neighbors, friends and colleagues.

We've got to do what we can — government and the medical community in partnership — to restore those lives and dreams, and prevent the tragedy from occurring in as many lives and families as possible.

The problem of alcohol abuse and/or alcohol dependency is particularly troubling in young people. 

Teenagers use alcohol more frequently and heavily than all other drugs combined.  And it starts early.  41% of ninth graders report drinking in the last month. 

And 42% of tenth graders report having been drunk at least once. They view it as a rite of passage.  We’ve got to let them know drinking excessively is not a rite of passage.

According to research by NIH's National Institute on Alcohol Abuse and Alcoholism, kids who drink are more likely to be victims of violent crime, to be involved in alcohol-related traffic crashes, and to have serious school-related problems. 

Tragically, there is also a strong link between alcohol use among adolescents and attempted suicide. 

40% of children who begin using alcohol before age 13 will eventually become alcoholics. 

That is not a legacy I want for America's children or their children.  In America, we want the best for our kids.  We want them to have the best there is — the best opportunities, the best education, the greatest happiness. 

We want them to be better off than we are.  As the father of four, I feel this with my whole heart, my very being. 

My parents both struggled with alcohol.  Those addictions caused our family suffering, hardship and deception.  Each and every family touched by addiction, knows the heartbreak of broken dreams. 

Drugs and alcohol are thieves, and liars.  They steal their victims' spirits.  Few American families are immune.  I would venture a guess that every person in this room knows someone who has fallen victim to alcohol dependency or alcohol abuse.

Prevention — stopping drug and alcohol abuse before they start — is the best strategy for reducing the tragic public and individual health consequences they bring about.

I like to tell audiences that I am a 'recovering surgeon.'  Two or three out of every four cases I cared for as a trauma surgeon in Arizona on any given night — falls, car accidents, shootings, domestic violence - were preventable.  

We can only do so much for a victim once he or she is in the emergency room.  We need to do more to prevent them from getting there in the first place.  We’ve got to reach people early, in middle school and even before.

When President Bush nominated me to be Surgeon General, he asked me to speak regularly to the nation, particularly students, about alcohol and drug abuse, and the tremendous toll they take on our society.

And that's what I am doing.  Last year I started my 50 Schools in 50 States initiative to visit at least one school in each of the 50 states, Washington, D.C. and Puerto Rico during my tenure as Surgeon General. 

I tell the kids my own story of overcoming hardship in a poor family where there was alcoholism.  

Because alcohol addiction is such a complex and pervasive health issue, we must continue to strengthen our public health approach to addressing it. 

Such an approach must include extensive efforts in the areas of prevention, as I've mentioned, and education, early intervention, treatment, and research.

Many agencies at HHS are dealing with the problem, including SAMHSA, CDC, NIH, and NIAAA.

We fund treatment programs for the addicted, conduct research on the effects of alcohol among various populations, and provide information to the public about what they can do to get help if they have a problem, or someone they love has a problem.

But government, alone, can only do so much.  We need the partnership of the medical community.  The people you represent — health care providers from all settings — can all play a role in fighting this pervasive public health problem.

Certainly, laboratory alcohol screening is a good early intervention tool in many settings.

In the event there are not the funds for this type of screening, health care providers still have the opportunity to screen by asking about alcohol use; assessing the level of severity, advising and assisting, and arranging for follow-up.

This can be done by pediatricians, nurse practitioners, psychologist, and social workers — anyone who provides services to a person at risk for alcohol abuse, which, as we know, is nearly everyone.

And those of us who are health practitioners have the power to intervene and prevent virtually every time we see a patient.  And we can help close the health literacy gap — the difference between what we know as medical professionals and what our patients understand — in every visit.

A teenager might not know he's at risk for alcoholism; he thinks it's cool to drink.

A pregnant woman might think it's OK to have the occasional glass of wine, unaware that even small amounts can cause birth defects.

And the elderly may not know they are at greater risk for fractures with each and every drink they take.  We can help equip them to make better decisions.

Those of us in leadership positions have an additional responsibility.  The decisions we make today will have an impact on the future course of alcohol abuse and alcohol dependency in this country. 

Many of you already have programs within your organizations to fight alcohol abuse and dependency, and that's great.  Keep thinking, and striving. 

It's too easy to give in to the temptation to view alcohol abuse as 'routine,' as an 'old problem.'

Certainly there are other public health issues that get higher billing in the newspapers and on television. 

But alcohol abuse and dependency are still serious public health problems in America that require our best efforts to fight.

Thank you.

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Last revised: January 9, 2007