Development and Effectiveness of a Placebo Beverage Similar in Sensory Properties to an Alcoholic Beverage

ABSTRACT As many as 4.5 live births per 1000 are affected by fetal alcohol spectrum disorders (FASDs), preventable birth defects with lifelong consequences. Prevention of FASDs is gaining in importance, and recruitment of diverse disciplines in delivering prevention to women of childbearing age is essential. This needs assessment explored to what extent FASD education has been embraced by academic programs and incorporated into curricula. Results (based on 45 programs) suggest that directors are open to FASD education for trainees but with few resources to support it within their own programs. Misunderstandings about their own disciplines' roles vis-a-vis FASD prevention may limit their commitment to incorporating FASD requirements into their programs. Entities interested in facilitating FASD prevention need to be prepared to educate directors about their disciplines' roles in FASD prevention and to make resources available that are neither cost- nor time-intensive. Online resources and clearinghouses of guest lecturers prepared to deliver a variety of contents and methods appear particularly likely to bear fruit. Keywords: fetal alcohol syndrome, fetal alcohol spectrum disorders, alcohol abuse, alcohol dependence ********** Since the term fetal alcohol syndrome (FAS) was coined by Jones and Smith (1973), research has enhanced understanding of the complex consequences of prenatal alcohol exposure. FAS, a diagnosis requiting a specific pattern of facial features, is but one outcome of prenatal alcohol exposure. A much wider range of adverse effects of alcohol on the fetus is described as fetal alcohol spectrum disorders (FASDs). FASDs encompass "the full range, from mild to severe, of disturbances of physical, behavioral, emotional, or social functioning attributable to in utero alcohol damage" (Streissguth & O'Malley, 2000, p. 178). Several factors combine to determine the extent to which an exposed child will evidence symptoms, including how much alcohol is consumed, at what stage in pregnancy alcohol is consumed, and individual, genetic, nutritional, and metabolic factors of mother and fetus (Maier & West, 2001). Despite increased knowledge related to the dangers of prenatal alcohol exposure and two public health advisory warnings by Surgeons General in 1981 and 2005, 12% of pregnant women report drinking alcohol, and up to 2% report binge drinking in the last 30 days (Food and Drug Administration, 1981; Office of the Surgeon General, 2005; Centers for Disease Control and Prevention, 2009). Commensurately, prevalence estimates suggest that 0.5 to 2 per 1,000 individual are born with FAS every year (Bertrand et al., 2004); estimates for FASDs are three times higher, approximately 4.5 per 1,000 live birth (May & Gossage, 2001). With regard to the substantial financial burden associated with FAS, annual cost estimates to the nation are $3.6 billion, and lifetime cost estimates are as high as $1.6 million per affected individual (Lupton, Burd, and Harwood, 2004). One cost study specific to Alaska estimated costs for FAS births for 1999 based on 14 FAS births and found the lifetime economic cost for these individuals to the State of Alaska totaled approximately $21 million (McDowell Group, 2001). Since these cost estimates are based on FAS alone, it is expected that the collective costs related to prenatal alcohol exposure are much higher. One measure used to assess the impact of specific health problems is to calculate the population- attributable-risk (PAR), or the proportion of cases for a given condition that may be attributable to etiologic factors. In the case of FASDs, the only cause is prenatal alcohol use. If exposure can be prevented through risk reduction interventions with women, FASDs are completely preventable, making the PAR 100% given that prenatal alcohol exposure is the only cause. Current knowledge related to effects of prenatal exposure clarifies that medical, allied health, and behavioral health professionals play an important role in primary and secondary prevention of FASDs. …