The Anatomy of Addiction (18 page)

Critical thinking is also an integral part of evidence-based medical practice. Obviously, we need an increase in critical-thinking abilities, in addition to factual information, to counter the prevalence of harmful ideas regarding addiction, dependence, and treatment.

I
f there's any underage group that deserves special consideration in any discussion of the disease of addiction, it's the unborn. You may be thinking that this statement is leading to a prolife or prochoice view on the rights of the unborn fetus and the mother. But the point that I'm about to make has nothing to do with partisan politics and everything to do with preventing a devastating condition that it is 100 percent preventable.

In 1968, Christy Ulleland, chief resident at Harborview Medical Center, University of Washington, first discovered the link between prenatal alcohol exposure and adverse outcomes in infants. In January 1968, Ulleland received funding to conduct an eighteen-month study to scientifically assess her clinical observation that infants born to alcoholic women had impaired outcomes. Her conclusion: “Chronic alcoholism can be appropriately added
to the list of maternal factors that create an unhealthy intrauterine environment for the developing fetus; the consequences of which may be life long.”

Fetal alcohol syndrome (FAS) is the most common preventable cause of mental retardation in the United States, as well as the most preventable cause of birth defects and developmental disabilities.

If you are pregnant or planning to become pregnant, you must absolutely not touch a drop of alcohol. There is no safe amount of alcohol at any time during pregnancy. Not a glass of pinot, a small vodka martini, a glass of hard cider, or a bottle of hand-craft beer.
There is no safe amount of alcohol while you're pregnant.

It is an established fact, beyond dispute, that even the slightest amount of alcohol, depending on the metabolism of the mother, can cause irreversible birth defects in her child, especially in the first trimester of pregnancy. A baby can emerge from a drinking mother's womb appearing perfectly normal on the outside, but damage to the baby's brain is permanent and irreversible.

There is nothing complex to preventing FAS. All you have to do is not drink alcohol while pregnant. If you can simply refrain from alcohol, you can prevent your child from alcohol-caused mental retardation, physical disabilities, and possible future behavioral problems leading to problems with the law.

Many mothers stop drinking only after they know they are pregnant, but damage to the developing fetus may already have been done. The Surgeon General's recommendation is that a woman refrains from drinking during pregnancy and even earlier if she is planning to become pregnant.

Once again, there is an enormous gap between what people believe and what is actually true. Many people mistakenly believe that mothers of children born with FAS were all heavy drinkers or full-blown alcoholics. This is a false and dangerous belief.

The degree of damage depends on the metabolism and liver functioning of the mother during pregnancy, and no two women are exactly alike. As you don't know details of your metabolism or liver functioning, there is no way to know the severity of damage to your child by having a drink. Drinking a wine cooler while pregnant is not much different from placing a handgun in front of a baby, spinning the cylinder, closing your eyes, pulling the trigger, and hoping to hear
click
while having no idea how many chambers, if any, are empty.

Even brief exposures to small amounts of alcohol may kill brain cells in a developing fetus. A study carried out by John Olney, at the Washington University School of Medicine in St. Louis, showed that just two drinks consumed during pregnancy may be enough to kill some developing brain cells, leading to permanent brain damage.

The Canadian Paediatric Society found that “Fetal alcohol syndrome (FAS) is a common yet under-recognized condition resulting from maternal consumption of alcohol during pregnancy. While preventable, FAS is also disabling. FAS diagnostic and treatment services require a multidisciplinary approach, involving physicians, psychologists, early childhood educators, teachers, social service professionals, family therapists, nurses and community support circles.”

All of those diagnostic and treatment services would be
unnecessary if women would simply not drink while pregnant, if they plan on becoming pregnant, or run the possibility of becoming pregnant.

There are really only two reasons why a pregnant woman would drink despite being informed and warned about FAS and the risk of brain damage and mental retardation. The first reason would be that the woman understands the danger but is willing to put her child's brain at risk in exchange for the pleasure she derives from drinking.

The second reason would be that the mother, despite understanding the danger, has the medical illness of alcohol addiction known as alcoholism. The addict cannot stop without professional medical help. If you are pregnant and can't stop drinking, get help immediately.

Devastating Life-Long Brain Damage

Another problem that doctors face in alerting women to the very real danger of FAS is the culture of disbelief resulting from the media-driven “crack baby” scare of the 1980s. The process of medical research that disproved the crack-baby myth is the same process of professional research that has continually proven the truth of FAS and has taught us that fetal alcohol syndrome isn't a single birth defect. It's a cluster of related problems and the most severe of a group of consequences of prenatal alcohol exposure. Collectively, the range of disorders is known as fetal alcohol spectrum disorders (FASDs).

As with the illness of addiction, both the physical and
functional brain damage of FAS can be seen with brain imaging technology. According to a study recently published by a team of researchers at the University of Washington, it is possible to differentiate FASD-diagnosed brains from normal brains with 80 percent accuracy using magnetic resonance imaging of the brain.

The most devastating disability caused by a mother's prenatal use of alcohol is the organic brain damage that impairs an individual's executive brain function—the ability to understand and adapt to the world. A consideration of the following incidents of disease, while more accurate in the generality than the specificity, will give you a sense of perspective.

On any given day in the United States, 10,657 babies are born. Of these, 1 is HIV positive, 2 are born with spina bifida, 3 are born with muscular dystrophy, 10 are born with Down's syndrome, and 120 are born with FAS- or alcohol-related neurodevelopment disorder. It's the number one cause of mental retardation in United States.

The Institute of Medicine's report to Congress on FAS made it clear that the incidence figures were to give a sense of perspective and “to emphasize the magnitude of a problem that has serious implications—for the individual and for society.”

Life Problems End Only at Death

Individuals with FASD have problems planning and organizing information in their daily lives, have trouble comprehending the consequences of their behavior, and act on impulse with diminished control. According to expert Kay Kelly, project director of
the FAS/FAE Legal Issues Resource Center at the University of Washington, “These individuals typically have an excessive desire to please others, an attitude that may lead them to take (or acquiesce in) actions that are harmful to their own interests.”

The social skills of people damaged in the womb by alcohol destine them for a difficult life, despite having an average IQ. “Most individuals with average IQ lead productive and organized lives,” says Kelly. “Individuals who have an average IQ but who also have brain damage caused by alcohol in uteri, often struggle unsuccessfully to deal with the usual demands of life.”

Easy Prey for Predators

The behavioral disabilities make people with FAS, be they children or adults, easy prey for criminals and perverts. They are more likely to put up with abuse and not complain about it because they don't want to upset the person abusing them. They want to keep people happy and be accepted. Hence they are easily exploited. Some 7 percent of adolescents and adults with FAS or fetal alcohol effects (FAEs) have been physically or sexually abused. Sexual abuse of children with FASD by adults in their own home is a particularly serious problem.

In the court system or in law enforcement, victims or witnesses with FASD can compromise cases because they are eager to please and are very believable. They may think that the “right answer” to a question is the answer the questioner wants to hear. To the FAS person, he or she is not lying, but simply giving the proper answer.

For the millions of individuals who already have FAS, it is too late to protect them from the harm that maternal alcohol caused in their developing brains. But it is still possible to take effective measures to protect them from criminal abuse.

Adults with FAS, if left to fend for themselves, will too often end up living on the streets or, in other circumstances, where they are likely to be particularly vulnerable to crime. The social services that many of these adults need, ranging from supported community living environments to job training, are as important to preventing victimization as they are to preventing poverty.

Studies of FAS in the United States, Canada, and elsewhere portray horrific medical and social consequences for the innocent victims of their mothers' drinking. Children afflicted with full-blown FAS display both physical and mental abnormalities. Those with partial FAS may not have the obvious physical characteristics, but they suffer the same behavioral and psychological problems. These include a low IQ, difficulty in learning from experience, poor judgment, poor cause-and-effect reasoning, and an unawareness of the consequences of behavior. Obviously, these are the very attributes that can lead them to prison.

A child born with FAS will also be an adult with FAS. The condition cannot be cured; it doesn't get better. People born with FAS are very impulsive and do things without thinking about consequences. They are not malicious in their behavior. In fact, they are usually exploited by more talented criminals to do some of the running, or high-risk tasks, and are more likely to get caught.

As many as half the young offenders appearing in court may be there because their mothers drank during pregnancy, says
psychologist Josephine Nanson of the Royal Hospital in British Columbia, Canada, who with four of her colleagues conducted a study of 207 cases of FAS over two years. Her assessment could have tremendous implications for how the criminal justice system handles youth in custody.

“The criminal justice system is based on the premise that people understand there are rules, why they have to be obeyed, and if they aren't obeyed then society has the right to come up with any number of options,” said Canadian Legal Aid Commission lawyer Kearney Healy, in an interview with the Saskatoon
Star Phoenix
newspaper about Nanson's study. “All of those things are irrelevant to these kids. It's got nothing to do with good or bad—they just don't see it the same way. There are an increasing number of cases reaching the courts because we've been diagnosing this for about 20 years. Those individuals are now in adolescence and adulthood, and at a prime age for when they're going to be involved in the court system.”

For every full-blown case of FAS, it is estimated there are four with partial effects.

One of the ironies is that children with FAS often make model prisoners because they do very well in structured environments. “Often people are fooled in the early stages of treatment into thinking somebody is doing really well, not realizing that they're doing really well because all the opportunities for them
not
to do well are taken care of in a structured program,” Nanson told the newspaper “This is an illusion. The FAS individual will fall apart emotionally outside that system.

Ignorance Will Send Your Child to Prison

Popular misconceptions about mental illness and mental retardation are partially responsible for railroading FAS sufferers through the criminal justice system. From arrest to the determination of competency to stand trial and beyond, a person's mental health affects every stage of passage through the criminal justice system.

If you doubt that assertion, simply ask yourself whether or not mentally ill people act weird, peculiar, or suspicious. Does the behavior of people with mental problems attract attention? Of course it does, and that includes attracting police attention, even if a crime hasn't been committed.

Untrained to recognize and handle mental illness, be it caused by exposure to alcohol in the womb or any other factor, arresting officers and other staff inappropriately assume the arrestee understands such things as their Miranda rights. Children and adults with FAS are more likely to give false confessions simply to please the police.

A Public Health Issue

Even the brief review presented here should prove adequate to make my case: FAS is a devastating problem with a dreadful impact on millions of lives. All the pain, suffering, punitive measures, imprisonment, and fortunes spent on researching effective ways to treat FAS would all vanish in a generation if women simply didn't drink alcohol before or during pregnancy. Not one drop. Not one beer. No loving mother would trade her child's future for a six-pack, a wine cooler, or a bottle of single malt scotch.