‘alcohol, pregnancy and harm reduction: a review of the american experience’

Message in a Bottle:Message in a Bottle:

The Making of Fetal Alcohol The Making of Fetal Alcohol SyndromeSyndrome

Janet Golden, Ph.D.Janet Golden, Ph.D.Rutgers UniversityRutgers University

National Organization on National Organization on Fetal Alcohol Syndrome Fetal Alcohol Syndrome

poster, c. 1992poster, c. 1992

Phase I: 1973-1977Phase I: 1973-1977

Discovering theDiscovering theOffspring ofOffspring of

Alcoholic WomenAlcoholic Women

Discovering FASDiscovering FAS

Dr. David Smith and Dr. Kenneth Dr. David Smith and Dr. Kenneth Lyons JonesLyons Jones

““Pattern of Malformation in the Pattern of Malformation in the Offspring of Chronic Alcoholic Offspring of Chronic Alcoholic Mothers,” LANCET 1 (1973): Mothers,” LANCET 1 (1973): 1267-12711267-1271

““Recognition of the Fetal Alcohol Recognition of the Fetal Alcohol Syndrome in Early Infancy,” Syndrome in Early Infancy,” LANCET 2 (1973): 999-1001LANCET 2 (1973): 999-1001

Cigarette WarningCigarette Warning

American Lung Association American Lung Association Poster, c. 1988Poster, c. 1988

Phase 2: 1977-1986Phase 2: 1977-1986

The Crusade to WarnThe Crusade to Warn

1977 Warning from the 1977 Warning from the NIAAANIAAA

• Pregnant women who consume Pregnant women who consume more than six drinks a day incur a more than six drinks a day incur a significant risk of producing a significant risk of producing a child with birth defectschild with birth defects

• Limit drinking to two drinks per Limit drinking to two drinks per dayday

Consult doctorConsult doctor

1981 Advisory on Alcohol 1981 Advisory on Alcohol and Pregnancy:and Pregnancy:

Pregnant women and those Pregnant women and those considering pregnancy considering pregnancy should not drink alcoholic should not drink alcoholic beveragesbeverages

FAS CostsFAS Costs

Warning from the Warning from the NIAAANIAAA

NIAAA PamphletNIAAA Pamphlet

Rate of FASRate of FAS

Phase 3: 1986-1990Phase 3: 1986-1990

The Discourse The Discourseof Law and Responsibilityof Law and Responsibility

Warning LabelWarning Label

Michael ThorpMichael Thorp

The Broken CordThe Broken Cord

National Organization on National Organization on Fetal Alcohol Syndrome Fetal Alcohol Syndrome

poster, 1991poster, 1991

Arizona Department of Arizona Department of Behavioral Health Services Behavioral Health Services

poster, c. 1992poster, c. 1992

Crack MothersCrack Mothers

AMA ReportAMA Report

"Pregnant women will be likely to avoid "Pregnant women will be likely to avoid seeking prenatal of other medical care for seeking prenatal of other medical care for fear that their physicians’ knowledge of fear that their physicians’ knowledge of substance abuse or other potentially substance abuse or other potentially harmful behavior could result in a jail harmful behavior could result in a jail sentence rather than proper medical sentence rather than proper medical

treatment."treatment." Board of Trustees Report, Legal Interventions During Pregnancy, 264 JAMA 2663, 2667 (1990)

Phase 4: the 1990’sPhase 4: the 1990’s

From Victim toFrom Victim toVictimizer—Victimizer—

the Death Row Debatesthe Death Row Debates

Robert Alton HarrisRobert Alton Harris

Charles Krauthammer, M.D.Charles Krauthammer, M.D. : :

““We can either do nothing, or we can We can either do nothing, or we can pass laws saying that any pregnant pass laws saying that any pregnant woman who takes cocaine will be woman who takes cocaine will be sent until delivery to some not sent until delivery to some not uncomfortable, secure location uncomfortable, secure location (boot camp, county jail, house (boot camp, county jail, house arrest--the details are purely a arrest--the details are purely a technical matter) where she can do technical matter) where she can do anything except leave or take anything except leave or take drugs.”drugs.”

Alaska Department of Alaska Department of Health and Social Health and Social

Services poster, c. 2001Services poster, c. 2001

Phase 5Phase 5

An Imagined ResponseAn Imagined Response

SubstanceSubstance Use in PregnancyUse in Pregnancy