Prevention and Treatment of Alcohol Problems: Research Oppportunities Alcohol use is involved in nearly 100 000 deaths annually and plays a major part in numerous medical and social question s The National Institute in succession Alcohol Abuse and Alcoholism (NIAAA) asked the Institute of Medicine (IOM) to assess the state of knowledge about alcohol-related moot points and to identify the greatest in quantity important and promising avenues for research into their prevention and treatment.

Prevention and Treatment of Alcohol Problems: Research Oppportunities

Alcohol use is involved in nearly 100 000 deaths annually and plays a major part in numerous medical and social question s The National Institute in succession Alcohol Abuse and Alcoholism (NIAAA) asked the Institute of Medicine (IOM) to assess the state of knowledge about alcohol-related moot points and to identify the greatest in quantity important and promising avenues for research into their prevention and treatment.

The findings and research recommendations of the IOM committee were published in February 1990 in prevention and treatment of Alcohol Problems: Research Opportunities. (1) This overview highlights a certain quantity of of those recommendations.

The IOM report is divided into three parts. Part I examines research opportunities in prevention, and Part II considers research opportunities in treatment. Part III, which is not included in this brief summary, shows recommendations to NIAAA concerning the kinds of funding mechanisms considered chiefly suitable for achieving the agency's goals.

PART I: RESEARCH OPPORTUNITIES

IN THE PREVENTION OF ALCOHOL

PROBLEMS

The Public Health Perspective

The public health perspective is useful for understanding now passing prevention research and future research opportunities. The public health standard considers that three elements--the alcholic beverage, the individual, and the environment--interact to originate or reduce specific problems. This perspective forms the framework around which the IOM recommendations, highlighted below, are based.

The Epidemiology of Alcohol-Related

Problems

Alcohol use is associated with physical and social question s ranging from disease, violence, homelessnes and unemployment to marital enigmas Alcohol is involved in many injuries and deaths in the United States, whether resulting from motor vehicle crashes, falls, drownings, or fires. however it is difficult to make good that alcohol is a cause of traumatic envent or to determine the magnitude of the relationship. Although there is widespread belief that child abuse and pass over are associated with alcohol abuse, this association is unproven and should be investigated further. Studies also are needinessed on the influence of alcohol onward sexually transmitted diseases and sexual activity, including early sexual activity and adolescent pregnancy. The part of epidemiologic research on the prevention of alcohol riddles is important in defining the length and prevalence of the enigmas that need to be addressed.

Individual-Environment Interactions:

Focus onward the Individual

There are many possible approaches to prevention research from the vantage point of the individual alone. A fruitful area for further research is tht of the individual in the connected thought [i]or[/i] thoughts of the environment--both specific drinking milieu and the environment in which a bodily form grows, develops, and matures.

Researchers lately have suggested that certain interactions between risk factors in an individual (such as neurophysiological variables, temperament, and behavior) and factors in the environment (such as life issues family, peers, and work) contribute to the disentanglement of alcohol problems. Identifying those risk factors is important to devising effective prevention programs.

Social Learning Models

Social learning consigns to the processes by which individuals acquire and maintain behavior, and encompasses biological vulnerability combined with life experience. Research to proof the social learning model should describe the interactions among behavior, learning, and the environment; explore the relation between beliefs and expectations in developing drinking problems; and examine the stages of motivation that underlie an individual's readiness to change.

Genetic Determinants of Risk

The single best predictor of alcohol depedence today is family history, although not all children of alcoholics are at equal risk. The basis of the differential risk is not now understood. Research should continue to locate the specific gene that predispose an individual to alcohol prop and to search for physiological indicators of susceptibility. At this time, however, research has not advanceed far enough to allow health care providers to base their prevention efforts forward this genetic investigation.

Individual-Environment Interactions:

Focus upon the Environment

Many factors in the environment influence the choices that individuals make about their drinking practices. Efforts to manipulate these factors have been seen as useful to preventing alcohol-related problems

Researchers should investigate the relation between alcohol availability, retail price, and hours of sale and consumption. In addition, studies are straited to assess the effect of changes in spe limits in succession the number of alcohol-related crashes; the impact of server liability statutes; and the relation between the workplace environment and alcohol consumption.

Community Approaches and

perspective from Other Health