Health promotion: Alcohol and drug misuse prevention.

Currently, average apparent consumption of alcohol for all persons older than 14 is 10 percent higher than 10 years ago, and is equivalent to about 2.75 gallons of ethanol per person per year. Approximately 10 million adult Americans (i.e., 7 percent of those 18 or older) can be considered problem drinkers. Youthful problem drinkers, aged 14 to 17, are estimated to number more than 3 million and comprise 19 percent of this age group. In addition to the social costs, the economic costs to society as a result of alcohol misuse are substantial--an estimated +49.4 billion in 1977. Ten percent of all deaths in the United States are alcohol-related. Cirrhosis, which is largely attributable to alcohol consumption, ranks among the 10 leading causes of death. Alcohol use also is associated with cancer of the liver, pancreas, esophagus, and mouth. Alcohol consumption during pregnancy is associated with a wide range of possible harmful effects to the fetus--among them decreased birth weight, spontaneous abortion, and physical and mental birth defects. Drug misuse is also an expanding problem. There are some 16 million current marijuana users. The popularity of cocaine continues to increase--over 10 million Americans have tried cocaine at least once and there are an estimated 1 to 2 million current users. Misuse of barbiturates remains a significant problem with at least 1 million persons believed to misuse these drugs and the 30,000 estimated to be addicted to them. In addition, heroin addiction is still considered by many to be the most serious drug problem in the United States. Drug misuse leads to a number of social and health problems. Excessive doses of depressants can result in both physical and psychological dependence. The toll from heroin includes premature death and severe disability, family disruption, and crime committed to maintain the habit. Misuse of hallucinogens often results in emergency room visits. A special problem is the relationship of marijuana to automobile accidents, especially when used in combination with alcohol. While these events are disconcerting, progress has been made. National surveys indicate no changes in peak quantity consumed by teenagers 12 to 17 or in regularity of their drinking, between 1974 and 1978. Alcoholism mortality rates and alcoholic psychosis rates have shown little overall increase between 1950 and 1975. And similar encouraging trends have occurred in drug misuse. Several drug abuse data sources simultaneously have begun to reflect a down turn in use rates. These early indicators must be monitored overtime before conclusions as to their true significance can be evaluated.Nonetheless, the daily use of marijuana by high school seniors dropped from a peak of 10. 7 percent in 1978 to 7.0 percent in 1981. Daily regular cigarette smoking among seniors also declined dramatically-from 28 percent to 10 percent in the same period. The use of the hallucinogenic drug PCP also dropped markedly. Cocaine,heroin and sedative use among high school seniors remained relatively stable in terms of annual and lifetime prevalence, although the use of stimulants rose markedly. Of the 16 categories of drug use analyzed in the recent High School Senior Drug Use Survey, drug use in 15 categories was either stable or was decreasing(the second year of decline since the survey began in 1975).