JOSEPH J. ZUSKA, M.D.
Immediate Past President

Executive Committee

MARVIN A. BLOCK, M.D.

LUTHER A. CLOUD, M.D.

RUTH FOX, M.D., (Life Member)

STANLEY E. GITLOW, M.D.

DONALD W. GOODWIN, M.D.

PETER O. HANSEN, M.D. (AAFP Liaison Member)

DAVID H. KNOTT, M.D., Ph.D.

CHARLES S. LIEBER, M.D.

ERNEST P. NOBLE, M.D., Ph.D.
FRANK A. SEIXAS, M.D.

MAXWELL N. WEISMAN. M.D.

Donald W. Riegle, Jr.

Chairman, Subcommittee on Alcoholism

and Drug Abuse

United States Senate

Washington, D.C. 20510

Dear Senator Riegle:

As current President of the American Medical Society on Alcoholism, I received your letter of June 18th, 1979 to Ms. Claire Osman, our staff assistant, for reply. Although AMSA, the medical arm of the National Council on Alcoholism, has had an active interest and leadership role in encouraging the study and communication of knowledge of the effects of alcohol on the human mind and body, the family, society and the unborn fetus, the organization has not adopted an official position on the use of warning labels as a vehicle for public education on these

areas.

I have, today, sent a letter to all AMSA members asking their opinions
on the subject. I hope to have this poll completed so that action may
be taken at our next AMSA Executive Committee meeting in October.

Since I realize that your Subcommittee would like immediate replies
from as many people as possible, I offer below my personal opinions
on the subject, based on seventeen years of experience as a psychiatrist
treating alcoholic men and women, including directing a large alco-
holism treatment complex for fifteen years, and my present position as
Director of the New York State Division of Alcoholism and Alcohol Abuse
since January of this year. The answers below do not reflect an official
AMSA position.

1.

I believe warning labels do have an effect in imparting health in-
formation to the public. Such labels may not in themselves ab-
solutely deter use of a product, but they are able to incorporate
into general common knowledge important facts about such substances.
a good example is the label on saccharine-containing products, which
I believe has had that effect. In the case of alcohol our general
purpose is not necessarily to ask people to give up drinking altogether,
but rather to encourage a more informed approach to alcohol use.

Allow me to quote from a very ancient document, the Announcement About
Drunkenness written in China in 650 BC. "Men will not do without kiu
(a beer). To prohibit it and secure total abstinence from it is be-
yond the power even of sages. Here, therefore, we have warnings on
the abuse of it."

2.

3.

4.

5.

6.

According to one historian, The Chinese passed and repealed prohibition laws no less than 41 times between 256 BC and 1312 AD. They were apparently no more successful than the United States.

Since the purpose of the labels is to encourage a better-informed approach to alcohol use, the information should be specific. At a minimum, information should be provided on the interference of alcohol with safe operation of a motor vehicle or other machinery, the dangers to the unborn fetus, and the fact that alcohol is a drug which is potentially habit-forming in from 1/10 to 1/12 of users. Other adverse health consequences of excess use might also be covered. The greatest problem in this area in my opinion, has to do with the "how much is too much?" question. Such a message as "If you drink don't drive; if you drive don't drink" skirts the fact that small amounts of alcohol may be consumed without major driving impairment and within the law. Thus such a message, then, does not apply easily to ordinary experience. I would, therefore, suggest that to make labelling as effective as possible its imposition should be preceeded by and accompanied by public information campaigns to explain the reasons for the labels and provide the background information needed to apply such knowledge. Specifically, I would recommend that simple charts relating blood alcohol to number of drinks and body weight for men and women, and indicating legal driving limits, be posted by law in every place in which alcoholic beverages are sold. I would further recommend that a nationwide public education campaign on fetal alcohol syndrome, drinking and driving, and on problem drinking and alcoholism be initiated to explain the labels.

Because of the diverse nature of the information to be conveyed, the rotating system would be desirable to keep each individual message reasonably short.

Labelling distilled spirits only would give the erroneous impression that beer and wine were somehow "safe." Since beer and wine are the preferred beverages of the youthful drinker in most cases, this would be poor public policy. All of us in the treatment field have seen many cases of severe alcoholism in people who do not drink distilled liquor, "only" beer or wine.

Both beer and wine should indicate alcohol content for the information of the consumer. I would also suggest substituting percentage of alcohol on liquor labels for the older "proof" measure which many people do not understand.

Advertisements for beer, wine and liquor are so widespread it is difficult for any American to spend a single day without being cajoled to drink this or that alcoholic beverage. The few public service spots and magazine or newspaper articles on the subject of alcohol and health are nowhere near "equal time." Although a warning message on an advertisement will not cancel its positive impact, the warning message will get very wide exposure. For that reason I would personally favor the use of labels on advertisements.

Such labels would have one more very positive effect. Millions of visitors come to this country each year from all parts of the world. The prominent display of warning labels and background information will convey a clear message to the rest of the world that we are seriously concerned about our alcohol problems. This is a message I have seldom perceived in my travels to other countries.

I hope the above has been of some assistance.

I will be happy to convey an official

AMSA position when one is adopted. Please feel free to call on me for any further help I may provide.

Yours very truly,

Sheila Blume

Sheila B. Blume, M.D.
President

1.

AMERICAN MEDICAL SOCIETY ON ALCOHOLISM
733 Third Avenue

New York, New York 10017

QUESTIONNAIRE

Warning Labels on Alcoholic Beverages

Would warning labels be effective in raising public awareness of the
health hazards involved in the use of alcohol? yes_____

no

4.

5.

6.

Content of label: (check all that apply)

Do you favor a rotating system of labelling? For example, require that
10% of the labels contain a warning about the fetal alcohol syndrome,
10% on driving impairment, etc.

yes

no_

Should beer and wine containers be required to indicate the percentage of
alcohol per volume? beer, yes V no
wine, yes X

no

Should warning labels also be required on advertisements of alcoholic
beverages?

уль

We are pleased to respond to your letter of June 4, 1979, requesting our views regarding the labeling of alcoholic beverages.

This matter has been presented to our Executive Committee and

we are pleased to inform you that the National Association of Alcohol

ism Counselors (NAAC) has adopted the following positions:

1. NAAC favors the labeling of alcoholic beverages to indicate

2.

3.

that alcohol may be hazardous to the consumer's health.

NAAC favors the labeling of alcoholic beverages to provide

a warning to pregnant women indicating that the consumption
of alcohol during pregnancy may cause birth defects.

NAAC recommends that all alcoholic beverages and other products
containing alcohol be clearly labeled to indicate the percentage
of alcohol contained in the particular product.

We would also like to express our appreciation for your letter of
June 5, 1979 and to thank you for your support of continued action by
the National Institute on Alcoholism and Alcohol Abuse to fund a
National Commission for the Credentialing of Alcoholism Counselors.
With your support, we trust that NIAAA will be able to move expeditiously
toward activation of the long awaited National Commission for the
Credentialing of Alcoholism Counselors, and the provision of full
financial support for this undertaking.