Dear Dr. Arias,

I was delighted to see your new blog and its attention to older Americans, of which I am one. I have worked with members of the Injury Center for 15 years on advancing alcohol screening and brief intervention in general medical settings. The progress made to date has been remarkable, but we have a long way to go. So I would like to encourage your greater attention to the issue not only for the Injury Center but for the entire CDC as well.

One might begin with the fact that the report you cite on falls among older people fails even to mention alcohol use as one of leading causes of such falls. Indeed, alcohol is a leading factor in all aspects of the Injury Center’s work—general injury, unintentional injury, and violence—yet it has not found a place of real prominence across all those issues. Even worse, it does not even merit a mention among the CDC’s priority topics. See, for example, the website on Healthy Living where alcohol use is not even mentioned! When a search of the CDC website turns up 37,800 mentions of alcohol, it is clear that the subject must be of considerable importance to the CDC’s work. Why, then, is alcohol not an explicit priority issue amid the CDC’s mission, goals, and strategies?

Having worked with many Federal agencies over the years, I know one factor in the CDC’s failure to give explicit priority to alcohol issues is the existence of other agencies whose missions focus more clearly on alcohol. But let’s look more closely at that excuse. NIAAA’s name and mission limits it to only two of the three major alcohol use disorders—abuse and alcoholism. SAMHSA has until quite recently followed the same course. But we all know that the most common alcohol use disorder is acute intoxication, which occurs among almost 25% of adult Americans at least once every year, compared to the mere 4% who are alcoholics. Clearly, addressing the excessive use of alcohol, with or without intoxication, is an appropriate role for CDC.

With the discovery, successful research, and now dissemination of alcohol screening and brief intervention (SBI) over the past 25 years, a mechanism is available for CDC to help. Your division has already set an admirable example in its work on SBI with emergency and trauma centers, and the fetal alcohol program has seen benefits from this approach. However, this strategy urgently needs attention across the full spectrum of CDC programs and activities to advance the dissemination of SBI into all aspects of health promotion and disease and injury prevention. Other Federal agencies (NHTSA, IHS, CMS, VA, and others) are already taking decisive action in this direction. CDC needs to catch up with this revolution on how America is reducing the burden of alcohol.

If I can be of any assistance in helping you in this direction, I would be delighted. Having retired from the University of Connecticut School of Medicine five years ago, I have time for consultation and volunteering. CDC has huge potential to make a difference in this cause. I hope you will make it your priority.

Cheers,

John