As the nation enters the next millennium, we have chosen to focus Keeping Score 1999 on America’s most pervasive drug problem: alcohol. To underscore alcohol’s far reaching effects on society, we examine drinking from many different perspectives including public health, criminal justice, the workplace, the impact on children and young adults, treatment and prevention. Among the nation’s 113 million drinkers, 10 million are underage and 33 million binge drink (have five or more drinks at a time). An estimated 14 million Americans need treatment for alcohol problems. Alcohol-related deaths outnumber deaths related to illicit drugs four to one, and accidents, health problems, crime and lost productivity due to alcohol abuse cost $167 billion each year.

Most Americans are well aware of the devastating toll illicit drugs take on the nation’s health, safety and general well-being. Adults and children alike point to illicit drugs as one of the biggest problems facing youth today. However, underage drinking has not elicited similar widespread concern. Even though the costs of alcohol abuse to society are 50 percent greater than all illicit drug abuse costs combined, voters are not telling elected officials that alcohol abuse presents a pressing problem.

Although the nation has a clearly defined Federal strategy for combating illicit drug problems, with exact dollar figures tied to specific goals, the same cannot be said for alcohol. There has been relatively little Federal investment and no comprehensive strategy to address alcohol-related problems despite their pervasiveness and adverse consequences for public health and safety.

One of the Federal government’s largest drug prevention initiatives—the Office of National Drug Control Policy’s anti-drug media campaign—is aimed at preventing illicit drug use among youth. No similar effort exists for underage drinking. Yet, alcohol is the drug of choice among young people; more teenagers drink than use all illicit drugs combined. Federal funding for research on alcohol also has not kept pace with funding for research on illicit drugs.

Keeping Score 1999 explores the many dimensions of drinking among youth and adults and the myriad effects of alcohol on families and communities. Underage drinkers are much more likely than non-drinkers to participate in risky behaviors, such as unprotected sex and other drug use. Alcohol abuse is a factor in seven out of ten child abuse and neglect cases. Despite the well-known risks, drinking is increasing among pregnant women. Four in ten violent offenders report having been drinking when they committed their crimes.

Keeping Score 1999 also looks at the availability of alcohol in America and the impact on society. Alcohol excise taxes have not kept pace with inflation; a six-pack of beer is well within a youngster’s budget. At least two-thirds of licensed alcohol outlets sell to underage buyers.

Despite the lack of concentrated Federal response to alcohol abuse, much has been learned over the past several years about pharmacological treatments for alcoholism, the effectiveness of brief interventions by physicians and the risks associated with early initiation of alcohol use. Nonetheless, significant problems remain. These problems will persist well into the next century unless greater leadership emerges to address alcohol abuse and its consequences.