It had been that way for hundreds of years--ever since European traders introduced American Indians to alcohol and swindled them out of land in exchange for bottles of fiery liquor. In 1971, a federal commission concluded that alcoholic abuse is "the most severe and widespread health problem among Indians today."
Not all American Indian tribes are plagued to the same degree, and some have worked diligently to purge themselves of alcohol abuse. But of those tribes affected, as many as 50% of the members surveyed have family problems because of drinking, Dorris found in his research. Among American Indians, alcohol-related deaths are occurring at 6 1/2 times the national rate.
In 1968, the year Adam was born, even more troubling data surfaced. French scientists reported that mothers who drank during pregnancy ran the risk of damaging their unborn children, in some cases exposing them to the risk of mental retardation.
When scientists at the University of Washington reached the same conclusions in 1973, the term \o7 fetal alcohol syndrome \f7 was born. Researchers also coined the term \o7 fetal alcohol effect \f7 (FAE), referring to patients who had less severe forms of alcohol-related impairment.
Fetus Also Gets Drunk
In a nutshell, scientists found that most of the alcohol a pregnant mother drinks eventually passes through her placenta and is distributed in the amniotic fluid surrounding the embryonic child. If the mother gets drunk, so does her fetus, and repeated exposure to ethanol, the active ingredient, can cause long-term damage to an unborn child.
Doctors cannot test for FAS or FAE like they can for other forms of mental retardation, such as Down's syndrome, but there are telltale signs of the impairment. Affected babies are often premature, and continue to be much smaller than other children their age.
Many FAS children have a small head circumference, a flat nasal bridge, a small midface and shortened eyelids. They also are characterized by shortened attention spans, learning disabilities, memory problems and hyperactivity. In particular, they often show a lack of basic judgment, an inability to predict consequences for their behavior.
Although it can be years before doctors make a proper diagnosis, some babies show signs of inebriation at birth, lapsing into delirium tremens after the umbilical cord is cut. In extreme cases, Dorris writes, FAS babies "enter the world tainted with stale wine. Their amniotic fluid literally reeks of Thunderbird or Ripple, and the whole operating theater stinks like the scene of a three-day party. . . . Nurses close their eyes at the memory."
Estimates are imprecise, but Dr. Ernest L. Abel at the Research Institute on Alcoholism in Buffalo, N.Y., and other scientists suggest that more than 7,400 FAS children are born each year. Dr. Ann Streissguth at the University of Washington, one of the nation's leading experts on the problem, says that five or six times that many FAE cases are born annually.
On Indian reservations, Dorris found that as many as 30%-40% of newborn babies show signs of fetal impairment because of maternal drinking. More ominously, many of these children themselves grow up to be alcoholics, and give birth to similarly impaired children.
Disorder Can Be Prevented
The irony, Streissguth wrote in 1988, is that "this tragic disorder could be entirely prevented if women refrained from the use and abuse of alcohol during pregnancy."
Much research remains to be done on FAS. It is not clear, for example, why some women can drink heavily during pregnancy and not endanger their children, while others who drink moderately put their unborn babies at risk. Scientists also are evaluating data that suggests physical damage to the fetus can result from drinking in the first and second trimesters of pregnancy, with emotional and learning damage caused by drinking in the third trimester.
For all these reasons, the U.S. surgeon general and the American Medican Assn. have stated recently that there is no safe level of alcoholic consumption for women during pregnancy. Meanwhile, the number of FAS and FAE births continues to grow.
"Who is going to take responsibility for all these children?" Dorris asks. "Are we going to have an entire nation of people like Adam, who cannot in the most fundamental sense take care of themselves?"
In the years since they learned about FAS, Dorris and his wife have accepted that Adam will be retarded forever. Today, he lives in a group house near his parents and sees them once a week. Counselors make sure he socializes with other residents, and help him manage his money.
A few weeks ago, Adam called his father and asked what season it was. Dorris says if he had told him it was winter, his son would have believed him and asked if there was snow on the ground. It is a conversation the two have had many times.