A letter from a problem drinker asks a very serious question that will require several columns to answer:

"I have been an alcoholic for many years and am now pregnant. I believe that this child has been given to me to help me to change my life, but as yet I am unable to control my drinking. What should I do?"

Before I give a more detailed answer, I will immediately say that all pregnant drinkers or drug users need to contact their nearest alcohol and drug treatment center as soon as possible. Professional evaluation and advice are absolutely necessary. Do not delay. (If you don't know where a treatment center is, call your nearest hospital, AA chapter, or Public Health Office and ask for the information.)

An alcoholic frequently doesn't comprehend the amount of damage he or she causes to other people. He may be painfully aware of the damage he does to himself... the loss of health and money and self-esteem; but when it comes to other people, an alcoholic often dismisses a victim's complaint by insisting that the victim is also guilty of bad behavior or even may even have contributed to the problems that caused the alcoholic to drink in the first place. It's as if those who were harmed somehow deserved it.

But when it comes to Fetal Alcohol Syndrome (FAS) there can be no spreading of guilt. This baby is a completely innocent victim.

FAS babies are identified by varying degrees of the following characteristics: lower I.Q.; short memory span and other learning disabilities; impaired balance and coordination; deformed facial features; joint and limb abnormalities; smaller elfin-like head and shortened body. Frequently, they are easily frustrated, suffer emotional illness, and exhibit social maladjustments such as inappropriate sexual behavior. Because of all this they are often unable to acquire the skills necessary to earn a living. Incarceration, homelessness, and sexual exploitation are not uncommon fates.

Many people would like to believe that an FAS child is no different from any handicapped child born to a normal family and would positively respond to the nurturing of loving parents and a supportive family environment. Unfortunately, this is not the case. The FAS child is not the unexpected victim of natural forces, for example a disruptive virus contracted by the mother or a genetic abnormality. No, the FAS child is born into a dysfunctional environment. A woman who cannot stop drinking during her pregnancy is not likely to become the model of sobriety when this unmanageable child enters her home. Institutional or foster care usually await this child.

In view of all this, the alcoholic woman usually makes the sad but ultimately responsible decision to have an abortion. She may, in this decision, also be considering her own future encumbrances. In many places in the world a FAS baby may be considered the victim of felony pre-natal child abuse; but in all jurisdictions post natal neglect is always considered criminal neglect. Crime carries punishment. The pregnant woman who has a serious drinking problem needs also to consider future criminal penalties.

Despite all this, sometimes, as in the case of the woman who wrote to me, an alcoholic woman may fantasize about the possibility of change.. of a sober lifestyle that the baby will force or inspire her to adopt. It is as if she, having no willpower to cease drinking on her own, will automatically rise to the occasion of caring for a beautiful and healthy baby. She may make this decision in a sober moment, but if she cannot extend that moment to months of sobriety, she is deluding herself and endangering her child.

There is also paternal financial responsibility to consider. With the advent of DNA testing, it is no longer possible for the father of a FAS child to avoid being charged with financial support. Unfortunately, many substance abusers, both men and women, are sexually promiscuous and careless about using birth-control methods. Sexually active alcoholics in particular need to enter a recovery program.

I'll close this column by addressing the issue of "alcoholic" hysteria. There are safe levels of alcohol consumption. Extensive studies have shown that one alcoholic beverage per day has no effect whatsoever on fetal development. A pregnant woman who has a single glass of wine with her dinner has no cause for alarm. This woman is not an alcoholic and is not the subject of this discussion.

There are, however, women who will use this limited alcohol consumption as an excuse to call attention to themselves or to terminate a pregnancy that they would otherwise be religiously enjoined from having. Occasionally we find such a woman presenting herself as a martyr who, rather than inflict injury upon the innocent, has taken upon herself the "sin" of abortion. But usually a casual drinker's intrusion into the subject serves to excuse the alcoholic's excessive drinking. The casual drinker may later say, "I drank when I was pregnant and my child was perfect!" This gives a false impression about the safety of all degrees of alcohol consumption.

Of course no pregnant woman should tempt fate by consuming any quantity of alcohol during her pregnancy. I have mentioned the non-injurious effects of limited consumption only to allay the fears of those women who drank socially before they learned that they were pregnant.

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