By: Michael Rass
Alcoholism Rate In America: The Overlooked Epidemic
By Michael Rass
The United States has a long history of struggling with problem drinking. “Every century, our drinking pendulum—the radical change in our relationship to alcohol—swings,” writes Susan Cheever in Drinking in America. “In the 1830s, we were the drunkest country in the world. By 1930, we had outlawed drinking entirely, with disastrous results. The swings accelerated after prohibition—in the 1950s and ’60s, we were again awash in alcohol. Although in the twenty-first century there are more laws and more stringent social controls on drinking than there have ever been in our history, we are drinking enough to make alcoholism a significant public health problem.” There are indications that alcohol use disorder is on the upswing again. Nevertheless, most of the nation’s attention is currently focused on the opioid epidemic—with good reason. The official number of all drug overdose fatalities reached a record of 52,404 in 2015 and is estimated to have gone up another 21 percent in 2016. The trend is largely driven by opioid overdoses, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. In October 2017, President Donald Trump directed the Department of Health and Human Services to declare the opioid crisis a public health emergency. Interestingly, President Trump went off script during the announcement and talked about his older brother, Fred Trump, an airline pilot who struggled with alcoholism and died at the age of 43. “He had a very, very, very tough life because of alcohol,” Trump said. “He was a strong guy, but it was a tough, tough thing that he was going through. But I learned because of Fred.” The President’s remarks were emblematic. While the death toll for opioids—including heroin and prescription painkillers—has risen dramatically in recent years, Fred Trump’s disease is more common and kills far more Americans than opioid use disorder. In his groundbreaking report on addiction, the Surgeon General stated last year that “alcohol misuse contributes to 88,000 deaths in the United States each year; 1 in 10 deaths among working adults are due to alcohol misuse.” That is more than twice the annual death toll of opioid overdose. At this point, we have to note that this frequently quoted alcoholism statistic is an average based on data from 2006–2010 provided by the Centers for Disease Control and Prevention (CDC). The current numbers could be much worse. A study published in JAMA Psychiatry in September suggests that alcohol misuse in the U.S. has increased significantly in recent years. The authors compared data from 2001–2002 and 2012–2013 and documented substantial increases in the prevalence of past-12-month drinking, high-risk drinking, and alcohol use disorder (AUD). Overall, AUDs shot up by almost 50 percent, from 8.5 percent in 2001–2002 to 12.7 percent only eleven years later. “Alcohol use and specifically high-risk drinking, which often leads to alcohol use disorder (AUD), are significant contributors to the burden of disease in the United States and worldwide,” the study’s authors conclude. They note that alcohol misuse is a significant driver of mortality from a plethora of ailments: “fetal alcohol spectrum disorders, hypertension, cardiovascular diseases, stroke, liver cirrhosis, several types of cancer and infections, pancreatitis, type 2 diabetes, and various injuries.” If this trend continued in the last four years, the number of alcohol-related deaths in the United States should be well over 100,000 now.
Deaths of Despair
While the CDC registered a significant decline in current and binge drinking among US high school students from 1991 to 2015, data suggest that among middle-aged Americans, an alcoholism crisis has been emerging quietly. In 2015, the CDC reported that 76 percent of alcohol poisoning deaths between 2010 and 2012 were adults between the ages of 35 and 64. In 2015, two Princeton economists argued that middle-aged white Americans without a college degree were now facing “deaths of despair”—suicide, overdoses from drugs and alcohol, and alcohol-related liver disease. Distress born of globalization and rapid technological change probably drove the deadly outcome, the research by Anne Case and Nobel Prize winner Angus Deaton suggests. Middle-aged whites are now more likely than their predecessors to report pain and mental-health problems and are experiencing symptoms of alcoholism at a younger age. People drinking alcoholic beverages excessively often abuse prescription sedatives as well. Alcohol can intensify the sedative effects of anti-anxiety drugs (such as Xanax), antipsychotics, antidepressants, sleep medications, and muscle relaxants. Scientific American called such combinations “deadly duos.” “Alcohol and Xanax both inhibit the central nervous system, lowering heart and breathing rates, and their effects can be synergistic—meaning that their combined effects can be greater than the sum of their individual effects would suggest.”
The dangers of severe alcohol use disorder should not be disregarded. Quitting alcohol misuse is often difficult without the help of addiction professionals. At Lakeview, patients can safely detox in the in-house facility with around-the-clock supervision by the medical team. Following admission, Lakeview patients are first assessed by qualified physicians, who will look at all relevant symptoms and determine the appropriate treatment plan based on individual needs. Detoxing at home by going “cold turkey” often fails because the withdrawal symptoms become too unbearable and the person will go back to using drugs or alcohol to alleviate the pain. Detoxing on your own can also be dangerous. After long-term abuse of alcohol, withdrawal can lead to seizures and delirium tremens. “Without adequate medical attention, patients can become delirious within 72 hours of cessation,” says Ellen Ovson, M.D., a member of the medical team at Lakeview Health. “Withdrawal from benzodiazepines and other sedative-hypnotics can cause similarly dangerous symptoms.” Overcoming addiction to alcohol requires a comprehensive approach, including abstinence from substance use, therapies to address co-occurring conditions, and developing healthy coping skills. “The treatment approach at Lakeview is abstinence-based because the real recovery work happens only in true sobriety,” says Kacie Sasser, the senior director of medical services at Lakeview Health. “Therapy at Lakeview addresses the whole self of the patient, not just the substance use. Recovery is so much more than detoxification. Patients need a lot of professional support and they won’t get that at home.” Many addiction professionals regard addiction as a bio-psycho-social-spiritual disorder that requires treatment of all four aspects. Lakeview Health’s integrative health model addresses body, mind, and spirit. If all aspects of the disease are treated, a “death of despair” can be avoided and rehab can become a life-changing experience, laying the foundation for long-term recovery.