At this point in time, no matter where you live in this country, you are probably aware that we are in the throes of a major opioid epidemic. You may know that drug overdoses are now the leading cause of death among Americans under 50. You may know that in 2016, more than 42,000 people died from an opioid overdose. You may also know, that earlier this month, the United States Surgeon General, Jerome M. Adams, issued a national advisory urging Americans to carry and learn how to use naloxone, a life-saving drug which can reverse the effects of an opioid overdose.
What you may not know, is that we are also in the midst of another deadly crisis: excessive alcohol use. In 2015, more than 33,000 Americans died from alcohol-induced causes, including alcohol poisoning and liver disease. And if this tally included deaths from drunk driving, other accidents, and homicides committed under the influence of alcohol that number swells to 88,000. In fact, today excessive alcohol use is the fourth leading preventable cause of death in the United States. Over the past decade, the alcohol death rate has continually gone up at an average of 4 percent a year with a 40 percent total increase during the 10-year period.
So why is the alcohol crisis, which is responsible for twice as many American deaths as opioid overdoses, less visible? Why hasn’t anyone sounded the alarm?
The truth is drinking is ingrained in our culture. Because alcohol in moderation is not harmful, it has been normalized in our society. For many, turning 21 and gaining the right to drink is on par with getting one’s license or becoming eligible to vote. It’s a rite of passage that anchors many of life’s greatest celebrations. We raise a glass to celebrate a job promotion, we toast to the New Year, we buy beers at baseball games, and knock a few back with each birthday. In addition, alcoholic beverages are promoted through all major media, available anywhere from the grocery store to our favorite restaurants, to the sports arena. In New York City, the City that never sleeps, you can order a drink between 8 am and 4 am—20 hours out of the day. However, alcohol can be addictive and dangerous if abused.
In 2014, the New York City Health Department found that nearly one third of New Yorkers engaged in high-risk or binge drinking, which is defined as consuming five or more drinks for men or four or more drinks for women, within two hours.
Turns out, the rest of America likes to drink as well.
According to a study published by JAMA Psychiatry, in 2017, the percentage of American adults who consume alcohol increased from 65 to 73 percent from 2002 to 2013. Though the majority of Americans who drink do so without causing significant risks or health problems, this study makes a compelling case that the United States is currently facing a crisis with alcohol abuse that is getting worse. It documents substantial increases in the prevalence of drinking in general, increases in high-risk (or binge) drinking, and increases in the prevalence of alcohol use disorders (AUDs), with the biggest changes related to AUDs, the most serious condition.
Alcohol Use Disorder, the medical term used by medical professionals to describe someone with an alcohol problem, is diagnosed as either mild, moderate, or severe based on the number of eleven different symptoms an individual has experienced in the past twelve months. According to the study, which reviewed data from two nationally representative surveys of US adults, prevalence of AUDs increased nearly 50 percent during the time period 2001-2002 to 2012 to 2013. The researchers concluded that “substantial increases in alcohol use, high-risk drinking, and alcohol use disorder constitute a public health crisis”. They go on to say that with the increase in alcohol use and abuse, we can expect increases in related and co-occurring chronic disease, especially among woman, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged.
It’s time for a national wake-up call.
It is the role of public health to sound the alarm and to elevate a national conversation around alcohol abuse. We need a national strategy to address the alarming increase in high-risk drinking and AUDs.
It is essential for public health to advocate for policies and programs that support the creation of healthy environments that encourage healthy practices over unhealthy ones. We need to adopt and implement effective messages and programs that help people understand and avoid the dangers. We also need to adopt evidence-based policies that create and support environments where the healthy choice is the easiest. Though certain to elicit resistance and cause controversy, this may mean closing bars earlier or opening them later in the day, changing serving sizes, limiting the number of liquor licenses, or increasing the alcohol tax.
This month, when the surgeon general announced the new advisory related to opioid use, he became part of a chorus of public health professionals advocating for different policies and societal behaviors with the potential to upend a deadly crisis.
We should be doing the same thing with alcohol abuse.