The percentage of Americans drinking alcohol in general and in ways that are high-risk or problematic rose dramatically between 2001 and 2012, and these increases constitute a public health crisis, according to a new study. It's a crisis that's not getting as much attention as, say, the opioid epidemic.
Drinking might be your go-to social activity, but over time it can put your health at risk. Alcohol consumption is tied to a slew of chronic medical problems, including cancer, stroke, heart disease, cirrhosis of the liver, diabetes, a number of psychiatric problems, and higher risk of death. The more you drink, the higher your risk.
Public health officials estimate that about 16 million Americans have alcohol use disorder (AUD), the medical diagnosis of problem drinking that becomes severe. Data from the 90s and early 2000s showed a slight increase in AUD, but they weren't sure what the prevalence looked like today. That's important because they need to know if policies meant to address the condition are working.
In the study, published Wednesday in JAMA Psychiatry, a team of researchers from the National Institute on Alcohol Abuse and Alcoholism estimated the prevalence of AUD based on data from two large cohorts collected just over 10 years apart. Data from the first group of about 43,000 adults was collected between April 2001 and 2002; the second group of just over 36,000 adults was surveyed between April 2012 and June 2013. The participants were interviewed face-to-face about their drinking habits over the previous 12 months.
Having four or more drinks a day at least once a week constituted high-risk drinking for women (for men, it was five drinks). The researchers considered a participant to have AUD if they met a number of the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM), including things like drinking (or being sick from drinking) interfering with their job or personal life or wanting to cut down on or stop drinking but being unable.
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The researchers found increases across the board. The percent of people who'd consumed alcohol in the previous 12 months rose by 11.2 percent, especially among women, minorities, adults over the age of 65, and people with lower education levels and low incomes. That in and of itself isn't worrisome, but the prevalence of high-risk drinking—those four or five drinks a day, at least once a week—also rose by nearly 30 percent in that time, but primarily among the same groups. Problem drinking increased from 9.7 percent to 12.6 percent of the population, representing a rise from 20.2 million to 29.6 million Americans.
Perhaps most worrisome of all, the estimated prevalence of people with alcohol use disorder rose by 49.4 percent, from 8.5 to 12.7 percent of the population, representing 17.6 million and 29.9 million Americans, respectively. That means an estimated one in eight Americans fit the diagnostic criteria for alcoholism. Rates of AUDs rose even higher in certain subgroups: Women saw an 83.7 percent increase in AUDs, African Americans had a 92.8 percent increase, people with only high school educations saw a 57.8 percent increase, and people with incomes less than $20,000 had a 65.9 percent increase.
So not only are more people drinking, but it seems casual drinkers are also becoming problem drinkers at much higher rates. The researchers have a few ideas as to why drinking might be increasing. "Drinking norms and values have become more permissive among women, along with increases in educational and occupational opportunities and rising numbers of women in the workforce, all of which may have contributed to increased high-risk drinking and AUD in women during the past decade," they write, compounded by the stress of pursuing a career and raising a family. The researchers note that stress and demoralization caused by increased income inequality after the 2008 recession may have driven up drinking rates among minorities.
Together, these statistics paint a bleak picture. The increases, the researchers wrote, "constitute a public health crisis that may have been overshadowed by increases in much less prevalent substance use (marijuana, opiates and heroin) during the same period." Excessive alcohol use kills more than twice as many people every year than those who die from prescription opioids and heroin—from 2006 to 2010, there were 88,000 deaths annually related to alcohol versus 33,000 opioid overdose deaths in 2015. Despite the big increases in alcohol misuse, treatment rates for alcohol use disorders remain low, at less than 10 percent. The authors say high-risk drinking and AUD are still stigmatized.
Higher drinking rates overall and increases in problem drinking foreshadow increases in chronic health conditions, they say, especially among those demographic groups. To say nothing of the terrible emotional cost for the people struggling with alcohol misuse, these health problems will affect the healthcare costs of the entire nation: in 2010, alcohol-related problems cost society an estimated $250 billion. Some of the biggest increases in problem drinking were among groups that may not have sufficient medical coverage, according to an editorial published in conjunction with the study penned by Marc A. Schuckit, a professor of psychiatry at the University of California, San Diego.
We're seeing some of the effects already, the study authors note—rates of many of the conditions associated with problem drinking, such as heart disease, stroke, high blood pressure, and cirrhosis, had previously decreased but had either become more prevalent or their decreases started to plateau during the study's timeframe. So, too, have fatal alcohol-related car accidents and injury-related emergency room visits increased. The link between the rise in alcohol use and the increase in obesity rates also warrants further investigation, the researchers write.
To combat the growing misuse of alcohol, researchers need to develop better prevention and intervention strategies for the general public. Education, too, is necessary—past studies have shown that pointing out the health risks of heavy drinking among college freshmen causes them to drink less and there are programs that can help pregnant women drink less. But policy makers and healthcare professionals need to be educated, too.
Schuckit also tied in the healthcare debate and how the Republican efforts to repeal the Affordable Care Act might affect alcohol treatment. "It is worth noting the greater-than-average increases in AUDs and related conditions in individuals with less education and lower incomes because these individuals who drink often cannot afford insurance or might have policies that severely limit or do not cover alcohol-related treatments," he wrote, adding that "Most of the problems raised here will escalate further if as many as 23 million people lose health care benefits under a plan passed by the House of Representatives."
He concluded: "I believe there are people in the United States who are in situations where it is hard for them to mobilize themselves to work toward avoiding future health-related problems and who do not have the financial resources to pay for their care when they need it. My view is that if we ignore these problems, they will come back to us at much higher costs through emergency department visits, impaired children who are likely to need care for many years for preventable problems, and higher costs for jails and prisons that are the last resort for help for many."