The U.S. Alcohol Crisis, Still Deadlier Than the Opioid Epidemic

By Robert Castan 05/05/21

95,000 people died from alcohol-related causes in 2019, more than the recent number of fatal drug overdoses, yet the opioid epidemic steals the headlines. Why?

Image: 
Man in mask sits at bar with alcohol bottle and glass, head in hands.
People with anxiety and depression were more likely to report an increase in drinking alcohol during the COVID-19 pandemic. Photo 179593276 © Dmitrii Melnikov | Dreamstime.com

As deeply disturbing as the U.S. opioid epidemic is now becoming, having taken a record number of lives - over 81,000, in the 12 months up to May, 2020 - and now being firmly driven to worsening depths by the prevalence of the synthetic opioid fentanyl in virtually every other illicit drug, here’s something else for you to consider:

Alcohol, our perfectly legal, yet highly addictive, and potentially deadly substance of choice, continues year-on-year to take even more lives - 95,000, at the last count. Thousands and thousands more.

Because their bodies have become sensitized to alcohol, once they have taken that first drink, the tissues of the body cry out for more and more, until sufferers find that they cannot control the amount of alcohol consumed.

One drink is too many - a hundred, not enough.”

- John G. Cooney, eminent Irish psychiatrist, lecturer, and author of “Under the Weather: Coping with Alcohol Abuse and Alcoholism.”

Make no mistake, the record death toll from fatal opioid and other drug overdoses is awful, sad and shocking - there is no doubt about that. However, if you are considering which addictive substances require even more education, far greater awareness, especially for our children and adolescents, and significantly more treatment options for all, you would have to look at the biggest killer, and that, by far, is alcohol.

Liking “One Too Many Beers” Doesn’t Make Newspaper Headlines

Alcohol has continued to be the toxic factor in most year-on-year U.S. substance use deaths for decades. Did you know that alcohol has continued to cause at least 88,000 deaths every single year in the U.S. since 2006? In fact, in 2019, it is estimated that 95,000 U.S. citizens died from alcohol-related illness and accidents, making alcohol the third-leading preventable cause of death in the nation.

Let that figure sink in for one moment. 95,000. And preventable, too.

Alcohol - the “third-leading preventable cause of death”? You would imagine, then, that the conversation about the recent tragic deaths from substance use, substance use disorders (SUDs) and addiction isn’t focused on the biggest killer, alcohol or alcohol use disorders (AUDs), at all - pandemic or no pandemic.

However, the conversation continues to be placed “fairly and squarely” onto drugs, and those who take those drugs, who get their “product” from shady, downtown street corners, purchased from criminals, too - not on those who drink alcohol, perfectly legally (as long as they’re old enough to know better), and who get their tax-generating “product” from corner supermarkets and liquor stores, purchased from normal, law-abiding folk. Folk like you and me.

Alcoholism is an addiction - it’s just one type of addiction. When you break out the specific things that someone who is suffering from alcoholism contends with, they are no different from any other type of addict.”

- Dr. John Sharp, M.D., Harvard Medical School

The hard truth of the matter is this: the hard-working, blue-collar guy who shifts of few bottles a beer on his way home after a long day, or the housewife who sneaks a bottle of wine during her lonely day spent at home, do not look upon themselves as “addicts,” and they would be the first to tell you that they are certainly nothing like the media’s constant portrayal of “addicts” as desperate, potentially dangerous people.

That’s the simple truth, and the reality of how alcohol has always been viewed in the U.S… “He’s ok, salt of the earth - just likes his beer is all.”

Now if that doesn’t tell you we have a seriously long way to go in addressing the unnecessary shame and stigma surrounding substance use and mental health issues in this country, well… monkey’s uncle, and all that.

Legal, Easily Available & Acceptable

Alcohol doesn’t attract constant media attention as a serious and dangerous killer in the U.S. because it’s legal, it’s easily available, it’s socially acceptable, and those who misuse it aren’t “desperate, potentially dangerous people.” They would consider themselves the exact opposite - quite “normal.”

However, should it be considered “normal” when alcohol drives its related death rate in women up a colossal 85% in the space of just 10 years (from 2007 to 2017, to be exact)? In fact, with 95,000 people dying every year now in the U.S., should it be not called what it actually is - an alcohol epidemic?

Alcohol: The Subtle & Immediate Dangers

The majority of people still know and understand the dangers of high alcohol consumption and AUDs, eg. serious health problems, like liver damage. However, much of the physical damage done by alcohol can be initially subtle, often immediate, and can act as a contributing factor to other serious health issues. Examples of this include:

  • Cardiovascular Symptoms: Alcohol causes cardiomyopathy, which is a disease of the heart muscle, making it harder for your heart to pump blood around your body. This decreases how much blood the left ventricle pumps out with each contraction, known as “ejection fraction,” greatly increasing the real risk of congestive heart failure. As you can imagine, that’s fatal.
  • Furthermore, cardiac arrhythmia, an irregular beating of the heart, can be caused by a few days of hard drinking, and is often called “holiday heart syndrome.” Additionally, it can lead to atrial fibrillation - a fast and irregular heart rhythm. The heart rate in atrial fibrillation can range from 100 to a massive 175 beats a minute. Lastly, alcohol is also associated with high blood pressure and increased stroke risk, particularly among women.
  • Pancytopenia: This serious, yet not fatal condition (in itself, that is), occurs when the bone marrow can only produce limited amounts of blood cells, causing the body’s cell count of red blood cells, white blood cells, and platelets to be low. The cessation of alcohol consumption is usually enough for recovery.
  • Dementia: Excessive alcohol consumption can cause the development of a type of dementia, known as alcohol dementia, understandable considering its drastic effects on the brain. However, alcohol dementia is quite different from Alzheimer’s, and is becoming increasingly more common as dementia diagnoses become more accurate.
  • Cancer: Alcohol is associated with an increased risk of cancer, notably esophageal, liver, mouth, throat, and colorectal cancer. Additionally, it also increases the risk of breast cancer in women.
  • Immune Suppression: Regular alcohol use makes you more susceptible to infections - vital to know during a viral pandemic.

Sadly, the truth is your family physician will often overlook alcohol as a contributing factor to your illness, such as the previously mentioned congestive heart failure or atrial fibrillation. However, this “traditional” approach is now changing as more and more healthcare professionals are trained in the vast range in effects of substance use disorders.

  • Mental Health Disorders: Alcohol, among other things, is a powerful central nervous system depressant. Because of the euphoric feeling people get from alcohol, they often don’t believe that drinking alcohol when they are anxious or depressed can further worsen these mental health issues, and, perhaps, lead to an active disorder, eg. major depressive disorder, also known as clinical depression.

In fact, a prime example of this direct link in action was seen last year. You’d best read on. We haven’t finished yet, and, unfortunately, neither has alcohol...

2020: A Year of Increased Alcohol Use & Decreased Mental Health

In November 2020, the Pennsylvania Liquor Control Board announced colossal increases in statewide online alcohol purchases, like much of the rest of the U.S. In Pennsylvania, the statistics were quite incredible, when compared to the previous year: Unit alcohol sales increased by 851%, and dollar alcohol sales increased by 436%.

Furthermore, in 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline - 800-662-HELP - for individuals and families seeking either mental health or substance use disorder support saw a 27% increase in phone calls year-on-year.

In one particular medical research study, “Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults,” it was found that nearly two-thirds of the participants reported that their drinking had increased in 2020 when compared with their drinking pre-pandemic, citing a number of reasons, including increased stress, anxiety, ease of alcohol purchase online, and, obviously, sheer boredom.

In terms of the nation’s declining mental health, another research study, conducted by the NYU School of Global Public Health, found that people with anxiety and depression were more likely to report an increase in drinking alcohol during the COVID-19 pandemic than those without mental health issues.

This increase in drinking, particularly among people with anxiety and depression, is consistent with concerns that the pandemic may be triggering an epidemic of problematic alcohol use.”

- Ariadna Capasso, NYU School of Global Public Health doctoral student, and the above study’s author

“Triggering an epidemic of problematic alcohol use”? We’re already there, Ariadna. In fact, we’re probably far, far beyond anything seen before. Furthermore, in the NYU study, the clear link between mental health and increased alcohol consumption was evidenced by the following findings:

  • 29% of participants increased their alcohol use during 2020; however, those with symptoms of a depressive disorder were 64% more likely to have increased alcohol use
  • Younger respondents (aged 19-39) had the highest probability of reporting increased alcohol use - regardless of their mental health status, and
  • Adults over the age of 40 with poor mental health were far more likely to report increased drinking

Alcohol Abuse: A Significant Factor in COVID-19 Infection

Numerous studies pre-pandemic and mid-pandemic (as we are now) have all acknowledged the direct link between alcohol abuse and other forms of substance abuse with a greater infection risk for COVID-19. One particular study, “Clinical Vulnerability for Severity and Mortality by COVID-19 among Users of Alcohol and Other Substances,” carried out by the Center for Drug and Alcohol Research, in Porto Alegre, Brazil, found that not only are individuals with addiction more susceptible to a worse COVID-19 prognosis, but additionally, alcohol, crack cocaine and polydrug users had distinct vulnerability factors for the virus.

The Link Between Alcohol & Opioid Overdoses

One of the main drivers of the huge increase in fatal drug overdoses seen last year was polyuse, where, knowingly or unknowingly, users combine substances; for example, knowingly, opioids with alcohol, and, unknowingly, methamphetamine cut with fentanyl. In fact, in 2017, considered the peak of the opioid epidemic before 2020, 15% of opioid-related deaths, or 1 in 7, involved alcohol.

Why? Because alcohol is a central nervous system depressant, and will contribute negatively to the respiratory depression seen in opioid overdoses - the reason why people die.

Furthermore, from 2012 to 2014, more than 2 million people who misused their prescription opioids were also binge drinkers, twice as many as nondrinkers. Evidence indicates that around 23% of people who currently have an opioid use disorder (OUD) have a concurrent AUD.

Changing People’s Perspectives: An Uphill Battle

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), among other similar organizations, has since understood that public perceptions about alcohol, particularly what constitutes “low-risk” vs. “high-risk” alcohol consumption, have been very wide of the mark. In response, the NIAAA has since created a new website, titled “Rethinking Drinking,” to highlight the extent of these clear misperceptions.

The new website has a wealth of evidence-based information about alcohol and its consumption, such as how much is too much, strategies for cutting down your alcohol intake, and a list of essential help links, with contact information for social support services like Alcoholics Anonymous (AA) and other mutual aid groups.

When it comes to changing people’s perspectives about a health issue, alas, it’s an uphill battle - or more accurately, “upmountain” when you consider the huge volume of misinformation circulating in 2020 about COVID-19 (and it’s still circulating, too).

The trouble with perceptions nowadays is our world of digital technology, where one online fact is easily disputed with another online “fact.” However, sometimes, it takes more than researched, evidential statistics, published by leading public bodies, like the CDC, to change people’s minds. Unfortunately, for some people, it takes real, first-hand experience of the issue, and, when it comes to the dangers of alcohol, that’s sadly the premature death of a loved one.

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Robert Castan.jpg

Robert Castan is a member of the Executive Leadership Team at SpringBoard Recovery. Robert started his professional career as a house manager and has become an industry leader and trusted voice in the treatment world. He brings extensive knowledge of organizational growth, industry-leading outcomes, and comprehensive marketing to SpringBoard Recovery.
 
Robert has been walking his own path of recovery for over 10 years.  This path has truly driven his ambition to help make treatment available to others who are struggling with addiction.  Robert finds great joy in traveling and keeping physically active, with an emphasis on biking. Robert resides in Arizona with his husband and two four-legged children.