You’ve probably heard of America’s increasing struggles with opioid addiction in the past few years. But there’s another drug that the country appears to be increasingly misusing as well: alcohol.
According to a new study published in JAMA Psychiatry, several signs of alcohol misuse are on the rise. Between 2001-’02 and 2012-’13, 12-month alcohol use increased from 65.4 percent to 72.7 percent, and high-risk drinking increased from 9.7 percent to 12.6 percent. And alcohol use disorder (alcoholism) increased from 8.5 percent to 12.7 percent — a whopping 49.4 percent increase. The increase in alcoholism in particular suggests that nearly 30 million Americans now suffer from alcohol addiction.
The increase in alcoholism was more pronounced among women, racial minorities, older adults, people with a high school education or less, people earning $20,000 or less a year, people living within 200 percent of the poverty threshold, and people residing in urban areas — many of which are socioeconomically disadvantaged groups.
The study looked at two waves of data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which involved face-to-face interviews with tens of thousands of US adults. They then compared how the findings differed in the 2001-’02 period with the 2012-’13 period. They found an across-the-board increase in alcohol misuse.
One caveat: Data from a separate survey, the National Survey on Drug Use and Health (NSDUH), indicates that the prevalence of alcohol use disorder slightly declined from 2002 to 2013. The surveys do use different methodologies, but it’s unclear why there are such stark differences in the two surveys’ findings.
A statistician with the Substance Abuse and Mental Health Services Administration (SAMHSA) also pointed out to me that there were significant methodological changes between the 2001-’02 and 2012-’13 periods with NESARC, the survey that the JAMA Psychiatry study used. That may have skewed the survey’s — and study’s — findings. (Here is a follow-up article on the methodological changes NESARC went through.)
Still, the JAMA Psychiatry study’s data isn’t the first to indicate a rise in alcohol-related problems in America. Between 2001 and 2015, the number of alcohol-induced deaths (those that involve direct health complications from alcohol, like liver cirrhosis) rose from about 20,000 to more than 33,000. Before the latest increases, an analysis of data from 2006 to 2010 by the Centers for Disease Control and Prevention (CDC) already estimated that alcohol is linked to 88,000 deaths a year — more than all drug overdose deaths combined.
In short, alcohol already posed major public health problems for the US. But now we have evidence that such problems are getting much worse very quickly.
America’s struggle with addiction
There are several possible explanations for the study’s findings. Over the past few decades, alcohol has become easier to access, while addiction treatment services have remained hard to reach. It’s also likely that socioeconomic and mental health issues are playing a role, as people turn to alcohol and other drugs to essentially self-medicate all sorts of problems.
For one, the effective price of alcohol has dropped over the past few decades — making it much easier to buy and misuse the drug. A 2013 study published in the American Journal of Preventive Medicine, for example, estimated that one drink per day of the cheapest brand of spirits cost the typical person 4.46 percent of his disposable income in 1950, but just 0.29 percent in 2011. There were similar decreases for wine and beer as well.
“The price of alcohol has fallen sharply over recent decades, and that is the most compelling explanation for why the population is drinking more,” Keith Humphreys, a drug policy expert at Stanford University, told me. “Even the heaviest drinkers respond to changes in the cost of alcohol.”
At the same time, treatment for alcoholism and other kinds of drug addiction remains stubbornly inaccessible. According to the surgeon general’s 2016 report on addiction, only 10 percent of people suffering from a drug use disorder get specialty treatment. The report attributed the low rate to shortages in the supply of care, with some areas of the country lacking affordable options for treatment — which can lead to waiting periods of weeks or even months just to get help.
Some experts argue that the simultaneous increase in deaths of despair — alcohol-related deaths, drug overdoses, and suicides — point to deeper problems in America. Leo Beletsky, a professor of law and health sciences at Northeastern University, points to “changes in welfare policy, changes in the economy, and social isolation” as crucial to understanding why America has seen an increase in these deaths.
We know the environment can play a big role in addiction. There’s a classic experiment behind this idea: the Rat Park. Some of the original experiments on cocaine and heroin addiction were conducted under animal testing settings in which rats were caged off and socially isolated, with drugs as their only real form of recreation. These experiments suggested the drugs were extremely addictive, leading rats to use them literally to their deaths.
So Bruce Alexander, a Canadian researcher, decided to see what would happen if drugs were instead offered in a bigger cage in which rats could interact with other rats. His results were striking: While rats in cramped, isolated cages preferred drug-laced water, rats in healthier, more social environments preferred plain water — even when the drug-laced water was made intensely sweet. The results suggest that it’s not just the presence of drugs but other variables that drive people to use these substances.
The alcohol study in JAMA Psychiatry cites socioeconomic conditions to explain the increases in alcohol-related problems among racial minorities: “Wealth inequality between minorities and whites has widened during and after the 2008 recession, possibly leading to increased stress and demoralization.”
When you put all of these issues together, you begin to get an idea of how America has over the past few years seen its alcohol problem grow worse and worse.
There are policies to deter alcohol misuse
There are policies to combat alcohol-related problems. Now, when Americans think about alcohol policy, the first thing that comes to mind is probably Prohibition, which effectively banned the manufacture and sale of alcohol from 1920 to 1933. But there are all sorts of other policies that could help address bad outcomes due to drinking.
A small sample:
- A higher alcohol tax: A 2010 review of the research in the American Journal of Public Health came out with strong findings: “Our results suggest that doubling the alcohol tax would reduce alcohol-related mortality by an average of 35%, traffic crash deaths by 11%, sexually transmitted disease by 6%, violence by 2%, and crime by 1.4%.”
- Reducing the number of alcohol outlets: A 2009 review published in the American Journal of Preventive Medicine also found that limiting the number of alcohol outlets (such as liquor stores) in an area through stricter licensing, for example, can limit problematic drinking and its dangers. But it also found that going too far can have negative results — by, for example, causing more car crashes as people take longer drives to outlets and possibly drink before returning home.
- Revoking alcohol offenders’ right to drink: South Dakota’s 24/7 Sobriety program effectively revokes people’s right to drink if a court deems it necessary after an alcohol-related offense. The program, specifically, monitors offenders through twice-a-day breathalyzer tests or a bracelet that can track blood alcohol level, and jails them for one or two days for each failed test. Studies from the RAND Corporation have linked the program to drops in mortality, DUI arrests, and domestic violence arrests.
- Put state governments in charge of selling alcohol: A 2014 report from RAND concluded that when state governments monopolize alcohol sales through state-run shops, they can keep prices higher, reduce access to youth, and reduce overall levels of use.
These are just a few of the ideas that experts have put out there. There are many more ways to curtail alcohol consumption and misuse without outright banning it.
Different individuals will likely disagree on whether these proposals go too far in restricting personal liberty, even if they do save some lives. But the research suggests such policies are at least worth considering.
Yet lawmakers have paid very little attention to alcohol policy. As Philip Cook, a public policy expert at Duke University who wrote Paying the Tab: The Costs and Benefits of Alcohol Control, previously told me, the last time Congress raised the federal alcohol tax was 1991 — and that’s let the real impact of the tax erode due to increasing inflation.
“The great opportunity we have is to restore taxes to the real value that they had a few decades ago,” Cook said. “That’s justified by the current social costs of drinking, and would have all kinds of beneficial effects, while being justified just from the point of view that drinkers should pay for the damage that they do.”
Part of the problem is that policymakers just don’t feel much pressure to act on these kinds of public health problems — at least in the same way they feel compelled to act on an issue like, say, terrorism. So alcohol misuse and related problems get worse and worse, and thousands of people die needlessly every year.
Update: Added separate data from the National Survey on Drug Use and Health, as well as a federal researcher’s comments on the survey used for the study.