Alcohol Abuse Remains Too Prevalent

The numbers are startling. Nearly 18 million people in the U.S. abuse alcohol or are alcohol dependent, while excessive alcohol use contributes to some 79,000 deaths, 1.6 million hospitalizations, and 4 million emergency-room visits each year.

The Centers for Disease Control (CDC) states that alcohol is the most commonly used and abused drug among youth under age 21 in the country. But the problem is global. According to the World Health Organization, alcohol causes nearly 4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of deaths worldwide — some two and half million each year — and is a causal factor in 60 types of diseases and injuries.

The fact is that alcohol has become a major part of our culture. Most Americans take it for granted that they will drink, and research shows just how prevalent drinking is.

More than 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Americans drink alcohol, and some start very early. A U.S. Substance Abuse and Mental Health Services Administration survey earlier this year discovered that nearly 6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of 12- to 14-year-olds — about 700,000 middle-school children — drank alcohol in the past month. But here’s the surprise: 45{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of them got it free in their own homes, including 16{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} who got it from their parent or guardian.

The 2009 National Survey on Drug Use and Health discovered that 86{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of American youths by age 21 have used alcohol and that 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are binge drinking (defined as five or more drinks in a single session for men, four or more for women). Binge drinking, in fact, has been declared a major public health problem by the CDC, and the problem has become so serious on college campuses that Dartmouth College has announced a national initiative with other universities to curb the behavior. Surveys show more than 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults reporting binge drinking. It is most common in adult men age 18 to 34.

The ill effects of excessive drinking are clear and well documented, and we need only to read the stories about drunken drivers or alcohol-induced violence to know how much of an impact there can be.

Excessive drinking can also destroy one’s health. Alcohol can affect the liver, heart, and brain. It is associated with dementia and gastrointestinal cancer, and in many cases occurs along with psychiatric disorders such as bipolar disease, depression, or attention deficit disorder. Besides health concerns, excessive drinkers also experience more divorce, problems in relationships, and trouble with work and holding a job. And drinkers have a high rate of smoking, along with a ‘mixing in’ of other drugs such as painkillers or stimulants.

But the question still arises: is alcoholism a disease?

The answer is yes. The old view that it resulted from bad behavior has given way to abundant evidence that alcoholism is a biological condition and that it’s often inherited and runs in families. It is indeed a chronic disease, influenced by a person’s family history and lifestyle. That’s why it’s so important that, in families where alcoholism is present, parents and adolescents must be educated that drinking can be dangerous and that a pattern may be set for young people that could affect them for a lifetime.

Yet, alcoholism is only one type of alcohol problem. Alcohol abuse, such as underage drinking, drinking while driving, and, as noted above, binge drinking, can be just as harmful. Alcohol can lead to unintentional injuries, violence, risky sexual behavior, miscarriage and stillbirth among pregnant women, and alcohol poisoning. Even moderate drinking under certain conditions — such as pregnancy, or while taking medications — can be dangerous.

What about those reports that drinking is good for you? Moderate drinking — one or two drinks daily — may have some benefits, but that applies only to healthy people who have no medical conditions and who are not on medications.

Alcoholism is the most common addiction in our culture, and it is difficult for people to hold up a mirror to themselves to acknowledge the problem. For those with the disease, no cure exists, but people should know that it can be treated with counseling and medication. And treatment works. The key is not to avoid or delay treatment; the sooner one gets into treatment, the more successful it will be.

To learn more about this topic, visit Alcoholics Anonymous at www.aa.org and the National Institute on Alcoholism and Alcohol Abuse at www.niaaa.nih.gov. For a video discussion, visit www.physicianfocus.org.

Dr. John A. Renner Jr. is associate chief of Psychiatry at VA Boston Healthcare System, associate professor of Psychiatry at Boston University School of Medicine, and chair of the American Psychiatric Assoc. Council on Addiction Psychiatry. This article is a public service of the Mass. Medical Society.