Alcohol Continues to be the Most Common Problem Substance

With opioid addiction getting much-deserved attention, it is possible to forget that alcohol addiction continues to be an even larger problem. In our outpatient detoxification and rehabilitation program, alcohol continues to be the most common problem substance. A disturbing reminder of this is an article from the U.S. Center for Disease Control recently published in the British Medical Journal suggesting that the alcohol problem may, in fact, be getting worse.

More Questions

The study documents the increase in mortality from alcoholic cirrhosis between the years of 2009 and 2016. The details of the study raise more questions than it answers:

• Timing – The increase began in 2009, just after the 2008 economic crises which triggered a severe recession with major social consequences. Was this a coincidence or was there a causal connection?
• Geography – The South saw the greatest increases, followed by the West with the Northeast having the lowest. Kentucky, Arkansas and New Mexico were the states with the greatest increases. Maryland and DC were the only states that actually had decreases.
• Ethnicity – Native Americans and Hispanics have higher rates than white Americans, but increases were high in all three groups, especially compared to African-Americans and Asians.
• Gender – Men had double the death rate of women, but the rate of increase was the same for both
• Age – The greatest increase by age group was in those 25 to 34, which is younger than the age group usually affected by alcoholic cirrhosis.

What should be done in response to these alcohol findings?

The authors had two suggestions –

1. Explore why particular subgroups – young Native Americans, Hispanics, and whites –  and particular regions of the country are so affected
2. Consider the impact of increased excise taxes on alcohol, citing Scotland as a country in which data about this approach will soon become available

The cost of alcohol is a complex and controversial issue. The regulation and taxation of alcohol is a model frequently cited by those arguing for the legalization of recreational cannabis. The interaction between public health and alcohol industry forces around pricing issues could be seen as a model which will be reprised in the growth of the cannabis industry.

All in all, this is a good example of the advantage of considering addiction more broadly as a disease with biological, psychological, and social elements rather than simply a “brain disease.”