All of Washington state is moving to Phase 3 of reopening! On April 1, some of us will be at T-Mobile Park for Opening Day, cheering on the Mariners with a Seattle hot dog and a cold one.
Some of us will welcome spring in outdoor barbecues with beer and wine or just hang out on the couch with a drink and some chips watching reruns of Cheers ( the bar where everybody knows your name) or scrolling through Tik-Tok videos of moms trying to juggle kids in on-line school, work at home and manage chores with wine in a sippy cup. As we welcome spring and relaxed Covid regulations, I’d like to propose a toast to Alcohol Awareness Month.
America and Alcohol have a complex relationship. Drinking is a pervasive and deep-rooted feature of American life unlike any other drug with the possible exception of tobacco. In early colonial days when water wasn’t necessarily safe to drink, alcohol consumption was 6-7 gallons of pure alcohol annually per American. From just before the Civil War on, it has been between 1.75 – 2.75 gallons/person/year of pure alcohol with a dip down during prohibition in the 1920s and a decided uptick in the 1960s. Different cultures bring different customs regarding food and alcohol — drinking is never done in a vacuum. It is done at a certain time, a certain place, with or without the company of particular others and in the context of an intricate interplay of genetic, personal and social histories. Between 40-60% of risk of alcohol use disorder (AUD) can be attributed to genetic factors. Still, many people enjoy moderate drinking without any trouble at all.
Alcohol use and misuse accounts for 95,000 deaths annually in the US. Washington ranks 31st among states for alcohol-related deaths, 40th in excessive drinking and ranks 8th in DUI arrests according to national studies. Even moderate drinking increases risk for falls, traffic accidents and drowning. The most recent study published in the MMWR found that, across the US, alcohol was found to contribute to 18.5% of all Emergency Department visits, 21% of overdose deaths related to prescription opioids and 29% of all driving fatalities. All in all alcohol misuse costs the US about $300 billion annually and three quarters of that is related to binge drinking. These and many more facts and statistics can be found at these web sites: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics https://www.americashealthrankings.org/explore/annual/measure/ExcessDrink/state/WA
Alcohol use disorder often goes hand in hand with mental health conditions such as anxiety and depression. If these conditions are temporary, the AUD may be relieved when they are. People who suffer from chronic mental illnesses such as bipolar disorder, major depression, PTSD and psychosis may have comorbid chronic AUD. Both illnesses must be treated, as well as any medical conditions that may be related in order to achieve long term recovery.
Alcohol Awareness Month is a public health program organized by the National Council on Alcoholism and Drug Dependence (NCADD) in April 1987 with the intention of targeting college-aged students who might be drinking too much as part of their newfound freedom. It has since become a national movement to draw more attention to the causes and effects of AUD as well as how to help families and communities deal with drinking problems. A huge part of this effort is about reducing the stigma that still surrounds alcoholism and substance use in general. Denial is a common trait in those who drink either by underestimating the amount they drink, the duration of their drinking problem, the impact it has on their relationships and life or by overestimating their ability to quit or control their drinking. Denial is also common in friends and family members who feel uncomfortable discussing the reality and seriousness of the situation with their loved one.
According to the 2019 National Survey on Drug Use and Health (NSDUH), 5.3% or nearly 15 million people aged 12 or older have an alcohol use disorder, but only 7.2% of those get any sort of treatment in a given year. There are many reasons for this, not the least of which is the stigma of AUD as a character flaw or bad behavior, a moral weakness. But there are excellent and effective treatments for this chronic relapsing disorder. With the level of genetic variability in AUD, there are no “one size fits all” treatments. Some do well with motivational interviewing, counseling and 12-Step programs, others do better with one of several medications that either make one feel ill if they intake alcohol (Antabuse, disulfiram) or stop or ameliorate cravings (naltrexone, ReVia, Vivitrol and others). There are outpatient, intensive outpatient and residential programs and many that work with those with Medicare/Medicaid and even no insurance. Sometimes, given the potentially life-threatening effects of withdrawal (seizures, hallucinations, injuries) harm reduction through alcohol management is the first step for those with chronic alcohol addiction. DESC in Seattle began such a program and presented it at the Housing First Partners Conference in 2014. After understanding client’s goals for drinking the plan details the dosage of alcohol to be administered by staff at specified times.
Helping a loved one or yourself to take the first step toward recovery involves learning about alcohol addiction, researching different types of treatment covered by your insurance and deciding on a time (and assistance if necessary) to talk with that person about the problems. There are many places to seek information and treatment such as findtreatment.gov, and the national help-line samhsa.gov/find-help/national-helpline (1-800-662-4357).
So as we move into spring and summer and perhaps find ourselves socializing again, or not able to, think about the role that alcohol plays in your life and relationships and about what it means to Drink Responsibly.
Author: CMO, Camis Milam, M.D.