A new study published in JAMA Psychiatry this month finds that the rate of alcoholism in the U.S. rose by a shocking 49 percent in the first decade of the 2000s. One in 8 American adults, or 12.7 percent of the U.S. population, now meet the diagnostic criteria for what is called alcohol use disorder.
The authors characterize the findings as a serious, overlooked public health crisis, noting that alcoholism is a significant driver of mortality from many ailments: “fetal alcohol spectrum disorders, hypertension, cardiovascular diseases, stroke, liver cirrhosis, several types of cancer and infections, pancreatitis, type 2 diabetes, and various injuries.”
More deaths than opiate ODs
Indeed, the study’s findings are bolstered by the fact that deaths from a number of these conditions, particularly alcohol-related cirrhosis and hypertension, have risen concurrently over the study period. The CDC estimates that 88,000 people a year die from alcohol-related causes, more than twice the annual death toll of opiate overdose.
How did the study’s authors judge who is an alcoholic?
The study’s data comes from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey administered by the National Institutes of Health. Survey respondents were considered to have alcohol use disorder if they met widely used diagnostic criteria for either alcohol abuse or dependence.
The study found that rates of alcoholism were higher among men (16.7 percent), American Indians (16.6 percent), people below the poverty threshold (14.3 percent), and people living in the Midwest (14.8 percent). Stunningly, nearly 1 in 4 adults under age 30 (23.4 percent) met the diagnostic criteria for alcoholism.
What do the researchers think is driving the increase?
“I think the increases are due to stress and despair and the use of alcohol as a coping mechanism,” said the study’s lead author, Bridget Grant, a researcher at the National Institutes of Health. The study notes that the increases in alcohol use disorder were “much greater among minorities than among white individuals,” likely reflecting widening social inequalities following the 2008 recession.
“If we ignore these problems, they will come back to us at much higher costs through emergency department visits, impaired children who are likely to need care for many years for preventable problems, and higher costs for jails and prisons that are the last resort for help for many,” said UCSD psychiatrist Mark Schuckit in an editorial accompanying the study.
While the study’s findings are alarming, a different federal survey, the National Survey on Drug Use and Health (NSDUH), found that alcohol use disorder rates are lower and falling, rather than rising, since 2002. Grant said she’s not sure what’s behind the discrepancies between the two federal surveys, but it’s difficult to square the declining NSDUH numbers with the rising mortality rates seen in alcohol-driven conditions like cirrhosis and hypertension.
A separate study looking at differences between the two federal surveys found that the disparities are likely caused by how each survey asks about alcohol disorders; it found that the NESARC questionnaire used in the current study is a “more sensitive instrument” that leads to a “more thorough probing” of the alcohol use disorder criteria.
If the more sensitive data used in the current study is indeed more accurate, there’s one final caveat to note: The study’s data only go through 2013. If the observed trend continues, the true rate of alcoholism today would be even higher.
For a diagnosis of alcohol abuse, an individual must have exhibited at least one of the following characteristics in the past year:
• Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home
• Recurrent alcohol use in situations in which it is physically hazardous
• Recurrent alcohol-related legal problems
• Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol