‘Dangerous’ Alcohol Consumption on the Rise in the U.S.

“Since our focus has been on the opioid epidemic, we obviously are not paying enough attention to a surging alcohol use epidemic that may also harm a lot of people,” said Andrew J. Saxon, M.D., a professor of psychiatry and behavioral sciences at the University of Washington and director of the Center of Excellence in Substance Abuse Treatment and Education at VA Puget Sound Health Care System in Seattle, Wash.

Saxon said he could only speculate on how these numbers skyrocketed. “I do wonder if it’s related to the events of the recession, which as we all know caused a lot of dislocation and hardship—events that often lead people to turn more to alcohol. I also think binge drinking is becoming more acceptable among younger people and in the baby boomer generation,” said Saxon.

“Drinking norms and values have become more permissive among women, along with increases in educational and occupational opportunities and rising numbers of women in the workforce, all of which may have contributed to increased high-risk drinking and AUD in women during the past decade, compounded by the stress of working and raising a family,” the authors wrote.

The impact of excessive alcohol use in this country is a public health crisis, according to the authors. From 2006 to 2010, there were 88,000 deaths annually related to alcohol, but treatment rates for AUD remain low—at less than 10 percent—despite the existence of evidence-based behavioral and pharmacological approaches.

“The findings highlight the urgency of educating the public, policymakers, and health care professionals about high-risk drinking and AUD, destigmatizing these conditions, and encouraging those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” wrote the researchers.

Clinicians should routinely screen for alcohol disorders using clinical interviews, questionnaires, and blood tests. Treatments for alcohol-related disorders include motivational interviewing to help people evaluate their situation, brief interventions to guide them toward more healthy behaviors, detox to address withdrawal symptoms, cognitive-behavioral therapy (CBT) to avoid relapses, and judicious use of drugs to diminish cravings and discourage relapse, according to Schuckit, who wrote the article’s accompanying editorial in JAMA Psychiatry.

The best intervention is a combination of medication and psychotherapy, said Saxon, adding there are at least three evidence-based therapies, including 12-step facilitation, CBT, and motivational enhancement. In addition, three FDA-approved medications are available: naltrexone, acamprosate, and disulfiram. “There is also very good evidence for topiramate, although it is not FDA approved. There is a long-acting injectable formulation of the naltrexone that I often recommend because it obviates most concerns about medication adherence and requires at least a monthly check-in with a treatment provider to get the injection. Providers and patients should select from these options through shared decision making,” Saxon said.

If Schuckit had his way and sufficient funding, he would consider the use of prevention programs to help people determine whether they have genetically influenced or other types of risk factors. Knowing their personal risks may influence their behavior and decrease the probability of becoming heavy drinkers or developing AUD. “The programs would be much more effective if individuals’ particular vulnerabilities were identified and their relevance discussed,” he said.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. ■