Deaths related to alcohol doubled over the past 20 years in the U.S, particularly in women and drinkers middle-aged and older, a new analysis shows.
Rates of death involving alcohol increased more for women (85%) than men (35%), between 1999 and 2017, the National Institute on Alcohol Abuse and Alcoholism found.
The finding is part of a growing body of research showing a long and steady national increase in drinking and in alcohol-related harms. Other recent studies have found jumps in alcohol-related ER visits, in alcohol-related rates of hospitalization related to drinking and for per capita alcohol consumption, with increases also especially among women and middle-aged and older adults.
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Local health officials said this issue is happening in the Dayton area.
Alcohol doesn’t get the level of attention or public outcry because its legal but the misuse of it has been one of the primary source of accidental deaths in this community, said Helen Jones-Kelley, Montgomery County Alcohol, Drug Addiction and Mental Health Services.
“There’s no question that there has been an increase particularly in traffic related fatalities as a result of alcohol misuse,” Jones-Kelley said.
Dr. George Koob, director of National Institute on Alcohol Abuse and Alcoholism, said in a statement that the current findings suggest that alcohol-related deaths involving injuries, overdoses, and chronic diseases are increasing across a wide swath of the population.
“The report is a wakeup call to the growing threat alcohol poses to public health,” Koob said.
Researchers found the number of death certificates mentioning alcohol more than doubled from 35,914 in 1999 to 72,558 in 2017, the year in which alcohol played a role in 2.6% of all deaths in the United States. Since the role of alcohol in deaths is vastly under-reported and the study only looked at death certificates, the authors noted the actual number of alcohol-related deaths may be much higher.
Nearly 1 million people died from alcohol-related causes during the study period.
Dr. Dennis Mann, Miami Valley Hospital emergency physician, said when he saw the article, the increase was more than he expected.
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“Like anything else that increases very, very slowly over a number of years, you just sort of adopt to it,” Mann said.
Compared to when he started in the emergency department 20 years ago, Mann said he has noticed a much higher percentage of younger people — young women in particular — coming in with alcohol-related problems.
With the way that women metabolize alcohol, a woman cannot safely drink the same amount as a same size man.
“I think that’s an important thing that needs to be put out there and become more common knowledge because it’s certainly not common knowledge about the difference between men and women in alcohol effects,” he said.
He said one of the common ways people end up with an emergency department visit from drinking is from falls. When you’re drunk and fall, he said your reflexes that protect you from letting your head hit the ground are severely blunted compared to when you are sober.
“I think a lot of younger people really don’t understand how easy it is to get on the train that leads to an ER visit … particularly the loss of balance, coordination, judgment, that can lead to an ER visit which for many people can be the beginning of a long process of injury recovery,” Mann said.
Different Ohio reports show similar increases in drinking-related harms.
Amy Bush Stevens, vice president at Health Policy Institute of Ohio, said excessive drinking also leads to health problems like chronic liver disease, which is the 10th leading cause of premature death in Ohio. She also said there's a troubling trend of a growing number of Ohio drug overdose deaths increasingly also involving alcohol, with state data recording 442 drug ODs also involving alcohol in 2018, up from 181 in 2008.
“This indicates that the national trends in that report are likely happening in Ohio as well,” she said.
Starting the conversation
The news comes at a time when hundreds of primary care providers in the region have recently completed training on how to regularly talk with their patients about alcohol and substance use, through a grant managed by Wright State’s Boonshoft School of Medicine.
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While an important health topic to discuss, Paul Hershberger, director of the division of behavioral health, said a primary care provider naturally wants to focus on why the patient made the appointment, which is typically not their alcohol use. Routine screenings help providers feel comfortable bringing the topic up and feel equipped ahead of time on what to do if a patient needs a referral.
“It is clear from the research that given how prevalent alcohol-related problems are in society it needs to occur more in clinical settings that it is occurring,” Hersberger said.
Hershberger said the grant program trained providers to use a screening model called Screening, Brief Intervention, Referral to Treatment, which is an evidence-based model that teaches doctors how to systematically screen and to ask questions in a non-judgmental way.
Instead sorting patients into either “having” or “not having” a problem, patients being screened are encouraged to think through what they like and don’t like about their drinking, what their health goals are and how changing habits could help meet those goals.
The grant program was jointly hosted by Wright Rural Medical Scholars. Hershberger said rural providers might face a barrier of working in a community where excessive drinking is culturally common and that can make bringing up the conversation additionally difficult.
Hershberger said they originally sought to train at least 250 local providers, and ended up with interest from more than 408 providers over the course of 26 training events.
“One of the things we discovered was most of the folks we were working with were not doing any routine systematic screenings regarding patients use of alcohol,” Hersberger said.
Bush Stevens said there are evidence-based policies that the state could adopt to prevent drinking problems.
Stepping up enforcement and monitoring to make sure alcohol isn’t being sold to minors is important, because the younger a child is when they first use alcohol, the higher at risk they are for addiction later in adulthood. There are also proven school-based prevention programs such the Good Behavior Game, which Ohio could use administer more comprehensively across the state.
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Ohio now requires ignition interlocks for repeat offenders convicted of alcohol-impaired driving, which prevent a driver from using their car if they have a high blood alcohol content. Bush Stevens said this is an evidence-based tool and Ohio could expand to the CDC recommendation of requiring ignition interlocks for the first offense.
Increasing the alcohol tax is also a demonstrated way to lower consumption. Health Policy Institute of Ohio's 2018 addiction policy scorecard said the state's relatively low alcohol taxes are "not aligned with evidence."
“The more expensive alcohol is, the lower consumption,” Bush Stevens said.
Alcohol-related harms: By the numbers
25.5 per 100,000: Rate of alcohol-related deaths in 2017, up 50.9% from 16.9 per 100,000 in 1999
2.6%: Percent of all U.S. deaths that involved alcohol in 2017
6.9%: Annual increase in rate of chronic alcohol misuse-related ER visits for women, 2006-2014
4.5%: Annual increase in rate of chronic alcohol misuse-related ER visits for men, 2006-2014
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