The study's authors characterize the findings as a serious and overlooked public health crisis, noting that alcoholism is a significant driver of mortality from a cornucopia of ailments: “fetal alcohol spectrum disorders, hypertension, cardiovascular diseases, stroke, liver cirrhosis, several types of cancer and infections, pancreatitis, type 2 diabetes, and various injuries.”
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 Centers for Disease Control and Prevention estimates that 88,000 people a year die of alcohol-related causes, more than twice the annual death toll of opiate overdose.
How did the study's authors judge who counts as “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.
For a diagnosis of alcohol abuse, an individual must have exhibited at least one of the following characteristics in the past year (bulleted text is quoted directly from the National Institutes of Health):
Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household).
Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use).
Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication).
For a diagnosis of alcohol dependence, an individual must experience at least three of the following seven symptoms (again, bulleted text is quoted directly from the National Institutes of Health):
Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol.
The characteristic withdrawal syndrome for alcohol; or drinking (or using a closely related substance) to relieve or avoid withdrawal symptoms.
Drinking in larger amounts or over a longer period than intended.
Persistent desire or one or more unsuccessful efforts to cut down or control drinking.
Important social, occupational, or recreational activities given up or reduced because of drinking.
A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking.
- Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking.
Meeting either of those criteria — abuse or dependence — would lead to an individual being characterized as having an alcohol use disorder (alcoholism).
The study found that rates of alcoholism were higher among men (16.7 percent), Native Americans (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.
While the study's findings are alarming, a different federal survey, the National Survey on Drug Use and Health (NSDUH), has shown that alcohol use disorder rates are lower and falling, rather than rising, since 2002. Grant says 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 probably 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 criteria for alcohol use disorder.
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 go only through 2013. If the observed trend continues, the true rate of alcoholism today would be even higher.
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 after 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,” University of California at San Diego psychiatrist Marc Schuckit said in an editorial accompanying the study.