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Alcoholism and Alcohol-Related Problems


A SOBERING LOOK

  • Alcohol, the most widely used psychoactive drug in the United States, has unique pharmacological effects on the person drinking it (Substance Abuse and Mental Health Services Administration {SAMHSA}, National Household Survey on Drug Abuse: Main Findings 1992, US Department of Health and Human Services {USDHHS}, 1/95, p.2; National Institute of Alcohol Abuse and Alcoholism {NIAAA}, Eighth Special Report to US Congress on Alcohol and Health, 9/93, p. 129).

  • Alcohol contributes to 100,000 deaths annually, making it the third leading cause of preventable mortality in the US, after tobacco and diet/activity patterns (J McGinnis & W Foege, "Actual Causes of Death in the United States," Journal of the American Medical Association {JAMA}, Vol. 270, No. 18, 11/10/93, p. 2208).

  • Among 9,484 deaths attributed to non-medical use of other drugs in 1996, 37% also involved alcohol (SAMHSA, Annual Medical Examiner Data 1996, 7/98, p. iii).

  • More than seven percent of the population ages 18 years and older--nearly 13.8 million Americans--have problems with drinking, including 8.1 million people who are alcoholic. Almost three times as many men (9.8 million) as women (3.9 million) are problem drinkers, and prevalence is highest for both sexes in the 18-to-29-years-old age group (NIAAA, Alcohol Health & Research World {AHRW}, Vol. 18, No. 3, 1994, pp. 243, 245).

  • About 43% of US adults--76 million people--have been exposed to alcoholism in the family: they grew up with or married an alcoholic or a problem drinker or had a blood relative who was ever an alcoholic or problem drinker (National Center For Health Statistics {NCHS}, Advance Data, USDHHS, No. 205, 9/30/91, p. 1).

  • 62% of high school seniors report that they have been drunk; 31% say that have had five or more drinks in a row during the last two weeks (LD Johnston, et.al., Monitoring the Future Study, Institute for Social Research, University of Michigan, 12/99). [For more information, see NCADD's "Youth, Alcohol and Other Drugs" facts.]

  • People who begin drinking before age 15 are four times more likely to develop alcoholism than those who begin at age 21(NIAAA news release, 1/14/98).

  • From 1985 to 1992, the economic costs of alcoholism and alcohol-related problems rose 42% to $148 billion. Two-thirds of the costs related to lost productivity, either due to alcohol-related illness (45.7%) or premature death (21.2%). Most of the remaining costs were in the form of health care expenditures to treat alcohol use disorders and the medical consquences of alcohol consumption (12.7%), property and administrative costs of alcohol-related motor vehicle crashes (9.2%), and various additional costs of alcohol-related crime (8.6%). Based on inflation and population growth, the estimated costs for 1995 total $166.5 billion (NIAAA, news release, 5/13/98).

  • Nearly one-fourth of all persons admitted to general hospitals have alcohol problems or are undiagnosed alcoholics being treated for the consequences of their drinking (NIAAA, Eighth Special Report, op. cit., p. xi).

  • On average, untreated alcoholics incur general health care costs at least 100% higher than those of nonalcoholics, and this disparity may exist as long as 10 years before entry into treatment (Ibid., p. 259).

  • Based on victim reports, each year 183,000 (37%) rapes and sexual assaults involve alcohol use by the offender, as do just over 197,000 (15%) of robberies, about 661,000 (27%) aggravated assaults, and nearly 1.7 million (25%) simple assaults (US Department of Justice, Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol Involvement in Crime, 4/98).

  • Alcohol is typically found in the offender, victim or both in about half of all homicides and serious assaults, as well as in a high percentage of sex-related crimes, robberies, and incidents of domestic violence, and alcohol-related problems are disproportionately found among both juvenile and adult criminal offenders (NIAAA, Eighth Special Report, op. cit. p. xi).

  • Fetal alcohol syndrome (FAS), which can occur when women drink during pregnancy, is the leading known environmental cause of mental retardation in the Western World (Ibid., p.221). [For more information, see NCADD's "Alcohol and Other Drug-Related Birth Defects" facts.]

A PREVENTABLE, TREATABLE DISEASE

Prevention:

  • Alcohol-related problems are not likely to be reduced by strategies involving single interventions directed solely at the individual; economic, political, social and environmental forces that work together to encourage and perpetuate these problems must also be addressed (NIAAA, AHRW, Vol. 17, No. 2, 1993, p. 133).

  • Price increases on alcoholic beverages may be especially effective at reducing addictive consumption by younger, poorer, and less educated consumers, while information on the long-term health impacts of drinking may have a greater effect on addictive consumption by older, richer, and more educated consumers (NIAAA, Eighth Special Report, op. cit., p. 262).

  • School-based prevention programs that focus on social influences, such as peer resistance training or attempts to change perceived norms about alcohol, show more promise for changing alcohol use patterns than programs that emphasize the development of personal capabilities such as self-esteem, skill in making decisions and solving problems, and understanding how alcohol use can interfere with personal values and goals (Ibid., p. 269-270).

  • Nations banning the advertising of distilled spirits, compared to nations with no bans, had approximately 16% lower alcohol consumption; countries banning beer and wine ads had 11% lower alcohol consumption than those prohibiting only the advertising of spirits. The reductions in motor vehicle fatality rates were 10% and 23% respectively (Ibid., p. 140).

Treatment:

  • 3.1 million Americans--approximately 1.4% of the population ages 12 and older--received treatment for alcoholism and alcohol-related problems in 1997; treatment peaked among people between the ages 26-34 (SAMHSA, National Household Survey on Drug Abuse: Main Findings 1997, 4/99, p. 169, 172).

  • A study examining the relative cost effectiveness of 33 specific treatment modalities for alcoholism suggested that more costly treatments are not necessarily more effective; of the six treatment modalities classified as having "good evidence of effect," all appear in the minimal-, low-, or medium-low-cost categories (NIAAA, Eighth Special Report, op. cit., p. 261).

  • Providing heavy drinkers who are not alcohol-dependent with self-help materials relating to alcoholism can, by itself, be an effective method of brief intervention (Ibid., p. 309).

ENVIRONMENTAL INFLUENCES

  • Parenting practices, parental alcohol use, and peer drinking can influence a person's alcohol use and the associated problems that can stem from drinking (Ibid., p. xxv).

  • Content analyses of alcohol advertisements on television show that the ads link drinking with highly valued personal attributes such as socialibility, elegance, and physical attractiveness, and with desirable outcomes such as success, relaxation, romance, and adventure (NIAAA, AHRW, Vol. 17, No. 1, 1993, p. 63).

  • Alcohol advertising may influence adolescents to be more favorably predisposed to drinking (NIAAA, Alcohol Alert, No. 37, 7/97, p.3.)

NEGATIVE CONSEQUENCES

On Health:

  • The regular consumption of large amounts of alcohol (defined as more than three drinks per day) is undesirable from the standpoint of health for almost all people and drinking low-to-moderate amounts can be desirable or undesirable, depending on individual characteristics (G Friedman & A Klatsky, "Editorial: Is Alcohol Good For Your Health?," New England Journal of Medicine, Vol. 329, No. 25, 12/16/93, p. 1883).

  • Although there are fewer deaths from alcohol-related causes than from cancer or heart disease, alcohol-related deaths tend to occur at much younger ages (NIAAA, Eighth Special Report, op. cit., p. 16).

  • Studies of suicide victims in the general population show that about 20% of such suicide victims are alcoholic (NIAAA, AHRW, Vol. 17, No. 2, 1993, p. 133).

  • Heavy and chronic drinking

    --can harm virtually every organ and system in the body     (Ibid., p. xxvii).

    --is the single most important cause of illness and death from liver disease (alcoholic hepatitis and cirrhosis) (Ibid., p. 165).

    --is associated with cardiovascular diseases such as cardiomyopathy, hypertension, arrhythmias, and stroke (Ibid., p. 172).

    --contributes to approximately 65% of all cases of pancreatitis (Ibid., p. 171).

    --depresses the immune system and results in a predisposition to infectious diseases, including respiratory infections, pneumonia, and tuberculosis (Ibid., p. 176).

    --increases risk for cancer, with an estimated 2-4% of all cancer cases thought to be caused either directly or indirectly by alcohol. The strongest link between alcohol and cancer involves cancers of the upper digestive tract, including the esophagus, the mouth, the pharynx, and the larynx. Less consistent data link alcohol consumption and cancers of the liver, breast and colon (NIAAA, Alcohol Alert, No. 21, 7/93).

    --can lead to inadequate functioning of the testes and ovaries, resulting in hormonal deficiencies, sexual dysfunction and infertility (NIAAA, Alcohol Alert, No. 26, 11/95).

    --is related to a higher rate of early menopause and a higher frequency of menstrual irregularities (duration, flow, or both) in women (NIAAA, Eighth Special Report, op. cit., p. 179).

  • Each year 4,000 to 12,000 babies are born with the physical signs and intellectual disabilities associated with FAS, and thousands more experience the somewhat lesser disabilities of fetal alcohol effects (SAMHSA, Center for Substance Abuse Prevention, Toward Preventing Perinatal Abuse of Alcohol, Tobacco and Other Drugs, USDHHS, Technical Report, No. 9, 1993, p. 1).

  • An association has been established in both homosexual and heterosexual populations between alcohol use, drug use and behavior that increases the risk for contracting HIV and other sexually transmitted diseases, but underlying processes and mechanisms that explain this relationship have not been definitively identified (NIAAA, Eighth Special Report, op. cit., p. 245).

On the Family:

  • Separated and divorced men and women were three times as likely as married men and women to say they had been married to an alcoholic or problem drinker (NCHS, Advance Data, op. cit., p. 6).

  • An estimated 6.6 million children under the age of 18 years live in households with at least one alcoholic parent (NIAAA, Alcohol Alert, No. 9, 7/90, p. 1).

Unintentional Deaths and Injuries:

  • 38% of all traffic fatalities (the leading cause of accidental death) are alcohol-related (National Highway Traffic Safety Administration, 5/27/99 press release); alcoholics are nearly five times more likely than others to die in motor vehicle crashes (NIAAA, Eighth Special Report, op. cit., p. 233).

  • One study showed that half of all boating fatalities had a blood alcohol content (BAC) of .04; BAC's of .10 or more were found in 31% of the fatalities(US Department of Transportation, United States Coast Guard, Boating Statistics 1994, 9/95).

  • Alcoholics are 16 times more likely than others to die in falls, and 10 times more likely to become fire or burn victims (Ibid.).

  • Estimates suggest that alcohol is associated with between 47% and 65% of adult drownings (Ibid., p. 243).

  • Up to 40% of industrial fatalities and 47% of industrial injuries can be linked to alcohol consumption and alcoholism (M Bernstein & JJ Mahoney, "Management Perspectives on Alcoholism: The Employer's Stake in Alcoholism Treatment," Occupational Medicine, Vol. 4, No. 2, 1989, pp. 223-232). [For more information, see NCADD's "Alcohol and Other Drugs in the Workplace" facts.]


CONSUMPTION PATTERNS & PRACTICES

  • From 1996 to 1997, annual per capita consumption of alcohol in the US decreased 0.5% to 2.18 gallons; per capita consumption in 1997 is second only to 1995 in being the lowest in 35 years. (NIAAA, Apparent Per Capita Alcohol Consumption: National, State and Regional Trends, 1977-97, Surveillance Report #51, 12/99, p. 1.).

  • Two-thirds of the population drink, but 10% of all drinkers (those who drink most heavily) drink half of all alcohol consumed (NIAAA, Sixth Special Report to US Congress on Alcohol and Health, USDHHS, 1/87, p. 3).

  • Moderate drinking is defined as no more than one drink a day for women and no more than two drinks per day for men. Twelve ounces of beer; 5 ounces of wine; or 1.5 ounces of distilled spirits (80 proof) counts as one drink. (US Department of Agriculture & USDHHS, Nutrition and Your Health: Dietary Guidelines for Americans, 1995, p.40)

GENDER DIFFERENCES

  • Study findings suggest that women metabolize alcohol less efficiently than men, a difference that leads to higher blood alcohol concentrations in women over a shorter period of time. This difference may make women more vulnerable than men to alcohol-induced liver damage (NIAAA, Eighth Special Report, op. cit., p. xxvi). [For more information, see NCADD's "of Alcohol and Other Drugs Among Women" facts.]

  • Alcohol-related problems more prominent for women than men include serious reproductive and sexual dysfunctions; rapid development of dependence; more serious liver disease among those who are patients; victimization by others, particularly spouses; and sexual victimization (Ibid., p. 275).

Revised 1/00

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