Understanding Unhealthy Alcohol Use in America

Understanding Unhealthy Alcohol Use in America

Alcohol misuse remains one of the most pressing public health challenges in America, claiming around 178,000 lives annually. This issue surpasses any other substance-related mortality, underscoring the urgent need for improved understanding, prevention, and treatment of unhealthy alcohol use. Below, we explore its prevalence, associated health impacts, challenges in treatment, and necessary policy interventions.

The Prevalence of Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) is the most common substance use disorder in the United States, with nearly 30 million people living with the condition. AUD is characterised by an inability to reduce or stop drinking despite adverse effects on health, work, and personal relationships. The condition can range from mild to severe, depending on how many symptoms a person has.

Excessive drinking is alarmingly common. In 2022, out of 137 million Americans who reported drinking in the past month, 45% admitted to binge drinking. Heavy drinking and binge drinking significantly increase the risk of AUD, along with biological, psychological, and environmental factors, such as a family history of alcoholism.

The Spectrum of Unhealthy Alcohol Use

Unhealthy alcohol consumption falls into three main categories:

  • Heavy Drinking: Over 15 drinks per week for men and over 8 drinks for women.
  • Binge Drinking: Five or more drinks in one sitting for men and four or more for women.
  • Alcohol Use Disorder (AUD): Diagnosed when an individual meets at least two diagnostic criteria, such as cravings, inability to limit drinking, or interference in daily life.

Unhealthy alcohol use not only fosters dependency but also correlates strongly with a host of conditions, including cardiovascular disease, liver damage, mental health issues, injury, and certain cancers.

The Impact of COVID-19

The pandemic exacerbated the issue, as stress and isolation led to increased alcohol consumption. George F. Koob, Ph.D., highlights this by stating, “The pandemic has shone a light on how stress and negative emotions drive a good bit of alcohol misuse”. See more

This caused a 26% jump in alcohol-related deaths during the first year of the COVID-19 pandemic, highlighting the harsh impact of ongoing uncertainty and emotional distress.

Barriers to Treatment and Gaps in Care

Despite the existence of effective screening tools and treatment options, only 10% of individuals with AUD receive treatment. Barriers include stigma, a lack of awareness about treatment options, cost, and insufficient provider training. Medications, such as naltrexone and behavioural therapies, have proven highly effective but remain underutilised due to misinformation, limited stock in pharmacies, and a lack of integration into primary care.

Particularly concerning is the failure to connect patients with continued care following withdrawal management—often a necessary first step for people with AUD. Without proper follow-up care, such as behavioural therapy, medication, or recovery supports, most patients eventually relapse.

Disparities in Alcohol-Related Deaths and Treatment

Some communities face disproportionate harm and additional barriers to treatment:

  1. American Indian and Alaska Native Communities
    These groups experience significantly higher alcohol-related mortality rates compared to others. Historical trauma, cultural dislocation, and higher rates of poverty and mental health issues contribute to their vulnerability. Integrating culturally appropriate interventions that include traditional healing practices has been identified as a promising solution.
  2. Rural Populations
    Rural residents face higher alcohol-related death rates than those in urban areas but often lack access to treatment. Geographic isolation, limited healthcare infrastructure, and concerns about privacy deter many from seeking help. Telemedicine holds potential for improving access to care; however, a lack of reliable broadband in these areas remains a critical barrier.

The Role of Primary Care and Emergency Departments

Primary care providers are uniquely positioned to identify and address alcohol misuse, yet many fail to follow up after identifying problematic drinking. In the same way, emergency departments often deal with alcohol-related cases and must screen most patients, but they usually don’t have the setup to provide care after the immediate problem is handled.

Promising Practices for Continuity of Care

Improving treatment outcomes requires a focus on connecting patients to continuous care. Promising practices include:

  • SBIRT (Screening, Brief Intervention, and Referral to Treatment) in both primary care and emergency settings to address alcohol misuse early.
  • Peer Recovery Coaches, who use their lived experience to guide patients through recovery, increase access to resources, and maintain motivation.
  • Initiating medication-assisted treatment (MAT) during withdrawal management and ensuring a “warm handoff” to the next stage of care.
  • Expanding telemedicine and virtual support groups while continuing to bolster in-person care where needed.

Recommendations for Policymakers

Policymakers, healthcare providers, and communities must work together to combat AUD by:

  1. Encouraging Universal Screening
    Implementing routine alcohol use screening in healthcare settings and ensuring appropriate follow-up care can help identify risky drinking behaviours early on.
  2. Improving Continuity of Care
    Strengthening the connection between withdrawal management and follow-up services ensures that patients are supported in their recovery journeys.
  3. Using Medications for AUD
    Increasing provider education and access to appropriate medications, which only 2% of patients with AUD are currently receiving, could significantly improve health outcomes.
  4. Addressing Disparities in Treatment Access
    Expanding culturally competent services for marginalised communities and increasing care availability in rural areas would help close gaps in alcohol-related mortality rates and treatment access.

Tackling Unhealthy Alcohol Use

Unhealthy alcohol use has profound social and health consequences, but it is preventable and treatable. By adopting evidence-based policies and integrating effective treatments into primary care and other healthcare settings, it is possible to reduce the burden of AUD and support individuals on their path to recovery.

It’s important to have ongoing care, treatments that respect different cultures, and fair access for everyone to effectively tackle this widespread problem.

Source: Pew

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