The next 'public health crisis'? Alcohol consumption, researchers argue

High-risk alcohol consumption increased by nearly 30 percent among U.S. adults between 2001-2002 and 2012-2013, representing a "public health crisis" that might have been overshadowed by the misuse of other substances—such as opioids, marijuana, and heroin—according to a study published Wednesday in JAMA Psychiatry.

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Study details

For the study, researchers from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and New York State Psychiatric Institute reviewed face-to-face interviews conducted for a nationally representative survey of U.S. adults from April 2001 to June 2002 and from April 2012 to June 2013. The researchers analyzed the data in November and December 2016.

The researchers looked at 12-month alcohol use, alcohol use disorder, and high-risk drinking. The researchers defined alcohol use disorder as a dependence on alcohol, and high-risk drinking as the regular consumption of four alcoholic drinks daily for women, or five drinks daily for men.

Findings

The researchers found several indicators of alcohol misuse rose during the study period. For instance, between 2001-2002 and 2012-2013, the study found:

  • 12-month alcohol use increased from 65.4 to 72.7 percent;
  • Alcohol use disorder increased by 49.4 percent from 8.5 to 12.7 percent; and
  • High-risk drinking increased 29.9 percent from 9.7 to 12.6 percent.

According to the study, the greatest increases for alcohol use, high-risk drinking, and alcohol use disorder occurred among:

  • Older adults;
  • Racial/ethnic minorities;
  • Socioeconomically disadvantaged individuals; and
  • Women.  

For example, the researchers found that, among older adults who are at higher risk for disability and morbidity, the rate of alcohol use disorder increased by 106.7 percent from 2001-2002 to 2012-2013. 

The researchers wrote, "Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role." In particular, the researchers wrote that alcohol use disorder and high-risk drinking are important risk factors for:

  • Cancers;
  • Cardiovascular diseases;
  • Hypertension;
  • Infections;
  • Liver cirrhosis;
  • Morbidity and mortality from fetal alcohol spectrum disorders;
  • Pancreatitis;
  • Stroke; and
  • Type 2 diabetes.

Though the study did not examine the reasons behind the increases, the researchers hypothesized that they could be related to a shift in social norms and the use of alcohol as a coping device.  The researchers wrote that the "substantial increases in alcohol use ... constitute a public health crisis" and are "alarming," although consistent with previous studies.

Discussion

Bridget Grant of the NIAAA said, "These are the largest alcohol increases we have seen in three decades." She added, "The focus has been on opioids, heroin, and marijuana use, but these are low prevalent disorders," saying, "[t]hirty million Americans now abuse alcohol."

Lead study author Deborah Hasin of New York State Psychiatric Institute and Columbia University said, "People need to really take some of the information about the potential harms of heavy drinking into account when determining when and how much to drink," and "[p]olicymakers and health professionals need to be aware … too." Hasin added, "Researchers will be trying to examine why these changes are happening."

Marc Schuckit of the University of California, San Diego in an accompanying editorial wrote that elderly and low-income populations are particularly vulnerable to the effects of alcohol misuse. He expressed particular concern " about the 106 [percent] increase in [alcohol use disorders] for older individuals because they are likely to carry multiple preexisting medical disorders that can be exacerbated by heavier drinking."

Schuckit called for increased federal funding for research into these issues, explaining, "Efforts to identify risk factors for substance-related problems and to test prevention approaches take time and money and are less likely to be funded in the current financial atmosphere" (Boyles, MedPage Today, 8/9; Seaman, Reuters, 8/9; Lopez, Vox, 8/10; Grant et al., JAMA Psychiatry, 8/9).

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