In the United States, the leading preventable cause of death is tobacco and second is poor diet and physical inactivity. Care to guess what comes in third? You can’t be faulted if you guessed opioids such as illicit fentanyl, given all the media attention it gets. But no, it’s something much more accessible, advertised directly to the consumer and having a negative impact across all socioeconomic groups: Alcohol, and specifically the problem of alcohol abuse which is dramatically worsening recently.
From 1999 to 2017, the number of alcohol-related deaths in the U.S. doubled, to more than 70,000 a year. These numbers got much worse at the height of the Covid-19 pandemic. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol-related deaths soared, reaching 178,000 in 2020 and 2021. Comprehensive federal datasets have yet to be released for 2022 and 2023.
In a study published in 2020 in the Journal of the American Medical Association, researchers showed that significant increases in mortality started emerging in the mid 2010s across all racial and ethnic groups. But the steepest rate of acceleration of alcohol-induced deaths occurred among younger, white individuals, especially women. Authors noted that the large increases among younger age groups presaged “substantial future increases in alcohol-related disease.” In light of more recent figures which suggest an intensifying problem, it appears that the researchers’ warning provided more than four years ago was prescient.
What could be compounding the problem of youth drinking are the ways in which advertisers depict alcohol consumption. They emphasize its social acceptability—even its supposed link to social success—and this especially applies when commercials direct their messages at a comparatively young demographic.
The data demonstrate that the marketing works. Researchers publishing in the Journal of Public Health Research found a strong association between the youth-appeal of marketing content of televised alcohol advertisements and the brand-specific consumption of both underage youth and adults.
Critics of certain commercials that are aimed at a younger demographic, like a beer ad which aired in 2019 promoting “Coors Light. The Official Beer of Saturday Morning,” suggest the companies that sponsor the advertising are going too far.
The negative health effects of alcohol are usually because of excessive drinking over long periods of time. Here, the leading causes of alcohol-attributable deaths are liver and cardiovascular diseases, seven types of cancer—including liver, throat, mouth, esophagus and stomach—as well as alcohol use disorder. NIAAA defines the latter as a “medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” This can encompass alcohol abuse, dependence, addiction and the colloquial term, alcoholism.
But consuming a large amount of alcohol in a short period of time can also be deadly, as it may lead to alcohol poisoning or other dangers like motor vehicle accidents. The Centers for Disease Control and Prevention estimates that 17% of U.S. adults binge drink. Moreover, in 2021 alcohol-impaired driving fatalities accounted for 13,384 (roughly a third) of all motor vehicular deaths. And 40% of violent crimes such as assault, homicide and domestic abuse, were committed by people who had high blood alcohol content at the time of their arrest.
The rise in alcohol abuse certainly isn’t limited to the U.S. In the United Kingdom, for instance, The Guardian reported last month that heavier drinking during the Covid-19 pandemic led to 2,500 more deaths from alcohol in 2022 than in 2019, a 33% jump.
While alcohol can be a toxic, carcinogenic drug, it’s also enjoyed by many people in moderation and often as an accompaniment—a lubricant of sorts—in a variety of social settings. Research psychologists have found that drinking moderate amounts of alcohol in a group setting “boosts people’s emotions and enhances social bonding.”
In addition, there may be physical gains associated with consumption of small amounts of alcohol. The Harvard T.H. Chan School of Public Health and others, like WebMD, still tout certain cardiovascular health benefits related to moderate intake of alcohol.
Nevertheless, other health entities, such as the Mayo Clinic, appear to be taking a different stance lately. The hospital group now says that “drinking alcohol in any amount carries a health risk,” though it qualifies the statement by suggesting that “while the risk is low for moderate intake, the risk increases as the amount you drink goes up.”
And a STAT News article published this month indicates that “alcohol isn’t healthy after all.” The publication asks whether the new dietary guidelines, set by the U.S. Departments of Agriculture and Health and Human Services and scheduled to be released in 2025, will be shaped more by health or (alcohol) industry interests? It’s suggested that changes in guidance are likely if the experts who draft the recommendations take into account the evidence of alcohol-related harms, including “heightened risks of certain cancers, chronic diseases, and injuries.”
While prevention is important, treatment is equally vital. Research published by The Lancet shows that early, preventive strategies in primary care can be effective, and a variety of interventions are available to treat alcohol dependence.
However, access to quality care for alcohol misuse and alcohol-associated diseases is often lacking. Additionally, there may be a stigma attached to seeking help for something as socially acceptable and easily accessible as alcohol.
Public health specialists have therefore asserted that it’s time for a national dialogue about substance misuse of all drugs, legal and illegal, and that this discussion should include alcohol. In this context, experts suggest that efforts need to be centered around research on alcoholism, addiction and abuse, as well as ways to improve access to therapy for alcohol use disorders, possible curbs on advertising and targeted awareness and education campaigns.
However, alcohol abuse and misuse is not (yet) considered a public health emergency. Without declaring it as such, sufficient funding for a concerted nationwide policy is not forthcoming, which means the federal government hasn’t prioritized an alcohol policy in the same way it has done for illicit drugs, or prescription opioids for that matter. Perhaps the latest alarming figures on the rising toll of alcohol abuse will help trigger more urgency.
