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Study offers a new reason for 'rethinking drinking'

Beer flight
The Centers for Disease Control and Prevention says alcohol abuse is the third-leading preventable cause of death after smoking and obesity.

The following editorial appeared in the Rochester Post-Bulletin.

Most of us don't give it a second thought if we stop for a beer after work or attend a party where drinks are served.

After all, because alcohol is safe in moderation and at the center of a multibillion-dollar industry that markets beer, wine, spirits and alcopops, we give it something of a pass, unless we have a friend or relative struggling with addiction.

That's what makes a survey published last week so noteworthy. Problem drinking affects nearly 33 million adults, or 14 percent of the population, and most have never sought treatment, according to a report published in the JAMA Psychiatry journal.

Take that in for a moment. Look around your workplace or the next party you attend. One in seven people there probably meet the definition of a problem drinker, making it more pervasive and less frequently treated than previously thought. Many problem drinkers are holding jobs and functioning for the most part, but it doesn't mean they and their families are not suffering.

"That's a lot — 14 percent of adults," said Abby Larson, a health educator at Olmsted County Public Health. "And most people aren't going to think that's the case. It's really just a social norm. People feel like alcohol is acceptable, that it's not a drug. I bet if you ask people, most of them will say that alcohol is not a drug."

The Centers for Disease Control and Prevention says alcohol abuse is the third-leading preventable cause of death after smoking and obesity. The CDC says alcohol is directly related to 88,000 deaths each year as a contributing factor to cirrhosis, esophageal cancer, overdose, homicide and other causes of premature deaths.

"It would help if community events or family gatherings didn't always have a need to have alcohol present," said Larson, whose work focuses on underage drinking. "Maybe they don't realize that someone might have an issue with alcohol or someone is there who is recovering."

The survey is the first estimate based on a new term, "alcohol use disorder," in a widely used handbook, the Diagnostic and Statistical Manual of Mental Disorders, that was updated in 2013. The handbook, considered the authoritative reference for mental disorders, used to divide alcohol use disorder into two categories, alcohol abuse and alcohol dependence, but the new definition eliminated the categories. Instead, it evaluates alcohol use disorder using a spectrum, ranging from mild to severe.

Researchers from the National Institute on Alcohol Abuse and Alcoholism, which already has a "Rethinking Drinking" campaign underway, surveyed adults during 2012 and 2013 about their lifetime drinking habits. About 14 percent of adults were current or recent problem drinkers, and 30 percent had been at some point in their lives.

Using the previous definition for problem drinkers, the rates were 14 percent for current or recent problem drinking and 44 percent for lifetime prevalence — up from 9 percent and 30 percent in the agency's 2001-02 survey. The researchers didn't provide an explanation why problem drinking has increased, but it was clear denial and stigma were the factors keeping people from seeking treatment.

"There may be options, but a lot of times insurance companies don't cover it, or there are other barriers or roadblocks for people to seek help," Larson said. "And it's something that not widely publicized because of the stigma."

Maybe we can't do much about a someone's denial about problem drinking, but we can lend a hand in eliminating the stigma.

We can remind them that they're not alone. There are 33 million Americans just like them.

Reprinted with permission.

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Comments (3)

Finding Effecdtive, Affordable Treatment

is a major issue for those dealing with alcohol consumption issues,...

and one reason why so many do not seek treatment.

AA works for some folks, but not at all for others.

Even for those for whom classic "treatment" works, the old figure I've always heard claims that it takes three times through treatment before it finally helps, which still seems accurate.

Alcohol use seems to be more than a physiological addiction,...

but there still doesn't seem to be a working model for the mechanisms within the human psyche,...

that are so often mis-programmed by painful events in a person's life,...

in ways which render them likely to misuse alcohol and other chemicals once they discover those substances.

I remain convinced that the excessive use of alcohol and many other "addictive" chemicals is not a problem in an of itself,...

but a symptom of one or more underlying mis-programmings of the psyche,...

mis-programmings which cause the person to respond in inappropriate, destructive, and/or self destructive ways,...

to the events of the their daily lives.

If and when these mis-programmings can be discovered and the psyche re-programmed,...

to remove their effects from an individual's day-to-day responses to life,...

the motivation for and need for the misuse of chemicals should be reduced or removed.

This would need to be a very individualized approach, however,...

since it needs to address the issues in each individual person's earlier life,...

rather than the usual one-size-fits-all approach that's currently most common.

In a society of dysfunctional

and ignorant people, the continuous promotion of intoxicants, whether it's every other song on the country music station, gleefully welcoming every new bar and brewery, or the open embrace of the legalization of marijuana, does not bode well for the future.

This nation's problem is not too much morality or too few intoxicated people. Now get off my lawn.

Our history contributes to the problem

I once read a Scientific American article about the history of alcohol use in the Western world. In eras when clean water was in short supply, people came to realize that those who drank alcoholic beverages instead of, say, river water, suffered fewer gastrointestinal problems. Even the New England Puritans drank ale regularly, and began doing so at an early age.

Naturally, this was a toxic environment for anyone prone to alcoholism.

Alcoholism became a visible and serious problem once Americans began moving to cities. Bars were open 18 hours a day, and factory workers drank before their shifts, on their lunch breaks, and after work. Alcohol abuse was especially rough on the families of the factory workers, since the children would suffer if Mom and Dad drank up their meager earnings or if Dad got drunk and started beating up the rest of the family.

These social problems gave rise to the temperance movement and Prohibition, which was supposed to remove alcohol from the United States entirely. Of course, it didn't. Drinking merely became something a person did in secret in seedy surroundings.

We still have a dual attitude toward alcohol. In the popular culture, alcohol is an ingredient of fun and fellowship, but at the same time, anyone who drinks before his or her 21st birthday is considered a lawbreaker. Parents are even urged not to serve alcohol to their own minor children.

But what happens when their parents are not around to keep them away from alcohol? What happens when no one has modeled responsible consumption for them?

When I taught college, I saw many students who seemingly lived to drink themselves into unconsciousness up to three times a week, Friday, Saturday, and Wednesday, with Wednesday added because their lives were so difficult and they needed something to get them over "the hump" in the middle of the week, or so they said. This culture of binge drinking was so strong that after I told one class that I had attended a Halloween party given by a colleague, the students wanted to know if any of their professors had gotten drunk, and if so, what they had done under the influence. The students did not believe me when I told them that nearly everyone had had some beer or wine but nobody had gotten drunk.

Binge drinking was never a temptation for me after I discovered my limits through a couple of agonizing hangovers. Perhaps that's because I grew up among my mother's relatives, who were either German immigrants or the first generation born in the U.S. From my early teens, I was included when drinks were served before dinner, but getting drunk was frowned upon. My other exposure to alcohol was Communion wine.

Really, consuming alcohol, something I did in the presence of my older relatives and in church, did not tempt me as a means of adolescent rebellion. To this day, I'm strictly a two-drink person, as is one brother, and the other brother chooses not to drink at all.

Perhaps if we didn't say "Alcohol is absolutely prohibited in all contexts if you're under 21," young people would learn to be more responsible at an earlier age.