In the Face of Opioid Epidemic, Alcohol is the Main Cause of Substance Abuse Deaths
With news honing in on the opioid crisis—understandably so—we don’t often zoom out to see that it’s just one patch on the larger red flag representing nationwide substance abuse as a whole. Alcoholism is claiming twice as many lives as opioids each year of the past decade. Several U.S. studies point to a substantial enough increase in alcohol abuse-related deaths to warrant a public health crisis label.
Americans are drinking more heavily, frequently and fatally than ever before.
Insight from the CDC
According to the Centers for Disease Control and Prevention (CDC), deaths attributable to excessive alcohol use are estimated to be 88,424 per year. That includes “chronic causes” and “acute causes” of death. The leading chronic causes are alcoholic liver disease, liver cirrhosis, alcohol dependence syndrome, alcohol abuse, hemorrhagic stroke, hypertension and several types of cancer. The leading acute causes—or those that occur in a shorter period of time—are motor-vehicle traffic crashes, suicide, homicide, fall injuries and alcohol poisoning.
According to CDC data from the same time period, there’s an average of 55,403 deaths per year from drug-induced causes. The statistic factors in both legal and illegal drugs. More specifically, estimates show that there were:
- 52,898 drug overdose deaths in 2015, up 21% to 64,070 in 2016
- 42,000 deaths attributed to opioids in 2016—less than half the amount of alcohol related deaths
- 15,500 heroin overdose deaths in 2016, up 19.5% from the 2015 total
In 2017 JAMA Psychiatry published a comparison of twin studies by the National Institutes of Health, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and NESARC III, conducted 11 years apart. The data was collected via face-to-face interviews of about 40,000 individuals aged 18 and older, focusing on their drinking habits over the course of 12 months (April 2001-June 2002 and April 2012-June 2013). 5
The studies found that alcohol use increased by 11.2%, high-risk drinking increased by 29.9%, and alcohol use disorder spiked by a drastic 49.4% over the 11 year span. The study used the DSM-IV’s criteria for alcohol use disorder (AUD). High-risk drinking was defined as 5 drinks per occurrence for men, and 4 for women, at least weekly. Since the survey only asked about past-12 month drinking, the numbers do not reflect alcoholics who had quit drinking for at least one year.
Increase in Alcohol Use Disorder Findings:
Women: 83.7% increase
African Americans: 92.8% increase
Age 45-64: 81.5% increase
Age 65 and over: 106.7% increase
High School Education Only: 57.8% increase
Incomes less than $20,000/year: 65.9% increase
High-risk drinking increases were associated with similar demographic and socioeconomic groups. 5
One in 8 Americans, according to the study, or 12.7% of the U.S. population, met the criteria for AUD—plainly known as alcoholism.
Again, it’s important to point out that the data only goes through 2013, so if the pattern continued at that rate, the current statistics for alcohol abuse and alcoholism would be substantially higher.
There are other studies showing that alcoholism rates have decreased in the same time period—namely, the National Survey on Drug Use and Health (NSDUH), published annually each September. The discrepancy is likely due to different survey methodology. While NESARC surveyed individuals aged 18 and older, NSDUH included a younger demographic; its participants, 70,000 in total, were 12 and older. NESARC’s survey, up until 2016, was also not gender-sensitive, as it used 5 drinks per occurrence to identify heavy drinking in women as well as men. In NESARC, the 5 drinks per occurrence to identify AUDs in men were adjusted to 4 drinks per occurrence to identify AUDs in women. Additionally, the NSDUH focuses on past one-month drinking rather than the full year NESARC observed. 6
NSDUH’s 2016 publication states: “The NSDUH questionnaire underwent a partial redesign in 2015 to improve the quality of the NSDUH data and to address the changing needs of policymakers and researchers. For measures that started a new baseline in 2015, estimates are discussed only for 2016.” 6
In other words, the redesign adjusted criteria to suit men and women so that it’s more consistent with the gender-specific criteria used by NESARC and other big studies. Because of the change, NSDUH’s 2016 results are incomparable to previous years.
According to the 2016 NSDUH, 136.7 million Americans aged 12 or older currently use alcohol, 65.3 million binge drink, and 16.3 million are heavy alcohol users. 6
- For the 12-17 age group, 4.9% reported binge drinking and .8% were heavy users
- For the 18-25 age group, 38.4% reported binge drinking and 10.1% were heavy users
- For the 26+ age group, 24.2% reported binge drinking and 6% were heavy users
So how does alcohol abuse measure up to illegal drug use? In this study, the twofold death rate observed by the CDC matches up with the number of use disorders observed in NSDUH.
In 2016, 15.1 million people met AUD criteria and 7.4 million people met illicit drug use disorder criteria. 6
What’s Spurring Alcoholism?
While many researchers agree that alcoholism has become an increasingly common coping mechanism for stress, despair, untreated mental illness and the like, others think that its increases can also be somewhat attributed to “widening social inequalities” after the 2008 recession, explaining the dramatic increases for certain demographics. 7
While studies point to a variety of causes, sources agree that substance abuse treatment, so much for alcoholism as illicit drug use, is an increasingly important commodity.
The NSDUH determines the need for substance use treatment by the number of people who either had a substance use disorder or received treatment for one in the past year.
According to its findings, about 1 in 13 people aged 12 and over need substance use treatment. For those aged 18-25, the statistic shoots up to 1 in 7 people in need of treatment. 6
 Centers for Disease Control and Prevention. Alcohol Related Disease Impact (ARDI) application. www.cdc.gov/ARDI
6 https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.pdf Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/