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April 26, 2020
A recent study has found that the rate of alcohol use-related deaths in the U.S. has increased by more than 50% in the past 20 years. According to R. Kathryn McHugh, PhD, a psychologist in McLean Hospital’s Center of Excellence in Alcohol, Drugs, and Addiction, this troubling trend has gone largely unnoticed by the general public.
“This is something that has been flying under the radar,” said McHugh. She suggested that these trends may have been overshadowed by the recent “tremendous and needed attention to opioid-related deaths.” However, she said, it’s apparent that we now need to also place a spotlight on alcohol misuse.
While alcohol-related deaths have continued to be much higher among males than females, the most dramatic increase in mortality was found to be among women, especially white women. Mortality has also continued to be high among all adults aged 45-74 years.
McHugh isn’t surprised by the findings about women.
“It’s a consistent trend across the world,” said McHugh. “The gap between men and women regarding the prevalence of substance use is shrinking nationally and internationally. Developed nations have a smaller gap than developing nations, but the differences in use between men and women continue to shrink in virtually all nations.”
McHugh noted that this gap refers to substance use overall, not just alcohol.
“It’s not surprising that we’re seeing the same thing with opioid-related deaths,” she said. “More men die from opiates than women, but the escalation of deaths in women is faster than in men.”
As troubling as these substance use statistics are, McHugh warned that the situation is probably even worse than the numbers suggest. She said that the use of alcohol or other drugs as a potential contributing factor to death is often not taken into account by those who sign death certificates.
“There’s a lot of concern that we’re grossly undercounting the contribution of alcohol and other substances to mortality because of the focus on more immediate causes,” said McHugh.
Deaths related to falls, car accidents, certain diseases, and suicide are a few areas where we may be neglecting alcohol’s involvement. McHugh said that it’s easy and appropriate to cite alcohol as the cause of death in an alcohol overdose. But, she explained, there are many other things that are directly related to alcohol addiction that can kill you but aren’t as apparent, such as pancreatitis.
“If someone develops pancreatitis because of their alcohol use and dies, are we thinking of that as a death attributable to alcohol, or are we only thinking of that as a death attributable to pancreatitis?” asked McHugh.
The cause of this increase in alcohol misuse in women is unclear. Speculation ranges from changing cultural norms to the increased presence of women in the workforce. McHugh noted that it is also interesting that the gaps seem to close as a country’s overall gender equity increases.
To determine why drinking habits among women have been changing and why alcohol use has been affecting women so adversely, we need more research, said McHugh. Unfortunately, research on alcohol addiction in women has historically lagged behind research on men—without good reason. However, noted McHugh, there recently has been a significant push, led by the National Institutes of Health, to ensure that males and females are studied equally across all types of research.
“We are seeing that this is not just a male problem,” said McHugh. “I don’t know that it ever has been.”
She stressed that more research has to be done on women because alcohol affects them differently, and research thus far strongly suggests that women are more vulnerable to the negative effects of alcohol.
Women, for instance, absorb and metabolize alcohol differently. They reach higher concentrations of alcohol in the blood—thereby becoming more impaired than men—after drinking equivalent amounts of alcohol.
This disparity appears to be just one factor that contributes toward women having greater health risks associated with alcohol use. Some of these risks are liver damage, heart disease, and brain damage.
While McHugh believes that it is indeed important to figure out why women are drinking more and why it has such a disparate impact on their health as compared to men, she said that our immediate focus should be on prevention.
“The earlier that you can catch these issues, the better,” she said. “Many of those who died from alcohol use, particularly the older adults, were drinking chronically for many years. If we identify these patterns of chronic use early, we have a better opportunity to intervene.”
Intervening early would be much easier, said McHugh, if screening were a mandatory practice.
“Screening for alcohol misuse is something that should be universal but isn’t,” said McHugh. “At low levels of use and early in the trajectory of illness, brief informational interventions can be quite useful. Once it gets farther down the path, you start to need more active addiction treatment, which tends to be more involved.
“From a public health perspective, mandatory screening would go a long way toward keeping people from moving up a tier—from drinking at a low-risk level to drinking at a high-risk level to developing a disorder. We need to intervene when people are at the bottom of the pyramid, not at the top.”
She stressed that not only should screening be done, but it should also be done properly. She noted that McLean’s Shelly F. Greenfield, MD, MPH, led the push to start National Alcohol Screening Day as a means to both advocate for greater screening and promote the use of an effective tool. “The way that you ask a question matters for the type of answer you get,” said McHugh.
McHugh identified the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach as one effective, evidence-based means for health care professionals to screen patients for alcohol or other substance use. SBIRT is comprehensive yet easy to apply in a variety of community settings, such as a doctor’s office, school, or clinic.
“From a public health perspective, mandatory screening would go a long way toward keeping people from moving up a tier—from drinking at a low-risk level to drinking at a high-risk level to developing a disorder. We need to intervene when people are at the bottom of the pyramid, not at the top.”– Dr. R. Kathryn McHugh
Screening should also be accompanied by strong, consistent public health messaging, said McHugh. She noted that such messaging seems to have contributed toward a cultural shift among youth, who appear to be using alcohol and other drugs much less than other age groups.
However, even among youth, alcohol-related deaths have continued to go up. McHugh said that this points toward alcohol-related deaths as being part of an even larger crisis.
“There is something going on from a broader societal or cultural perspective,” explained McHugh. “We’re seeing alcohol- and drug-related deaths and suicides—these so-called deaths of despair—all increase. Why are they worsening at the same time? That’s a much trickier, more complicated question.”