Monday, March 12, 2018

Don't Forget the Alcohol

All of us in the U.S. have become all too aware of the devastating impact of opioid addiction and overdose in our population.  A problem that was once found more around the margins of our society, thus more easily ignored, now affects all kinds of people in all kinds of American environments, and as a result we are more willing to devote attention and resources to our fellow human beings whose brains have been hijacked.  In many cases, the original pushers and dealers have been physicians and pharmaceutical companies who chose to minimize or ignore the risks of addiction.  Don’t get me started on the string of prescribers, in medical and dental practices and emergency rooms who found it laughable years ago when I raised this concern with them.
Yes, the scourge of opioids is frightening, and there is no cure-all for it.  But, with all our attention on that, it’s easy to forget that alcohol is still our biggest drug problem and killer.  The most recent government statistics indicate that, while drug overdoses are killing close to 64,000 Americans a year [CDC], tripling between 1999 an d 2016, 88,000 of us per year die of alcohol-related causes [NIAAA]. Another 10,000 deaths result from drunk driving.  Perhaps unquantifiable are the consequences of foolish, impulsive decisions made by people under the influence of alcohol, which anesthetizes the part of the brain largely responsible for judgment, reasoning, and inhibition.

Alcohol, of course, is not only legal, but a well-embedded part of social life.  Commercials encourage us to use beer, wine, and liquor, and when talk show guests mention getting drunk audiences applaud enthusiastically.  There are even some indications that moderate drinking (currently defined as 7 drinks/week for women or 14 for men) may have some beneficial health effects – less publicized are indications that drinking has negative cognitive effects – with a couple of drinks a day maybe you’ll gain months but lose IQ points (sorry – gross oversimplification). 

The good news about alcohol, as I’ve found among those I’ve been privileged to see in my practice, is that in many cases the challenge of overcoming the grip of addiction is somewhat more surmountable for those with alcohol use disorder than for many opioid addicts.  It’s not easy, by any means, and often not free of relapse, but there is a range of helpful treatment approaches, supports, and resources, and the company of millions of Americans whose lives are no longer ruled by their drinking.  We are also finding more effective responses to opioid addictions, but don’t kid yourself – alcohol is still our most pervasive drug problem.