America, Can We Talk About Your Drinking?
By Gabrielle Glaser, NYT, 12/31/17
More people are consuming alcohol in risky ways. That’s not a good trend.
“After a season of indulgence, many Americans resolve to drink less in the new year. It’s a common pledge – many of us can recall cringe-worthy texts sent after a raucous night or a regrettable comment uttered after that third glass of wine.
These intentions are rooted in a stark reality. For all the deserved attention the opioid crisis gets, alcohol overuse remains a persistent public health problem and is responsible for more deaths, as many as 88,000 per year. While light drinking has been shown to be helpful for overall health, since the beginning of the century there has been a 50 percent uptick in emergence room visits related to heavy drinking. After declining for three decades, deaths from cirrhosis, often linked to alcohol consumption, have been on the rise since 2006.
The pattern has been years in the making. Rick Grucza, an epidemiologist who has been studying alcohol consumption patterns for more than a decade, says the numbers are incontrovertible. Since the early 2000s, according to five government surveys Dr. Grucza has analyzed, binge drinking – often defined as five per day for men and four per day for women – is on the rise among women, older Americans, and minorities.
Behind these figures there’s the personal toll – measured in relationships strained or broken, career goals not met, and the many nights college students can’t remember. In researching my 2013 book on women and drinking, and many articles on the topic since, I’ve spokes with hundreds of problem drinkers of all races. Most of the people I’ve spoken to were college-educated; it’s a sad fact that many people learn to drink excessively in college. I have found that a lot of people lack physical symptoms of alcohol dependence, but they think they are overdoing it, and they are worried.
Many alcohol researchers and substance-use clinicians believe the steady increase in problem drinking arises from a deeply felt sense of despair: “Since the attacks of 9/11, we’ve been in a state of perpetual war, and a lot of us are traumatized by that,” said Andrew Tatarsky, a clinical psychologist who specializes in treating people with substance-use disorders.
The super-rich might be making money, Dr. Tatarsky said, but many pothers are just worried about making ends meet. Uncertainty about tax changes and the cost of health insurance only adds to their burdens.
And the culture around drinking, the way we drink, has grown more intense. Epidemiologists say that excessive and binge drinking begins in college, and that for many it continues through early adulthood with after-work happy hours – so much so that Thursdays, in many circles, have become “Little Friday” – code for hitting the bar after (or in some Silicon Valley companies during) work.
Cues from popular culture make alcohol look glamorous and fun: “They send the message that you’re missing out if you’re not up on the latest cocktail,” said Carrie Wilkens, also a clinical psychologist treating substance abuse. And as adults age and feel burdened by the responsibilities of family and work, alcohol can be an instant stress reliver.
Many who struggle with drinking aren’t getting the help they need, largely because they think that the only way to gain control over alcohol is to abstain. Facing such a severe restriction, they may not try to change unless they hit a mythological “rock bottom.”
Nobody wants to view himself as an addict, and the fact of the matter is most problem drinkers aren’t. Many people are afraid even to discuss the topic with their doctors for fear of being labeled. But in fact, researchers have long shied away from using the term “alcoholic,” because it’s both negative and dated.
In the DSM-V, the new term to describe problematic drinking is alcohol-use disorder – a clunky but more expansive phrase that denotes a spectrum of risky drinking from mild to moderate to severe. Only about 10% of the estimated 16 million Americans who abuse alcohol fall into the severe category, according to Reid Hester, a clinical psychologist who has been studying addiction for more than 40 years. While those in the severe category might need to abstain from drinking, the vast majority of others don’t, he said.
Newer treatments embrace an array of techniques and are effective for those with mild to moderate problems. A great deal of research supports the use of anti-craving medications, such as Naltrexone, and harm reduction therapy which, Sheila Vakharis, an assistant professor of social work at Long Island University, says provides practical tools for solving behavioral problems…”
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Next week I’ll go into more detail on the issues raised in Ms. Glaser’s observations. For more on her writing, see www.gabrielleglaser.com and of particular interest to women is her best seller, Her Best-Kept Secret: Why Women Drink – and How They Can Regain Control.