There are layers to unhealthy drinking. A binge, according to the Centers for Disease Control and Prevention, is anything that brings a person’s blood-alcohol level to 0.08 or higher, typically five drinks for men or four for women over the course of a couple of hours. High-risk drinking, meanwhile, is consuming binge-level amounts of alcohol at least once a week. Alcohol Use Disorder, more commonly referred to as alcohol abuse or dependence, is diagnosed according to criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, including experiencing withdrawal symptoms and drinking interfering with work or family.
And all of those, it seems, are on the rise. According to new research published earlier this month in JAMA Psychiatry, a growing number of Americans are engaging in dangerous drinking behaviors — so many, in fact, that the study authors described their findings as “a public-health crisis.”
The researchers conducted face-to-face surveys with roughly 40,000 Americans, first in 2001–2002 and then again in 2012–2013, about their drinking behavior over the previous year. Comparing the first round of interviews to the second a decade later, they discovered some startling changes: Alcohol use was up 11 percent, and Alcohol Use Disorder was up a whopping 49 percent. Based on the 2001–2002 numbers, they had initially estimated that around 20.2 million Americans engaged in high-risk drinking; by the 2012–2013 survey, that number had grown by 9.4 million.
These leaps are “pretty unprecedented,” says lead study author Bridget Grant, an epidemiologist at the National Institute on Alcohol Abuse and Alcoholism. Particularly troubling is the fact that these increases were most concentrated in a few specific groups: Heavy drinking was up 65 percent among those aged 65 and older, 62 percent among black Americans, and 58 percent among women. For Alcohol Use Disorder, people aged 45 to 64 saw an 82 percent increase, while those 65 and older a 107 percent increase. Among women and black Americans, Alcohol Use Disorder increased 84 percent and 93 percent, respectively. Notable increases were also seen among those with lower incomes and lower education levels.
Grant says while there are numerous factors behind the increases, the economic downturn of 2008 likely had something to do with it. “Whenever there’s more economic stress for the country as a whole, people increasingly turn to alcohol as a coping mechanism,” she explains. Depression rates have also seen an upswing, and Grant hypothesizes that many people are likely turning to alcohol as a form of self-medication. She also posits that for racial minorities in particular increases in problem drinking rates may partly be the result of financial stress, since a widening of the racial income gap has been observed during the same timeframe.
As for women, changing gender-based norms around what constitutes acceptable drinking behavior may play a role. “The gender gap in drinking is narrowing,” Grant says, possibly because “stigma for women drinking is lessening.”
Both Grant and Marc Schuckit, a psychiatrist at the University of California–San Diego School of Medicine who wrote an editorial accompanying the study, say they were particularly alarmed by the increases in problem drinking behaviors in older people. “This is concerning because of the risk of falls, traumatic injury death in this group is already high. And older adults tend to be on more medications, which alcohol can interfere with,” Grant said, noting that the size of the elderly population is projected to nearly double by 2050.
Schuckit worries that people aren’t aware of the specific dangers of drinking for older adults: “They experience a higher blood-alcohol level per drink, so the number of drinks they could handle at age 35 or 40 would now tip them into a level where it starts interfering with their family life or daily functioning.” Older people are also already more vulnerable to infection and face an increased risk of cancer, both of which can be exacerbated by heavy drinking.
Whatever the reason for these changes, the study findings paint a worrisome picture — and yet problematic drinking, Grant says, still doesn’t get the attention that an issue of its magnitude deserves. “Increases in the use of less-common drugs — marijuana, opioids — have overshadowed the major problem we have with alcohol in this country,” Grant said. “Many chronic diseases are associated with alcohol: cardiovascular disease, liver cirrhosis, diabetes. There are many more ways that alcohol can kill or impair compared with opioids.” High-risk drinking and Alcohol Use Disorder are also risk factors for high blood pressure, stroke, various types of cancer, infections, pancreatitis, and physical injuries.
In his editorial, Schuckit noted, “There are already signs that the changes in drinking observed since 2001-2002 may be associated with increases in alcohol-related health consequences … data already indicate increases in alcohol-related cirrhosis and in hypertension as well as a leveling off of previous decreases in cardiovascular and stroke-related deaths.”
To put it in more concrete terms, “as little as a drink and a half per day can cause a significant increase in the risk of breast cancer,” while heavy drinking can take as much as five to ten years off a person’s life, Schuckit explains. Alcohol-related problems are estimated to cost society as much as $250 billion per year.
The public-health community faces substantial challenges when it comes to curbing the use of alcohol: It’s legal, it’s relatively cheap, and it kills us more slowly than other substances. “Once a substance is made legal and becomes generally acceptable, you’re going to have a heck of a time getting people to restrict their use of it,” Schuckit said. “It’s so common, with a fairly low effect per dose — the effect is not as dramatic as, say, a line of cocaine. It’s been around a long time, and been acceptable for many, many generations. That interferes with people looking at themselves and seeing that they have a problem.”
There’s also the simple fact that alcohol is, well, fun. It’s a key part of plenty of social rituals, which is one big reason why we desperately want to believe that it’s fundamentally different from other drugs — just look at all the research looking for any glimpse of a potential benefit of a daily glass of wine. Schuckit says to think of it like aspirin: a very small dose is beneficial, but too much starts to cause problems. Research touting the benefits of very small doses of alcohol, then, can lead people to deluding themselves about its safety. “People think, ‘One drink didn’t do any harm,’” he says. “‘Five or six can’t be that bad.’” This latest study, though, is a sobering reminder of how dangerous that line of thinking can be.