ALCOHOL USE AND ABUSE (PART II)

ALCOHOL USE AND ABUSE [SECOND PART]

PREVALENCE

In the United States, 44 percent of adults eighteen years of age and older are current drinkers, consuming at least twelve drinks in the last year. Meanwhile, 7.4 percent, or approximately 14 million Americans, experience alcohol abuse or alcohol dependence. Heavy episodic or binge drinking has remained at the same approximate level of 16 percent for all adults since 1988, with the highest rate, 32 percent, among young adults ages eighteen to twenty-five. Over one-half of adults report having a close family member who has experienced alcoholism.

As few as 5 percent of the heaviest drinkers consume as much as 42 percent of the alcohol drunk in the United States, and 20 percent of drinkers account for nearly 90 percent of the alcohol consumed. The bulk of the alcohol drunk in the United States, therefore, is consumed by a relatively small population of very heavy drinkers.

Alcohol is also the drug most frequently used by children and adolescents. In 1999, over half (52%) of eighth graders (14-year-olds) and 80 percent of twelfth graders (18-year-olds) reported having used alcohol at least once. More problematic drinking occurs in 15 percent of eighth graders and 31 percent of twelfth graders, who reported binge drinking (consuming five or more drinks in a row) in the previous two weeks. Of American high school adolescents, over half (51%) currently drink alcohol. In 1999, one in three high school students reported heavy episodic drinking of five or more drinks on at least one occasion during the previous thirty days. The prevalence of heavy drinking commonly increases through adolescence into early adulthood.

HEALTH OUTCOMES

Alcohol use has health and social consequences for those who drink, for those around them, and for the nation as a whole. Approximately 100,000 deaths each year are attributed to alcohol use, making it the third leading cause of preventable mortality in the United States. Worldwide, 750,000 deaths are attributed to alcohol use each year. Alcohol-related deaths occur from cancer, cirrhosis of the liver, pancreatitis, motor-vehicle crashes, falls, drowning, suicide, and homicide. Alcohol affects nearly every system in the body, and contributes to a range of medical problems, including altered immune system functioning, bone disease, hypertension, stroke, cardiovascular disease, reduced cognitive functioning, fetal abnormalities, traumatic injury, depression, gastrointestinal disorders, and cancers of the neck, head, stomach, pancreas, colon, breast, and prostate. Alcohol also produces significant social problems, including domestic violence, child abuse, marital and family disruption, violent crime, motor-vehicle crashes, worksite productivity losses, absenteeism, and lowered school achievement. The estimated cost of alcohol misuse in the United States in 1998 was nearly $185 billion.

Young people are particularly vulnerable to acute alcohol effects due to their lower tolerance to alcohol, their lack of experience with drinking, and drinking patterns that often include heavy episodic drinking in high-risk situations, such as during driving and sexual encounters. Leading causes of mortality and morbidity among youths include alcohol-related motor-vehicle injuries, homicide, and suicide. Alcohol use among young people is associated with reduced scholastic achievement, increased delinquency, and the development of psychiatric problems later in life. Alcohol has also been found to precede other illicit drug use, thereby serving as a "gateway" to other drug consumption, including marijuana and cocaine use.

Women and the elderly are also at greater risk for experiencing alcohol harm because of their lower levels of body water, meaning that smaller amounts of alcohol result in higher levels of intoxication than in younger men. Drinking during pregnancy has been linked to higher rates of miscarriage, stillbirth, and premature births, and fetal alcohol syndrome—a set of birth defects caused by maternal consumption of alcohol during pregnancy. For the elderly, drinking even modest amounts of alcohol may cause considerable problems due to chronic illness, interactions with medications, and grief and loneliness from the death of loved ones.

At the same time, moderate to low levels of alcohol consumption have been linked to a lower risk for heart disease and stroke. These positive effects appear to be confined primarily, however, to middle-aged and older individuals in industrialized countries with high rates of cardiovascular diseases. Individuals and populations must weigh the risks and benefits of drinking to themselves and others, including such factors as the situations under which drinking is to take place and the amount likely to be consumed, to determine the net results of drinking.

SOLUTIONS

The burden of alcohol misuse is measured in a number of ways, including the prevalence and incidence of deaths, injuries, and illnesses attributed to alcohol; hospitalization rates; potential years of life lost to alcohol misuse; and quality of life indicators. Vast resources are expended each year in the United States to address the health and social problems resulting from alcohol misuse. Because no single solution can reduce all alcohol-related harm to individuals and populations, a comprehensive approach using a range of strategies that address the multiple causes and dimensions of alcohol problems is needed. These strategies should include educational approaches—such as public health education and awareness programs, including school, family, and community-based prevention programs; environmental approaches—such as controls on the price and availability of alcohol, minimum age for purchase of alcohol, legislative measures to curb driving under the influence of alcohol, and restrictions on the promotion, marketing, and advertising of alcohol; and health care efforts—such as primary health care screening, advice by health care providers, preventive services, and effective treatment using psychological and pharmacological approaches.

For more information about alcohol use among individuals and populations, its relation to health and social problems, or how to reduce alcohol risk, contact the following:

 

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