Forget about the thousands of deaths caused by drunken driving accidents. Forget about the discomfort and pain of delirium tremens, Alzheimer’s, cirrhosis, hepatitis, or fatty liver disease. Forget about the children born with fetal alcohol syndrome, which can be fatal in the worst cases. As terrible as these outcomes of alcohol abuse are, remember this: Alcohol is killing six Americans every day from alcohol poisoning, as reported by the Centers for Disease Control (CDC) last year.
Also, somewhat strangely, the overwhelming majority of alcohol poisoning deaths are occurring in adults aged 35 to 64. Even stranger, 7 out of every 10 people who die this way are NON-ADDICTS. This goes to prove how dangerous the substance alcohol is, let alone the risky behavior it causes and its addictive nature.
We as a nation are combating an alcohol (and drug) epidemic. In this article, the CDC report is summarized, as well as what alcohol poisoning actually is and how it can happen to anyone. The recent Surgeon General’s Report on Alcohol, Drugs, and Health, the first of its kind, is a major step along the way to reducing, eliminating, and eventually preventing unsafe alcohol (and drug) abuse.
The CDC found there to be 2,200 alcohol poisoning deaths every year in the US, which averages out to 6.02 people per day. An overwhelming 75% of these deaths involve 35 to 64 year old adults. Those between 45 and 54 showed the highest alcohol poisoning death rate. This came as a shock to the researchers.
Ileana Arias, principal deputy director of the CDC, told US News in their article on the findings, “The majority of these deaths are not among college students, whom we typically associate with binge drinking. We were surprised.” This goes to show that American adults are not only dealing with severe alcohol issues, they are not getting the help they need.
“Obviously we still have serious alcohol addictions around people in middle age that are unaddressed or untreated,” commented University of Pittsburgh professor of psychiatry Dr. Antoine Douaihy to US News. Obviously he’s right. Not only is that so, but due to recent changes in how alcohol poisoning deaths are calculated, government health officials believe the death rate to be higher than 6 a day.
In an effort to increase the overall health of Americans, the government issued Dietary Guidelines in 2010. According to the section regarding alcohol, “low risk” drinking is defined as “no more than 14 drinks a week for men and 7 drinks a week for women with no more than 4 drinks on any given day for men and 3 drinks a day for women.” Essentially, this is two drink daily for males and one drink daily for females.
Apparently ignoring the guidelines, over 38 million American adults binge drink four times a month. During these binges, an average of eight drinks is consumed. In contrast, underage binge drinking (and drinking in general) is at its lowest since 1975, as found by the National Institutes of Health. Right now, fewer 15-24 year olds die from alcohol poisoning than those over 65. The consensus is that a combination of anti-alcohol efforts and programs, peer disapproval of alcohol, and difficulty to acquire all contribute to the decline in underage drinking. This graph from the CDC shows how alcohol use is lowest among schoolchildren and highest among the middle-aged:
David Jernigan directs the Center on Alcohol Marketing and Youth for the Johns Hopkins Bloomberg School of Public Health. According to Jernigan, another reason adults are three times more likely to die from alcohol poisoning is actually pretty simple. Younger people can tolerate higher amounts of alcohol, as they haven’t lived long enough to develop long-term physical issues. Plus they stay awake longer. The fact that alcohol poisoning deaths are lowest among young adults and highest among middle-aged adults proves this.
Common sense tells us there is a wide age range regarding drunk driving. A sixteen year old is just as likely as a 60 year old to crash a vehicle if intoxicated. There is also a wide age range regarding alcoholism, research shows. Someone can become alcohol-dependent at virtually any age. So, the fact that alcohol poisoning occurs mainly in middle-aged adults is a concern.
“When people think about alcohol, they tend to think about two problems: addiction and drinking and driving. This [the CDC report] shows there is another big problem – you can die from alcohol itself,” said Jernigan. So what exactly is alcohol poisoning?
Poisoned by Booze
Alcohol poisoning is medically defined as “a condition in which a toxic amount of alcohol has been consumed, usually in a short period of time. The affected individual may become extremely disoriented, unresponsive, or unconscious, with shallow breathing.” However, there truly is no clear-cut definition of alcohol poisoning, because alcohol is a poison.
Online news source Gizmodo interviewed an emergency room doctor about alcohol poisoning. (Because the doctor wished to remain anonymous, she is referred to in the article as Doctor L.) She explained how alcohol poisoning actually occurs with every single drink. The doctor said, “‘Alcohol poisoning’ is a layman’s term. Alcohol intoxication is a spectrum and there isn’t a specific threshold that one crosses and suddenly becomes poisoned.”
Every case is individual. All people respond to alcohol uniquely, and therefore no terms exist to define levels of alcohol poisoning. Obviously though, some cases are worse than others. Doctor L explained what an emergency room staff would do for a mild case of alcohol poisoning, and then for a severe case.
In a Mild Case
The doctor explained how mild alcohol poisoning is accompanied by dehydration, increased heart rate, and low blood pressure in some cases. Therefore, other than hooking an IV up to the patient, mostly the medical staff simply observes. “Often it is just a matter of watching the patient until he/she recovers. Intravenous fluids are often administered to help hydrate the patient…” said Doctor L. Victims of alcohol poisoning suffer from severe dehydration because alcohol is a diuretic, a substance which increases urination. Also, vomiting rids the body of water, furthering this dehydration.
A mild case of alcohol poisoning is no laughing matter. The term ‘mild’ is only being used here in comparison to a severe case, which can be fatal. The difference between a mild case and a severe case can literally be a drink or two. This is because someone can continue to drink even once diagnosable alcohol poisoning has set in.
In a Severe Case
Again, there are no clear levels of alcohol poisoning. However, with more severe cases of alcohol poisoning, victims are usually unconscious, unresponsive, vomiting, or any combination of the three. In severe cases, Doctor L said to Gizmodo, “the goal is to maintain adequate breathing and circulation until the body (mainly the liver) metabolizes the alcohol. It (alcohol) depresses the respiratory drive and may result in inadequate oxygen levels and/or excess carbon dioxide levels.” Patients are usually oxygenated.
Worse yet, alcohol causes failure of the gag reflex, greatly increasing the likelihood of choking to death on vomit. Preventing this used to be done by stomach pumping, but it has since been realized that pumping a stomach is more harmful than helpful. Nowadays, “a different, smaller tube is inserted through the mouth or nose, then threaded through the esophagus and into the stomach. The tube is placed on suction, which decompresses the stomach and greatly reduces the risk of vomiting,” said the doctor.
In any case, alcohol poisoning can be life-threatening. It is altogether dangerous, and a medical emergency in every case. A study performed two years ago by the CDC and multiple state health departments revealed that between 2006 and 2010, “9.8% of all deaths in the United States… were attributable to excessive drinking, and 69% of all AAD [alcohol-attributable deaths] involved working-age adults.” Furthermore, the study showed that in just those five years, a total of 2,560,290 years of life were taken away by excessive alcohol use. This is measured in YPLL, or years of potential life lost.
Not only is alcohol killing us, it’s giving us shorter lives.
What We’re Doing About It
In the recent CDC report regarding alcohol poisoning, (linked again here), three suggestions are given to both individual states and communities. Summarized, they are:
- Support alcohol awareness and prevention programs. The stronger the alcohol policy, the less binge drinking per state.
- Partner with law enforcement, medical personnel, health care providers, the addiction recovery community, etc. to help reduce excessive drinking
- “Monitor the role of alcohol in injuries and deaths.”
While practicing safe drinking is a strong recommendation, it’s rather apparent that Americans do not drink safely. Therefore, in addition to alcohol awareness and education, there needs to be a focus on treating those who already have alcohol issues.
The Affordable Care Act (ACA) of 2010 was enacted in order to increase the number of Americans with health insurance, and to keep the insurance at a reasonable cost. The act included a list of ten “essential health benefits.” In a beautiful stroke of luck for addicts seeking help, substance abuse disorders are one of them. Since January 1, 2014, “all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults… must include services for substance use disorders,” according to the Office of National Drug Control Policy.
While this was an essential step to be taken, the year 2014 had the most fatal drug and alcohol overdoses ever recorded in American history. In a well thought out response to this, Surgeon General Vivek Murthy made history recently by releasing the first-ever Surgeon General’s Report on Alcohol, Drugs, and Health (linked again here). In it, Murthy explains how two major things need to happen. The public image of addicts needs to shift from one of negativity to one of care and concern. Also, the healthcare system needs to incorporate drug and alcohol screening into routine medical visits for all patients.
The Surgeon General’s Report (and why we should all be screened)
Murthy believes the first step is for addicts to be treated like people with a disease, as opposed to like a criminal or an outcast. After all, addiction is indeed a disease of the brain. Once the societal outlook on addiction is similar to the outlook on any other disease, Murthy believes the next step is to integrate screening for substance abuse disorders into all doctor visits. Consider this section taken from the report itself, as there is simply no better way to phrase the screening argument:
“Historically, our society has treated addiction and misuse of alcohol and drugs as symptoms of moral weakness or as a willful rejection of societal norms, and these problems have been addressed primarily through the criminal justice system. Our health care system has not given the same level of attention to substance use disorders as it has to other health concerns that affect similar numbers of people.
“It is known that most people with substance use disorders do not seek treatment on their own, many because they do not believe they need it or they are not ready for it, and others because they are not aware that treatment exists or how to access it. But individuals with substance use disorders often do access the health care system for other reasons, including acute health problems like illness, injury, or overdose, as well as chronic health conditions such as HIV/AIDS, heart disease, or depression. Thus, screening for substance misuse and substance use disorders in diverse health care settings is the first step to identifying substance use problems and engaging patients in the appropriate level of care.”
89% of drug/alcohol addicts receive zero treatment in their lives. The reasons for this are many, but seemingly screening for addiction routinely, in combination with addiction treatment being covered by insurance, would end the addiction crisis in America. One can only hope that these changes are made, and that they are effective.