While Alcohol Awareness Month was initially established in 1987 with the intention of focusing on college-aged individuals, it has since become a national movement to draw attention to the causes and potential impact of alcoholism and to offer resources for communities and families in-need.
According to the 2021 National Survey on Drug Use and Health (NSDUH), 219.2M people in the U.S. ages 12 and older reported that they drank alcohol at some point in their lifetime, which accounted for over 78% of that portion of the population. However, 133M (47.5%) reported drinking within the past month and 60M (21.5%) acknowledged binge drinking in the past month. Further, 16.6M reported heavy alcohol use in the same time period. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports on the emerging trend of high-intensity drinking, which is defined as consuming alcohol at two or more times the gender-specific binge drinking thresholds, which are typically 4 drinks for females and 5 for males. Based on an article in the American Journal of Preventive Medicine, compared with people who do not binge drink, people who engaged in high-intensity drinking were 70x more likely to have an alcohol-related emergency department visit, and those who consumed alcohol at three times the gender-specific binge thresholds were 93 times more likely to have an alcohol-related department visit.
According to ERPHealth data, those who responded to the Alcohol Use Disorders Identification test (AUDIT) screened, on average, in the hazardous or harmful category (mean = 8.5).
Alcohol Use Disorder (AUD) encompasses the conditions that some refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the more colloquial term alcoholism. It is a medical condition characterized by an impaired ability to stop or control alcohol use despite negative impact on social, occupational, or health consequences. AUD can be mild, moderate or severe, and multiple factors can contribute to one’s risk for AUD, including drinking at an early age, genetics and family history of alcohol problems, and mental health conditions or history of trauma. Based on NSDUH survey results, 29.5M people in 2021 had an Alcohol Use Disorder diagnosis and, unfortunately, only 10% of people received any treatment. Within that group, 894k were ages 12-17, highlighting the necessity for focus on early intervention and prevention.
BH Co-occurrence
Importantly, AUD often co-occurs with other mental health disorders and vice versa. For example, anxiety disorders, the most prevalent psychiatric disorders in the U.S. are found in 20-40% of those with AUD. Three specific anxiety disorders that most commonly co-occur with AUD are Generalized Anxiety Disorder (GAD), Social Anxiety Disorder, and Panic Disorder. Thorough assessment helps determine whether anxiety disorders pre-existed the AUD or are, instead, alcohol induced. Mood disorders that most commonly co-occur with AUD are Major Depressive Disorder and Bipolar Disorder and among those with Major Depression, co-occurrence with AUD ranges from 27-40%. Again, thorough assessment of mood symptoms will drive treatment planning and regular screening for suicide risk is imperative.
Between 30-60% of those seeking treatment for AUD have co-occurring PTSD and the two conditions may serve to exacerbate one another. While alcohol may be used in attempts to manage symptoms of PTSD, alcohol use may also increase the likelihood of PTSD. Looking more closely at the relationship between AUD and PTSD, heavy alcohol use may increase risk for experiencing traumatic events, AUD can impact one’s ability to cope with traumatic events, particularly through sleep, arousal, or cognition disruption, and the two conditions have shared risk factors, such as premorbid depressive symptoms or the experience of Adverse Childhood Experiences (ACEs). Finally, sleep disorders are often reported by those with AUD and the co-occurrence of sleep disorders is common with a prevalence rate of 36-91%. Similar to the reciprocal relationship between AUD and PTSD, sleep disorders can facilitate the development of AUD and AUD can cause sleep disorders such as insomnia, hypersomnolence, parasomnias, and breathing-related sleep problems.
Treatment
Given the prevalence of co-occurring AUD and behavioral health conditions, the primary focus of treatment is best tailored to the individual and based on the severity of presenting problems. The AUD may take precedence in treatment, there may be emphasis on the behavioral health condition, or the two might be addressed simultaneously. Integrated treatment of AUD and co-occurring conditions that might include medication and behavioral healthcare is proving to be the most effective. Further a full continuum of care will best serve the needs of individuals as those needs vary from intensive to long-term maintenance, which can include peer support specialists for continued support throughout recovery.
Improving our language surrounding AUD
Clearly, alcohol consumption impacts many people of diverse age, sex, and walks of life, and has increased since the start of the Covid-19 pandemic. When it comes to reducing alcohol-related stigma for these individuals, words matter. The NIH Institute on Alcohol Abuse and Alcoholism provides recommendations to help alleviate stigma by using person-first language to describe alcohol concerns and the individual affected by them. For example, “Alcohol Use Disorder” is preferred language to “alcohol abuse” and “person with alcohol use disorder” is preferred instead of “alcoholic.” We can refer to a “person in recovery” instead of a “recovering alcoholic.” Knowing that stigma is a significant barrier to an individual’s help-seeking behavior as well as access to quality care, any step we can take to increase level of comfortable is a positive step toward addressing these issues.
Decreasing stigma by normalizing
Making the patient’s alcohol use a routine point of discussion in behavioral health and medical encounters sends the very important message that alcohol use is a pertinent, allowable, and normal topic when considering overall health. Regular and consistent screening as a part of behavioral health assessment allows providers to keep track of any changes in health behaviors and gives patients regular opportunities to discuss this potentially sensitive topic.
Resources
Rethinking Drinking website
SAMHSA FindTreatment.gov
SAMHSA Help Line: 1-800-662 HELP (4357)
