Alcohol-Related Deaths Spike By 29% in US, But Opioid Crisis Overshadows Alcohol Use Disorder
The number of people who died from alcohol-related reasons per year increased by more than 40,000 within six years, new CDC data revealed.
Yet, alcohol use disorder (AUD) remains overlooked in the substance use disorder (SUD) industry, which is laser-focused on the opioid crisis, industry insiders told Addiction Treatment Business. More work needs to be done to educate the general public, primary care providers and the behavioral health industry to address the impact of AUD and excessive alcohol consumption.
The CDC study found that more than 178,300 people died from excessive alcohol use during the years 2020 and 2021 in the U.S., a 29% increase from 2016 and 2017.
A strategic approach is necessary to address the dangers associated with AUD, Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing, told ATB.
“It’s complicated in our country to talk about alcohol because it’s so prevalent,” Ingoglia said. “If you have exposure to fentanyl or fentanyl-laced drugs, you could die instantly. Alcohol use disorder is usually a slow death. … It’s [one] reason why it’s invisible to people.”
The CDC study also detected a sharper uptick in alcohol deaths among females, with a 35% spike compared to 27% for males. This echoes other research demonstrating that while males have a higher burden of alcohol-involved deaths, the rate of increase has been significantly higher among women in recent years.
The authors of the CDC study attributed the rise in alcohol-related deaths, in part, to increasing rates of binge drinking, citing data showing that 30.5% of young adults reported binge drinking in the past two weeks.
To mitigate the rising alcohol-related death toll, the study’s authors recommend implementing new public health policies that would limit the availability and accessibility of alcohol, including reducing the number of retailers selling alcohol and increasing alcohol taxes.
They also recommend integrating alcohol screenings into primary and acute care as well as nonclinical settings.
AUD, which SAMHSA defines as a medical condition that impairs a person’s ability to stop or curb alcohol use despite adverse consequences, affects 28.8 million adults, according to SAMHSA’s most recent National Survey on Drug Use and Health.
The disease often co-occurs along with other SUDs or mental health conditions, resulting in “polysubstance use.”
“There’s actually many more people out there who struggle with alcohol than opioids,” Brian Wind, chief clinical officer of Regard Recovery LLC and JourneyPure LLC, told ATB. “It just so happens that the opioid epidemic had such an impact on this country so quickly that alcohol use disorder got pushed aside a bit in terms of attention paid.”
Florida-based Regard is a SUD provider offering detox, outpatient, intensive outpatient (IOP), medication-assisted treatment (MAT) and sober living treatment programs across Florida, Kentucky and Tennessee. Tennessee-based JourneyPure offers residential and outpatient SUD and mental health treatment in Tennessee, Kentucky and Florida.
Regard acquired JourneyPure in 2021.
While Regard and JourneyPure’s patients primarily seek care for OUD, Wind estimates that between 70% and 85% also have a history of alcohol misuse or AUD.
Why is AUD overlooked?
Industry insiders told ATB that while the opioid epidemic should remain a top concern within the behavioral health industry, media coverage and national attention focused on opioids have overshadowed AUD.
Media continue to extensively cover the opioid crisis because of its dramatic acceleration and extreme lethality.
“The opioid crisis has grabbed attention, whereas alcohol, for decades upon decades, has been an ever-present issue in the background,” Wind said.
Americans recently identified opioids and fentanyl as the most significant threat to public health, ranking above cancer, access to guns or firearms, smoking and alcohol.
The attention on the opioid epidemic over matters like AUD is a problem of “acute lethality,” according to Alexandra Plante, senior advisor of substance use at the National Council for Mental Wellbeing.
“There are other substances that very objectively kill, injure or harm more Americans every day, every year, such as alcohol use disorders and tobacco use disorder,” Plante told ATB. “But they don’t have the dramatic acute lethality [of the opioid crisis]. They often result in things like 26 different types of cancer that don’t show up for 20 or 30 years.”
Mike Russell, co-founder and CEO of digital alcohol recovery provider Monument, said that while AUD can be difficult to talk about because of guilt and shame, the disease is gaining notice.
“With the increase in popularity of dry January and more press coverage about alcohol being the leading cause of death in the US, we think we are at a turning point with how much attention this issue receives,” he told ATB in an email.
New York City-based Monument offers online, clinician-led therapy, medication-assisted treatment (MAT) in the form of disulfiram or naltrexone, an anonymous online forum and therapist-guided support groups.
Monument acquired fellow digital AUD treatment provider Tempest in 2022.
The alcohol climate
Despite the dangers of excessive alcohol use, alcohol remains socially celebrated, and its legality and widespread availability contribute to a lack of attention to AUD.
“I don’t think people have ever appreciated the incredible impact that alcohol has on us as a society,” Wind said. “Alcohol absolutely destroys the fabric of families and people in ways that people don’t recognize.”
While illicit drugs like fentanyl are almost exclusively discouraged, alcohol requires a more nuanced conversation because of its widespread acceptance.
“There’s also the glaring issue of the legality of it,” Wind said. “We have commercials celebrating alcohol and the vibrant lifestyle it is for some people.”
While alcohol consumption may be accepted and encouraged by many, primary care physicians are not adequately prepared to meet alcohol’s impacts.
Primary care physicians do not receive sufficient education about SUDs, Ingoglia said. Many providers have never heard of certain medications widely used to treat AUD.
However, the industry has progressed in equipping providers with up-to-date SUD treatment information. In 2023, the Drug Enforcement Administration (DEA) announced a requirement that all DEA-registered practitioners must receive continuing education on the treatment and management of patients with opioid or other substance use disorders.
Integration and a ‘mental shift’ are necessary
All SUDs require adequate coverage and attention, but more still could be done to increase the accessibility of AUD treatment.
Increased integration with primary care could lead more people to receive substance use treatment.
“Your primary care physician doesn’t need to be an expert,” Ingoglia said. “But the same way that my physician talks to me about losing weight, they could also say, ‘Hey, you might want to cut back on the amount of alcohol that you’re taking.’ And then have a structured conversation about what that might look like.”
The behavioral health industry also needs to better integrate care for people who have a mental illness and AUD, Ingoglia continued.
The American Society of Addiction Medicine (ASAM) released a fourth edition of its guidelines for treating patients with SUDs and co-occurring conditions in October 2023. The guidelines include recommendations for SUD providers to increasingly be able to tackle co-occurring conditions.
Ingoglia sees the updated guidance as a step in the right direction.
“Our funding systems for years have been bifurcated,” Ingoglia said. “They’ve made it more difficult for [providers] to do integrated treatment and I think there’s a growing recognition that we need to be doing both.”
For Wind, managed care plans should better recognize that residential treatment is necessary for many people with AUD.
“More people need to go into treatment for a substantial period of time in order to effectively treat their alcohol use disorder,” Wind said.
Increasing awareness of medication-assisted treatment (MAT) could help lead people to recovery, Russell said.
“Many of our patients share that they had no idea it was an option before they joined our platform,” Russell said. “This highlights the importance of reducing stigma around unhealthy alcohol use – if people felt more comfortable speaking up about the problem, there would be more conversation around potential solutions, such as MAT.”
Russell also recommended that the behavioral health industry provide ongoing training to enhance health care professional’s ability to recognize and treat SUDs, as well as implement routine screening and assessment procedures.
Preventative education could address stigma and help people with AUD seek help without fear of judgment.
“It requires a mental shift on our part to recognize there are other altering substances like alcohol out there that are just as threatening, just as lethal and have just as much of an impact on our society as opioids,” Wind said.
Morgan Gonzales
Morgan Gonzales is a reporter for Behavioral Health Business. She was educated at the University of South Carolina and the University of Georgia. She has previously worked for Daily Voice and as a health care and medical reporting fellow for Dallas Morning News. Her work has appeared in Kaiser Health News and U.S. News and World Report. When not reporting, Morgan is usually doing yoga, hiking or cuddling with her two cats.
