Minorities, the elderly and women are drinking much more alcohol

THE White House has plans to declare the opioid crisis a national emergency. This concern is justified: in their legal and illegal forms, opioids kill an American every 16 minutes. Yet a focus on opioids has eclipsed the damage caused by an even deadlier, more common substance. Between 2006 and 2010, an average of 106,765 Americans died each year from alcohol-related causes such as liver disease, alcohol poisoning and drunk driving—more than twice the number of overdoses from all drugs and more than triple the number of opioid overdoses in 2015. Although Americans quaff less alcohol per person than the pub-loving British and Irish or the beer-fond Germans, they are drinking far more heavily than they used to.

On August 9th, researchers at the National Institute on Alcohol Abuse and Alcoholism, New York State Psychiatric Institute and Columbia University published a study in JAMA Psychiatry that compared American drinking habits in 2001-02 with those in 2012-13. It found that the share of Americans who are considered “high-risk” tipplers—women who, in any given week, have at least four drinks in a single day, or men who have five drinks—increased by nearly 30% in the period studied.

The percentage of Americans who met the criteria for alcohol-use disorder (AUD) in the DSM-IV—a psychiatric handbook that uses questions such as, “In the past year, have you found that drinking—or being sick from drinking—often interfered with taking care of your home or family?” to diagnose alcoholism—jumped from 8.5% of Americans in 2001-02 to 13% in 2012-13, or nearly 30m people. By comparison, 2.6m are estimated to have prescription-opioid and heroin addictions.

Anne Case and Angus Deaton, two (married) economists at Princeton University, roll alcohol poisonings together with opioid deaths and suicides into what they call “deaths of despair”. Having suffered lurching economic and social change, they argue, white folk with high-school diplomas or less have turned to opioids and alcohol for comfort. Such anguish is what they believe underpins a rising mortality rate among middle-aged white Americans, even as that rate falls in other developed countries. Is the rise in problem drinking part of the same phenomenon?

Not obviously. Opioid overdoses are killing more white males than any other group. But heavy drinking seems to be increasing most not among middle-aged whites, but the elderly and certain minority groups. Over the period measured by the JAMA study, the prevalence of alcoholism among Americans over 65 jumped 107%, though from a low base. Among black Americans it rose 93%: a larger share of blacks than whites are now considered to suffer from alcoholism. Women are also hitting the bottle harder. Whereas 5% of women were found to meet the criteria for alcoholism in 2001-02, in 2012-13 that number rose to 9%.

Previous studies suggest that Americans who drink heavily tend to drink very heavily indeed. Analysis by Phillip Cook, a professor at Duke University’s Sanford School of Public Policy, published in 2007 suggested that whereas 30% of Americans did not drink at all in 2001-02, 10% of Americans—or about 24m—had an average of ten drinks a day. He believes such habits would not look different today.

Bridget Grant, an epidemiologist at the NIAAA and the JAMA study’s principal author, blames the rise in drinking largely on different manifestations of stress. For women, that pressure might stem from their increased participation in the workforce. “It may be that women are finding it difficult to both manage their families and their work, which leads to stress, which invites drinking,” Dr Grant says.

The upshot is that, for the first time since the early 1970s, the mortality rate associated with alcohol-related liver cirrhosis rose dramatically between 2009 and 2013. The decline in mortality rates related to cardiovascular diseases and stroke—both of which can be brought on by heavy drinking—recently slowed. Mitigating the opioid epidemic is critical, but curbing heavy drinking is just as pressing.