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Alcohol - Health and Economic Impacts

Alcohol - Health and Economic Impacts. Richard A. Yoast, Ph.D., Director AMA Dept. of Public Policy & Primary Prevention Tuesday, September 16,2008 American Council on Alcohol Problems National Meeting, Springfield IL. Who drinks?. What are the impacts?.

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Alcohol - Health and Economic Impacts

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  1. Alcohol - Health and Economic Impacts Richard A. Yoast, Ph.D., Director AMA Dept. of Public Policy & Primary Prevention Tuesday, September 16,2008 American Council on Alcohol Problems National Meeting, Springfield IL

  2. Who drinks? What are the impacts?

  3. Alcohol - the Drug of Choice Among 12-20 Year Olds NSDUH Survey, 2002

  4. Drinking among Americans 12 or older (2007) NSDUH • 51.1% are current drinkers (last 30 days) = est. 126.8 million people • 56.6% of males, 46 % of females • (ages 18 to 25: 57.1% of females, 65.3% of males) • 3.5% of 12 or 13 year olds • 14.7% of 14 or 15 year olds • 29.0% of 16 or 17 year olds • 50.7% of 18 to 20 year olds • 68.3% of 21 to 25 year olds • Binge drinking (last 30 days): 23.3% = 57.8 million people • Heavy drinking: 6.9% = 17 million people • Current adult use decreased with age: • 63.2% of ages 26 to 29 • 47.6 % of ages 60 to 64 • 38.1% of ages 65 or older.

  5. U.S. Youth2005 YRBS Sizeable youth population engaging in risky alcohol-related behaviors (last 30 days) • 43.3% grades 9 -12 (50% of 12th graders) had at least one drink • 25.5% binged (5 or more drinks in a row) • 28.5% rode 1 or more times with drinking driver • 9.9% (19.2% of 12th grade males) drove after drinking • 23.3% of currently sexually active students drank or used other drugs before last sexual intercourse [CDC MMWR June 9, 2006]

  6. Underage Drinking Negative consequences costs the US: $62 billion per year(medical costs, lost productivity & quality-of-life costs due to motor-vehicle crashes, violence, property crime, suicide, burns, drowning, fetal alcohol syndrome, high-risk sex, poisonings, psychoses & dependency treatment). [Miller TR, Levy DT, Spicer RS, Taylor DM. Societal costs of underage drinking. J Studies Alcohol and Drugs 67: 519-528, 2006.]

  7. Acute Health and Safety Consequences of Alcohol Use in the Younger Population • alcohol poisoning • motor vehicle crashes • risky sexual behaviors • suicide attempts • drowning • other drug use • significant contributor to injury in adolescence • a role in more than 50% of traumatic brain injuries in adolescents • violence

  8. Early Onset - Not Benign • Age at which young people begin using alcohol has decreased over the last 35 years; • On average, youths now take their first drink at the age of 12 years.

  9. Early Alcohol Involvement – • associated with poorer behavioral measures of thinking abilities of youth. • Memory • Learning Strategies • Visual Spatial Abilities • Attention • associated with under activation in several brain regions during cognitive tasks(frontal and prefrontal,parietal, cingulate)

  10. Alcohol and Neuroanatomical Findings with Youth • Smaller hippocampus in adolescence • Greater responsivity to alcohol cues • Score worse than non-users on vocabulary, general information, memory, memory retrieval and at least three other tests • Significant neuro-psychological deficits exist in early to middle adolescents (ages 15 and 16) with histories of extensive alcohol use

  11. Alcohol-related chronic symptoms or medical conditions in youth • Appetite changes • Weight loss • Eczema • Headaches • Sleep disturbance • Serum enzymatic markers of liver damage are elevated in alcohol-abusing adolescents.

  12. What Do We Need to Learn? • Are these deficits permanent? • How long do they last? • Can we speed recovery? • To what extent are neurocognitive and neuroanatomical differences present before alcohol use starts? • Which children are most vulnerable to these adverse alcohol consequences? • Withdrawal may impact different abilities than use.

  13. Youth/young adult drinking Alcohol a leading contributor to the main cause of death—injury—for people under age 21 (ca. 5,000 deaths/yr related to underage drinking)- result of motor-vehicle crashes, unintentional injuries from other causes, homicides, and suicides. Faden V.B., Goldman M. (Co-Chairs), NIAAA Interdisciplinary Team on Underage Drinking Research. Alcohol development in youth – a multidisciplinary overview: The scope of the problem. Alc Res & Health 28(3):111-120, 2004/2005.

  14. Source: Tapert SF, Brown GG, Kindermann SS, Cheung EH, Frank LR, Brown SA (2001). fMRI Measurement of Brain Dysfunction in Alcohol-Dependent Young Women. Alcoholism: Clinical and Experimental Research. 25 (2):236-245.

  15. Neurocognitive Impact of Alcohol Pre-natal: fetal alcohol effects Middle Adolescence: fewer learning strategies, memory impairment Late Adolescence: attentional decrement, visuospatial impairment Adults: Prolonged abuse has harmful to liver, lungs, pancreas, kidneys, endocrine system, immune system,cardiovascular system, and brain.

  16. BUT - • If drinking onset is delayed by 5 years, a child’s risk of serious alcohol problems later in life is reduced by 50%.

  17. Alcohol Drinking Patterns • Binge drinking • For women, 4 or more drinks during a single occasion. • For men, 5 or more drinks during a single occasion. • Heavy drinking • For women, more than 1 drink per day on average. • For men, more than 2 drinks per day on average. • Excessive drinking includes heavy drinking, binge drinking or both.

  18. Dietary Guidelines for Americans If you drink alcoholic beverages, do so in moderation, For women: no more than 1 drink/day (7/week) For men: no more than 2 drinks/day (14/week)

  19. Dietary Guidelines for Americans Those who should not drink any alcohol: • Pregnant or trying to become pregnant. • Taking prescription or over-the-counter medications that may cause harmful reactions when mixed with alcohol. • Under the age of 21. • Recovering from alcoholism or unable to control amount. • Have medical condition that may be worsened by alcohol. • Driving, planning to drive, or participating in other activities requiring skill, coordination, and alertness.

  20. Immediate Health Risks of Excessive Use • Unintentional injuries: traffic injuries, falls, drownings, burns, firearm injuries. • Violence, including intimate partner violence (2/3 of incidents) and child maltreatment. • Risky sex: unprotected, multiple partners,increased risk of sexual assault – can lead to unintended pregnancy or sexually transmitted diseases.   • Miscarriage & stillbirth: lifelong physical & mental birth defects among children • Alcohol poisoning: unconsciousness, low blood pressure & body temperature, coma, respiratory depression, or death.

  21. health problems that might be alcohol induced • cardiac arrhythmia • dyspepsia • liver disease • depression or anxiety • insomnia • trauma

  22. Signs of possible alcohol problems chronic illness that isn't responding to treatment as expected, such as: • chronic pain • diabetes • gastrointestinal disorders • depression • heart disease • hypertension

  23. Long-Term Health Risksof Excessive Use Development of chronic diseases, neurological impairments & social problems: • Neurological problems, including dementia, stroke and neuropathy. • Cardiovascular problems, including myocardial infarction, cardiomyopathy, atrial fibrillation and hypertension. • Cancer of the mouth, throat, esophagus, liver, colon, and breast - risk increases with increasing amounts of alcohol. Risks greatly increased among smokers.

  24. Long-Term Health Risksof Excessive Use Liver diseases, including: • Alcoholic hepatitis. • Cirrhosis - among 15 leading causes of all deaths in US • For persons with Hepatitis C virus, worsening of liver function & interference with treatment medications used Other gastrointestinal problems, including pancreatitis and gastritis Social problems, including unemployment, lost productivity, family problems, street violence, alcoholic riots

  25. The Shape of U.S. Drinking Some overviews

  26. Hazardous U.S. Alcohol Consumption Rogers & Greenfield, 1999

  27. Drinking Volume Partitioned by 6 Contexts HAZARDOUS TOTAL 37% 1984 & 1995 National Alcohol Surveys; Clark, 1988; Greenfield et al, 2000

  28. Major costs of alcohol (1990) Total cost: $98.6 BILLION Health care: $10.7 billion Indirect costs: $70.2 billion: • Mortality: $33.6 billion • Morbidity: $36.6 billion Crime: $5.8 billion Auto crashes: $3.9 billion Incarceration: 4.8 billion

  29. Economic Costs of alcohol and other drug abuse are increasing; $277 billion in 1995 Billion Dollars Sources: Rice et al. 1990; Robert Wood Johnson Foundation, 1993; National Institute on Drug Abuse & National Institute on Alcohol Abuse and Alcoholism, March 1998.

  30. Alcohol in Primary Care • Patients with all stages of alcohol problems frequently seen in clinical settings(McDonald, 2004). • Patients screened in 22 primary care practices: 9% at-risk drinkers, 8% problem drinkers, 5% alcohol-dependent.( Manwell 1998): • Binge drinkers compared to other primary care patients: higher rates of related problems (injury, hypertension), 1.5 times more primary care visits, higher per patient costs (psychiatry, emergency room, drugs) (Mertens 2005)

  31. Alcohol, Injury & Acute Care • Emergency Departments ~ 110 million visits/yr, ~⅓ are injuries alcohol problems: 15 to 30% • Trauma Centers ~ 3½ million visits/yr, all are injuries alcohol problems: 40 to 60%Dan Hungerford, CDC

  32. The Spectrum of Alcohol Use heavy Alcohol Use Disorders severe Alcoholism Dependence Unhealthy Use Harmful, abuse Problem consumption consequences Risky Lower risk Abstinence none none

  33. Age at Onset of DSM-IV Alcohol Dependence

  34. REASONS FOR DRUG TREATMENT: 72% involve alcohol Source: Treatment Episode Data Set, DHHS/SAMHSA, Sept 2000

  35. Distribution curve, e.g. consumption of a drug Number of people Many Few Level of consumption Low High

  36. The main problem Binge Drinking

  37. Binge Drinking, Current Drinkers Naimi et al, JAMA, 2003

  38. Alcohol Dependence among Binge Drinkers – example New Mexico Dependent 7% Non-dependent 93% New Mexico, BRFSS, 2002

  39. Percent of Alcohol Consumed by Frequent Bingers, Infrequent Bingers, and Nonbingers Frequent bingers: 6% of population, drink 56% of the alcohol Overall, bingers: 16% of population, drink 75% of the alcohol Adults 21+ Years Old Source: National Household Survey, 1998

  40. Binge Drinking, by Average Alcohol Consumption, 2001 Binge Episodes Binge Drinkers

  41. 5+ Drinks Especially Increase Bad Outcomes • Impaired driving(Naimi, JAMA, 2003) • Unintentional injuries(Anda, JAMA, 1988) • SIDS(Iyasu, JAMA, 2002) • Violence(Rossow, Addiction, 1996) • Unintended Pregnancy(Naimi, Pediatrics, 2003) • Sexually transmitted diseases(Lauchli, AEP, 1996) • Myocardial infarction(Rehm, Am J Epidemiol, 2001) • Meningitis (Imrey, Am J Epidemiol, 1996)

  42. Risk of Injury, by Usual Number of Drinks College Alcohol Survey, 1999

  43. Obstacles to change & A New Framework

  44. Structural Obstacles • Alcohol not treated as a drug, food or carcinogen - by law FDA can’t review or control alcohol • Federal Trade Commission - protection of youth?: • uses alcohol industry data on advertising to kids • youth “prevention” campaign uses alcohol industry materials • Government & private foundations rarely fund research on alcohol industry, rarely support advocacy • No national media campaign since 1980’s/ except DUI • Government agencies fear reprisals if they counter industry economic interests or messages • Courts consistently support industry rights to free speechover parental rightsand needs of children –unrestricted advertising

  45. Common Misperceptions: • Most understand alcoholism is a disease, but don’t know that like diabetes and other chronic diseases, it can be treated and controlled if not cured & may be relapsing • Don’t understand concept of alcohol problemsas amenable to change – we look only for alcoholism and see the rest as social, not health problems • myths about alcoholics applied to all problem drinkers]

  46. Common Misperceptions: • Old information: no effective treatment, prevention doesn’t work, drinking never changes for better or worse, laws have no impact • Many hold beliefs fostered by alcohol industry, mass media & culture: ‘problems due to individual choice & irresponsibility’ – ‘failure to change is individual failure’ – ‘alcohol problems are not health problems -only social, personal failings’

  47. Obstacles • Medical and public health communities fail to address alcohol use disorders as mainstream health issue – focus on individuals, social disruption, particular alcohol problems – rarely as larger health problem • Media & government focus only on social, not health impacts. • Heavy publicity for research on positive health impacts of alcohol (are they finding what they’re looking for?) - summarized by media as “drinking is good for you”

  48. Underlying dynamics • Much of public health community accepts alcohol industry “expertise” in determining and discussing health issues– legitimizes their self interest & perspectives on problems • Alcohol industry and the policies they support focus on individual choice & punishment – ignore their own role, environmental, even governmental roles in promoting problems

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