What Drinking Costs the US every Year

Drinking too much has well-known personal costs—headaches, nausea, and regrettable 4 a.m. text messages.
The Centers for Disease Control has put a figure on how much it costs the American economy: $249 billion.
That includes spending on health care as well as the economic toll of lost productivity, car crashes, crime, and deaths attributable to excessive alcohol consumption.


The biggest economic drag from tipplers manifests in the workplace. Alcohol cost $77 billion in impaired productivity at work in 2010, according to the CDC’s breakdown published in the American Journal of Preventive Health. Adding in absenteeism and other factors, the total productivity toll from excess drinking approached $90 billion. That’s not counting losses from alcohol-related deaths. The CDC has previously estimated that one in 10 deaths of working-age Americans are caused by too much drinking.
The total cost of excessive drinking to the economy is rising. The last time the CDC made a similar calculation, excess drinking was blamed for $224 billion in costs, estimated for 2006. The increase, about 2.7 percent annually from 2006 to 2010, outpaced inflation. Most of the costs are attributable to binge drinking, and 40 percent of the total is borne by the government.
Measuring such a big and abstract thing as economic damage from drinking is inherently imprecise. If anything, the CDC says its estimates lowball the true cost. It counted only factors in which alcohol was considered the primary cause, so illness or deaths from other causes that drinking may have exacerbated are left out. “Intangible costs like pain and suffering were not included,” the paper noted.
So drink responsibly. The economy will thank you in the morning.

Is Medicine Driving Doctors to Drink?

Between 10% and 15% of US physicians suffer from a substance use disorder, a rate slightly higher than that of the US population as a whole, a recent Medscape article revealed.

But physicians struggling with abuse or addiction differ from other members of the public in one critical respect: They have taken an oath to care for others. However, the article cited two surveys in which physicians who met the criteria for substance abuse and dependence were more likely to say they had committed a major medical error in the previous 3 months than their peers who didn’t meet the criteria.

“When doctors are impaired, everyone suffers,” the article pointed out, including the physicians themselves.

Why do some doctors become hooked? “Medicine attracts many high-achieving, compulsive, perfectionistic individuals who derive a strong sense of self-worth from their jobs,” the article noted. “If a doctor’s commitment morphs into overwork, exhaustion, and a work/life imbalance, alcohol and other drugs may become a dangerous balm.”

Add to that physician access to potent prescription medications, and it’s not hard to understand how some doctors might step over the line. “Whereas alcohol abuse is the most common form of drug abuse for both physicians and the population as a whole, research shows physicians are more likely than the general population to abuse benzodiazepines and opiates,” the article stated.

The article quoted addiction experts who urged doctors with an alcohol or drug abuse problem to get help, offering some suggestions. Doctors who suspect that a colleague is impaired were urged to broach the subject with that individual or at least bring the matter to a hospital wellness committee’s attention as an act of compassion and a patient safety concern.

For a number of doctors who offered comments, the problem of physician addiction and dependence reflected a larger problem with society as a whole.

The reason a lot of people get hooked is because of the sanctimonious ‘all-or-nothing’ attitude of our society,” wrote an orthopedic surgeon. “Why are the numbers so much better in Europe, where 6-year-olds have a thimbleful of wine with Sunday dinner and hit adulthood ‘knowing’ about alcohol?”

“For as much physical, emotional, and economic damage that alcohol causes, it gets hardly any attention; instead, it is advertised and promoted to our youth,” an ophthalmologist remarked. “A shameful, festering wound on the face of our society.”

But other commenters saw the problem as one endemic to medical culture.

“Why do medical professionals often become alcoholics/addicts and then hide it as the disease progresses? I think one reason has to do with the culture of medicine,” an internist opined. “Medicine is all about identifying symptoms and reflexively prescribing substances to alleviate those symptoms. I don’t think we realize what a huge impact that has on us subconsciously over time as healthcare providers. We are expected to be super-human while teaching our patients to take good care of their bodies. We are discouraged from taking time off when we are sick or burnt out, and as the for-profit medical system evolves, we are pushed harder and harder. There is a disconnect between teaching and preaching wellness and the way healthcare providers live themselves. The system is broken.”

“Medicine is uncomfortable discussing and admitting its substance abuse problem,” another doctor wrote. “Case in point: When I was starting to have daily problems that were harder and harder to hide in medical school, no one ever spoke to me in the clear terms I needed to hear. They knew I was drug-seeking for the pills I was addicted to. They knew I was drinking alcohol daily (“they” being MD department heads and advisers, as well as student counselors at the Top 10 medical school I trained at). No one said to me, ‘You have a disease, and it’s called addiction/alcoholism. You need to go to rehab and 12-step meetings to get better.’ Meanwhile, I went to student/faculty events and saw students getting wasted to the point where they could not speak in front of faculty, who thought it was cute and part of normal medical student life.”

Other physicians took the opposite view: that focusing on the minority of physicians who abuse substances misses the larger picture.

“Ten percent of physicians suffer from a substance use disorder,” a surgeon commented. “Ninety percent do not. Thank you for that indirect credit to the majority of us.”

“Is it less interesting to write about how the vast majority of physicians lead productive lives without chemical dependencies?” an orthopedic surgeon wondered.

Several physicians, recovered alcoholics, took personal responsibility for their problem.

Say what you want about ‘stress, perfectionism, compulsion,’ etc., the fact is, I drank alcohol because I am an alcoholic,” wrote an emergency physician, who said he has been sober for 13 years. “I don’t understand what underlies the difference between me and a ‘normal’ person,” he confessed. “Many of my colleagues are just as perfectionistic and compulsive as I am and are doing the same job. They don’t abuse alcohol or drugs. I was very good at trying to hide my drinking, and I got away with it for years. Thank goodness I don’t remember any poor clinical outcomes that resulted from this. In fact, I took some pathetic pride in the fact that I was never drunk on the job. I lived in constant fear of being discovered, and much of the fear was based on my assumption that if I admitted to my addiction, I would have to stop being a doctor. By the time I was finally confronted by hospital administration and tested positive for alcohol during clinical duty, I was so tired of running and hiding that I was actually relieved. I did have to take a few months off for rehab, and I followed guidelines for monitoring by my state medical board. For the past dozen years I have been back to work, and my clinical practice has flourished. I feel better than I ever did prior to my intervention. I am very grateful for all of those people who helped me through the transition away from alcohol.”

A few commenters weren’t buying the reasons that some doctors develop substance use problems.

“There are reasons and there are excuses,” a vascular surgeon remarked. “You list factors contributing to drug and alcohol abuse, but the reason is that some people make bad choices.”

“So now we make excuses for a profession in which persons have lost their way, using words like ‘high-achieving,’ ‘compulsive,’ ‘perfectionist,’ ‘overwork,’ ‘exhaustion,’ and ‘work/life imbalance’ to make the absurd excuse that alcohol and other drugs then become a dangerous balm,” a medical oncologist remarked. “My goodness, no other profession, now or in history, has had these same characteristics? They have only recently been discovered in ONLY the medical profession? How about a dose of ethics, morality, balance, strength of character, and positive outlook in the ‘good’ that doctors can do?”

“Nobody is making excuses!” a radiation oncologist fired back. “And medicine was not singled out. Physicians have the SAME rate of alcoholism as the general population, not significantly higher than dentists or other educated, intense professionals. Look at firefighters and policemen: Their rates of substance abuse are higher. The point is that there is help. Most university-affiliated hospitals have physician health teams that will treat anonymously. I myself have benefitted from this interaction (not for addiction but for burnout), and it was done quietly and effectively. Now that I am much healthier, I no longer feel the need to hide my problems, and have pointed several colleagues in the same direction. The point is not to make excuses. The point is to get appropriate treatment and get better.”

Obama Plan for Opioid Abuse Stresses Prescriber Training

More physicians will receive training on prescribing opioid pain medications as part of a White House initiative against abuse of prescription drugs and heroin use.

President Barack Obama issued a memorandum yesterday requiring federal departments and agencies to provide opioid prescribing education to all “federal prescribers.” This group includes clinicians who are employees or contract workers of the departments of Defense, Health and Human Services (HHS), and Veterans Affairs, as well as residents who primarily work in federal facilities. A White House spokesperson told Medscape Medical News that the Obama administration has yet to come up with an exact head count of how many clinicians would be affected.

The required training must address such topics as principles of pain management, identification of potential substance abuse, and referral for further evaluation and treatment.

In addition, the memorandum orders federal agencies that either directly provide healthcare services or reimburse for them (HHS is an example) to identify barriers that individuals with opioid use disorder might encounter in receiving “medication-assisted treatment” (MAT) such as buprenorphine, which also is an opioid. Considered widely underused, MAT normalizes brain chemistry and relieves craving for opioids without the harmful effects of the abused drug, according to HHS.

The White House also announced that more than 40 provider groups ranging from the American Medical Association to the American Dental Association have committed themselves to get more than 540,000 clinicians trained in opioid prescribing during the next 2 years. Other voluntary goals these groups have set for themselves include:

doubling the number of physicians certified to prescribe buprenorphine from 30,000 to 60,000 during the next 3 years;

doubling the number of providers who prescribe naloxone, which can reverse an opioid overdose; and

doubling the number of providers registered with their state prescription drug monitoring program.

“We obviously need to work with the medical community,” Obama said yesterday at a community forum on opioid abuse and heroin addiction in Charleston, West Virginia, “They’re the front lines on prescribing this stuff. So there’s got to be a sense of responsibility and ownership and accountability there.”

The American Academy of Family Physicians, one of the provider groups involved in the Obama initiative, will do its part by promoting continuing medical education on opioid prescribing, a spokesperson told Medscape Medical News. The academy aims to train 10,000 of its members on how to prescribe the drugs and have another 600 complete overview training on MAT.

Treatment More Important Than Prison

The president’s latest sally against prescription drug abuse and heroin use enlists companies ranging from CBS Television Network to Google to donate airtime and advertising space for a media campaign by the Partnership for Drug-Free Kids. Likewise, the National Basketball Association and Major League Baseball will run public service announcements and the Dr Oz Show will encourage parents to talk with their children about the risks posed by prescription pain medications, heroin, and other drugs.

In one of many public sector actions, HHS will review how patient satisfaction surveys evaluate pain management and how they may influence current practices and opioid prescribing.

West Virginia was an apt setting for Obama to announce new efforts to combat abuse of prescription painkillers and heroin use. He noted that the state has the highest rate of fatal drug overdoses in the nation.

“More Americans now die from drug overdoses than they do from motor vehicle crashes,” he said. “This crisis is taking lives, destroying families, and shattering communities all across the country.”

Obama said fighting this epidemic depends more on getting people with a substance abuse problem into treatment than putting them in prison. That task will be easier, he said, when substance abuse is no longer stigmatized with terms such as “junkie.” Such pejorative language often deters from people from seeking help.

“Part of our goal today is to replace those words with father, daughter, son, friend, or sister, because then you understand there is a human element,” Obama said. “This could happen to any of us.”

ASAM Releases New Guidelines on Treating Opioid Addiction

New guidelines from the American Society of Addiction Medicine (ASAM) on the use of medications in the treatment of opioid addiction should increase the number of patients who receive medication-assisted treatment, says the chair of the guidelines committee. Broad implementation of the guidelines can save lives, according to Kyle Kampman, M.D.

“Less than 30 percent of treatment programs offer medications to treat addiction, and less than half of those eligible patients in those programs receive medications,” said Dr. Kampman, who is Professor in the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania Treatment Research Center.

The consequence of untreated addiction – overdose from prescribed opioids and heroin – kills 68 people a day in the United States. The number of deaths from prescription opioids has more than tripled since the 1990s. From 2002 to 2013, the rate of heroin overdose deaths nearly quadrupled.

Dr. Kampman noted that while there are existing guidelines for treating opioid addiction, they tend to focus on single medications—such as guidelines for using buprenorphine or methadone. Until now there have been no comprehensive guidelines that included all medications approved by the Food and Drug Administration (FDA) to treat opioid addiction, he noted. The National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use, released on September 24, will help doctors treating patients addicted to opioids match the best treatment to each individual patient.

“Doctors treating patients with opioid addiction have many questions about which patients are appropriate for which medications,” Dr. Kampman said. “They want to know which drug to use, at what dose, and for how long. They also want to know about how to treat special populations, such as pregnant women, adolescents, and patients in pain. All of these are addressed in the guidelines. The answers are all in a single place, which makes this unique.”

The guidelines also include a section on how to use the opioid overdose antidote naloxone. “This is an area that is very important, but not very well known among doctors,” Dr. Kampman observed.

The guidelines are designed for any doctor who treats patients with opioid addiction, including internists and family practitioners, Dr. Kampman said. “Our hope is that doctors who have been reluctant to treat opioid addiction, or were unaware there were so many effective treatments available, will start to use these treatments now that they have guidelines from ASAM, which is a trusted source.”

Two areas generated a lot of discussion among the experts who devised the guidelines, Dr. Kampman said. First, although buprenorphine treatment is generally started in a doctor’s office, the experts ultimately decided that treating patients at home is appropriate if both the doctor and patient are familiar with the treatment.

Second, although the hypertension drug clonidine is not approved by the FDA for opioid addiction, many doctors prescribe it for this purpose. The experts decided that since it is so widely used for opioid addiction, they would include it in the guidelines.

AAP Clinical Report on Binge Drinking in Adolescents

National Recovery Month

Pediatricians should talk to kids about the dangers of drinking alcohol starting when the children are as young as 9 years old, a new clinical report from the American Academy of Pediatrics recommends.

Initiating this discussion at such an early age is “absolutely” a “very reasonable” approach, says addictive behavior expert Harris Stratyner, PhD, regional vice president, Caron Treatment Centers, New York City, who trains pediatric residents and fellows in this area.

“That’s the age when kids are becoming aware of what alcohol is,” said Dr Stratyner, who had no role in preparing the new report. “And that’s when the brain starts to formulate and understand that something can be enjoyable, but it can still be deleterious to your health.”

But if the child comes from a family of heavy alcohol users, the conversation should start even earlier. “If the child is exposed at age 7, then that’s a good time to sit them down and talk to them about addiction,” said Dr Stratyner.

If adults do not broach the subject at that early stage, in today’s world, where children see advertisements for alcohol just about everywhere they turn, “you’re going to see kids around the age of 12 start to drink and smoke pot as gateway drugs.”

The new clinical report on binge drinking was published online August 31 and appears in the September issue of Pediatrics.

In-Office Screening

According to the surveys cited in the report, 21% of young people have had more than a sip of alcohol before the age of 13, and 79% have done so by the 12th grade. The proportion who drink heavily is higher among youth who drink than among adult drinkers.

The report also advises pediatricians to screen every adolescent for alcohol use. “Just using one’s clinical impression can underestimate substance use and therefore structured screening instruments are recommended,” write the authors, co-led by Lorena Siqueira, MD, Miami Children’s Hospital.”When time does not permit, alcohol-only screening tools may be a reasonable approach.”

A screening tool developed by the National Institute on Alcohol Abuse and Alcoholism in collaboration with the American Academy of Pediatrics can quickly identify youth at risk for alcohol- related problems, say the authors. It includes only two questions ― one on alcohol use among friends, and the other on use among the patients themselves. The questions are changed slightly depending on the age of the child.

Pediatricians should not only ask whether youngsters ever drink alcohol but also tell these kids why that question is important, said Dr. Statyner. “They need to say that alcohol affects your liver and the liver is an organ in your body that cleans your blood before it goes through your brain.”

This, he said, “raises consciousness” so that kids will think about the consequences of excess drinking. “At 9 years old, you have to raise consciousness so that at 16 years or 17 years, you don’t have binge drinkers” on college campuses.

The report defines binge drinking as the pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08% or greater. In adults, binge drinking refers to the consumption of five or more alcoholic drinks in a row by men, and four or more by women, during a 2-hour period.

Because youth typically weigh less than adults, they are likely to reach a BAC much higher than 0.08% with five drinks in a 2-hour period.

Binge drinking is a common problem. In a 2013 report, 22.9% of Americans aged 12 years and older reported binge drinking in the 30 days before the survey. It revealed that 0.8% of 12- to 13- year-olds and 4.5% of 14- to 15-year-olds reported binge drinking.

Dr Stratyner sees a growing rate of such drinking in his practice. “I’m seeing a lot more binge drinking on weekends among college students,” he said. “I think youngsters are under more pressure, and pressure to self-medicate. They see alcohol as being legal and safe.”

Certain personality characteristics might increase the risk for underage drinking, including sensation seeking, low inhibitory control, and impulsivity, according to the report. Hormonal changes during puberty may affect sensitivity to alcohol, making adolescents less sensitive to the effects of intoxication.

Underage drinkers (those younger than 21 years, which is the legal drinking age in all states) typically obtain alcohol from adults, including from parents, siblings, and other relatives. They drink most often at home or at the home of others.

Costly Habit

Binge drinking among kids is costly. According to a 2006 study, underage drinking was responsible for a median of $361.4 million in economic costs, including healthcare expenditures, lost productivity, court costs, property damage from vehicle crashes and fires, and special education for those with fetal alcohol spectrum.

Adolescents who binge drink are more likely to exhibit poor judgment, such as driving while drunk. Alcohol use is involved in each of the major causes of mortality in adolescents ― accidents, suicides, and homicides ― says the report. In the United States, 50% of all head injuries in adolescents are associated with alcohol consumption.

The developing adolescent brain is more vulnerable to alcohol-induced brain damage and cognitive impairment than the adult brain, says the report.

Binge drinking may result in a “blackout” or losing memory of events that occurred while drinking. During a blackout, drinkers are disinhibited and may engage in risky behaviors, such as having unprotected sex, which increases risk for pregnancy.

Research shows that binge drinking is more harmful to the fetus than more continuous drinking patterns, even if the overall amount of alcohol consumed is less.

Traditional Views on Alcoholism Challenged by New Study

National Recovery Month

Recent findings from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC) are challenging traditional views of alcoholism and point to the need for a paradigm shift in prevention and treatment strategies, a leading expert says.

Among other findings, recent data from NESARC, a prospective, population-based study that surveyed 43,000 US adults in 2001–2002 and again in 2004–2005, show that more than half of alcohol-dependent individuals are healthy, functional, young adults — a far cry from the stereotypical middle-aged, white-male, skid-row alcoholic, said Mark L. Willenbring, MD, director of the division of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

“Much of what we thought we knew about alcoholism was based on middle-aged people, primarily white men in treatment programs and Alcoholics Anonymous, but the NESARC data are turning what we thought we knew about alcoholism completely on its head,” Dr. Willenbring told reporters attending a press conference here at the American Psychiatric Association 162nd Annual Meeting.

NESARC data also show that young adult alcohol-dependent individuals tend not to seek treatment and have the lowest rates of recovery and full remission.

Tip of the Iceberg

Furthermore, he said, the NESARC results show 72% of individuals who have alcohol dependence in their lifetime have 1 episode that lasts an average of 3 to 4 years and then remits and does not come back.

“This isn’t how I have traditionally viewed alcoholism, because I have worked in treatment programs where we see the most severely affected patients — those with chronic and severe dependence who frequently have psychiatric, medical, and social comorbidities,” Dr. Willenbring told Medscape Psychiatry in a follow-up interview.

“The fact is that most people who develop heavy drinking or alcohol dependence do not fit that stereotype. There are many who are not falling apart — their marriage is intact, they parent, they go to work, and in many cases nobody even knows they are coming home and drinking a pint or more of whisky, and these people are not getting any attention at all,” he said.

The NIAAA guidelines recommend that women should drink no more than 3 drinks in any day and 7 drinks in any week. Men should drink no more than 4 drinks in any day and 14 drinks in any week. One standard drink equals 14 g of ethanol, the amount in 12 oz of beer, 5 oz of table wine, or 1.5 oz of 80-proof spirits.

Dr. Willenbring added that only 1 in 8 individuals who develop alcohol dependence ever receives any treatment for the disorder and only 1 in 4 gets any kind of support such as going to an Alcoholics Anonymous meeting or talking to a counselor.

“We are really missing the boat here, and we need to shift our focus and start paying attention to this large group of people who are heavy drinkers and focus on risk reduction, early identification, and treatment.”

To help clinicians screen and treat their at-risk patients, NIAAA has developed 2 resources. The first, Helping Patients Who Drink Too Much: A Clinician’s Guide, is available in booklet form and on the Internet (www.niaaa.nih.gov/guide). It provides training to help clinicians identify and counsel at-risk drinkers as well as treat individuals with mild to moderate alcohol dependence.

The second resource, Rethinking Drinking, is a patient guide that is also available online or in booklet form that is geared toward individuals who are heavy drinkers or who are concerned about their drinking (www.rethinkingdrinking.niaaa.nih.gov).

Waiting for the Prozac Moment

One particularly promising area is the recent development of medications to treat alcoholism. While behavioral therapy can be effective, 1 of the major challenges with this mode of treatment is that it is not widely available, said Dr. Willenbring.

However, he said, the development of medications to help treat alcohol-dependence provides an opportunity to reach a greater number of individuals with drinking problems.

“I think treatment for alcohol dependence is going to mirror what happened with depression treatment — that is, 35 or 40 years ago very few people got treatment for depression and only psychiatrists treated it. Then along came Prozac and all of the other medications that revolutionized the treatment of depression.”

Primary-care physicians treat most patients with depression today, while psychiatrists treat the most severe and chronic cases.

“I think that’s where we’re heading with treatment for alcohol dependence. The bulk of people with mild to moderate dependence, who are the majority, can be effectively treated with medication and brief behavioral support in primary care and general psychiatry,” said Dr. Willenbring