Treat Heavy Drinking Like the Public Health Epidemic It Is
Excessive alcohol consumption is very common in America, but quality treatment is scarce. It’s time we transform our current treatment system into a modern one that can sufficiently respond one of the largest public health problems we face. At a time when government leaders show little interest in increasing commitments to health treatments, doing so requires that business leaders step in.
Sixteen to 30 million adults annually suffer from alcohol use disorder (AUD) — involving impaired control over drinking, which may lead to the development of tolerance, withdrawal, social impairment, and health problems. Even more common are heavy drinkers that do not yet have an AUD but are at increased risk for developing one. Collectively, these approximately 70 million people face an elevated risk for several cancers, heart disease, high blood pressure, accidents and trauma. In total, the CDC reports heavy drinking costs the US economy about $250 billion annually, mostly in lost productivity, including premature death.
Drinking to excess is responsible for one in 10 deaths among working adults age 20–64 years; in total, nearly 90,000 people annually.
Most people who struggle with heavy drinking defy the common stereotypes; they are employed, married, good parents, and respected members of the community. In most cases, the only people who may know about an individual’s struggles are close family members, but even they may be unaware. Moreover, most people with AUD have a milder form of it and are aware that they are drinking more than they would like. Such people are often distressed by their inability to keep alcohol use within safe limits and are deeply unhappy about its impact on their lives and those who rely on them.
Tragically, despite well-intended efforts, effective treatment for those suffering from mild and moderate AUD is unavailable in most communities. Despite millions of federal dollars spent on research and implementation grants, primary care physicians are not equipped to deal with the crisis. Across the board, only about 10 percent of those with AUD ever receive treatment. And traditional approaches grounded in rehab facilities most often employ an outmoded model that has hardly changed since the 1950s.
The situation has gotten so bad that Google — reportedly the number one “referral” source for people in need of help — has recently stopped selling ads for search terms like “alcohol treatment centers” because of rampant, profit-motivated and (their word) “misleading” practices by too many bad actors. In the past, Google has taken similar action to combat the predatory practices of payday lenders.
It is time for a new approach, one that incorporates current scientific understanding of heavy drinking and how to address it. Unlike the “cookie-cutter” approach many rehabs are known for, current evidence has found that treatment for high-risk drinkers and people with mild to moderate AUD should be truly individualized and unique to each person. Drinking goals (including but not limited to abstinence) and specific treatment plans should be developed collaboratively with each participant. Drink-reducing medications (naltrexone is perhaps the best known, but there are several others) should also be made available since these medications increase the proportion of people able to achieve and maintain their drinking goals.
Our very own smartphones make it possible to deliver quality care directly and rapidly to people in need. Research and clinical experience show that shows that both at-risk drinkers and people with mild to moderate AUD respond well to relatively minimal interventions. So such individuals represent a prime target for large-scale strategies that leverage technology. We also know that high-risk drinkers and people with milder AUD will seek and accept services if they are confidential, convenient, and affordable.
Given the widespread nature of the problem — as well as myths, misunderstandings, and stereotypes surrounding it — such a solution must take a true, population-based approach to this epidemic.
Since three in four heavy drinkers are employed, it makes sense for efforts to combat heavy drinking to focus on the workforce. Employers have a stake in helping their employees lead healthier and more productive lives. The financial incentive is obvious and we need leadership from the business community.
There’s no need for employers to wait to deliver treatment to those in need — and there's actually a good case to take action now. If even 10 percent of heavy drinking employees were to reduce drinking to safer levels, or to abstain entirely, the public health and economic impacts would be huge.
Mark Willenbring, MD, the chief medical officer and co-founder of Annum Health, was formerly the head of recovery research at the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. Dr. Willenbring is also CEO, founder and medical director of alltyr clinic, which has been transforming treatment for addictions since 2012.
