MI: People often don’t think about it, but health consequences of alcohol use can be deadly

MLive
By Danielle Salisbury
December 27, 2022

One of the most popular party nights of the year is fast approaching and chances are good adults will be sipping something other than hot chocolate.

It happens at any gathering, really, festive or otherwise.

Alcohol is a pervasive part of American society, and regardless of how cavalierly or commonly it may be served and imbibed, its dangers cannot be overlooked, experts say.

The consequences of heavy drinking can be fatal.

About 12.1% of deaths of people aged 20 to 64, younger than most people die and of working age, were due to excessive alcohol use from 2015 to 2019 in Michigan, found a U.S. Centers for Disease Control and Prevention study published in November.

It looked at national and state mortality data, survey information on alcohol use and alcohol sales to estimate deaths partially attributable to alcohol use and those unquestionably caused by over consumption, such as people diagnosed with alcoholic liver disease.

Michigan’s rate was lower than the nation’s overall, but a few percentage points greater than the lowest — 9.3% in Mississippi. The rate was generally higher in the upper Midwest, West and New England compared to the Southeast, the CDC found.

Western Michigan University Professor Dennis Simpson, who studies psychoactive, psychotropic drugs and was long director of the Specialty Program in Drug and Alcohol Use, did not find the results surprising. The data has changed little in the last couple decades, he said.

The situation is even worsening.

Though the estimates are not comparable because methods have advanced, there were annually about 121,000 alcohol attributable deaths from 2011 to 2015 and about 140,000 such deaths per year in the United States from 2015 to 2019, according to the CDC.

Addictive behaviors have been increasing nationally. Not just alcohol, but opioids too. The pandemic likely played a part. Socioeconomic issues could also contribute and there is a mental health crisis the country is yet to handle, said Anne Fernandez, associate professor in the Michigan Medicine Department of Psychiatry and a clinical psychologist with the health system’s addiction treatment services.

The rate of death makes sense, Simpson said, because about 10% of people consume about 50% of the alcohol, and it is the 10%, not the person who has a glass of wine at dinner, who are the issue.

“The impact of this on people physically, socially, legally that occurs is the problem,” Simpson said.

Alcohol, he said, is a toxin. “Toxin is another word for poison.” It has no nutritional value and only leads to the buildup of fat.

Binge drinking, as can frequently happen during the holidays, tends to produce a lot of rigor on the liver or hepatic system. Over time, it can lead to a fatty liver and eventually cirrhosis. By then, it’s not whether it will be fatal, but when, he said.

The buildup of fat too can affect the heart.

“People don’t think of it in terms of health consequences,” Fernandez said of alcohol, viewed differently than, say, cigarettes or illicit drug use.

They recognize the dangers of driving drunk and getting into a crash, but they don’t think about chronic use and the consequences, such as cancer or liver disease.

“So many patients, they’re so surprised when they develop liver disease. They don’t think it’s possible,” said Fernandez, who started with colleagues a multidisciplinary alcohol-related liver disease clinic.

Patients are getting younger and younger, sometimes under 30, she said.

In Michigan, the study found 24.4% of deaths in people 20 to 34 were attributable to alcohol over the five-year period. This was far higher than any other examined age group. The rate among people 50 to 64 was less than 9%, although the number of deaths was greater.

Younger people are less likely to die so it is an issue of proportion. If someone dies young, the likelihood alcohol is involved is higher.

The consumption level per capita is higher among the younger, Simpson said. Heavy drinking year after year and a person will start to see the “untold physiological effects” as they reach or near 40. In the older group, some already have died, he said.

Men have historically been more at risk — about 97,000 men died on average during the five-year period compared to about 43,000 women — but women are drinking more.

Experts said this has to do with cultural changes. Women’s role has changed. More women are working mothers. Anecdotally, Fernandez said, there is a wine-drinking culture among young women and mothers.

There could also be social or behavioral effects, maybe most notably drunken driving.

Socially, alcohol is a disinhibitor, Simpson said. “No drug teaches new behavior. But you become disinhibited and maybe produce behavior that you’re capable of but you restrain for a lot of reasons, legal, social, moral, ethical.”

So what are the solutions?

The study suggests the number of premature deaths could be reduced by enacting “evidence-based, population-level alcohol policies,” such as increasing alcohol taxes or regulating alcohol outlet density.

Simpson said raising taxes will not stop the most significant of drinkers — the 10%, and if there isn’t an alcohol outlet near them, “people have cars.”

Communities already regulate liquor licenses and alcohol already is significantly taxed, he noted. Yet, problems persist.

Simpson has argued more public money should go to treatment programs for people who do not have the money or the insurance plans to pay for it. “Many times, by the time people get to the point where they themselves can actually stop their denial of the issue, they are in that indigency position. They’ve drank themselves out of jobs. They’ve drank themselves out of a family.”

There are good protocols for treatment, but the other limiting factor is people’s willingness to participate. Most people with alcohol use disorders do not want to quit, Simpson said.

Fernandez agrees the treatment system does not match the need. For hospitals, reimbursement for addiction care is not generous so health systems are not incentivized to do it or to do it well.

Further, there is a lot of stigma. The way people talk about addiction is a “huge problem,” she said. “We don’t talk about or think about addiction to alcohol in the same way that we talk about other chronic illnesses, like diabetes.”

It is not binary or black and white. There is a spectrum, from mild to severe, of alcohol abuse disorder.

“I think, often, the words we use and how we label people or how we explain or think about what addiction is can be stigmatizing and also limiting.”