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Drinking data show harsh reality of binge boozing by young and old

But new treatments can help, using genetics and behavior to personalize care

woman holding empty wine glass
Researchers say the increase in the number of people who drink too much alcohol, including women, older adults, racial and ethnic minorities and people who are socioeconomically disadvantaged, is now so high that it's a public health crisis.
Helen Adams | adamshel@musc.edu | January 18, 2018

“It’s almost a hidden epidemic.”

That comes from a worried Raymond Anton, M.D., an alcohol abuse treatment and research specialist at the Medical University of South Carolina. He’s referring to a recent study described in JAMA Psychiatry, showing the rates of alcohol use, high-risk drinking and alcohol use disorder all rose sharply between 2001 and 2013.
 
“Even among young people, the rates of binge drinking are going up, and the rates of women drinking heavily are more like men than they ever were, accelerating. Older people, too,” Anton says.
 
“Everybody sees it all the time. Everybody has a relative, friend or business associate who has an alcohol problem, and for the most part, they don’t want to talk about it. The opiate epidemic has gotten a lot more attention. But if you take the number of alcohol related deaths, it’s way more than deaths from opiates, and people aren’t talking about it.”
 
He’s trying to change that by not only pointing out the problem but also highlighting the growing array of personalized solutions for people who want to cut back on or stop drinking alcohol.

Binge Boozing

The statistics from the JAMA study, which looked at the National Epidemiologic Survey on Alcohol and Related Conditions, are pretty stunning. Comparing drinking data from 2001 and 2002 with data from 2012 and 2013:
  • Alcohol use rose by about 11 percent
  • High risk drinking climbed by almost 30 percent 
  • The rate of alcohol use disorder jumped more than 49 percent 
High risk for women was four or more drinks a day at least once a week, and for men it was five or more drinks a day at least once a week. To qualify as having alcohol use disorder, a person has to meet certain criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders.
 
So why were there such big increases? There’s no single answer.
 
The researchers behind the study speculated that widening wealth inequality and race may be factors, leading to stress and discrimination for some people, triggering more drinking. 
 
Anton points to other possible factors. “As baby boomers retire, they have more time for cocktail parties and might act like adolescents again. Women have undergone major changes, too, in recent decades. As they seek equality across a spectrum of social and economic life, alcohol consumption seems to tag along for some of them.”
 
Dr. Raymond Anton 
Dr. Raymond Anton 
He says drinking is socially acceptable for many people and encouraged by the companies that profit from sales of alcohol. “That has caused people to put their heads in the sand when it comes to seeing heavy drinking as a public health problem.”
 
And the reality is, most people who have tried alcohol don’t have a problem with it. “While 90 percent of Americans have sampled alcohol sometime in their lives, the vast majority control their drinking,” Anton says. 
 
“Despite solid scientific evidence that has existed for 30 years, many people continue to see heavy alcohol use and alcohol use disorder as a failing of will.”
 
It’s not, Anton says. “Science shows it is clearly an acquired brain disease, likely rooted in heredity and genetics.”

Scientific Solutions

Scientists at MUSC are finding new ways to pinpoint what causes people to be vulnerable to alcohol use disorder and which treatments work best.
 
“We’re developing a new treatment paradigm for which medication you should use based on both behavioral traits and genetic structure,” Anton says. “We know considerably more than we did 20 years ago about the brain chemistry and its areas that are affected by alcohol, and how all this leads to craving and relapse. Having that information, we can begin to tailor medication to help people stop drinking and not relapse if they want to stay abstinent.”
 
Yes, he said “if they want to stay abstinent” on purpose. “We need a harm reduction approach in addition to a full abstinence approach,” Anton says.
 
“I chair a public-private work group that’s trying to better understand how reduced alcohol consumption during treatment can improve people’s health and lives. We hope to have discussions with the Food and Drug Administration to have it consider a reduction in drinking approach as a goal for medication clinical trials.
 
“The vast majority of people participating in our alcohol clinical trials over the past 20 years do not have a goal of abstinence but really want to control their drinking. This is reflective of the population at large, and pharmaceutical companies are more likely to develop medication if that’s an endpoint, because that’s what the market is calling for,” Anton says.
 
He says a combination of medication and counseling has the greatest impact. “That’s way more acceptable to the vast majority of people who cannot afford or just don’t want a 28-day inpatient rehab program that for many does not work well once they leave.”
 
Anton says people who struggle with alcohol have a chronic condition, comparable to hypertension or diabetes, and doctors should recognize that. “It requires a different mindset. You might have to be on medication for a sustained period of time, or go on and off like you would for many other diseases.” 
 
As the JAMA Psychiatry study shows, the problem is growing. Anton says researchers continue to develop new, better ways to help. “The treatment of alcohol use disorders will be very different 10 years from now.”

Alcohol under the microscope (The Post and Courier, Sept. 8, 2017)

Study helps predict which teens will abuse alcohol later in life (MUSC News, Jan. 6, 2017) 

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