Over 3 million annual deaths due to alcohol and drug use, majority among men
With the exception of fatal injuries caused by alcohol intoxication, drugs (particularly opioids) kill people more quickly than does alcohol. This complicates the ability to draw a clear link between cohort-based trends in the availability and consumption of alcohol among younger adults and subsequent period changes in mortality among older adults. Relative to drug poisoning, the extended period of consumption before the onset of many diseases caused by alcohol provides greater opportunity for intervention before alcohol-induced mortality occurs, as well as greater opportunity for deaths from other causes. In contrast, drug poisoning mortality may be more likely to track contemporaneous trends in the supply of particularly lethal drugs.
Associated Data
Increases in substance-related mortality, while affecting all demographic groups and places, have been larger in some groups and places than others. Various meso- and macro-level structures have had varied impacts on different groups of people and places, making certain individuals more vulnerable to adopting harmful health behaviors and certain places more vulnerable to the infiltration of addictive opioids. The rise in alcohol consumption has been linked to a relative decline in the price of alcohol; alcohol industry efforts to increase the times at which and number of places where people can consume alcohol; the development and aggressive promotion of new alcoholic products, particularly to youth, young adults, and women; and weakening government oversight of alcohol (Freudenberg, 2014). “The age-adjusted death rate for alcohol-induced causes increased 5.1%, from 9.9 in 2018 to 10.4 in 2019 (Tables 5, 10, and I–3). For males in 2019, the age-adjusted death rate for alcohol-induced causes was 2.6 times the rate for females. The rate increased 3.4% for males and 5.4% for females from 2018 to 2019 (Tables 5, 10, and I–3). “ For each year, rates of alcohol-induced deaths for males aged 25 and over were higher than for females.” “● In 2018, there were 67,367 drug overdose deaths in the United States, a 4.1% decline from 2017 (70,237 deaths).
WHO report highlights global burden of alcohol and drug-related deaths
More systematic completion of the MCD section on death certificates would facilitate research on comorbid physical and mental health conditions and on the interrelationships among mental illnesses, SUDs, and suicides. Information from more complete and accurate death certificates could also be integrated into population surveillance, cohort studies, and interventional clinical trials addressing use of drugs and alcohol. As policy makers, state health officials, and physicians began to recognize the dangers of opioids and alcoohol is better than drugs prescribing subsequently declined, prescription opioids became less available and more expensive. As a result, people who had become addicted to or dependent on them (and people with existing heroin addictions) turned increasingly to heroin. This transition introduced a new clientele and created a “thick market” for heroin, lowering its prices, and ushering in the second wave of the U.S. addiction and overdose crisis. The third wave began in the early 2010s with the infiltration of fentanyl into the U.S. drug supply.
- Also needed is greater understanding of how trends (changes) in physical pain and psychological distress (or subjective measures of despair) vary by individual demographic group, SES, and geography.
- These explanations include those that are both proximate to individuals (physical pain, mental illness, ACEs, psychological distress or despair) and those that are more structural and distal (macro-level economic, family, and social changes).
- Similarly, the latest trend in females increased at an annual rate of 14.7% (95% CI 9.1, 20.5) from 2018 to 2020 (Fig. 1).
- In conclusion, this study underscores worsening alcohol-induced mortality in the recent two decades and the need for research to identify its determinants.
- These forces created a “thick market” for heroin (Quinones, 2015), lowering its prices and introducing a new clientele to the drug.
Heavy drinking sessions
Most people who used it experienced a much shorter relief period, leading them to take the pills more frequently. “During 1999–2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR increased in parallel (Figure 2). The overdose death rate in 2008 was nearly four times the rate in 1999. Sales of OPR in 2010 were four times those in 1999.” The combination of that assumption with the methodology change resulted in a dramatically higher cost estimate than previous research had shows. The CDC reports that in 2016, 15,469 deaths involved heroin; 14,487 deaths involved natural and semi-synthetic opioids; 3,373 deaths involved methadone; and 19,413 deaths involved synthetic opioids other than methadone, a category which includes fentanyl.
“Substance use severely harms individual health, increasing the risk of chronic diseases, mental health conditions, and tragically resulting in millions of preventable deaths every year,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. In the absence of clinically validated measures, researchers have used various indicators to measure despair (e.g., hopelessness, optimism, happiness). As elaborated in Chapter 11 (see Recommendation 11-2), the interrelationship between mental and physical health and the implications for mortality trends also require further exploration, as some physical health morbidities (e.g., obesity, diabetes, hypertension) that have contributed to rising midlife mortality rates may also be related to mental health and/or psychological distress.
Rethinking Drinking
Future studies should consider multiple causes of death involving alcohol use (Polednak, 2016). Potential misclassification bias in death certificate data cannot be ruled out, but underrecognition of alcohol use disorders would likely result in lower recorded death rates (Castle et al., 2014). Alcohol use, as the seventh leading risk factor for both death and disability globally in 2016, poses an undeniable threat to public health (GBD 2016 Alcohol Collaborators, 2018). In the USA, it ranks as one of the most prevalent preventable causes of death, https://ecosoberhouse.com/article/how-to-stop-alcohol-shakes-tremors/ trailing behind cigarette smoking, poor diet, and physical inactivity (Mokdad et al., 2004). Chronic alcohol abuse has been linked to a myriad of life-threatening diseases and conditions that amplify mortality risks, such as various malignancies, liver cirrhosis, gastrointestinal complications, and severe cardiovascular and neurological consequences, including stroke (Shield et al., 2013). As a result, an estimated 81.7 percent of Americans ages 12 and over with SUDs do not receive the treatment they need (Huskamp and Iglehart, 2016).
Implications for Public Health Practice
In a presentation to the committee in October 2019, she described how—in a context in which family ties are fragile, opportunities for mobility seem scarce, and social safety nets have diminished—her respondents often had turned to drugs, alcohol, and even food to cope with life’s disappointments, the lack of economic opportunity, and hopelessness about the future. Muennig and colleagues (2018) make the case for a longer-term trend of worsening psychological health in the United States since the early 1980s that spanned demographic groups. Using data from the General Social Survey 1983–2012, the authors examined trends in measures of psychological well-being in the United States, including self-reported happiness and trust in others, whether people tended to be fair, whether parents had a better standard of living, and frequency of sex. Compared with similar data from Australia on the happiness and trust measures, they found a greater decline in overall well-being in the United States, especially toward the late 1980s. They similarly noted declines in subjective ratings of physical and mental health from the BRFSS. Based on their exploratory analysis and the prevailing literature, they concluded that there has been a long-term trend of increasing mistrust and loneliness and worsening mental and physical health across all age, racial/ethnic, and SES groups (Muennig et al., 2018).
“Negative affect” (so sad nothing cheers you up, nervous, restlessness, hopeless, everything was an effort, worthless) showed smaller differences by SES. Moreover, scales of psychological well-being, which Cherlin argued were better measures of despair, showed weak and insignificant SES gradients. Overall, Cherlin suggests that a rising tide of despair is probably an overstatement based on the MIDUS data, concluding that trends in generic happiness, sadness, and life satisfaction differed by SES more so than trends in despair-related psychological and social well-being. Nonetheless, he acknowledges that even if a “rising tide of despair may be an overstatement,” the concentration of declining psychological health among individuals of lower SES is troubling (Cherlin, 2018, p. 7177). Case and Deaton’s 2015 article resulted in massive media coverage and public attention (Cassidy, 2015; Douthat, 2015; Fox News, 2017; Krugman, 2015; Rugaber, 2017; Saslow, 2016; Tavernise, 2016), as well as commentary by scientists (Auerbach and Miller, 2018; Diez Roux, 2017; Erwin, 2017; Scutchfield and Keck, 2017). The notion that the recent rise in midlife mortality was due to increasing psychological distress among working-class Whites accorded with economic, cultural, and societal trends in the United States.
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