Despite high mortality and morbidity, alcohol use disorders remain a silent epidemic in the USA. We briefly explore the high burden of alcohol in the United States and why this burden persists as well as solutions for the future.

The COVID-19 pandemic exposed many problems in global health systems. One such issue in the United States is the silent epidemic of alcohol use disorder. In a previous article Movendi International explored the burden of alcohol in the USA and necessary policy solutions to tackle the heavy alcohol harm.

Some facts about alcohol harm in the United States include:

  • Alcohol use is the third leading cause of death in the country.
  • A study of death certificate data between 1999 and 2017 found the number of annual alcohol-related deaths doubled during this period. Death certificate data is usually an underestimation of the extent of the problem.
  • A 2018 government survey found that over a quarter of American adults reported a binge alcohol use episode in the past month.
  • About 20 million American adults could be having an alcohol use disorder.
  • More people die from alcohol every year than from the entire opioid epidemic.
  • Alcohol accounts for more crime than all other drugs combined.

Despite the high mortality and morbidity caused by alcohol, alcohol use disorders are given much lesser attention and importance compared to the opioid epidemic. This is largely attributable to the fact that opioid overdose deaths are sudden while alcohol deaths are gradual or categorized as other causes. Alcohol can lead to a number of non-communicable diseases including cardiovascular disease and cancer which have gradual prognosis. Alcohol related accidents and injuries are often reported ignoring the element of alcohol. Alcohol use disorder remains therefore a silent epidemic but as statistics show far more harmful than the opioid epidemic.

COVID-19 strains treatment services

In the context of COVID-19, alcohol problems have become even worse in the United States. Reportedly more people are consuming alcohol during the pandemic. Yet support services for people with alcohol problems are lacking. For example,  in 2018, only one in every 13 people who needed substance use treatment in the country received treatment. Matters are made worse, as Medscape reports, by the pervasive misconception among many physicians that no effective treatment is available for alcohol use disorder and dependence; therefore, these physicians do not refer their patients for any kind of treatment.

A report released by the Well Being Trust and the American Academy of Family Physicians predicted the COVID-19 pandemic could accelerate deaths of despair in the United States. Deaths of despair are deaths driven primarily by alcohol harm and drug overdoses, suicides, and liver disease. 

This prediction seems to be accurate as treatment centers are reporting higher numbers of requests for help with alcohol and other substance use disorders during the pandemic. Unfortunately the centers have had to deal with COVID-19 outbreaks thus making it even more difficult to offer services.

Most centers offer virtual programmes for those whose residential treatment gets interrupted due to an outbreak or contracting the virus or being in quarantine. However, this affects the recovery of patients as residential treatment offers in-person therapy sessions, support groups and family visits which become a challenge in virtual systems.

A groundbreaking new report reveals the lethal interaction between alcohol and the coronavirus crisis, showing how alcohol weakens the immune system, drives to other health conditions that increase the risk of COVID-19 infection and how alcohol burdens the health system; it also shows which policy responses do not work and which alcohol policy solutions actually do help in containing the pandemic; it illustrates how the alcohol industry is pushing to exploit the current public health crisis for their profit maximization; and the report makes a number of compelling recommendations – these would surely be applicable and impactful in the US context.

Alcohol policy falls short

The existing alcohol policy in the US falls short in effectively addressing the heavy alcohol burden. In addition, a recent report by Vital Strategies exposed how governments perversely incentivize the alcohol industry which causes a high rate of death and disability globally. The USA is no exception to this.

Even though excise taxes exist for alcohol, studies have proven they remain insufficient. A study from Boston University School of Public Health published in the Journal of Studies on Alcohol and Drugs found inflation has reduced American alcohol tax rates by 70% since 1933. Despite this, in December 2019, the United States Congress incentivized the alcohol industry by extending the major tax break to the industry, losing billions of dollars in government revenue.

What can be done?

To ensure that those who need support receive it, early identification and brief intervention needs to be strengthened in primary care systems. There is a necessity for increased investment in supporting recovery and increasing awareness and access to available resources.

To ensure prevention of alcohol problems, awareness about the real effects of alcohol must be increased while population-level alcohol policy solutions need to be improved. The World Health Organization’s (WHO) SAFER package includes five high-impact strategies that can help governments to prevent and reduce alcohol harm and related health, social and economic consequences.

Solutions to tackle the alcohol use disorder epidemic in the United States exist. What is necessary is the prioritization of action to tackle the alcohol burden and high-level political leadership to make alcohol policy the priority it should be.


Recovery Review: “Alcohol Use Disorders– the Silent and Common Killer Amongst Us

Medical Xpress: “COVID-19 has more people seeking help for addiction and mental health. But treatment centers struggle with outbreaks