Bartending comes with more than a few occupational hazards. Three, though, immediately come to mind: 1) The hours are late; 2) You’re on your feet for up to 12 hours at a time; and 3) You’re surrounded by alcohol.
It’s the last one that gives me pause when I go to the doctor and I’m handed the survey that covers my basic health risk — e.g., sexual activity, drug use and cigarette intake. In particular, I have to stare long and hard at the question, “How many alcoholic beverages do you consume a week?”
The answer is always too many.
While I’ve never had an addiction to alcohol, I definitely classify as a binge drinker (that is, drinking to the blood-alcohol content of 0.08, the legal limit at which you can be arrested for a DUI, in two hours or less).
Sadly, that makes me very American. In fact, according to a study published in JAMA Psychiatry last fall, there are enough binge drinkers in the U.S. for it to be considered a public-health crisis. Specifically, the study pulled data from face-to-face interviews with nearly 80,000 American adults — about 43,000 between 2001 and 2002 and just over 36,000 between 2012 and 2013 — and compared answers to questions about drinking behavior. “Substantial increases in alcohol use, high-risk drinking and DSM-IV alcohol use disorder portend increases in chronic disease comorbidities in the United States,” it soberly reported (yes, pun intended).
To clarify, comorbidities are simultaneously occurring chronic diseases in the same patient — common ones include Hepatitis C or HIV and addiction to heroin, as well as depression and cancer. Such comorbidities have a fairly simple cause and effect: Cancer causes many people to become depressed; sharing needles to inject drugs can cause someone to contract Hepatitis or HIV.
With binge drinking, comorbidities can be present at both ends of the spectrum. Or better put, the relationship between mental-health issues and substance abuse is highly symbiotic. For instance, people with anxiety, depression and other mood disorders are nearly twice as likely to be addicted to drugs compared to the general population. The reverse is also true: People addicted to drugs are more likely to develop anxiety and depression.
Taken together then, the prognosis isn’t great, with the JAMA Psychiatry study predicting that as levels of problematic drinking continue to increase, the more people will die of alcohol-related diseases like cirrhosis. “We’ve been charting what we call alcohol-related emergency room visits, overdoses and alcohol-related hospitalizations — surrogates, essentially, for binge drinking — and there’s been a steady increase in all three of those areas in the U.S. over the last 10 years,” says George Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). “And we’re seeing younger and younger people seeking liver transplants because of alcohol-related cirrhosis.”
But wait, it gets worse. Also in 2017, Trust for America’s Health, a nonprofit focused on preventing epidemics and advancing the country’s mental and social health, published “Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy,” a report documenting the intersection of those three things (i.e., drugs, booze and suicide). “In 2015 alone, 127,500 Americans died from drug- or alcohol-induced causes or suicide,” it read. “That is 350 deaths per day, 14 per hour, and one person dying of a preventable cause every four minutes. Projections say it will only get worse.”
More largely, in 2015, Princeton-based economists Anne Case and the Nobel Prize-winning Angus Deaton published a study examining a disturbing trend: Mortality rates in the developed world have been declining steadily, for all populations, over the past 30 years, except in the U.S., where white males without a college degree between the ages of 45 and 54 have been dying faster than they have in decades.
What exactly is killing them? Overdose, suicide and alcohol-related liver failure. So much so that these causes of death now outnumber deaths by cancer and heart disease, the two historically largest killers of men in this age group.
Case and Deaton called this surge in substance-related mortality “deaths of despair,” linking them to poor economic conditions and citing a lack of education as a barrier to lucrative employment. Since then, however, it’s become abundantly clear that no one — regardless of sex, age, race, income or education level — is faring well when it comes to death by alcohol-related causes. “We’re seeing the narrowing of differences in drinking between men and women — with women drinking more. We’re also seeing men and women 65 and older showing increases in binge drinking as well,” Koob explains. “Similarly, there’s been an increase in problems on college campuses with the same issue — where deans and provosts talk about young people aspiring to drink to blackout.”
This isn’t to say economic factors don’t play a part. The opiate crisis is still an epidemic in poorer regions of the country, like Appalachia, where nearly 20 percent of the population lives below the poverty line, and where, in 2015, inhabitants were 65 percent more likely to die of an overdose than those living outside of the region.
As for how we kick our national binge-drinking problem, the “Pain in the Nation” reports (a follow-up was published in February) call for a National Resiliency Plan — basically, a comprehensive approach covering prevention, early identification and treatment. Not to mention, an old public-health standby: “Policies for moving health insurance and healthcare systems to provide better behavioral and physical ‘whole health’ of individuals.”
Koob and the NIAAA are also launching their own initiative, what Koob terms a “Noah’s Ark Committee.” “We’re taking from everywhere — sociologists, cultural anthropologists, pediatric researchers, individuals who focus on adolescents,” he explains. “We’re gonna cover all the bases and start to work up which questions we should be asking to determine where we should focus research in this domain.” (The committee is being formed now; Koob plans to launch the initiative in October.)
In the meantime, the NIAAA has a whole site dedicated to rethinking how we drink. It covers covers everything from what counts as “a drink” (martinis and Manhattans and many other cocktails, for example, are more like two drinks); to how much is too much (problematic drinking for men is more than four drinks on a given day or more than 14 drinks a week, and for women, more than three drinks a day or more than seven a week); to tools for making a change (avoid people and places that make you want to drink and have a quick and firm “no, thank you” at the ready).
The site aims to emphasize that drinking in general isn’t a problem, it’s how much of it (and how quickly) you’re doing it. “We don’t know what’s causing this,” Koob says. “It could be anything from general dystopia to economic factors, but there’s also a cultural piece. One of the things we do in our country is we extol people who can drink everyone else under the table. That sends a very bad message.”
Because if it wasn’t before, it’s definitely now abundantly clear that drinking someone under the table also means drinking them (and yourself) into an early grave.