America is in the middle of a drug epidemic that’s killing an average of 200 people a day. But it’s probably not the one you’re thinking of.

Alcohol-related deaths have doubled this century, going from 35,914 in 1999 to 72,558 in 2017, according to a study of death certificates published in the scientific journal Alcoholism.

The totals combine acute causes — like alcohol poisoning, drunken-driving collisions, falls and drownings — with deaths resulting from chronic causes like liver disease, heart disease and cancer in which alcohol was identified as a contributing factor. The authors caution that these numbers are almost certainly understated because they relied on death certificates that listed alcohol as the primary or contributing cause. Other studies have shown that the contribution of alcohol use is underreported and may not even be known at the time the death certificate was filled out.

Why is this happening? Americans are drinking more.

About 70 percent of Americans age 18 and over consumed alcohol in 2017. By 2017, they averaged 3.6 gallons of pure alcohol per drinker, or more than two standard drinks per day. According to an analysis of six national surveys, the authors estimated that the number of people who used alcohol increased by about 4 percent during the period studied, while the amount each drank increased by 8 percent. The biggest change involved women, who were 10 percent more likely to drink and 23.3 percent more likely to binge drink (four or more drinks at one time) than they were at the start of the century.

Not surprisingly, women accounted for the biggest increase in deaths in which alcohol use played a role. While most alcohol-related deaths still involve men, the death rate for women drinkers is rising much faster, especially for women older than 55. Because women reach higher blood alcohol levels than men of comparable body weight when drinking the same amount, they are exposed to more of the toxic chemicals that cause liver damage, heart disease and some cancers.

What should we do about it?

A century after the start of prohibition, we have some good information about what won’t work. But there are a number of ways to discourage abuse without turning every drinker into a criminal.

The rare piece of good news in the Alcoholism report was that alcohol-related deaths among teenagers did not increase during the course of the study, suggesting that raising the drinking age and other prevention programs have been successful.

There are also lessons to be learned from the fight against tobacco use (even though smoking still kills more people than alcohol does). It’s well established that raising the price of cigarettes through taxes reduces the number of people who smoke. And public information programs, including frank warning labels on tobacco products, also have a positive effect. So does the availability of evidence-based treatment programs that help people stop the  behavior before it kills them.

Some of that is already being done around harmful alcohol use, but as the numbers indicate, not nearly enough.

Findings like these cannot be ignored. Maybe the best place to start is just by admitting that we have a problem.


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