Busting the flashy car for 75 mph to let the 250 mph Peterbilt pass

The public relations approach to hiding an alcohol pandemic

In opioid news this week, state attorneys general across the country are stepping up their game against the opioid crisis. Awhile back, the AGs sent letters to insurers, asking them to do more to curb the opioid epidemic. Now, they say they're expanding an ongoing investigation into pharmaceutical companies make or distributing opioids. That's according to MedPage Today. The publication also reports the Substance Abuse and Mental Health Services Administration (SAMHSA) offered up an additional $144 million in grants for preventing and treating opioid addiction … a crisis costing the economy $78.5 billion a year.

That's correct. Opioid use and addiction costs the U.S. $78.5 billion.  

Alcohol use and addiction costs the U.S. $250 billion a year, using the same measurements of health care costs, lost productivity, and legal system expenses.

We focus on an epidemic, so we don't have to focus on a pandemic. The 75 mph 'vette gets the ticket. The 250 mph Peterbilt gets a pass. Classic PR.

The public relations tactician works it something like this: 

Pick a drug – One that is sold only by prescription, generating profit for a few, wealthy souls vs. a drug sold nearly everywhere in the U.S., generating profit (and tax revenue… but not as much as you think) for every restaurant, bar, retailer, grocer, hotel, gas station, henhouse, outhouse, and doghouse where it's sold. Villify alcohol? Not on your life.

Draft in support – According to FollowTheMoney.org, Big Pharma contributed $163 million to local, state, and federal candidates in 2016… alcohol interests (manufacturers, distributors, retailers) donated $219 million. Don't bite the hand.

Choose an opponent you can outspend – BusinessInsider.com put beverage alcohol spending at $421 million in a single calendar quarter. Every one of those ads tells Americans we can drink a toxin and known carcinogen 'responsibly.' You're not going to run with these big dogs. Stay on the porch.

Capitalize on ignorance – Fewer than 1 in 10 Americans know that alcohol kills three times as many people as opioids (89,000/yr. vs. 30,000/yr). Less than 1 in 4 know that alcohol's a carcinogen and a third of the 22,000 annual alcohol-related U.S. cancer deaths occurred in people who had downed one and a half drinks a day or less. Alcohol is legal. Legal equals 'safe' in our society. Except for those nasty drunk drivers, binge-drinking college kids and hard-core, red-nosed alcoholics, this isn't a drug: It's responsible and fun in moderation. Opiates and opioids are controlled substances, illegal without a prescription, and have a high risk of addiction and/or overdose. Nevermind the medicinal relief in chronic pain situations: Opioids are definitely the baddie.

Don't make them think, either – There is a short line between opioid use and overdose death. Drinking alcohol is more like stepping out onto the highway and waiting for the Peterbuilt to hit you: It could take years or decades. Too many dots to connect – and other causes to which to pin the death while you're waiting. Brevity is better in our 'always-on' planet. A recent Pew Internet study in the US suggests that people benefit from instant access to a wealth of information from numerous sources, but their attention span and desire for in-depth analysis is consequently diminished. That's how we got the term bounce rate. “If you start a message and I can't see the end from the beginning, I will find it elsewhere… and bounce.” Opioid tragedies tell what time it is… alcohol deaths tell how to build a watch.

Sell the sizzle, not the steak – There are 91 deaths a day from opioid overdose. Opiates and opioids take lives in a single-dose for some people. And sadly, the lives are often kids and young adults that society wouldn't have picked out as a drug user. The old newsroom saying was, “If it bleeds, it leads.” Crass and cynical? Yes. Accurate? Pretty close. Stories of an honor student dying are tragedies with great images on par with hurricanes, school shootings, and blazes… compared to someone dying a death from alcohol-related illness like heart attack, stroke or cancer.

Wag the dog – We have a genuine health crisis. The opioid problem is real and tragic and a worthwhile fight. Now, if we turn a genuine health crisis and spin it up to an epidemic… maybe we don't have to talk about a pandemic or other health crises like fetal alcohol spectrum disorders (FASDs) which are now more prevalent than autism. It's the sleight of hand performed by politicians, PR wags, confidence men, and magicians for millennia: Watch what I do with this hand, while the other takes your wallet. Or your health. 

And, most importantly of all, don't make enemies – According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.1 percent reported that they drank in the past year; 56.0 percent reported that they drank in the past month. Even if you went with the lowest figure, 56 percent of adults used alcohol in the last thirty days. That's 137 million adults. By American Society of Addiction Medicine (ASAM) stats, 2.5 million adults have substance use disorder involving prescription pain relievers or heroin. You've got a good shot at convincing me something is bad if you're not doing it. You're even more effective telling me something is bad if I'm not doing it.

It's not the back bumper of the Peterbilt that hits you

What we've got here, is failure to communicate: There's a drug acceptance problem in the U.S. There's not just an opioid overdose crisis. There isn't only an alcohol pandemic. There isn't a weed legalization debate. The problem is cultural in the way we normalize drug use, stigmatize those who've become ill from them, and throw too little money, too late, at treatment instead of prevention. Did any alcoholic become alcoholic without taking the first drink? Is any case of alcohol-related injury or illness possible without a first drink? Giving a 'gateway drug' a free pass negates prevention efforts on other drugs we find less 'responsible.'

No amount of PR is going to paper over it for long before it becomes fiscally unsustainable.

Scott Stevens, is the author of four alcohol books including the December 2016 release, I Can’t See The Forest With All These Damn Trees In The Way: The Health Consequences of Alcohol. Get the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere you buy books.  Click Alcopocalypse for the author’s 2017 Alcohol Awareness Month whitepaper. Image by  Peter Lecko, used with permission.

Alcohol, addiction, education… and the barbarians at the gate

(Originally on Addicted Minds)

Archaic, or ancient, Greece saw unequaled advances in art, medicine, poetry, science, technology, and philosophy. Before this period, around 800 BCE, people lived scattered in small farming villages. Around 1,000 BCE, villages grew. People became closer. Some villages built walls. Most built a market and a community meeting place, developed governments, and organized their citizens according to some of laws. It was the rise of the city-state humankind, being social creatures, was destined to populate. What did we know in Archaic Greek times? That alcohol is a toxin and some of our neighbors were no damn good when they drank alcohol. You couldn’t witness either when people were nomadic or living is sparsely populated villages.

Here are two important factors in which to frame the discussion of this drug:

A) Alcohol is a mood-altering drug. Case closed. Every physical and mental health professional since Hippocrates knows this clinically if not from personal consumption. This fact has been undisputed for millennia or the human race would have abandoned the relationship with this toxin and known carcinogen before the rise of the first city-state, Sparta.

B) Today exists a mountain of conclusive evidence that it is a mind-altering drug, impacting at the molecular level the organ that houses it, the brain. Evidence-based research in the later half of the 20th Century has demonstrated it damages or destroys other organs and tissues as well.

So why is this drug still so widely used today? Go back to A. It’s damn effective. Alcohol users, advertisers, brewers, distillers, and economic engineers who insists on alcohol’s pertinent role in commerce will do anything to preserve the dominance of A over B. There is no amount of wishful thinking, junk science, or fantasy those with a vested interest in alcohol use won’t embrace to preserve the status quo. Follow the money behind every observational study appearing in mainstream media in favor of this drug’s use – theorized health benefits, for example – and here’s who you’ll find writing the check: Alcohol users, advertisers, brewers, distillers, and economic engineers who insists on alcohol’s pertinent role in commerce.

Not physicians. Not mental health professionals.

David v. Goliath

It’s not that people trust ads more than doctors as much as that human nature supports keeping doing what we’re doing. Change isn’t on fleek.

What this spells is out is the David v. Goliath battleground onto which every puny addiction professional trods every day. Helping professionals aren’t just trying to reach an altered brain with no interest in stopping A. They also battle a culture, family, friends, and economy that are so immersed in A that they’ve become alco-centric when it is killing clients.

Nobody seeks out a helping professional because they want change. They seek out to keep doing what they’re doing and just feel better about doing it. I wrote that for 2012’s Every Silver Lining Has a Cloud in respect to how addiction runs counter to common disease procedure. When I have a tumor, I ache. So I see a professional to change. When my blood sugar is out of whack, I’m lethargic and achy. So I see a professional to change. When I am drinking, I feel crummy only when I stop. So I don’t really want to change because I don’t feel achy when I do it. To put it another way, when a physical system driven by the brain becomes dependent on a drug that alters the brain, the physical system is at dis-ease when it’s NOT getting the drug. The defense mechanisms to preserve A come out in full force despite B.

That alone is reason enough why addiction treatment isn’t immediately effective. Throw in alco-centric attitudes in society telling everyone ‘moderation is safe and even healthy’ and Goliath has an AR-15 compared to David’s slingshot. That’s why it sometimes takes two or four or fourteen kicks at the cat to make the transition to long-term recovery.

Succeeding against drug use requires a talented professional or para-professional who can battle through the defense mechanisms to demonstrate the consequences of B outweigh any benefit of A. That’s the case-by-case victory everyone in this profession takes on daily. A larger battle stays largely unfought. We fight tooth and nail to save the life of someone addicted, but expend very little energy in preventing use in the first place. It isn’t a desire to preserve job security that addiction pros will always have someone to save. Instead, it is unwinding centuries of accepted use of the drug that predate Sparta by about four thousand years.

Barbarians at the gate

We’ve already convinced most of the 7.5 billion people on this rock that this drug is ok, safe, fun, ceremonial, and celebrated. So what if some will use it and become addicted to it… it’s good for the economy, healthy, and a rite of passage. We fix the addicts or cast them out. We don’t prevent them from using the drug in the first place.

Have we created the same aura of safety around cocaine? A little use is ok… more, not so much? Is there a meth bar on Main Street? Have we identified a moderate use of heroin? Do we have crack and smack ads? What is the suggested daily intake of tobacco smoke as part of a healthy diet, two Pall Malls? No. Preposterous. We have prevention education that talks about health consequences beyond addiction or car wrecks for those drugs.

We lack meaningful prevention education for the world’s deadliest drug, alcohol. Alcohol advertisers provide their own at $1.5 billion a year.

The ‘alcohol-is-the-antidote-for-wellness’ message has been out there for decades on page three (if covered at all) buried behind the slick alcohol ads and front-page, above-the-fold article on alcohol health promises and underneath the announcements for the church beer tent at the fall festival. For the last 36 months, in fact, alcohologist.com has tracked that for every pro-alcohol study mention in an article on Google (109 studies, 10,419 mentions) there were three evidence-based research projects (320 studies) on adverse health consequences of alcohol released… but a 10th of the mentions (1,022).

Where the dialogue is moving is that it is not just the addicted who become sick. Every user faces an increased risk of physical illness and disease from any use of the drug. Even moderate users.

Prevention of alcohol use disorders starts with prevention of alcohol use. It is the same tape the tobacco industry has heard for the last two decades: We prevent substantial loss of life and productivity by keeping people from smoking in the first place. We still make cigarettes. And we’ll still make alcohol, even when it isn’t glorified any longer.

The tide began to turn against tobacco in 1964. The U.S. Surgeon General issued a landmark report on health problems related to a very popular thing to do: Smoking tobacco. Thirty-four years later, the U.S. had the unprecedented Tobacco Settlement, capping a shift in education. The anti-tobacco sentiment took 34 years to soak in sans the internet. Last fall, the U.S. Surgeon General issued a landmark report on the health problems related to a very popular thing to do: Drinking alcohol. The public sentiment toward the drug is beginning to shift as indicated in this very clear signal to change the current alcohol policy costing the U.S. economy $250 billion a year.

It won’t take 34 years this time.

To the citizenry of Archaic Greece, a barbarian was anyone who was not of their extraction or culture. Because these ‘strangers’ regularly challenged Greece’s established ways, ‘barbarian’ gradually evolved into a negative term… only because the history books were written by Greeks. The truth is that they were far from barbaric and they were actually enjoined with the Romans, who took over the joint. Those who challenged the established Greco lifestyle were of nutty acts and opinions, not welcome, and kept outside the gates… no matter what their beliefs… only because they didn’t drink the same KoolAid as the Greeks.

A weird bit of irony, the story of the leveraged buyout of RJR/Nabisco (a major tobacco stakeholder) is entitled Barbarians at the Gate. The real moment the barbarians arrived on the tobacco doorstep was the 1964 Surgeon General’s Report. The 2016 report is a barbarians-at-the-gate moment for the alcohol industry. The Surgeon General fired the starting gun for practitioners who have not already incorporated prevention into their practice to do so today and be at the forefront of change the way the American Legacy Foundation – today known as the Truth Initiative – is at the forefront of smoking education and prevention.

In 1967, 72 percent of adult men smoked. Today, 72 percent don’t. Those who challenged at the gates of the establishment won the public dialogue with facts. The same ones we all have at our disposal. Remember, Greece fell because the Romans outGreeked the Greeks. The ‘barbarians’ made the thing better than being Greek was being a non-Greek. As we figure new dimensions in treating alcoholism, we need to establish that the only thing better than being a drinker, is being a non-drinker.

Addicted Minds’ Editor-in-Chief, Scott Stevens, is the author of four alcohol books including the December 2016 release, I Can’t See The Forest With All These Damn Trees In The Way: The Health Consequences of Alcohol. Get the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere you buy books.  Click Alcopocalypse for the author’s 2017 Alcohol Awareness Month whitepaper. Image by Kevin Carden, used with permission.

Photo by Remy Musser, used with permission.

The Sobriety :60 - Alcohol and healthcare costs

Twenty to 40 percent of general hospital beds are used for managing alcohol-related health complications.  Here's a minute on the top driver of healthcare costs. Episode #5 - Healthcare Overhaul can be found at http://youtu.be/j7Xif-Azh0g

Visit alcohologist.com for a replay of the Bringing Inspiration To Earth show feature with Scott Stevens. Lucy Pireel's "All That's Written" included a feature on Every Silver Lining Has a Cloud called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud also can be found on www.alcohologist.com, plus an interview with Scott Stevens on Health Media Now and one at Christoph Fisher Books.  Mr. Fisher is an acclaimed international author from the UK, among his works is the Alzheimer's book "Time to Let Go."  

FASD Awareness Day 9/ 9: Fetal alcohol syndrome more common than autism

The date 9/9 is a reminder to women who are or may be pregnant that during the nine months of pregnancy, there are significant and life-long risks due to alcohol for the child they carry. The Substance Abuse and Mental Health Services Administration (SAMHSA) has enhanced its message about Fetal Alcohol Spectrum Disorders (FASD) each year since the 9/9/99 observance of FASD Awareness Day.

Fetal Alcohol Syndrome (FAS), the most recognized condition in the spectrum, now outranks Down syndrome and autism in prevalence. A child is born with FASD every 4 1/2 minutes.

According to SAMHSA, women with the disease of alcoholism are not the only ones risking fetal development: Even infrequent social drinking is dangerous. "There is no known safe level of alcohol use in pregnancy." 

When an expecting mother drinks, the alcohol is passed directly to the fetus. The unborn will have the same blood alcohol concentration (BAC) as the mother, but lacks the ability to process the alcohol the way an adult does, so the BAC remains high for a long time. The alcohol causes a number of physical, cognitive, social and neurological problems in the infant that are permanent and irreversible. Alcohol also can kill a fetus.

FASD is a broad category conditions including FAS, alcohol-related neurodevelopmental disorder and alcohol-related birth defects. In the United States, about 130,000 pregnant women each year drink at levels shown to increase the risk of having a child with an FASD, according to the Center for Disease Control and Prevention (CDC). As many as 40,000 babies are born with an FASD annually, costing the U.S. up to $6 billion annually in institutional and medical costs. Costs of FAS alone are estimated at between 1 and 5 million dollars per child. This estimate does not include cost to society, such as lost productivity or incarceration, nor does it factor in the burden on families and poor quality of life.

Physical deformities (facial abnormalities, fused joints, organ problems) are one of the more obvious consequences of prenatal exposure to alcohol. However, the development of the brain is of particular concern. The brains of FASD babies are measurably smaller than otherwise healthy babies. Resulting impairments may include:
• Mental retardation
• Learning disabilities
• Attention deficits
• Hyperactivity
• Problems with impulse control, language, memory, and social skills

The brain and nervous system are among the first to develop, beginning around week three of pregnancy when some women may not even realize they're expecting. In the U.S. 1 in 2 adult women reports any alcohol use in the past month: Some women might not even know if they're pregnant 30 days after conception. For those who know they're pregnant, SAMHSA's stats are cause for concern. One in 30 pregnant women drinks at levels shown to increase the risk of FASD and more than 20 percent of pregnant women report alcohol use in the first trimester. The latter number drops to five percent in the third trimester.

A 2004 University of Washington study found that children born with FASD have a lifetime of difficulties. More than 90 percent had mental health problems, 83 percent experienced dependent living into adulthood, 80 percent had employment problems as adults., 6 in ten of those age 12 and older had trouble with the law and more than a third had had alcohol and drug problems.
SAMHSA notes that protecting babies from alcohol goes beyond pregnancy. "When a woman uses alcohol, her baby does, too. That’s why abstaining from drinking throughout pregnancy and during breastfeeding is the best gift a mother can give her child—it’s a gift that lasts a lifetime."

FAS, a diagnosis that first gained national attention in 1973, has four major components:
• A characteristic pattern of facial abnormalities (small eye openings, indistinct or flat philtrum between nose and mouth, thin upper lip)
• Growth deficiencies, such as low birth weight
• Brain damage, such as small skull at birth, structural defects and neurologic signs, including impaired fine motor skills, poor eye-hand coordination and tremors
• Maternal alcohol use during pregnancy

The SAMSHA message is abrupt, but clear. "FASD is 100 percent preventable. If you get pregnant, don't drink. If you drink, don't get pregnant."
-- from examiner.com 9/7
www.alcohologist.com

National Recovery Month: Five things to know about quitting alcohol

When a person recognizes there’s a problem with his or her drinking, it's usually followed by promises (often broken) to quit or cut back. Quitting or cutting back can be as life-changing as pledges to lose weight or goals for getting a new job. Here are five things to know about drinking, quitting and staying sober during Recovery Month, a national observance throughout September to educate Americans on how treatment can enable those with an alcohol use disorder to live a healthy and rewarding life.

1. Alcohol abuse and alcoholism are not the same thing, though are often treated as such. The newest version of the Diagnostic and Statistical Manual (DSM 5), the clinicians' diagnostic guide for related disorders, categorizes them together, but the conditions are different. Cutting back on alcohol consumption may be a practical outcome for an alcohol abuser. If a person has the disease of alcoholism, total abstinence is the only way to put the disease into remission. (Know the difference between alcohol abuse and alcoholism?)

2. Nine out of ten people who quit drinking fail to stay sober the first time they quit. More than half drink again within six months. Set your expectations accordingly. Lapse or relapse or slips are as likely with alcoholism than with any other disease. They are not the end of recovery. It just means you have another chance to quit. One man, who might be the most famous alcoholic ever, lapsed four times in 22 months. He quit a fifth time though. That’s Bill Wilson, one of the founders of Alcoholics Anonymous (AA).

3. AA is not the only game in town. There is rehab if you have the resources or insurance, either inpatient or intensive outpatient. There is counseling, either one-to-one or as part of a group… there are also several other self-help groups, such as Self-Management and Recovery Training (SMART), Secular Organizations for Sobriety (SOS) and Women for Sobriety (WFS). None of the latter enjoys the widespread availability of the 12-step program of AA however. Those who have success in sobriety acknowledge one common thing: No one gets sober and stays that way without help, whether through counseling or self-help groups or both.

4. A chronic, heavy drinker should never attempt to stop drinking on his or her own. Alcohol is the only drug aside from benzodiazepines (think Valium) in which the withdrawal can be fatal. Heroin withdrawal is not fatal. Cocaine withdrawal is not fatal. Alcohol withdrawal can be. Alcohol changes the body tissues. Once the tissues become dependent upon alcohol, it is possible that taking the alcohol away will cause cardiac arrest, stroke or seizures. Supervised detox means medical assistance is nearby and nearly all supervised detox involves medication to ease the physical discomfort of withdrawal, which increases the probability for success.

5. Changing a habit takes three to four weeks, which is one reason many inpatient rehabs have a 28-day program. But that isn’t nearly the end. More severe alcoholics are barely medically stable after just a month. It takes effort – some days more than others – for the first year of sobriety, and an acknowledgement that alcoholism is not curable so the change will mean making adjustments for the rest of one’s life. Alcoholics and non-alcoholics alike return to alcohol for the same reasons of stress, grief, guilt or shame. Getting sober and staying sober only begins with a desire to stop drinking and getting some help in the first part of abstinence. The rest of recovery is learning to live without alcohol for those stressors.

National Recovery Month, now in its 24th year, is an initiative started by the Substance Abuse and Mental Health Services Administration (SAMHSA).