Look What Dragged the Cat In: The rise of an opioid crisis

Excerpted from the 2018 USA Best Book Winner, Look What Dragged the Cat In.

The decade of the 2010’s shelled hospitals and first responders with an explosion of opioid-related illness, injury, and death. Preventable drug overdoses tallied 54,793 lives lost in 2016 – an increase of 391 percent since 1999. Accidental drug overdose deaths increased 327 percent over the same period. The majority of OD deaths (38,000) involve opioids, The drug category most frequently involved in opioid overdoses and growing at the fastest pace includes fentanyl, fentanyl analogs, and tramadol. The fentanyl category of opioids accounted for nearly half of opioid-related deaths. The dirty cat in the litter, heroin, accounted for the second highest number of deaths, claiming 14,606 lives.

America struggles with what the opioid cat dragged in: Hard-to-treat opioid addictions, fatal relapses, and needless loss of mainly young lives. Now legislators, first responders, treatment pros, and those in the medical field are forced to focus not on the death toll the cat dragged in, but instead what dragged the cat in.

Every opioid related death is alcohol related

The abuse of drugs, regardless of classification, begins with the permissiveness granted the world’s most lethal drug and third-leading cause of all preventable deaths: Alcohol. It’s a straight line.

Nearly every non-Muslim civilization on this rock has embraced alcohol. As a result, ours is largely a numbing planet, especially in the sedation-happy Americas. This is the root. This is the seed of the opium trade that has gone unstemmed since prehistory. There is legit medical use for opium derivatives: What has driven growth is demand – not by the sick but by people who cannot get the mind alteration they desire through alcohol use alone.

Alcoholics and non-alcoholics alike drink the first drink for the same reason: To relieve a stress. In the U.S., which has a laissez faire agenda toward alcohol since its prohibition failure, the culture embraces a drinking lifestyle. Americans normalize alcohol use. In other words, Americans (like many cultures) normalize drug use. The 1960’s have nothin’ on the 2010’s.

What you ignore, you permit. What you permit, you condone.

Opioid abuse happens when a person can’t get where they want to get with alcohol. The opioid crisis wasn’t created by doctors overprescribing, manufacturers wooing doctors, China shipping heroin and cheaper fentanyl via cartels and the U.S. mail. Drinking, especially binge drinking, is the pandemic that dragged in the opioid ‘epidemic.’ Americans condone the buzz, the sedation. We created this monster on our own.

What’s the way out?

Legislative attempts to curb use of potentially lethal drugs resemble shooting an arrow and then drawing a target around where it hit. Locking up dealers and traffickers, creating prescription databases and prescribing limits, and promoting Narcan availability all deal with control of the supply and its aftermath. The demand is unchanged. Within a cultural adoration of the buzz, our current crisis can only be curbed by control of the demand. If a drug user wants a drug, theywill get that drug. It’s the American freedom thing.

In 1967, 72 percent of adult men smoked. Today, 72 percent don’t. Prevention works. If there is genuine interest in healthy outcomes and preventing premature death from opioids, Americans’ permissiveness of the starter or feeder or gateway or predecessor drug has to be addressed on five levels to reduce demand for all antecessor drugs.

• Advertising agencies court alcohol manufacturers with a promise of creating demand for the drug. You can ban advertising without banning the product. When cigarette marketing/advertising was banned, demand dropped without banning the product. The National Bureau of Economic Research (NBER) studied bans in 20 countries over 26 years. The results indicate that an increase of one ban could reduce alcohol consumption by five to eight percent.

• Public drinking encourages drug use. Smoke-free regs cut down on the demand by curtailing where cigarettes can be smoked. Applying the same model for drinking – instead of popping up a brew pub on every corner – can reduce demand. The idea of having a cocaine bar on every corner is absurd, but a pub peddling a drug that kills more people (89,000 Americans per year) is somehow acceptable. The availability of alcohol can be regulated either through restricting the hours or days it can be sold or by reducing the number of alcohol retail outlets, according the a World Health Organization (WHO) study. Logicaly, reduced sales hours have been found to be effective in lowering consumption. In the former Soviet union in the mid-1980s, strict alcohol regulation, which included among other measures restricted hours and fewer outlets, led to a dramatic reduction.

• The ‘Smoking Stinks’ campaign brought an anti-smoking message down to the earliest grades. A modest effort to create similar anti-drinking messages demonstrating health risks of even moderate use (see viewbook.at/prehab) will stunt demand by discouraging the very first drink of the gateway drug.The American Journal of Public Health analysis of the anti-smoking campaign suggests that per capita consumption would have been one-fifth to one-third larger than it actually is, had the years of anti-smoking publicity never materialized.

• Increase the tax on the gateway drug. The bottom line is that many states and municipalities balance their bottom lines with so-called ‘sin taxes.’ The sin taxes on alcohol haven’t kept pace with inflation. These taxes are usually based on the amount of beverage purchased (not on the sales price), so their effects can erode over time due to inflation if they are not adjusted regularly. The Community Preventive Services Task Force (CPSTF) recommends increasing taxes on the sale of alcoholic beverages, on the basis of strong evidence of the effectiveness of this policy in reducing excessive alcohol consumption and related harms. Opioid use is a related harm. The CPSTF is an independent, non-federal panel of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and other interventions aimed at improving population health.

• Many will argue that legalizing recreational use of marijuana will reduce opioid abuse and erroneously point to Colorado as an example. (By the Center for Disease Control and Prevention’s (CDC) numbers, you can call BS: Colorado’s death rate from opioid overdose is barely in the top half of the state-by-state death-rate comparison … if you wanted to complete the morbid, pointless comparison. One death is too many.) What’s entirely missing from the debate is that no evidence exists that encouraging recreational use of another drug furthers public health in general. Marijuana is revenue-neutral when you subtract societal, medical, and legal costs.

When we rethink the drink we can douse the pandemic that begat the current opioid crisis. Legislators and treatment experts must lead the transition from managing aftermaths of the current crisis to prevention of the next one. And phase out the ancient alcohol crisis – the elephant in the room – America ignores.

Stevens is author of four alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He will Chair the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France.

Don't become an ugly Christmas sweater: Dodge the holiday minefields

It'll come to you...

Relapse traps sneakily pop up on any page of the calendar, but the 63 days between Halloween and New Year's Day can be the trickiest gauntlet to run. Sequestering in a bunker? Not an option. Here are nine tips for not sweating the season of celebrations:

1) Stay out of your medicine chest. Cough and cold season is here. It's especially easy to overdo the cough meds. In typical addict fashion, the think the dosage on the label is only a suggestion and if a small amount works, the whole bottle will really kick the symptoms to the curb. Not so. And the little buzz from an OD of the over-the-counter drug can lead back to the drug of choice.

2) Stay out of your medicine chest: Part II. Another relapse trap in the medicine chest is sleep aids. With the time change and extra holiday-season stress, sleep is a casualty of the calendar. Alcohol is a depressant. Sleep aids are depressants. The brain doesn't make such an exact distinction between the two and, historically, drinkers have used alcohol as a sleep aid – or excused their drinking by saying it helps them sleep. It isn't just the prescription sleep aid like Roseanne's favorite, Ambien. It's also the OTC one, and especially concoctions like Motrin PM or Tylenol PM.

3) Find sober celebrations. Not as rare as you might think. If you're timid, take someone along with you who might be even newer to sobriety. If there aren't celebrations, it could be time for a diversion like a museum or pick a dry theater and watch The Last Jedi. All the older kids are doing it.

4) Bail out. There is nothing wrong with the word 'no.' We were all pretty creative with excuses for our drinking. If you are even slightly apprehensive about an event, put the same creativity to use for why you can't go. And if you're busted telling a little white one… isn't it better than possibly challenging your sobriety? Real friends understand.

5) If you can't bail, bring candy. Seriously. Satisfying an oral fixation can make a difference. The taste on your palate will make alcohol flavorings less inviting, too. If you've ever had a beer on top of a candy cane, you know.

6) Never stay late if you do go. Our reputations as the last soldiers standing – gone. Be the first leaving. Everyone has seen a dreaded morning after, or the photos of the night before, and uttered the words, 'I shoulda left way earlier.' The more tired you get, the weaker your defenses become. My grandmother's rule was that nothing good ever happens after 10 p.m. anyway.

7) Go help another alcoholic who might be struggling. The twelve-steppers founded their fellowship on this simple act. Even if you're not a twelve-stepper or vow to never become one, give this a try. It works. There's a flawed thinking that the holidays are an inappropriate time to challenge someone who's challenged by drugs including alcohol. It may be the best gift you ever give the person with the disease of addiction – and the family around him or her. Inside every sick person sick with this disease is a trembling, sorry, sad person dying to feel well again. Invite him or her out onto the path to recovery. In the case of the disease of alcoholism, there's no worse time than waiting for tomorrow or the New Year. You wouldn't imagine postponing treatment for a chronic, fatal, progressive disease like cancer. Why postpone it for a chronic, fatal, progressive disease like alcoholism? If the worry is that it wouldn't be the holiday without that person near, what have the past few holidays told you about that… and what if there isn't a next holiday?

8) Breathe. The holidays are loaded with financial stress, family stress, traffic stress, cold-and-flu stress, and end-of-the-year work stress in addition to the normal, everyday stress of life. Alcoholics and non-alcoholics alike drink to relieve stress. There isn't a single stressor that is cured by drinking: There isn't one that got worse because you chose to just breathe rather than drinking it off the calendar.

9) Be brutally honest with yourself. The biggest charge in the holiday minefield is in the eight-inch gap between your left ear and your right. Nearly every relapse comes in the collision between reality and the five words, 'It won't happen to me.' Here's the very alcoholic reason why I still have Ibuprofen PM in my own nightstand: Because it won't happen to me, the second warning above is only for those other guys, right? Right.

By the way, these nine aren't just for the end of the year and the start of the new one. They work anytime.

– Scott Stevens is the author of five award-winning alcohol and health books, The A-Files: Alcohol A-Z DVD series, Alcohologist.com, and the Alcohology app for Android. He is a founding influencer of the world's largest medical portal HealthTap.  Image by Marina Gloria Gallud Carbonell used with permission.

Resurrected: Five addiction recovery tips from the original millennial

It isn’t out of reach to consider recovery from addiction as a sort of ‘rebirth’ or ‘resurrection’ of life within the man or woman challenged by substance abuse. No, we didn’t die. Some of us came gruesomely close – a lot closer than most acknowledge – as a result of dependence on chemicals human tissues don’t favor much.

Each Spring, Christians around the world commemorate the death and resurrection of Jesus of Nazareth around 33 A.D. The man was executed in the Roman tradition of the time: Crucifixion. Christians believe Jesus rose from the dead three days later when the tomb was found empty. He then ascended into heaven 40 days after being put to death. By all historical accounts, he (He) really lived and really was put to a gruesome death.

Whether you fancy yourself to be a non-believer or just choose to believe something else, the Biblical story of Jesus’s resurrection carries a few lessons about the metaphoric resurrection addicts in recovery experience.

Don’t be afraid to come back

Jesus was slain. Martyred. The man’s body was nailed to a cross and pierced. The Romans at the time were a brutal cast of characters and this was their method of public infliction of pain for those who dared cross Rome, and creating stigma by terrorizing and shaming those who would ever think to run afoul of Caesar. Those crucified are nailed or roped to an elevated cross beam and left for dead. In reality, they died agonizing deaths from bleeding out, exhaustion, suffocation, exposure, or any combination of the four. The Romans did this for centuries. They got it from the Greeks: Alexander the Great humiliated his conquests with public crucifixions 300 years before Jesus lived.

When the Romans did it in Jerusalem it was because the Romans had the city within their empire. They lived there. Jesus came back to the same land where people KILLED him.

When we come back from our addictions, home awaits. Regardless of what transpired or who we hurt. Go back. You have a new life. Live it where you want.

Be humble

Look, nobody is going to build a shrine to any of us just because we got sober or got off the pipe. Recovery doesn’t work that way.

Jesus wasn’t revered and shrines weren’t built in his honor because he came back from the dead either. He embodied humility. Most martyrs throughout history are known for decent, humble lives of service, not for miracles. The lesson of Jesus life was simple: Although revered as the Son of God, he washed the feet of peasants and common folk. He helped others out of a willingness to do so, not for reward. Jesus saw a need and filled it without consideration of money or notoriety.

Be prepared to prove yourself

One great Biblical account of Jesus and his rising from the dead in the Christian New Testament is his encounter with one of his followers. His friend Thomas was notably absent when the resurrected Jesus first appeared to other followers. Thomas – throughout history known as Doubting Thomas – would not believe Jesus was for real unless he got to probe the crucifixion wounds. He needed proof.

There are people who will require proof from you of your sobriety or abstinence. Some people will require years of it. Some people will never be satisfied with your recovery no matter what evidence you present. Nobody says you have to prove them wrong. It’s not their lives you’re living, it is your new one. However, the worst possible scenario for your new life, is to prove the doubters right.

Even if you relapse, you’ve proven only that you have a chronic, relapsing, progressive, fatal disease. Go back to bullet point one. Face them another day.

Be visible

The main reason Jesus’s followers believed in the resurrection is that they saw Him alive after He was dead. Jesus hung around for 40 days after his come back. He presented Himself alive on a number of different occasions to His followers. This firsthand evidence is a powerful argument for the believers in Christ. It’s going to be a part of people believing in you once again once you’re done with your drug of choice.

Take your time in recovery. There isn’t a need to rush back out to every social event. However, the hard work of rebuilding your life means nothing if you don’t leave your living room.

In my third book, I wrote about becoming a PANonymous alcoholic: One who doesn’t hide the disease and is visible in recovery. It helps others to see that recovery is possible. And it helps reduce the ridiculous public stigma attached to addiction that all in its grip are forever hopeless degenerates.

Know when to leave

Jesus was visible for more than a month after dying. So isn’t it conceivable that He could’ve just gone back to what he was doing? Or stayed and lived a resurrected life indefinitely? Theologians will argue that because there is a huge worldwide following and an addiction recovery article mentioning him two millennia later, Jesus in fact lives today. Converting you to that mindset isn’t the point. The point is that Jesus knew when to leave.

You don’t need to show up for every event to which you’re invited. You never have to stay. Nobody has to participate in every argument brought to your doorstep. In fact, the greatest gift we learn from our walking away from a drug that once controlled us is that we can walk away. From anything.

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.

Addiction recovery’s low, low admission price: Own your $#1+!

(originally posted to Addicted Minds)

Admission. Great noun. It means two related things when it comes to addiction recovery:  A) The right to enter, and B) a voluntary acknowledgment/concession of a fact or truth. There is no A) without B) in our family.

Caveat: Most normies – so called ‘normal’ people – have no clue how great we have it so they don’t bother with admission. Either definition.

Drug of choice doesn’t matter. Pills, weed, alcohol, meth, fill-in-the-blank. While active with a drug of choice addicts concede very few facts about their own condition. The reason, the drug alters the function of the same organ responsible for the voluntary acknowledgment of fact. The result, as expected, is the continued use of the same drug of choice until death. Sometimes it is the drug actually causing the death. Other times it just hastens the journey. Addiction is that way when it comes to choices. Addiction means lack of choices and you have exactly two: Admission. Or shorter life expectancy.

Owning your addiction begins to slam the door on the less desirable of the two choices.

Slam the door

You begin to admit other things on the path back to society once you’ve crossed addiction’s Rubicon by admitting your problem is your problem. “I did really crummy things when I drank. I’m sorry.” “I stole from you to get more because I am addicted to more. Let me make it right.”

Sounds quite 12-steppish (ninth, to be precise), so how about a history lesson. Stepping back to admit so you can move forward is much older. There’s a Latin phrase, ‘mea culpa.’ The literal translation from the Latin is ‘through my own fault.’ Yes, the Roman Catholics use it in their Mass, but don’t get your shorts in a knot over the AA connotation or the religious affiliation: Geoffrey Chaucer used it in Troilus and Criseyde, a poem, in 1374.  Six-hundred-plus years later, we just say, ‘My bad.’

In doing so an addict isn’t saying he or she is a bad person. Just flawed. (Guess what? Normies are flawed, too.) It’s a liberating moment. No longer does an addict blame his buddies or a crummy childhood or her despotic husband. He or she takes responsibility for his addiction being nobody else’s. We own our $#1+. We move on from that point. We become people in (or aspiring to) long-term recovery.

Own your $#1+. Admit it. Your admission gains admission to the prestigious and graciously welcoming recovery family. It beats the other choice. And you have only two.

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. Image by Ivan Zamurovic, used with permission.

Barney, participation trophies, and Nintendo: We didn’t see an opioid crisis coming?

(Originally posted on AddictedMinds.com)

Overdose deaths involving opiates and opioids have quadrupled since 1999, according to the Center for Disease Control and Prevention (CDC). Using information from death certificates compiled for the CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER) database, almost half of the 13,000 heroin overdose deaths in 2015 (5,941) were to people born between 1981 and 2000. Prescription opioid drug overdose deaths match the same age bubble.

Clearly, a single generation or demographic isn’t involved in the crisis. If half of the deaths occur to one age band, half don’t. However one half is a statistically significant batch of dope deaths.

There are those who would direct the anger about this at pharmaceutical companies. They made stronger opioids and aggressively marketed them by the truckload to every doc with a prescription pad. There would be no supply, however, without demand. Economics. So what spiked the demand? A purple dinosaur, a medal for everyone, and constant entertainment with a reset button. They could be as much to blame as overzealous Rx writers and an uninterrupted flow of street smack.

An entire generation programmed for susceptibility

Barney, the purple dinosaur, became a phenom with the Pack-n-Play set in 1992. It was geared toward kids aged 1 to 8 years with sometimes educational value. Barney had kids singing, “I love you, you love me” etc. until the runaway hit was canned in 2009. It lives on today in syndication.

One specific rub on Barney is that the show didn’t help kids learn how to deal with negative feelings and emotions. As one commentatorput it, the real danger from Barney was, “denial: the refusal to recognize the existence of unpleasant realities. For along with his steady diet of giggles and unconditional love, Barney offers our children a one-dimensional world. Everyone must be happy. Everything must be resolved right away.'” Ouch.

On the topic of not dealing with unpleasant realities is that there is, in the real world, a concept of winning and losing. They are not two separate and unrelated concepts: You cannot have all winners and no non-winners. We used to call them ‘losers,’ a la racer Dale Earnhardt once proclaiming ‘second place is the first place loser.’

It’s hard to peg an exact year when the everyone-gets-a-trophy movement began but a 2015 episode of the HBO Real Sports with Bryant Gumbel documentary points to the late 1980’s or early 90’s as well. It was initially a California phenomenon. It was to boost the self-esteem of inner city youth. “We thought, especially for kids in struggling communities, if we just told them they were great they would believe it. Then they’ll achieve more because they were certain they were great,” researcher Ashley Merryman told HBO.

The first gaming system to reach mega-saturation in American households was the 8-bit Nintendo. It launched in October 1985 and Mario Bros. could be spotted babysitting millions of kids by the next fall. In fact, the entire gaming industry was $100 million in 1985: In 1986 it was $430 million, $310 million of it was Nintendo’s share.

Not blaming the opioid victim

Sociologists are big on generational cohorts like GenX or Millennials or Baby Boomers and enjoy painting with a broad brush the ills or successes of each cohort. The ones turning to the relief they find in opiates and opioids are not the ones to find fault with. Who gave them Barney, participation trophies, and gaming systems?

The Recession stymied economic growth, halted job creation, kept older Americans in the workforce longer, and encouraged younger American couples to have two wage earners. That Recession was 1982, NOT the most recent one of 2008. The opioid tragedy of those born 1981-2000 was written before many of them had even learned to read. GenX and Baby Boomer parents and grandparents who authentically loved and cared for kids, hobbled the same kids. How? By setting up an unrealistic world of expectations that all things are resolved in an hour, everyone gets an award and we must all be entertained all the time.

The grave consequences of an opioid crisis for this generation were entirely foreseeable – in hindsight. It’s like when the world first heard that Queen’s Freddie Mercury was gay. When we went back and watched the old videos we collectively said, ‘Well, that makes sense.”

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. Buy the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere books are sold. Stevens also heads up BlogTender LLC, a content marketing firm headquartered in Lake Geneva, Wis.

An addiction is anything you have to hide

(Originally posted on AddictedMinds.com)

A many-faceted challenge for families, interventionists, and other addiction pros alike is defining an addiction. We have textbook definitions. We have tests. But when it comes down to addressing the addiction with an addict in denial that he or she has one, we are consistently challenged with breaking down denial.
Signaling the problem, we turn to the Diagnostic and Statistical Manual (DSM). The latest version is October 2016’s DSM-5. Its 11-part impersonal analysis for any substance use disorder:

1. Taking the substance in larger amounts or for longer than the you meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home or school, because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of substance use
8. Using substances again and again, even when it puts the you in danger
9. Continuing use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Signs, signs, everywhere signs

The DSM 5 allows clinicians to specify how severe the addiction is, depending on how many of the 11 signs are present. Two or three symptoms indicate a mild substance use disorder, four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder.

BOOM! That was easy.

Now tell the addict he or she is one and needs help. The 947 pages of the American Psychiatric Association’s ‘bible’ do little for that discussion. Assume very few people under the influence of a mind-altering drug have the capacity to use that same mind to analyze (honestly) the symptoms.

A simple pair of personal questions gets at the a-ha moment the impersonal DSM can’t get at eyeball-to-eyeball:
Are you hiding your use? Why?

The answers are C-R-I-T-I-C-A-L to making change. You can get at any of those 11 DSM criteria with those two questions. We hide use because we don’t want anyone to see. Or judge. Or evaluate us on a DSM scale. We don’t want them to see because we don’t want to hear that it’s “wrong” or “shameful” or fill-in-the-blank. Yet, family sees. Counselors see. The addict needs that vision and it comes from that introspection. And very few – if any – are ever asked directly what they are hiding, and why are they hiding it.

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. Buy the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere books are sold. Stevens also heads up BlogTender LLC, a content marketing firm headquartered in Lake Geneva, Wis.

Photo by Vasilisa Karpova, used with permission.

How others' alcohol use became your business: The Toxin-omics

Drinking is 'The American Way,' 'How We Roll,' 'Harmless Fun,' or just 'None of Your Damn Business.' Just ask a drinker. He or she doesn't even need to have the disease of alcoholism: You attempt to get between a person and the beverage of choice and you'll hear defense. The defense is offensive when you know the economics of the toxin and drug alcohol.

The economic impact of drinking – casual drinking and alcoholic use – tallies an eye-popping $250 billion every single year in the U.S. By way of comparison, smoking costs the economy $173 billion… all other drugs combined cost the economy $130 billion. A 2011 study in the Journal of the National Cancer Institute determined the cost of all cancer care in the U.S. totaled $124.5 billion in 2010 … half as large as the alcohol toll. How big is the we-don't-have-a-problem alcohol problem, by the numbers?

• That's enough to buy a 48 inch HDTV for every man, woman and child in the U.S. And an X-Box. Every year.
• Two-hundred-fifty billion dollars is the same as the annual expenditure on fashion and apparel in the entire U.S.
• The Treasury in 2008 bailed out the banks with a $250 billion “investment” that created critical echoing still heard in the 2016 Presidential campaign and brought hundreds of 99 Percenters camping in Wall Street. That was just a one year expense.
• For the ubersmart Keynesian economists out there, $250 billion is a NEGATIVE GDP (gross domestic product) value of $74 billion. (For those of us less-smart: Alcohol shrinks the economy the way it shrinks libido.)
• For the 216 world economies tracked in the CIA World Factbook, $250 billion is bigger than the 40th largest economy on the planet, and bigger than the output of the bottom one-third of countries COMBINED. 

The costs are in healthcare, lost productivity, legal and corrections costs. Alcoholism is part of the total, but $250 billion is driven by all drinking, even social or moderate use. The CDC readily admits the $250 billion is on the low side, too. The researchers believe that the study still underestimates the cost of excessive drinking because information on alcohol is often underreported or unavailable, and the study did not include other costs, such as pain and suffering due to alcohol-related injuries and diseases.

Alcohol revenue does not cover alcohol economic damage
The monetary consequences are something everyone shares: Drinkers and non-drinkers alike. The numbers get complicated, because the drug Americans enjoy and defend so vigorously, also costs the most in health and hard dollars. Each drink consumed has a median cost of $2.05 in economic harm (lost productivity, health care costs, property damage and criminal justice system expenses). That's according to the Centers for Disease Control and Prevention (CDC). So the drinker pays for that in alcohol tax, right? No. The median paid in tax per drink is less than a nickel a drink. The Tax Policy Center estimates that state and local taxes on alcoholic beverages bring in about $6 billion in revenue nationwide. The overall economic benefit from the manufacture and distribution is less than a quarter per drink.

Industry watchdog, Alcohol Justice, suggests closing the gap between tax revenue and the economic damage, which may also reduce use. According to Alcohol Justice's Charge for Harm Campaign, "Big Alcohol produces, sells, and promotes products that cause harm and incur costs - to both government and its citizens. Appropriately taxing alcohol at state and federal levels will help reduce related harm and provide needed funds. We support state and federal increases in alcohol taxes and fees."
Even if drinkers bore the full $2.05, everyone else still pays in lost productivity. Show up late, never, hungover or just without your A-game and someone has to step in or step up. It doesn't always happen that way. Which costs the company. So the company charges more for its goods or services. Lost productivity, according to the National Institutes of Health (NIH) is more than 70 percent of the $250 billion annual cost of alcohol use in the United States. Every shopper pays… no matter if we shop Walmart or Macy's.

This is the part of the revenue formula pro-alcohol forces leave out of the dialogue when pushing for more beverage licenses, longer hours of service, and absurd ideas like selling alcohol at college sports venues. With greater access to alcohol, the revenue does go up in a bar, store, or restaurant. But so does the economic damage. And never the twain shall meet.

Need a hospital bed? Wait. And pay more.
Here's another way to look at the economic harm. There is an alcohol-related hospital admission every 30 seconds and, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 20-40 percent of general use (non-specialty) hospital beds are used to tend to alcohol-related complications. Heroin addicts aren't breaking the healthcare system. Aging Baby Boomers aren't pushing it past capacity. Alcohol use is drowning it.

Health care costs related to alcohol use are not limited to the drinker. There are unintended – and sober – victims in traffic crashes you've no doubt heard about from the impaired driving activists, Mothers Against Drunk Driving (MADD). However, children of alcoholics who are admitted to the hospital average 62 percent more hospital days and 29 percent longer stays according to the Children of Alcoholics Foundation.

Nested inside of every major cause of death in the U.S. is the fact that alcohol use is a contributing factor to each of those causes of death or hospitalization. Alcohol is a carcinogen, for example. It is the second-leading cause of oral cancers and is the only dietary connection ever made to an increased risk of breast cancer. The Agency for Healthcare Research and Quality (AHRQ) estimated the price of cancer care for one year of life increased to $207,000 in 2013.

Heart disease, not cirrhosis, is the leading killer related to drinking. Annually, about one in every six U.S. healthcare dollars is spent on cardiovascular disease. By 2030, annual direct medical costs associated with cardiovascular diseases are projected to rise to more than $818 billion, while lost productivity costs could exceed $275 billion. What is the preventative measure hiding in plain sight? Stopping drinking. About 1 in 3 adults—or approximately 86 million people—have at least one type of cardiovascular disease, which means many more Americans could die from what is often preventable through lifestyle changes or managing medical conditions. There are 1.5 million heart attacks and strokes in the U.S. annually. One in five strokes is alcohol-related. One dollar spent on alcohol education (e.g. abstinence) saves $4 in healthcare costs down the road. (Plus $7 in criminal justice system costs for good measure.)

Bottom line: We ALL pay
The healtcare cost equation under mandated insurance means part of every insurance policy premium is gobbled up to care for alcohol-related problems. An insured person doesn't have an account from which he or she dips. Insurance premiums are pooled. You can be a non-drinker… your own premium will be lower because of your relationship with alcohol… but your premium will still reflect the experience of the insurance pool. With insurance mandatory, and 67 to 70 percent of adults using alcohol in the past year, there is a majority of your insurance dollar used to mitigate the expense of drinking.

Binge drinking alone – four or more drinks per occasion for a woman and five or more drinks for a man – accounts for more than 75 percent of costs related to excessive alcohol use in all states, just under $171 billion. Binge drinking is reported by about 18 percent of adults in America. (Wager that the self-reported binge drinking number is MUCH higher, people aren't typically honest about their answer to the non-of-your-damn-business question.) According to the CDC. binge drinkers and their families paid less than half of the costs associated with high alcohol use (41.5 percent) while federal, state and local governments paid about 42 percent, or more than $94 billion, of the costs.

The government doesn't have a separate checkbook funded by drinkers or beverage companies to pay for this: It uses your checkbook.

Visit www.alcohologist.com for more on the health and economic costs of drinking a toxin and known carcinogen. And order The A-Files: Alcohol A-Z for what alcohol does TO you, not FOR you. I Can't See The Forest With All These Damn Trees In The Way is now available in paperback.

The A-Files, Alcohol A-Z for Alcohol Awareness Month: Underage Drinking

(online video and article)

Twenty-six episodes of 'The A-Files' air throughout Alcohol Awareness Month on YouTube, Facebook, LinkedIn, Alcohologist.com and AddictedMinds.com, among other web and social media sites. Episode U looks at underage drinking. Impaired driving crashes are the leading cause of alcohol-related deaths among teens, but it is not the only underage drinking concern. Nearly two-thirds of deaths due to underage drinking are not related to intoxicated driving, according to data analysis MADD compiled. Thirty percent of alcohol-related deaths in people age 15 to 20 are from homicides.

Fourteen percent are from suicides. Nine percent are from alcohol overdose. Other causes, such as drowning and household accidents, comprise the remaining 15 percent.
The group's blog also notes, “Compared with non-drinking classmates, teens who drink are more likely get pregnant, fail in school, become sexually assaulted or take their own lives.” They also point to teen alcohol use as an indicator for alcohol use disorders later in life. The National Institute on Alcohol Abuse andAlcoholism reports that teens who start drinking before age 15 are four times more likely to develop an alcohol addiction.

The European model of letting teens experiment with drinking at home – with meals or socially – doesn’t stand up to its alleged benefits of educating them about responsible use. Research from Australia’s National Drug and Alcohol Research Centre (NDARC) studied 2000 families over four years and proved it doesn't work. Ian Hickie from the University of Sydney’s says "In fact, it's the opposite, you've probably increased the chance that they'll drink irresponsibly in another place. It normalizes the behavior of drinking a toxin and known carcinogen, in addition to injuring a developing brain.

The health consequence is the most severe and overlooked part of the equation. According to the Federal Trade Commission, teens don't just drink; they drink excessively. More than one in eight sophomores and one in four seniors report binge drinking. A report from the Surgeon General notes that since the brain continues to develop into a person's mid- 20's, frequent binge drinking can have long-lasting effects on intellectual abilities. The brain’s frontal lobes are among the final pieces of the brain to fully develop in our 20's. They are important for planning, forming ideas, making decisions, and using self-control. When alcohol damage the frontal lobes of the brain, it is permanent. It's like luggage, you're stuck with it forever.

The entire 26 episode HD series is available on disc, along with fact sheets, for helping professions. See the preorder special at tr.im/AFiles


Visit alcohologist.com for a replay of CBS Sports' Power Up Your Health featuring Scott Stevens.  Another interview is on Alcohol Awareness.  Syndicated radio program Savvy Central Radio did this interview, too. Lucy Pireel's "All That's Written" included a feature called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud and the first for Adding Fire to the Fuel also can be found on www.alcohologist.com. Download the FREE Alcohology app in the Google PlayStore today. Stevens also is the public relations officer with AddictedMinds.com