The Behavioral Health Network’s recent Grand Rounds program revolved around alcohol use disorder, the changing attitudes towards drinking and sobriety, and the ways that practitioners can help.
“Trends in Alcohol Use: From Dry January to Damp February’ was presented by J. Craig Allen, MD, the medical director of Rushford, chief of Psychiatry at Midstate Medical Center, and vice president of Addiction Services for the Behavioral Health Network at Hartford HealthCare.
Dr. Allen opened his talk referencing social media trends such as “Dry January” and “Damp February.”
“Dry January started as a health movement,” he noted. “Then it became sort of a ‘fun’ and ‘fashionable’ thing to do. But it’s still healthy, when you try not drinking at all and you see what changes there might be for you.”
As for “Damp February,” which is when participants don’t abstain completely but rather cut down on the amount of alcohol they consume, Dr. Allen said this may be a more rational, realistic approach. “The bottom line is for your patients who drink alcohol, it’s always a good idea to look at their relationship with alcohol, how alcohol plays a role in their life, and whether there’s an opportunity for some changes.”
Impacts on the brain and body
During his presentation, Dr. Allen reviewed the biological effects of alcohol use and overuse on the body, as well as the neuroscience behind what happens to the brain when someone drinks. There is still much to learn and understand, he noted.
What is clear is that alcohol use and overuse is a major problem in the United States, as demonstrated by the data. More than 174 million people in the U.S. use alcohol – that’s 62% of the population.
Of those people, nearly 30 million have alcohol use disorder – just over 10%.
The ramifications of those usage statistics show up in Emergency Department visits and alcohol-related deaths. Nearly 5 million people a year arrive at a hospital emergency department with an alcohol-related issue, and 1.7 million are there because of alcohol specifically.
Alcohol-related deaths are higher than opioid deaths in this country, with more than 80,000 people dying annually from chronic diseases, such as liver failure, and nearly 68,000 dying from acute issues, such as an alcohol-related injury.
There are more than 200 diseases and injury conditions related to alcohol use disorder.
The detrimental effects on young people also are significant, especially because in the United States, more than 90% of adults started drinking before they were 18 years old. Among high school students, 12% report having an addiction.
“This matters because the brain is not fully developed, and the addictive substances will have a greater negative impact on their developing brain,” Dr. Allen explained.
Mental illness connections
Everyone at the Behavioral Health Network should be aware of alcohol use disorder because studies show a “strong correlation between substance use disorders and mental illness.”
“From our experiences at Rushford, it’s actually unusual if a substance use disorder patient doesn’t also have a mental illness,” he noted.
And when it comes to suicide and suicide ideation, alcohol use disorder is the second most common diagnosis when someone dies by suicide. Of those who are entering alcohol use disorder treatment, 40% have attempted suicide at least once.
Dr. Allen noted that the American ways of categorizing drinking as a problem differs greatly from pretty much the rest of the world. In the US, there are indicators to determine “problem” and “binge” drinking. For example, five drinks per day for a man means that person is “at risk” for alcohol use disorder.
Outside the U.S., “there’s no risk to alcohol if you don’t consume it,” he said. “In America there’s this idea that there’s a safe amount of alcohol to drink. That’s not how it is viewed elsewhere.”
That said, studies show that if a person is able to reduce their drinking, the benefits to their health can be profound. “The good news is that lowering your risk level even one can be really impactful,” he said.
After running through all the available treatments and medications BHN offers patients, Allen reiterated the importance for clinicians of being skilled in the technique of Motivational Interviewing. Motivational interviewing is a therapeutic intervention designed to help people find the desire to make changes in their patterns and behaviors.
“Lean into your empathy,” he counseled. “That’s so important.”
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