The Public's Health: The Downside of Drinking | Public Health Post

In the midst of a lethal opioid epidemic, alcohol kills more Americans than fentanyl, heroin, and prescription pills combined. During the past decade, in parallel to the increase in opioid use, deaths by alcohol have increased 35 percent. Although men still make up three-quarters of alcohol deaths, young women have had the greatest rise in deaths through accidents, suicide, cancer, and cirrhosis. Around forever, culturally normalized, this ancient substance seems to be newly hazardous. What’s happening?
We have some ideas. First, the alcohol industry continues to be powerful and savvy. Beverage companies spend $2 billion a year advertising, 90% on television, mostly on beer. Industry advertising never says that alcohol is not addictive; rather the message is “use responsibly,” which implies that alcohol’s use—unlike the use of drugs—is controllable. 
Second, although we don’t have a greater proportion of Americans drinking (it’s remained steady at about 2 in 3 people over the past 70 years), we are drinking more, and more easily. We can now buy liquor in movie theaters and in grocery stores and on Sundays. Last year, Congress reduced alcohol excise taxes, bringing down prices; state legislatures won’t raise taxes and risk losing revenue.
Third, during this decade of economic expansion, many Americans have more income. In contrast to the stereotype, affluent people are more likely to drink than low-income people. At the same time, as the poor get poorer, the devastating health effects of heavy drinking are compounded by higher cigarette and other substance use and greater mental health problems.
Fourth, binge-drinking is now a rite of passage in college. With women a growing percentage of collegiate heavy drinkers, and with alcohol-makers targeting women with sweeter and fizzier products, health risks accumulate as women generally experience greater effects at lower doses than men.
Fifth, we’ve become complacent about driving under the influence because seatbelts and safer cars have lowered alcohol-related fatalities. Yet paradoxically, alcohol-related traffic accidents are on the rise (perhaps worsened by growing marijuana co-use). Our drunk-driving blood alcohol threshold remains steady at .08 despite the National Transportation Safety Board’s recommendation to lower it to .05, the standard in many other countries with lower rates of traffic fatalities.
We used to think that drinking a little bit had cardio-protective effects. But the science has advanced to show that that is not the case. No level of alcohol consumption improves health. Simply put, alcohol is an eminently preventable cause of social harm and premature death. Consuming less alcohol in total or on a per-occasion basis would probably improve the health of most of us. That’s a credible and reasonable public health goal. 

Michael Stein & Sandro Galea