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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Alcohol: Killer in a Bottle

August 13, 2018 | Addiction | Substance Use | Comments
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First you take a drink, then the drink takes a drink, then the drink takes you. – F. Scott Fitzgerald, The Great Gatsby

Alcohol is a killer hiding in plain sight. While we demonize the use of other drugs, we celebrate with alcohol. It’s part of our weddings and graduations, our birthday parties and bar mitzvahs. Alcohol is a legal drug, and our own ambivalence about its use may stop us from talking about it with our family members, friends, coworkers and patients. But the consequences can be deadly.

Excessive alcohol use results in some 88,000 deaths each year, more than twice the number who die from opioids. This makes alcohol the third leading cause of preventable death in the United States, after tobacco and poor diet and physical inactivity. In 2010, the cost of excessive alcohol use in the United States was $2.49 billion or $2.05 a drink. Alcohol contributes to more than 200 diseases and injury-related health conditions. And alcohol is the number one substance found on autopsy in those who die by suicide.

As if these statistics weren’t startling enough, new research indicates that our young people are at special risk. A study published in BMJ reveals that fatal liver disease is on the rise, driven by alcoholic cirrhosis among people ages 25 to 34 years old. Between 1999 and 2016, the number of people in this age group who died annually from alcohol-related liver disease nearly tripled.

We can’t sit idly by while people literally drink themselves to death. We can start addressing this issue today by following some simple steps.

  1. Start the conversation. Because alcohol is so prevalent in our private and public gatherings, it is not uncommon for many of us to drink socially. This may hamper our attempts to address another person’s drinking when we think it’s problematic. Too often, we don’t talk about alcohol addiction until we think someone has “hit bottom.” The conversation may be awkward, even for medical professionals, but it can save a life. We need to be talking about alcohol in our schools, at the dinner table and in primary care offices. There are some simple screens – the S2BI for adolescents and the Audit–C for adults – that are as easy to use as the PHQ–9 for depression.
  2. Recognize that alcohol use disorder is a chronic condition and relapse happens. Not everyone who drinks develops a disorder, but we must treat those who do and their families with understanding, compassion and the best evidence-based treatments we have to offer.
  3. Provide a continuum of evidence-based treatment. As with any chronic condition, there is no one-size-fits-all treatment, and the intensity of services a person needs may vary throughout their recovery. Beginning with Screening, Brief Intervention and Referral to Treatment, providers have any number of evidence-based modalities available. These include cognitive behavioral therapy, motivational interviewing and FDA-approved medications. Alcohol addiction is well treated in integrated care settings, such as that provided by Certified Community Behavioral Health Clinics (CCBHCs). They offer a proactive approach to treating addiction and provide the right level of care at the right time in an individual’s community.
  4. Address trauma and the social determinants of health. At first, alcohol feels effective in numbing the pain of traumatic experiences, but it has tremendous negative consequences. Researchers studying the increase in liver-related deaths found a significant spike beginning in 2009 and surmise the recession may have played a role – job loss is associated with an increase in drinking among men. In addition, many people with alcohol addiction have a co-occurring mental illness, which places them at significantly higher risk of relapse. That’s why CCBHCs and other integrated care settings are so critical; we must treat the whole person – body, mind and spirit.
  5. Build recovery communities. “I am told there are people who recover from addiction all by themselves, but I personally don’t know any of them,” says Tom Hill, National Council vice president of practice improvement. People seem to recover best when they recover together, in community settings that prioritize ongoing recovery by offering resources, support and common space.

Excessive alcohol use may be the elephant in the room, but we don’t have to ignore it any longer. Just as we have begun dispelling the stigma about mental illnesses and opioids, so, too, can we begin to talk about and treat alcohol addiction.

In the meantime, I’d love to hear from you. Reply to this post or write to me at and tell me how you are addressing alcohol addiction. People are literally dying for our help.