Policy Changes Could Cut Alcohol Related Deaths, Study Suggests

News Feature
By Bob Curley

Policymakers should look to the types of strategies outlined in Join Together's Ten Drug and Alcohol Policies That Save Lives to prevent the alcohol-related deaths detailed in a new report from the Centers for Disease Control and Prevention (CDC), experts say.

CDC researchers estimated that about 75,000 alcohol-attributable deaths occur each year in the United States, split about evenly between chronic causes like liver disease and acute causes like accidental injuries and automobile crashes. The study also estimated that each alcohol-related death cost an average of 30 years of life, indicating that many of those who died from alcohol-related causes were relatively young.

"These results emphasize the importance of adopting effective strategies to reduce excessive drinking, including increasing alcohol excise taxes and screening for alcohol misuse in clinical settings," the authors wrote in the report, "Alcohol-Attributable Deaths and Years of Potential Life Lost, United States, 2001."

Richard Saitz, M.D., MPH, one of the study authors and associate professor of medicine at the Boston Medical Center and Boston University School of Medicine, said the goal of the project was not to recommend policy changes, but noted, "This is precisely the kind of information that policy should be based on."

Many alcohol related deaths could be prevented by adopting the 10 policies that Join Together recommended to all of the candidates running for office this year, said David Rosenbloom, Ph.D., director of Join Together. "Screening for alcohol problems in emergency-room and primary-care visits, and then providing insurance coverage for treatment, would have a dramatic impact," he said.

Bob Brewer, alcohol team leader for the National Center for Chronic Disease Prevention and Health Promotion at CDC, said that in addition to the Join Together document, policymakers could look to the World Health Organization's 2003 report, Alcohol: No Ordinary Commodity, written by Thomas Babor, for effective strategies to prevent alcohol-related deaths.

"Effective intervention strategies include excise taxes -- any number of organizations have recognized that," said Brewer. "In the clinical arena, we know that screening for alcohol problems is greatly underutilized. The WHO study highlighted restriction of physical access and enforcement of age-21 laws. And outlet density is also something appropriate to look at."

Looking at Binge Drinking

In order to distinguish between moderate alcohol consumption and excessive drinking, the CDC researchers based their estimates on a definition of binge drinking that included consuming more than 5 drinks per occasion for men and more than 4 drinks per sitting for women. "The study looks at the consequences of excessive consumption, and it eliminates, to a great extent, concerns about alcohol being beneficial," said Saitz. "At this level, moderate drinking is a non-issue."

Brewer added that many of the drinkers included in the report had consumed far more than the minimums established by researchers. "It's quite clear that the majority of binge drinkers are drinking to get drunk," he said.

Injury deaths were only considered alcohol-attributable when they involved a blood-alcohol content of .10 percent or higher. Estimates of chronic alcohol-related deaths were based on a combination of diagnoses solely related to alcohol use (e.g. alcoholic cirrhosis) and relative-risk estimates for other diseases. Researchers said a number of study limitations, such as self-reported data, suggested that the estimates of alcohol-related deaths are, if anything, conservative.

The health costs of alcohol use among young people was illustrated by the finding that while smoking kills six times more people than alcohol use, drinking cost 2.3 million years of life lost in 1999 -- about half the estimate for smoking. "This difference exists because many alcohol-attributed deaths, particularly those caused by injuries, primarily affect youth and young adults, and deaths attributable to tobacco use are uncommon in this population," the study noted.

"We've known that alcohol has had a huge public-health impact, but the numbers on potential life lost were shocking," said Brewer, who also co-authored the CDC report.

Chronic vs. Acute

Saitz suggested that one way to look at the findings is to distinguish between the problem of heavy, daily drinking, which may tend to cause more chronic alcohol deaths, and excessive episodic drinking, which may tend to cause more acute deaths.

Brewer noted, however, that while older drinkers suffered the bulk of chronic alcohol-related deaths, they also fell victim to their share of accidents and other fatal misadventures. Among those ages 35 and older, for example, 58 percent of deaths were from chronic conditions, but 42 percent were categorized as acute.

"The important take-home message is that acute alcohol-related death is a problem across the lifespan," said Brewer. "It isn't just a problem for young people."

Editor's Note: The CDC has established the Alcohol Related Disease Impact (ARDI) system, which allows researchers, policymakers, advocates and others to quickly and easily generate estimates of alcohol-related deaths and lost years of life on a state and national level. To use the calculator, see the ARDI website.