Health & FitThe Addiction Crisis No One Is Talking About
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Stress levels continue to soar in our society — a 2017 Gallup poll found that 8 in 10 Americans consider themselves stressed, and 40 percent of U.S. citizens said they were more anxious last year than the year before. A growing body of research demonstrates links between substance abuse and stress, with the opioid crisis getting the lion’s share of attention. But two new reports suggest alcohol abuse is creeping up as another alarming manifestation of our highly stressed culture.
A new study published in the journal JAMA Internal Medicine found that the No. 1 reason for liver transplants in United States is no longer hepatitis C — it’s alcohol-associated liver disease. From 2002 to 2016, the number of alcohol-related transplants nearly tripled. While the researchers report that 48 percent of the spike is associated with improved treatments for hep C that have rendered transplants for sufferers unnecessary, the lead author of the study, Dr. Brian Pei Lim Lee, a gastroenterology and hepatology fellow in the School of Medicine at the University of California, San Francisco, speculates that excess alcohol consumption is partly to blame. “We hypothesize that the significant rise in liver transplants for ALD, and the prevalence of ALD in general, relate, in part, to rising harmful drinking patterns,” he tells Thrive Global.
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A study in BMJ last year seems to bear out that theory, finding that from 2009 to 2016, individuals between the ages of 25 and 34 experienced the highest annual increase of death by cirrhosis, resulting entirely from alcohol-related liver disease.
And certain groups are more at risk. “Epidemiologic studies have shown that harmful drinking patterns are increasing across all groups, but particularly in women and lower socioeconomic populations,” says Lee, whose research showed an increase of women undergoing liver transplants for ALD.
At the root of our excess drinking and the increasing incidence of ALD is stress, says Dr. George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism. “There are a lot of factors, but stress plays a big role,” he tells Thrive.
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Health care providers can take direct actions that prevent injury while allowing patients to participate in their care. Tomas Villanueva, DO, MBA, FACPE, SFHM, serves as the clinical and operational lead for the Vizient Transforming Clinical Practice Initiative team and the Vizient Practice Transformation Network. Prior to his current position, he served as chief of primary care for the Baptist Health Medical Group, part of Baptist Health South Florida. A Fellow of the American College of Physician Executives, Villanueva is double boarded in Internal and Palliative Care Medicine.
Indeed, alongside spikes in alcohol-related liver disease and cirrhosis, Yale University research shows that skyrocketing stress levels can make individuals more susceptible to substance abuse. Millennials, who comprise part of the demographic who died by alcohol-related liver cirrhosis in the BMJ study, also reported the highest levels of stress compared to every other age group in 2016 (5.6 on a 10-point scale), according to the APA.
The problem with reaching for a glass of wine to soothe stress, Koob says, is that alcoholism approaches sneakily, and one glass can slowly become two or three or four — and what’s worse, alcohol exacerbates stress. “We know from neurobiology that the stress system is activated during the development of moderate to severe alcohol use disorder,” Koob explains. “So you get into a spiral of self-medication where you end up more stressed when treating your stress with alcohol. You’re trying to fix the problem with something that’s making it worse.”
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Koob, who’s researched the relationship between stress and alcohol use disorder for 30 years, advises us to reach for our gym bags instead of a drink to ease tension. “Even a limited amount of exercise can improve cardiovascular function, which extends to stress,” he says. To help assess whether your drinking is in check, visit the National Institute on Alcohol Abuse and Alcoholism’s Rethinking Drinking, which includes helpful tips and guidance on how to healthily approach alcohol consumption. (Government guidelines suggest women drink no more than one drink per day and men, no more than two.)
“Fifty to 70 percent of Americans, depending on where in the United States they’re located, drink,” Koob says. “Most don’t have a problem, but there’s that 6 percent who get into trouble. They think they are immune, but they’re not.”
For his part, lead author Brian Lee hopes his findings will encourage more research. “Hopefully, our work will raise awareness of the growing importance of alcohol as a public health issue and the need for further studies and interventions to stem its rise in disease burden.”
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