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Americans Drink Too Much, But We’re Not All Alcoholics

A new survey shows that while many Americans drink excessively, they aren’t dependent on alcohol. This is problematic—but promising.

11.25.14 10:45 AM ET

The vast majority of people who drink too much are not alcohol-dependent, indicating that with help, many can be helped to moderate their consumption, a new government report has found.

These findings, published by researchers from the Centers for Disease Control and Prevention, come from a government survey of 138,100 adults. It contradicts the persistent belief that heavy drinkers, including those who drink to get drunk, are physiologically dependent on alcohol. In fact, these results show that nine out of 10 people who overdrink are not addicted to booze, and, with help from a medical professional, may learn to change their unhealthy habits. The study surveyed drinkers in 2009, 2010, and 2011.

The authors of the report wrote that by implementing simple strategies—such as asking patients about their drinking habits and discussing how they might cut back—medical professionals could have could have an impact on reducing excessive drinking. Much of the U.S. approach toward drinking problems uses a one-size-fits-all approach—lifelong abstinence, attendance at support groups such as Alcoholics Anonymous, and specialty inpatient rehab—for all drinkers, regardless of the severity of their problems. In fact, evidence shows that there are many routes to recovery, and most of them take place outside those realms.

This study is important because it bolsters the growing body of evidence showing that the majority of problem drinkers can gain control of their unhealthy habits before dependence takes hold. In fact, an earlier government study of 43,000 Americans’ lifetime alcohol and drug use found that about 75 percent of people who recover from alcohol dependence do so without seeking any kind of help, including at specialty rehab centers or support groups. Many of those who recover return to low-risk drinking.

Excessive alcohol consumption is a major public health problem in the United States. The CDC says that it results in 88,000 deaths annually, from auto accidents, liver disease, alcohol poisoning, and cancers that are tied to heavy alcohol use. The economic costs of excessive drinking are also high: in 2006, it resulted in $223.5 billion in health care costs, missed work days, court and attorney fees.

Conventional wisdom holds that most excessive drinkers are alcohol dependent. But few studies have examined the actual prevalence of alcohol dependence among them, so the study’s findings are important.

The government defines excessive drinking as drinking too much on one occasion over the course of a week. For women, that’s having four drinks at one sitting, or more than eight drinks a week. For men, excessive, or binge drinking, is defined as five or more drinks at one time, or more than 15 drinks during the week. Women who drink while pregnant—any amount—as well as underage drinkers, are also defined as “excessive drinkers.”  The thresholds for safe drinking differ widely among global health officials, and U.S. recommendations are among the lowest in world. (The wine-producing countries of Spain, Italy, and France, suggest limits that are double and triple that of the U.S.)

While about 29 percent of the U.S. population meets the criteria for excessive drinking, 90 percent of them do not meet the criteria for alcohol dependence. In keeping with the most recent version of the psychiatric bible, the Diagnostic and Statistical Manual V, researchers now use the term “alcohol use disorder.” This replaces the older “alcohol abuse” and even older “alcoholism,” which has been out of favor among scientists for decades. The new term denotes a spectrum of problem drinking that can range from mild to moderate to severe. The more criteria a person meets on the scale, the more severe the problem. The fewer a person meets, the more likely the person is to be able to modify their drinking by cutting back, says psychologist Reid Hester, director of the research division of Behavior Therapy Associates in Albuquerque and a research associate professor at the University of New Mexico. Hester is a longtime researcher on evidence-based methods of moderating drinking.

Indeed, a large federally funded study published in 2006 found that a brief intervention by a doctor—addressing alcohol use with patients and encouraging them to make healthier choices—is effective in cutting alcohol consumption. That study also found that brief interventions, combined with the use of the opioid blocker naltrexone, was the most effective way in getting patients to reduce their heavy drinking days.

The new report is consistent with a great deal of research that has not yet shifted public thinking about alcohol problems. It is what National Institutes of Alcohol Abuse and Alcoholism reported in 2004: that the prevalence of dependence was declining while that of heavy drinking was increasing.

Hester noted that it’s also consistent with epidemiological data that the Institute of Medicine cited in their book, Broadening the Base of Treatment for Alcohol Problems. “And that,” he said, “was published in 1990!”