Nor Is It A Bright Line

The popular view of addiction in America is misinformed

Recently we wrote that the popular view of addiction in America is misinformed.  A well-intentioned media creates the false impression that addiction to alcohol and drugs is a problem for the young, often minority individual living in poverty or, perhaps, living in homeless encampments.  Our discussion showed that while this image is often the “bottom” of the addiction curve, it portrays only a fraction of alcohol and drug use, abuse and addiction in America.  So what does substance use, abuse and addiction look like?  We suggest that rather than a bright line between “normal” drinking and drug use on the one hand, and the individuals who have “hit bottom” on the other, drug use, abuse and addiction in America occurs over a continuum. There isn’t a bright line; it isn’t that simple.  

The National Institutes for Health estimate that there are 27 million Americans suffering substance use disorder (SUD); alcoholism and drug addiction to the lay person.  The Department of Housing and Urban Development (HUD) estimates that there are 580,466 homeless Americans (yes, that seems low to us too).  HUD estimates that 38% of the homeless suffer from alcohol abuse and 26% abuse drugs.  Given these estimates, 371,498 people are those depicted in the general image of addiction --  accounting for 1.4% of SUD in America.

We can assume that people who do not drink or use narcotics are not those with substance use disorder (allowing there are some abstaining in recovery). The NIH estimates that 14.4% of adults in America do not use alcohol.  Further, we calculate that 84% of Americans do not use schedule I or “street drugs”. This leaves us with 221 million Americans who use alcohol and 54.4 million who use drugs.  Our point is that among these are those who drink to excess, use and abuse drugs, and have problems stemming from those behaviors on an occasional and on a regular basis. 

The Centers for Disease Control (CDC) defines binge drinking as the consumption of 7 or more drinks per day for men and 5 per day for women.  The CDC reports that 1 in 6 American adults binge drinks on average 4 times per month equal to approximately 43 million Americans.  Heavy drinking is defined as 14 drinks per week for men and 7 for women. 5.1% of Americans heavy drink once per month totaling 13.4 million American adults.

The issue of schedule 1 and 2 narcotics is somewhat more complex.  Except for the evolving issue with marijuana, and the use of schedule 2 narcotics “as prescribed”, all of these drugs are sold and used illegally.  There is also the generally unresearched issue of a “safe” use of these drugs.  Noting these issues, the National Institutes for Health and the National Institute for Drug Abuse estimate that Americans used these drugs in the past year as follows:

• Marijuana c. 36,000,000 13.5% of Americans

• Opioids 12,500,000 4.0%

• Inhalants 1,800,000 .7%

• Methamphetamines 1,700,000 .6%

• LSD 1,500,000 .6%

• Cocaine 833,000 .3%

• PCP 120,000 <.1%

These 54.4 million American adults are all candidates for substance use disorder and strictly speaking meet the definition since they are consuming illegals drugs.  The evolving policy of marijuana clouds this discussion.

For our purposes, then, we assume that there are between 100 and 110 million American adults who binge drink, heavy drink and/or use schedule I narcotics.  Our assumption is that among these individuals there are those who on occasion or regularly abuse alcohol and/or drugs.  Of these, the NIH estimates that there are 27 million people with a substance use disorder.  A small fraction of these numbers (1.4% as noted above) fit the common, public vision. Our point, then, is that harmful behaviors occur across the spectrum of the 100-110 million American adults exhibiting the alcohol and drug use noted in this article.  Their behavior costs America in many ways:

• Self-Harm

Suicides totaled 44,834 in 2020 in the U.S. and ranked 10th among the leading causes of death reported by the CDC.  The CDC estimates that 60% of these deaths are attributable to alcohol and/or drug abuse

• Crime

Alcohol is a large contributor to crime.  According to the Alcohol Rehab Guide, alcohol was involved in 15% of robberies, 37% of sexual assault, 27% of aggravated assault, and 40% of homicides. The relationship of drug and crime is more complex given the issues created by the “war on drugs” that has made criminals of people with addiction.  However, 18% of incarcerated inmates reported that their violent crime was committed while using illegal drugs

• Driving Under the Influence

The CDC data includes 111,000,000 self-reported incidents of driving while impaired by alcohol.  Among all car crashes in the U.S. where drugs other than alcohol are involved total 16%  marijuana is the largest contributor at 13%.  Individuals under the influence of marijuana are 25% more likely to be involved in car crashes

• Physical Abuse

The National Institutes for Health reported that men abusing alcohol are 11 times more likely to commit intimate partner violence.  Men abusing drugs were 3 times more likely to commit intimate partner violence

• Workplace Absenteeism, Tardiness, Turnover and Accidents

NIH estimates that absenteeism alone costs business $225.8 billion annually.  Psycnet estimates that employees are 3 times more likely to be absent the day after binge drinking which as we have noted 1 in 6 Americans does four times monthly.

In recovery circles it is often said that a problem drinker/drug user is anyone who had a problem while drinking/using drugs.  We are not that strict.  Further, we are not puritans defined by H.L. Mencken as someone who has "the haunting fear that someone, somewhere, may be happy."  We do intend to say that the stereotype of an addict or alcoholic as destitute, homeless is misinformed and there is far more harm being done regularly and on occasion by Americans using and abusing alcohol and drugs.  Binge drinking, heavy drinking, marijuana dependence, driving under the influence, domestic abuse, self-harm, and business costs are all serious problems caused in great part by alcohol and drug abuse that may not qualify as addiction.

It is time for us to abandon the thought that problem drinking, and drug use is only that among the homeless persons.  It is time for us to abandon the 85 year old model that relegates treatment only to those who have hit bottom.  Without becoming puritans we need to recognize the ill effects of so called “casual” alcohol and drug use and arrest those behaviors earlier in the cycle of abuse and addiction.

Louisville, Kentucky

January 23, 2022