FILE - A vendor holds up alcoholic beverages for sale during a Portland Trail Blazers game at the Moda Center in Portland, Ore., Wednesday, Nov. 13, 2019.
Bradley W. Parks / OPB
During the pandemic, alcohol consumption increased more than it has in the last 50 years. Alcohol-related deaths have also been increasing, according to the National Institutes of Health.
In Oregon, six people die each day on average from alcohol-related causes, according to the Oregon Health Authority. As the holiday season approaches, the state agency wants Oregonians to talk to their loved ones about excessive drinking. Tom Jeanne is the deputy state healthy officer and epidemiologist at the public health division of OHA. Mike Winer is the associate medical director at Hooper Detox Center in Portland and is an assistant professor in addiction medicine at OHSU. They both join us to share more on the increase in alcohol consumption in the state and share the best ways to navigate difficult conversations with loved ones about drinking.
The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Alcohol consumption around the country increased more during the pandemic than it had in the last 50 years. Alcohol-related deaths went up as well. That’s all according to recent numbers put out by the National Institutes of Health. Meanwhile, the Oregon Health Authority says that an average of six people in the state die every day from alcohol related causes. As the holiday season approaches, a state agency is encouraging Oregonians to talk to each other about excessive drinking. Tom Jeanne is a deputy state health officer and an epidemiologist in the public health division of the Oregon Health Authority. Mike Winer is the associate medical director at Hooper Detox Center in Portland and an assistant professor in addiction medicine at OHSU. They both join us now. Welcome to the show.
Tom Jeanne: Thanks, Dave. Good to be here.
Mike Winer: Thank you for having us.
Miller: I want to start with a voicemail that we got. This is from somebody who chose not to leave their name.
Voicemail: Yeah, the last four years have been really, really tough. I’m a nurse and between the pandemic, the political situation, climate change, feeling isolated and lonely, having had a few injuries, my alcohol intake has definitely increased. It’s self medication basically. And, it has the potential to ruin my life and I’m doing everything possible to avoid that. But, I’m still struggling.
Miller: Tom Jeanne, how much did alcohol consumption go up during the pandemic?
Jeanne: Yeah, Dave. So we have a lot of data in Oregon, of course. And unfortunately there are some lags. So the latest data we have for alcohol related deaths is from 2020, but we do have some data that comes through the pandemic. And that includes our per capita alcohol consumption which increased from 579 drinks per person in 2019 and 2020, up to 601 drinks per person in the state in 2021. We also saw that during the first year of the pandemic, deaths increased by 26%. So that’s an increase from 2019 to 2020. And in the past three years alone, deaths related to alcohol have increased nearly 40% in the state. So this is definitely a concerning trend.
Miller: In terms of consumption, do we know yet if those rates have gone down in the years since the shutdown years of the pandemic?
Jeanne: No, we really don’t. But if we look at the trends through 2021, it’s actually part of a larger pattern, both binge drinking and heavy drinking among Oregon adults have been steadily increasing over the past 20 years. Binge drinking increased 22% between 2001 and 2021 and heavy drinking increased 46% over that same period. So that long term trend, which was we think likely exacerbated by the stress of the pandemic, is something that we’re concerned about
Miller: Mike Winer, what are the definitions, I guess the federal definitions, of binge drinking and heavy drinking?
Winer: Yeah, that’s a great place to start. So the kind of the national view, our standing is that for binge drinking, no more than five drinks in a session for cisgender men and no more than four drinks in a session or in a day for cisgender women. And then the recommendation for heavy use is for cisgender women, more than seven drinks in a week. And then for cisgender men, more than 14 drinks in a week.
Miller: Meaning if you have, for a cisgender woman, more than one drink a day over the course of a week, that’s considered heavy drinking.
Winer: Considered heavy and what’s defined as kind of unhealthy alcohol use.
Miller: How common are these rates of alcohol consumption in Oregon?
Winer: I’m going to turn that one over to Tom, I think. I know the national data and so we know that around 30 million U.S. adults meet that definition for alcohol use disorder. And I think that’s an important definition to know as well. So alcohol use disorder and binge drinking aren’t the same thing. But alcohol use disorder is kind of when it becomes a diagnosis. And so that diagnosis is when somebody is compulsively using alcohol despite problems, and those problems can be in your life like in your relationships or your ability to work or carry out functions in your household. So continuing to use alcohol despite knowing or having these known health problems or mental health problems.
Miller: Tom Jeanne, do we know how many people in Oregon would qualify under those categories of heavy drinking, excessive drinking or binge drinking?
Jeanne: Yeah, we do, Dave. So more than one in five people living in Oregon are excessively and the thing is many of them may not realize that their level of drinking is excessive. And so that’s why we’re, part of our campaign, our ‘Rethink the Drink’ campaign is trying to raise awareness of what is heavy drinking and what is binge drinking. And many people may actually meet those definitions while not really realizing it.
Miller: I mentioned that stat, from your agency, the Oregon Health Authority, that on average, six people die every day in Oregon from alcohol related causes. What falls under that category?
Jeanne: That’s a great question. So, first I have to say alcohol is the third leading cause of preventable death in Oregon. It’s responsible for over 2,000 deaths a year. And that’s actually quite a bit above the number of deaths from drug overdose. And we know that those deaths are far too high, but many people may not realize that alcohol is actually the substance that’s related for the most deaths. So we all know that car crashes related to alcohol and drunk driving are a factor. We know about alcohol related liver disease, hepatitis, cirrhosis. But there are actually many, many other alcohol-related deaths, and that includes many cancers, breast cancer, prostate cancer, colon cancer and many others. That includes deaths related to heart disease, high blood pressure. Of course, there are mental health related effects, suicide, injury, falls. So it’s really a huge spectrum of diseases and risk factors that can be related to alcohol.
Miller: Can you help me understand, just a statistical question here, because recently we’ve heard a stat on our show that came, I think from the National Institutes of Health, that right now the leading cause of death for Americans ages 18, I think, to 49 is fentanyl overdoses. So, if that’s the case, how is it that alcohol accounts for a higher number of deaths than fentanyl?
Jeanne: Yeah, I mean, it can get complicated with all the different ways we have to categorize and look at the populations and the risk factors and deaths in different subgroups. I think one of the issues is that fentanyl has been just a rapid and massive increase, in terms of a risk factor and how it’s affecting deaths here. So the exact comparison right now in 2023 maybe a little muddy, but the bottom line is, these are both significant risk factors and yes, alcohol is one of the leading risk factors for that kind of middle age group, for people in their twenties, thirties, forties, that people may not be aware of.
Miller: Let’s listen to another voicemail that came in.
Michael Kennedy [Voicemail]: Yeah, I’m Michael Kennedy. I live in Portland. I found myself, I never get drunk or anything but I would go like, from having a glass at dinner, then two glasses, then maybe two or three. And then I was just finding myself falling down that rabbit hole and my wife the same thing, and so we just kind of looked at each other and thought, that’s enough of that.
Miller: I gotta say, Mike Winer, at the end there, he makes it sound very easy, but we wouldn’t be talking right now, I think, if everyone found it that easy to stop drinking or to drink less. What are the various challenges that people encounter if they decide they actually want to do just that?
Winer: I think, well, what that voicemail showed and in that listener for being very honest, kind of having that realization that you yourself are having a hard time stopping or slowing down or somebody in your life has kind of noticed that you’re having a hard time with alcohol. That’s a great place to kind of realize, maybe I need to access treatment. I don’t think a lot of people know, especially [those] that use alcohol, that there is treatment and that it works. Of the 30 million folks that we know have alcohol use disorder in our country, we know that fewer than around 8% really access treatment in a given year. And of those less than 2% access treatment with medications and medications for alcohol use disorder are pretty effective and they’re not really talked about or known about. So I think having folks talk to their providers or doctors is a really good first start.
Miller: What are those medications? I think you’re right. I mean, on this show over the last year, we’ve talked a lot about overdose reversal drugs from opioid overdoses or medication assisted therapy for opioid use disorder. But what are the medications for people with alcohol use disorder?
Winer: There are three medications that are FDA approved for alcohol use disorder. And then there’s some off-label medications that sometimes providers will try or use based on a person’s kind of unique scenario. But the three medications are naltrexone, acamprosate, and disulfiram. And the best evidence we have are for naltrexone and acamprosate. And these medications have been shown to help reduce the urge to drink and kind of limit the reward pathway when you do drink. And they’ve been shown to help people who are ready to or decide they want to stop using alcohol to actually achieve that.
Miller: As I mentioned at the beginning, you are the associate medical director at Hooper Detox Center in Portland. My guess is that when a lot of people hear the word detox now in 2023, they think about opioids. What percentage of your patients come in because of alcohol?
Winer: Yeah, especially in the fentanyl era. But so at Hooper Detox, we provide medically managed withdrawal services. And in the last year, we provided services for almost 3,000 patients. And I would estimate about half of our patients have some form of alcohol withdrawal during their time at Hooper. So it’s still a pretty significant amount of our patients.
Miller: Can you describe alcohol withdrawal?
Winer: Yeah. So when people come to Hooper Detox here or access our medically managed withdrawal services, this is a very kind of end of the spectrum, kind of more severe alcohol use disorder. And alcohol withdrawal is one of the withdrawal symptoms that can be pretty severe, and actually deadly. An alcohol withdrawal is, for folks listening who might notice or have somebody in their life that has this, it’s when you try to stop drinking and you notice that you are kind of anxious, jittery and your entire kind of nervous system is on red alert and you actually can have seizures and the process for withdrawal can be about three to four days from the last time that you use alcohol. And what we do is we use medications that help reduce the risk of having a seizure and help with that withdrawal process.
Miller: Tom Jeanne, you mentioned your ‘Rethink the Drink’ campaign which originally started last year and now there’s a kind of winter version of it. I’m curious just about the language here. How do you think people in general currently think about drinking and how do you want them to change that? What do you want them to rethink?
Jeanne: Yeah, it’s really a great question. We have to emphasize, we’re not telling people to stop drinking. What we’re really trying to do is educate and inform about all the health effects of alcohol. And we’re asking people to start a conversation, to really think about the way alcohol is present in their own lives and communities. The campaign is really trying to highlight how common alcohol has become in community settings. And that includes holiday celebrations, of course, but also in barbershops and at runs, people are drinking in many different settings. And it’s really just a way to try to get people to think about that, to talk about it and think about how they want alcohol to be a part of their life, or not.
And so that’s what we saw, the first campaign last summer, we were really thrilled with the results from it. It was seen by millions of people throughout the state on social media, TV, radio, newspapers. And we found from evaluating that one that people were having more conversations about their own drinking and their friends and family’s drinking. It did increase knowledge and awareness of what excessive drinking is, and got people to think more about their drinking habits, and maybe planning on cutting back. So, we’re hoping to extend that with this campaign which runs now through the end of January.
Miller: Well, but let’s say someone’s planning a holiday party right now or a family get together or, I don’t know, planning a 5-K fun run for this coming summer and figure out who the vendors are going to be. I mean, what’s an example of an actual kind of conversation that you would like to foster?
Jeanne: I think it’s a question for people hosting events like this to think, is your gathering a safe space for people? Will they feel comfortable not drinking if they choose? Does alcohol have to be at this gathering and are there other options? And I think it’s just trying to normalize that thinking and normalize not drinking as opposed to having alcohol kind of be a default in these kind of gatherings and events.
Miller: I wanna play another voicemail. Let’s have a listen.
John [Voicemail]: Hey, there, this is John and yes, I have found myself drinking more since the pandemic and I have tried to cut back. I recently started just drinking on the weekends, not during the work week, but yes.
Miller: Mike Winer, what do you make of strategies like that? I mean, ‘Dry January’ is a phrase that probably many of us have heard. It’s just around the corner. After that, I mean, the reason it’s called that is because of ‘Wet December,’ which I don’t know is a phrase we use. But obviously that’s the reason for ‘Dry January.’ Or John’s idea here of only drinking on the weekends or some people saying, I’m only gonna drink if I’m with friends, I’m not gonna have a beer by myself. Do these strategies work?
Winer: It’s a great question and I really like the way Tom put it. I have the same kind of view. My goal is never to tell somebody they have to stop drinking. It’s to meet them where they are and with their individual goals and to reduce harm and reduce death. And often when somebody comes to see me in our low barrier walk-in clinic at Hooper Detox, sometimes they’re not ready to stop drinking and they want to reduce their drinking. And so those strategies can be really helpful. So having a drink and then following it with a glass of water, spacing out the time between drinks, limiting it to weekends, can all be great strategies to help people get what they want to get.
Miller: Do you find that if people limit drinking to certain days, they end up drinking more on those days?
Winer: It’s very patient dependent. So I think it’s going on those kinds of guidelines we talked about. So people that do say I want to only drink on the weekend, so you can talk about what would be a healthy range if you were to drink on that weekend. So by letting them know what binge drinking is, letting them know what to do if they feel like they’re drinking more and they can’t help themselves afterwards. And apparently having access to resources.
Miller: Tom Jeanne, there was a one small glimmer of good news that I saw in the press release your agency put out today, which is that, and even as you mentioned, that while binge drinking and heavy drinking among adults are on the rise in Oregon and around the country, that younger people, at least in Oregon, are drinking less. How do you explain that?
Jeanne: It’s a tough question. I think we have seen significant changes in youth substance use and for certain substances, it did actually go down during the pandemic. Again, the pandemic was a huge disruptor in many ways. Kids were not in school in person for a lot of that. So that may have played a role. Kids are obviously much more online than they were in the past and on devices and social media. And I think some of that may result in less drinking because there’s maybe less in person social interaction. But I think this is a question that researchers will need to be studying and thinking about because it’s, again, a really complex issue, but we’re certainly happy that we’re not seeing large increases in drinking among youth.
Miller: That press release, it also notes that while people of all education and income levels drink excessively, some populations experience higher rates of alcohol-related diseases. What are those populations?
Jeanne: Several populations, but especially the Black and Indigenous communities in Oregon, as well as people in general with lower incomes and less education. And I think it’s really important to highlight that the negative harms from excessive alcohol use are disproportionately impacting these communities, despite consumption rates that are generally lower than white Oregonians. And that just gets at the unjust disadvantages and stressors, racism, and discrimination that increases the harms from alcohol even though these communities aren’t necessarily drinking more, they may be drinking less. So I think it just highlights the need to reduce the disparities and injustices that these people are facing in our state.
Miller: The press release didn’t just talk about the impact on human lives, sometimes deadly, but also the financial impact overall to the state with a kind of eye popping number. $4.8 billion a year, the impact of drinking in this state, and that’s not, say, sales to breweries; that is, I guess, externalities. What’s included in that nearly $5 billion?
Jeanne: It’s a very big number, and that’s including things like motor vehicle crashes and the direct cost from that, the health care expenses, of course, and that includes healthcare expenses from cancer treatment and all those chronic diseases that alcohol can cause. It also includes criminal justice costs and it includes lost productivity of workers from these impacts, including people who just maybe are drinking too much. So that number breaks down to about $1,100 for every person in Oregon per year. So this is really significant. It’s kind of under the radar, we don’t necessarily think about it. But it’s one of the things that needs to be part of the conversation when we’re talking about alcohol, which of course there are benefits to alcohol. We have small businesses, wineries, breweries that are important parts of our community. We don’t want to ignore that, but we just want to make sure that conversation is complete and considers the harms as well.
Miller: Mike Winer, what role do you think the price of alcoholic drinks plays in this conversation?
Winer: Oh, that’s a good question and hard to really answer. We know for youth and adolescents that legislation can be helpful in reducing. But I hesitate to kind of comment on that, not really knowing.
Jeanne: Dave, if I could add, we know from an abundance of research that raising the price of alcohol does reduce alcohol use and it does save lives. So policy approaches here are also complicated but we know that for sure. And there is a new task force from the House Bill 3610, a task force on alcohol pricing and addiction services that is starting up and we’ll be studying some of these issues.
Miller: The NIH found that from 2001 to 2015, increases in state level excise taxes on cigarettes were associated with a reduction in smoking. And from what I’ve read, this is especially true for younger people in terms of smoking. And I have read analyses saying that the same could be true for higher prices on alcohol, that perhaps the biggest benefits would be among younger people, who I think in general would have less money to spend on alcohol. But obviously one huge difference in terms of cigarette tax increases and alcohol ones is that Oregon doesn’t have a big cigarette industry. We do have a big craft beer and wine industry, an increasingly large liquor one and ones that are really associated with Oregon’s brand and marketed at the state or local levels. Go to wine country or sample Oregon’s tasty beers.
How do you square that with this pure issue of public health?
Jeanne: Yes, they have to all be part of the discussion, Dave. Again, OHA recognizes Oregon is an alcohol producing state. We understand the economic value of our local breweries, wineries, and our spirit producers, [and] in our bars. They provide thousands of jobs for people living in Oregon. I want to reiterate that our priority is to reduce excessive drinking. Given that it has such a substantial burden and cost, we’re not trying to eliminate or prohibit drinking of alcohol as a whole. That is not something that we would ever plan to do. So this effort is really trying to minimize the harms to communities and build safer environments for everyone. And I would also add that harms from excessive drinking affect small businesses as well in terms of, in terms of lost earnings for workers, revenue for those businesses, healthcare expenses, etcetera. So we’re really just trying to balance the different pros and cons and benefits and harms.
Miller: I guess the only thing that comes to mind there though is a numerical one that, given everything you were saying before and the prevalence of problematic, of excessive drinking, the only way to truly address that would be to have a sizable reduction in the total number of drinks that were being sold in this state. You can’t have that unless there is a relatively significant hit to producers. And those obviously, they include Anheuser Busch and ones that are not just craft producers here, but something has to give.
Jeanne: Yeah. And I think our role in this is to educate and raise awareness of the science of the Oregon numbers and the impacts and make sure that’s part of the discussion, so that the policymakers can grapple with these tough decisions and decide kind of where we need to move the needle, if we do. And I don’t envy people making those decisions, but I think it is absolutely important that we look at it and reconsider given what we know.
Miller: Tom Jeanne and Mike Winer, thanks very much.
Jeanne: Thank you, Dave.
Winer: Sure.
Miller: Tom Jeanne is deputy state health officer and epidemiologist at the public health division of the Oregon Health Authority. Mike Winer is an assistant professor in addiction medicine at OHSU and the associate medical director at Hooper Detox Center in Portland. They joined us to talk about alcohol and excessive drinking in this state.
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