An important new study related to Americans’ use (and abuse) of alcohol was recently published in the Archives of General Psychiatry. I caught up with Revolution Health’s addictions specialist, Bruce Phariss, MD to get his perspective on this very common, yet often disabling addiction.
Dr. Val: Is there anything surprising or new
presented in this study? If so, what is it?
Dr. Phariss: It
isn’t necessarily surprising, but it is striking that 30% of Ameicans have an
alcohol problem at some point in their lives. Alcohol problems often develop
slowly and no one “notices” that it has become a problem until well after the
fact. That’s why it takes 10 years on average for those that get treatment to
actually get the treatment. The study also highlights the fact that a huge gap
exists between those needing treatment and those receiving treatment. We’re
still not doing a very good job in the treatment community of getting the word
out there that treatment is available and that treatment
Dr. Val: Why do you think that only 25% of
people with alcohol abuse problems get treatment?
Dr. Phariss: Three things: First, denial and stigma keep many “unaware” that they have a
problem. The first step in the stages of how people change behaviors is
awareness. If you don’t know you have a problem, you can’t change it. Along
this same line, if alcoholism is viewed as a moral failing instead of as a
medical condition, then good, moral people don’t think they can be alcoholics.
That’s good logic, but unfortunately, alcohol is non-discriminatory and even
good, moral people develop alcohol problems. Fighting through that
generalization of stigma is too tough for many people and they never seek
treatment or attempt to change their behavior.
Second, our cultural still
galmorizes drinking and drugging. Although the hype surrounding the many young
starlets currently in rehab centers appears to say how tough these addictions
are to kick, the overall slant is to add cache to the celebrity. It’s cool to
need rehab, it’s cool to be that out of control with alcohol and substances,
it’s almost synonymous with celebrity of a certain type. Sadly, this message
influences the behavior of many Americans, especially the under 25 crowd, who
are the most venerable to developing addictive behaviors.
Third, many people stop on their
own without treatment. Almost anyone who does find their way into treatment of
any kind (AA, treatment programs, etc.) has tried to stop on their own at least
once, maybe a hundred times. Just think of the many times you’ve heard someone
say “New Year’s Eve is my last day of drinking” or “I’m going to give up booze
for Lent and not pick it up again” or, my favorite, “I can give it up any time I
want….” In fact, some of the 75% of the people who need to deal with their
drinking do deal with it on their own. But many others need help of some kind.
Breaking down barriers to treatment — access and psychological and financial
barriers — remains the goal of the treatment community.
Dr. Val: What sorts of interventions might be
most useful (on a personal and on a national scale) to reduce alcohol abuse and
The debate on a national level as to how to intervene to reduce alcohol
abuse and dependence is ongoing and heated at times. However, many intervention
and prevention programs focus on underage, college age and the under 25-year-old
drinkers. If you don’t a drink until age 21 you are four or five times less
likely to develop an alcohol problem than someone who drinks before the age of
21. But underage and college age drinkers are becoming more numerous, not less,
so we must be doing something wrong. A few colleges have taken an approach I
like: in addition to providing counseling, supporting AA meetings by providing
space, a few colleges have taken to trying to change the “perceived norm” about
drinking on campus. Although in fact most kids on campus do not binge drink on
a regular basis, the perception by incoming freshman is that everyone drinks
more than they do. This holds true for the guy who drinks two six packs a day
(clearly way too much)….he actually thinks that the majority of students drink
more than he does. What is a motivating emotional factor for college students:
they want to be accepted, to be a regular, normal guy or girl. If the
perception is that normal is to drink a bucket, then as a group they will be
more likely to drink heavily. A few colleges have taken the simple step of
making the student body aware that, in fact, most students do not drink to
excess. That simple step has helped to curb the trend of more and more alcohol
Dr. Val: What’s the take-home message to be
gleaned from this study?
Dr. Phariss: The take-home message is that the medical profession has a long way to go in
de-stimatizing treatment for alcohol use disorders and that the substance abuse
treatment community remains too distant, too inaccessible and too timid in
announcing that treatment works. As the AA slogan says: “It works if you work
it, so work it, you’re worth it.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.