A beer at a ballgame. A cocktail at dinner. Champagne toasts at a wedding.
To most Americans, alcohol is an innocuous part of everyday life, so commonplace as to go unnoticed. But the nation’s everyday drug is also the culprit behind its most enduring and overlooked drug crisis.
Drinking, and especially heavy use, is driving an epidemic of injuries, illnesses, and deaths in the United States. Despite recent declines in drinking, alcohol remains the nation’s deadliest drug — more deadly than opioids, fentanyl, methamphetamines, or heroin.
Alcohol kills 178,000 Americans each year and sickens countless more. Yet the public, corporations, lawmakers, and federal officials mostly act as though the problem doesn’t exist. This widespread denial pervades even the Trump administration, which, more than any administration in recent memory, is attuned to the burden of addiction.
The Deadliest Drug, a new investigative series by STAT, reveals the nation is failing in key areas:
Inconsistent detection
Screening for excessive drinking and related health problems is inconsistent, and tends to flag only severe cases. Many health care providers are still uncomfortable pressing patients on their drinking levels, referring them to treatment, or prescribing medications known to help patients reduce or eliminate alcohol consumption.
Relying on individual willpower
When Americans do get help, they often encounter a one-size-fits-all approach. The U.S. still relies disproportionately on individual willpower, and on the ideology and practices of 12-step programs like Alcoholics Anonymous. While the group has helped millions quit alcohol, its sometimes dogmatic approach has failed many who reject its God-centric bent, experienced emotional or physical abuse at the hands of sponsors, or wished to reduce their drinking instead of cutting out alcohol entirely.
Fragmented treatment infrastructure
More broadly, the nation’s treatment infrastructure for excessive alcohol consumption remains fragmented, medications remain underutilized, and harm-reduction strategies long embraced by other countries remain taboo. Even though most cases of alcohol use disorder are mild or moderate, many Americans seeking treatment are forced to choose between labeling themselves “alcoholics” and never drinking again — or foregoing treatment altogether.
While the U.S. is not alone in experiencing high rates of alcohol-related harm, it is facing a uniquely troubling twin epidemic of alcohol use and metabolic disease. The ongoing crises of obesity, diabetes, and cardiovascular disease, coupled with alcohol use, have made for a nightmarish liver landscape. More young Americans are dying from liver disease than ever before, even as drinking rates dip to historic lows in those under 50. A growing number of experts believe the combination of alcohol and poor diet is the reason why.
Old problems linger
Over one in 10 pregnant women in the U.S. drink, and experts worry that increasingly relaxed attitudes about alcohol in pregnancy could drive a wave of neurodevelopmental issues estimated to be more common than autism. Despite widespread understanding of the risks of alcohol use during pregnancy, about 25% of pregnant women who drink report having more than four drinks in one occasion, according to STAT’s analysis of federal data. They, along with children disabled by alcohol exposure, are especially vulnerable to fall through the cracks of the health care system.
Influence of industry
STAT has also found that lawmakers, regulators, and administration officials let public health-focused proposals wither away. Approaches such as higher state-level fees or updated labels could make a dent in alcohol abuse and its myriad dangers. Yet even in the age of Make American Healthy Again, when Americans are focused on their health, the administration has kept alcohol and its many risks outside of the limelight. In key ways, leaders have made it easier for the alcohol industry and its allies to bend science, and more difficult for people to understand how much they should be drinking, or the risks of their alcohol use.
These alcohol-driven problems and others will continue to plague the country if left unchecked, experts told STAT over the course of more than 100 interviews. Ultimately, if the Trump administration continues to ignore or sideline the epidemic of problem drinking and addiction, it is unlikely to improve Americans’ health.
“You can’t have MAHA without mental health and addiction,” former congressman and addiction treatment advocate Patrick Kennedy — the health secretary’s first cousin — told STAT.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.