Hooch; booze; sauce; moonshine; oats soda; liquid courage; whatever you call it, alcohol is by far the most commonly used drug globally. Yes –alcohol is a drug, and, despite societal acceptance, alcohol causes more harm to Canadian society than heart attacks and strokes combined.
Four out of every ten visits to an emergency room are directly contributable to alcohol… which is an improvement over the fifty percent we used to see but, that one in ten, or ten percent, of ER visits which are no longer attributable to alcohol now come in the form of opioid overdoses – are we really ahead?
Last time we spoke about human beings innate ability to digest alcohol and the evolutionary advantage those quickly accessed calories gave us, but, like most good things, humans also have an ability to overimbibe, and a tendency towards gluttony.
For example, did you know, the detox facilities in St Catharines were originally created to allow for a place for alcohol detox away from the prying eyes of the public? True story.
Regardless of which chemical strikes your fancy, and helps you escape, or explore, substance use falls within three categories: use, misuse, and abuse; much of the public’s concept of alcohol abuse is false, according to diagnostic tools and statistics. If you think about it, would you classify a weekend drinker ‘a drunk’? What about a weekend heroin user? Are they a ‘junkie’? Or the occasional hallucinogenic trip while camping or at a concert… does that make you a ‘druggie’?
And yet we ignore alcohol misuse, and are much more forgiving of it… is that due to its prevalence, availability, or simply long held societal norms? For while heroin and marijuana were considered the ‘scourge of the Jazz world’ (ie. a racial problem) and, later in the twentieth century, crack cocaine was seen as a ‘ghetto’ problem (again, that means racialized for those of you in the back), so-called nice white society has continually imbibed in alcohol.
(Or prescription heroin and cocaine… again, these are chemical compounds which do have medicinal properties, particularly in their natural state, which were readily available with a prescription well into the twentieth century in North America).
And, other than the odd successful temperance movement, alcohol is the only major drug easily accessible throughout the western world – for the sake of this article, lets ignore tobacco and caffeine usage. So, before we go any further, let’s explore the term ‘alcoholic’ and the actual medical, and DSM-V, classification of substance use disorders, which include alcohol.
What is a Substance Use Disorder?
Have you ever used a substance for a reason other than its intended purpose? Taken an antibiotic not prescribed to you? Or an old medication without revisiting a physician? What about drinking to get drunk? Those are all substance misuse and while misuse oft leads to abuse, particularly when speaking about opioids, that is not always the case.
Some are able to use drugs recreationally without forming the tolerance, cravings, and withdrawal, symptoms which are hallmarks of abuse. But abuse does have other symptoms which are often missed as keystones in the diagnosis of a substance use disorder including:
• continued use in spite of negative consequences;
• using greater quantities of the substance than planned;
• excess time spent obtaining, using, or recovering from substance use;
• an inability to perform as expected (ie. multiple missed days at work or school); and
• an inability to continue valued social and work roles.
Many of these symptoms must present in order for us to diagnose a substance use disorder – but that doesn’t mean that most who enjoy alcohol are using it correctly. In fact, according to Niagara Region Public Health, 59% of Niagarans aged TWELVE and over are considered regular drinkers while 44% of adults are hazardous drinkers.
Recently released data from the Canadian Institution for Health Information (CIHI), states that while 2017 was the record breaking year for opioid deaths in Ontario, that same year saw three out of four substance related deaths, in Ontario, were caused by alcohol.
75% of all substance related deaths were due to alcohol, not opioids.
50%+ of all substance related hospital visits were due to alcohol.
Both of these statistics are well above the national average – the only province or territory which fared worse was Newfoundland and Labrador.
If we look at the data sets coming out of the Canadian Centre on Substance Abuse and Addiction (CCSA), the cost of substance use on Ontario is $14 billion annually – with alcohol accounting for 36% of those costs (for reference: tobacco 30%, cannabis 8%, opioids 9%, cocaine 7%).
Ontario spends $5,344Bil annually on alcohol related health care, lost productivity, and criminal justice, costs. Think about that next time Premier Ford espouses his infamous ‘letting adults make their own choices’ line regarding ease of access to alcohol related products… or as we realize health care and public health costs are being slashed.
The data further that 40% of those hospitalized for substance misuse, have a concurrent mental health issue, diagnosed or otherwise.
While men are twice as likely to be hospitalized for alcohol related harms, in the age 15 to 19 category, girls are far more likely to be hospitalized – the only age group in which we see this trend.
So while most of those who are seen for alcohol-related harm abuse alcohol, they would not be characterized as a ‘chronic alcoholic’.
Why does this matter? Because until we start to discuss the true societal harms of alcohol, particularly in relation to those self-medicating a mental health issue, we will continue to stigmatize with words such as drunk, alcoholic, wino… none of which are medical terms and do more harm by closeting the issue. We must discuss alcohol misuse in the same terms we do other substance misuse – and do more to educate our children on the adverse effects and health imbibing practices.
That same NRPH study shows 14% of Niagara area high school students abuse alcohol in a harmful way. Alcohol must be discussed in the same harm reduction terms we employ with the opioid overdose epidemic – particularly if beer will soon be found in every corner store.