Addiction Policy Forum Blog

7 min read

The role of alcohol, drugs, and despair in falling U.S. life expectancy

By Mark Gold, MD on January 16, 2020

After 2014, U.S. life expectancy fell for 3 straight years. This striking trend is not associated with other wealthy countries in the world and has given rise to a cottage industry of speculation on causes, with varied social, cultural, and political actors making use of the findings for preferred narratives. Some of this speculation arose after Princeton economists Anne Case and Angus Deaton coined the term “deaths of despair,” an easily misunderstood phrase. Case and Deaton used the term to refer to fatal drug overdoses, alcohol-related diseases, and suicides. “We think of all these deaths as suicides, by a very broad definition,” these economists have written,“and we attribute them to a broad deterioration in the lives of Americans without a college degree who entered adulthood after 1970.”

In late 2019, a National Institute on Aging-supported review offered a comprehensive examination of falling U.S. life expectancy. This study used data from the CDC, National Center for Health Statistics, and U.S. Mortality Database to trace life expectancy trends over a longer time frame and analyze mortality rates for particular age cohorts. It paints a complicated picture of poor U.S. mortality trends, which are not driven just by our polysubstance epidemics, and a decidedly unhappy one. The authors write, “According to one estimate, if the slow rate of increase in US life expectancy persists, it will take the United States more than a century to reach the average life expectancy that other high-income countries had achieved by 2016.”

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7 min read

Alcohol use disorders are complex, but new research should improve practice

By Mark Gold, MD on November 14, 2019

 

Alcohol use disorders (AUDs) are one of the most common and least-treated health conditions in the world. Some AUDs decline in severity or even get better without treatment.1 AUDs often accompany depression, anxiety, fears and phobias, sleep disorders, liver problems, and other diseases. They may be caused by shared genes underlying other psychiatric conditions, especially depression.2 And while there’s a strong genetic component in many AUD cases, there are a host of contributing factors, from cultural and regulatory environments to psychological disposition to brain circuitry and anxiety, that can play important roles in the development of the condition—or, at least, that can play anything from a substantial role to a very limited one. It all depends. 

As any patient, involved health care practitioner, and/or expert would be quick to point out, AUD is a highly complicated condition, sometimes frustratingly so. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 6.2 percent of adults over 18 in the U.S. have an AUD, including over 9 million men and 5 million women.3 These numbers can be difficult to gauge in part because of the condition’s complexity—if we had a blood test that a physician could perform or a throat culture that could be sent to the lab, it would establish a diagnosis to everyone’s satisfaction. AUD is the most prevalent substance use disorder in the world, and from a public health perspective, it’s important not to let the complexity of AUD get in the way of sound policies and treatment practices. A comprehensive seminar recently published in The Lancet offered an updated discussion of the state of research on AUD, covering diagnosis, treatment, epidemiology, risk factors, environmental issues, and other considerations, as a guide to what we’ve learned about the condition.

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