Ask a friend this question, “What drug is causing a human and health crisis in the US today?” and he or she very likely would answer opioid pain medications.  After all, aren’t 70,000 people per year dying of opioid use or overdoses? Aren’t pharmaceutical companies being sued by States and individuals for misleading or false advertising that downplayed the risk when they actually knew that patients could quickly become addicted to their legal drugs?  Didn’t a bi-partisan Congress, after many hearings and much speech-making, pass comprehensive legislation last Fall aimed at addressing the “opioid epidemic”?  

The answer to all those questions is yes. And the US is still in a public health crisis concerning opioids, which continue to kill more Americans than do all traffic accidents and more than the number killed by gun violence.

 

The other drug crisis

But there is another drug crisis going on in the US.  It’s a quiet one, unless it touches your family or friends.  It’s the crisis of alcohol misuse. Many people don’t even think of alcohol as a potentially addictive drug.  Many have been fortunate to not experience an alcohol-related tragedy in their family or circle of friends.  

The alcohol misuse crisis was highlighted earlier this month when new Federal research was published.  It showed that alcohol misuse is killing over 72,000 Americans each year. That’s about the same number as those killed by the much more publicized opioid epidemic.  And the scientists’ data came directly from U.S. death certificates. It’s not an extrapolation, conclusion or estimate.

 

Alcohol misuse is killing over 72,000 Americans each year, about the same number as those killed by the much more publicized opioid epidemic.

 

Researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is a part of the National Institutes of Health, analyzed U.S. death certificates and found that nearly 1 million Americans have died from alcohol-related causes between 1999 and 2017. In fact, the number of death certificates mentioning alcohol more than doubled from 35,914 in 1999 to 72,558 in 2017! In other words, alcohol plays a role in nearly 3% of all deaths in the United States. The increase in alcohol-related deaths is consistent with reports of increases in alcohol consumption and costly alcohol-involved emergency department visits and hospitalizations during the same period. 

Alcohol in our culture

Yet public perception of alcohol is often clouded by the fact that its use by adults is legal, culturally acceptable, and widespread.  And advertising by the $1.4 trillion global alcohol industry tells us its use can also be fun, make us look sophisticated, and can even make some of us more charming and attractive to the opposite sex.  In fact, in limitation it might even bestow some purported health benefits. Therefore it must be safe and relatively benign. Right?  

“Alcohol is not a benign substance and there are many ways it can contribute to mortality,” said NIAAA Director Dr. George F. Koob in his recent news release. “The current findings suggest that alcohol-related deaths involving injuries, overdoses, and chronic diseases are increasing across a wide swath of the population. The report is a wakeup call to the growing threat alcohol poses to public health.”

Alcohol-related deaths are increasing

The researchers found that, in 2017, nearly half of alcohol-related deaths were due to liver disease related to years of heavy drinking (22,245 deaths) or overdoses on alcohol alone or with other drugs (12,954 deaths).  People aged 45-74 had the highest rates of deaths related to alcohol, but the biggest increases over time were among young people age 25-34. By the way, keep in mind that the high rates among middle-aged adults are consistent with other reports of increases in what mental health professionals sometimes call “deaths of despair.”  These are deaths related to overdoses, alcohol-associated liver cirrhosis, and suicides, which have also dramatically increased in the last 20 years.

Alcohol misuse and women

The main point of the NIAAA study is that alcohol related deaths have increased among people of almost all demographic groups.  However, death rates in one population group raised particular concern: women. Death rates for women have increased more than men. “Alcohol is a growing women’s health issue,” said Dr. Koob. “The rapid increase in deaths involving alcohol among women is troubling and parallels the increases in alcohol consumption among women over the past few decades.”

Lessons for employers

This is not just a public health issue. It’s also a business issue.  What lessons, what actions should employers take from this information? 

The first lesson is that employers have a business stake in helping to address the issue by effectively using means already at their disposal.  Doing so is not benevolence, it’s good business practice. After all, the NIAAA study demonstrated that misuse of alcohol contributes to higher employer healthcare costs.  Preventable Emergency Room visits alone costs consumers, businesses and taxpayers more than $32 Billion per year according to Kaiser Health News.  

And the cost to employers doesn’t just come from ER and medical claims.  There’s also the cost of absenteeism and presenteeism. Ask any employer if they have employees coming to work hungover and not fully engaged.   Or ask if they have employees who incur excessive or unexpected sick days or workers comp and disability benefits. Then there is the risk of employee accidents, some which can be catastrophic, costly workplace mistakes or delays and workplace conflicts that too often escalate to violence. Not to mention the demoralizing and disruptive impact of a premature and preventable death of an employee. Employers bear the cost for all these alcohol misuse related events or results. 

The role of your EAP

The second lesson is for employers to examine the engagement with their Employee Assistance Program.  Ask yourself a few important questions. Do you have proactive employee engagement with this important workplace resource?  Is your EAP acting as a prevention tool? Is your EAP provider an engaged partner helping you achieve your business goals? Does your EAP provider even know your business’ goals and challenges?  Does your provider routinely provide behavioral health and human behavior input, expertise and consultation to your leaders?

Five things to expect from your EAP

Your EAP should:

1. Help your organization create a workplace culture of awareness around the dangers of alcohol, other drug misuse and other risky behaviors.
2. Help create social acceptance of and easy access to the means you are providing for getting professional assistance when it is needed.
3. Provide multifaceted, primary prevention activities aimed at educating employees about managing stress, about the signs of alcohol or other drug misuse, and the early warning signs that can lead to the “deaths of despair”.
4. Provide confidential secondary prevention through early case finding and referral to treatment and support groups for your employees who are on a path of misusing alcohol or other drugs. This also includes working closely with your human resource professionals and supervisors who detect job performance issues that are unresponsive to coaching, or policy violations that might be related to personal issues that the EAP can help the employee address.
5. Provide understandable reporting of your organization’s use of their EAP services.  The U.S. Surgeon General’s Reports have for many years estimated that in our increasingly fast-paced, stressful, complex society as many as one in four Americans has some type of behavioral health issue in any given year.  (Not to mention caregiver stress, financial problems, parenting issues and other distracting life situations.) Your EAP may not be reaching the Surgeon General’s percentage of your workforce, but if it’s reaching only a few percent each year, or if you’re human resource or benefits managers don’t know its level of use then it’s time to examine your program. And keep in mind, some EAP vendors are content if you don’t notice their low impact. They will check your box and move on.  So be proactive.

As we enter a new year and a new decade, let’s resolve to work to strengthen the partnership between employers and preventive behavioral health resources.  Let’s resolve to make 2020 a year that slows or reverses the disturbing trend in alcohol related deaths.

About the author and Espyr

Norman Winegar, LCSW, CEAP, NCAC II is a DOT Qualified Substance Abuse Professional. He is the Chief Clinical Officer at Espyr, a national behavioral healthcare company that provides employee, student and member assistance services and a variety of coaching programs that improve organizational effectiveness and employee health, safety and wellbeing. He is also the author of four books related to the behavioral health industry.