America’s drug crisis has led to another tragic celebrity death. Only the drug crisis in this case isn’t the nation’s opioid epidemic. Instead, it’s a drug crisis that’s been with us for much longer: alcohol.
Last week, True Blood actor Nelsan Ellis died at age 39. A few days after his death, Ellis’s family released a statement to the Hollywood Reporter confirming the death was linked to alcohol and other drugs:
Nelsan’s father has bravely agreed for me to share the circumstances of Nelsan’s heart failure. Nelsan has suffered with drug and alcohol abuse for years. After many stints in rehab, Nelsan attempted to withdraw from alcohol on his own. According to his father, during his withdrawal from alcohol he had a blood infection, his kidneys shut down, his liver was swollen, his blood pressure plummeted, and his dear sweet heart raced out of control.
On the morning of Saturday July 8th, after four days in Woodhull Hospital, Nelsan was pronounced dead. Nelsan was a gentle, generous and kind soul. He was a father, a son, a grandson, a brother, a nephew, and a great friend to those that were lucky enough to know him. Nelsan was ashamed of his addiction and thus was reluctant to talk about it during his life. His family, however, believes that in death he would want his life to serve as a cautionary tale in an attempt to help others.
We don’t know specifics beyond what Ellis’s family said in the statement.
But one thing we do know is that this kind of death has happened many times before, and may happen potentially thousands of times this year alone.
The most recent analysis from the Centers for Disease Control and Prevention (CDC) estimated that alcohol is linked to 88,000 deaths every year — more than the 52,000 who died to drug overdoses in 2015. If anything, the alcohol estimate is likely too low. It’s from 2006 through 2010, but more recent data suggests that at least some alcohol deaths are trending up: Between 2010 and 2015, the number of alcohol-induced deaths (those that involve direct health complications from alcohol, like liver cirrhosis) rose from less than 26,000 to more than 33,000.
That’s only the deaths. Alcohol is also linked to millions of hospitalizations every year, as well as crime and violence.
It’s clear that alcohol misuse is a serious problem — one that, again, the data suggests is getting worse. Yet it’s a problem that gets little public attention.
America’s approach to drug treatment is woefully inadequate
Last year, the US surgeon general released the results of an extensive investigation into drug misuse and addiction in America. Out of the many numbers in the report, this was the most shocking: Only 10 percent of Americans suffering from a drug use disorder get specialty treatment. Just imagine if there were similar numbers for other deadly diseases; it would be widely considered a national disgrace.
The report attributed the low uptake of addiction care to severe shortages in the supply of care, with some areas of the country, particularly rural counties, lacking affordable options for treatment.
Another problem, alluded to by the statement from Ellis’s family, is that often the addiction care available to people just isn’t very good.
Consider the gold standard for opioid addiction care: medication-assisted treatment, when drug users are given medications to treat their addiction. The research shows medication-assisted treatment is highly effective — with several studies showing it can cut the all-cause mortality rate among opioid addiction patients by half or more, and groups like the CDC, the National Institute on Drug Abuse, and the World Health Organization supporting its use.
Yet very often, this kind of treatment isn’t accessible — often due to explicit policy decisions. As one example, the federal government caps how much buprenorphine, a kind of opioid addiction medication, can be prescribed to patients. As a result, a HuffPost analysis found that even if every doctor who can prescribe buprenorphine did so at the maximum rate in 2012, more than half of Americans with opioid use disorders could not get the medication.
With alcohol, we also have effective medications for treatment. One of those drugs is also used for opioid treatment: naltrexone. Yet they’re often inaccessible to patients, because patients either don’t know about the drugs or can’t find a doctor or clinic to provide them.
Instead, the most common form of treatment for addiction in the US is based on the Alcoholics Anonymous and Narcotics Anonymous model. This is a model built largely on the notions that addiction is a moral failure, not a disease — among other things, the 12 steps of AA and NA ask that you submit to a higher power, remove your “defects of character,” and repent for past transgressions. Some (but not all) AA and NA programs even condemn the use of medications to treat addiction.
As Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, recently told me, “Let’s say you go to a doctor to get your depression treated. If they told you that you have to surrender to a higher power, address your character defects, make a moral inventory, [and] pray, you would probably think that you had gone to a quack. If we’re going to argue, as the 12-step people strenuously do, that addiction is a disease, it cannot be the only disease for which the treatment is confession, prayer, and meetings.”
That doesn’t mean AA and NA are all bad. Some studies indicate they can be helpful for certain people, although Szalavitz points out that the studies are riddled with very big methodological problems, particularly selection bias. But more than providing medical treatment, these programs can be helpful as peer support services — similar to support groups that give assistance to people with other chronic illnesses, like cancer and diabetes.
America can do a lot more to offer the full spectrum of care for people suffering from addiction. Based on the surgeon general’s report, though, it doesn’t provide even the bare minimum to 90 percent of those afflicted by a drug use disorder.
There are alcohol-specific policies that could help
Beyond access to treatment, there are other steps America can take to address its problems with alcohol.
When Americans think about alcohol policy, the first thing that comes to mind is probably Prohibition, which effectively banned the manufacture and sale of alcohol from 1920 to 1933. But there are all sorts of other policies that could help address bad outcomes due to drinking.
A small sample:
- A higher alcohol tax: A 2010 review of the research in the American Journal of Public Health came out with strong findings: “Our results suggest that doubling the alcohol tax would reduce alcohol-related mortality by an average of 35%, traffic crash deaths by 11%, sexually transmitted disease by 6%, violence by 2%, and crime by 1.4%.”
- Reducing the number of alcohol outlets: A 2009 review published in the American Journal of Preventive Medicine also found that limiting the number of alcohol outlets (such as liquor stores) in an area through stricter licensing, for example, can limit problematic drinking and its dangers. But it also found that going too far can have negative results — by, for example, causing more car crashes as people take longer drives to outlets and possibly drink before returning home.
- Revoking alcohol offenders’ right to drink: South Dakota’s 24/7 Sobriety program effectively revokes people’s right to drink if a court deems it necessary after an alcohol-related offense. The program, specifically, monitors offenders through twice-a-day breathalyzer tests or a bracelet that can track blood alcohol level, and jails them for one or two days for each failed test. Studies from the RAND Corporation have linked the program to drops in mortality, DUI arrests, and domestic violence arrests.
- Put state governments in charge of selling alcohol: A 2014 report from RAND concluded that when state governments monopolize alcohol sales through state-run shops, they can keep prices higher, reduce access to youth, and reduce overall levels of use.
These are just a few of the ideas that experts have put out there. There are many more ways to curtail alcohol consumption and misuse without outright banning it.
Maybe these policies still go too far for some people. Different individuals will likely disagree on whether these proposals go too far in restricting personal liberty, even if they do save some lives. But the research suggests such policies are at least worth considering.
Yet lawmakers have paid very little attention to alcohol policy. As Philip Cook, a public policy expert at Duke University who wrote Paying the Tab: The Costs and Benefits of Alcohol Control, previously told me, the last time Congress raised the federal alcohol tax was 1991 — and that has let the actual impact of the tax erode due to increasing inflation.
“The great opportunity we have is to restore taxes to the real value that they had a few decades ago,” Cook said. “That’s justified by the current social costs of drinking, and would have all kinds of beneficial effects, while being justified just from the point of view that drinkers should pay for the damage that they do.”
Part of the problem is that policymakers just don’t feel much pressure to act on these kinds of public health problems — at least in the same way they feel compelled to act on an issue like, say, terrorism. So thousands of people continue to die needlessly every year.