The Focus is on Synthetic and Opioid Drugs, but What About Drug X? Part II

If you read my column in the last issue of Counselor, you have probably figured out that the “Drug X” I described is alcohol. This is the number one drug problem in the US and the world. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2013 there were 21.6 million people in the US age twelve or older with an alcohol or drug problem, which is 8.2 percent of the population (2014). Of these 68 percent (14.7 million) had alcohol abuse or dependence, 20 percent had drug abuse or dependence (4.3 million), and 12 percent had both alcohol and drug abuse or dependence (2.6 million). 

SAMSHA also reported that only 2.5 million (11.6 percent) received specialty treatment for their alcohol or drug problem: 37.4 percent of those received treatment for a drug problem, 35 percent for an alcohol problem, and 22 percent for both an alcohol and a drug problem (2014). These data show that although alcohol problems are 3.4 times more prevalent than drug problems in the US, more people receive treatment for a drug problem.  

The NIH budgeted over $1.5 billion for research on alcohol and drug problems for fiscal year 2016 (2015a). Nearly 70 percent of this goes to NIDA and 30 percent goes to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).    

Individuals who drink too much on a single occasion or even innocent bystanders can be exposed to a tragic outcome from the effects of alcohol. A woman was walking with her six-year-old daughter and sixty-one-year-old mother when a drunk driver lost control and drove onto the sidewalk, killing her daughter and mother (Booz & Holmes, 1981). Just imagine the heartache and heartbreak she and her family experienced over these tragic deaths.

According to a World Health Organization (WHO) report entitled “The Global Status Report on Alcohol and Health” (2014) and “Alcohol Facts and Statistics” (2015) published by the NIAAA, alcohol related deaths in the world from injuries, cancers, heart and liver diseases, and toxic overdoses are estimated to be between 2.5 and 3.3 million. The WHO report lists the top nineteen global health concerns using the disability-adjusted life year, which estimates the potential years of life lost to premature death. Alcohol use ranked number three in the world, but is the leading risk factor in the Western Pacific and the Americas, and the second in Europe.

There are many effective interventions for alcohol problems. Key issues for affected individuals are to get professional care, stick with treatment long enough to reap the benefits, and engage in mutual support programs like Alcoholics Anonymous (AA) or other community-based programs to sustain long-term recovery. Common challenges facing these people include dealing with low motivation to quit drinking, resisting strong cravings to drink, fighting off obsessive thoughts of alcohol, refusing pressures from others to drink, engaging in nondrinking activities for fun, using the support of others, seeing the impact of the alcohol problem on self and family, catching early signs of relapse, and getting back on the sober track if alcohol is used. Embracing long-term recovery is the best way to address more severe alcohol problems. For alcohol dependent individuals who have trouble staying sober, medications such as Acamprosate, Disulfiram, Naltrexone, Naltrexone XR or Topiramate can help, along with counseling and AA or other mutual support programs like SMART Recovery or Women for Sobriety. For those with a co-existing psychiatric disorder like clinical depression, integrated treatment that focuses both on the alcohol and psychiatric illness is the preferred approach.

The key issues for family members are to assist their loved one to get help, support them while in treatment and recovery, but not get so obsessed with this person that they get lost in the process.  Family members may need to learn how not to direct most of their time, energy, and resources to the member with the alcohol problem. Counseling and participation in Al-Anon can provide much needed help and support for family members. Recovery for families provides a context to reduce or let go of worry, anxiety, anger or resentment and focus more on self-care and positive change.  

For medical and mental health professionals who do not specialize in treatment of substance use disorders (SUDs), the challenges are to put negative attitudes and behaviors aside, and see individuals with SUDs who need help no different that individuals with diabetes, hypertension, depression, anxiety or other medical or psychiatric disorders. Early and regular screening or evaluating patients or clients for alcohol or drug problems, educating them and families about substance problems and treatment options, providing brief interventions, and referring to specialty care and AA for more severe problems are helpful interventions. The worse thing a professional can do is wait for a person with an alcohol problem to “hit bottom,” because this may never happen. Or, a bottom may be severe or fatal.

So, we should continue to address problems with all types of drug use in the US. But, let’s not forget that alcohol is a significant problem for many people, and impacts on families and society in many negative ways. Treatment and recovery are the best ways to deal with these problems.

The idea for this article came from late Sidney Cohen, MD, who posed this question in an article: “What would happen if a drug came into use (let’s call it Drug X), and it turned out to have these wide-spread and devastating effects?” (Cohen, 1981, p. 102). Dr. Cohen stated the adverse effects of Drug X would occur with the user, families, others, and “the entire social system.” In his article, he discussed fourteen adverse effects of Drug X and stated these effects would be so extensive to make us wonder “whether we will be able to afford the human and financial costs of Drug X abuse in years to come” (Cohen, 1981, p. 102–6). His Drug X was alcohol.

I am the son of an alcoholic who got sober at age sixty-six and died sober at age eighty, and have witnessed firsthand how alcoholism can wreak havoc on a family. However, I have also seen how treatment and recovery can help those with alcohol problems as well as family members harmed by it.

Booz, G., & Holmes, R. M. (1981). Kendra. Independence, MO: Independence Press.  

Cohen, S. (1981). Drug X: The most dangerous drug on earth. In S. Cohen (Ed.), The substance abuse problems (pp. 102–6). New York, NY: Haworth Press.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2015). Alcohol facts and statistics. Retrieved from http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

National Institute on Health (NIH). (2015a). Congressional budget justification, department of state and foreign operations and related programs: Fiscal year 2016. Retrieved from http://www.state.gov/documents/organization/236395.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Results of the 2013 national survey on drug use and health: Summary of national findings. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf

World Health Organization (WHO). (2014). Global status report on alcohol and health 2014. Retrieved from http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf