Whether it's binge drinking or addiction to alcohol, Americans have a real problem with the bottle.
So says new research released Monday, which found that nearly one out of three Americans can expect to have a problem with alcohol at some time during their lives.
"We found that 30.3 percent of the U.S. population at some time in their lives -- though maybe not currently -- has had an alcohol use disorder," said study author Bridget Grant of the Division of Biometry and Epidemiology at the National Institute on Alcohol Abuse and Alcoholism.
But the nature of this problem can vary widely -- from a sustained streak of binge drinking behavior all the way to serious physiological addiction to alcohol.
The findings, generated from face-to-face interviews with more than 43,000 U.S. adults, appear in the July issue of the journal Archives of General Psychiatry.
To find out whether subjects had experienced problems with alcohol, interviewers questioned them looking for the symptoms of alcohol abuse and dependence listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
What researchers found was that 17.8 percent of those interviewed reported that they had abused alcohol at one time or another, and 12.5 percent reported alcohol dependence.
But perhaps most sobering was the fact that few with alcohol problems ever reached out for help.
"What we found was that very few people who have lifetime disorders ever seek treatment," Grant says, adding that only 24 percent of those suffering from alcohol dependency seek help. The percentage of those seeking treatment for alcohol abuse is even lower, at 7 percent.
"This is a big problem in our society, and every time we write a paper it becomes more clear," says Dr. James C. Garbutt, medical director of the Alcohol and Substance Abuse Program at the University of North Carolina at Chapel Hill.
"Nearly 100,000 people die every year of alcohol-related causes. Alcohol carries a $200 billion or more cost to society. These are huge statistics."
Spectrum of Alcohol Problems
Before anyone can meaningfully say how many Americans experience problems with alcohol, it is first necessary to define exactly what constitutes a problem.
After all, unlike illicit drugs, alcoholic beverages are both legal and socially accepted.
In the current study, Grant and her fellow researchers broke down those with alcohol problems into two categories: those who abused alcohol, and those who experienced dependency.
Questions related to alcohol abuse -- which normally involves periods of heavy drinking or numerous binge drinking episodes -- centered on problems with work or family due to alcohol, or even a tendency to drink and drive. Respondents experiencing alcohol abuse accounted for more than half of those reporting alcohol problems in the study, or 17.8 percent of the total number of subjects.
On the other side of the spectrum is alcohol dependence -- a more serious diagnosis that suggests a physiological addiction to alcohol. Those who reported experiencing such effects as tolerance to alcohol, unsuccessful attempts to cut back on their consumption or excessive time lost due to alcohol fell into this category, which accounted for 12.5 percent of all of those interviewed.
Regardless of the severity, those suffering from any alcohol-related problem open themselves up to significant risks -- whether from accidents or the physical effects of intoxication. But considering the common nature of alcohol-related problems, why aren't more people seeking help?
"One of the major findings of the study is that the proportion of people seeking or receiving professional treatment was unchanged or declined in the last 10 years -- and it is a small proportion of people who develop the disorder," said Dr. Mark Willenbring, director of the Treatment and Recovery Research Division of the National Institutes of Health.
Willenbring says one reason for this treatment gap could be the stigma of such a diagnosis. Another problem is that insurance companies often fall short when it comes to coverage of problems related to alcohol abuse and dependency.
"It is not uncommon for an insurance company to be restrictive with the number of treatments they pay for," Willenbring said. "Can you imagine a health care professional saying, 'We'll treat your first heart attack, but not your second,' or 'We'll provide your first diabetes treatment but not your second?'"
Garbutt adds that the problem is further magnified by the fact that drinking -- moderately or otherwise -- is a more or less commonly accepted behavior.
"Alcohol is integrally part of our society," Garbutt said. "This is something that the average American does. So it becomes hard to draw the line between drinking and problem drinking."
Another part of the problem, Grant says, is that many feel that they have their alcohol-related behaviors under control.
"I think a lot of people feel they can get over the problem themselves," Grant says. "Certainly, some people can, but definitely not as many people as who think they can."
Garbutt agrees. "One of the biggest impediments to treatment is that people who have these problems think they will never get better. The other problem is denial -- folks don't think they have a problem."
Turning the Corner on Alcohol
If there is any silver lining to alcohol abuse and dependency, it is that both problems are largely treatable.
"The good news is that the majority of people who seek treatment, or even who don't seek professional treatment but try to change their behaviors are eventually successful," Willenbring said.
But Grant says that to ensure that treatment reaches those who need it, more people need to be aware of new medications and treatment strategies that can help them overcome alcohol.
"There is a general lack of understanding of how treatment has advanced over the past decade," she says.
Garbutt agrees. "We've kind of been beating this drum for years," he says. "I think as always we will keep beating the drum because eventually it will maybe get heard.
"This study at least makes people aware again that this is a problem."