Way more Americans are drinking themselves to death. Here's why

As the country deals with a rise in opioid painkiller and heroin overdose deaths, a drug that already kills more people is causing more and more deaths each year: alcohol.

According to new data from the Centers for Disease Control and Prevention, after controlling for age, the alcohol-induced death rate reached 8.5 per 100,000 people in 2014, up from 7.1 in 1999 and 7 in 2006.

As a result, nearly 31,000 people died by alcohol in 2014, up from 22,000 in 2006. That means more people died to alcohol in 2014 than the nearly 29,000 who died from opioid — including heroin — overdoses, but fewer than the nearly 34,000 who died to gun violence or car crashes that same year.

Still, the 2014 data likely under-counts alcohol-related deaths, since it only includes deaths induced directly by alcohol, like liver cirrhosis. It doesn't include deaths from drunk driving, other accidents, and homicides committed under the influence (alcohol is linked to 40 percent of violent crimes). Counting those deaths, alcohol's death toll in the US reached 88,000, according to the CDC — and that's before accounting for the recent rise in alcohol-induced deaths shown in the chart above. All together, this puts alcohol behind only tobacco, which is by far the deadliest drug in the US, in terms of total drug deaths.

It's hard to pinpoint why, exactly, alcohol deaths are going up, given that the use and consumption of drugs and, really, any substance, food, or product tends to fluctuate due to various fickle demographic, social, and cultural influences. But there are a few plausible explanations that can explain the latest decades' trend, according to other data and drug policy experts.

For one, Americans are drinking more. According to the latest National Survey on Drug Use and Health, the number of Americans who reportedly drank in the previous month slightly increased as alcohol-induced deaths did: from 51 percent of all persons 12 and older in 2006, when deaths began to climb, to 52.7 percent in 2014.

Most of the rise in alcohol consumption occurred among women. Men reported no statistically significant change in drinking in the previous month, and actually saw statistically significant decreases in binge drinking (five or more drinks in the same occasion) and heavy alcohol use (five or more days of binge drinking in the previous month) between 2006 and 2014. But women reported increases in drinking and binge drinking — from 45.2 percent to 48.4 percent and 15.2 percent to 16.4 percent between 2006 and 2014, respectively — but no statistically significant change in heavy alcohol use.

But why are people drinking more? Sometimes consumption is driven by cultural and social trends that are difficult to pinpoint. But another possibility is that alcohol is more affordable than ever: According to a 2013 study published in the American Journal of Preventive Medicine, as a result of rising incomes and falling prices, alcohol is more affordable than it has been in 60 years. And since most US alcohol taxes aren't indexed for inflation and are rarely raised by lawmakers, one of the key policy levers for making sure alcohol doesn't become too affordable — and therefore too easy to abuse — is doing little to stop this rise in affordability.

Still, a rise in drinking doesn't fully explain why alcohol-induced deaths have risen so much. For one, while women are reportedly drinking more, alcohol-induced deaths rose more among men — the age-adjusted alcohol death rate rose by 2 per 100,000 among men between 2006 and 2014, but 1.2 for women. And even though population-wide drinking rose, population-wide binge drinking and heavy alcohol use did not, at least according to the National Survey on Drug Use and Health. (The survey does have a big methodological problem: Since it only surveys households, it doesn't count homeless or incarcerated populations, both of whom are more likely to have alcohol and substance use problems.)

So what other factors could exist? I turned to several drug experts for possible explanations, including Beau Kilmer at the RAND Corporation, Mark Kleiman at New York University's Marron Institute, Keith Humphreys at Stanford University, and Ken Beck at the University of Maryland.

One consistent answer: The opioid painkiller and heroin epidemic could have made alcohol deadlier. When taken together, alcohol and opioids interact to intensify each other and make each other more dangerous. So it's possible that alcohol deaths rose as more people used — and died from — opioids throughout the 2000s, and many of those deaths were counted as alcohol-induced deaths in the CDC data.

Another factor could be greater use of the anti-anxiety medication, benzodiazepine. About one-third of opioid deaths now involve benzos like Xanax, and these drugs were prescribed more and more throughout the 2000s. Since benzos can intensify alcohol's effects, it's possible they helped cause more alcohol-induced deaths in the same way opioids might have.

Whatever the specific reason, the underlying issue is that people are drinking too much — or at least drinking when they shouldn't be. There are policy responses that could help allay that problem.

US drug policy has typically reacted to dangerous substances by banning them. The country even tried this with alcohol in the 1920s. But there are more innovative ways to bring alcohol use and deaths down.

Many, many studies, for example, have found benefits from a much higher alcohol tax. A recent review of the research from David Roodman, senior adviser for the Open Philanthropy Project, made a case for a higher alcohol tax:

[H]igher prices do correlate with less drinking and lower incidence of problems such as cirrhosis deaths. And I see little reason to doubt the obvious explanation: higher prices cause less drinking. A rough rule of thumb is that each 1 percent increase in alcohol price reduces drinking by 0.5 percent. Extrapolating from some of the most powerful studies, I estimate an even larger impact on the death rate from alcohol-caused diseases: 1-3 percent within months. By extension, a 10 percent price increase would cut the death rate 9-25 percent. For the US in 2010, this represents 2,000-6,000 averted deaths/year.

This wasn't the first positive finding in favor of raising the alcohol tax, but it was one of the most convincing. Roodman found not just that high-quality research supports a higher alcohol tax, but that the effects seem to grow stronger the higher the tax is.

So for the US, boosting alcohol prices 10 percent could save as many as 6,000 lives each year. To put that in context, paying about 50 cents more for a six-pack of Bud Light could save thousands of lives. And this is a conservative estimate, since it only counts alcohol-related liver cirrhosis deaths — the number of lives saved would be higher if it accounted for deaths due to alcohol-related violence and car crashes.

Aside from raising taxes, a 2014 report from the RAND Drug Policy Research Center suggested state-run shops kept prices higher, reduced access to youth, and reduced overall levels of use. And a 2013 study from RAND of South Dakota's 24/7 Sobriety Program, which briefly jails people whose drinking has repeatedly gotten them in trouble with the law (like a DUI) if they fail a twice-a-day alcohol blood test, attributed a 12 percent reduction in repeat DUI arrests and a 9 percent reduction in domestic violence arrests at the county level to the program.

But to get any consideration for these types of proposals, policymakers and the public need to acknowledge that America does have an alcohol problem. The rising death toll should make that issue more obvious.

/By Vox/