The Epidemiology and Prevention of Excessive Alcohol Use Bob Brewer, MD, MSPH Alcohol Program Leader National Center for Chronic Disease Prevention and Health Promotion/CDC Midwest Alcohol Policy Summit April 2, 2014

National Center for Chronic Disease Prevention and Health Promotion Division of Population Health

Outline
Overview of the CDC Alcohol Program
Public Health Impact of Excessive Drinking
Intervention Strategies & Alcohol Policies in States
Community Guide Recommendations
Status of Guide Recommendations in States
Translation Tools and Capacity Building

CDC Alcohol Program
Established in July 2001.
Public Health Surveillance on excessive alcohol use and related harms.
Applied research on health impacts and intervention effectiveness.
State capacity building & technical assistance.
National leadership & collaboration

Public Health Impact of Excessive Drinking in the U.S.
88,000 deaths every year  4,400 (5%) are due to underage drinking
2.5 million Years of Potential Life Lost (YPLL) every year
4th leading preventable cause of death
Cost  $223.5 billion in economic costs (2006) or ~$1.90/drink • $24.6 billion (11%) were due to underage drinking

 $94.2 billion (42%) paid by government or ~$0.80/drink
Most excessive drinkers are not alcohol dependent Alcohol-Related Disease Impact (ARDI); available at: www.cdc.gov/alcohol ;Mokdad A, et al JAMA 2004; 291(10):1238-45; Bouchery, et al Am J Prev Med 2011;41(5):516-24

4

Binge Drinking is the Main Problem in the U.S.
Accounts for most health and economic costs  54% of the deaths due to excessive drinking  66% of the Years of Potential Life Lost (YPLL)  76% of the economic costs


Binge drinking  ≥4 drinks per occasion for women and ≥5 for men  Most common pattern of excessive drinking in the United States  About 90% of the alcohol consumed by youth  About 50% of the alcohol consumed by adults

CDC. Vital Signs: Binge Drinking Prevalence, Frequency and Intensity Among Adults−United States, 2010 . NIAAA. NIAAA Scientific Advisory Council Approves Binge Drinking Definition Newsletter. 2004;3(3) 5

RISK FACTOR

POTENTIAL CONDITION Motor Vehicle Crashes Interpersonal Violence

Binge Drinking

HIV, STDs Unintended Pregnancy Fetal Alcohol Spectrum Disorder Alcohol Dependence

“It [excessive drinking] seeds and squires a broad range of diseases. Multiplies the effects of illicit and prescription drugs. Adds the twitch to a trigger finger. Puts wobble in legs on a staircase or hands on a steering wheel.” Frank Bruni, New York Times, February 19, 2012

Binge Drinking* Prevalence Is Unchanged but Episodes Have Increased Measure

1993

2001

2009

Prevalence

14.2%

14.3%

15.2%

Total Episodes

1.2 billion

1.5 billion

1.7 billion

Episodes per Person

6.3

7.4

7.1

*Defined as ≥5 drinks/occasion for men, ≥5 drinks/occasion for women from 1993-2005, and ≥4 drinks/occasion for women from 2006-2009. Naimi TS, et al. JAMA 2003 289(1):70-75; CDC. Vital Signs: Binge Drinking Among High School Students and Adults — United States, 2009; Behavioral Risk Factor Surveillance System (BRFSS), 2009

Binge Drinking is Common Across the Lifespan 35 30.0

30

Percent

25

29.7

21.9

21.1

20 14.1

15 10

4.3

5 0 High School Students

18-24

25-34

35-44

45-64

65+

Youth Online: High School YRBS; Kanny D, et al. Binge Drinking — United States, 2011. MMWR 2013;62 (Suppl):77-80.

Binge Drinking Increases with Household Income 25

Percent

20

22.2 19.4

19.8

17.6

15 10 5 0