STAT: U.S. alcohol crisis ignored

STAT launched a new investigative series, The Deadliest Drug, on the toll of alcohol and lack of adequate response.

The main point: Alcohol is by far the most popular and harmful substance in the U.S. but is not seen as a public health emergency.

• Why it’s important: Alcohol-related injuries, disease, and fatalities have spiked in recent years, with older adults, women, and young people especially harmed.
• This is the result of failures of the medical and public health systems, industry, and government.

The details:

Part 1 — Lacking response: Political leaders have largely ignored alcohol’s toll, with industry groups exerting strong lobbying power against proposals for higher taxes or stricter regulation. Successive administrations have done little to address alcohol’s harms, with efforts on substance use targeting illicit substances.

• This is continuing so far in this administration, despite both President Trump and HHS Secretary Kennedy having personal connections to the issue. Both have vowed to reduce rates of chronic illness and addiction specifically, but significant policy has not followed. Instead, the administration has loosened guidelines on drinking and has cut agencies and programs focused on preventing, treating, researching, and tracking alcohol addiction.
• Addressing alcohol should fit squarely within Make America Healthy Again (MAHA) movement efforts. Alcohol shares many qualities with MAHA’s ultraprocessed food targets, it is a main driver of chronic disease, and MAHA has made it a goal to teach Americans how corporate interests shape their health (e.g., Big Pharma, Big Food). But alcohol has been left out of these efforts.

Part 2 — Inadequate screening: Most doctors agree that asking about alcohol consumption is an essential part of a checkup, but studies suggest alcohol screening and counseling are often compressed or skipped during primary care visits.

• For a long time, a major obstacle to effective screening was surveys that were too long or narrowly focused. But there is now an effective, three-question survey. In even a short follow-up conversation, providers can help clarify the health effects and offer resources when needed.
• But: Even with a script, many doctors are not trained to routinely ask about alcohol use.
• Some health systems have figured out ways to screen more patients. For example, some are baking alcohol screening into digital platforms and checklists clinicians use to manage patient visits or asking about alcohol in the emergency department.

Part 3 — Concurrent metabolic disease: The U.S.’s obesity and diabetes epidemics, combined with heavy alcohol use, are causing more metabolic dysfunction and alcohol-associated liver disease (MetALD).

• MetALD is now nearly twice as common as alcohol-associated liver disease, and the risk factors are hitting younger adults.
• Treating both obesity/diabetes and heavy alcohol use can be complicated. Patients need counseling and support for both conditions, and alcohol use can often disrupt care. Some hospitals are adapting by building out addiction medicine teams or creating clinics where transplant hepatologists work alongside social workers, nutritionists, and other specialists.
• GLP-1 drugs could help address MetALD, as they have shown addiction-curbing potential in addition to ability to induce weight loss. But there are still debates on the best way to screen for and treat MetALD, and many insurers do not cover comprehensive metabolic panels that would detect wonky liver enzymes as part of preventive primary care.

What’s coming: Parts 4-7 of the investigation, focusing on 12-step programs, alcohol use during pregnancy, how alcohol research and prevention has been derailed, and the power of the alcohol industry.