Comparing NIH Stats – Alcohol Use Disorder to Opioid Use Disorder

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By R Carter

According to the American Psychiatric Association “alcohol use disorder” AUD and “opioid use disorder” OUD, share the same definition. Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems. Other definitions include “a chronic relapsing brain disease characterized by compulsive use, loss of control over intake, and a negative emotional state when not using”, National Institute on Alcohol Abuse and Alcoholism

Statistics given on both opiate and alcohol abuse are as follows:

  • As of 2015, the U.S. population was estimated to be 242,800,000.
  • Of those, 16 million, ages 12 and older have AUD, (6.6%)1.
  • Of those, 1.9 million, ages 12 and older have OUD, (0.78%)2.
  • For every person suffering from OUD, 8.42 people are suffering from AUD.
  • 210 million (86.4%) of people ages 18 or older reported drinking alcohol in 20153.
  • 91 million (37.8%) of people ages 18 or older reported using prescription opioids. There are no statistics on the prevalence of illegal opiate use, but 33,091 opiate overdose deaths were reported in 2015 or (0.01%) of the population which includes legal and illegal sources 2.
    • Combing both alcohol and prescription opiates would exceed the U.S. population, clearly indicating some are doing both.
    • These 6 facts underscore the deception behind continually reporting prescription opiates alone, as the leading problem in abuse and addiction.
  •  Adolescents can be diagnosed with AUD as well, and in 2015, an estimated 623,000 (0.3%) of the population of adolescents ages 12–17 had AUD1.
  • No government data exists for adolescents ages 12-17 with OUD, but using the ratio from bullet 4, an estimate would be 73,990 (0.03%) of the population.
  • Genetic research has identified variants in the human genome that occur globally and strongly suggest a probability for addiction to Alcohol and Opiates. For both variants, that rate is about 5%.
    • Given relative unrestricted access to alcohol in the U.S., an AUD rate of 6.6% is right in line with the occurrence we see with these genetic variants.
    • Many foreign countries that have legalized or have reduced restrictions for controlled substances also report addictions rates close to this 5% level.
    • This is strong evidence, counter to U.S. claims, on the risks for addiction to opiates and runs counter-intuitive to America’s efforts to use caps and limits, forced tapering or termination of opiates in treating pain.
    • Given the genetic basis of addiction, denying access to one substance is at best a temporary obstacle, easily overcome by switching to a different substance. This is known in addiction recovery as developing cross addictions.
    • Once addiction is triggered, brain craving overrides the common sense of the uneducated.
    • In a practical sense, plugging one hole in the dike without plugging the others, leads to no benefit at all.
  • Where is the rationality in a White House declaration for a Public Health Emergency on opiates with an addiction rate of 0.78%, targeting prescription opiates as the cause, while ignoring an alcohol addiction rate of 6.6%?

These stats are about abuse and abuse leads to unintentional deaths, as most would guess, overdose death rates are comparable to abuse rates.

So why is it that prescription opiates are cited as the leading cause for opiate abuse and deaths when going into a declaration for a Public Health Emergency, the White House knew the leading cause was illicit drugs including Fentanyl

  • Well for one, the number of people illegally using opiates is unknown and the government has given up trying to arrest its way out of this crisis. This is why the government’s approach has been supply reduction  as opposed to cutting off the supply, even if doing so creates mass collateral damage and is morally corrupt.
  • Secondly, data collection methods for prescription opiate identification remain broken and therefore unreliable. but most Americans don’t know this and could care less.
  • Third, a wide range of raw data sources as of 2019 remain incompatible and incomplete, despite best efforts to reconcile these differences.
  • Fourth, an unconscious bias, one which gives privileged status to some substances but not to others despite medical evidence to the contrary. In other words, it’s OK to restrict mood-altering substances, as long as it’s not my drug of choice.

But with 86% of the population using alcohol and a larger cause for addiction that opiates, the government can’t make a dent in addiction without cutting its own throat in the process. The solution targets a minority population (chronic pain patients) already devastated and incapable of fighting back.

Spin the message just right and all of this encourages researchers, public health officials and especially the media, into blindly ignoring addiction to other substances and quote numbers for which there is no data or at best-mischaracterized data, implying prescription opiate abuse and deaths as the problem.

All this makes our current efforts an ideological and political war for saving face, the appearance of doing something when in fact nothing can be done as Nancy Reagan said, because of America’s hunger for mood-altering substances.

Reporting the facts on opiates remains at best an estimate, primarily because illegal opiate use remains a behavior hidden from view and therefore untestable and impossible to quantify, yet overdose deaths continue to rise and alcohol use goes on unabated. With a need to respond to a crisis of sorts, yet lacking the moral and ethical backbone to own its failures, government and public health must save face, but can only do so by blaming the crisis on the only thing they can measure, prescription opiates, while quietly and deceptively ignoring the larger problem of alcohol, which is still viewed as controllable while implying that opiates are not.

And within this broken system of reporting opiate abuse and deaths, alcohol abuse and deaths outnumber opiates 8.5:1, which fails to get any reporting in the press. The failure to treat Alcohol abuse equally with opiates remains a glaring oversight of government policy and public health. In essence, straining at gnats while a swarm of locus overtakes the landscape. The hypocrisy of such an oversight defies description.

To be diagnosed with AUD or OUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD or OUD. The severity of which can be mild, moderate, or severe and based on the number of criteria met.

Many healthcare professionals recognize these diagnoses, yet with a gun pointed to their head by the government over opiates, they can’t treat pain appropriately and remain consistent with the DSM-5 guidelines. Forced to compromise, some doctors will forego labeling chronic pain patients as having OUD and instead opt for labeling them as falling into drug-seeking behavior. rather take a risk in treating. This is, in fact, a more untenable situation as there are no criteria for drug-seeking behavior. You’ll not see this in any DSM-5 manual, yet chronic pain patients are continually confronted with such claims.

For this reason, definitions for drug-seeking behavior vary widely and are more often than not, highly influenced by personal bias and prejudice. One such definition as recognized by NCBI, is, “Drug-seeking behavior is a commonly used [term], although poorly defined, that describes a range of activities directed towards the attainment of sought-after drugs”.

By this definition anyone coming into a doctor’s office, ER or clinic seeking pain relief is in fact, in drug-seeking behavior. Despite this, if you’re are chronic pain patient already taking opiates the default assumption is, this behavior is for abuse. This is the purest form of bias and prejudice since there are no widely accepted scientific criteria identifying what drug-seeking behavior looks like or how it operates. In essence, this becomes a “Get Out of Jail Free Card” for healthcare professionals who have no moral and ethical dilemmas at throwing these patients under a bus for professional and personal protection. Several clinics have already been sued successfully for such actions.

Despite the fact there’s no medical definition for drug-seeking behavior, the term continues to show up in papers by researchers where it’s as poorly defined and prone to personal bias there as it is with healthcare professionals who use it in a clinical setting. As in the above link, such retrospective chart reviews assume those filing out the charts are somehow qualified to identify and document facts related to this phenomenon, even though there is no standard definition for it. So this is another example of bias working it’s way into our healthcare system, furthering the myths of drug abuse. Our policymakers rely on such research and naturally draw opinions from them, propagating the myth further down the line.

This post is only a small list of deficiencies that exists in our current system of government policy, public health, and healthcare delivery, regarding the broader concept of abuse and addiction. Yet it points out the inconsistencies, bias, and prejudice which is the social stigma that’s been with us for more than a hundred years. Such stigmas and bias beg the question, “When is a healthcare professional making a medical judgment or exercising their prejudice?”.

Furthermore, it reflects the power of such stigmas to override rational thinking in individuals whose education and profession are based on science and critical thinking. Proving again in 2019, the ability of those who have some measure of power over us, to exploit those powers for their benefit while wearing blinders to the ethical violations they commit, or their involvement in similar risk behaviors with alcohol use.

Denial is a terrible mental deficiency!

Regardless of the substance, alcohol or opiates, the real war remains an ideological one by virtue of its ability to deny the larger problem of alcohol while overreacting to the lesser ones which are prescription opiates.

In the annals of survival, throwing your neighbor under a bus to save your skin has more variations than can be imagined. When slavery was made illegal we simply denied blacks the right to own property, vote, hold positions of public service, unless it was dying for your country, or jobs which led to true wealth and independence. Women’s suffrage and women’s rights is another example. Holding onto power, wealth and influence in the U.S. is the great corruptor and we are still practicing it today in new and varied forms. The war on opiates is just another variation on a theme.

A better title for this post may have been “Nation of Abuse” or perhaps “Nation in Denial”. For if the public looked beyond the headlines and 30 second sound bites, if all the definitions and social stigmas were applied equally, both to those who use opiates for legitimate medical purposes as well as those who consume alcohol to simply take an edge off at the end of a day, none would escape unscathed and all would be guilty We need to replace bias hearsay with scientific facts which can be applied rationally. This is reason enough to apply the same restrictions to all substances which have the potential for abuse and addiction. Or we could simply stop lying to ourselves about what is an acceptable level of addiction based on our knowledge of genetics, and use these funds to treat those who can’t self-correct on their own.

  1. National Institute on Alcohol Abuse and Alcoholism.
  2. American Psychiatric Association
  3. 2015 National Survey on Drug Use and Health (NSDUH)