Alcohol Awareness Month Advocacy Guide

Alcohol is everywhere. And even though it is regulated, there is a lot of potential for abuse. The majority of adults in the United States drink; according to the 2019 National Survey on Drug Use and Health (NSDUH), 85.6 percent of people ages 18 and older reported having had alcohol at some point in their lifetime. 

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that binge drinking is an ongoing problem. In 2019, 25.8 percent of people age 18 and older (29.7 percent of men in this age group and 22.2 percent of women in this age group) reported binge drinking within the past month, and 6.3 percent (8.3 percent of men in this age group and 4.5 percent of women in this age group) reported that they engaged in heavy alcohol use in the past month.

It is estimated that in pre-pandemic 2019, 14.5 million people ages 12 and older had alcohol use disorder. It is not hard to imagine that isolation, job loss, and emotional difficulties during the pandemic would have exacerbated the problem for millions of people. More men than women have alcohol use disorder, except among youth 12 to 17. For this group, more females than males have alcohol use disorder.

SAMHSA, the Substance Abuse and Mental Health Services Administration, says that alcohol is the most frequently used and misused substance in the United States. Alcohol misuse is especially prevalent among people who are college-aged and younger populations. 

People who drink to excess, including binge and heavy drinkers, are at even greater risk. SAMHSA staff collect and analyze data better to understand patterns of use and risk and protective factors. CBHSQ reports inform prevention, treatment, and recovery efforts at national and state levels.

SAMHSA and NIAAA have different definitions of drinking levels. NIAAA defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent—i.e., 0.08 grams of alcohol per deciliter—or higher. For a typical adult, this pattern corresponds to consuming five or more drinks (male), or four or more drinks (female), in about two hours. SAMHSA defines binge drinking as five or more alcoholic drinks for males or four or more alcoholic drinks for females on the same occasion (within a couple of hours of each other) on at least one day in the past month.

NIAAA defines heavy drinking as men consuming more than four drinks on any day or more than 14 drinks per week. For women, that level would be reached if they were consuming more than three drinks on any day or more than seven drinks per week. SAMHSA defines heavy alcohol use as binge drinking on five or more days in the past month. Moderate drinking is considered to be two drinks or less in a day for men and one drink or less in a day for women. Drinking less is considered to be better for health than drinking more.

The NIAAA says alcohol use disorder (AUD) is a medical condition in which the drinker can’t stop or control their alcohol use even when it causes problems in their life. Alcohol use disorder can range from what people think of as the most severe form, that of alcoholism or alcohol dependence, to more mild forms.

Alcohol abuse affects physical health, mental health, and the fabric of society in the form of damage to families, friendships, and lost productivity at work. Alcohol Awareness Month seeks to remove some of the stigma that someone might feel in admitting that they need help managing their drinking. Its goal is also to raise awareness of the many health problems that can be exacerbated or caused by alcohol misuse.  

Alcohol Awareness Month is observed throughout April. Alcohol Awareness Month is sponsored by the National Council on Alcoholism and Drug Dependence (NCADD) and was established by the group in 1987. The group encourages activities throughout the month like Alcohol-Free Weekend to raise public awareness about the use of alcohol. The group encourages people to notice how they feel after three days without alcohol, and if there are cravings, to seek help. 

Understanding that alcoholism is a preventable disease can encourage people to seek treatment before their drinking becomes a problem for them, and the group encourages people who are already addicted to seek treatment.

Alcohol is a legal substance and is popular all over the world, and it’s acceptable for people to drink from a very young age in many cultures. Alcohol is even a common theme in religious contexts. Edmund Murphy, editor-in-chief of Recovered, says alcohol is at the forefront of most cultures in the world so it’s not really perceived as a problem, which is, of course, part of the problem. 

“Three million people die from alcohol-related deaths worldwide each year, 95,000 of those are from alcohol addiction in the US alone,” says Murphy. “It’s a huge, huge issue and it’s that lack of awareness and that perceived cultural acceptance that Alcohol Awareness Month strives to diminish a little bit—or to at least shed a different light on it—and let it be known that there are people struggling.”

Many people may not realize that they have an alcohol dependence issue or an alcohol use disorder. “Alcohol awareness is about increasing the perception of what the signs of alcohol abuse are and letting people know that there is help out there,” says Murphy.

Of course, people know about the private and expensive in-patient clinics that are out there. But there are other options too, including state-funded programs and the free Alcoholics Anonymous program, along with the global SMART Recovery Program (Self-Management And Recovery Training). 

“There are various things that you can do to get help,” says Murphy. “And some people might not need the full course of a substance use disorder treatment. Some people might just need to go and sit in a room and say out loud ‘I’m an alcoholic.’ That might be enough to start the process for recovery.”

Types of alcohol abuse treatment include medication-assisted treatment, inpatient rehab, outpatient rehab, or physician assisted detox. Detox and withdrawal are important first steps for those with a more severe alcohol addiction. It’s often advisable to go through this process under medical supervision, as it can be extremely uncomfortable. 

Inpatient treatment centers offer around-the-clock treatment and support in a residential setting. Medications are often used in this setting to help patients through the withdrawal process and also to manage any co-occurring issues such as mental or behavioral disorders. Inpatient centers are often expensive. 

Outpatient rehab treatments can encompass many of the same treatments and therapies as an inpatient option, but they allow the patients to return to their own homes each day. The self-help groups that are commonly known, such as Alcoholics Anonymous, offer a safe place for people to go to on a regular basis in which they can reaffirm their commitment to being sober and be around other sober individuals. Those who graduate from an inpatient program may be referred to a residential home in which they are introduced back into the working and social world in a more controlled environment. 

According to the American Addiction Centers, the relapse rate for substance use disorders is 40 to 60 percent. This is a relatively high number that is similar to that of other chronic diseases such as hypertension or asthma. The current focus on addiction treatment is that of harm reduction. 

The Biden-Harris administration has made harm reduction part of their platform of addressing substance use disorder, which has risen to dramatic levels during the pandemic. With a harm reduction point of view, it is less important for the amount of alcohol or substance use to be zero than it is to reduce the amount. In this point of view, someone may still be drinking, but may be drinking only two beers a day rather than a fifth of vodka each day. If the person is holding their job, has healthy relationships with their friends and family, and is taking care of their children each day, that is a success, even if the amount of substance use is not zero.

Murphy says alcohol affects health in a multilayered way. It’s inextricably linked to general health, mental health, and the negative consequences of addiction itself. Murphy shares an overview of the multivaried effects:

Alcohol affects everything from cirrhosis of the liver to heart disease, the pancreas, and the brain. The toxins in alcohol literally destroy and strip down your body functions and long-term abuse can lead to life-ending health conditions. Alcohol use exacerbates mental health conditions like anxiety and depression. The third thing is that dependency physically changes the way your brain behaves due to an interaction with the substance. So if you drink too much repeatedly over time, the brain can’t produce enough neurotransmitters like dopamine and serotonin, and the brain starts to rely on the substance for it. Once physical dependence has formed, negative consequences of fulfilling that dependence start to occur. The individual may stop interacting with family and friends, they may drink in harmful situations and have withdrawal symptoms if they don’t drink, which can reinforce the desire to drink more. These negative consequences are what lead to a diagnosis of addiction to alcohol.

Many times, people are not honest with their healthcare provider about how much alcohol they’re actually drinking. This can negatively impact interactions with medications they may be taking for other conditions. “When this happens, whether you’re trying to lose weight or manage your blood pressure or whatever, if you’re not being honest with your doctor then they’re not getting the full picture to be able to actually help,” Murphy says. 

Warfarin, for example, is a commonly used medication for treating and preventing blood clots. Alcohol can also cause your body to make fewer platelets than normal. Platelets are the cells in your body that start the blood clotting process. Drinking alcohol while you take warfarin can increase someone’s risk of major bleeding.

“Part of Alcohol Awareness Month is to share the belief that these aren’t things you should be ashamed of,” says Murphy. “These are things you should talk about.”

NIAAA reports that of the 85,688 liver disease deaths among individuals ages 12 and older in 2019. An alarming 43.1 percent involved alcohol. About half of cirrhosis deaths are alcohol-related. Liver disease due to alcohol is the primary cause of almost one in three liver transplants in the United States. 

Research has shown that people who misuse alcohol have a greater risk of liver disease, heart disease, depression, stroke, and stomach bleeding, as well as several cancers (cancers of the mouth, esophagus, larynx, pharynx, liver, colon, and rectum). Alcohol can also make it harder to manage diabetes, high blood pressure, pain, sleep disorders. Alcohol can make it harder to maintain a healthy weight and can increase unsafe sexual behavior.

People like Murphy and other professionals working in the addiction and recovery space want to get people talking about alcohol dependence and alcohol addiction and how it affects them: “There are so many people who suffer and who just don’t talk about it,” he says. “These are the men, women, fathers, mothers, young people, and elderly people who drink alone or drink in silence because they are worried about how they will be perceived culturally, socially, and in their community. Alcohol Awareness Month is about disowning that prejudice and those preconceived ideas that alcoholism and alcohol addiction is something that is incurable or is a stigma.”

No one should feel stigmatized because they have a problem with alcohol. They may have a problem, but it’s also important for them to know that there are treatment options and that help is available. “You won’t find that help unless you tell someone,” says Murphy, “and keeping it bottled up is only going to diminish your health, your mental health, and lead to addiction.”

• Recovered.org: Recovered is a resource base for fact-checked articles and guides and relevant and useful information about substance abuse, co-occurring mental illness, and treatment. Its information is sourced from current medical journals, relevant publications, and government guidelines. They also have a rehab directory to allow people to find affordable, free, or insurance-covered inpatient and outpatient treatment across America.
• SAMHSA.gov: The Substance Abuse and Mental Health Services Administration,
• NIAAA.NIH.gov: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 
• Health.gov: Health.gov provides a toolkit for Alcohol Awareness Month that includes ideas to help people take action and raise awareness of alcohol misuse and abuse.  
• Youth.gov: The US government website for creating, maintaining, and strengthening effective youth programs.
• IHS.gov: Indian Health Services