Question: What has cost the United States nearly $250 billion and affects more than 15 million adults and 600,000 youth?
(Here's a quick hint: It's not overuse of illegal drugs, e-cigarettes or cancer.)
"It speaks to the heavy problem of alcohol misuse," said Dr. Howard Becker, director of the Charleston Alcohol Research Center and a psychiatry professor at the Medical University of South Carolina.
E-cigarettes have recently been front and center after experts discovered that at least 10 deaths in the U.S. were associated with vaping. Juul Labs has agreed to an advertising ban related to its flavored e-cigarettes and Juul CEO Kevin Burns is stepping down.
But in the midst of these developments, the Centers for Disease Control and Prevention reports that excessive alcohol use has cost the United States billions in terms of health care expenses, workplace productivity and vehicle crashes. Alcohol takes the lives of an estimated 88,000 people in this country each year, and in South Carolina, costs the state nearly $4 billion.
Addiction experts emphasize that they do not want to ban alcohol. But they do want people to understand that alcohol use disorder is a serious medical condition. According to Becker, people often don't view it as a serious illness, even people who actually have the disorder.
"It's a brain disorder," Becker said. "It's a chemical imbalance in the brain."
Becker and his colleagues at MUSC recently received a five-year $3.1 million grant renewal from the medications development program at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). With the money, they can continue researching and testing new medications to help with alcohol use disorder.
There currently are three medications available that are approved by the Food and Drug Administration for the treatment of excessive alcohol use. One medication, called Disulfiram, makes a person nauseous anytime they drink alcohol.
The second, called naltrexone, potentially helps in reducing alcohol cravings. And the third, acamprosate, is designed to ease symptoms associated with alcohol withdrawal.
But a lot of people don't get to the point where they even learn about potential treatment options. According to the NIAAA, less than 10 percent of people with alcohol use disorder actually receive any kind of treatment. Meanwhile, more than 14 million people are living with the disorder, approximately seven times the number of people suffering from an opioid use disorder, according to National Survey on Drug Use and Health.
This is partly why Becker believes it's extremely important to have an understanding of the severity of alcohol misuse, especially in heavy-drinking cities like Charleston. At least 50 percent of U.S. liver disease deaths can be attributed to alcohol misuse. And alcohol-associated liver disease passed hepatitis C as the chief cause of liver transplants related to a chronic disease.
"It's a chronic relapsing disease," Becker said.
Dr. Sarah Coker, a psychiatrist with Roper St. Francis Physician Partners Behavioral Medicine, has found that most people don't think they have a problem unless they drink a certain amount or type of alcohol.
"One type of alcohol isn’t worse than another," she said.
For example, many people often look at beer as a mild alternative. But according to Becker, the amount of alcohol found in a bottle of beer is "like having a shot of whiskey."
According to the NIAAA, a 12-ounce can of beer contains the same amount of alcohol as a shot of distilled spirits, such as whiskey or gin. Coker explained that the best way a person can evaluate if their alcohol consumption has become a problem is by examining the role it plays in their daily life.
"Have they had legal problems from it, missed work, mood changes?" she said.
Future of treatments
Now that researchers can observe the brain's reaction and the chemical imbalance people with alcohol use disorder have with alcohol consumption, researchers at MUSC are hoping to use that knowledge in their medication research.
If they can find treatments that alter that imbalance, then it would potentially alter the response some people have to chronic drinking. They are currently doing blind studies to examine medications' effectiveness without bias. They also are exploring other avenues, such as the potential of creating a treatment that mimics the results of exercise.
They have found that exercise elevates a factor in the brain that experiences a deficit during chronic alcohol exposure. Even with their extensive research, there likely will not be a one-stop cure.
"There is no magic pill that will cure you," Becker said.
He compares it to someone living with diabetes. They have to manage the condition in a variety of ways. There are medications, exercise and dietary restrictions that often are advised.
For alcohol use disorder, it is somewhat the same. Some people might need talk therapy and cognitive behavioral therapy to pinpoint triggers that cause them to relapse. Others could need all of this plus medication.
"So we still need to try and develop more effective medications," Becker said.
Furthermore, alcohol is a legal substance and everyone doesn't have the same relationship with it. There is often a stigma and misunderstanding associated with overuse, Becker said.
And Coker has found that even with increased awareness throughout the years, there are still people having trouble finding support.
"There are unfortunately still many who minimize or don’t understand," she said.
People who want to get involved with a clinical trial at MUSC can email firstname.lastname@example.org. Becker said the hope is that more people see the severity of alcohol use disorder before they hit rock bottom with their addiction.