Here & Now

Noon Wednesday: Pandemic Propels Deaths from Drinking

Marisa Wojcik:

Welcome to “Noon Wednesday,” Im Marisa Wojcik, multimedia journalist with “Here & Now” on PBS Wisconsin. Today is January 19. Wisconsin’s drinking reputation proceeded the covid-19 pandemic, but the stress of the past two years has propelled consumption, and alcohol-induced deaths have increased by 25%. Joining us to talk about how these numbers have gotten to where they are Ari Brown, researcher for Wisconsin Policy Forum and Brien Gleeson, an addiction counselor of Mayo Clinic from Eau Claire, and thank you, both, for this conversation.

Ari Brown:

Thank you.

Brien Gleeson:

Thank you, good to be here.

Marisa Wojcik:

Ari, starting with you, your latest report dug into the numbers which found not only have alcohol-related deaths increased by 25% in Wisconsin, but Wisconsin is also 25% higher than the rate nationwide. What made you want to look into this research and find those numbers?

Ari Brown:

Yeah. So that’s a great question. This research is something we’ve been pursuing in different forms for quite a while. Back in 2019, we looked at similar data set that looked at life expectancy, and we found some concerning trends around life expectancy in Wisconsin being driven things by like alcohol-induced deaths, and then mid last year, we actually looked at alcohol tax revenues, which is the best proxy that we as policy researchers, have for what overall alcohol consumption looks like in the state of Wisconsin, and we found in 2020 that alcohol tax revenue in Wisconsin increased quite a bit, in a way had not been seen for multiple decades since there have been major changes to taxation rules around alcohol in Wisconsin. So that, I think, really is what spurred this research. We were able to use a data set that’s published by the Centers for Disease Control and prevention that singled out alcohol-induced deaths so these are deaths that are directly caused by alcohol. Things like alcoholic liver disease, mental and behavior disorders due to alcohol use, and it excludes things that would result from the consumption of alcohol, but not be directly caused by it. Things like car accidents, violence caused by or, you know, in approximate distance to the consumption of alcohol, so just the deaths that are really a direct result of alcohol, but, yeah, you’re right, you know, found alarming trends here and things we have been looking at for the last couple of years, even before the pandemic started.

Marisa Wojcik:

And, Brien, have you been seeing this in your day-to-day work with as the pandemic has progressed?

Brien Gleeson:

Well, I’ve been doing this for a while, and Ive seen it for a long time, but I would say, yes, during the pandemic, it’s gotten worse. I also asked before this interview a couple colleagues of mine who work in other places, and they’ve seen the same trend, that particular form of harm caused in relationship with alcohol where, you know, alcohol essentially as a poison of sorts is hurting a person’s body, and that that leads to illness and death, that, yes, that is something we’ve seen on the rise since the beginning of covid.

Marisa Wojcik:

And, Brien, have you, I guess, seen how this has played out with clients, and has it made you busier? Have you basically understood what people are going through as these last two years have progressed?

Brien Gleeson:

I would say yes. It’s not that it’s something new as much as it is just something that’s gotten worse because of the, you know, socially what’s occurred. You know, generally, as a person’s alcoholism progresses, they’re likely to become more isolated, and there’s any number of people who kind of try to function as best they can using social contacts as a way to keep from, essentially, drinking too much, and in a sense controlling their own drinking by making sure they have regular social contact, whether it is with family or friends or, of course, on the job. During covid, people have been isolated, and so it is not surprising at all to me that we have seen an uptick, a significant rise in the number of people dying essentially from the somatic effects of alcohol.

Marisa Wojcik:

Ari, do we know who this is happening to most acutely?

Ari Brown:

Yeah. So that was one of the things we were really trying to figure out was, you know, is this something that’s happening across all different kinds of people, or is this really contained to specific groups? What we found was that the rate of alcohol-induced deaths among basically all groups, age, race, ethnicity, geographic location, all groups were increasing kind of over the span of not just during the pandemic, but the entire 21st century. What we’ve found in terms of the groups that were really driving the increase, both in 2020 and kind of the last decade specifically were those between the ages of 45 to 84, so kind of our middle-aged and older Wisconsinites, and then what we found in the support that was alarming was, you know, for the most part, the death rate in racial and ethnic groups in Wisconsin tracks closely to that as of the U.S. rate, so, for example, death rate for white Wisconsinites is similar to the death rate of white Americans. One of the things we found quite concerning was around 2012 or so, the death rate for Black Wisconsinites increased, and diverging quite heavily from the death rates for Black Americans. So, for most of the 21st century, the death rate for Black Americans has been well below that. For white Americans, in Wisconsin, that was mostly true as well, they kind of — I believe, 2005 was the last year that Black Wisconsinites were above white Wisconsinites for the death rate, but that has continued for America generally, but not for Wisconsin. In 2019, the Black death rate rose that above the white death rate. We thought that was important to highlight because it was really one of the trends where you start to see a divergence in overall trends and same divergence in the middle age and older in Wisconsinites as well where their rate in 2011, 2012 starts to increase above the rate of all Americans of similar groups.

Marisa Wojcik:

And it kind of makes sense that an older group is going to have more health related issues, either from being older or from drinking, and so it is not necessarily younger people we are seeing from alcohol-induced deaths, but, Brien, are we seeing younger and younger alcohol abuse problems in people? Is that something that you’re seeing in your work?

Brien Gleeson:

It’s interesting. It’s kind of a little bit of a mixed picture there I would say. Overall, I would say, yes, you know, there’s a culture of drinking in Wisconsin, and not just drinking, but one of the main things that shows up from the statistics that I looked at is that it is not so much that people are drinking younger than they used to or that they are more — that more of them are drinking, you know, per capita or whatever, but what they are doing more is drinking more heavily when they drink. That’s been pretty clear, I think, from the research I’ve seen. What they are doing more is binge drinking, and so that’s the type of drinking that’s liable to bring about — you know, for younger people, the medical problem is more likely to be along the lines of alcohol poisoning. Where a person drinks so much so quickly that they simply anesthetize their central nervous system to the point that they die. It is not real common. It is not real frequent. But it is certainly going to happen more commonly among young people where it’s a culture where younger people are drinking more when they drink. It’s not that more of them are necessarily drinking or that they are drinking more often, but when they drink, they drink more, and we have seen that be an even greater — and I don’t have the figures in front of me — but off the top of my head, I know that’s been actually through the past few decades, happening more often with young women than it used to. Young women, in particular, drinking more when they drink than young women in generations previous. Now, I will say this, though, to kind of counter it, I think that there is less — especially for underage drinkers — I think there’s less tolerance or expectation in our culture today for that, not a huge amount. I mean, there’s still plenty of underage people drinking, especially in Wisconsin. It’s been said in Wisconsin we start them out young, and we do. We tend to. It’s kind of a known thing if you grow up in Wisconsin, you’re likely to be drinking before you are of legal age, but I think there’s been a trend of less tolerance for that in the past few years. I think that, frankly, a lot of that is probably due to liability. You know, in the past, it was not unusual that parents would sponsor a drinking party for the high school football team. Even though they were all underage, you know, we’ll have them drink at home. It’s safe there. They will be drinking anyway. At least they are drinking where we won’t let them drink and drive, and so there was some thought about that, but, you know, there’s been — I’ve even seen road signs or advertisements on the roads that say, you know, parents who sponsor drinking aren’t liable for what happens. I think I’ve seen some change, although, again, not dramatic, but some change in the tolerance for underage drinking, but overall, yeah, the overall trend has gotten worse for all ages, and as you said, especially older people.

Marisa Wojcik:

So a lot of factors that are going into cultural shifts, and I believe, Ari, in your report, specifically, that alcohol-induced deaths were not — did not include young people who had given themselves alcohol poisoning, but can you talk about what are the consequences of the health and economic consequences of this large scale rise in severe drinking that you laid out in this report?

Ari Brown:

Yeah. So, just to respond to the first part, as, you know, our other guest mentioned, we did — those are alcohol poisoning is one of the things that’s included, but the numbers are pretty small in terms of people actually drinking themselves to death like in an acute way rather than in a chronic way. I believe it was the third leading cause among the alcohol-induced causes, but a distant third where the first two being alcoholic liver disease and then mental and behavior disorders due to alcohol use being around 90% of all alcohol-induced deaths, both in Wisconsin and nationwide. To respond to the second part of that, yeah, it is such a good question, and it’s really something that I think policymakers should be thinking about in terms of, you know, what does this rise in alcohol-induced deaths mean for the health of Wisconsinites and for the health of, you know, the economy in Wisconsin, and I think one of the thing we were thinking about throughout the report was, you know, there is a big economy for purchasing alcohol in Wisconsin. You know, Wisconsin does — is kind of one of these states that’s thought of as having a pretty strong drinking culture. There’s breweries all around the state. What we found out in the report, and this was not just Wisconsin specific. It happened in other places, but it did happen also in Wisconsin, was that there was, you know, a motion from the state to allow for what was termed to-go cocktails from, you know, bars and restaurants in the beginning of the pandemic, and at the beginning of the pandemic, the concern, I think, rightfully so, was making sure that small businesses could, you know, continue to function, continue to, you know, do their business, and not, hopefully, you know, go away as a result of the pandemic, and for, you know, a lot of things, that was a good motion, and it helped a lot, but potentially one of the side effects that you have is the overall increase in the accessibility of alcohol. This was just another example. But you could go back the last couple decades and find little motions here and there that have kind of served to increase the accessibility and availability of alcohol, so in terms of the economic picture, I think that’s one with of the important things to think about is, you know, it is an important economic industry in the state, but there are also these potential side effects. When it comes to health, I think one of the things that we focused on a lot in the pandemic, again, rightfully so, was we are really focused on getting covid under control, and, obviously, it’s been a major factor in all of our lives for the last two years, but one of the things that we’ve kind of been thinking about as policy researchers is what is all of these kind of side effects of the pandemic on other areas of public policy, and alcohol is one of them, especially in our state. You know, the increase that we saw, the 25% increase, about 25% from 2019 to 2020 was by far the largest one-year jump in alcohol-induced deaths from — for any year over the 21st century, and, you know, the doctor mentioned social isolation and things like that, and that’s one with of the things we’ve been hearing from other experts on this as well that that played a really big factor, and so, you know, I think that those are kind of the big things to focus on when it comes to the health of wees and overall Wisconsin economy.

Marisa Wojcik:

If I remember correctly, when the pandemic first hit, kind of March 2020, many businesses were shut down, including restaurants and bars, but grocery stores and liquor stores were considered essential, and liquor stores were kept open. Brien, I wanted to ask you, in Wisconsin, as we already said, binge level drinking levels were already high before the pandemic. Many places in Wisconsin were ranked top drinking cities nationally, so were people already on the edge or experiencing kind of a full blown addiction, but it just wasn’t being talked about?

Brien Gleeson:

Sure. Yeah. I would say so. You know, the thing that tends to get the headlines and get noticed are abuse of other drugs. It’s more dramatic, its more immediate. One of the real — boy, I don’t know what to call it — dangers, I guess you would say or one of the things in my job I see very often is the real harmful effect of alcohol quite often, it is the subtlety. It seeps in gradually. So we will tend not to notice the effect because the effect does not come on in rapid onset like it might with a drug like methamphetamine. Generally, if someone is, if you will, drinking themselves to death, it is a slow death. It is a very gradual thing, and that trend is something that’s been a part of the culture for a long time. It’s — you know, to call it “suicide” is maybe not quite to understand it because I don’t think most people that drink themselves to death are doing so because they want to die, but rather the — you know, as you watch it progress, it is so gradual that it is more subtle, and it is going to be below the radar, as you are suggesting, and people find a way to hide it in a million of ways that we lost in the pandemic, and so it is making sense it increased. But, yes, it’s definitely always been there, and, you know, as the illness progresses, I don’t think that very many alcoholics decide that, oh, you know, I just decide I want to die. I don’t think it’s suicide. It’s been called “slow suicide,” by self-poisoning, but I don’t think it is so much a matter of somebody willingly of their own volition deciding I don’t want to live anymore as much as they recognize that it is harming them. They recognize that it will end with their death, but as the disease progresses, that doesn’t bother them as much as not drinking, as much as the idea stopping drinking. It is more troubling to them than knowing that eventually this is going to take my life. So that’s what I’ve seen for years in working in this field, and that has not really changed with the pandemic. That’s always been there.

Marisa Wojcik:

And kind of that gradual progression, as you are describing, kind of sounds like the frog in boiling water. You don’t notice it at first, and by the time it gets really bad, it’s almost kind of too late to stop it, and often drinking is seen as a good thing, a celebration, a positive thing to kind of relax and let loose, but it doesn’t always stay that way for folks. Ari, I wanted to ask you, so why has Wisconsin failed in the past to pass legislation that could address this, even for policies like more severe punishment for drunk driving offenses? Is Wisconsins drinking culture directly impacting our policy decisions?

Ari Brown:

Yeah. This is such a great question, and I think it’s something that we were, you know, interested in pursuing as well. One of the things that we’ve kind of talked about a little bit with this report specifically is, you know, alcohol really seems to be what we refer to as a policy blind spot in Wisconsin. I think it is something that people are generally aware of, you know, you see things like the lists of, like, the top 40 drinking cities or the top 10 drinking counties, and usually a lot of them are in Wisconsin, and so I think it is something people are aware of, but, you know, it can be hard sometimes to get a lot of energy behind certain legislative proposals or to figure out, you know, exactly what sort of policy solutions, you know, can be pursued in order to cut down on this as an issue. I do think it is important to note that if you go back to around 2000, the rate of death from alcohol-induced causes in Wisconsin was basically exactly at the national average. We don’t have data before 1999, only since then, but what we have seen a the rate of alcohol-induced deaths in Wisconsin tracked very closely to that as was national rate until about 2010, 2011 or so where it went in the wrong direction. Another thing to potentially point to here is this real divergence in the 25% gap now between 2020, the rate of alcohol-induced deaths in Wisconsin and rate of alcohol-induced deaths in the United States in general is really kind of a newer phenomena. The other thing I’ll point to here that has kind of been pointed out to us in doing this research, is that a lot of alcohol policy decisions are made at the local level in Wisconsin. For example, you have items like liquor licenses. Those are largely determined by municipalities, and so it is really hard, sometimes, to get a handle on the availability and accessibility of alcohol, which in doing our research, were two of the big items that, you know, institutions like the CDC pointed to in terms of what could potentially reduce the rate of alcohol-induced deaths nationwide, and when you have decisions being made at the local level, you know, in Wisconsin here, over 1800 municipalities, and so kind of that spread out decision making, a lot of times, it is hard to really get a handle on, you know, what exactly is being done and just the overall increase in the availability of alcohol.

Marisa Wojcik:

Brien, we know there are stigmas against people struggling with addiction, but is this more of a mental health crisis, and what do you see as ways of addressing root causes of alcohol addiction?

Brien Gleeson:

Well, okay. So, yeah, absolutely is. In fact, that’s where you find alcohol use disorder, as we call it now, or alcoholism, is not really the medical term, but it is alcohol use disorder, where, you know, the criteria for that diagnosis is found in the diagnostic and statistic manual of the American Psychiatric Association so it is a mental health issue, it absolutely is. It is interesting that way. Sometimes the individual alcoholic or addicted person will wonder, am I addicted or am I crazy, you know, if you will, thinking about it in the simple sense. It’s, like, well, there — that’s where this particular illness is couched, under that heading, if you will, mental health. So, I don’t think I would necessarily separate the two, by any means. Certainly, other issues in regards to mental health impact it, and it impacts other issues in regard to mental health, dramatically, but it is its own thing. I would add that. We know today — and this is something, actually, you know, I feel kind of privileged to get to say just in the course of my career, we have come to see with hard science and neurological research and brain imaging that this thing we call addiction is a real thing. It is not just somebody behaving poorly. It is a change in the way that the brain operates, and it is really best described as a neurological hijacking. There’s a lot of things that happen when you — when a person drinks alcohol that kind of separated, in many ways from other drugs, that it, as — it is such a simple organic molecule. It literally goes everywhere in the body, and that makes it difficult to research in a hard science way. It’s actually one of the more difficult drugs to research because of that because it’s not kept to just a single pathway in the body. However, today, we can say authoritatively that there’s a real thing that happens here. There’s a change in the way that the brain operates. That seems pretty indelible. We don’t know how to undo it. It’s maybe the best description that I can think of is that it is a neuro hijacking at the psychology level, and what is essentially the reason I have this job is because of that psychological hook that we understand the mechanism of that much better today, that it’s a real thing, and it is best described as a hijacking of the neuropathways involved with attachment. It is an attachment. That is a really good word to think of when you are trying to understand addictions. Addictions are about attachment. They are about a lot of different things, but that, in particular, is what makes it a tough nut to crack.

Marisa Wojcik:

Huh. Very interesting. So, Ari, if there’s not a lot of statewide policies that are going towards addressing root causes and prevention, does Wisconsin have enough resources kind of on the reaction back end side for services like counseling to wrap around those who need it?

Ari Brown:

Yeah. This is a great question and one that I think, you know, policymakers should also be interested in digging into. One of the items that we mentioned in the report is that we found last year that the state is now working with one of the bigger budget surpluses it’s had in recent years with definitely the potential to, you know, focus some of that revenue towards things like addressing, you know, prevention, education, treatment for those who are experiencing issues surrounding alcohol use. You know, there are definitely avenues that policymakers could be taking. It is hard to say right now indefinitely, you know, you’d expect that in terms of services that are available, you’d expect things kind of differ geographically, you know, there are different issues, you know, facing Milwaukee than say Vilas County, you know, so I think it is a great question for policymakers to continue to pursue. The other thing to mention here is, you know, you have recent stimulus bills, for example, the American Rescue Plan Act, that gave local governments a lot of revenue to work with on, you know, of course, a lot of the revenue’s going towards, you know, filling other holes when it comes this things impacted by the pandemic, but we think, you know, this is certainly one area that at a local level, if there is revenue, that could potentially be used for, you know, public health spending. I’ll say, also, the Wisconsin policy forum does not advocate for — as a nonpartisan organization, we do not advocate for specific policies, but just, you know, in terms of what’s out there, those are the big items when it comes to what policies could be pursued, both at the local and state level.

Marisa Wojcik:

And, Brien, if many people were possibly abusing alcohol before the pandemic, and now we see this getting worse, how does someone know if they need help, and if someone watching this today is a friend or family member of someone who needs help, what’s the best way to approach this topic?

Brien Gleeson:

I’m glad you got to that question. First of all, if you are asking yourself, geez, I wonder if I have a problem with alcohol, that’s a good indicator that you probably do. The advice I’d have for the individual or for the family member would be this, keeping in mind the word that I use before can be really helpful, because it’s very confounding for the individual and the family to face this. If you can remember this is like a relationship, this is like an attachment, and so if you ever had a friend who fell in love with someone who just was no good for them, it’s — that’s kind of like what you’re facing here. You have a friend who fell in love with something, it is an attachment. They did not ask for it. With attachments, they are not that voluntary. They are decisions we make in regard to them, but they are not really voluntary. Attachment is what occurs. If it occurred, then you’re going to need to help a person kind of get through a breakup, if you will. If you approach it like that and that mind set, you’re more than likely — and loving caring mind set, I care both you, but I see this happening, it is much more likely to be successful. Again, both for the family person and for the individual to recognize, I’ve got this attachment, I didn’t really ask for it, I don’t really want it, but I got it, and, therefore, I have to move forward with trying to change my life and, you know, I think in all of the details that go along with that breakup, with the attachment, it is the best way to approach it.

Marisa Wojcik:

All right. We need to leave it there, definitely a very important topic, and I really appreciate both of you contributing your unique perspectives. Ari Brown, researcher from Wisconsin Policy Forum, and Brien Gleeson, addiction counselor with the Mayo Clinic Health System out of Eau Claire, thank you, both, very much for the conversation.

Brien Gleeson:

Well, thank you. I enjoyed it

Ari Brown:

Thank you for having us.

Marisa Wojcik:

For more from “Here & Now” and PBS Wisconsin, visit pbswisconsin.org/news, and thank you so much for joining us on “Noon Wednesday.”