With about 80,000 Americans dying each year, excessive alcohol use remains the third most-preventable cause of death in the United States, topped only by smoking and obesity. Alcohol remains a stubborn killer of people in their prime. The tragedy is propagated over generations, through poverty, violence, broken families and harm to fetal brains. The consequences of excessive alcohol use are also a disaster in crass economic terms. At a quarter trillion dollars a year, alcohol-use disorders are some of the most neglected and mismanaged medical conditions.
A comparison with nicotine addiction makes this abundantly clear. Much work remains, but sustained policy efforts have reduced U.S. smoking rates from about 40 percent a few decades ago to about 20 percent. For remaining smokers, scientifically supported treatments have become widely available. Success rates of behavioral interventions are modest but over the years have been supplemented by increasingly effective medications approved by the Food and Drug Administration (FDA).
The situation is fundamentally different when it comes to alcohol-use disorders. Only about one in 10 people with alcoholism ever receives treatment. For those who do, treatment in the U.S. is almost synonymous with joining Alcoholics Anonymous (AA). AA was once critical for advancing a view of alcoholism as a disease rather than a moral defect, and it created an admirable fellowship of people willing to support each other. But AA was formed three-quarters of a century ago. At the time, medicine had little to offer alcoholics beyond treating the shakes of acute withdrawal. Much has happened since.