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Let’s Not Forget About Alcohol: It’s Still King!

April 11, 2024

By: Mark Sanders, LCSW, CADC

As it pertains to substance use, in recent decades the U.S. government, media, law enforcement, substance use disorders (SUDs) treatment community, and the general public have primarily focused on impacts of cocaine, methamphetamines, prescription drug misuse, and opioid use disorder. Discussions of alcohol use disorders have gone the way of the dinosaur.

In the early days of my 44-year career as a SUDs professional, most of the attention in the treatment community focused on alcohol use disorder (AUD). Back then, detox facilities focused on alcohol withdrawal and thousands of residential alcohol treatment centers were operating throughout the country. Routinely, clients would be discharged from treatment centers and referred to Alcoholics Anonymous (AA). Justice-involved individuals under court supervision were often required to attend AA meetings and provide documentation of their attendance. Employee Assistance Programs were known as Alcohol Assistance Programs.

In 1970, the United States Congress passed the Hughes Act, named after Senator Harold Hughes, a person in long-term recovery. This legislation established the National Institute of Alcohol Abuse and Alcoholism, also known as NIAAA. One of the goals of NIAAA was to reduce the stigma of alcoholism (Kinney, 2020). In 1975, Congress also passed the Uniform Alcoholism and Intoxication Treatment Act, which shifted the view of public intoxication from a crime to a public health crisis (Kinney, 2020). It was in this same decade First Lady Betty Ford publicly announced her AUD.

Today, there is barely a whisper about alcohol misuse. What changed? Seasoned SUD professionals and I weigh in on this question.

Alcohol is considered a socially celebrated drug. It is used to bring in the new year, celebrate birthdays, holidays, anniversaries, weddings, and graduations. Crack, heroin and meth amphetamines are considered socially prohibited drugs. Use of these drugs receive the greatest stigma, ostracism, and legal consequences. Because of the fear factor and cost of incarceration they grab all of the attention.

William White, MS, Historian

I don’t think it’s all that complicated. Politics, movies, the media, and funding have led to a shift of focus to other drugs besides alcohol. Many people don’t even call alcohol a drug anymore.

Bill Green, Author and SUD Consultant/Educator

There are 88,000 alcohol-related deaths in the United States and 81,000 drug overdose deaths. We cannot always draw a straight line from alcohol deaths because the deaths are not always recorded as alcoholism. They are recorded as fatal car accidents, cirrhosis, strokes, heart attacks, all of which can be caused by alcohol use. Opioid overdose on the other hand is usually recorded as opioid overdose.

Jamelia Hand, MHS, SUD Consultant and Educator

Alcohol use disorder has always been a major problem historically and currently. The most influential and wealthy members of society tend to bless what they do and curse what others do. They protect their freedom to drink alcohol while using their power to help assure that people who use drugs like heroin and crack are punished. Thus, these drugs grab all the attention.

Joe Rosenfeld, PhD, CADC, Chair of Addiction Counselor Training Program, Elgin College

In my view, alcohol use destroys individuals slowly like termites eating away the structure of a house. It can gradually impact every organ of the body. Some people can drink alcohol for 20 to 30 years before reaching chronicity. Methamphetamines, crack, fentanyl, and oxycontin destroy quickly like fire. Fire grabs everyone’s attention!

Dr. Carl Hart’s research indicates that it is a mistake to ignore alcohol. In nearly 70% of opioid overdose deaths, alcohol was also present in the body at the time of death (Hart, 2022). In four decades of clinical practice, I have learned that a return to drugs like cocaine and heroin can be triggered by one drink. This drink can lower one’s inhibition and make it easier to return to the drugs they received treatment for. Over the years, I’ve had numerous clients who have given up illicit drugs as a result of being exhausted from hustling to purchase these drugs or tired of going to prison, only to die of complications caused by alcohol misuse.

Those of you who work with younger clients should be particularly concerned with alcohol use. Drinking and driving remains a leading cause of death for adolescents in the U.S. (Kinney, 2020). Emerging adults, particularly on college campuses, have the highest rates of binge drinking in the country (Smith, 2017). There is also a strong link between death by suicide and alcohol use among emerging adults (Smith, 2017).

The early editions of the book Loosening the Grip described alcohol as “King” (Kinney, 2020). Today, millions of people have AUDs, which if unaddressed wreak havoc on individuals, families, and communities. Alcohol use still plays a major role in health-related challenges, overdose, fatal accidents, and other drug related deaths.

 The NIAAA shares these sobering statistics about alcohol-related emergencies and deaths in the United States:

  • Estimates suggest alcohol played a role in 17.4 % of deaths due to opioid overdose in 2020
  • Deaths involving alcohol rose by 25.5% between 2019 and 2020
  • In 2021, alcohol-impaired driving accounted for 31% of all driving fatalities
  • Alcohol use disorder is involved in roughly 1 in 4 deaths by suicide

 As we work to improve client services for SUD treatment, let’s not forget about alcohol—not just during April, Alcohol Awareness Month, but all-year round.

See related NIAAA announcement: Alcohol Awareness Month: Raising Awareness about the Dangers of Alcohol Use Among Teens

Access the Great Lakes ATTC, MHTTC, and PTTC’s Alcohol Is STILL a Drug series for more information on alcohol-specific considerations shared by professionals throughout Region 5!


Hart, C. Drug Use for Grown-Ups(2022). Penguin Books. New York, NY.

Jaffe, I. (2011, July 9). Betty Ford: An advocate and an inspiration. NPR.  

Kinney, J. Loosening the Grip: A Handbook of Alcohol Information (12th edition)(2020). Outskirts Press. Pittsburgh, PA.

Smith, D. Emerging Adults and Substance Use Disorders Treatment(2017). Oxford University Press. Oxford, England.

Mark Sanders, LCSW, CADC
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