Number of Alcoholics

Alcoholism and Other Drug Problems
by James E. Royce, S.J., Ph.D., David Scratchley, Ph.D.

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In 1993 NCADD put the figure at 12.1 million. Using our working definition but applying it conservatively, one can say as a rule of thumb that alcoholics constitute 4 percent of the general population. In an adult population where at least three-fourths are drinkers, about 6 percent of the total group are probably alcoholic. In groups where practically all are drinkers, as in certain professions or types of work, the alcoholism rate may run about 8 percent, or one in twelve. If we include alcohol abusers as well as alcoholics, the best estimate is 10.5 percent of working Americans.

Those percentages vary markedly by locality and ethnic background, so the chances of developing alcoholism if you drink are not always one in twelve. They may be 1 percent for some and 90 percent for others. These are averages, which can be very misleading when applied to individuals, just as the concept of average temperature is meaningless if we talk about a man with his head in the refrigerator and his feet in the stove.

Among Americans, Eskimos and then other Native Americans seem to rank highest, followed by blacks, Irish, Poles, and those of Scandinavian origin. But again, generalizations are unwarranted. For example, upper-class blacks have less per capita alcoholism than whites at the same socioeconomic level. Jews have much more alcoholism than previously thought (see Blaine, 1981), although they still have the lowest rate of alcoholism in spite of a high rate of use.

Comparisons between countries in per capita incidence of alcoholism suffer to an even larger extent from all the research difficulties presented earlier in this chapter. Definitions, methods, samples, and survey objectives differ so widely that one despairs of any valid rankings. International figures and comparisons are difficult at best (Heizer and Canino, 1992). The United States and France top all lists, followed, usually in varied order, by Chile, England-Wales, Ireland, some Sandinavian countries, Canada, and Australia. It is a mistake to lump all of Italy together; rates among wine-drinking southern Italians have traditionally been reported as low, whereas industrialized northern Italy shows high rates now. The Irish in America have a higher incidence than the Irish in Ireland. Russia and Poland have very high rates; it was difficult to get accurate figures from behind the Iron Curtain, but the Kremlin's strong crackdown on alcohol in 1985 did reveal a widespread and severe problem. There has been a sharp rise in alcoholism in Japan in the last decade or so, especially in Tokyo. China has more than a billion people scattered over a vast area: to generalize about the Chinese seems vapid, as there must be wide differences in their use of and reaction to alcohol. Whereas the problems may be leveling off in some industrialized nations, the World Health Organization (WHO) says they are increasing in the developing countries.

Other Victims, Other Problems

Alcohol causes more than alcoholism. If each alcoholic affects the lives of four or five others " spouse, children, employer, employee, innocent victim of accident, or other " then our 12.1 million alcoholics have an impact on 40 to 50 million others for a total of about 60 million citizens. The president of a state association of judges stated that "90 to 95 percent of all the cases that come before my bench " civil, criminal and family " involve alcohol." Alcohol may not be the sole cause, but is a part-cause in much juvenile delinquency, illegitimate pregnancy, truancy, and fights. Numerous reports indicate that about 73 percent of felonies are alcohol-related. A survey of the literature shows that in about 67 percent of child-beating cases, 41 percent of forcible rape cases, 80 percent of wife-battering, 72 percent of stabbings, and 83 percent of homicides, either the attacker or the victim or both had been drinking. Hard to research, incest is now coming out in the open; one report estimates as high as 90 percent of incest may be alcohol-related. Alcohol accentuates depression, and reports indicate a range of 30 to 80 percent of suicides as alcohol-related (Murphy, 1992). As high as 45 percent of our social welfare aid in categories like Aid to Dependent Children, and 60 percent of "mental cruelty" divorce cases, have been estimated as associated with alcohol and other drugs, which is the primary complaint in one-third of all broken marriages (see Parker and Rebhun, 1995; Pernanen, 1991).

Traffic. Automobile crashes in the United States kill nearly as many people each year as the total of 46,483 American soldiers killed in the entire dozen years of the Vietnam War. (Why no protest parades about that?) Including the drinking pedestrian, alcohol is involved in about 46 percent of those fatalities. Not all of the drinking drivers are alcoholics; some of them were not even legally drunk. Short of death, the cost from traffic crashes in broken bones, permanent disabilities, hospital bills, and auto repairs is staggering-a total of $46 billion in a 1992 NHTSA estimate.

Cost. Money may not be the most important value, but it is a useful measure to help grasp the size of alcohol problems (see Berry and Boland, 1977; Cook, 1984; Fein, 1984; Grant and Ritson, 1983). We complain about the high cost of life's necessities, yet we Americans spend $71.9 billion (more than $197 million a day, $8.2 million an hour) on taxable alcoholic beverages, plus an untold amount on bootleg liquor (about 24 million gallons) and home brew. And $60 billion more goes to pick up the pieces: health care, motor vehicle accident losses, fire losses, losses caused by violent crime, social programs responding to the problems created by alcoholism, and loss to business and industry. Total losses to the nation from alcohol problems and alcoholism were estimated at $116.7 billion in 1982 by Research Triangle Institute, $120 billion in 1983 by the U.S. General Accounting Office, $142 billion in 1986 by the University of California at Berkeley School of Health, 136 billion in 1990 by NIAAA, and $148 billion in 1993 by MADD.

About 29.2 percent of our liquor bill goes to federal and local taxes, more than $10 billion a year. Obviously this is not enough to pay for the loss, even if the whole alcohol tax went into programs instead of only the one-twentieth that actually does. Yet treatment and rehabilitation could turn a large number of alcoholics from tax liabilities into taxpayers; one Seattle treatment center claims that the recovered alcoholics it returned to society as wage earners paid more than $100,000 in taxes in one year. A cost/benefit study by NIAAA shows that for every dollar spent in treatment there would be three dollars in benefits returned to the nation. Yet in some states a public welfare recipient gets more from the state if he continues drinking than is paid to a rehabilitation center if he tries to stop. Families seem to get even less help than alcoholics.

The Immeasurables. We cannot measure in dollars the value of lost human lives, wrecked families, deteriorated personalities, suicides, reduced quality of life, and human misery. We cannot ever know the impact of all this deep inside a spouse or child. Statistics ignore individuals: Even one alcoholic in your family is one too many. We talk of "victimless crimes," but here we are all victims, and especially the alcoholic.

This also answers the question, "Is it any of your business if I drink?" If you pay taxes and insurance premiums, it is indeed your business. As our number-one public health problem, alcohol misuse adds enormously to the cost of living for all of us. In addition, the life of everyone who gets into a car is threatened by drinking drivers. Alcohol impinges on almost every aspect of our lives.

Sources

Full identification of sources cited in the text will be found in the General Bibliography. Listing there does not mean full agreement; the reader must decide on particular points. The principal scholarly journals are listed at the beginning of the General Bibliography. Much material in this relatively new field, of varying quality, is to be found in semipopular pamphlets and books, many of them in paperback, produced by the publishers listed in the Appendix. No attempt is made to list the many biographies and autobiographies of recovered persons, though these are especially useful for those who are not alcoholics themselves.

Penny B. Page (1986) compiled Alcohol Use and Alcoholism: A Guide to the Literature. Kaye M. Fillmore (1988) has produced Alcohol Use Across the Life Course: A Critical Review of 70 Years of International Longitudinal Research. Other important sources are SALIS (Substance Abuse Librarians " see Appendix); the Classified Abstract Archives of Alcohol Literature (CAAAL), initiated at Yale and continued by the Rutgers Center of Alcohol Studies in New Brunswick, NJ; and the bibliographical search service provided by the National Clearinghouse for Alcohol and Drug Information (NCADI) in Rockville, MD. In Canada, the Addiction Research Foundation (ARF) in Toronto has done extensive bibliographical work.

Computer search can be accessed via ETOH at NCADI, or Medline, or Psychinfo, or the Project Cork database at Dartmouth Medical School, or Drug Information Services (DIS) at the University of Minnesota College of Pharmacy. This last and many databases are available through BRS Information Technologies at 800-468-0908. Since items on this topic are widely scattered in other scientific, medical, and social science journals, consult Index Medicus (including the "Medical Reviews" section, which often cites valuable review articles) and the annual or volume index of the journals.

EXTENT OF ALCOHOL PROBLEMS

In view of all the difficulties mentioned in the chapter, plus the inevitable lag between fact gathering and publishing, it is obviously impossible to give current figures. In addition to the sources cited that are listed in the General Bibliography (e.g., the Berry and Boland study), the following are useful founts of statistical information: The Bottom Line, the Center for Science in the Public Interest (Washington, DC); DISCUS (Distilled Spirits Council of the U.S., Washington, DC); the Gallup polls; NCADD; National Highway Traffic Safety Administration (NHTSA, U.S. Department of Transportation, Washington, DC); NCADI and NIAAA Special Population Issues; Research Triangle Institute (Research Triangle Park, NC 27709), U.S. General Accounting Office; U.S. Public Health Service; Dr. Robin Room and Dr. Don Cahalan at the University of California at Berkeley; and the Wall Street Journal.

Copyright © 1981, 1989 by The Free Press
Copyright © 1996 by James E. Royce and David Scratchley

About the Author

James E. Royce, S.J., Ph.D., is Professor Emeritus of Psychology and Addiction Studies at Seattle University. He is the author of Alcohol Problems and Alcoholism and coauthor of Ethics for Addiction Professionals.

David Scratchley, Ph.D., is a psychologist and addiction specialist with experience in neurosciences and pharmacology.