Why Are Alcohol-Related Emergency Room Visits Rising?

A dramatic increase in alcohol-related ER visits occurred in the nine-year period ending in 2014, a new study finds, but it’s unclear what caused it.

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Most Americans drink safely and in moderation, as many of us could attest earlier this week. But a steady annual increase in trips made to emergency rooms as a result of drinking alcohol added up to 61 percent more visits in 2014 compared with 2006, according to a study published this week in the journal Alcoholism: Clinical and Experimental Research.

Visits to hospital emergency rooms for alcohol-related issues rose rapidly over a nine-year period, though it’s unclear why.

Visual by Helena Yankovska/Unsplash

The increase is alarming but also a bit mysterious to neuroscientist Aaron White, one of the study’s authors, in part because the same nine-year period showed a mere 2 percent increase in per capita alcohol consumption overall, and an 8 percent increase in the number of emergency room visits for any reason.

White and his four co-authors, three of whom work with him at the National Institute on Alcohol Abuse and Alcoholism, have yet to understand what’s behind the dramatic increase in alcohol-related ER visits.

“The lowest hanging fruit in terms of hypotheses is that there must be an increase in risky drinking in some people,” White says. “Even though that is not showing up in increases in overall per capita consumption, it’s enough to drive the increase in alcohol-related emergency department visits.” But there is no strong evidence for a national increase in binge drinking, he added.

The new finding comes from an analysis of a nationally representative data set that includes information on about 30 million visits to U.S. hospital-based emergency departments annually, from 945 hospitals in 33 states and Washington, D.C.

White also was puzzled by a higher rate of increase in alcohol-related ER visits year to year among women, who are catching up with men nationally in overall drinking as well as in binge drinking, drunk driving, and deaths from cirrhosis of the liver caused by alcoholism. The gender gap in ER visits grew larger when the researchers looked at just at visits related to chronic use of alcohol, which means drinking that causes pancreatitis, cirrhosis, withdrawal, and other ongoing health problems.

It is clear though that alcohol use is responsible for a growing proportion of all visits to emergency rooms, which is concerning in part because it’s an expensive way to deal with over-drinking. Excess drinking costs an estimated $249 billion a year, according to a 2010 study.

The human costs are significant too. Nearly 88,129 deaths annually were caused by excess drinking in the U.S. between 2006 and 2010, according to the Centers for Disease Control and Prevention. White and his colleagues estimate that this represents nearly 10 percent of all deaths among working-age adults. And alcohol is a carcinogen that increases the risk of several types of cancer. A separate study in mice, published this week in the journal Nature, clarified the underlying biology — a byproduct of a single dose of ethanol damages DNA in immature blood cells if that toxin accumulates. Unrepaired, this damage eventually can cause cancer.

Most people forget that alcohol is a drug that can lead to medical emergencies by itself or provoke other conditions, he says. Even people who drink in moderation should talk about their alcohol use with physicians and other health care workers to avoid any dangerous interactions with medications.

For drinkers who end up in ERs, including repeat customers, brief, non-judgmental conversations about the path they’re on can lead them to cut back on drinking or drunk driving, or reduce alcohol-related injuries, at least for a few months, according to a 2016 review of past studies. Ideally though, screenings and other coordinated public health measures would prevent drinking that ended in a hospital visit.

The rise in emergency room visits due to alcohol is unsurprising in at least one sense, White says. More than two-thirds of Americans over the age of 17 (more than 170 million people) drank alcohol at least once in 2014, according to statistics from the Center for Behavioral Health Statistics and Quality. In that light, the raw number of ER visits due to alcohol — just under 5 million in 2014 — is a drop in the bucket.

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10 comments / Join the Discussion

    Too often the ED is used as a homeless shelter, especially in inclement weather. Intoxicated patients frequently say they want detox or that they are suicidal so they end up in a bed on a Behavioral Health unit. As soon as they sober up, they leave AMA (against medical advice), only to repeat the process several times a month. They have no intention of quitting drinking. Also, there is an increased number of people who exhibit this behavior at the end of each month, as they are out of money to buy booze. Disability checks arrive around the 3rd day of the month.

    Reply

    Somehow or other my first comment disappeared from the conversation. Here’s a short re-cap:

    You may want to check out

    Mueller RG, Lang GE, Alcohol levels in emergency room patients. Wis Med J 79, Nov 1980 pp29 ff, and

    Lang GE, Mueller RG, Ethanol Levels in Burn Ptients, Wis Med J 75, January 1976, ppS5 ff

    At that time we found 27% positives among the ER patients, 61% positives among the burns. The ER data may be skewed; on 2 of 25 Women in the study of 97 patients were positive.

    Reply

    Jägermeister is also a laxative, one of the many of the “Alpenkräuter” used by Germans for that purpose.

    Reply

    Societal, social, and cultural changes might be involved. Alcohol is the one drug, legal or not, that is small enough in molecular size so that it can pass through the blood – brain barrier and make you drunk. Moreover, it absorbs straight to the bloodstream directly from the stomach with no metabolic change.

    That said, people try amazingly stupid things with alcohol like pouring it into their eyes to be absorbed by the membranes and sinuses connected to them.

    And when was the Jaeger Bomb invented? I hadn’t heard of it before about five years, but when I did, it was in connection with a girl who consumed four or more Jaeger Bombs(one source says ten), which are energy drinks with Jaegermeister shots in them. It’s often Red Bull but Monster has also been used as well as other energy drinks.

    And if you are in a place where there is a special on Jaeger Bombs, you don’t spend any more on them than you do a beer.

    And then there was a lady I knew who would give plasma and then later go out and get drunk. It was a very cheap drunk.

    There is more to this story than come from numbers.

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    The lady who consumed the Jaeger Bombs collapsed in her bathroom and had three heart attacks, and required a defibrillator to be implanted.

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    “Even people who drink in moderation should talk about their alcohol use with physicians and other health care workers to avoid any dangerous interactions with medications.” Expect to see the requirement for ‘alcohol counseling’ in MIPS/MACRA (or its successor)

    Reply

    This question could be answered by any one of thousands of ED physicians, of which I am one. Simply put, cities have had “incidents’ in their “Drunk Tanks” and now in most cities patients who are simply highly intoxicated, even if they have no injury and no issues managing their airways or secretions, are taken to the ED to “Sober up”. The press tends to assasinate the police in the court of public opinion whenever the rare event of a person deteriorating in a “drunk tank” occurs.

    In other words, there is not much difference across the years in beverage sales, and probably not much difference in numbers of pts with public intoxication, but many more are taken to the hospital in a “liability dodge”.

    The problem with this police tactic is that they have the power to hold patients in a locked facility, under arrest, til the patient has someone come to get them or til they demonstrate sobriety. On the other hand, in the ED, if a person is apparently able to make competent decisions for themselves and they demand to leave, we must release them. If we stop them forcibly we can be arrested for battery.

    This peculiarity has resulted in patients having avoidable deaths, as they have been able to demonstrate competence before they are no longer alcohol-impaired.

    This study also shows a weakness of a “big data” approach. To have numbers to report without being able to explain the context can easily lead to misleading or misstated results.

    Simply stated, the authors have confirmed that local police are getting out of the “drunk tank” business and depositing the drunk patients in the ED, so they won’t have to be botherred with them and so that they won’t be blamed, if the rare event of a patient deterioration occurs.

    There is a better way. Transport those with injuries, inability to maintain an airway, or suppression of respiration to the ED, but take those who are just drunk to the drunk tank!

    Reply

    My thought is it is multifactorial. However, there are probably some contributing factors. One is the decline in resources for mental health – individuals with a dual diagnosis of mental health and substance misuse disorder have a significant challenge getting meaningful assistance. There may also be a liability issue. Many years ago someone found intoxicated would be brought to jail. Today, an individual found intoxicated, sleeping on a park bench is brought to the emergency department. Likewise, many college campuses have a lower threshold for transporting intoxicated students to EDs. I am not saying this is right or wrong, but something we see on a daily basis.

    Reply

    Has anyone thought to relate this to the opioid crisis? People that are coming down off of opioids will often use alcohol to stem the tide

    Reply
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