The Number One Drug? Alcohol.

[Jaunty Guitar Music]

Mike: Welcome, everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting and the Kenosha County Substance Use Disorder Coalition. I'm Mike McGowan.

Mike: For those of you listening, what's the number one drug in your community? Got a guess? Well, we're going to talk about the number one drug today, and the number one drug is alcohol.

Mike: We're going to do it with our guest, Maureen Busalacchi. Maureen is a returning guest, and she's the director of the Wisconsin Alcohol Policy Project and has decades of experience in public health policy. She works at the Medical College of Wisconsin and is currently the president elect for the Wisconsin Public Health Association and served as chair of the Ad Hoc Work Group on Alcohol Prevention for the Wisconsin State Council on Alcohol and Other Drug Abuse, whose purpose was to develop evidence based recommendations to reduce excessive alcohol use.

Mike: Maureen presents at state and national conferences on advocacy, systems change, and public health issues. Welcome back, Maureen.

Maureen: Thank you. It's good to be back.

Mike: Well, I'm so glad we can be together. I know you have a conference upcoming, and we're going to talk about that in a minute. But first, we could talk about alcohol nationally, internationally.

Mike: You can go anywhere you want. But let's start in yours in my home state of Wisconsin. You know I present a lot at high schools, colleges. And when I ask kids, in assemblies, what are the top three drugs in your community? Alcohol is rarely mentioned. In other states, Maureen, it is. But in Wisconsin, it's just not.

Mike: Talk about alcohol as a drug and the perception by quite a few people that it's actually not

Maureen: Right. So in Wisconsin, we know from the YRBS, which is a survey of our high school students that for example, binge drinking is not considered problematic. At higher, you know, at lower levels than other states.

Maureen: So that kind of goes with your findings. I was on a call with a national speaker with Wisconsin and he asked, what is the number one drug? And nobody said alcohol. So there is a perception that alcohol is not a drug. It's not only a drug, but it's a carcinogenic. So you know, it's definitely associated with seven different types of cancer.

Maureen: So we do have a perception and I think it's somewhat because it's the wallpaper of our lives. There's alcohol wherever we go. There's lots of advertising and many places to buy alcohol or be served alcohol.

Mike: Do I remember this correctly that you worked with tobacco for a long time?

Maureen: Yes.

Mike: Okay. We kind of got there with tobacco though. Do you think we can get there with alcohol?

Maureen: I think we can make change. We've certainly reduced tobacco rates though we are seeing upticks in vaping, which is a big concern. And part of that's kind of the FDA and you know, how they're handling the product.

Maureen: But you know, we don't regulate alcohol evenly across the nation. Different states have different levels of regulation. I'm not saying there's not a lot of regulation, but some of it is looser than others in Wisconsin. So that's been proven by a national study that we do have looser restrictions than most states on our alcohol service and buying.

Mike: Well, and excessive alcohol consumption comes at a huge economic and human cost, doesn't it?

Maureen: Absolutely. So in 2018 a report by the UW Population Health Institute estimated it was $4 billion in the economy, most of which was a result of binge drinking. So people not able to show up for work. All kinds of injuries, diseases, the World Health Organization lists 200 different injuries and diseases as related to excessive alcohol use.

Maureen: And so it really takes a toll here in Wisconsin, and of course those with an alcohol use disorder it takes a very heavy toll on their families, their employer. And their ability to hold a job and even housing. So it's definitely a concern. But we can do more to reduce binge drinking and prevent excessive alcohol use.

Maureen: And that's really our focus.

Mike: Yeah, because we're not talking about the person goes out and has a margarita. We're talking about, for the most part, excessive drinking. Isn't it a small percentage of people who drink most of the alcohol?

Maureen: Yes, I've seen various estimates on that. So I'm not sure I could give you a clear statistic.

Maureen: I've seen anything from 50 percent of the people drink most of the alcohol to 20%. So I don't want to quote something there. But we do know that binge drinking takes a lot of that, and we also, the NIAAA a federal organization looking at alcohol and alcoholism has said that they had to make a new category called high intensity drinking, so that's 10 or more drinks in a single setting.

Maureen: Binge drinking is generally four to five over a couple of hours. And the reason why that is set is because you get to your blood alcohol content at 0.08 within that time period. And that many drinks.

Mike: Ten or more?

Maureen: Ten, yes.

Mike: That is, that's almost intolerably impossible for most humans.

Maureen: I think some people would have significant harms, if not alcohol poisoning with that type of drinking

Mike: And Wisconsin, since we're on Wisconsin, we raised... I know I have this. I read this. We raised more money in alcohol taxes during the pandemic when bars were closed and restaurants were closed than at any time in our state's history. I think it was since World War II or some somewhere back, so years and years and years, which means that people were too excessively drinking at home for the most part.

Maureen: We definitely saw that trend.

Mike: Well, so you mentioned a number before. Do we know? If those monies raised outweigh the cost.

Maureen: As I said the cost is estimated at $4 billion in 2018 numbers. But the amount raised in the period you're talking about I believe was $81 million.

Mike: So we're spending a heck of a lot more than we're raising.

Maureen: Yes.

Mike: Who picks up the cost?

Maureen: Taxpayers pay for that. Health care pays for that, you know, local services, your police, your sheriff, your local municipal courts, your circuit courts, state courts, depending on, you know, what the penalties were. You know, so really we pay for it in a variety of different ways, through our employee health benefits, through Medicare, Medicaid you know, so it's, it's many, many different ways that we end up paying a higher cost.

Mike: Is there a mandate for how that money raised is spent?

Maureen: No, it just goes into general purpose revenue.

Mike: So it can be for anything?

Maureen: Yes.

Mike: We saw during the pandemic that women's drinking in particular went way high. We've had guests on this podcast talking about that. Over the last several years, women's drinking has become excessive.

Maureen: We sure have. And we're also seeing those numbers when they're young. We're seeing girls drinking in higher rates than boys in high school. So we're seeing female binge drinking at 11. 9 percent versus 9. 5 percent for boys. If they drank alcohol in the last 30 days, It's 30 percent female and 22.3 percent male. So, it's very concerning that we're seeing that trend happen with our young people, and then we're seeing women that are drinking more and drinking more heavily. And, you know, breast cancer is about, you know, alcohol related breast cancer is about 15 percent of all the breast cancers.

Maureen: And as I mentioned, there are seven total different types of cancer, not to mention cardiovascular disease. So the myth that, you know, red wine is good for your health has been debunked. And in fact, actually it causes problems in your cardiovascular system as well as other chronic diseases.

Mike: Isn't it, you know, when you talk about policy, isn't it amazing how something like that can get started and just take over?

Mike: I mean, everyone listening to this, I know has heard that, oh, red wine's good for you. And that study has been debunked.

Maureen: Right. It will take quite a bit for the public to understand that, and most of the public doesn't know that drinking alcohol can cause cancer and, you know, to reduce your risk, you want to drink less you know, certainly, and you know, it is a carcinogen, so people who really want to put their risk at zero for cancer may decide not to drink at all.

Mike: Do you think, what we saw with tobacco, since you came from that area, was that as women smoked more, and girls smoked more, their rates of tobacco related cancer began creeping up to equalize men. Do you foresee that happening with these statistics with alcohol as well?

Maureen: It certainly could. We know there's a lot of alcohol advertising that is targeted to different populations, and we see the impact of that.

Maureen: So there's a lot going on in the alcohol industry in terms of targeting women as well. So it makes sense that those rates are changing over time.

Mike: Yeah, how do we get it? This is an off the board question, Maureen, but if you don't have an answer, that's fine. How do we get from it becoming a joke to an issue?

Mike: You know, because in the public it's joked about, alcohol consumption, even heavy alcohol consumption is joked about.

Maureen: Right. I think and this is something we try to put out there is that people need to look at the facts, the figures, and the data. And last year, 3,331 people died from alcohol attributable disease or injury in our state.

Maureen: That's more than double the amount of people who died from opioids. And I think we need to do everything we can to reduce the people who are dying from opioids. But we are not seeing that same public outcry around alcohol because it's acceptable in so many spaces. But I am hearing from a lot of thought leaders that there is more concern now that all of these studies and research has come out about alcohol's harms. And so I do think people are rethinking their drink. And that is a CDC campaign to rethink your drink. And I think that's really important for people to consider that. We also find that acute alcohol deaths, so those are from injuries like falls, drownings, railroad crossings, of course, motor vehicle accidents, but also suicide, homicides are also above the opioid death rate.

Maureen: You know, in round numbers about, you know, 1400 to 1700. And that's just the acute deaths. Alcohol poisoning falls into that category as well, of course. So, you know, we're losing people not only from that chronic disease, but we're losing people from injuries. And according to the CDC, one in five people in the age range of 20 to 49 are dying from a preventable death from alcohol.

Mike: And, and those statistics, I know, don't include people in my family who the list, you know, the doctor listed the cause of death as something other than their chronic drinking, which led to their, ultimately to their heart disease or liver disease.

Maureen: Right it's, you know cause of death is a very complicated subject, so we're not going to go into that here and there is some concern that we're seeing under reporting of this, and I know there's some really great researchers working on that to try to figure out how do we make [inaudible] we account for the toll of excessive alcohol use in our communities, in our society.

Mike: Well, speaking of thought leaders you have a conference coming up. Do I have it right? October 7th and 8th.

Maureen: Yes.

Mike: I better have it right. I think I'm at that conference. And it's in Oshkosh, Wisconsin.

Mike: Talk about the conference.

Maureen: Great. Yes. So it starts at one o'clock on Monday, October 7th. We're super excited to have that. We're going to start out with you hosting a legislative panel. And then we're going to hear from the Department of Revenue and the Department of Transportation about really critical pieces some tools from the Department of Transportation, and then how Act 73, which passed the last legislative session, is impacting municipalities.

Maureen: And then we will also have a kind of a World Cafe discussion about. You know, what people are doing to reduce excessive alcohol use in their communities. The next day, which we'll run from 8:30 to 4:30. We've got a fantastic keynote speaker coach Tim Decora. He's played for Bo Ryan in Platteville and has had a journey himself he's from the Ho-Chunk nation.

Maureen: And I think he's going to give a very inspiring talk about alcohol and alcohol policy. And then we go to breakout sessions where we've got, you know, law enforcement coalitions, other experts from MCW and UW speaking about alcohol and alcohol policy and health issues. And then lunch is going to be a MAD Heroes Award Luncheon.

Maureen: So, Mothers Against Drunk Driving will be awarding law enforcement officers who have gone above and beyond to reduce OWIs. And so, not just the number of arrests they've made, but the scale was really looking at what they're doing in their communities and what they're doing for their agencies to reduce excessive alcohol use and OWIs in their communities.

Maureen: So it's going to be a great day and a half.

Mike: Who's it geared towards?

Maureen: Really it's geared towards anyone that's really interested in what we call primary prevention. So the work we do is intended to reduce excessive alcohol use. And of course, reduce the number of people who end up with an alcohol use disorder.

Maureen: So we are really targeting coalition members, substance use coalitions, public health departments, law enforcement, which has been our statewide partners at DHS, DOT, Department of Transportation, Department of Revenue. Those who are really interested in seeing reductions in excessive alcohol use and impaired driving as well as, you know, reducing injury, because we know that alcohol is a huge factor in that.

Maureen: Also people who want to learn more about alcohol and cancer.

Mike: So, you know, people make a difference. We've had a lot of people on this podcast, Maureen, who lose a family member. That's always tragic. And it's amazing how those people with less of the professional background that you have all of a sudden get involved and they get stuff done, right?

Mike: So you don't have to be immersed professionally in this field to take advantage of the information you guys will be offering at the conference.

Maureen: You're exactly right. We hope that local elected officials will come. People on licensing committees and, of course, anyone impacted by alcohol, you know, would benefit from coming to the conference.

Mike: When you mentioned Act 73 before, right? You passed over that. Can you tell the audience what that is for those that aren't familiar with that?

Maureen: Yes, I'm sorry. I should have explained that better. Act 73 was kind of sweeping changes in alcohol regulation. So it changed a number of things. What was covered by the media was about wedding barns.

Maureen: Yep.

Maureen: Because they had kind of slipped through in terms of, you know, how are they really regulated? And the bill was intended to regulate them. There's arguments about, you know, in a lawsuit, in fact, about whether or not they hit the mark on what that means. But basically, you know, if you hold less than six events, and you can, you know, operate and, and they have to be once a month with no event venue license. But otherwise you'd need to get a class B liquor license and they've made accommodations for folks to be able to apply and get those, but many in the venue industry don't feel that that's fair.

Maureen: So that's you know, one piece of it. I don't know what will happen with the lawsuit. But it also made a division in the Department of Revenue on alcohol beverages. And so they're going to have more enforcement because there were many changes made. So, in Wisconsin, we have a three tier system. So, you've got your producers.

Maureen: You've got your wholesalers who sell to the retailers. Right. So there's those three and they made some changes so that there's it used to be, you couldn't work in any other tier. You could only work in one. And now they have changed that a little bit. And so it's allowing some producers to sell and you know, that kind of thing.

Maureen: So the department of revenue will have more permits to offer as well as offering a statewide operator's license. So that means that instead of getting operator's license to be a bartender basically and to supervise other bartenders, you could get a statewide so you could practice in other communities.

Mike: Was part of that act also, the who can serve alcohol, who can take it to the table. Was that the whole 14 year old thing?

Maureen: No, that was a separate bill and that did not pass. There was quite a bit of press around that and there's concern by those in the public health community by putting, you know, young people in a situation of having to turn down requests for alcohol, if the person was intoxicated, for example and then also having to ID, you know, those under 21. So it can be a difficult issue for young people and so we did not see the bill go anywhere.

Mike: I don't mean to. Ask you questions you don't know the answer to, but I grin a little bit when you talk about increased the licenses. Whenever I have friends from out of state into Wisconsin, their first comment is, Holy cow, you can buy alcohol almost everywhere. (laugh) It doesn't seem like we're lacking for places to buy alcohol.

Maureen: No, our density is really high of alcohol licensees to people. You know, it's about an average of 350 people to one liquor license or alcohol license. In other states, you know, like New Jersey, it's 1 to 3000. In Idaho, it's 1 to 1500. You know, so we have it serve and sold in many more places and the changes in the alcohol regulation could allow more licensees, even on top of that.

Mike: Wow. And we're in no short supply of taverns.

Maureen: No, but I don't know those numbers off the top of my head.

Mike: We all see those articles every now and then about the top 10 cities of taverns per capita and you know, I never know if those are real statistics or if they just look good, but we're always near the top in all of them.

Mike: I'd venture to say, Maureen, that there's not a person listening that doesn't know someone with an alcohol problem, yet it's not treated the same way as you mentioned before of opiates or fentanyl. Why doesn't it get the attention of fentanyl, for instance? Since you just gave some of the statistics and it's much more damaging.

Maureen: Again I don't think people realize the toll of excessive alcohol use. So we're not talking like you were saying. You know, having one margarita or, you know, a beer or two with friends, you know, with a meal. But instead we're talking about, you know, excessive consumption. And so I don't think it's well understood.

Maureen: I also think because so much of Wisconsin's population drinks. We see that kind of, you know, it's like, well, everybody does it. And it's not true, not everyone does it. It's about 64, 65 percent of the population. Though there are age groups where it is higher that we see that in young adults, for example.

Maureen: And so that's, that's a concern and we have generally trended higher than other states in terms of the number of people who drink alcohol. And I think that's because, as you pointed out, there's a lot of availability. You know, everywhere you go, every festival you attend, you know, you can get alcohol.

Mike: And what you're doing is really important because policy does matter.

Maureen: We think so. Yes, for sure. We know that it really helped reduce cigarette usage, for example. The lowest youth behavioral risk survey came out in, you know, cigarette smoking for our kids. So that's exciting to see that.

Maureen: You know, those kind of policies have really made a change. However, you put one down and something else happens. So we are seeing, you know, like I said, more vaping going on. But alcohol is the most accessible, uncommonly used drug. So that's kind of the big concern with that.

Mike: Right. Well, I know I'll be there in person, but good luck on the conference.

Mike: It sounds terrific. Oh, I should ask. It's not just in person, is it?

Maureen: It will also be virtual, so folks can join us that way as well. And if you go to Wisconsin Connect and put in 2024APS, Alcohol Policy Seminar, it will get you to our registration page.

Mike: And those of you who listen to this know that I'm going to put that link right at the blurb on the podcast.

Mike: So all you've got to do is click on it too.

Maureen: Yeah, great. It's going to be a really great conference. Lots of wonderful people are going to be there and all working towards the goal of healthier communities.

Mike: That's a great way to end it. Maureen, thanks so much for being with us. And as I said, there's not only links to the conference, but also to the Wisconsin Alcohol Policy Project attached to this podcast.

Mike: For those of you listening, we hope you can listen whenever you're able. And until next time, stay safe, stay involved, and stay educated.