DefinitionThe age-adjusted alcohol-induced mortality rate is defined as the number of deaths attributed to alcohol per 100,000 population. The list of codes included in alcohol-induced causes was expanded in data years 2003 and 2006 to be more comprehensive. The following ICD-10 codes comprise the list of alcohol-induced codes: E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, R78.0, X45, X65, and Y15.
Certain causes of death are, by definition, due to alcohol consumption. These deaths are classified as being 100% alcohol-attributable and are reported in [https://nccd.cdc.gov/DPH_ARDI/default/default.aspx Alcohol-Related Disease Impact (ARDI)], a CDC web based application providing estimates of alcohol-related health impacts^1^, as having an alcohol-attributable fraction (AAF) of 1.00. The following chronic causes of death are listed as 100% alcohol-attributable in ARDI: alcoholic psychosis, alcohol abuse, alcohol dependence syndrome, alcohol polyneuropathy, degeneration of the nervous system due to alcohol use, alcoholic myopathy, alcohol cardiomyopathy, alcoholic gastritis, alcoholic liver disease, fetal alcohol syndrome, fetus and newborn affected by maternal use of alcohol, alcohol-induced chronic pancreatitis. Three acute causes of death are 100% alcohol-attributable: alcohol poisoning, excessive blood alcohol level, and suicide by and exposure to alcohol.
Alcohol-induced deaths include fatalities from causes such as degeneration of the nervous system due to alcohol (G31.2), alcoholic liver disease (K70), gastritis (K29.2), myopathy (G72.1), pancreatitis (K85.2), poisoning (Y15), and more. It does not include accidents, homicides, and other causes indirectly related to alcohol use.^2^[[br]] [[br]]
1. Centers for Disease Control and Prevention. Alcohol Related Disease Impact (ARDI) application, 2013. Available at www.cdc.gov/ARDI.
2. Xu JQ, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: Final data for 2016. [https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf]. Published 2018. Accessed November 30, 2018.
NumeratorNumber of deaths induced by alcohol in the resident population for a specific time period.
DenominatorMid-year resident population for a specific time period.
Data Interpretation Issues[http://live.laborstats.alaska.gov/pop/index.cfm Alaska population estimates] provided by the State Demographer in the [http://laborstats.alaska.gov/ Research and Analysis Section] of the [http://labor.alaska.gov/ Alaska Department of Labor and Workforce Development].
The list of ICD-10 codes with descriptions for alcohol-induced mortality can be found in the National Vital Statistics Reports,
[https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf Deaths: Final Data for 2016].
Why Is This Important?Alcohol and substance misuse have a devastating impact on individuals, families, and entire communities across Alaska. The effects of alcohol and other drug misuse include unintentional and intentional injuries, violence, high-risk sexual behaviors, cirrhosis, and alcohol poisoning.^2^ Alaska experiences a disparately high rate of alcohol-induced mortality compared to the U.S. Alcohol and other drug use is common among adolescents and is a strong predictor of dependence in later life.^2^
The long-term negative health effects of excessive drinking include widespread tissue damage, leading to birth defects, brain damage, cancer, cardiomyopathy, liver fibrosis/cirrhosis, and skin disorders, among other conditions. A further danger is the development of alcohol use disorder, characterized by a persistent and progressive pattern of abnormal alcohol-seeking behavior leading to tolerance, a compulsive need to drink, and an inability to stop. In 2015, the estimated cost of alcohol use to the Alaska economy was $1.84 billion, with the highest cost category being lost productivity, which occurs as a result of premature death, reduced efficiency due to physical and/or mental impairment, employee absenteeism, incarceration for criminal offenses, and medical treatment or hospitalization.^3^[[br]]
2. Hull-Jilly DMC, Casto LD. State epidemiologic profile on
substance use, abuse and dependency-2007-2011. [http://dhss.alaska.gov/dbh/Documents/Prevention/EPI2013.pdf]. Published 2013. Accessed October 5, 2016.
3. Pachoe M, Alaska Department of Health and Social Services, Division of Public Health. Health impacts of alcohol misuse in Alaska. Epidemiology Bulletin. Published May 7, 2018. [http://epibulletins.dhss.alaska.gov/Document/Display?DocumentID=1976]. Accessed July 19, 2018.
Healthy People Objective: Decrease the number of deaths attributable to alcoholU.S. Target: 71,681 deaths
Other ObjectivesHealthy Alaskans 2020 Indicator 14: Reduce the alcohol-induced mortality rate to 15.3 per 100,000 by 2020.
How Are We Doing?In 2017, there were 156 deaths attributed to alcohol-induced mortality among all Alaskans, an age-adjusted rate of 19.8 per 100,000. Alaska Native people had 76 deaths during the same period for a rate of 67.9 per 100,000.
In 2017, there were 3,723 years of potential life lost due to alcohol-induced deaths, with 23.9 years lost prematurely for each death, on average.^4^
Alcohol-induced mortality is typically higher in males than females. Alaska Native people at 67.9 per 100,000 had rates of alcohol-induced mortality that were 5 times higher than those experienced by non-Hispanic whites at 12.1 per 100,000 in 2017.
The highest rates of alcohol-induced mortality in the 5-year period from 2013-2017 were confined to the northern and southwest regions, with rates of 32.5 per 100,000 and 32.2 per 100,000, respectively. The remaining regions hovered around the statewide rate of 16 per 100,000 for the period.[[br]]
4. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2017 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2017.pdf]. Accessed January 4, 2019.
How Do We Compare With the U.S.?In 2016 (the most recent year for which national data are available), the rate of alcohol-induced mortality was 9.5 per 100,000 for the U.S.^5^ In comparison, the 2016 rate for all Alaskans was more than double at 23.0 per 100,000 and over 7 times higher for Alaska Native people at 81.7 per 100,000.[[br]]
5. Xu JQ, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: Final data for 2016. National Vital Statistics Reports. 67(5) July 26, 2018. [https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf]. Accessed December 6, 2018.}}
What Is Being Done?The State of Alaska (SOA) is expanding its use of [https://www.samhsa.gov/sbirt Motivational Interviewing and Screening, Brief Intervention, and Referral to Treatment (SBIRT)] services statewide to ensure that there is early identification of SUD and appropriate interventions provided to individuals that require additional supports and services to meet their treatment and recovery needs. SBIRT can be provided in a variety of settings such as primary care, emergency departments and in schools.
Individuals who present with moderate to severe symptoms of alcohol use disorder may participate in residential or outpatient treatment services. They system of services available in Alaska are comprised of publicly funded and private providers. The Division of Behavioral Health manages a network of providers that receive grants and Medicaid. Detox services and residential beds have limited capacity due to workforce shortage and limited funding. These are service areas within the continuum that have need for development and the SOA is focusing on development at this time.
[http://dhss.alaska.gov/dbh/Pages/Prevention/programs/adis/default.aspx Alcohol & Drug Information School (ADIS) Programs] provide education to first-time Driving While Intoxicated (DWI) and Minor Consuming offenders, as well as those convicted of other alcohol/drug related offenses, if that person would not be diagnosed as a substance abuser. The goal of the ADIS program is to reduce the subsequent alcohol and/or other drug related offenses and the associated high risk behaviors. ADIS programs cover the effects of alcohol and other drugs on driving and social behaviors as well as health and legal consequences. Each ADIS program conforms to the same standards and are approved and monitored by Division of Behavioral Health. These programs are designed to be available to all Alaskans involved in alcohol and/or other drug related offenses.^6^
The [http://dhss.alaska.gov/dbh/Pages/Prevention/programs/asap/default.aspx Alaska Alcohol Safety Action Program (ASAP)] provides substance abuse screening, case management and accountability for DWI and other alcohol/drug related misdemeanor cases. This involves screening cases referred from the district court into drinker classification categories, as well as thoroughly monitoring cases throughout education and/or treatment requirements.^7^[[br]]
6. Alaska Department of Health and Social Services. Alcohol & Drug Information School. [http://dhss.alaska.gov/dbh/Pages/Prevention/programs/adis/default.aspx]. Accessed October 5, 2016.
7. Alaska Department of Health and Social Services. Alcohol Safety Action Program. [http://dhss.alaska.gov/dbh/pages/prevention/programs/asap/default.aspx]. Accessed October 5, 2016.
Evidence-based PracticesEvidenced-based practices (EBP) that are implemented by the State of Alaska are:
[https://motivationalinterviewing.org/ Motivational Interviewing]
[https://www.akpeersupport.org Peer Support]
Pharmacotherapy for the treatment of alcohol use disorder
As part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs.
[[br]]Ensure there is access to a complete continuum of care throughout Alaska for substance abuse treatment, including for people with both mental health and substance abuse disorders.
[[br]]SAMHSA recommends a modern addictions and mental health service system that includes prevention, treatment and recovery supports. This continuum of care comprises nine domains, including:
* Health Homes
* Prevention and Wellness Services
* Engagement Services
* Outpatient and Medication Assisted Treatment
* Community Supports and Recovery Services
* Intensive Support Services
* Other Living Supports
*Out of Home Residential Services
*Acute Intensive Services
Description of a Good and Modern Addictions and Mental Health Service System [http://beta.samhsa.gov/sites/default/files/good_and_modern_4_18_2011_508.pdf]
[[br]]Promote environmental strategies to reduce alcohol consumption. Environmental strategies focus on creating an environment that makes it easier for people to act in healthy ways. Environmental strategies incorporate prevention efforts aimed at changing or influencing community conditions, standards, institutions, structures, systems, and policies. Strategies that lead to long-term outcomes should be selected.
[[br]]There is substantial evidence that environmental strategies are effective in preventing and reducing substance abuse. Increasing fines for underage drinking, not selling cold, single-serving containers of beer in convenience stores, and increasing access to treatment services by providing counselors who speak the local language are all examples of environmental strategies.
[[br]]Community Trials Intervention to Reduce High-Risk Drinking [http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=9]
Prevention Topics: Environmental Strategies [http://captus.samhsa.gov/access-resources/environmental-strategies-selection-guidereference-list-and-examples-implementation-guidelines]
Birckmayer JD, Holder HD, Yacoubian, Jr. GS, Friend KB. A general causal model to guide alcohol, tobacco, and illicit drug prevention: assessing the research evidence. J DRUG EDUCATION 2004;34(2):121-53.
Holder HD, Gruenewald PJ, Ponicki WR, Treno AJ, et al. Effects of community-based interventions on high risk drinking and alcohol-related injuries. JAMA 2000;284(18):2341-7.
A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_14_Alcohol.pdf].