Alcohol’s toll high in New Mexico

Source: read://https_www.santafenewmexican.com/

July 25, 2022

Alcohol kills New Mexicans at a higher rate than anywhere else in the country – and no one can fully explain why.

New Mexicans die of alcohol-related causes at nearly three times the national average, higher by far than any other state. Alcohol is involved in more deaths than fentanyl, heroin and methamphetamine combined. In 2020, it killed more New Mexicans under 65 than COVID-19 did in the first year of the pandemic – 1,878 people.

This outsize harm defies easy explanation. Alcohol kills people in New Mexico at higher rates than in states that are poorer, states where more people drink and states where the drinkers drink more. “Our risk behaviors do not line up with our deaths,” said Michael Landen, New Mexico’s state epidemiologist from 2012-20.

But state leaders haven’t shown much interest in unraveling this mystery or doing much about it. Last year, the Legislature voted to make alcohol easier to buy.

This is the first of eight articles that lay bare the damage alcohol does in New Mexico. The series draws on data gathered from a dozen national, state and local agencies and over 150 interviews, including police officers, clinicians, scientists, lawmakers, brewers, bartenders, liquor store owners and people struggling in recovery.

The conclusion: Alcohol in New Mexico is an emergency hiding in plain sight. We’ve failed to address the crisis because we’ve misunderstood it. And we’ve given up on basic measures governing where and how alcohol is sold that can save lives.

Alcohol poses a thorny political problem because hundreds of thousands of New Mexicans enjoy drinking. It’s woven into everyday life, at weddings and barbecues and Communions and sporting events, some of our happiest moments.

Alcohol “transcends generations, centuries, cultures, geography,” said Rep. Moe Maestas, D-Albuquerque, a lawmaker deeply versed in the state’s liquor laws. “It’s one of the most popular commodities – with the highest social cost.”

And that social cost is growing. Over the last two decades, while death rates from heart disease and cancer in New Mexico declined, alcohol-induced deaths more than doubled. One in 5 deaths of working-age New Mexicans is now attributable to alcohol.

Blind spots

In 2020, the most conspicuous alcohol-involved deaths were the more than 100 New Mexicans killed in crashes on public roadways and the headline-grabbing victims of 100 drunken homicides. Behind closed doors, another 125 died by suicide with alcohol in their blood. Twenty-eight more drinkers died from falls, and a few more fell asleep outside and never woke up.

But most New Mexicans killed by alcohol died of chronic illnesses in a handful of emergency rooms and intensive care units.

Perhaps no place receives more of these patients than the medical ICU at University of New Mexico Hospital, the state’s largest. Of its 24 beds, recent medical director Dr. Erik Kraai estimated two to three typically hold someone who wouldn’t be there but for drink.

Alcohol increases risk of certain cancers and injures the brain in ways not easily distinguished from Alzheimer’s, but the most profound impacts of heavy drinking are on the liver. It can inflame and scar the organ in a process that permanently alters its architecture, resulting in cirrhosis.

As liver function deteriorates, problems cascade. Nearby veins in the esophagus are put under pressure and may rupture and bleed. Toxins that a healthy liver would filter from the bloodstream accumulate, causing delirium and even coma.

Alcoholic liver disease, cirrhosis, and a constellation of illnesses attributed to alcohol abuse and dependence together killed 963 people in New Mexico in 2020 and drove the growth of its alcohol-related death rate.

Kraai described these deaths as brutal, degrading and unmercifully prolonged. But patients often lose their grip on their surroundings, he said. “I think it’s often more traumatic for the family.”

Scattered across the health system, these deaths are rarely considered together by the public or policymakers, obscuring alcohol’s overall impact, one of several blind spots that affects New Mexico’s response to the crisis.

Another concerns one of our greatest successes: reducing intoxicated driving.

No harm caused by alcohol has received more attention – and with reason: In the early 1990s, the state’s rate of fatal DWI crashes was 70 percent higher than the nation’s. Then a tragic Christmas Eve crash in Albuquerque shocked New Mexicans and their leaders into taking a whole-of-government response and made New Mexico’s roads safer. But today, DWI has overshadowed the state’s larger problem of alcohol-related deaths, 90 percent of which have nothing to do with traffic crashes.

In contrast, the relationship between alcohol and violence is overlooked. New Mexico has among the highest rates of homicide, suicide, and child abuse and neglect in the country; alcohol plays a bigger role than many public safety officials realize.

Of people who die violently in New Mexico, 30 percent to 40 percent have alcohol in their blood, according to a New Mexico In Depth analysis of toxicology data – a finding one sheriff called “alarming.” Yet earlier this year, when Gov. Michelle Lujan Grisham and Albuquerque Mayor Tim Keller publicly prioritized violent crime, neither connected that violence to alcohol.

Perhaps the most pernicious myth about New Mexico’s alcohol problem is that it mostly affects Native people.

Native Americans in New Mexico do die of alcohol-induced causes at four times the statewide rate, but Anglo and Hispanic people also have vastly elevated death rates compared to their peers elsewhere, and together account for 80 percent of residents killed by alcohol.

There’s another group that attracts an unwarranted share of the blame: inveterate drinkers. Dividing the population into drunks and responsible drinkers conveniently allows most everyone else off the hook, but scientists no longer view addiction in this black-and-white way.

Alcohol disorders emerge among far more people than generally believed, particularly in New Mexico, and those patients would benefit from counseling during routine medical visits – yet primary care doctors rarely provide this basic service or medications to counter their cravings. More people in New Mexico need and are failing to receive treatment for dependence on alcohol – 73,000, according to the Legislative Finance Committee – than all other substances combined.

Hanging over all this is the misconception that the state can only react to the consequences of alcohol after the fact rather than preventing them through policies that change how people drink. There is strong evidence that certain measures can reduce the hazardousness of alcohol: maintaining limits on days and hours of sale, regulating the number of alcohol outlets and, above all, increasing the price of alcohol by raising taxes.

Yet according to the state Department of Health, on the majority of these measures, the state “needs improvement” or is moving in the wrong direction.

Paying the tab

Reversing the state’s surging alcohol-related death rate will require ending the political paralysis that’s brought us to today.

“It’s not like everybody is in agreement about this,” said Sen. Gerald Ortiz y Pino, D-Albuquerque, a consistent champion for greater public intervention. “We have a serious opponent: There are a lot of people who make a great deal of money from alcohol.”

Based on tax revenues, in 2021, the state’s alcohol distributors sold at least 48 million gallons of beer, cider, wine and liquor – enough to fill 72 Olympic swimming pools. By a conservative estimate, 2021’s sales in New Mexico generated more than $1 billion in revenue, which flowed through 2,800 businesses licensed to sell alcohol: bars and restaurants and liquor stores as well as gas stations and supermarkets and even ski areas.

These interests routinely argue that any policy changes that limit their alcohol sales will hurt the state’s economy.

Alcohol trade associations estimate the wine industry contributed more than $370 million to the state economy in 2020 and beer manufacture and distribution contributed $1.6 billion.

That accounting leaves out damages caused by consuming alcohol. In 2010, the CDC estimated drinking cost the state of New Mexico $2.23 billion ($2.9 billion in today’s dollars), a higher cost per drink than in any other state. That estimate includes years of productive labor that alcohol sapped from the state’s workforce, property destroyed in alcohol-involved crashes, health care expenses attributable to drinking, and salaries of police and prosecutors handling alcohol-fueled crimes.

Since that analysis, the state’s alcohol-induced death rate has more than doubled. If the price tag has grown in proportion, alcohol now costs the state more than $6 billion per year, dwarfing the economic impact of businesses that profit from alcohol.

The politics of change

At best, New Mexico’s leaders have tried and failed to address the problem. Most have ignored it, and a few have abetted it.

Landen, who worked to draw attention to alcohol-related deaths during his years in the Health Department, said governors of both political parties viewed preventive measures as “a nonstarter.” When he published scientific research about alcohol, he was pressured to soften his language, he said. “You would have to mince words about what were effective interventions.”

Jim Roeber, the Health Department’s alcohol epidemiologist from 2004-13, credited the state for its effective work addressing DWI but said the growing number of alcohol-related deaths signaled it’s time for a change in strategy. “Whatever we’re doing, it’s just not enough,” he said.

It’s unclear if politicians will take heed.

Lujan Grisham has supported measures that increase access to alcohol. Reforms to the state’s laws she pressed for in 2021 made it easier for restaurants to acquire licenses to sell liquor. The final legislation also allowed existing license-holders to deliver alcohol to consumers at home and eliminated some of the remaining restrictions on sales on Sundays and Christmas Day.

In a statement to New Mexico In Depth, the Governor’s Office defended the measure, saying it “included numerous safeguards” such as limits on the volume of alcohol dispensed and the locations where it could be delivered.

Most important of all, the state’s alcohol taxes – which public health scientists say should be proportional to the true social cost of alcohol – have fallen to their lowest real value in 30 years.

But blame for New Mexico’s inaction doesn’t rest with state leaders alone. Public interest organizations that seek to improve the state’s well-being either have focused on small slices of the larger problem or sat on the sidelines.

A coalition of public health groups and citizens that emerged in 2017 to press for statewide changes in alcohol policy quickly fell apart. The local chapter of Mothers Against Drunk Driving said it confines itself to making the roadways safer.

New Mexicans themselves are largely in the dark.

“People just are not aware of just how much higher New Mexico’s rates are than the national average,” Roeber said. And even after a full accounting of the devastation, change may not seem possible.

New Mexico tolerates tens of thousands of inebriated people – including lawmakers – taking to the roads each year.

Hospital care for seriously ill patients is delayed because beds and staff are occupied by patients there on account of alcohol. Billions of tax dollars are spent reacting to harms rather than trying to prevent them.

Landen said a further increase in alcohol-related deaths is “not inevitable.” Just as alcohol’s harms have grown over the years, the state needs to make sustained efforts.

Jeff Erway, founder of La Cumbre Brewing Co., is a proud member of what he described as “the oldest profession on Earth.” In his late 20s, he spent five years teaching music at a school in the Navajo Nation. There, where several of his students were orphaned by alcohol, he got deeply exposed to the impacts of drinking.

“It is incredibly awkward to try to balance both your desire for people to enjoy your product – but to enjoy it in a way that is responsible to society and that is not detrimental to their health,” he said.

“I do believe you can have both,” he said, adding, “It can’t be all or nothing.”