Why New Mexico Leads the Country in Alcohol-Related Deaths

0:00:13 William Moyers
Hello and welcome to Let's Talk, Hazelden Betty Ford's podcast series focused on the interests of people like you, our viewers and our listeners everywhere. I'm your host, William C. Moyers, thank you for joining us today. The legalization of marijuana, the opioid epidemic, Fentanyl, methamphetamines, psilocybin and the power of hallucinogens to probe deeper consciousness, there is a lot of attention these days on drugs. But not a lot of attention on the drug we're here to discuss today. Specifically, alcohol. My guest is Ted Alcorn, an independent journalist whose reporting on health and justice has appeared in The New York Times, The Washington Post Magazine, and The Atlantic. Recently, Ted reported and wrote a seven-part series for New Mexico In Depth. Focused on the rising trend of alcohol use disorders in the state of New Mexico. A series with implications far beyond the state. Welcome, Ted!

0:01:13 Ted Alcorn
Thanks for having me. [smiles]

0:01:15 William Moyers
Thanks for joining us today! Tell us just a little bit about the series.

0:01:19 Ted Alcorn
Well, the series is a deep investigation into that substance that as you said is causing sort of an emergency but is hiding in plain sight. Alcohol has a really catastrophic impact on New Mexico. It killed about 2,000 New Mexicans last year and it's killing them at a rate about three times the national average. But it really doesn't get very much attention by policymakers. And the series is both an attempt to unravel some of the mystery about why the state's rates are so high, but maybe more importantly, what to do about it. And identified a number of blindspots that the state and its lawmakers have about alcohol, a number of misconceptions that seem to have held back progress in addressing it. Cataloging them, trying to clarify them, and then point lawmakers and the public to some of the most trust-tested solutions.

0:02:12 William Moyers
Let's talk just briefly about those blindspots before we go to how they've been addressed.

0:02:17 Ted Alcorn
Well, one of the state's biggest successes in addressing alcohol started about 30 years ago when the state really tackled DWI. I was a kid in New Mexico then when a crash on a Christmas Eve night killed a family and really galvanized a movement of people to take a sort of sustained, systematic approach to tackling DWI in the state. And the state cut DWI fatalities significantly. The problem is we kinda missed the forest for the trees. Because many people in New Mexico now think of DWI as being the state's main alcohol problem when in fact it accounts for just one in ten of the alcohol-related deaths in the state. Another blindspot that the state had is around disparities. People often asked me as I was reporting this, 'Does this have to do with the Native American population?' And whether well-meaning or not, I think they were pointing to the fact that Native American people in New Mexico have high rates of alcohol use disorder, but, it's a mistake to think that Native Americans account for the elevated rates of alcoholism in the state. In fact, Anglo and Hispanic residents of the state have very, very high rates of alcohol-related deaths compared to their peers elsewhere in the country. So, these are the sort of misconceptions that I wanted to tackle and what it all comes down to I think is that, you know, this is truly a statewide problem. It's one that affects violence in the state, illness, it does still continue to affect road safety. But it's gonna take an all-of-society approach to address it.

0:03:50 William Moyers
Let's talk about how the series highlighted how policymakers and communities are addressing the problem. Can you give us a couple of examples?

0:04:01 Ted Alcorn
Well, you know, when it came to addressing the Native American population, the disparities, I went into the Western part of the state to a small town called Gallup which has a reputation, decades-old, of being a place where there's a lot of alcohol use disorder, a lot of alcohol-related harms. Although I found that it's still very afflicted, it's also a place that because that spotlight on it has addressed alcohol more openly and more assertively than any other part of the state, lawmakers have created some special policies that are possible in that county. They've allowed them to impose their own liquor excise tax at the local level. They were ahead of the rest of the state in adopting a stricter blood alcohol concentration on the road. So on and so forth. And then there's a number of amazing practitioners there working in the hospitals and in the treatment centers who are developing kind of very proactive ways of screening for alcohol use, counseling in appropriate ways, that I hope the rest of the state can learn from. But then even in my hometown of Albuquerque I found although there's a lot of gaps in the system for addressing alcohol use, there's also some providers that are giving sort of the gold standard of care to people who need it and seeing amazing results for those individuals.

0:05:19 William Moyers
Let's talk about the treatment component. What sort of resources exist, what did you find in your reporting around treatment options for residents of New Mexico?

0:05:32 Ted Alcorn
Well, you know, it's kind of a knee-jerk reaction of policymakers to say, you know, 'Oh we have an alcohol problem in this state, we need more treatment. More resources for treatment.' And that kind of becomes a throw-away without people really knowing what that means or what it entails. And New Mexico is a state that is at the bottom of the rung in a lot of metrics, it's a poorer state, and so, saying that there's a scarcity of resources for something, you know, you can throw a rock and hit something that is a need or a deficit in New Mexico. But in this case, learning about treatment, there's a couple things that I came to realize that surprised me. One is certainly there is a lack of intensive treatment facilities and the state is doing what it can to, you know, recruit and sustain more addiction specialists. But one of the biggest gaps in treatment is primary care. Because everybody, or most everybody, sees a doctor with some regularity who they talk about their daily behaviors with. And in New Mexico as in nationwide, doctors do regularly ask their patients how much they're drinking. But, again, as nationwide surveys have shown, these clinicians are rarely taking a step beyond that to counsel patients about reducing their level of drinking. And this sort of brief counseling intervention doesn't seem like maybe something that would be effective, but in fact, a doctor's simple conversation on alcohol use can—has been shown to significantly reduce someone's excess of alcohol use. And in ways that, over a population level, could have a major impact on health.

0:07:15 Ted Alcorn
[continued]
And, you know, in my reporting I met a man named Steve Harvin who I've profiled who's now doing very well in a treatment program, but for 40 years he struggled with alcohol, his marriage fell apart because of it, he lost his job because of it, his healthcare. And for all that time, his primary care clinician was the same man he'd been very loyal to, was very fond of. But never recognized his alcoholism. Who in fact, you know, gave him a prescription for an anti-anxiety drug, a Benzodiazepine, that is also highly addictive. And should only be used really in a short-term basis and he became addicted to that as well. So, there were some I think really obvious treatment failures in the way that he, you know, failed to receive care that had huge impacts on his life and his world and his family. And one of the things that doctors told me is that we really need to motivate medical societies and medical professionals to recognize their role in being proactive and talking about alcohol with their patients.

0:08:17 William Moyers
Did it surprise you that the healthcare profession as a whole doesn't understand or recognize alcohol dependence or alcoholism?

0:08:29 Ted Alcorn
Well, I think that there's—the science of alcohol and how it affects health is clear, and I think clinicians have been trained to know that it's a risk behavior that should be on their radar. But I'm thinking of you know a geriatrician that I interviewed in the state who, you know, said she universally asked her patients about alcohol use, but then I said, 'Well how many have you referred to treatment, how many have you counseled on alcohol use?' And after a pause she said, you know, 'Very few.' She was, you know, rightly wary of and wanting to preserve her personal relationships, her friendly relationships with her patients. And I think, you know, like you or me, is not used to necessarily recognizing that you sometimes need to provide people with a little bit of tough love. You need to step outside of your role as you know, a friend, and be the doctor. And you know I talked to the major medical societies of the state, the New Mexico Medical Society and the Greater Albuquerque Medical Association. And although they had both done trainings—the New Mexico Medical Society had done trainings on alcohol counseling in the past with grant funding from a foundation in the state. When the grant ran out, they ended the program. And so I think that those societies that are doing continuing education could think about being a lot more proactive on this issue and recognizing that they have a real responsibility to be a part of the solution for it.

0:09:53 William Moyers
We only have a couple minutes, Ted, and I could go on with you for another half an hour, so I've got a couple of rapid-fire questions here. One of them is do you think that a tax on alcohol as a way to fund treatment in New Mexico is a viable option?

0:10:09 Ted Alcorn
Well like most states, New Mexico does impose alcohol excise taxes. The problem is that they've really shrunk over time there. As a share of the total alcohol sales, they're as small as they've ever been. And that's not only true in New Mexico, that's going on in most states and federally last year, senators reduced the federal alcohol excise tax. Typically we think of this as a revenue raiser, as a sin tax, it's a way for government to pull a little bit more revenue in. But policy researchers say that alcohol taxes actually their more important role is keeping the price of alcohol taxes up. So most of the scientists that I spoke with, the very first thing that they recommended is increasing alcohol excise taxes to again have alcohol prices more accurately reflect their sort of total social cost to society. And, to the extent that lawmakers wanna divert those resources into alcohol treatment, there's definitely a need for those kinds of resources. But, you know, there's no need to them necessarily to be connected at the same time alcohol treatment does absolutely need public support and should be just a part of normal medical care, just like treating asthma or diabetes.

0:11:21 William Moyers
In the minute or two we have left, tell us what did you find in terms of the effectiveness or even the utilization of prevention around these issues?

0:11:33 Ted Alcorn
Well, I think that people don't wanna dismiss the importance of treatment. And doctors who are treating patients really wanted to emphasize how alcohol use disorder can be treated as effectively as other chronic illness. And people are just as likely to have a recurrence of symptoms, meaning you know a relapse, as they are to struggle with treating, you know, diabetes or treating asthma. But, those same clinicians and experts would also tell me, you know you're never gonna get ahead of this problem by just treating people who already have an alcohol use disorder. You have to create a safer drinking environment so there are fewer people developing those disorders. And that's where I think there is a lot of hope because there's, you know, a half-dozen measures that the CDC has endorsed for reducing excessive alcohol use at the population level. There's strong evidence to support things like limiting the hours of sale and days of sale of alcohol. Reducing alcohol outlet density. Preserving alcohol excise taxes. And all of those things can help create an environment where alcohol is, you know, still a part of our society, but not so easily accessible that it causes so many deleterious harms for individuals and for their communities.

0:12:47 William Moyers
And those specific points that you raised as they apply to the state of New Mexico, there's no doubt in your mind that those can also apply to all other 49 states, right? [chuckles]

0:13:02 Ted Alcorn
Yeah. I think that the basic concepts of how alcohol, you know, causes harm on the individual body, on our cities, and on our states, is true. [Moyers nods] It's not only true in Albuquerque or in Santa Fe, New Mexico, it's true across the U.S. and the world as a whole. So, you know, hopefully these lessons are ones that lawmakers in New Mexico can apply but people all around the country can learn from.

0:13:25 William Moyers
Where can people find your seven-part series?

0:13:29 Ted Alcorn
The series was published for New Mexico In Depth, which is a non-partisan, independent, in-depth sort of investigative outlet in New Mexico. And if you google the title of the series Blind Drunk New Mexico, it's sure to bring it up. It's also been excerpted and published in newspapers around the state.

0:13:45 William Moyers
Ted Alcorn, thanks for bringing your passion, your expertise, and your journalism to our audience today. It's good to see you. [smiles]

0:13:53 Ted Alcorn
Thanks for having me. [smiles]

0:13:55 William Moyers
[turns to camera]
And thanks to all of you for tuning in. On behalf of our Executive Producer, Lisa Stangl, and the crew at Blue Moon Productions, I want to invite you to keep coming back to Let's Talk. We'll see ya again soon.