If There is a Will, There is a Way

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[00:00:11] Mike: Welcome everyone to Avoiding the Addiction Affliction a series brought to you by the Kenosha County Substance Abuse Coalition. I'm Mike McGowan. You know, we've talked a lot here about the increase in alcohol and other drug consumption during the pandemic. Well guess what? We're going to continue that discussion today and explore ways that communities can address the issue. Today I'm really pleased to have as our guest, Maureen Busalacchi and Felice Borisy-Rudin. Maureen is the director and Felice is a Policy Analyst with the Wisconsin Alcohol Policy Project. Welcome to both of you.

[00:00:45] Maureen: Thank you very much.

[00:00:46] Felice: Thank you.

[00:00:47] Mike: Well, I'm, I'm just so glad to have you on, and I, I cannot wait to get into this because, um, there's some stuff that I think if people are listening, it's going to knock them over.

[00:00:56] I, because it knocks me over and I've been working in this field for a long time. But for those let's start here, though, for those folks not familiar with the Wisconsin Alcohol Policy Project could either of you just start by telling us a little bit about the project?

[00:01:11] Maureen: Sure. So the project was founded in 2010 at UW Madison Law School.

[00:01:17] Um, and then, you know, has done a great deal of work on training and technical assistance for local coalitions, elected officials, agencies about how to reduce excessive alcohol use, um, and in October of last year, it moved over to the Medical College of Wisconsin in the Comprehensive Injury Center. And we're thrilled to have this project [inaudible].

[00:01:43] The former director and founder retired, and then, you know, we've, um, I've taken over and Felice, fortunately came along with us. So she started at the UW Law School and is now with the medical college and the project. Uh, and so the comprehensive injury center, you know, works on a number of things like violence prevention, suicide prevention, falls prevention, um, and also does a great deal of research and epidemiology. So that mixed in with our continuing relationship with UW Law School, I think is a really great mix of bringing both the science, um, as well as the law. You know, to come to bear in terms of making sure folks understand what the issues are and then, um, giving the tools of what we can do to reduce excessive use of alcohol in Wisconsin.

[00:02:34] Mike: That's great. And Felice, I'll start with you. Uh, I don't know if you played sports in high school or afterwards, but I'll, I'll, we'll start with a softball here. Is it safe to say that alcohol consumption is a problem in Wisconsin?

[00:02:48] Felice: Well, Wisconsin has a really big problem with alcohol consumption. It's also a problem nationwide and worldwide.

[00:02:57] Um, there are about 3 million deaths a year worldwide due to alcohol consumption. And in the United States in the last year, there were 140,000 deaths. Wisconsin had about 3,100 deaths the last year and it keeps going up. It's been increasing for the last two decades and has doubled in that amount of time.

[00:03:29] Mike: And, but your statistics, I was reading them. Your statistics show a 54% increase in deaths due to alcohol in the past seven years.

[00:03:38] Felice: Yes, that's correct. And, and it's really unfortunate. So, you know, there's been, um, a lot made of the fact that there's been quite an increase in deaths during the pandemic, which, uh, has been about 25 to 26% increase.

[00:03:55] But. Overall, there has been an upwards trend. Every year there have been more deaths due to alcohol and it's not, this is not due to a population trend change. It's the, actually the rate of deaths is increasing as well. What appears to be more consumption, heavy consumption of alcohol and more binge drinking of alcohol.

[00:04:23] And these seem to be related to the deaths that are taking place.

[00:04:27] Mike: And Maureen, I was looking at one of your charts that I found somewhere, and we have a gradual increase in the number of alcohol induced deaths, right. Except in the last two years where it looks like. It's going straight up like a rocket. 26% increase in alcohol induced deaths just in the last two years.

[00:04:47] Maureen: Right. Um, so we think, um, the pandemic played a big role in those increases. Unfortunately for Wisconsin, those numbers have been on a continual up swing, um, for the last, over a decade, really. Um, and, but to see this immediate impact, um, we saw the death rates really start to spike in June of 2020. So that may have been related to, lack of access to a number of things, social networks, health care, and other things.

[00:05:21] So I'm sure there will be a lot of studies to figure out what was going on. But we also know in Wisconsin, there were, um, a big spike in alcohol sales.

[00:05:32] Mike: Yeah.

[00:05:32] Maureen: So we saw big increases in the tax collected regarding alcohol, in that same period of time. The sad part of all of this is that those do not seem to be going down.

[00:05:45] Uh, so now we increased to a higher rate and now it's even worse. Um, we've been talking to folks who deal with liver transplants and, um, those kinds of things. And they're seeing higher numbers and startling, higher numbers of young women, you know, in their late twenties and thirties needing liver transplants.

[00:06:08] Mike: Wow. Felice when we say alcohol related induced deaths. What specifically are we talking about? We were talking about cirrhosis. What else?

[00:06:18] Felice: Well, there's, there's two different classifications of deaths that are involved. So some people talk about alcohol attributable deaths, and some people talk about the alcohol induced deaths and the alcohol induced death have to do with a number of, um, diagnosis codes.

[00:06:39] For diseases that are known to be caused specifically by alcohol. But when we're looking at the alcohol attributable deaths, then we're looking at deaths that include accidents that have been caused by alcohol. So falls and motor vehicle accidents, um, poisonings are in the alcohol induced death category, uh, when it's directly from alcohol, but sometimes people get poisoned because they consume something else as a result of being intoxicated with alcohol. So you have a larger number that is then alcohol attributable. You also have a number of incidents where there's violence as a result of alcohol, and that would include. You know, homicides, but also, uh, violence that doesn't result in death, like intimate partner violence that's associated with alcohol.

[00:07:45] And then, um, there is, are diseases, so you're right. Alcohol induced liver cirrhosis would be, um, considered an alcohol induced disease, but there's many diseases that are considered alcohol attributable because they're at least partially caused by alcohol. And that includes seven types of cancer, heart disease, and stroke among other things.

[00:08:11] Mike: You know, for this is for both of you before we get off of this particular topic.

[00:08:16] Maybe I'm wrong, but I'd be willing to bet it's even higher, because some in the medical field must be hesitant to list that somewhere that you could actually make it a statistic. It's not on my, it's not anywhere on my Dad's death certificate. Yet, that's what killed him. And I hear that story again and again.

[00:08:35] So would it be safe to say that even the data that you have is under what the actual count is?

[00:08:43] Felice: I would, I would certainly bet on that. Uh, because a lot of times when the medical examiner needs to put something on their certificate. They're going to put what's most proximal and obvious.

[00:08:59] Mike: Like for my Dad it's aortic aneurysm, even though the physician said, when you opened them up, it was clear that he had a lifetime of abuse.

[00:09:08] So it must be common, Maureen, let's go, let's go back to what you said before, because this is the one I couldn't wait to get to actually, um. Alcohol revenues, tax revenues went up, alcohol consumption went up in the last two years, three years. Despite the fact that bars were closed, that people weren't going out.

[00:09:31] Right. So we saw tons of people just buying and consuming at home instead of out.

[00:09:39] Maureen: That's what it would appear to have happened? Yes.

[00:09:43] Mike: Okay. Now maybe I'm wrong. That to me, that's a different connotation. That's not going out for a fish fry. That's solitary, sometimes drinking or drinking to cope or drinking for anxiety and stress. Do you read it the same way?

[00:09:58] Maureen: You know, it's one of those things where that's seems to be where the data leads you. Um, but there needs to be additional research and really diving into that. Um, but what I've heard from physicians who treat folks with either cancer or liver disease or other things that they saw, like acute alcohol hepatitis. Um, so that means that they're drinking a lot of alcohol in a short amount of time and it's causing problems.

[00:10:31] Um, now it doesn't mean that people weren't drinking before, but you know, there's been a spike in kind of the amount, um, you know, so. Which is basically binge drinking, but it seems like heavy binge drinking, um, with some individuals. And it, you know, because of, we know what happened with folks, especially early on in 2020, that definitely was an issue, but now things are opened up, right. Um, you know, things opened up over time and we're still seeing those same numbers.

[00:11:09] Mike: So, so they're going out and drinking at home.

[00:11:13] Felice: It appears that of from the people who've been doing the research that there, some people actually reduced consumption during the lockdown phase of the pandemic. And some people stayed sort of steady at the level of consumption they had and then others increased consumption.

[00:11:35] It would be very interesting to look at the numbers of how much the increase consumption, balanced against the reduction. But if the increased consumption was in the tendency of heavy drinking or binge drinking, that could be enough to account for the additional sales numbers.

[00:11:55] Mike: Sure. You know, when I, when I'm in Wisconsin, as opposed to other states, I talk about this a lot.

[00:12:00] I, I always have to define this a little bit. So binge drinking is what exactly?

[00:12:07] Felice: Binge drinking is defined as drinking enough to get your blood alcohol concentration up to 0.08. So if you've been binge drinking, you can't go driving because you would be operating while intoxicated. It usually is for a man about five standard drinks in two hours and for a woman about four standard drinks in two hours. But the key there is being aware of what a standard drink is. Because, [laugh] right. We're not, we're not talking about, you know, 24 ounce can we're talking about. Um, it's about, uh, about an ounce, 1.2 tablespoons of alcohol or 0.6 ounces of alcohol, um, is a standard drink of, of pure alcohol.

[00:13:05] Um, so. That would be a, can, you know, a 12 ounce can of beer that's at about 5% alcohol, or if you've got one of those higher, uh, percent alcohol beers, like a malt liquor, just eight or nine ounces would be a standard drink, five ounces of table wine. You know, there's some people who think that a bottle of table wine is a serving.

[00:13:36] And I've, I've certainly seen 12 ounce cans of table wine out for sale on soccer fields. Um, but that 12 ounce can, that would be two and a half standard drinks. And then, you know, for something like 80 proof liquor, that's just one and a half ounces.

[00:13:55] Mike: Yeah, well, and, and Maureen go to a Kwik Trip and you see 12 packs leaving the building all the time after work, right. So that will put us well in excess of binge drinking.

[00:14:07] Maureen: I'm assuming that they consume the whole thing, right. Um, but we, we do hear. Um, I remember coming across some research that was showing that Wisconsin's average binge drink session was approximately nine drinks, um, which seems awfully high, but you know, almost more than double what is recommended, you know, or what is seen, it's more, much more than what's recommended. Excuse me. Um, more than double what we consider it to be a binge drink. So your blood alcohol concentration would be higher than that 0.08.

[00:14:47] Mike: Well, and I we've talked to people on this all podcasts all the time, and I've worked with people and in what they consume is, would kill me.

[00:14:56] Um, but they're going to work the next morning.

[00:15:00] Maureen: Well actually that's one of the big costs. Um, our employers feel the cost of excessive drinking, probably more than anything else. Um, if you look at the 2019 binge drinking, um, report by Department of Health Services. Lost productivity is one of the biggest factors.

[00:15:19] So they may be going to work and perhaps not as you know, on the ball as usual, or they are calling in for that as well as, you know, risk of injury and, and other things that come to that. So I think our employers, um, see this as, as a real issue and, um, a cost to them.

[00:15:40] Mike: What do we do then with people still working remotely?

[00:15:44] Um, cause it's right there. Uh, I've I've had people that I've worked with who have said it increased their drinking, simply being at home working.

[00:15:55] Maureen: Right. Um, so there's a number of strategies, um, that can be used that are helpful. So I'll give you, um, kind of an outside example to help you see, um, what could be done in alcohol.

[00:16:08] So when I was working for Smoke-free Wisconsin, one of the biggest concerns was people smoking in their homes and exposing their kids. Not to mention, you know, their spouse that maybe doesn't technically smoke, but of course did because they were living with a smoker in the home. As momentum changed around that issue. And you stop seeing smoking and workplaces, including restaurants and bars. You saw exposure at home also going down. People started going outside if they were smoking and they were having less access to, um, nicotine all of the time, which kind of helps reduce the demand that their body feels for that. Um, so the same thing can be done here.

[00:16:53] We can't regulate what people do in their home, but we can certainly set some community standards, like making sure we're not selling to kids. Um, really taking a look at the density issue of how many places, um, allow alcohol. Really putting some guardrails around our festivals to make sure that it's in a fenced area, that they're checking IDs, that you have to have a wristband, you know, so that you, um, really allow families to run free. Right. And then make sure that you know, that there is a supervised area where drinking is occurring.

[00:17:29] Mike: Well, and Felice, this, this gets us back to Wisconsin, right? Because in order to cope, the data is we saw excessive drinking skyrocket in Wisconsin, uh, as opposed to the rest of the time, even though the rest of the country went up, we kind of were the, uh, spear point for that.

[00:17:47] We led the way did we not.

[00:17:51] Felice: I couldn't tell you about, um, the amount of drinking other than the numbers that we've already shared with you. Um, I think that we're still getting data for what, for what happened and the stories are mixed, but some of the reasons that people have given in studies for increased drinking have been stress. And isolation and lack of their usual support network. So during the pandemic, one of the things that happened was people who had access to medical care or health care or behavioral health care, no longer had that access available. Either it didn't exist or it was not in a form that was as meaningful to them so that it was remote.

[00:18:42] Like people who'd been going as 12 step programs no longer had that available to them. And so we suspect that what may have happened was. All of these stressors made what were already problems, more difficult. And a lot of people did turn to alcohol as a way to cope, but those who were already suffering physical harms as a result of alcohol, then exacerbated their health conditions.

[00:19:15] Mike: Yeah. And, and didn't, uh, didn't I read where all 72 counties in Wisconsin Maureen, uh, reported excessive drinking as opposed to more. We, one of the only states where that was the case?

[00:19:28] Maureen: We're the only state that has a rate of excessive alcohol use. Um, recorded above the national average, every all 72 counties.

[00:19:38] Um, so the national average is approximately 17.4, 17.6. Um, and Wisconsin is on average 24%. Um, so, and some are higher. We go as high as 31%. So, um, it's a, it's a big concern. And certainly we see some cities that are higher and other areas that are lower, but, um, it's a concern across the state. Um, for sure.

[00:20:07] Felice: However, this, this high percentage of about a quarter of Wisconsin, adult Wisconsinites binge drinking was the case prior to the pandemic.

[00:20:16] Mike: Ya, uh, you know, we, it is funny when I go elsewhere and I talk about some of the patterns in Wisconsin and people look at me like I'm coming from somewhere on, on Mars.

[00:20:29] Right. They just doesn't, it doesn't compute with them. You know, you mentioned, um, stores before and other things that communities can do, it seems like we're inundated with alcohol, for lack of a better word, promotion. Uh, signage and convenience. I mean, it's, it seems to be everywhere. So I'll just throw this out, so what, what can communities do to somewhat, at least get a handle on it? Because as you said, it's driving up the cost of doing business for private business and for the public welfare medical costs and public welfare costs are up to.

[00:21:09] Felice: There are two things that communities can do. So one is they can enact a sign ordinance. And while they can't specify against alcohol advertising, per se, they can limit where advertising takes place.

[00:21:28] And one of the things that they can do is limit how much space a business can use of its windows. For example, for advertising, uh, what percentage of the window space. They can also limit, um, where advertising is located. So for example, a lot of advertising might be placed where young children can see it below three feet.

[00:21:55] We don't want that. And so a community could enact an ordinance that prohibits advertising below three feet. The other thing it can do is it can place conditions on licensees. So as a condition of the license being approved at the time of the initial license granting. The municipality can state, you know, you can only have advertising in this part of your store.

[00:22:23] You can only have displays of alcohol in this part of your store and limit the number of square feet or the linear footage of the advertising that's present. Municipalities can do one more thing, which is that they can choose not to allow alcohol advertising on municipal property because it's a public health matter.

[00:22:48] They can prevent alcohol advertising from, for example, the municipal bus system or the park benches. There's many places where this advertising takes place that municipalities actually do have authority to refuse it because of public health.

[00:23:09] Mike: If they have the will, right.

[00:23:11] Felice: If they have the willpower to do so.

[00:23:13] Mike: You know Maureen. Um, maybe we can close with this, but I I'm thinking about my grocery store. Right. We all get a cart and I don't know about you where you shop, but you go in and always the first place you hit is the produce department. Except you have to pass through the liquor now to get there. There's it seems like we put the liquor department in the wide open.

[00:23:34] Uh, in almost every grocery store, it used to be a separate facility. It almost seemed like the liquor part of it. We had to walk through doors. Now it's out in the open and if you're a kid you're walking past the liquor display, every time you go to the grocery store with your parent.

[00:23:50] Maureen: Right. So some communities still have restrictions on that, but that's something, of course that can be applied to new licenses if a city decides to do that.

[00:24:02] Um, but yes, I mean, we're very concerned about the amount of alcohol advertising that our kids see, um, in pharmacies and grocery stores. Uh, you know, many other places. I mean, I had a bakery that sold beer just down the street from my house. So, you know, we really should be thinking about this and we encourage cities to take a breath and come up with a kind of a vision of what, what do you want.

[00:24:31] Um, and also to think about. How much product you have in your community and how much more you think you need. Um, our density numbers are much higher than the national average, um, in terms of how many establishments or liquor stores there are per person, um, you know, versus the rest of the nation. And so there's things that they can think about.

[00:24:57] They can regulate, you know, um, keeping liquor departments within a grocery store, but a lot of let that cat out of the bag, so to speak, um, and allow that to happen. Um, and, and that's a challenge. It's also a challenge once that's happened to put that cat back in the bag, so to speak. Um, so that can get difficult.

[00:25:23] Mike: That sounds outstanding. You know, again, I think we can close this by saying if we have the will there's things we can do. Right?.

[00:25:31] Maureen: Absolutely.

[00:25:31] Felice: There are a number of things, yes.

[00:25:34] Mike: But hopefully we, uh, We get the will at some point. Ladies, I really appreciate you joining me today. And this is only part of the discussion. I hope we can do this again, where we get into more depth, because this is something we continue to talk about because, I guess, we have to keep talking about it. For those of you listening, I'll put the link to the Wisconsin Alcohol Policy Project on the end of this podcast.

[00:25:59] And if you would please listen in next week, when we talk about more issues around substance abuse and let's find the will somewhere.

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