It is a darkening evening in early winter, the sky lowering and the temperature dropping. Roughly two dozen people have gathered in a church classroom in Seaford with furniture better suited to kindergartners than adults. Attendees range in age from perhaps their early 20s to their late 70s, and from their dress and their stories, they are people who might not otherwise know one another in the ebbs and flows of their lives.
It is an open meeting of Alcoholics Anonymous, and the attendees have in common an interest in the disease of alcoholism. The group consists of couples and individuals. Some are attending their first meeting; others have been members for years.
Eighteen percent of Nassau County residents — more than 6,100 people in Seaford and Wantagh, out of a combined population in the two hamlets of roughly 34,000 — drank excessively in 2019, according to a study of U.S. counties by the Robert H. Wood Foundation and the University of Wisconsin. This tracks with the New York state figure of 19 percent, but is nearly 40 percent higher than the national average.
More than a quarter of Nassau’s adults covered in the Wood study admitted to binge drinking at least once a month, and to drinking excessively at least once a week. But numbers can be misleading, according to Susan Klein, program director at Southeast Nassau Guidance Center in Seaford, which treats substance abuse disorders of all kinds and has locations in Wantagh and Levittown. “The difference between someone who drinks excessively and an alcoholic isn’t always easy to diagnose,” Klein said, and it can go largely unnoticed. “People don’t see it as an addiction. Drinking’s socially acceptable, and it’s legal.”
And terms for different types of abuse are not always used consistently, even between academic studies or professional organizations.
What is consistent is that an estimated 88,000 people die of alcohol-related causes in the U.S. annually, according to the National Institute of Alcohol Abuse and Alcoholism, making it the third leading cause of preventable death, after nicotine abuse and poor diet. Figures compiled by the Centers for Disease Control and Prevention show that alcoholism accounts for 20 percent more deaths annually than all other drug overdoses combined, with nearly twice as many deaths as from opioids.
In fact, the numbers may be significantly higher, since alcohol and alcoholism are not always identified as contributing factors in mortality studies. For example, alcoholism may play a significant role in illnesses ranging from heart and kidney disease to some cancers without appearing on death certificates, according to the CDC.
“Look, no one is questioning the seriousness of the opioid crisis,” said a local pain-management specialist who requested anonymity. “It’s definitely a real thing.” But, he added, alcoholism continues to be a scourge year after year, and the numbers are rising. “We’re seeing more and more,” he said, “especially among seniors.”
In addition to the human toll, alcohol abuse takes an estimated toll on the U.S. economy of $250 billion annually, according to the NIAAA.
In Nassau County, treatment options range from A.A. to various in- and outpatient rehabilitation clinics and hospitals. A.A. offers nearly 700 meetings every week, with 16 each in Seaford and Wantagh. They are found in churches, schools and office buildings. A relatively small number are open to all (a total of four per week in Seaford and Wantagh), while most welcome only those “with a desire to stop drinking,” according to the preamble read at every meeting, although no one checks. A hat or basket is usually passed for small voluntary contributions — the organization accepts no outside contributions — but the groups emphasize that “there are no dues or fees” for membership.
In addition, groups may limit attendance to men, women or LGBTQ, and the Nassau County Intergroup’s meeting calendar includes roughly a dozen Spanish-speaking groups as well. Formats also vary, with some 20 permutations listed on A.A. website, including “Big Book”; meditation; candlelight; newcomer; and child-friendly.
Roughly half of the 1,500 patients at the Southeast Nassau Guidance Center are alcoholics, Klein said. Somewhat surprisingly, dually addicted, or cross-addicted, patients — those who abuse more than one substance — are comparatively rare, despite the easy availability of opiates and drugs like cocaine, she said. “Most of our alcoholic patients who use other drugs in addition to alcohol do it to deal with the cravings or for the symptoms of alcohol withdrawal,” she said.
SNG sees patients strictly on an outpatient basis, Klein explained, and while patients are encouraged to attend 12-step meetings such as A.A., that isn’t the main treatment modality, as it often is in other treatment centers; nor does the center sponsor its own 12-step groups — also a common feature at other treatment facilities.
“There’s still a lot of shame attached to alcoholism, the stigma,” which prevents people from reaching out for help, Klein said. “Some of our patients are very high-functioning professionals who still have a lot of pride.” One of the major barriers to recovery in any form of treatment is the necessity of accepting the problem. “They have to accept that they’re powerless over the disease,” she said, “just as if it were pneumonia or any other serious illness.”
And alcoholism is a very serious illness, according to the American Medical Association. Left untreated, chronic alcoholism is nearly always fatal.
A higher power
A.A.’s overtly spiritual approach is difficult for some to accept, Klein said. Although it is not a religious program, it does emphasize a spiritual aspect to recovery that many find challenging. Even at SNG, though, “patients recognize the need for something beyond themselves, whether it’s the group or the treatment plan itself,” she said. “For many of our patients, group therapy sessions provide the peer support they need.” The goal, she added, is to help them return to their jobs and families as functioning members of society.
A.A. members say much the same thing. The group often functions as a “power greater than themselves” for many newcomers, according to A.A. literature.
For many patients at SNG, however, the state and the courts are their higher power, at least initially. “Most of our patients are mandated,” Klein said. “Treatment is offered as an alternative to other legal measures. Eventually, though, many begin to see [sobriety] as a better way of life.”
In addition to more familiar therapeutic approaches, SNG also treats alcoholism medically. “We do use various medications to help manage the cravings and the withdrawal,” Klein said. “That wouldn’t be considered sober in some 12-step groups,” she said, because their members believe that recovery should include abstinence from all mood- or mind-altering chemicals, including some that she prescribes.
At the same time, “A.A. has never claimed to have a monopoly on recovery,” said one longtime member who, like many others, requested anonymity. “Personally, I haven’t seen anything else with as much long-term recovery as A.A., and I want to know that it’s at least possible to maintain my sobriety a day at a time. But even in A.A., the number of people who stay sober is really small, compared to the size of the problem.”
The member took no credit for his own recovery, saying it had nothing to do with willpower or determination. “I did what was suggested,” he said with a smile. But “if I could have gotten sober by myself, I would have.” He was reluctant to say how long he had been in recovery, saying only that it had been “many years” since his last drink.
The causes of alcoholism are obscure, most experts agree. “Our understanding of the brain’s chemistry is still at a really primitive stage,” Klein said. And CDC data show that it is difficult to describe a “typical” alcoholic, because the disease can affect those in any age group, occupation or social standing.
Many come from homes where drinking was common, Klein said, and children and grandchildren of alcoholics have a statistically higher rate of alcoholism than children in nonalcoholic families, she said. But many have no known family history of alcoholism.