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A Missing Ingredient

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A Missing Ingredient

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Ted Alcorn reported this story while participating in the USC Annenberg Center for Health Journalism’s 2022 Impact Fund for Reporting on Health Equity and Health Systems, which provided training, mentoring, and funding to support this project.

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EVERY DOOR IS THE RIGHT DOOR

PAYING THE TAB

A SOBER APPRAISAL

ALCOHOL AND YOUR HEALTH

RESOURCES FOR REPORTERS

Effort to raise New Mexico's alcohol tax falls flat

Every door is the right door: Doctors can do more to treat alcohol dependence in New Mexico

Dr. Larissa Lindsey of UNM’s Addiction and Substance Abuse Program, known as ASAP, at her home in Tijeras, N.M.
Dr. Larissa Lindsey of UNM’s Addiction and Substance Abuse Program, known as ASAP, at her home in Tijeras, N.M.
Adria Malcolm for New Mexico In Depth
New Mexico In Depth
Sunday, July 24, 2022

New Mexico is a violent state. It ranks among the worst for women murdered by men, child abuse and neglect are almost twice as common as they are nationwide, and its rate of suicide is one of the highest of any state. Last year, Albuquerque’s homicide rate shattered previous records, a 46% jump from 2020, and the state’s reached heights not experienced since 1986.

That makes violence a potent political issue. In recent annual addresses, Albuquerque Mayor Tim Keller bridled at “spiking gun violence, fentanyl trafficking and treatment, domestic violence, and that persistent revolving door” and Gov. Michelle Lujan Grisham called for more police and stiffer penalties to “keep violent criminals behind bars.”

A crucial factor they didn’t mention was alcohol.

It’s understood that drinking and violence go together but the public may not recognize just how intertwined they are — particularly in New Mexico, where violence involves alcohol more than any other intoxicant.

New Mexico In Depth analysis of toxicology records obtained from the state health department shows in the last 10 years, at least 42% of homicide victims were drinking alcohol at the time of death. So were at least 32% of people who died by suicide, which is also considered a violent death. In 2020, the health department attributed a total of 231 violent deaths to alcohol, outnumbering alcohol-involved traffic fatalities that year. 

The analysis also showed that more than half of homicide victims in Santa Fe County in that period had alcohol in their blood, a finding Sheriff Adan Mendoza called “alarming.” After reviewing the data, his staff examined the records of six recent homicides and found drinking involved in five.

“I don’t think as law enforcement sometimes we’re thinking about some of the underlying issues, why we respond, why we handle calls. But when you sit down and think about it, and you look at the data, it’s concerning,” Mendoza said.

And just as alcohol can encourage violence, victims may self-medicate with alcohol or other drugs, propelling an unrelenting cycle. To break free, addiction specialists say people need to address their substance disorders and traumas simultaneously —  but few New Mexican healthcare providers make that easy. 

Adding fuel to the fire

Physiologically, drinking contributes to violence in multiple ways. Alcohol can inhibit reasoning and empathy, encourage impulsive behavior, and blind people to the long-term consequences of their actions. That makes those who are intoxicated both easier targets and more audacious attackers. 

Alcohol alone does not cause violence, scientists say, but it increases its likelihood. David Jernigan, a professor at Boston University School of Public Health, compared it to pouring gasoline on a lit fire. “If there is potential for violence, and you add alcohol, the potential increases.”

It’s not just the drinking that matters. Businesses that sell alcohol have been shown to generate violence in their proximity, both because their customers are appealing targets of crime and because trips to the alcohol outlet brings them into contact — and sometimes conflict — with one another. A study in Baltimore found that for each additional liquor store in a census tract, violent crime increased 4.8% after adjusting for other factors such as poverty and vacant housing. 

Alcohol also contributes to suicide deaths, which outnumber homicides statewide by more than two to one but receive far less attention from policymakers. 

The data analyzed by New Mexico In Depth are part of the New Mexico Violent Death Reporting System (NM-VDRS), which draws on police reports and death certificates from nearly every violent death statewide. Whenever possible, health department officials also investigate the circumstances preceding violent deaths. Historically, about one in five New Mexican suicide victims had chronic drinking problems that contributed to their despair. Notably, nearly half of people aged 35 to 44 who died by suicide in New Mexico last year were intoxicated.

Wendy Linebrink-Allison, who manages the state’s crisis hotline, said that among the 93,480 calls that operators fielded in 2021, callers were more likely to report being intoxicated with alcohol than any other substance. “I would put alcohol as it relates to suicide prevention as one of the top three concerns that people should be aware of,” she said.

Layers of trauma

Dr. Larissa Lindsey began her career in clinical psychology on the East Coast treating patients who had experienced profound traumas, including veterans and prisoners. But this didn’t prepare her for the patient population she met in Albuquerque. “The only community I’ve worked in that I would say very closely parallels this one is Newark, New Jersey, which was a relatively stable community until the 70s and 80s when it was just decimated by the crack cocaine epidemic,” she said.

Lindsey now directs clinical services at the University of New Mexico’s Addiction and Substance Abuse Program, known as ASAP, a catchment for this sorrow.

ASAP occupies a two-story building of russet stucco a couple miles south of the university campus, out by the airport. Lindsey and others say the remote location reflects stringent regulations governing where prescribers of substance use medications can operate, as well as long-standing stigma towards the people who need them. The program opted for a building near a city bus route, since many patients lack personal transportation.

The UNM Addiction and Substance Abuse Program is located well south of the main campus, near a public bus route. CREDIT: Marjorie Childress for New Mexico In Depth

The program cares for about 800 patients at any time. Though many are middle-aged and have a well-worn relationship with drugs or alcohol, their addictions are often rooted in childhood traumas.

In New Mexico, surveyed children report higher exposure to adverse childhood experiences (ACEs) than kids in most other states, including physical abuse and the misery of deep poverty. Lindsey explained that for developing minds, hunger and homelessness are similar in effect to violence: “They don’t know where the next meal is going to come from —  and in a child’s brain, that’s life threatening.” In turn, studies show that each ACE puts a child at higher risk of developing alcohol problems later in life.

Advocates note that many people exposed to trauma recover, particularly if they have attentive families and strong support systems. “Children are really resilient,” said Amber Wallin, executive director of the advocacy organization New Mexico Voices for Children, particularly if they are only exposed to one or two ACEs. But if trauma accumulates beyond that, she said, the challenges become more difficult to overcome — “and that’s where New Mexico fares really poorly.”

By adulthood, nearly one in four New Mexican adults reports four or more ACEs, according to the Department of Health, well above the share in other surveyed states.

Improving outcomes for New Mexico’s kids is the “million-dollar question,” said Wallin, but the state has been perpetually mired near the bottom of rankings for overall child well-being.

Breaking the cycle

In Brittany’s childhood in northern New Mexico, alcohol and violence intermingled from the very beginning. Her first memory is of her grandfather returning home extremely drunk and getting into a physical fight with her dad. 

All the adults in her family drank regularly, Brittany said. (To protect her confidentiality, in this article she is identified by a pseudonym.) Physical and verbal abuse were routine. “I don’t remember a lot because I would disassociate myself, because it was stressful,” she said. At school, she was shy, she said. “I had friends but not anybody I could get close to.”

Untreated trauma like Brittany’s can lead to addiction through a cascade of neurodevelopmental problems. Lindsey explained that a child may begin to struggle in school and in relating to other children, exacerbating conflicts with his or her family. Spending time with other troubled children can increase the chances the traumatized child experiments with alcohol and drugs and then comes to depend on them to cope with life’s difficulties. “That’s essentially what addiction is.”

In early adolescence, Brittany found an outlet in basketball, volleyball, and softball, but at 16 she discovered alcohol. Where she had once struggled to relax, now she was at ease — as long as she was drinking. But her traumas accumulated: at a party the summer after she graduated from high school, she was drugged and sexually assaulted, she said. Injuries she suffered during the attack led to a near-fatal infection, which required a months-long hospitalization and even longer recovery to regain her motor skills. “So, that was a big thing that I drank over, after that,” she said.

She struggled through three semesters of community college before dropping out to take a series of low-wage jobs. “I really didn’t have any dreams — or I did, but I’m like, it’s just not for me.” Drinking more heavily, she was convicted of a DWI, then another.

After the second arrest, her mindset began to shift. She completed a court-mandated treatment program and met with a therapist for the first time at Sexual Assault Services of Northwest New Mexico

She also began attending 12-step meetings and opened up to a friend who had similar experiences. “She would say things that I felt, or that I had thought before, that I never heard anybody else say,” Brittany recalled. “I felt more connected than I had ever been.” Three years later at her college graduation, she was asked to give a speech to her classmates, and has since taken on leadership roles in the state’s network of Alcoholics Anonymous chapters.

But she said she wouldn’t have succeeded without treating her trauma and her addiction simultaneously. She emphasizes this to other women with substance use disorders rooted in similar traumas, which she said is common among the people she knows in recovery.

That’s the approach taken by Lindsey and the providers at ASAP, which is one of the state’s foremost programs for trauma-informed care of addiction —  and among the few that accept Medicaid, which insures nearly half of New Mexicans. Most other providers around the state don’t offer that combination. 

“They would be told ‘we can’t treat your PTSD or your depression or bipolarity until you stop using’,” said Lindsey, “and then they go to that treatment center and they say ‘we’re not going to be effective at treating your substance use disorder because your trauma symptoms are so pronounced’.”

“I would put alcohol as it relates to suicide prevention as one of the top three concerns that people should be aware of.”

- Wendy Linebrink-Allison, manager of the state’s crisis hotline

Missing approaches

It’s important for patients to get treatment that interrupts cycles of trauma and substance use, but statewide policies that address the underlying causes of alcohol-fueled violence could prevent such cycles from even beginning. 

Specifically, there’s a growing body of evidence for limiting the ubiquity of alcohol and increasing its price.

A recent review by scientists in the CDC’s Division of Violence Prevention identified several alcohol policies that reduce sexual violence, including raising alcohol taxes and reducing the number of businesses that sell it in a given area.

Sara Markowitz, a professor of economics at Emory University who co-authored a book chapter assessing how alcohol affected the rate of child abuse and neglect, concluded that more than 10% of incidents could be prevented by a 10% increase in alcohol taxes.

Mark Kleiman, a late professor of public policy at New York University, was an unabashed supporter. “The single most effective thing you can do to reduce crime right away is to raise the price of alcohol,” he once argued. “It doesn’t cost you anything. You don’t have to kick in anybody’s door. You just have to change a number in the tax code and crime goes down.”

But this tactic is one that New Mexico’s leaders and civic organizations have so far ignored.

Some local non-profits simply don’t buy the connection. “I haven’t seen anything that would lead me to believe that regulation of when you can buy alcohol or how much it costs has any kind of impact,” said David Garvin, a director at the New Mexico Coalition Against Domestic Violence.

Other organizations are determined to reduce levels of childhood trauma by strengthening the social safety net. New Mexico Voices for Children helped push the state to increase funding for food security programs, expand early childhood education, and more than double the working families’ tax credit. The organization also advocates for home-visiting programs for pregnant women and families with newborns, programs to prevent teen pregnancy and domestic violence, and cash assistance for families who have suddenly lost income —  but nothing directly alcohol-related. “We haven’t done much work in that area, beyond reporting on things like binge drinking and teen and drug/alcohol abuse,” said Wallin.

Katherine Ortega Courtney, one of the founders of the Anna, Age Eight Institute, another organization focused on child wellbeing, is no stranger to the role alcohol plays in the state’s troubles. Growing up in Española, she saw its impact on her own extended family and peers. “I had way too many classmates die, either as a direct result of alcohol or car accidents and things like that,” she said.

Nevertheless, while her organization presses to increase access to behavioral health care, including treatment for alcohol use disorders, it has not attempted to influence alcohol sales or consumption. “People are going to self-medicate in the way that’s most accessible to them,” she said. “So if you make alcohol harder to get, they’ll find a different way.”

In Albuquerque, the mayor’s office acknowledged the connection in a written statement. “Substance abuse and addiction are a central factor of violent crime in our communities.” Although the public sessions of this year’s Metro Crime Initiative do not explicitly reference alcohol (the second is entitled “Drugs and behavioral health”), the mayor’s office cited Keller’s support for barring the sale of miniature bottles of alcohol before it became a state law.

New Mexico In Depth asked the office of the governor whether she had connected alcohol and violence in any public address, or taken actions to address it. Her office did not indicate any. 

Versions of this series appear in print in The Santa Fe New Mexican, The Las Cruces Sun NewsThe Gallup Independent, and other newspapers across New Mexico.

Additional reporting

Resource: PDF version of article 7, A Sober Appraisal, which can be used as a solutions handout.

Help New Mexico In Depth better understand alcohol’s role in the state by sharing your story with alcohol.

Credits

Reporting: Ted Alcorn / Photos: Adria MalcolmMarjorie Childress, Tara Armijo-Prewitt / Videos: Marjorie Childress, Tara Armio-Prewitt / Illustrations: Shelby Criswell / Development: Joseph Bergen / Editing: Marjorie Childress and Trip Jennings / Cartography: Chris Girlamo

Funders

This reporting was made possible by grants from the USC Annenberg Center for Health Journalism, the McCune Charitable Foundation, the Con Alma Health Foundation, and the Association of Health Care Journalists as supported by The Commonwealth Fund.

[This article was originally published by New Mexico In Depth.]

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