Proposed Office of Alcohol Prevention steps up ambition, but is short on vision

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The New Mexico Department of Health has asked the legislature for $5 million to build an Office of Alcohol Prevention, which would expand the staff focused on reducing excess drinking from a single epidemiologist to a team of 13. If created, the office would represent a significant increase in resources and personnel focused on the state’s epidemic of alcohol-related deaths, by an agency long cowed into inaction against the challenge.

But some experts who reviewed an internal description of the proposed office, which New Mexico In Depth obtained by public records request, said the plan was not bold enough to meet the crisis.

Tim Naimi, who directs the Canadian Institute for Substance Use Research at the University of Victoria, said that to reverse the state’s climbing death rate would require sustained strategies that influence drinking by everyone in the state, not just those who have already developed serious problems with alcohol. But he said the activities highlighted in the plan were redundant with existing practices and lacked focus and resolve.

“Without committing the political resources and specifying more effective policies to support, it will constitute a fig leaf — just one that is pricier and better staffed than most,” he wrote in an email.

According to the draft proposal, the new office would pursue four main strategies: encouraging clinicians to screen more patients for excessive alcohol use and to counsel them on reducing their consumption, funding community organizations and tribes to expand policies and practices they are already pursuing, engaging more county and tribal health councils in local activities to reduce excessive drinking, and continuing to regularly convene government officials from across agencies to coordinate further efforts.

Those strategies are not new. They come directly from a State Health Improvement Plan published in December 2018, before Gov. Michelle Lujan Grisham’s first administration began.

Counseling people with alcohol disorders can help reduce their problem drinking, according to Pamela Trangenstein, a scientist with the California-based Alcohol Research Group. But she cautioned that emphasizing that strategy alone would leave out the subset of the population with less access to health care. Eleven percent of New Mexicans are uninsured, according to the Kaiser Family Foundation.

And while counseling may help individual patients cut back on alcohol, according to Naimi, there was no evidence that clinical practices could be sufficiently improved to measurably alter the statewide death-rate. The proposed goals of the office — including reductions in binge drinking by 10% and in alcohol use disorder by 20% — were “ambitious,” according to Trangenstein.

Naimi was more blunt. “Utterly unrealistic,” he wrote.

The draft proposal pays lip-service to policies that would apply population-wide, not just to patients with alcohol use disorders, which experts regard as key to reducing death rates: “enhanced enforcement of laws prohibiting sales to minors, increasing alcohol taxes, maintaining limits on days of sale, maintaining limits on hours of sale, increasing alcohol outlet liability, limiting alcohol marketing to reduce exposure to underage youth, and regulation of outlet density.”

Although the proposed office would hire a policy coordinator, the plan doesn’t specify policies the office would pursue nor does it indicate any resources devoted to them. “This is the important bit but where is the buy-in or political will behind this?” Naimi wrote.

Instead, the majority of the office’s budget would be granted to local organizations for implementing undefined programs and communications campaigns in their communities, according to the document.

Gov. Lujan Grisham, who in her 2023 inaugural address called confronting the opioid addiction “an urgent moral priority,” has not shown similar mettle for addressing alcohol-related deaths. 

In her first term, over the objections of her administration’s alcohol epidemiologist, she signed into law a measure that expanded alcohol access by increasing the days and hours of sale, creating new categories of liquor licenses for restaurants, and allowing for at-home alcohol delivery — even as statewide alcohol-related deaths rose more than 32% between 2019 and 2021. New Mexicans die of alcohol-related causes at nearly three times the national average and alcohol is involved in more deaths than fentanyl, heroin, and methamphetamines combined.

No single agency has the power to curb alcohol-related deaths on its own, experts told New Mexico In Depth. But last July they recommended nearly a dozen actions the state could take to begin stemming the tide, including raising the price of alcohol, using data on alcohol tax revenues to track sales by community, strengthening cities and counties’ means for restricting where businesses can sell alcohol, and limiting alcohol marketing to youth.

Throughout the fall, state lawmakers held legislative hearings on the crisis and several have introduced responsive legislation, including bills to increase alcohol taxes.

But the administration remained mostly silent until mid-December, when then-health secretary David Scrase walked state lawmakers through the agency’s budget request and mentioned the plan to create its first-ever Office of Alcohol Prevention.

On January 3, Gov. Lujan Grisham appointed as her new health secretary, Patrick Allen, who most recently headed the Oregon Health Authority. During his tenure the authority ran a six-figure media campaign to reduce excess alcohol consumption entitled Rethink The Drink, and pushed for an increase in the state’s alcohol tax rates. Scrase, who for more than a year led both the health agency and the state human services department, will remain at the human services department.

Through a spokesperson, Allen declined to answer questions about whether he would address New Mexico’s alcohol crisis as assertively as he did in Oregon, saying he was still meeting senior staff and learning the contours of his new job.

Whatever strategies he pursues, the $5 million budget of the proposed office would be dwarfed by revenues that even a small change in state alcohol taxes would generate.

A bill Sen. Gerald Ortiz y Pino, D-Albuquerque, is sponsoring this session would direct all alcohol tax revenues to drug and alcohol treatment, instead of depositing half in the general fund per current law. He said this would result in an additional $62.5 million in such services, due to matching federal funds available for treatment paid for through Medicaid. 

Sen. Bill Tallman, D-Albuquerque, introduced a bill that would shift the revenues from the general fund to a new domestic violence victims fund, and would allow all counties in the state to impose a local alcohol tax, which is only currently allowed in McKinley County.

A bill co-sponsored by Rep. Joanne Ferrary, D-Las Cruces, and Sen. Antoinette Sedillo Lopez, D-Albuquerque, would go even further. By raising alcohol tax rates and equalizing them across beer, wine, and spirits at $0.25 per drink, it would generate about $150 million in additional annual revenue, Ferrary said.

Shelley Mann-Lev, a public health advocate who is volunteering to promote the bill, said that scale of resources is necessary to address the state’s spiking death rate. The budget of the proposed health department office, though modest in comparison, demonstrated “that the governor understands how serious an issue this is.” 

But she added, “It needs to be a much bigger pot.”

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