Alcohol Abuse
•4.6 million American women suffer from alcoholism or abuse alcohol.
•The rate of alcohol abuse and dependence is 16% between ages 18 and 29 and drops to 6% between 30 and 44
•In 1999 there were 12,547 traffic deaths due to alcohol abuse---resulting in 30.1 per cent of all traffic deaths
•In 1995 the cost for hospitalization, medical services, lost wages, and accidents due to alcohol abuse was $166 billion dollars
•31 % of students during the past 30 days rode one or more times in a vehicle driven by someone who had been drinking alcohol
•Alcohol abuse leads to increased risk of high blood pressure, stroke, and heart failure, reduced hormone (testosterone) levels in men, resulting in possible infertility and other sexual and reproductive problems, extremely dangerous for anyone being treated for diabetes, osteoporosis [sources: National Institute on Alcohol Abuse and Alcoholism; Blue Cross of California]
•The 17,448 fatalities in alcohol-related crashes during 2001 represent an average of one alcohol-related fatality every 30 minutes.
•An estimated 275,000 persons were injured in crashes where police reported that alcohol was present - an average of one person injured approximately every 2 minutes.4
Unsafe Driving
•Car Accidents are the leading cause of death for people between ages 6 and 27.
•Sixty-three percent of the occupants of passenger vehicles killed in traffic crashes in 1999 were not wearing seat belts.5
•36% of male drivers (15 to 20 years old) involved in fatal crashes were speeding
•A combination of 3-point lap/shoulder belts and airbags offers the greatest chance of survival. Lap/shoulder belts are 45 percent effective in cars in preventing occupant deaths. Airbags reduce driver fatalities 31 percent in cars. [NHTSA]
•Seatbelts have saved more than 112,000 lives since 1975
•Approximately 1.5 million drivers were arrested in 2000 for driving under the influence of alcohol or narcotics.
•Every year, falling asleep while driving is responsible for at least 100,000 automobile crashes, 40,000 injuries, and 1550 fatalities.6
•In 1999, approximately 15,794 fatalities were associated with the presence of alcohol. Alcohol involvement accounted for about 38 percent of the fatalities.
Unprotected Sex
•Fewer than half of unmarried adults used condoms the last time they engaged in sexual intercourse.7
•Only one-fourth of drug abusers used condoms the last time they had sex
•15 million new STDs are acquired annually by Americans. Of the top 10 most frequently reported infections, five are STDs.8
•By age 25 more than 33% of the population will have a sexually transmitted disease. 15 million new cases of STDs are diagnosed each year.9
•More than 65 million people are currently living with an incurable STD
•Two-thirds of all STDs occur in people 25 years of age or younger
•One in four new STD infections occurs in teenagers
•One in five Americans has genital herpes, yet at least 80 percent of those are unaware they have it.10
•In 1994, the direct and indirect costs of the major STDs and their complications were estimated to total almost $17 billion annually.11
•How Americans became infected with HIV, through 1999? For 407,169 people it was through unprotected sex.12
Inattention to Medical Care
•The cost of medication non-compliance is $50 billion annually
•Compliance rates for colonoscopy are as low as 10%
•50% of patients do not take their medication for high-blood pressure.13
•There is a 76 % discrepancy between what medications are prescribed to patients and which medications they actually take
•50% of patients with high blood pressure (hypertension) did not take their medication
•50% of heart patients discontinue cardiac rehabilitation in the first year
•Non-adherence is just as high in patients with symptomatic diseases (e.g., epilepsy and diabetes) as it is with diseases without symptoms (e.g., hypertension).
Financial Irresponsibility
•In 2002 there were 1.5 million filings for bankruptcy
•This was the highest in history
•Home foreclosures are the highest in history
•20% of credit cards are maxed out
•The average household has $8400 in credit card debt
•60% of households carry credit-card balances
•The average household receives an offer of one new credit card per week14
Some of these risks can kill you, others can drive you into financial ruin---and all of them are preventable. You can do something about each one of these risks. However, as widespread as these risks are I have never had a patient come in to me for the first time and tell me that they are "worried" about their tendency to engage in these preventable risks. People may want to lose weight, stop smoking or decrease their drinking, but they do not say that they are worried about these behaviors. Perhaps they are worried---but that is not what they say. They think it's a "good idea" to make some changes. Perhaps their husband or wife may have told them to make a change or perhaps their doctor thinks it's a good idea --but these are not the things people worry about.
What could account for the apparent blindness to real risk in people who are anxious? Why would people not worry about daily behaviors that are so substantially risky-and avoidable?
Estimating Risk
How to evaluate risk
The assessment of "risk"-or the chance that something bad could happen in the future-has been an important question for investors since the middle-ages when ships left the port of Venice, Italy and investors had to estimate, "What is the likelihood that I could lose this boat that I invested in?"15
Risk represents your estimate that something bad will happen in the future. But how would you go about estimating the likelihood of an event that has not happened? Typically, you might consider the following information---but each piece of information is up for debate:
•How often has this event happened in the past?
•How many times have I (or others) been exposed to this in the past?
•What is the magnitude of the outcome? How bad would it be?
•How much do I enjoy the behavior?
These questions are difficult to answer-which is one of the reasons that most of us don't estimate risk logically. Much of this information is abstract or even unavailable to you when you are estimating the risk of any given behavior. For example, smokers ignore information about lung cancer and nicotine-that is, they ignore the "baseline" information of the percent of people who smoke who get lung cancer. Moreover, they will often use evidence that they have been exposed to the risk---of smoking for years-as evidence that they have less risk: "I've been smoking for years and I'm fine". Smokers also will justify their smoking by selective sampling of examples of non-smokers who die from cancer---"He never smoked and he died at fifty from cancer".
We tend to reduce our estimate of risk if we enjoy the behavior. For example, few people enjoy being near electrical power lines or nuclear power plants, but many people enjoy smoking, drinking and unprotected sex. Consequently, we tend to overestimate the risk of "deadly", but highly improbable events (like nuclear power-plant accidents or electrical leakage), and we underestimate the risk of behaviors that we enjoy (like smoking, drinking, and unsafe sex).
What are the Chances?
Let's consider the following: "Flip a coin-heads you win, tails you lose". What is the likelihood that this will be tails? What is the risk?
When you are facing preventable risks---you are usually using the famous gambler's fallacy--- superstitious beliefs about luck turning, string of luck or luck running out. In daily life we do not estimate risk in any consistently logical manner. We tend to rely on "patterns" that we see---we see tails ten times---we assume the next time it will be tails. We seem to think that the coin remembers what it has just been doing.
