This Week’s Focus: Alcohol + Special Alerts

This week’s NDEWS Weekly Briefing focuses on alcohol, drawing attention to emerging trends and special alerts that may signal heightened risk across communities. Although alcohol is legal and widely used, it remains one of the most pervasive substances in the United States, contributing to a broad range of harms and chronic health conditions.

This issue highlights the latest NDEWS Special Report on EMS encounters involving nonfatal alcohol use and an NDEWS Web Monitoring Report that examines the mentions of alcohol and ethanol throughout discussions by commenters on Reddit. The briefing also includes reporting from The New York Times that features NDEWS Scientific Advisory Group (SAG) Member Alex Krotulski, in addition to two Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Reports (MMWR) and one Health Advisory issued by the CDC.

As always, we welcome your input.

Nationally, 227,417 nonfatal EMS encounters involving nonfatal alcohol use were recorded from January 1, 2023 to March 31, 2026. Of these, 62,333 (27.4%) occurred in Western states, 38,838 (17.1%) in Midwestern states, 81,807 (36.0%) in Southern states, and 44,439 (19.5%) in Northeastern states. Counties with ≥ 10 encounters are presented below as encounters per 10,000 population; counties with fewer than 10 encounters have been suppressed. To view the entire Special Report from the weekly briefing, click here.

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Why are we reporting on this? Alcohol and ethanol consumption remain a primary subject of concern within online communities due to frequency of reports involving tolerance, withdrawal, and significant occupational and social impairment. Reddit discussions indicate patterns of use involving high-volume alcohol consumption cycles, the use of alcohol-free products such as mouthwash when beverages are unavailable, and the physiological and psychological impacts associated with quantity, frequency and duration of drinking.

What is Alcohol/Ethanol? Alcohol, or ethanol, is a legal, widely available psychoactive substance that acts as a central nervous system depressant. While frequently consumed in regulated beverage forms such as beer, wine, and spirits, high-proof ethanol and non-beverage products containing alcohol are also discussed in the context of high-risk consumption.

Public Health Impacts: Reddit discussants report devastating physical and mental health consequences from chronic alcohol consumption, including liver dysfunction, gastrointestinal distress, and severe malnutrition. Commenters describe life-threatening withdrawal symptoms such as tactile and auditory hallucinations, tremors, and "brain zaps." Multiple discussants mention significant social and occupational decline, including job loss, housing instability, and the fracture of family relationships. There are also reports of severe psychological distress, with individuals describing a cycle of depression, agoraphobia, and cognitive decline characterized by memory loss and impaired verbal communication.

How is it Being Discussed? Reddit commenters frequently discuss alcohol in the context of "benders" or round-the-clock consumption, often involving high-proof spirits like vodka to maintain a constant state of intoxication and avoid withdrawal. There is a prominent trend of discussants sharing "war stories" regarding embarrassing public behavior, medical emergencies, and the failure of prior abstinence attempts. Discussants often debate the difficulty of "de-escalation," or tapering from hard liquor to beer or wine to mitigate health risks. There is frequent discussion of "kindling," a phenomenon where repeated withdrawal episodes become progressively more severe and dangerous. Commenters also describe the use of cannabis as a tool reduce harm, often referred to as "California sobering," to reduce or replace alcohol intake. The community frequently exchanges advice on navigating medical detox and the perceived inadequacies of mental health care and rehabilitation facilities.

A recent video report published by The New York Times discusses the surge in overdose rates in the US due to the emergence of new synthetic drugs. The report features NDEWS SAG Member Alex Krotulski and his work with the Center for Forensic Science Research and Education. Watch the full video here.

A recently published Health Advisory by the CDC and Prevention alerts to increased reports of medetomidine in the illicit drug supply and a severe withdrawal syndrome due to medetomidine exposure. Data used from the National Forensic Laboratory Information System (NFLIS) showed that reports of medetomidine increased by 950% from 247 in 2023 to 2,616 in 2024, followed by a further 215% increase to 8,233 in 2025.  Read the full advisory here.

A recently published MMWR by the CDC describes data on kava-related use from January 2000 to December 2025 presented to the National Poison Data System. Since 2017, reports involving combined use of kava and kratom have increased, reaching 30% (61) of all kava reports in 2025. The increases have coincided with higher rates of serious reported clinical outcomes in recent years (32% in 2025 compared with 12% in 2000). Read the full report here.

A recently published MMWR by the CDC analyzed National Poison Data System data from 2015 to 2025 and found an increase of approximately 1,200% in kratom-related exposure reports (from 258 to 3,434), including a marked surge in 2025. Multiple-substance exposure reports, often involving addictive substances and antidepressants, were linked to the most severe clinical outcomes. Read the full report here.