Whether quaffing artisanal cocktails at hipster bars or knocking back no-name beers on the couch, Americans are drinking more heavily – and binge-drinking more often, concludes a major study of alcohol use.

Heavy drinking among Americans rose 17.2 percent between 2005 and 2012, largely due to rising rates among women, according to the study by the Institute for Health Metrics and Evaluation at the University of Washington, published Thursday in the American Journal of Public Health.

The Centers for Disease Control and Prevention defines heavy drinking as exceeding an average of one drink per day during the past month for women and two drinks per day for men. Binge drinking is defined as four or more drinks for women and five or more drinks for men on a single occasion.

The increases are driven largely by women’s drinking habits as social norms change, researchers found. In Santa Clara County, Calif., for example, women’s binge drinking rates rose by nearly 36 percent between 2002 and 2012, compared with 23 percent among men.

Nationwide over the course of the decade, the rate of binge drinking among women increased more than seven times the rate among men.

“It seems like women are trying to catch up to the men in binge drinking,” said Ali Mokdad, a lead author of the study. “It’s really, really scary.”

The study is the first to track adult drinking patterns at the county level. Despite the increases in heavy drinking, the percentage of people who drink any alcohol has remained relatively unchanged over time, it found.

Madison County, Idaho, reported the lowest rate of binge drinking in 2012, at 6 percent, while Menominee, Wis., had the highest, at 36 percent. Hancock County, Tenn. had the fewest heavy drinkers (2 percent of residents) and Esmeralda County, Nev., recorded the most (22 percent).

About 88,600 U.S. deaths were attributed to alcohol in 2010, the researchers note, and the cost of excessive drinking has been estimated at more than $220 billion per year.

The increase in binge drinking doesn’t surprise Terri Fukagawa, clinical director of the New Life Recovery Centers in San Jose, Calif., where 15 of her 24 treatment beds are filled with clients primarily addicted to alcohol. She said she’s seen more people seeking treatment for alcoholism in the past four years.

Still, she noted, “there are a lot of people still out there needing treatment, but they won’t come in unless they have a consequence like losing a job or [getting] a DUI. They think they have control over it.”

Public health experts offer a number of cultural and economic explanations for the increase in excessive drinking.

As a result of changed social norms, it’s now more acceptable for women to drink the way men traditionally have, said Tom Greenfield, scientific director at the Alcohol Research Group at the Oakland, Calif.-based Public Health Institute.

Young people are more likely to binge drink, and affluent people have the money to drink more. So the influx of wealthy professionals in cities like San Francisco, San Jose and Oakland – many in hard-working, hard-partying tech jobs – may have helped spur significant spikes in drinking rates in the Bay Area and similar communities, experts said.

Taxes on alcohol have not risen along with the Consumer Price Index, so wine, beer and liquor have gotten cheaper over time in real dollars, he said.

Alcohol advertising, particularly for hard liquor, has increased in recent years. A Federal Trade Commission study found that companies spent about $3.45 billion to advertise alcoholic beverages in 2011.

Alcohol control policies, such as limits on when and where alcohol can be sold and how long bars can stay open, have weakened in past decades, Greenfield said. That may partly explain rising consumption nationwide, particularly in some states where “blue laws” once prohibited alcohol sales on Sundays or in supermarkets.

To conduct the study, researchers analyzed data on about 3.7 million Americans aged 21 and older from the Behavioral Risk Factor Surveillance System, an ongoing telephone survey of health behaviors conducted by the U.S. Centers for Disease Control.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Medicare officials are considering changes in the hospice benefit to stop the federal government from paying twice for care given to dying patients. But patient advocates and hospice providers fear a new policy could make the often difficult decision to move into hospice care even tougher.

Patients are eligible for hospice care when doctors determine they have no more than six months to live. They agree to forgo curative treatment for their terminal illness and instead receive palliative or comfort care. However, they are also still allowed Medicare coverage for health problems not related to their terminal illness, including chronic health conditions, or for accidental injuries.

Medicare pays a set amount to the hospice provider for all treatment and services related to the terminal illness, including doctor’s visits, nursing home stays, hospitalization, medical equipment and drugs.  If a patient needs treatment that hospice doesn’t provide because it is not related to the terminal illness — or the patient seeks care outside of hospice — Medicare pays the non-hospice providers. The problem is that sometimes Medicare pays for care outside the hospice benefit that it already paid hospice to cover.

To reduce the chances of these duplicative payments, Medicare officials have announced that they are examining whether to assume “virtually all” the care hospice patients receive should be covered under the hospice benefit.

Medicare has been paying millions of dollars in recent years to non-hospice providers for care for terminally ill patients under hospice care, according to government reports.

The Medicare Payment Advisory Commission (MedPAC), an independent organization that advised Congress, found that in 2012, Medicare paid $1 billion to hospitals, nursing homes, therapists and other providers for services for hospice patients unrelated to their terminal illness.

The commission did not estimate how much of that was incorrectly billed and should have been covered by hospices. Prescription drug plans received more than $33 million in 2009 for drugs that probably should have been covered by the hospice benefit, according to an investigation by the Department of Health and Human Services’ inspector general.

Hospice is growing rapidly among older Americans. Of those Medicare beneficiaries who died in 2013, nearly half used hospice, double the rate in 2000, MedPAC also found. Over the same time period, Medicare spending for hospice services grew five-fold, to $15 billion.

Medicare officials initially mentioned last year that they were exploring possible changes. Concerns about duplicative payments “strongly suggests that hospice services are being ‘unbundled,’ negating the hospice philosophy of comprehensive, holistic care and shifting the costs to other parts of Medicare, and creating additional cost-sharing burden to those vulnerable Medicare beneficiaries who are at end-of-life,” they wrote in regulations containing this year’s hospice payment rates and other program rules. Officials have not yet issued a formal proposal.

“There will always be exceptions for people who have terminal conditions and have other conditions that need to be attended to,” said Sean Cavanaugh, deputy administrator at the Centers for Medicare & Medicaid Services. “But the majority of their services would be provided through hospice.”

Seniors’ advocates are worried that putting all coverage under the hospice benefit will create obstacles for patients. Instead, Medicare should go after hospice providers who are shifting costs to other providers that Medicare expects hospice to cover, said Terry Berthelot, a senior attorney at the Center for Medicare Advocacy, who urged the government to protect hospice patients’ access to non-hospice care.

“The easiest thing for CMS to do is to say everything would be related to the terminal illness and then there would be no billing problems,” Berthelot said. But federal law, guarantees hospice patients Medicare coverage to control diabetes, blood pressure or other conditions not related to their terminal illness.

“If your blood sugar gets out of control, that could hasten your death,” she said. “But people shouldn’t be rushed off to die because they’ve elected the hospice benefit.”

Cavanaugh said the government is not trying to restrict drugs or other Medicare benefits for hospice patients.

“It’s more about getting the payment right,” he said. “The question is how to clearly circumscribe the benefit, to define what’s in the hospice benefit and what is not.”

That’s not always easy to figure out.

If a cancer patient in hospice slips on some ice and breaks her wrist, the injury could have happened because the cancer has attacked the bones, making them thin and brittle, said Dr. May Al-Abousi, medical director for hospice services at University Hospitals in Cleveland. Treatment for the injury would be covered by hospice.  But the injury would not necessarily be part of the hospice benefit for someone with a terminal illness other than cancer, she said.

“Medicine has no cookbook, where we can apply all-or-none rules,” she said.

Sometimes a hospice provider may not even know when a patient has gone to the hospital and there’s usually no way the hospital knows the patient is in hospice unless the patient makes that clear, said Judi Lund Person, at the National Hospice and Palliative Care Organization,  [http://www.nhpco.org/ ]  which represents nearly 2,000 hospice companies.

“The emergency room physician should be aware that this is a hospice patient with lung cancer as opposed to an 85-year-old male who fell at Denny’s,” she said.

Patients and their families may be afraid to volunteer that information, said Dr. Al-Abousi.  “A lot of people get scared when they hear the “H” word,” she said.  “They think once they sign that paper for Medicare, nothing else is going to be covered.”

Contact Susan Jaffe at Jaffe.KHN@gmail.com

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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Wynne Lee’s mind was at war with itself – one voice telling her to kill herself and another telling her to live. She had just turned 14.

She tried to push the thoughts away by playing video games and listening to music. Nothing worked. Then she started cutting herself. She’d pull out a razor, make a small incision on her ankle or forearm and watch the blood seep out. “Cutting was a sharp, instant relief,” she said.

Some days, that wasn’t enough. That’s when she’d think about suicide. She wrote her feelings in a journal in big loopy letters.

At first, Wynne thought she felt sad because she was having a hard 8th grade year. She and her boyfriend broke up. Girls were spreading rumors about her. A few childhood friends abandoned her. But months passed and the feelings of helplessness and loneliness wouldn’t go away.

“I was really happy as a kid and now I was feeling like this,” she said. “It was really unfamiliar and scary.”

Wynne Lee didn’t know where her despair was coming from. The words “depression” and “suicide” were not in her vocabulary. She knew, however, that she was failing — she was defying expectations of who she was supposed to be.

Growing up in the suburbs of the San Gabriel Valley, a well-known destination for Asian immigrant families with high educational and economic aspirations, she believed she was supposed work hard, get good grades and make her Taiwanese immigrant parents proud. She wasn’t doing any of that, and she didn’t know how to ask for help.

When it comes to mental health treatment, Asian Americans often get short shrift. Researchers say they are both less well-studied and less likely to seek treatment. While rates of suicide tend to be lower than national rates overall, Asian Americans are far from homogeneous and the limited research suggests depression and suicidal impulses vary significantly depending on age, gender and national origin.

For instance: Asian American college students are more likely to seriously consider suicide than white peers. According to 2007 data from the National Center for Health statistics, Asian-American females ages 15 to 24 were second only to Native Americans for suicide deaths.  In addition, researchers have found that Asian women born in the U.S. are at significantly higher risk of suicidal thoughts and attempts than others, including women immigrants and U.S.-born men.

Because they may not see depression as a brain disease or fear stigma, many Asian immigrant families don’t reach out for help until there is a crisis, experts say. “A lot of Asians avoid seeking treatment until the disease is advanced,” said MaJose Carrasco, director of the multicultural action center for the National Alliance on Mental Illness.

And even when they do reach out, they often find both medication and psychotherapy a poor fit. Patients who seek care “are telling us is that they don’t think that psychotherapy, which is designed for white Americans, really works for them,” said Hyeouk “Chris” Hahm of Boston University, who received federal funding to test a program addressing  culture and family issues among Asian American women.

There are relatively few psychologists and other mental health professionals of Asian heritage. Other therapists may use culturally biased screening tests, or fail to recognize that symptoms of depression may be different for Asian Americans. For example, these patients are more likely to report physical symptoms such as headaches than feelings of sadness, said Nolan Zane, director of the Asian American Center on Disparities Research at University of California, Davis.

Zane added that patients from immigrant families are frequently reluctant to take medications with which they are unfamiliar. They may prefer Eastern medicines or fear side effects, including fatigue, that make it harder to keep up with work or school.

Parents sometimes stand in the way of treatment, intentionally or not, because of the high standards they set. Kids can be burdened by the sacrifices their parents have made for their benefit.

“It takes a few generations before they can finally be free,” said Ranna Parekh, director of the division of diversity and health equity for the American Psychiatric Association.

At the beginning of her freshman year in high school, Wynne frequently woke up feeling exhausted and unable to get out of bed. She would curl up and go back to sleep under the red blanket she’d had since she was a toddler.

Wynne’s mom, Maggie Huang, begged her daughter to go to school. She yelled at her and took away her phone. Wynne still refused to go. “I thought she was just being lazy,” Huang said.

Altogether, Wynne missed 47 days in 9th grade — more than a quarter of the school year. She arrived late 21 days. The next year, she missed 39 days and was tardy 63 times.

Her grades fell. Administrators at Diamond Bar High School warned her that things had to change. The Los Angeles County district attorney’s office threatened her parents with prosecution because of the absences.

Huang said she and her husband believed they were doing everything they could for their three children. They didn’t know where they had gone wrong with Wynne.

They lived in a middle-class community east of Los Angeles, in a beautiful two-story home. Wynne’s father works for a mattress company. Huang stays home with Wynne and her younger brothers, helping them do homework and taking them to after-school activities and to museums and parks on weekends.

As a young girl, Wynne was good-natured and energetic, her mother said. She loved swimming and drawing; she excelled at hip hop and modern dance.  Now, Wynne was sullen and crying all the time. “I just worried,” Huang said. “I was so worried.”

But Huang didn’t know what to do.

Wynne was just finishing middle school when Huang went into her room, read her journal and saw the threats of suicide. Scared, Huang told the school counselor. A social worker came to the house to talk to the family about getting help.

Huang enrolled in a parenting class and tried to talk to her daughter more about her feelings. She asked for advice from her sister, a high school counselor in Taiwan. “She said it was a stage and that I needed to be patient,” Huang said.

But things only got worse. One afternoon Wynne asked for a ride to see a friend. She had skipped school that day and her mom said no. They argued. “I couldn’t do it anymore,” Huang said. She called the police.

Wynne ran downstairs and grabbed a bottle of prescription pills. She swallowed as many as she could.

Paramedics rushed Wynne to an emergency room; then she landed in a psychiatric facility.  She remembers sitting in a room with a huge window, coloring pictures.  Doctors told her she had depression.

Finally, Wynne had a name for what was wrong.

At the hospital, Wynne was glad to meet other girls like her. It made her feel less alone. But when she got home, her depression didn’t lift.

After the hospital, Wynne went into outpatient therapy at Pacific Clinics, a counseling and treatment agency based in Arcadia.

Maribel Contreras, the program director, said Wynne’s suicide attempt – along with the school absences, irregular sleeping and angry outbursts at her parents – made it very clear that her case was “very serious,” she said.

Wynne saw a few different therapists but didn’t feel a strong connection with any of them. She said one didn’t even take her depression seriously. The therapist treated her like “a little kid upset someone took my candy,” she said.

In art therapy, she drew her greatest fear – loneliness – as a swirl of dark colors.

Some days she came away feeling better. “There were bursts of healing,” she said. But other days, she still felt urges to hurt or kill herself. “That was the only thing I could control – whether to end my life.”

A psychiatrist suggested she take antidepressants, but Wynne rejected the idea. “I just wanted to get better on my own,” she said.

Wynne felt she made little progress in therapy and ultimately quit late last year.

At home, she rarely came downstairs to eat with her family. She feared being a burden to her family. Her 11-year-old brother, Kevin, said she often locked herself in her room. He could hear her crying. “It was hard to watch her like that,” he said.

After her grades dropped, she started on an independent study program. Being away from the drama of high school helped, Wynne said. But it also made her feel more isolated.

Huang, too, felt alone. Other Asian moms were always asking about Wynne and how she was doing in school. She felt they blamed her for Wynne’s lack of motivation.

“To them, grades are everything,” she said.

For Wynne, school wasn’t all that slipped. She started skipping practices for her hip hop team and showed up late for competitions. Unaware of Wynne’s depression, the owner of the dance studio was upset by Wynne’s lack of commitment, especially after she’d worked so hard to make the team.

“Once she achieved that goal, it seemed it meant so little to her,” the owner, Bobbi Dellos, said. “And she was so talented.”

In the end, Dellos asked Wynne to leave the team.

Near the end of her sophomore year in high school, Wynne’s mother took her out to dinner. Sitting across from her daughter at the Cheesecake Factory, Huang told her that she loved her. She said she believed that Wynne would succeed — no matter what.

“That’s when I started to open up to her,” Wynne said.

Wynne’s feelings were beginning to shift – she didn’t know exactly why. But it helped to talk to her mom that night. She wrote in her journal afterward: “This is going to be the best summer ever.”

That fall, Pacific Clinics invited her to participate in a panel for Hollywood screenwriters and producers about mental health. “I was nervous,” Wynne said, but the experience gave her confidence. Talking to others about her depression, in general, seemed to help.

In the last few months, she said, it has been easier to control intrusive, chaotic thoughts. “I can keep them on a leash,” she said. “Before, they were everywhere.”

Although she stopped therapy, she now believes she got something from it. “I used to be hotheaded and had tough times resolving conflicts,” she wrote in her journal. “But that’s before counseling.”

Her energy returned. She took a test to graduate early from high school and enrolled in community college, where she is taking a drawing class. She started dancing again.

On a recent night, she stood in the front row at a studio in a grey tank top, picking up the routine quickly and flipping her long hair to the music. During a quick break, she caught her breath. “I feel really, really good,” she said.

Wynne said she knows that the depression, and the loneliness, may return. “I’ve accepted it as part of who I am,” she said.

But as she ran back toward the blaring music, it seemed the last thing on her mind.

Blue Shield of California Foundation helps fund KHN coverage in California.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.