Brenda Long ticked off the names of men in her life who died young.
Mike Trafton, her father, at age 48. Tom Trafton, her older half brother, at 43. Gary Trafton, the younger brother she adored, at 44.
Each death, in one way or another, stemming from alcohol.
"It's been a life of hell," the International Falls woman said last week.
It's a hell that's all too common anymore. Alcohol is killing more Minnesotans than opioids, meth and all other drugs combined.
It's not because more people are drinking - that number's been steady in recent years, according to the Centers for Disease Control and Prevention. Yet per-capita consumption of alcohol has risen, meaning that those who are drinking are drinking much more.
Researchers say negative childhood experiences and a collapse of economic opportunity and community structures are driving this century's increase in drug and alcohol abuse. As more Minnesotans drink themselves to death, it also becomes the new normal.
"Our society is changing, and our relationship with chemicals is changing," said Jon Roesler at the Minnesota Department of Health. "It's happening in front of us. It's hard to capture all of it."
- - -
Intoxication was the norm for her father's family for generations, said Brenda Long, who at 53 already has lived longer than her dad did. Long brought her mother, June Alleman, 75, to Duluth for medical care last week, and the two women shared their painful story.
Mike Trafton, Long's dad, was the sixth of 19 siblings, most of whom were removed from their home by social workers because of their parents' alcohol abuse.
Trafton was always fun and had a wonderful sense of humor, Alleman said. He was never a mean drunk; he'd simply come home and pass out. But he had a rare disease affecting his arteries, so when they began their life together and started a family in Minneapolis, she worked and he was a stay-at-home dad.
But he didn't stay at home. Instead, Long said, he would take her and her younger brother Gary to the bar with him. She was maybe 5 years old.
"They actually had little stepstools for us, and we'd climb on the stepstools and play pool and all the old guys ... would be playing pool with me," Long recalled.
The family moved to Montana when she was 6 and to International Falls when she was 9. By that time, she said, her dad was so sick he would spend most of the rest of his life being treated in Minneapolis. Even then, he would continue to frequent bars, Long said.
Her dad died when she was 12.
Tom Trafton, her older half brother, wouldn't bother to pay his rent because booze was more important to him, Long said. That's how his name ended up in court records. On May 20, 1995, his landlord, Leonard Griese, "incensed over Trafton's drinking and failure to pay rent," stabbed Trafton and his girlfriend numerous times in their basement apartment in Blaine, killing them both.
Although Gary Trafton did some drinking as a high school student, Long said his problems didn't really surface until he came back from Iraq with PTSD after serving as a gunner on a tank with the Marines during Operation Desert Storm.
"He mostly drank because his nightmares would be so bad," said his mother, Alleman. "He couldn't sleep, so he'd drink so he'd be drunk enough to go to sleep."
Nothing seemed to change his behavior. On June 8, 2013, Gary's daughter called Alleman, asking her to check on him in his International Falls home.
She found him dead.
"I tell you when it's one of your kids just to have died, it leaves a hole in your heart," Alleman said. "But to see him there like that, lying on the floor with his head stuck partway into a dresser ..."
Her voice trailed off. Her daughter finished the sentence.
"That's our last memory of him."
- - -
While there was obvious dysfunction in the lives of some of Long's loved ones, alcohol can inflict pain on seemingly stable families and "normal" drinkers as well.
"I guess by textbook standards my mom would be considered a binge drinker or an alcoholic," said Melissa Rexrode of Grand Marais. "But she's always had a steady job, she was always an upstanding citizen. She was never a fall-down drunk."
Her mother's parents were both alcoholics, Rexrode said, but Sally Kulberg was never the type who had to have a drink or who hid bottles.
Then on Mother's Damopy weekend two years ago, while the Kulbergs were spending the weekend at their camper on a lake, Sally drank too much. She woke up in the middle of the night, throwing up blood. She was taken to the emergency room and was diagnosed with cirrhosis of the liver, a disease most commonly caused by alcohol use.
Both of her parents immediately quit drinking, Rexrode said. But on Super Bowl Sunday her mother became ill again, and she was admitted to the hospital the next day.
Sally Kulberg died on Feb. 12, at age 58, with a complication of cirrhosis listed as the cause of death.
"I guess I'm mad at alcohol," Rexrode said. "I'm mad because that's what caused her death."
- - -
Alcohol is a known carcinogen Minnesotans consume with increasing intensity every year. In 2016 the state swallowed the equivalent of 2.77 gallons of pure alcohol per person, according to the National Institute on Alcohol Abuse and Alcoholism. That's a 20 percent increase since 1996.
"It's the binge drinking. Minnesota has historically had one of the highest rates of binge drinking in the nation," said Dana Farley, alcohol and drug prevention policy director at the Minnesota Department of Health.
Excessive consumption - five or more drinks in a row for men or four for women - leads to long-term health problems that accumulate over time as well as short-term emergencies. The CDC estimates 977 Minnesotans die from alcohol-related diseases every year, and an additional 768 die from sudden causes like car accidents and injuries.
But even low levels of alcohol consumption can shorten life spans, according to a massive international study published this year that counters oft-cited claims of the benefits of a glass or two of wine a night.
"These data support adoption of lower limits of alcohol consumption than are recommended in most current guidelines," says the article published in Lancet in April.
That would mean "healthy" levels of drinking would be one drink a day for men and half a drink a day for women - half the current CDC recommendation.
"We prefer to think there is some benefit if we drink moderately," said Kari Gloppen, a researcher with the state health department. "There may be some minor benefits of impact on cholesterol, cardiovascular, but when you look at increased risk for cancer, stroke, the overall impact is negative."
- - -
Shana Flynn, a hospice and home care social worker at St. Luke's, has seen at least a dozen people die of alcohol-related causes in the past two years. They included people who were homeless and people who were affluent, people in their 80s and one man who was 26 when he died.
Holly Ostrowski, a nurse in St. Luke's hospice care, said she has seen healing in relationships that had been torn by alcohol abuse but also has seen a patient whose only "family" was the staff from his care facility.
"Alcohol, when you see the effect it can have on you physically it's just devastating," Ostrowski said. "And I don't think people fully realize what long-term abuse of alcohol can do to your body and do to your mind."
Excess alcohol consumption needs to be seen as a disease, Flynn said.
"It's an illness," she said. "It's an illness. They didn't do this by choice. In our society we think it's a choice, and initially it probably is but then it becomes an illness."
Since 2001, the number of Minnesotans hospitalized for alcohol-related conditions has tripled. Residents of low-income neighborhoods are far more likely to suffer alcohol-related injuries than wealthier neighborhoods, according to health department data.
"If we think health is created in the community, then we need to look at how we come together at community levels and how we can put together the resources to solve these problems," Farley said.
That could mean higher alcohol taxes - last raised in 1987 - limits on the location and density of alcohol retailers, better youth education and a hard look at the systems that shape society.
A groundbreaking study by two Princeton University economists last year found a sharp increase in "deaths of despair" - drug overdoses, alcohol abuse and suicides - among middle-aged Americans. Their research showed economic opportunity, family and community support systems.
"We can see this ... as a loss of the structures that give life a meaning," Anne Case and Angus Deaton wrote.
- - -
For those who shared their experiences for this story, the emotions are still raw. Both Brenda Long and Melissa Rexrode said they were willing to speak out in the hopes that it would help others.
Rexrode, who works in the Cook County Sheriff's Office, said she sees how families are torn apart by alcohol- and drug-related incidents.
Long has seen that in her own family.
She talked about those three years in Montana as a happy time in her childhood when her dad wasn't drinking. But she also talked about the pain, especially of losing Gary, whom she described as her best friend. Although she will have a single drink, usually a rum and coke, while watching a football game at a bar, she wants nothing to do with the culture of excess drinking.
It's a culture she doesn't want for herself or her grown children, Long said.
"I never realized how hard it was," she said. "I just thought of it as a fact of life until I got older.
And then I thought: This is wrong. This isn't life. This isn't what you do."
- - -
To get help
Here's a partial list of resources for people who may be affected by excess alcohol use and for their loved ones:
• The Substance Abuse and Mental Health Services national helpline: (800) 662-4357, https://www.samhsa.gov/find-help
• Center for Alcohol and Drug Treatment, Duluth: (218) 723-8444
• Duluth Bethel, drug and alcohol treatment: (218) 740-3771
• Alcoholics Anonymous, Twin Ports area intergroup: (218) 727-8117