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Alcohol Misuse

Health Consequences

Alcohol misuse can have a wide range of health consequences in young people and adults.

Main health consequences for alcohol misuse

  • Alcohol is causally related to more than 60 medical outcomes, in most cases detrimentally 1
  • In terms of alcohol related mortality, almost half the global burden (46 percent) is related to acute causes, with 32 percent from unintentional injuries and 14 percent from intentional injuries 2
  • Malignant neoplasms account for 20 percent of global alcohol related mortality, 15 percent is caused by cardiovascular disease, and 13 percent by other non-communicable disease, mainly liver cirrhosis 2
  • Alcohol related morbidity is generally measured in disability adjusted life years (DALYS), which take account of disability as well as disease 2
  • Worldwide, neuropsychiatric conditions are responsible for the largest proportion of alcohol attributable DALYS (37 percent), followed by unintentional injuries (28 percent), and intentional injuries (12 percent) 2
  • Essentially, virtually every system in the human body can be damaged by alcohol. 3

Liver disease

In England alcohol related mortality from liver disease trebled between 1970 and 1998, while the rate in the European Union fell by 30 percent 4 . Scotland now has one of the highest rates of death from cirrhosis in Western Europe. 4

Between 1970 and 2000 there was a ninefold increase in the number of deaths from alcohol related chronic disease in English men and women aged 25-44 years. 5

Cancer

Alcohol is second in importance, after smoking, as a proved cause of cancer 7 and is responsible for 3.5 percent of deaths from cancer in the UK, or nearly 5000 deaths a year. 6 4 Alcohol related cancer is particularly evident in the digestive system 8 ; furthermore, there is an interaction with smoking in the development of cancer in the upper gastrointestinal tract.

Stroke

Chronic heavy drinking also contributes to the risk of both haemorrhagic and ischaemic stroke. 3

Hypertension

The incidence of hypertension is about approximately double in people who regularly drink more than six units a day. 6 Hypertension accounts for about 3000 deaths a per annum in the UK, and about 300 of these may be specifically related to alcohol consumption. In 11 percent of men with hypertension, alcohol consumption is the main cause.

Hypertension is also linked to the risk of haemorrhagic stroke. Indeed, chronic high alcohol intake increases the risk of both haemorrhagic and ischaemic stroke. A 10 year study in Scotland found more deaths from coronary heart disease, particularly strokes, on Mondays (3 percent above average intake) among people with no previous hospital admission for such conditions; this spike in deaths has been ascribed to weekend binge drinking. 9

Fetal alcohol syndrome

Heavy or frequent drinking by women during pregnancy can affect the prenatal and postnatal development of their baby and lead in particular to fetal alcohol syndrome (FAS) or its less severe form, fetal alcohol spectrum disorders (FASD). Low level infrequent consumption is unlikely to have an adverse effect on the fetus. 15

In industrialised countries an estimated 0.4-2.0 live births per 1000 are affected by fetal alcohol syndrome. 10 Children born with fetal alcohol effects can experience a range of developmental problems and some consequences may be apparent throughout their lifetimes.

Acute intoxication

Acute intoxication, which tends to occur from binge drinking, refers to disturbances in levels of consciousness, cognition, perception, mood, or social behaviour. In the UK, intoxication was responsible for 23 000 hospital admissions in 2000-1. 9 These admissions peak steeply in those aged under 20 and then attenuate. 9 Given young people’s tendency to engage in binge drinking, and their relative inexperience with alcohol, they are at greater risk from acute intoxication. 16

Other consequences

Deaths from injuries

Each year alcohol misuse is also linked to about 14 percent of deaths from injuries, which involves about 1700 individuals. Alcohol misuse is thought to be linked to 38-45 percent deaths in fires, 7-25 percent deaths at work and 23-38 percent of deaths from drowning. 4 . In addition, around 16-41 percent of suicides may be attributable to alcohol use; half of those presenting to hospital with self harm were found to be regular drinkers and 23 percent were dependent. 4

Hospital admissions

In the UK, alcohol use is associated with 150 000 hospital admissions, and between 15 000 and 22 000 deaths each year are associated with excessive drinking. 3 Each year, alcohol related liver disease accounts for about 33 000 hospital admissions and over 4500 deaths. Moreover, there are 30 000 hospital admissions for alcohol dependence syndrome. Age specific mortality from liver disease has risen by 90 percent over the past decade; although an interaction with hepatitis C infections has probably contributed to this rise. 4

Harm from personal alcohol consumption

Most of the recorded mortality and morbidity relates to individual experience of harm from personal alcohol consumption. An important factor in alcohol misuse, however, is that a wide array of other people (known and unknown) can be affected by each drinker. 10 This list of "affected others" is extensive and can include the drinker’s partner and children, other family members and friends, acquaintances met in social situations involving alcohol, and unknown individuals in the vicinity of public drinking venues.

Health consequences in young people

Young people may experience adverse effects from alcohol misuse either from the drinking behaviour of other people (such as poor parenting because of parental drinking) or their own alcohol consumption.

Although many young people can use alcohol without serious adverse effects, a considerable minority cause substantial damage to themselves and other people. 11

The relation between alcohol and harm in young people is complex. 12 Alcohol may increase a young person’s probability of doing something that is potentially harmful (such as getting into fights); alcohol use in conjunction with an activity may increase the probability of harm (such as accidents related to drinking and driving); and alcohol use may itself lead to harm (such as physical illness, mortality).

For various reasons young people are more vulnerable than adults to the adverse effects of alcohol, including differences in body mass and metabolic handling of alcohol and experience in assessing alcohol related risk situations. 13

Young people’s alcohol misuse is known to have a deleterious impact on motivational and cognitive processes, including mood disorders, which influence school performance and risk of injury and death. 14

References

  1. Room R, Babor T, Rehm J. Alcohol and public health. Lancet 2005;356:519-39. External Link
  2. Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, et al. Alcohol as a risk factor for global burden of disease. Eur Addict Res 2003;9:157-64. External Link
  3. Royal College of Physicians. Alcohol—can the NHS afford it? Recommendations for a coherent alcohol strategy for hospitals. London: Royal College of Physicians, 2001. External Link
  4. Leon D, McCambridge J. Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet 2006;367:52-6. External Link
  5. Academy of Medical Sciences. Calling time: the nation’s drinking as a major health issue. London: Academy of Medical Sciences, 2004. External Link
  6. Prime Minister’s Strategy Unit. Interim analytical report. Strategy unit, alcohol harm reduction project. London: Cabinet Office, 2003. External Link
  7. Austoker J. Reducing alcohol intake. BMJ 1994;308:1549-52. External Link
  8. Anderson P, Cremona A, Paton A, Turner C, Wallace P. The risk of alcohol. Addiction 1993;88:1493-508. External Link
  9. Evans C, Chalmers J, Capewell S, Redpath A, Finlayson A, Boyd J, et al. "I don’t like Mondays"—day of the week of coronary heart disease deaths in Scotland: study of routinely collected data. BMJ 2000;320:218-9. External Link
  10. Alcohol Concern. Britain’s ruin? London: Alcohol Concern, 2000. External Link
  11. Perkins W. Surveying the damage: a review of research on consequences of alcohol misuse in college populations. J Stud Alcohol Suppl 2002;14:91-100. External Link
  12. Leigh BC. Peril, chance, adventure: concepts of risk, alcohol use and risky behavior in young adults. Addiction 1999;94:371-83. External Link
  13. Miller ET, Kilmer JR, Kim EL, Weingardt KR, Marlatt GA. Alcohol skills training for college students. In: Monti PM, Colby SM, O'Leary TA, eds. Adolescents, alcohol, and substance abuse. New York: Guilford Press, 2001:183-215.
  14. Hawkins J, Catalano R, Miller J. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychol Bull 1992;112:64-105. External Link
  15. Henderson , Gray R, Brocklehurst P. Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome. Br J Obstet Gynaecol 2007;114:243-52. External Link
  16. Murgraff V, Parrott A, Bennett P. Risky single-occasion drinking amongst young people: definition, correlates, policy and intervention. Alcohol Alcohol 1999;34:3-14. External Link