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Alcohol Misuse

Risk Factors

There are many causes of alcohol misuse, and genetic, psychological, and social factors are all important determinants. 1

Age

Earlier age of initiation is an important precursor to later alcohol misuse. 2 Others include parents’ drinking, friends' drinking and favourable attitudes towards substance use. 2

Individuals who begin using alcohol in the years before and during early adolescence (at 11-14 years) are most vulnerable to developing alcohol use disorders later in life. 3 Individuals who report drinking before the age of 14 are four times more likely to develop alcohol dependence than those who began drinking at age 20 or more. 4

Sex

Men are more likely than women to develop alcohol use disorders. 2

Social class

Heavy drinking in men occurs across all social classes. 5 The problems arising from heavy drinking, however, are experienced more severely by people from lower social classes. 5

Risks of alcohol consumption in adults

Alcohol related problems are associated with average volume consumed or different patterns of drinking, or both. 6 Frequent heavy drinking tends to result in chronic health conditions (such as hypertension or liver problems), whereas binge drinking tends to result in more acute health problems (injuries or trauma) and sociolegal consequences (antisocial or criminal behaviour).

The risks of alcohol misuse for adults include a wide range of chronic and acute health conditions, psychological disorders, and social, financial, legal consequences. 7

Heavy drinking

Heavy drinking is a key risk factor for liver cirrhosis, and cirrhosis mortality is an important indicator of alcohol related harm in populations. 8

Chronic heavy drinking

Chronic heavy drinking also contributes to the risk of both haemorrhagic and ischaemic stroke. 9 In the UK the association of alcohol and haemorrhagic stroke accounts for 1200 deaths a year. 9

The incidence of hypertension is about doubled in patients who regularly drink more than six units a day. 4 In 11 percent of all cases, alcohol consumption is the main cause of hypertension in men and is second only to obesity as an acquired determinant. There is a consistent association between reduced alcohol intake and reduced blood pressure. 10

Excessive drinking

Excessive drinking, especially if combined with cigarette smoking, contributes to the risk of a range of cancers, 11 particularly cancers of the gastrointestinal tract. There is generally a dose-response relation between level of alcohol intake and an increased risk of developing cancer. 11

Excessive drinking also has significant implications for mental health, including a causal link with anxiety, depression, 12 and suicidal behaviour. 13 About a third of psychiatric patients with serious mental illness in the UK have a substance misuse problem, mostly involving alcohol. 9

Alcohol increases the risk of death from injuries and may be associated with between one in three and one in seven such deaths, amounting to up to 1700 deaths a year in the UK. 8 Alcohol has been linked to 38-45 percent of deaths in fires and 7-25 percent of deaths at work, and around 23 percent deaths by drowning.

Around 16-45 percent of suicides are thought to be linked to alcohol use; half of those who present to hospital after deliberate self harm are regular excessive drinkers and 23 percent are alcohol dependent. 9

Benefits in adults

Individuals who do not drink alcohol have an increased risk of coronary heart disease compared with those who drink at low to moderate levels. 14 Most evidence has been found in older men and postmenopausal women.

Beyond a consumption level of about one or two standard drink units a day the risk of coronary heart disease rises in a dose-response fashion; the more alcohol consumed, the greater the risk. This pattern of risk where non-drinkers and heavy drinkers experience a greater risk of heart disease than low to moderate drinkers has been described as the J shaped curve. 11

References

  1. Galea S, Nandi A, Viahov D. The social epidemiology of substance use. Epidemiol Rev 2004;26:36-52. External Link
  2. Hawkins D, Graham J, Maguin E, Abbott R, Hill K, Catalano R. Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse. J Stud Alcohol 1997;58:280-90. External Link
  3. DeWit D, Adlaf E, Offord D, Ogbourne A. Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatry 2000;157:745-50. External Link
  4. Hingson R, Heeren T, Winter M. Age at drinking onset and alcohol dependence. Arch Pediatr Adolesc Med 2006;160:739-46. External Link
  5. Marmot M, Feeney A. Inequality, alcohol and alcohol-associated harm. In: Waller S, Crosier A, McVey D, eds. Inequalities in health. London: Health Education Authority, 1999.
  6. Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos C. The relationship of average volume of alcohol consumption and pattern of drinking to burden of disease: an overview. Addiction 2003;98:1209-28. External Link
  7. Room R, Babor T, Rehm J. Alcohol and public health. Lancet 2005;356:519-39. External Link
  8. 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
  9. Prime Minister’s Strategy Unit. Interim analytical report, Strategy unit, alcohol harm reduction project. London: Cabinet Office, 2003. External Link
  10. Xin X, He J, Frontini M, Ogden L, Motsamai O, Whelton P. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2001;38:1112-17. External Link
  11. Anderson P, Cremona A, Paton A, Turner C, Wallace P. The risk of alcohol. Addiction 1993;88:1493-508. External Link
  12. Manninen L, Poikolainen K, Vartiainen E, Laatikainen T. Heavy drinking occasions and depression. Alcohol Alcohol 2006;41:293-9. External Link
  13. Brady J. The association between alcohol and suicidal behaviour. Alcohol Alcohol 2006;41:473-8. External Link
  14. Royal Colleges of Physicians, Psychiatrists, and General Practitioners. Alcohol and the heart in perspective: sensible limits reaffirmed. Report of a joint working party. J Royal Coll Physicians Lond 1995;29:266-71. External Link