Alcohol consumption and alcohol dependence in the EU: room for improvement
- Created on Thursday, 10 May 2012 23:13
by Jürgen Rehm & Kevin Shield
Alcohol consumption has long been a major risk factor leading to mortality, morbidity, and social harms in the EU, with a large proportion of this burden being caused by heavy consumption. Alcohol dependence is arguably the most problematic health consequence of alcohol consumption from a public health view.
A substantial portion of the alcohol‐related burden in the EU is avoidable; cost‐effective measures such as taxation of alcohol, bans on alcohol marketing, and drunk‐driving countermeasures have the potential to reduce the burden at the population level, and interventions such as pharmacotherapy, counselling, cognitive behavioral therapy, and motivational interviewing may reduce the burden at the individual level. In our recently published book, Alcohol consumption, alcohol dependence and attributable burden of disease in Europe, we estimate the burden of mortality attributable to all alcohol consumption, to heavy drinking and to alcohol dependence, and evaluate the effect on this burden of increasing the number of individuals who receive treatment for alcohol dependence.
Alcohol has a large impact on mortality in the EU; almost 95,000 men and more than 25,000 women, in both cases aged 15 to 64 years, died of alcohol‐attributable causes in 2004. This means that 1 in 7 male deaths and 1 in 13 female deaths in this age category were caused by the consumption of alcohol. The proportional contribution to morbidity and disability is even higher. Heavy drinking was responsible for almost 80% of all male alcohol-attributable net deaths and approximately 67% of all female alcohol‐attributable net deaths. Alcohol dependence accounted for more than 70% of the overall alcohol‐attributable net mortality before age 65, and proportionally more in the younger age groups. Given the burden of alcohol dependence in the EU, it is surprising that less than 10% of Europeans living with alcohol dependence receive treatment. This lack of mental‐health care is alarming, since several effective treatment options are available. Increasing treatment coverage is a realistic goal, and would provide measurable results in lowering alcohol‐related harms including mortality, even in the short term.
To assess the impact of increasing the number of people with alcohol dependence treated in the EU we modelled the effect of increasing the percentage of people with alcohol dependence who are also treated to 40%. We found that If 40% of all people with alcohol dependence in the EU were treated with pharmacotherapy, the result would be a reduction of 10,040 male deaths and 1,700 female deaths in just the first year. This decrease is substantial, and represents a decrease of 13.3% of alcohol‐attributable deaths of men and almost 9.3% of alcohol-attributable deaths of women. Almost the same effect could be reached if brief interventions would be given in hospitals, i.e. to problematic drinkers with other diseases or injuries already present and thus at elevated risk for mortality.
Given the substantial health burden attributable to alcohol dependence in the EU, it is recommended to supplement the proposed alcohol prevention policies with other measures designed to increase treatment rates and the provision of appropriate services. Alcohol policy should strive for an integrated package of various forms of effective prevention measures, such as taxation increases, limitations on availability, and bans on advertising, supplemented by interventions for problem drinkers and people with alcohol dependence.