Alcohol misuse: tackling the UK epidemic - London

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BMA Board of Science Executive summary This report considers a range of evidence-based policies to tackle the problematic levels of alcohol misuse in the UK and is not intended to assail those who enjoy consuming alcohol in moderation. Alcohol consumption represents an integral part of modern culture in the UK and internationally. Alcohol is a psychoactive substance and its consumption in moderation can lead to feelings of relaxation and euphoria. It is also an addictive drug and its misuse is associated with a wide range of dose-related adverse sequelae that can lead to significant harm to the individual and society. Since 1950, alcohol consumption in the UK has risen from 3.9 litres pure alcohol per capita per year to a peak of 9.4 litres in 2004. Despite a recent fall to 8.9 litres, per capita consumption in the UK has remained consistently above 7 litres pure alcohol per year since 1980. The UK is among the heaviest alcohol consuming countries in Europe. The vast majority of the UK adult population consumes alcohol. The prevalence of alcohol consumption varies considerably by ethnic group. Only nine per cent of the White British population are non-drinkers, whereas 48 per cent of Black African origin and 90 per cent or more among those of Pakistani and Bangladeshi origin abstain from alcohol. There are also differences in alcohol consumption between men and women with men drinking twice as much alcohol as women on average per week. Individuals in employment are more likely to drink frequently compared to those who are unemployed. A similar pattern is also seen for socio-economic classification. Individuals in managerial and professional occupations are more likely to drink more frequently than those in routine and manual occupations. A large majority of the individuals in the UK who consume alcohol, do so in moderation. Analysis of the patterns of alcohol consumption, however, reveals that a significant proportion misuse alcohol by drinking above the UK recommended guidelines. Of particular concern is the pattern of drinking among adolescents, and the high level of binge drinking and heavy drinking among men and women in the 16 to 24 and 25 to 44 age groups. UK teenagers are among the most likely in Europe to report heavy consumption of alcohol, being intoxicated and experiencing adverse effects of drinking. During the 1990s, the prevalence of alcohol misuse increased among both men and women, and in particular in the 16 to 24 age group. This upward trend was particularly marked among young women to the extent that consumption among this group is now the highest in Europe. The upward trend may have peaked, however. In the 16 to 24 age group, there has been a downward trend since 2003 in the proportion of men drinking above recommended daily guidelines and drinking heavily. A similar downward trend has occurred among women aged 16 to 24 since 2002. Data on average weekly consumption show a similar downward trend in recent years. It is not yet possible to determine whether these recent trends in alcohol consumption are genuine long-term changes in drinking habits. Recent years have seen an increasing trend among UK adults toward home-based alcohol consumption. This trend toward home-based alcohol consumption most likely reflects the lower cost of alcohol in off-licences compared to licenced premises in the UK. Among younger adults, there is also an increased tendency to consume alcohol at home prior to going out. Alcohol consumption has been shown to be causally related to over 60 different medical conditions and is a significant cause of morbidity and premature death worldwide. In the majority of cases there is a dose-response relation, with risk increasing with the amount of alcohol consumed. Moderate alcohol consumption is not usually harmful to health. Indeed, consumption at moderate levels or below in older men and women is associated with a lower risk of coronary heart disease (CHD), ischaemic stroke and diabetes mellitus, compared to individuals who abstain from alcohol. Drinking heavily, however, can result in significant health problems through either acute or chronic misuse. In the UK, the burden of alcohol-related morbidity and mortality is Alcohol misuse: tackling the UK epidemic 1
2 BMA Board of Science shifting to younger age groups in both men and women, and toward the most socially deprived groups. The pattern of consumption is important in determining the impact of alcohol misuse on health. Binge drinking is a particularly harmful form of alcohol consumption and significantly increases the risk of alcohol dependence in men and women. The frequency of heavy drinking by the pregnant mother is also associated with the occurrence of a range of completely preventable mental and physical birth defects collectively known as Fetal Alcohol Spectrum Disorders (FASD). Alcohol misuse can lead to many harmful consequences for the individual drinker, their family and friends. It significantly impacts on family life and is also a significant contributory factor in domestic violence incidents in about 50 per cent of cases. Parental alcohol misuse is also correlated with child abuse and impacts on a child’s environment in many social, psychological and economic ways. Driving under the influence of alcohol is a significant cause of death and serious injury from road traffic crashes in the UK. In 2006, six per cent of all road casualties and 17 per cent of road deaths were due to alcohol intoxication. Alcohol consumption by other road users such as cyclists and pedestrians is also associated with fatalities and injuries. The levels of alcohol-related crime and disorder vary with age and pattern of drinking, with alcohol-related offences particularly common among binge drinkers in the 18 to 24 age group compared to other regular drinkers. Drinking alcohol, especially frequent drinking, is also a significant factor in criminal and disorderly behaviour in young people aged under 18. The cost of alcohol misuse in the UK is substantial, both in terms of direct costs (eg costs to hospital services and the criminal justice service) and indirect costs (eg loss of productivity and the impact on family and social networks). The control of alcohol at a national and international level is therefore essential. This requires the implementation of strategies that are effective at reducing overall alcohol consumption levels in a population, as well as targeted interventions aimed at specific populations who misuse alcohol, or individuals who are dependant on alcohol. Effective policies to reduce alcohol-related harm in the UK There is a substantial body of evidence demonstrating that targeted and population-wide alcohol control policies can reduce alcohol-related harm. Historically, changes in alcohol control policies in the UK have been accompanied by fluctuations in alcohol consumption levels and associated problems. Since the Second World War, there has been considerable deregulation and liberalisation of alcohol control policies in the UK, which have been accompanied by an increase in consumption levels and alcohol-related problems. Current UK governmental alcohol control strategies have been the subject of much criticism due to the lack of commitment to evidence-based harm reduction policies. Lessening the burden of alcohol misuse in the UK requires strong leadership and the implementation of effective alcohol control policies that reduce overall consumption levels and minimise the harm to the public and the individual. Developing comprehensive alcohol control policies requires partnership between governmental agencies and organisations throughout the UK. Access to alcohol – controlling price and availability Access to alcohol is an important determinant of alcohol use and misuse. This incorporates the implementation of policies that regulate the affordability of alcohol as well as the introduction and enforcement of strict controls on the availability of alcohol to adults and young people. In the UK, the affordability of alcohol increased by 65 per cent between 1980 and 2006. Over the corresponding time period, per capita alcohol consumption aged 15 and over increased from 9.4 to 10.9 litres pure alcohol. Since 1997, excise duties on wine and beer in the UK have only increased in line with inflation while the duty on spirits has not increased. There is strong and consistent evidence that increases in price have the effect of reducing consumption levels, and the rates of alcohol problems including alcohol-related violence and crime, deaths from liver cirrhosis, Alcohol misuse: tackling the UK epidemic
Page 1 and 2: BMA Board of Science Alcohol misuse
Page 3 and 4: ii BMA Board of Science Editorial b
Page 5 and 6: iv BMA Board of Science Acknowledge
Page 7 and 8: vi BMA Board of Science Glossary No
Page 9 and 10: viii BMA Board of Science Recommend
Page 11 and 12: x BMA Board of Science Alcohol misu
Page 13: xii BMA Board of Science Alcohol mi
Page 17 and 18: 4 BMA Board of Science Consideratio
Page 19 and 20: 6 BMA Board of Science Alcohol misu
Page 21 and 22: 8 BMA Board of Science Measures to
Page 23 and 24: 10 BMA Board of Science Introductio
Page 25 and 26: Litres of pure alcohol per inhabita
Page 27 and 28: 14 BMA Board of Science Patterns of
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Page 49 and 50: 36 BMA Board of Science Causes of a
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52 BMA Board of Science Legal age o
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54 BMA Board of Science Recommendat
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56 BMA Board of Science Box 5 - the
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BAC (mg/100ml) 58 100 90 80 70 60 5
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60 BMA Board of Science Understandi
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62 BMA Board of Science Early inter
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64 BMA Board of Science At present
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66 BMA Board of Science treatment s
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68 BMA Board of Science Internation
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70 BMA Board of Science Alcohol mis
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72 BMA Board of Science Appendix 2
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74 BMA Board of Science Licensing i
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80 BMA Board of Science 23 Hughes T
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82 BMA Board of Science 67 Dex S &
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84 BMA Board of Science 118 Edward
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86 BMA Board of Science 164 McKnigh
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88 BMA Board of Science 209 Babor T
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90 BMA Board of Science 253 Scottis
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92 BMA Board of Science Alcohol mis
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British Medical Association Board o
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Board of Science and Education This
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vi Contents Introduction...........
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viii
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2 heavier smoking, drinking and mor
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4 Nutrition, exercise and obesity N
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6 The data for 1998 shows a 21 per
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8 Interventions in adolescent nutri
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10 The efficacy of traditional educ
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12 The treatment of individuals wit
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14 Smoking, drinking and drug use A
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16 The use of illicit substances, a
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18 smoking prevalence was highest a
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20 Interventions in adolescent drug
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22 be expensive given the amount co
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24 is potential to use the media, n
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26 Summary Adolescents in the UK ar
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28 Mental health problems in adoles
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30 Risk factors for conduct, depres
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32 Currently, specialist mental hea
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34 Sexual health Adolescents and se
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36 interferes with the adolescent
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38 Interventions in adolescent sexu
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40 The timing of educational interv
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42 Helping adolescent parents The h
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44 are more difficult to reach than
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46 The way forward This report has
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48 Annex 1 BMA policy on adolescent
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50 References 1 Lobstein T J, James
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52 56 Social Exclusion Unit (1998)
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54 115 Charles Gallichan (2003) Pub
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56 173 NHS Centre for Reviews and D
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Subject: Young People and Alcohol D
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Call for Evidence: Children and You
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5. Do you know of any international
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