Alcohol misuse: tackling the UK epidemic - London

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BMA Board of Science The burden of alcohol on society The relationship between alcohol consumption and health and social outcomes is complex and multifaceted. In the short term, the acute intoxicating effects of alcohol on cognitive and motor functioning impair an individual’s reactions, judgement, coordination, vigilance, vision, hearing and memory. This impairment is associated with many adverse outcomes for the individual and those around them as it can lead people to have accidents, misread situations and react aggressively. Alcohol consumption is linked to long-term health and social consequences through three main causal pathways: intoxication, dependence, and toxic (and beneficial) direct biological effects. 55 These pathways are in turn affected by the volume of consumption and the pattern of drinking. Alcohol misuse is also frequently associated with drug abuse and other harmful behaviours such as smoking. Alcohol and health outcomes Alcohol consumption and health Moderate alcohol consumption is not usually harmful to health. 4 Drinking heavily, however, can result in significant health problems. These may occur after heavy alcohol consumption over a short period (eg intoxification or poisoning) or may develop more gradually (eg cirrhosis of the liver). “” The most upsetting (disturbing) memory relating to my clinical practice was watching a young patient in her 40s with multi-organ failure bid farewell to her children prior to dying a couple of days later. Her multiple medical problems were due to chronic alcoholism. BMA member Ethanol is a highly toxic compound that can affect the body in a variety of ways. The toxic effect on basic cell functions is produced by ethanol and its oxidation product, acetaldehyde, which accounts for much of the acute and delayed effects of ethanol toxicity. 56 Principally, ethanol affects the central nervous system (CNS), mainly through stimulation of opiate and benzodiazepine receptors as well as several neurotransmitters. The effects of alcohol on an individual are dependent on various factors including age, weight, type of drink, level of dehydration, previous exposure to alcohol, level and timing of food intake, and gender of the drinker. Table 3 outlines the possible effects of alcohol at different levels. Alcohol misuse: tackling the UK epidemic 27
28 BMA Board of Science Table 3 – progressive effects of blood alcohol concentration BAC (mg/100ml) Effect Impairment (continuum) 10 - 50 Relaxation Alertness Sense of well being Judgement Loss of inhibition 60 - 100 Pleasure Coordination (especially fine motor skills) 110 - 200 Mood swings Numbing of feelings Visual tracking Nausea, Sleepiness Emotional arousal Reasoning and depth perception Anger Sadness 210 - 300 Aggression Mania Slurred speech Reduced sensations Lack of balance Depression 310 - 400 Unconsciousness Stupor Loss of temperature regulation Death possible Loss of bladder control Coma Difficulty breathing > 410 Death Slowed heart rate Source: National Institute on Alcohol Abuse and Alcoholism Alcohol has been shown to be causally related to over 60 different medical conditions (see Box 2), and in the majority of cases there is a dose-response relation to the volume of alcohol 55, 57 consumption, with risk of disease increasing with higher volume. Alcohol consumption above recommended daily guidelines significantly increases the risk of various diseases and it has been suggested to be a significant contributory factor to a range of chronic conditions (see Table 4 and Table 5). 54 The disease conditions related to alcohol consumption fall into three categories that reflect the nature of the conditions and the nature of the aetiologic influence of alcohol on the conditions: wholly alcohol-attributable conditions which include alcoholic psychoses, alcohol-dependence syndrome, alcoholic polyneuropathy, alcoholic cardiomyopathy, alcoholic gastritis, alcoholic liver cirrhosis, and ethanol toxicity chronic conditions where alcohol is a contributory cause which include lip, oropharyngeal, oesophageal, liver, laryngeal, and breast cancer, epilepsy, hypertension, cardiac arrhythmias, stroke, oesophageal varices, gastro-oesophageal haemorrhage, liver cirrhosis, acute and chronic pancreatitis, spontaneous abortion, low birth weight, and psoriasis acute conditions where alcohol is a contributory cause which include road injuries, injuries from falls, fires, drowning, occupational and machine injuries, other accidents, suicide, assault, and child abuse. 55 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 and 14: xii BMA Board of Science Alcohol mi
Page 15 and 16: 2 BMA Board of Science shifting to
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 31 and 32: 18 BMA Board of Science increased w
Page 33 and 34: 20 BMA Board of Science Table 1 - p
Page 35 and 36: 22 BMA Board of Science Alcohol con
Page 37 and 38: 24 BMA Board of Science in 1997/98
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Page 43 and 44: 30 BMA Board of Science Box 2 - maj
Page 45 and 46: 32 BMA Board of Science attributabl
Page 47 and 48: 34 BMA Board of Science Figure 11 -
Page 49 and 50: 36 BMA Board of Science Causes of a
Page 51 and 52: 38 BMA Board of Science Box 3 - sum
Page 53 and 54: 40 BMA Board of Science Information
Page 55 and 56: 42 BMA Board of Science Driving and
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Page 71 and 72: BAC (mg/100ml) 58 100 90 80 70 60 5
Page 73 and 74: 60 BMA Board of Science Understandi
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Page 77 and 78: 64 BMA Board of Science At present
Page 79 and 80: 66 BMA Board of Science treatment s
Page 81 and 82: 68 BMA Board of Science Internation
Page 83 and 84: 70 BMA Board of Science Alcohol mis
Page 85 and 86: 72 BMA Board of Science Appendix 2
Page 87 and 88: 74 BMA Board of Science Licensing i
Page 89 and 90: 76 BMA Board of Science Appendix 4
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78 BMA Board of Science Appendix 6
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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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Alcohol misuse: tackling the UK epidemic - London

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