Alcohol misuse: tackling the UK epidemic - London

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BMA Board of Science “” One image that sticks in my mind was the patient who had such severe memory problems secondary to alcohol that he came out of his room every few minutes asking where his jacket was, not realising that he was doing this about 15 times per hour – and what I also remember is the sustained patience of the nursing staff! BMA member The evidence that alcohol consumption is a contributory cause of a number of cancers has 58, 59 strengthened in recent years. A 2007 review concluded that there is convincing evidence that alcoholic drinks are a contributory cause of cancers of the mouth, pharynx, and larynx, oesophagus, colorectum (men), and breast, and a probable cause of colorectal cancer in women and of liver cancer. 59 The review also concluded that there is no safe threshold below which no effect on cancer risk is observed. 59 The adverse effects of alcohol on health outlined in Box 2 are most notable in individuals who are alcohol dependent. Alcohol dependence syndrome is strongly associated with neurologic impairment, cardiovascular disease, liver disease, malignant neoplasms, and an increased risk of injury. 37 While the majority of effects from alcohol are detrimental to health, consumption at moderate levels or below is associated with a lower risk of CHD, ischaemic stroke and diabetes mellitus 55, 57, 58, 60-62 compared to individuals who abstain from alcohol. These positive effects on the risk of CHD appear to be confined to males over the age of 45 years and females past the menopause. 63 As consumption increases above moderate levels, however, the risk relation reverses. “” Unfortunately, us doctors, journalists and politicians have supported the concept that alcohol is good for you (raises HDL cholesterol, the good cholesterol), but of course not for all, and only in small amounts. BMA member Alcohol misuse: tackling the UK epidemic 29
30 BMA Board of Science Box 2 – major disease and injury conditions related to alcohol and proportions attributable to alcohol worldwide (%) i Men Women Both Malignant neoplasms Mouth and oropharynx cancers 22 9 19 Oesophageal cancer 37 15 29 Liver cancer 30 13 25 Breast cancer Neuropsychiatric disorders N/A 7 7 Unipolar depressive disorders 3 1 2 Epilepsy 23 12 18 Alcohol use disorders 100 100 100 Diabetes mellitus Cardiovascular diseases -1 -1 -1 Ischaemic heart disease 4 -1 2 Haemorrhagic stroke 18 1 10 Ischaemic stroke Gastrointestinal diseases 3 -6 -1 Cirrhosis of the liver Unintentional injury 39 18 32 Motor vehicle accidents 25 8 20 Drownings 12 6 10 Falls 9 3 7 Poisonings Intentional injury 23 9 18 Self-inflicted injuries 15 5 11 Homicide 26 16 24 Source: Room R, Babor T & Rehm J (2005) Alcohol and public health. Lancet 365: 519-30. Table 4: Increased risks of ill health to harmful drinkers Condition Men (increased risk) Women (increased risk) Hypertension (high blood pressure) Four times Double Stroke Double Four times Coronary heart disease 1.7 times 1.3 times Pancreatitis Triple Double Liver disease 13 times 13 times Source: Safe. Sensible. Social: the next steps in the national alcohol strategy (HM Government, 2007) i This table only summarises the major disease and injury categories and does not include diseases where there is currently insufficient epidemiological evidence to allow meta-analysis studies to be carried out. The negative percentages for diabetes mellitus, ischaemic heart disease and ischaemic stroke relate to the beneficial effect of alcohol consumption at moderate levels or below for these specific conditions. 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
Page 29 and 30: 16 BMA Board of Science Figure 3 -
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
Page 39 and 40: 26 BMA Board of Science Alcohol mis
Page 41: 28 BMA Board of Science Table 3 - p
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
Page 57 and 58: 44 BMA Board of Science Pedestrian
Page 61 and 62: 48 BMA Board of Science The sub-sec
Page 63 and 64: 50 BMA Board of Science Recommendat
Page 65 and 66: 52 BMA Board of Science Legal age o
Page 67 and 68: 54 BMA Board of Science Recommendat
Page 69 and 70: 56 BMA Board of Science Box 5 - the
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 85 and 86: 72 BMA Board of Science Appendix 2
Page 87 and 88: 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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