Mental health policy and practice across Europe: an overview

Addiction and alcohol 259
availability of alcohol, total alcohol consumption increased by 46 per cent from
1968 to 1969. The increase in consumption was influenced more by the addition
of new heavy drinking occasions than by new drinkers (Mäkelä 1970), and
the increase was greater in heavier consumption groups (Mäkelä 2002).
Within societies there is a direct relationship between levels of per capita
consumption and alcohol-related harm. The European Comparative Alcohol
Study reviewed the post-war experience of alcohol and mortality in EU countries
(Norström 2001). Time series analysis demonstrated that there is a positive
and significant relationship between changes in alcohol consumption and
changes in both overall and alcohol related death for both men and women
(see Table 11.2). The relationship applies to all types of alcohol-related harm,
and is stronger in countries with lower overall alcohol consumption than in
countries with higher overall alcohol consumption.
Due to the highly positively skewed distribution of alcohol consumption in
populations, it is likely that the level of alcohol consumption with the lowest
risk of death for a population will be considerably lower than that for an individual.
How much lower this is will depend on the shape of the individual risk
function and on how the distribution of alcohol consumption changes, as the
overall consumption level of the population changes. In not too unrealistic
circumstances (proportional changes in consumption), the minimum risk
consumption level for the population could be less than that for an individual
drinker by a factor of as much as five (Skog 1996). In countries with high
rates of coronary heart disease, the per capita level associated with minimum
risk for mortality may be in the order of about three litres of absolute alcohol.
In countries with low rates of coronary heart disease, the level is likely to be
Table 11.2 Change in death rates (%) from a 1-litre increase in alcohol consumption
per capita in low, medium and high consuming European countries for men (M) and
women (F)
Country group (alcohol consumption)
Low Medium High
M F M F M F
Cirrhosis 32* 17* 9* 5* 10* 11*
Alcohol dependence, psychosis and poisoning 35* 75* 18* 27* 3 1
Accidents 9* 10* 3* 3* 2* 2*
Suicide 9* 12* 0 3* 0 1
Homicide 18* 8 11* 7* 7* 2
IHD −1 1 1 2* 1 0
Total mortality (M+F) 3* 1* 1*
* p