A Great and Growing Evil?

The Medical Effects of Alcohol

Royal College of Physicians

• Publisher: Routledge
• Year: 2005
• eBook ISBN: 9781135800819
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

This new report shows that no system in the body is immune to alcohol. It discusses the role of the medical profession in identification and treatment of alcohol problems and suggests ways of implementing more effective prevention.

1
THE EXTENT OF THE PROBLEM

‘Alcohol misuse is a social problem with medical complications.’

(Sir Desmond Pond, Former Chief Scientist, DHSS)

This is not the first time that the Royal College of Physicians has felt it necessary to draw public attention to the harm caused by the immoderate use of alcohol. In 1726 it made a submission to the House of Commons on ‘a great and growing evil’ later to be compellingly portrayed by Hogarth in his engraving of Gin Lane.

‘We the President and College or Commonalty of the Faculty of Physicians in London, who are appointed by the Laws of this Kingdom to take care of the health of his Majesties Subjects in London and within seven miles circuit of the same, do think it our Duty most humbly to represent that we have with concern, observed, for some years past, the fatal effects of the frequent use of several sorts of distilled Spirituous Liquors upon great numbers of both Sexes, rend(e)ring them diseased, not fit for business, poor, a burthen to themselves and neighbours and too often the cause of weak, feeble and distempered children, who must be, instead of an advantage and strength, a charge to their country. We crave leave further most humbly to represent, that this Custom doth every year increase, notwithstanding our repeated advices to the contrary.

We therefore most humbly submitt to the Consideration of Parliament, so great and growing an evil.’

(Minutes of a meeting of the Royal College of Physicians, 1726)

Now, 260 years later, we have once again been led to write a report because of the increasing number of patients we see who are damaged by alcohol. About one in five of all men admitted to medical wards has a problem related to alcohol abuse,¹–⁹ and a recent study of medical outpatients has shown that 10–20 per cent drink more than 80 g (10 units) of alcohol a day4—an amount that may result in physical damage.Estimates of the number of alcohol-dependent people in England and Wales vary between 70,000 and 240,000, and of the number of problem drinkers between 0.5 and 1.3 million.⁸ Many of these individuals suffer physical, psychological, social, and occupational harm.

The main aim of this report is to illustrate and draw attention to the fact that alcohol produces wide-ranging physical harm and that no system in the body is immune from its effects.

Our report is aimed not only at doctors, but also at the general public, health authorities, members of Parliament, and the Government, because we believe that there is considerable ignorance among all these groups ¹⁰–¹² as to the depth and breadth of the problems associated with the use and misuse of alcohol.^12–20 It is important that the public and the Government understand the importance of alcohol in causing wide-ranging harm because the prevention of this cannot come from health professions alone. Alcohol problems are more easily prevented than treated, but if problems are to be prevented then individuals and controlling bodies must be provided with the necessary information upon which to make decisions and formulate plans.

Our sister colleges, the Royal College of Psychiatrists and the Royal College of General Practitioners,²¹,²² have also prepared reports to express their concern about the alcohol-related problems seen increasingly by their members. As physicians, we have chosen to concentrate on the physical problems associated with alcohol abuse.They are listed in Table 1 and elaborated in the relevant sections of this report.

We want to draw attention to the fact that alcohol-related disease is not confined to a relatively small number of individuals with ‘skid row’ problems of social and physical disintegration. Alcohol can cause medical illness when consumed at much lower levels than previously thought. Regular consumption of 60 g (7.5 units) of alcohol a day, equivalent to a daily intake of about four pints of beer, is associated with an increasing risk of sickness from high blood pressure, strokes, liver disease, infertility, and diseases of the nervous system. In women, half that amount puts them at increasing risk of developing illnesses.

Table 1 Summary of physical health hazards associated with alcohol abuse

Many individuals who are substantially harming themselves with alcohol may show no physical, social, or emotional side effects in the early stages. It is usually only by careful questioning about alcohol intake and by measuring several biochemical and haematological markers that it is possible to identify that a disease is alcohol-related.

In this report we shall draw attention to the many and varied ways in which alcohol can harm the body; and we will also discuss the strengths and weaknesses of the evidence that associates them.

Definitions

Throughout this report we use the term alcohol to refer solely to ethanol. There are many other natural and synthetic alcohols, but almost all are either highly toxic or undrinkable, or both.

A ‘standard’ drink is referred to in this report as ‘a unit’ and contains 8 g of pure alcohol. Figure 1 shows the standard public house measures, each of which provides one unit of alcohol.

Figure 1 One unit, or 8 g, of alcohol.

A can of beer or lager (450 ml) contains nearly 1.5 units (12 g), a bottle of wine about 7 (56 g), a bottle of sherry or port 15 (120 g), and a standard bottle of spirits and most liqueurs 30 units (230–250 g). These figures are only approximate because there is wide variation in the amount of alcohol in different alcoholic drinks (Table 2 ) and the size of a measure also varies from place to place throughout Britain.

Table 3 gives definitions of ‘social drinker’, ‘heavy drinker’, ‘problem drinker’, and ‘dependent drinker’. We must emphasize, however, that these divisions are arbitrary: social drinkers merge into heavy drinkers; some people who drink a little experience greater problems than some who drink more; and an individual who is drinking ‘heavily’ today may be ‘dependent’ tomorrow and vice versa. Terms like ‘alcoholic’ and ‘alcoholism’, though widely used, are impossible to define and we do not use them in this report because they also carry with them the mistaken idea that the condition is irreversible and untreatable.

Although it is true that the later stages have a poor outlook, recovery or arrest of the damage is possible in many cases without medical treatment.²³ It is also incorrect to think that only ‘alcoholics’ suffer problems through excessive drinking. Likewise, the idea that only a minority of the population is genetically and physically capable of becoming dependent on alcohol is misleading. Genetic factors may be important but, as yet, it is impossible to identify individuals doomed to alcohol dependence or those who are immune.

A man who regularly drinks more than an average of 8 units (64 g) alcohol a day and a woman who regularly drinks more than an average of 5 units (40 g) alcohol a day stands a high chance of damage. Anyone who becomes intoxicated is liable to a wide range of problems associated specifically with drunkenness, especially accidents and assault.

Table 2 Alcohol content of various beverages

Table 3 Definitions of different kinds of drinkers

Benefits and Risks

Doctors are not prohibitionists. However, because the amount of alcohol consumed by a population and the amount of damage caused are closely related, alcohol problems will only diminish when less alcohol is consumed and suitable drinking limits are observed (see p. 108). Moreover, what the nation spends on alcohol it cannot spend on other things that could improve its health and well-being.

Social and Economic Problems

The British spend more on alcohol than they do on clothes, cars, hospitals, schools, or universities. In 1981 this came to over £11,000 m, representing 7.5 per cent of consumer expenditure.²⁴

Alcohol is usually available at christenings, weddings, and funerals, at the launching of ships and at office parties. The sense of well-being associated with a blood alcohol concentration of 20 mg/100 ml (after drinking 1 unit) is clearly greatly appreciated, as too, is the mild disinhibition experienced when the blood level reaches 40 mg/ 100 ml (after drinking 2 units). The individual and social value of alcohol may

be hard to define, and the protective effect of a little alcohol against heart disease is not proven (see p. 27), but the economic benefits to the Government from alcohol revenue are more easily measured. The Government collected £5,825 million in excise duty and value-added tax from the sale of alcohol in 1983–84. ²⁵ Exports of alcohol are worth more than £1,000 million a year, giving, at the moment, a positive balance of trade. In addition, at a time when more than three million people are unemployed, at least 750,000 people are engaged in producing and selling alcohol.²² A dramatic fall in consumption might mean a loss of Government income and lost jobs. Furthermore, the positive...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgements
• Summary of Recommendations for Reducing Alcohol Abuse
• 1: The Extent of the Problem
• 2: Levels of Alcohol Consumption in Britain
• 3: The Nervous System
• 4: The Liver
• 5: The Gastro-Intestinal System and Pancreas
• 6: Nutrition
• 7: Heart Disease
• 8: Blood Pressure
• 9: The Chest
• 10: Endocrine Function
• 11: Occupation
• 12: Injuries
• 13: Children, Adolescents, and the Family
• 14: Medical Responsibilities
• Appendix 1
• Appendix 2