ABC of Alcohol

Anne McCune

• Publisher: BMJ Books
• Year: 2015
• Print ISBN: 9781118544792
• eBook ISBN: 9781118543962
• Edition: 5
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

The misuse of alcohol presents both individual physical and psychological problems as well as wider social consequences. Alcohol misuse is a frequent cause of attendance in accident and emergency departments and an underlying factor in a range of long term and chronic conditions commonly treated and managed within primary care settings.

This expanded fifth edition includes new chapters on alcohol and the young person, alcohol related liver disease, neurological problems, alcohol and the older person, alcohol and cancer, and the alcohol nurse specialist. There is also improved coverage of the role of alcohol health workers, and guidance on the availability of voluntary alcohol services more generally, and the concluding resources chapter provides further guidance on how to access appropriate services. It incorporates current NICE guidelines, the Government's Alcohol Strategy 2012, as well as case study scenarios and examples of best practice throughout.

From a new editor and a multidisciplinary contributor team, ABC of Alcohol is a practical guide for general practitioners, family physicians, practice nurses, primary healthcare professionals as well as for junior doctors, medical and nursing students.

This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand store.

CHAPTER 1
Alcohol use: Consumption and costs

Peter McGovern and Eric Appleby

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OVERVIEW

• The changing face of alcohol consumption around the world.
• Global alcohol morbidity and mortality.
• The growing burden and impact of alcohol misuse in the developing world.
• The rising health costs of alcohol at home and abroad.

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Alcohol misuse is an issue that expands beyond its physical and psychological consequences. Overconsumption of, and addiction to alcohol, is a global health challenge. The social consequences of alcohol transcend class and its impact at the individual and population levels are of equal importance. At home it is a burden on the NHS budget (Figure 1.1) and abroad an issue that stifles development in resource-poor countries. It is through understanding the nature of excessive consumption that health professionals can act as advocates for the best use of resources at home and abroad.

Figure 1.1 From the alcohol harm map 2013: City of Manchester.

Source: Alcohol Concern ( 2013). Reproduced by permission of Alcohol Concern.

Patterns of consumption

Although the United Kingdom over the past century has never been more than a moderate consumer in terms of the total amount of alcohol drunk per capita, it is nevertheless considered to have one of the more problematic relationships with alcohol, as a result of the drinking patterns and style that have developed. For the first half of the 20th century, the United Kingdom was relatively abstemious, but the decades after the Second World War saw a rapid increase, with per capita consumption almost doubling. This rise was highest within northern regions of the United Kingdom and was a divergence from the downward trend in southern European consumption. More recently the United Kingdom has reason to be positive in terms of alcohol consumption. Since 2008, there has been a downward trend in the proportion of adults drinking. In 1998, 75% of men and 59% of women had consumed alcohol in the week prior to a department of health interview. In 2011 this proportion dropped to 66% (men) and 54% (women). Over the past decade, there has been a 16% decline in the number of children of school age admitting to regular alcohol consumption. Attitudes are also changing, with fewer young people (9% between 2003 and 2010) agreeing that it was acceptable for a person of school age to get drunk. Unfortunately this shift has yet to translate into a reduction in accident and emergency (A&E) attendances in this age group.

Baby boomer boozers

The cohort of problem drinkers in the United Kingdom however is changing rapidly. Costly healthcare impacts of the binge drinking culture of the 1990’s were traditionally associated with 16 to 24 year olds. This demographic have now been surpassed by 55 to 74 year olds, costing £825.6 million in hospital admissions per year, 10 times that of their younger counterparts. This group of middle aged, and often middle-class drinkers, consistently drink above recommended limits and have the greatest complex care needs. Despite rising consumption within this age group (often parents), there has been a parallel decrease in alcohol consumption among young people. The cultural phenomenon of binge drinking remains a pervasive force for young people but is less likely in children with stronger school bonds that are bought alcohol by their parents, rather than their own expendable income (Bellis et al., 2007).

Alcohol and low- and middle-income countries

A large proportion of global alcohol consumption (24.8%) is homemade, produced illegally or sold outside of normal governmental controls. This unrecorded alcohol is much more prevalent in low- and middle-income countries where unregulated production often outweighs regulated brewers. In the eastern Mediterranean region and South East Asia, it amounts to more than 50% of consumption (WHO, 2014). Home-made spirits make up a particularly high proportion of consumption in India. The alcohol consumption rates of early economic development can worsen despite a shift to commercial alcohol production. A review by Riley and Marshall of middle-income countries showed that with economic development, the shift to industrial beverages can lead to more sustained drinking patterns within the population. Thus, alcohol is increasingly being identified as a health challenge that is part of a wider epidemiological shift to a non-communicative disease burden in resource-poor settings.

Currently the highest level of alcohol consumption is found in the high-income Western world (Figure 1.2), but this is partly due to a higher level of abstention across Africa and South East Asia. This hides the fact that regions with high abstention rates in the developing world and low average alcohol intake per capita often have the highest consumption per drinker. Any future reduction in abstention rates worldwide could result in a large increase in the global burden of disease from alcohol.

Figure 1.2 Total alcohol per capita consumption (15+ years; in litres of pure alcohol), 2010.

Source: WHO ( 2014). Reproduced with permission from the World Health Organization.

Morbidity and mortality

That the effects of long-term heavy drinking can be serious and even fatal is generally well known. Less well known is the range of medical conditions to which alcohol contributes (Figure 1.3) and the relatively low levels of consumption at which the risk of harm begins to be important. The relationship between alcohol and health is complex. Alcohol-related disease has a direct dose–response relation: the greater the amount drunk, the more the harm done. This applies to liver cirrhosis, hypertension, and haemorrhagic stroke. Alcohol-attributable disease results from a series of factors that can be ‘related to levels and patterns of consumption but also other factors such as culture, regulation and beverage quality’ (WHO, 2011). These are deaths that would not have happened without the presence of alcohol. In cardiovascular disease a modest beneficial effect had been reported with moderate amounts of alcohol; however, recent research suggests that any benefit had been overestimated and the so-called protective effect is losing favour among experts.

Figure 1.3 Distribution of alcohol-attributable deaths, as a percentage of all alcohol-attributable deaths by broad disease category, 2012.

Source: WHO ( 2014). Reproduced with permission from the World Health Organization.

In 2012, 3.3 million deaths globally were attributable to alcohol (WHO, 2014), which amounts to 5.9% of global deaths in the year. This is greater than the proportion of deaths from HIV/AIDS, violence and tuberculosis combined. The incidence of alcohol-related mortality is highest among men...

Table of contents

• Cover
• Title page
• Table of Contents
• Contributors
• Preface to fifth edition
• Preface to the fourth edition
• CHAPTER 1: Alcohol use: Consumption and costs
• CHAPTER 2: Alcohol use: Society and politics
• CHAPTER 3: Alcohol in the body
• CHAPTER 4: Definitions
• CHAPTER 5: The nature of alcohol use disorders
• CHAPTER 6: The detection of alcohol use disorders
• CHAPTER 7: Medical problems
• CHAPTER 8: Problems in the Emergency Department – and their solutions
• CHAPTER 9: Alcohol and the young person
• CHAPTER 10: Alcohol and the older person
• CHAPTER 11: Alcohol and the liver
• CHAPTER 12: Surgical problems
• CHAPTER 13: Alcohol, maxillofacial trauma and prevention of personal violence
• CHAPTER 14: Neurological and neurosurgical complications of alcohol
• CHAPTER 15: Alcohol and cancer
• CHAPTER 16: Alcohol and the heart
• CHAPTER 17: Drug–alcohol interactions
• CHAPTER 18: Management of acute unplanned alcohol withdrawal
• CHAPTER 19: The role of alcohol care teams in district general hospitals
• CHAPTER 20: Management in primary care
• CHAPTER 21: Advice and counselling
• CHAPTER 22: Psychological treatment and relapse prevention
• CHAPTER 23: Alcohol and psychiatry
• CHAPTER 24: Other resources, and alcohol and the doctor
• Advertisement page
• Index
• End User License Agreement