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  • A Lancet study suggests moderate alcohol use over time can “significantly shorten your life
  • Experts call for the study’s findings to be widely disseminated and discussed
  • A 2010 Lancet study suggested alcohol is more harmful than heroin or crack cocaine
  • Alcohol related harm is a global epidemic caused by a commercial product
  • There are 3.3m deaths each year caused by alcohol use
  • Policies to reduce the harmful effects of alcohol are palliative rather than preventative
  • A few giant alcohol beverages corporations dominate the global market
  • But 50% of the market is in the hands of informal small-scale producers
  • There is a dearth of reliable information on the alcohol beverages industry
  • Public health research has not kept up with the industry’s ability for innovative marketing
  • British drinkers contribute more in alcohol-related taxes than the direct costs of alcohol-related health and crime issues
  
Moderate alcohol use can kill
 
Just when you thought you knew everything there is to know about the harmful effects of alcohol, a study published in the April 2018 edition of The Lancet, brings new evidence to suggest that even modest alcohol use over time is as dangerous as smoking and can “significantly shorten your life”.  The study reinforces the fact that alcohol-related harm is a ‘global epidemic’ caused by a commercial product, which is aggressively marketed throughout the world. Policies aimed at reducing the harmful effects of alcohol have a limited effect and alcohol use continues to be a significant challenge to medicine and society.  
 
In this Commentary

This Commentary discusses some of the reasons why public policies to limit alcohol use fail to dent the vast and escalating burden caused by alcohol use. We begin by describing the findings of The Lancet 2018 study, which highlights the association between regular modest drinking and early death. The study’s findings motivated healthcare professionals to renew calls for lower limits on alcohol use. A study published in The Lancet in 2010 suggested alcohol is more harmful than heroin or crack cocaine. Public policies to reduce the harmful effects of alcohol use are compromised by the competing interests of the principal industry stakeholders. Such policies tend to be orientated towards the demand side of the market and focus on individual consumers and are less engaged with the supply side and large producers. This results in: (i) public policies that are more palliative than preventative, (ii) alcohol use continuing to be a major healthcare and social challenge, (iii) giant alcohol beverages producers receiving a “free pass”, and (iv) governments enhancing their “political capital” by pointing to the millions spent to correct the drinking habits of vulnerable individuals. This ecosystem is further influenced by: (i) the duty and tax revenues governments collect from alcohol use, (ii) public research failing to keep pace with the sophisticated marketing strategies of large drinks companies, and (iii) well resourced, and smart producers’ marketing strategies out-maneuverering government bureaucracies in endeavours to influence the tastes and preferences of individuals.
 
The Lancet study

The contribution of alcohol use to premature death is less well recognised than the connection between smoking, lung cancer and early death. The Lancet 2018 study helps to redress this by improving on previous meta-analyses to define low-risk drinking thresholds, and to suggest that people who consume more than 7 drinks a week can expect to die sooner than those who drink less. According to a February 2018 World Health Organization (WHO) report, an estimated 3.3m people a year worldwide die as a result of alcohol misuse. The harmful effects of alcohol ranks among the top 5 risk factors for disease, disability and death globally, and alcohol misuse is the 5th leading risk factor for premature death and disability worldwide. Most people who die because of their drinking patterns are not alcoholics, but are people who drink regularly over a number of years.
 
The Lancet 2018 study is significant because of its size and methodological robustness.  There is a high degree of comparability in the datasets used by the authors, which combined data from 83 previous studies undertaken in 19 countries, which yielded a cohort of 600,000 current drinkers for analysis. The previous studies used by the researchers to attain their cohort employed similar methods to quantify alcohol use, cardiovascular risk factors, and cardiovascular disease outcomes and cause-specific deaths. All participants in the cohort were from developed industrial economies, displayed similar patterns of alcohol use and none had a known history of cardiovascular disease.
 
The study’s findings imply that drinking alcohol is as harmful as smoking and suggest that there is a significant increase in all causes of death when more than 100g of alcohol (equivalent to about 4 large glasses of wine) is consumed weekly over a period of time. Every glass of wine or pint of beer over the daily recommended limit - the upper “safe” limit in the UK is 5 standard 175ml glasses of wine or 5 pints of beer a week - will cut 30 minutes from the expected lifespan of a 40-year-old and increase the risk of stroke, fatal aneurysm (a ruptured artery in the chest), heart failure and death. A 40-year-old who drinks up to twice that amount (200g or 8 large glasses of wine per week) will shorten their life expectancy by 6 months. Drinking between 200g and 350g (8 to 20 large glasses of wine) a week will reduce their life expectancy by 1 to 2 years, and 40-year-olds who drink more than 350g (>20 large glasses of wine) a week over a period, shorten their lives by 4 to 5 years.
 
Lowering the recommended limits of alcohol consumption
 
According to Angela Wood, from the University of Cambridge in the UK and lead author of the 2018 study, “The key message of this research for public health is that, if you already drink alcohol, drinking less may help you live longer and lower your risk of several cardiovascular conditions.” Although moderate drinking is commonly associated with reducing your chance of a non-fatal heart attack, “This must be balanced against the higher risk associated with other serious, and potentially fatal cardiovascular diseases,” says Wood. According to the researchers the study’s findings support, “limits for alcohol consumption that are lower than those recommended in most current guidelines [and add] long-term reduction of alcohol consumption from 196g per week (the upper limit recommended in US guidelines) to 100g per week or below was associated with about 1–2 years of longer life expectancy at age 40 years”. Co-author Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow’s Institute of Cardiovascular and Medical Science in Scotland said: "This study provides clear evidence to support lowering the recommended limits of alcohol consumption in many countries around the world."

 
Experts call for lower limits on alcohol use

Commenting on the study’s findings, Tim Chico, Professor of Cardiovascular Medicine at the University of Sheffield,UK, said, smokers lose on average 10 years of their life. “However, we think from previous evidence that it is likely that people drinking a lot more than 43 units (about 14 large glasses of wine a week) are likely to lose even more life expectancy, and I would not be surprised if the heaviest drinkers lost as many years of life as a smoker. . . The study makes clear that on balance there are no health benefits from drinking alcohol, which is usually the case when things sound too good to be true.”

In a commentary in the same edition of The LancetJason Connor and Wayne Hall both professors from the University of Queensland Centre for Youth Substance Abuse Research in Australia, anticipated that the suggestion to lower recommended drinking limits would be opposed by giant alcohol beverages corporations. “The drinking levels recommended in this study will no doubt be described as implausible and impracticable by the alcohol industry and other opponents of public health warnings on alcohol. Nonetheless, the findings ought to be widely disseminated and they should provoke informed public and professional debate,” say Connor and Hall.

 
A 2010 study published in The Lancet claims alcohol is more harmful that heroin

In the November 2010 edition of The Lancet David Nutt, Professor of Neuropharmacology at Imperial College London and co-author of the study suggested that alcohol is more harmful than heroin or crack cocaine when the overall dangers to the individual and society are considered. Nutt was the clinical scientific lead on the 2004-5 UK Government Foresight initiative “Brain science, addiction and drugs”. The Lancet 2010 study suggested that if drugs were classified on the basis of the harm they do, alcohol would be a class ‘A’ drug, alongside heroin and crack cocaine. In 2006 Nutt was dismissed for challenging the UK Government’s refusal to take the advice of the official Advisory Council on the Misuse of Drugs,  which he then chaired.

In answer to The Lancet 2010 study a UK government Department of Health spokesperson said: "In England, most people drink once a week or less. If you're a woman and stick to 2 to 3 units a day, or a man and drink up to 3 or 4 units, you are unlikely to damage your health".
No agreed international limits for alcohol use
 
The reality is that there are no internationally agreed limits on alcohol use and current recommended limits vary significantly between nations. In a study published in the June 2012 edition of the Drug and Alcohol Review  researchers from the University of SussexUK, examined government issued guidelines on alcohol limits in 57 countries and found, “a remarkable lack of agreement about what constitutes harmful or excessive alcohol consumption on a daily basis, a weekly basis and when driving”.

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Alcohol use and dementia

In 2016 the UK Government updated its 1995 guidelines  for limits on alcohol use and recommended that neither men nor women should drink more that 14 units of alcohol per week. A unit in the UK is equivalent to 8g of pure alcohol. This means British men are now being told they should drink less than those in Ireland (21.2 British units), Denmark (21), New Zealand (19) and considerably less than the recommended upper limit for men in Spain (35).
 
 
The supply side of the alcohol industry

Current public policies and industry pledges
Although public policies to reduce the harmful effects of alcohol use are aimed at both the individual and population levels, they tend to orientate towards individual problem drinkers. Among the most effective policy options are alcohol taxes, restrictions on alcohol availability and drink-driving countermeasures. The giant alcohol beverages corporations advocate responsible drinking and pledge their commitment to, “supporting balanced initiatives that are linked to their core business functions and those that address wider social and public health issues, relying on initiatives that are evidence based, culturally sensitive, and collaborative.” The drinks producers support the WHO’s Global Strategy to reduce the harmful Effects of Alcohol, and are committed to: (i) reducing under-age drinking, (ii) strengthening and expanding marketing codes of practice, (iii) providing consumer information and responsible product innovation, (iv) reducing drinking and driving, and (v) enlisting the support of retailers to reduce harmful drinking.  

Growth of service economies and the importance of individual preferences
Despite public policies and industry pledges to limit alcohol use, the large and escalating burden of alcohol problems continue to present significant challenges to medicine and public health. In part, this is because population-based public health policies tend to be overlooked in favour of policies oriented towards individual drinkers. This orientation can be explained by globalization.
 
Over the past 40 years globalization has shifted the economic base of developed nations from manufacturing to services, which places greater emphasis on consumer markets and individual preferences. In such a context, efforts to reduce the harmful effects of alcohol use are mainly focused on the demand side of the market, emphasising individual behaviours and preferences; and less focused on the supply side, which is dominated by producers. As a consequence, public policies to limit alcohol use tend to focus on the choices of vulnerable individual drinkers and call for responsible drinking. In effect this provides producers with a “free pass” to pursue and develop their strategies to sustain consumption.
 
50% of alcohol production is in the hands of “informal” small producers
Shifting the policy emphasis to focus equally on the demand and supply side of the alcohol beverages market is not straightforward. Although nearly half of the of the world's alcohol supply is dominated by giant producers, more than 50% is in the hands of ‘informal’ home and local producers. At the national level the industry comprises large and small beer, wine or spirit producers or importers, as well as bars, restaurants and a variety of retail outlets, which markets alcohol to the public. These players have diverging interests as well as interests in common in regard to policy frameworks. There is a dearth of reliable information on the industry and the principal sources of information come from market research firms and business journalism.  
 
Large global fast-growing market
The alcohol beverages market is large, global and fast growing. According to an April 2018 report by Transparency Market Research, in 2017 the market was worth US$1,205bn and is expected to expand at a CAGR of 6.4% and reach US$2,000bn by the end of 2025. Recent consolidation in the industry puts a significant and increasing proportion of alcohol production, distribution and marketing in the hands of a few giant corporations, which dominate national, regional and global markets and wield considerable political influence. Mergers and acquisitions are expected to continue, so the consolidation of the industry is expected to continue.

The market is driven by increasing urbanization, the global young-adult demographic, high and growing disposable incomes and increasing consumer demand for premium and super premium beverages. The latest figures suggest that the average alcohol use in the UK is about 9.7 litres per adult, which compares with 8.8 litres for adults in 34-member countries of the Organisation for Economic Co-operation and Development  (OEDC), and ranks the UK 16th out of the OEDC countries. Since 1970, alcohol consumption has decreased by an average of 15% across OEDC countries, while in the UK it has risen 14% over the same period. Alcohol use has declined 69% in Italy, 48% in France, 36% in Spain and 30% in Germany, but has increased 51% in Ireland. Consumption of alcohol per head in the UK has fallen by about 17% since its recent peak in 2004. But that followed a steep rise.

A study reported in 2015 in the International Journal of Advertising suggests that advertising has little impact on how much we drink, but it is effective at influencing what we drink. ‘Premiumization’ is a term used in the industry to describe how spirit brands have had success convincing consumers that they should drink “higher quality” and more expensive beverages. An example of this is the recent boom in the sale of gin, which corresponded with the industries premiumization strategies that linked gin with “fashionable” early 20th century style.
 
UK alcohol taxes far exceed the costs to public services
 
The “free-pass” enjoyed by alcohol beverages corporations is strengthened by the relative lack of public scrutiny they receive. This might be partly explained by the fact that governments benefit significantly from alcohol related taxes and duty. Consider Britain. In 2016 the UK government made nearly £3.4bn in tax revenue from spirits; beer sales made the UK government £3.3bn in 2017. Some 60% of the price of a pint of beer is taken in VAT and alcohol duty, while VAT on the price of a bottle of gin is 76%. Wine is the biggest earner for the UK exchequer yielding over £4bn in taxes from sales in 2016. These sums accord with a September 2015 Institute of Economic Affairs (IEA) study on alcohol taxes, which suggests that the annual revenue generated from alcohol taxes in the UK is  “illogical and excessive.”  Rather than tax alcohol the UK government taxes drinks. For instance, a unit of alcohol is taxed at 28p if it happens to be in a glass of whisky but only 8p if it is in a pint of cider. Further, if the cider is strong, the tax is 7p but if it is fizzy the tax is 34p. The tax on a unit of alcohol in a glass of wine is 20p, but if wine is sparkling, the tax is 25p. Confused? The structure of alcohol excise taxes is partly restricted by an EU Directive, which sets out different tax rates for different alcoholic beverages.

Revenues from UK alcohol taxes and duty far exceed the actual direct costs of alcohol-related health and crime issues. According to the IEA study, the UK exchequer collects about £10bn a year in alcohol taxes while the direct costs of alcohol related problems to the health, police, prison services, welfare system and judiciary, amount to some £4.6bn per year. Although studies that report cost-of-alcohol data are notoriously unreliable, the IEA suggests that British drinkers contribute about £6.5bn each year to the UK exchequer and believes that, even within the current constraints, the UK tax system could more effectively target problem drinking. In a February 2017 paper the IEA describes a suggested reform of the UK’s alcohol tax policy.

 
Takeaways
 
Findings of the 2018 study published in The Lancet suggest that risks from alcohol start from any level of regular drinking and rise with the amount being consumed and any amount of regular alcohol use can significantly shorten your life. This echoes a 2010 study also published in The Lancet, which suggested that because alcohol is so widely available it is more harmful than heroin and crack cocaine.

This commentary reaffirms the global epidemic of disease, injury, social problems and death caused by alcohol and suggests an explanation why for decades governments have failed to effectively limit alcohol use.
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Philip Helliwell

Associate Professor in Rheumatology, University of Leeds, UK; Honorary Consultant Rheumatologist, Leeds Teaching Hospitals and Bradford Teaching Hospitals NHS Trust

Philip Helliwell is currently Associate Professor in Rheumatology at the University of Leeds, UK, and Honorary Consultant Rheumatologist for the Leeds Teaching Hospitals and Bradford Teaching Hospitals NHS Trust.

Dr Helliwell qualified in Oxford in 1972 and worked initially in London before returning to work in his native Yorkshire in medical physics. After a period working in Australia and New Zealand he returned in 1985 to Leeds to join Prof Verna Wright and to work on psoriatic arthritis and biomechanics.

Dr Helliwell is a member of ASAS (Assessment of Spondyloarthropathy Society) and co-founder and President of the Group for Research and Assessment of Psoriasis and Psoriatic arthritis (GRAPPA). He established and led the CASPAR study for classification of psoriatic arthritis. He has worked with GRAPPA in developing single and composite outcome measures in psoriatic arthritis and completed the first treat to target strategy study (TICOPA) in early psoriatic arthritis.

He is co-founder and co-lead for the Bradford (University) Diploma in Rheumatology and Musculoskeletal Medicine and is an active member of the Bradford and Airedale Musculoskeletal Alliance, a tier 2 service provided to GPs in the designated geographical area.

Dr Helliwell is co-founder of the Leeds foot and ankle studies group and has published widely on foot and ankle problems in inflammatory arthritis including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. He has contributed to several guidelines on management of foot and ankle problems in the UK.

Dr Helliwell has published over 300 peer reviewed papers. Current and past research in psoriatic arthritis includes treatment paradigms, clinical features and classification of psoriatic arthritis and community based studies of psoriasis and psoriatic arthritis. He has also published on biomechanics of joints, gait assessment and foot disorders in inflammatory and non-inflammatory arthritis, and epidemiology of rheumatic diseases.


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  • 'Drunkorexia' is a growing and dangerous trend among young people to eat less, purge or exercise excessively before binge drinking
  • Purging prior to drinking includes vomiting, laxatives or self-starvation
  • The intention is to save calories for binge-drinking
  • 41% of 18 to 24 year olds in a 2016 survey of 3,000 say they are not concerned about their overall health
  • Health providers are wasting millions on traditional healthcare education
  • Experts say we need to rethink how to encourage people to assume greater personal responsibility and accountability for their health
  • Healthcare providers have failed to leverage ubiquitous technologies and people’s changed lifestyles to engage and educate patients
  • To reduce the burden of drunkorexia healthcare providers will need to gain a better understanding of patients’ behaviors and ubiquitous 21st century technologies

Drunkorexia: a devastating and costly growing condition
 
Drunkorexia is using extreme weight control methods as a means to compensate for planned binge drinking. The French refer to it as alcoolorexie: l'ivresse sans les kilos. Manger moins pour être ivre plus vite et ne pas trop grossir. Drunkorexia is a term coined by the media to describe the combination of disordered eating and heavy alcohol consumption. The condition is gaining recognition in the fields of co-occurring disorders (people who have both substance use and mental health disorders), psychiatry, and addictionology. The term attempts to reconcile 2 conflicting cultures: binge drinking and a desire to be thin. The former involves ingesting significant amounts of unwanted extra calories, so people starve themselves in preparation for a night out drinking. Drunkorexia results in significant human costs from hypoglycaemia, depression, memory loss, and liver disease, and substantial and unnecessary costs to healthcare providers.
 
Experts argue that traditional methods to lower the burden of drunkorexia cost millions and are failing, and suggest there is an urgent need to, “rethink how we try and engage with people and try and encourage them to assume greater personal responsibility and accountability for their health.” This Commentary describes drunkorexia, reports some research findings on the condition, and suggests health providers would lower the large and growing burden of drunkorexia by leveraging ubiquitous technologies such as the Internet and smartphones.
 
Not an officially medical diagnosis

Drunkorexia is not an officially recognized medical condition. There is no mention of it in Mediline Plus, the US National Institutes of Health's online medical information service produced by the National Library of Medicine. It is not mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association, and popularly known as  “The Psychiatrist’s Bible”. Neither is the condition included in the World Health Organization's International Classification of Disease; nor in WebMD, the UK’s NHS online, NHS Choices, and the UK’s General Medical Council’s (GMC) website.
Signs and symptoms
 
Signs and symptoms include calorie counting to ensure no weight is gained when binge drinking, missing meals to conserve calories so that they can be spent on the consumption of alcohol, over-exercising to counterbalance calorie intake, and binge drinking to vomit previously digested food.

A dangerous condition

Despite evidence to suggest that more people are turning away from alcohol and becoming teetotallers, the prevalence of drunkorexia is increasing.

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Orthorexia: when eating healthily becomes unhealthy

It is a dangerous trend, especially among young people, which can lead to an array of physical and psychological consequences. For example, drinking in a state of malnutrition can predispose you to a higher rate of blackouts, alcohol poisoning, alcohol-related injury, violence, or illness. Drinking on an empty stomach allows ethanol to reach the blood system more rapidly, and raises your blood alcohol content often with dangerous speed. This can render you more vulnerable to alcohol-related brain damage. In addition, alcohol abuse can have a detrimental impact on hydration and your body's retention of minerals and nutrients, further exacerbating the consequences of malnutrition, and damaging your cognitive faculties. This can lead to short and long-term cognitive problems, including difficulty concentrating and making decisions, which ultimately can have a negative impact on academic and work-related performance. Drunkorexia also increases the risk of developing more serious eating disorders and alcohol abuse problems. As binge drinking is involved there is also a greater risk of violence, of risky sexual behavior, alcohol poisoning, substance abuse and chronic disease later in life.
 
Research

Although much of the research on drunkorexia is focused on university students, the condition is believed to be more widely spread. A challenge for researchers is the attitudes of university administrators and parents who are reluctant to admit that there is a problem either in their institutions or homes. The condition is often dismissed as a rite-of-passage. Notwithstanding, there have been a number of research studies, which suggest that drunkorexia is significant, growing fast and dangerous.
 
University of Missouri study

A 2011 University of Missouri study of the relationship between alcohol misuse and disordered eating, including calorie restriction and purging, suggests that drunkorexia is predominately a young women’s condition, which could affect their long-term health. The study found that 16% of respondents reported restricting calories to "save them" for drinking. 67% of students who restrict calories prior to binge drinking did so to prevent weight gain, while 21% did so to facilitate alcohol intoxication. 3 times as many women reported engaging in the behavior than men, and their stated motivations included “preventing weight gain”, “getting intoxicated faster” and “saving money”, which could be either spent on food or to buy alcohol. According to Victoria Osborne, Professor of Social Work and Public Health at the university, and lead author of the study, drunkorexia can have dangerous cognitive, behavioural and physical consequences. It also puts people at risk for developing more serious eating disorders or addiction problems.
 
Australian study

In an Australian context, a 2013 study surveyed 139 female university students, aged between 18 and 29 to examine compensatory eating and behaviors in response to alcohol consumption to test for drunkorexia symptomatology. 79% of respondents engaged in characterized drunkorexia behavior. The study also found that social norms of drinking, and the social norms associated with body image and thinness, impacted significantly upon the motivation for these behaviors.
 
University of Houston study

Findings of a University of Houston study on drunkorexia presented at the 2016 annual meeting of the Research Society on Alcoholism in New Orleans, found that 80% of the 1,200 students surveyed had at least one heavy night of drinking in the previous month, and engaged in drunkorexic behavior. The methods of purging prior to drinking include vomiting, use of laxatives or missing meals. The study also reported that the condition is not limited to the US, and is present in both men and women.
 
Benenden’s National Health study
 
Healthcare group Benenden’s 2016 National Health Report suggests that drunkorexia is gaining ground among young people in the UK, and creating concerns among healthcare professionals. According to the study, young people in the UK prefer to eat less in order to “save” calories for alcohol consumption. Of the 3,000 people surveyed, 2 out of 5 (41%), between the ages of 18 and 24 said they eat healthily only to look good, but are not concerned about their overall health. According to the report, “Pressure to be slim, an awareness of exercising calorie control, and peer pressure to drink large amounts of alcohol are all factors in this phenomenon”, adding that a growing number of men are following this trend.

Survey participants were also asked general questions about healthy lifestyles. “By and large, the findings highlight that the public is in denial about how much they think they know about healthy eating, they claim to be near-experts, but when drilling down to real-life examples, the vast majority of respondents failed to choose the right answer to simple diet-related questions, or the healthier option when offered the choice between everyday food and drinks,” the report found.
 
There also seems to be a woeful lack of awareness about basic dietary advice, despite legislation and attempts by the food production and manufacturing industry. It isn't clear whether this is down to poor education or a lack of interest, but I think we need to rethink how we try and engage with people and try and encourage them to assume greater personal responsibility and accountability for their health," says Dr John Giles, Benenden’s medical director.

Traditional healthcare providers failing

Traditional healthcare providers continue to waste billions on failing traditional methods of engaging and educating patients. Increasing self-management of your health is relevant, especially as primary care resources are shrinking as the prevalence of drunkorexia is rapidly increasing. However, achieving effective education and self-management requires a fundamental transformation of the way healthcare is delivered. The majority of people living with drunkorexia regularly use their smartphones for 24-hour banking, education, entertainment, shopping, and dating. Health providers have failed to effectively leverage this vast and rapidly growing free infrastructure and people’s changed lifestyles to introduce effective educational support systems to enhance the quality of drunkorexia care, increase efficiency, and improve patient outcomes. Today, mobile technology is part of everyday life and people expect to be connected with their relevant healthcare providers 24-7, 365 days of the year from anywhere. 

Takeaways

A necessary pre-requisite for effective healthcare education to reduce the burden of drunkorexia is the actual engagement of people with the condition. Once patients are engaged, education should inform and empower people, and provide them with access to continuous self-management support. This is substantially different to the way traditional healthcare education is delivered as it transforms the patient–educator relationship into a continuous, rich, collaborative partnership. 
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Created by: szymon urynowicz
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What causes breast and oral cancer, heart disease, strokes, liver cirrhosis, depression, memory impairment and reduced fertility? . . . . . . . . Alcohol.

More dangerous than heroine

NHS figures show that alcohol related hospital admissions peaked in 2010 when over a million people were admitted. Alcohol Concern predicts that by 2015, the annual number of hospital admissions due to alcohol will reach 1.5m, and cost the NHS £3.7bn a year. A 2010 study in The Lancet suggests that alcohol is more dangerous than heroine. A study by the Independent Scientific Committee on Drugs agrees, and ranks alcohol as three times more harmful than cocaine or tobacco.

The WHO's 2014 Global Status Report on Alcohol and Health said that in 2012 there were 3.3m alcohol related deaths worldwide, and called on governments to implement policies to reduce the harmful use of alcohol.
 
 
˜Yes minister" government response
The UK government guidelines on drinking are being reviewed. Currently, they suggest hat a women should not drink more than two to three units of alcohol per day, and a man three to four units. But medical experts argue that people don't realise how much they're drinking.

Liver
Although the toxicity of alcohol is complex, there's a significant relationship between the greater the alcohol intake per week, and the greater the liver damage.  Over the past 25 years, UK deaths from liver disease have increased by 500%; the overwhelming majority alcohol related. Only in the last few years has this increase slowed. Alcohol has a bigger impact than smoking on health because alcohol kills at a younger age. The average age of death for someone with alcoholic liver disease is their 40s.

Heart
Moderate alcohol consumption raises good cholesterol, stops the formation of blood clots in the arteries, and helps protect against heart disease. Drinking more than three drinks a day has a direct and damaging effect on the heart. Heavy drinking, particularly over time, can lead to high blood pressure, alcoholic cardiomyopathy, congestive heart failure and stroke. Heavy drinking also puts more fat into the circulation of the body, which is dangerous for the heart.
 
Cancer
The link between alcohol and cancer is well established. Cancer occurs when DNA is altered. Acetaldehyde is a toxic created when alcohol in the liver is broken down by an enzyme, and has been shown to damage DNA. When you drink, the acetaldehyde corrupts DNA. One of the most common genetic defects in man is our inability to counteract the toxicity of alcohol.
 
A 2011 study published in the British Journal of Medicine estimates that alcohol consumption causes at least 13,000 cancer cases in the UK each year. Cancer experts say that for every additional 10g per day of alcohol drunk, the risk of breast cancer increases by approximately seven to 12%.

Other conditions
Studies also show that increasing alcohol intake by 100g per week increases bowel cancer risk by 19%. A recent report in BioMed Central's Immunology Journal found that alcohol impairs the body's ability to fight off viral infections. Studies on fertility suggest that even light drinking can make women less likely to conceive while heavy drinking in men can lower sperm quality and quantity.

Takeaway
It's time for governments to implement policies to reduce the harmful effects of alcohol.
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