1. Does alcohol increase the risk of social harms and harms to others? Alcohol increases the risk of a wide range of social harms in a dose dependent manner, with no evidence for a threshold effect. For the individual drinker, the higher the alcohol consumption, the greater is the risk. Harms done by someone else's drinking range from social nuisances such as being kept awake at night through more serious consequences such as marital harm, child abuse, crime, violence and ultimately, homicide. Generally the more serious the crime or injury, the more likely alcohol is to be involved. Harm to others is a powerful to reason to intervene for hazardous and harmful alcohol consumption.
2. Does alcohol increase the risk of ill-health? Apart from being a drug of dependence, alcohol is a cause of 60 or so different types of disease and injury, including injuries, mental and behavioural disorders, gastrointestinal conditions, cancers, cardiovascular diseases, immunological disorders, skeletal diseases, reproductive disorders and pre-natal harm. Alcohol increases the risk of these diseases and injuries in a dose dependent manner, with no evidence for a threshold effect. The higher the alcohol consumption, the greater is the risk.
3. Does alcohol reduce the risk of heart disease? A small dose of alcohol consumption reduces the risk of heart disease, although the exact size of the reduction in risk and the level of alcohol consumption at which the greatest reduction occurs is still debated. Better quality studies and those that account for possible influencing factors find less of a risk, and at a lower level of alcohol consumption. Most of the reduction in risk can be achieved by an average of 10g of alcohol every other day. Beyond 20g of alcohol a day the risk of coronary heart disease increases. It appears to be alcohol that reduces the risk of heart disease rather than any specific beverage type. Drinking larger amounts of alcohol on one occasion increase the risk of cardiac arrhythmias and sudden coronary death.
4. Is the consumption of alcohol risk free? The risk of death from alcohol is a balance between the risk of diseases and injuries that alcohol increases and the risk of heart disease that in small amounts alcohol decreases. This balance shows that, except for older people, the consumption of alcohol is not risk free. The level of alcohol consumption with the lowest risk of death is zero or near zero for women under the age of 65, and less than 5g of alcohol a day for women aged 65 years or older. For men, the level of alcohol consumption with the lowest risk of death is zero under 35 years of age, about 5g a day in middle age, and less than 10g a day when aged 65 years or older.
5. What determines hazardous and harmful drinking and dependence on alcohol? Genes play a role in the risk of harmful alcohol use and alcohol dependence, with some genes increasing the risk and other genes decreasing the risk. There is an interaction between genes and the environment, and people who drink more alcohol or who live in an environment in which more alcohol is drunk are those who are at increased risk of alcohol-related ill health. At any given level of alcohol consumption, women appear to be at increased risk, with differing sizes of risk with different illnesses. This is probably due to the fact that women have a lower amount of body water per weight than do men. Up to one quarter of the increased risk of death in middle aged men in lower socio-economic groups than in higher socio-economic groups may be due to alcohol.
6. How important is alcohol as a cause of ill-health? Throughout the European Union as a whole, alcohol is one of the most important causes of ill-health and premature death. It is less important than smoking and raised blood pressure, more important than high cholesterol levels and overweight.
7. Does reducing alcohol use lead to improvement in health? There are health benefits from reducing or stopping alcohol consumption. All acute risks can be completely reversed if alcohol is removed. Even amongst chronic diseases, such as liver cirrhosis and depression, reducing or stopping alcohol consumption are associated with rapid improvements in health.
1. Since alcohol is implicated in a very wide variety of physical and mental health problems in a dose dependent manner, there is an opportunity for all primary health care providers to identify all adult patients with hazardous and harmful alcohol consumption.
2. Since primary health care involves the treatment of many common physical and mental conditions, their causes in the use of alcohol need to be addressed and managed. It is of particular importance to reduce the risk of harm to others.