The Risks Associated with Alcohol Use and Alcoholism

By Rehm, Jurgen | Alcohol Research, Fall 2011 | Go to article overview

The Risks Associated with Alcohol Use and Alcoholism


Rehm, Jurgen, Alcohol Research


Alcohol consumption has been identified as an important risk factor for illness, disability, and mortality (Rehm et al. 2009b). In fact, in the last comparative risk assessment conducted by the World Health Organization (WHO), the detrimental impact of alcohol consumption on the global burden of disease and injury was surpassed only by unsafe sex and childhood underweight status but exceeded that of many classic risk factors, such as unsafe water and sanitation, hypertension, high cholesterol, or tobacco use (WHO 2009). This risk assessment evaluated the net effect of all alcohol consumption--that is, it also took into account the beneficial effects that alcohol consumption (primarily moderate consumption) can have on ischemic diseases (1) and diabetes (Baliunas et al. 2009; Corrao et al. 2000; Patra et al. 2010; Rehm et al. 2004). Although these statistics reflect the consequences of all alcohol consumption, it is clear that most of the burden associated with alcohol use stems from regular heavier drinking, defined, for instance, as drinking more than 40 grams of pure alcohol per day for men and 20 grams of pure alcohol per day for women (2) (Patra et al. 2009; Rehm et al. 2004). In addition to the average volume of alcohol consumption, patterns of drinking--especially irregular heavy-drinking occasions, or binge drinking (defined as drinking at least 60 grams of pure alcohol or five standard drinks in one sitting)--markedly contribute to the associated burden of disease and injury (Gmel et al. 2010; Rehm et al. 2004). This article first defines which conditions necessarily are caused by alcohol use and for which conditions alcohol use is a contributing factor. It then looks more closely at the most common disease risks associated with excessive alcohol use, before exploring how these risks have influenced guidelines for drinking limits. The article concludes with a discussion of the alcohol-related risk of harm to people other than the drinker.

DISEASE AND INJURY CONDITIONS ASSOCIATED WITH ALCOHOL USE

Conditions for Which Alcohol Is a Necessary Cause

More than 30 conditions listed in the WHO's International Classification of Diseases, 10th Edition (ICD-10) (WHO 2007) include the term "alcohol" in their name or definition, indicating that alcohol consumption is a necessary cause underlying these conditions (see table 1). The most important disease conditions in this group are alcohol use disorders (AUDs), which include alcohol dependence and harmful use or alcohol abuse. (3) AUDs are less fatal than other chronic disease conditions but are linked to considerable disability (Samokhvalov et al. 2010d). Overall, even though AUDs in themselves do not rank high as a cause of death globally, they are the fourth-most disabling disease category in low- to middle-income countries and the third-most disabling disease category in high-income countries (WHO 2008). Thus, AUDs account for 18.4 million years of life lost to disability (YLDs), or 3.5 percent of all YLDs, in low- and middle-income countries and for 3.9 million YLDs, or 5.7 percent of all YLDs, in high-income countries. However, AUDs do not affect all population subgroups equally; for example, they mainly affect men, globally representing the second-most disabling disease and injury condition for men. In contrast, AUDs are not among the 10 most important causes of disabling disease and injury in women (WHO 2008).

Alcoholic liver disease and alcohol-induced pancreatitis are other alcohol-specific disease categories that are of global importance. However, no global prevalence data on these disease categories exist because they cannot be validly assessed on a global level. Thus, these conditions are too specific to assess using verbal autopsies and other methods normally used in global-burden-of-disease studies (Lopez et al. 2006; Rajaratnam et al. 2010). Nevertheless, the prevalence of alcohol-attributable liver cirrhosis and alcohol-induced pancreatitis can be estimated indirectly via the prevalence of alcohol exposure and relative risk for the wider, unspecific disease categories (Rehm et al. …

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