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Burden of disease

The first topic featuring the Progress in Mind: Focus on Alcohol Use Disorders Resource Centre is the ‘burden of disease’. We have selected content from journal articles and video presentations with associated transcripts and slides to focus on the burden of disease from different perspectives. Alcohol is the most common single risk factor worldwide for men dying before the age of 60, and is the most harmful drug overall. As the speakers explain in their presentations, there are multiple instruments to prevent or reduce the burden of alcohol-related harm. If we want to tackle this massive problem with effective strategies, we need to make use of the complete armamentarium available. Preventive measures, like alcohol prevention and awareness campaigns and pricing and taxation policies should be complementary to treatment interventions. We need to improve early diagnosis and optimize treatment of alcohol use disorders and make better use of the available treatment options. Full awareness of the size of this huge burden is a prerequisite to tackle the problems and to reduce harm to users and others.

  • Association between alcohol and cardiovascular disease

    Michael V. Holmes, Caroline E. Dale, Luisa Zuccolo, Richard J. Silverwood, Yiran Guo, Zheng Ye et al., on behalf of The InterAct Consortium

    BMJ 2014;349:g4164

    Editor's comment:
    The results of this large (more than 260,000 participants) international study challenge the concept of a cardioprotective effect associated with light to moderate alcohol consumption reported in observational studies. In the absence of a viable randomised trial to confirm or refute the cardioprotective effect of light to moderate alcohol consumption, the authors followed an alternative approach in their study, using the ADH1B rs1229984 variant as an instrument to investigate the association of alcohol with cardiovascular biomarkers and events. In the study, individuals with a genetic predisposition to consume less alcohol were found to have a reduced risk of coronary heart disease and ischaemic stroke, and lower levels of several established and emerging risk factors for cardiovascular disease. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.

  • Doing it by numbers: A simple approach to reducing the harms of alcohol

    David J. Nutt and Jürgen Rehm

    Journal of Psychopharmacology 2014, Volume 28, pages 3–7

    Editor's comment:
    The authors present a clear, simple and evidence-based approach to reducing the public and personal harms and costs of alcohol-attributable health damage – a new approach that focuses on numbers, not on disease of diagnosis, and which by this lacks stigmatizing issues. They present a 10-point plan, including an approach focused on quantifying grams of alcohol intake and number of alcohol-free days on the individual user’s side. Governments, for their side, should take alcohol grams as basis for pricing and require the amount of grams of alcohol to be included on bottle label information, and should impose restrictions on the number of places and hours where strong alcohol can be bought. The authors also argue for a widening of treatments and a better use of the existing effective psychosocial and pharmacological treatments. Alcohol should be a public health priority.

  • Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones

    Tina Kold Jensen, Mads Gottschau, Jens Otto Broby Madsen, Anne-Maria Andersson, Tina Harmer Lassen, Niels E. Skakkebæk, Shanna H. Swan, Lærke Priskorn, Anders Juul, Niels Jørgensen

    BMJ Open 2014;4:e005462

    Editor's comment:
    High habitual alcohol intake in young men may affect not only their general but also their reproductive health, as is shown in this study where the authors investigated the association between semen quality and serum reproductive hormones and alcohol consumption in a cohort of 1221 young Danish men. A habitual alcohol intake was found to be associated with a reduction in semen quality already from more than 5 units/week in a typical week although the decreasing trend was most apparent for men with a typical weekly intake above 25 units. Recent alcohol intake was associated with an increase in serum testosterone and reduction in SHBG. No independent adverse effect of binging on semen quality was found. However, it was difficult to separate binging from typical alcohol intake as most young men who binged also had a high habitual alcohol intake. 

  • Do young people with comorbid mental and alcohol disorders experience worse behavioural problems?

    Caroline L. Salom, Kim S. Betts, Gail M. Williams, Jackob M. Najman, James G. Scott, Rosa Alati

    Psychiatry Research 2014, Volume 219, pages 372–379

    Editor's Comment:
    In a study conducted in a large cohort of young women, the authors found that adults with comorbid alcohol/mental health disorders experience more, and more severe, behavioural problems than those with single disorder types, indicating an increased burden from comorbidity, with implications for treatment and public order.

    The authors found that comorbid alcohol and mental health disorders emerge at young adulthood in significant numbers in the general population, and that this comorbidity is strongly associated with increases in internalizing and externalizing behavior problems.

  • Alcohol-attributable fractions for England

    Lisa Jones, Mark A Bellis, Dan Dedman, Harry Sumnall, Karen Tocque

    Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University, June 2008. ISBN: 978-1-906591-35-9 (web...

    Editor's Comment:
    This study conducted in 2005 illustrates the alcohol-related burden of disease with data from England. Attributable fractions (the proportion of disease risk in a population that would not have occurred if exposure to a risk factor or set of factors had not occurred) were calculated for alcohol. Alcohol-attributable fractions (AAFs) were calculated for 47 conditions, of which 13 were by definition wholly attributable to alcohol consumption, and 34 were partially attributable to alcohol consumption. Based on the AAFs calculated, 3.1% of all deaths in England in 2005 were estimated to be attributable to alcohol consumption. Men were more at risk of harm from their alcohol consumption than women; 4.4% of male deaths were alcohol related, compared to 2.0% of female deaths. Young people were disproportionably affected by their alcohol use, for example, among 16–24 year old males, 26.6% of all deaths were estimated to be attributable to alcohol consumption.

    The authors conclude that the 2005 figures of 14,982 deaths and 459,842 hospital admissions in England related to alcohol consumption, given the limitations of the evidence, are a conservative estimate of the harm attributable to alcohol consumption.

  • Drug harms in the UK: a multicriteria decision analysis

    David J Nutt, Leslie A King, Lawrence D Phillips, on behalf of the Independent Scientific Committee on Drugs

    The Lancet, November 6, 2010, Volume 376, pages 1558–1565

    Editor's Comment:
    The findings from the authors’ study lend support to previous work in the UK and the Netherlands, confirming that the present drug classification systems have little relation to the evidence of harm. They also accord with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy. Combining harm to users and harm to others, alcohol-related harms scored the highest of all drugs in this UK study.

  • DSM-IV alcohol dependence and drinking in the U.S. population: A risk analysis

    Raul Caetano, Tammy Tam, Tom Greenfield, Cheryl Cherpitel, Lorraine Midanik

    Annals of Epidemiology November 1997, Volume 7, Pages 542–549

    Editor's Comment:
    This paper examines the relationship between alcohol dependence according to the criteria found in DSM-IV, and drinking in the US general population. In the survey conducted, respondents who reported consuming five or more drinks per day were about six times more at risk of being alcohol dependent than those who did not report such drinking patterns. Studying the appearance of dependence indicators at low levels of drinking may help identifying subgroups of drinkers who may be more sensitive to alcohol and thus more at risk for developing dependence, and may help in understanding more about the course of dependence – how it begins and how it changes with time and amount of drinking. Once the alcohol dependence syndrome is installed, chronically dependent individuals may not need high levels of prolonged periods of consumption to present a full-blown syndrome of dependence.

  • Alcohol consumption and later risk of hospitalization with psychiatric disorders: Prospective cohort study

    Trine Flensborg-Madsen, Ulrik Becker, Morten Grønbæk, Joachim Knop, Leo Sher, Erik Lykke Mortensen

    Psychiatry Research 2011, Volume 187, pages 214–219

    Editor's Comment:
    This study found that women drinking above the sensible drinking limits (in Denmark: 14 drinks per week for women; 21 for men) showed an increase in risk of psychiatric disorders, especially anxiety disorders (a risk of 2.00 compared to women drinking below this limit). The risk function for men was slightly U-shaped, showing an apparent protective effect of drinking alcohol compared to not drinking alcohol. The psychiatric outcome diagnoses used in this study were obtained from hospital records and consequently, the result may not be applicable to mental disorders not leading to hospitalization. The authors speculate that, had the follow-up time been longer, such as 30–40 years, the prevalence of hospitalization with organic disorders, such as alcoholic dementia caused by alcohol, would possibly be higher.

  • Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence

    Georg Schomerus, Herbert Matschinger, Matthias C. Angermeyer

    Psychiatry Research 2013, Volume 209, pages 665–669

    Editor's Comment:
    From a representative population survey conducted in Germany in 2011, the authors found that, contrary to their expectations, associations between continuity beliefs (belief in a continuum of symptoms from mental health to mental illness) and social distance were considerably stronger in alcohol dependence than in depression, although alcohol problems may be considered a highly prevalent and thus presumably familiar disorder. Interestingly, alcoholism was rated as being different to normal experiences in a manner quite similar to schizophrenia. Alcohol dependence is among the most severely stigmatized mental disorders.