Prof Frank Murray

Registrar RCPI

Consultant Gastroenterologist/Hepatologist, Beaumont Hospital/RCSI,

Dublin 9

Alcohol in Ireland.Major health burden.

Major economic burden.Major opportunity.

Policies that reduce the availability of alcohol though:

Price increasesor

Reducing outlets and hours of sale

Have been shown to be effective

• Europe is the heaviest drinking region in the world

• Alcohol is the main cause of liver disease in Europe

• The prevalence of alcoholic liver disease is rising in Ireland

Problems addressing the alcohol problem in Ireland!!!!

• Drinking alcohol can be harmless, in contrast to cigarettes

• Alcohol is strongly rooted in our society

• The alcohol industries receive the majority of their turnover in UK from harmful and hazardous drinkers

Alcohol in Europe

• Europe is the highest drinking region in the world

• 200,000 deaths per year

• Cost €125 billion per year. 1.3% of GDP

• Third commonest cause of premature death and disability

• Main cause of liver disease and death

DALY (Disability adjusted life year)

• The sum of the life years lost due to premature death or years lived in disability

Alcohol cause huge health problems

• WHO:– 4% of global mortality– 5% of global DALY

• Europe worse– 7% mortality– 12% of DALY

Alcohol cause huge health problems

• Worse in males: 17% of DALYs( vs 4%)

• Worst in young males

• Alcohol cause 35% of deaths aged 35-50

Alcohol responsibility for many youth deaths

• 25% of male

• 10% of female

Major disease burdens attributable to alcohol

Main cause of alcohol DALY

• Liver disease

• 75% men

• 85% women

• There is a direct correlation between amount of alcohol consumed and cirrhosis mortality

Cirrhosis and

Portal Hypertension

Cirrhosis and

Portal Hypertension

CIRRHOSIS AND PORTAL HYPERTENSION

60604040 8080 100100 120120 140140 16016000

4040

6060

8080

2020

202000

100100

MonthsMonths

Probability of survival

Probability of survival

All patients with cirrhosisAll patients

with cirrhosis

Decompensated cirrhosis

Decompensated cirrhosis

180180

Decompensation in cirrhosis Shortens Survival

Decompensation in cirrhosis Shortens Survival

Gines et. al., Hepatology 1987;7:122Gines et. al., Hepatology 1987;7:122

Median survival~ 9 years

Median survival~ 9 years

Median survival~ 1.6 years

Median survival~ 1.6 years

SURVIVAL TIMES IN CIRRHOSIS

Mortality due to cirrhosis in Ireland

There is a big human cost here

• Ill and dying patients

• Often young

• Often little opportunity to change

• Families

Does not end there

• Absenteeism

• Loss of professional performance

• Domestic violence

• Unhappiness

3 main types of alcohol misuse

• Hazardous

• Harmful

• Dependent drinking.

Hazardous drinking

• Drinks over the recommended weekly limit of alcohol

• 21/17 units for men and

• 14/11 units for women.

• It is also possible to drink hazardously by binge drinking, even if within weekly limit.

Harmful drinking

• Drinks more than the recommended weekly maximum amount of alcohol and experiences health problems that are directly related to alcohol.

• Cirrhosis • depression • an alcohol-related accident, such as a head injury• acute pancreatitis (inflammation of the pancreas)• high blood pressure• some types of cancer • heart disease

Dependent drinking

• Both physically and psychologically addictive• Become dependent on it• Feels unable to function without alcohol• Consumption of alcohol becomes an

important, or sometimes the most important, factor in their life

• Can experience withdrawal symptoms (both physical and psychological) if they suddenly stop drinking alcohol.

Binge drinking

• 4 (female)• 5 (male) • units in 2h

– or

• 8 (male)• 6 (female)• units in 24 hours

• Rapidly increasing in prevalance

So most alcohol consumption is mostly drunk safely?…..

• 75% of alcohol consumed in UK is by hazardous and harmful drinkers in the UK

Absolute risk of death from alcohol-related disease

Adult alcohol consumption

Heavy episodic drinking of at least 60g of pure alcohol in last 7 days (women)

Irish consumption

• 11.9 litres of alcohol per adult (>15y) in 2010

• Over half Irish drinkers have a harmful drinking pattern

• Much more affordable

Irish costs of alcohol

• €3.7 billion

• Healthcare €1.2 billion (8% of total)

• Approx 2,000 hospital beds per night

• 7% of GP costs• 30% of Emergency Department costs

Fundamental problem in Ireland

• Too much alcohol

• Binge drinking

• Availability

• Number of outlets

• Opening hours

Availability

Supermarkets

• Promotions

• Special offers

• Packaging in larger units

• Not quarantined, all over the shop

Concerts

Sports sponsorship

Under-age drinking

Marketing towards young people

Options

• Do nothing

• Do “something”

• Take thought-through series of steps. Leads to immediate health social and political gains

Systematic reviews and meta-analyses.Proven policies.

• Policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm.

• Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm.

Key messages

A substantive evidence base of systematic reviews and meta-analyses inform alcohol policy

Making alcohol more expensive and less available are highly cost-effective strategies to reduce harm

• Banning of alcohol advertising• Drink-driving countermeasures• Individually-directed

interventions to drinkers already at risk

are also cost-effective approaches

School-based education does not reduce harm, but public information and education programmes can increase attention to alcohol on public and political agendas

If more stringent alcohol policies are not put into place, global alcohol-related harm is likely to continue to increase

Actions

• Reduce number of outlets dramatically

• Increase cost-minimum unit pricing

• Expand and enforce legislation re alcohol consumption in public and public order offences

• All of proven international proven benefit

Successful legislated constructive social changes in Ireland

• Smoking ban

• Reduction in alcohol driving limit

• Cycling helmets

RCPI alcohol group

• RCPI established a national policy group to address the health and social burden of alcohol in Ireland.

• The policy group brings together experts from a wide range of medical specialist bodies to speak with one voice on the issue of alcohol, to support

• Propose practical solutions backed up by a robust, international evidence base

• Focused on reducing the harm caused by alcohol to health and society.

Policies that reduce the availability of alcohol though:

Price increasesand

Reducing outlets and hours of sale

Have been shown to be effective