Scarred for life

The increase in the number of alcohol-related assaults in this country looks like continuing unless a serious effort is made to educate young people in the dangers of excessive drinking. This is the message of four oral and maxillofacial surgeons in The British Medical Journal.

Between 1977 and 1987 the number of patients requiring attention for maxillofacial fracture resulting from car accidents fell by 34 per cent. During the same time there was a 10 per cent increase in the proportion of injuries resulting from assaults. Since that time, there has been an increase of 77 per cent in violent crime of all types, whereas there has been a 38 per cent fall in deaths and injuries from road accidents.

From the data gathered in a survey carried out last September by the British Association of Oral and Maxillofacial Surgeons, it is possible to estimate that half a million people suffer facial injuries every year, 125,000 of them in violent circumstances.

A great many of these assaults involve young people and in the majority of cases (61 per cent according to the survey) either the victim or the assailant had been drinking alcohol. Half the facial injuries sustained by people aged 15 to 25 were the result of assaults, nearly always in bars or in their immediate vicinity, and 40 per cent of these necessitated specialist maxillofacial surgery.

Writing in the BMJ, the four surgeons* state that "other countries with similar alcohol consumption figures have not experienced such an epidemic of assaults in young people. Brief interventions to tackle alcohol misuse in the aftermath of injury are both effective and valued by patients." In an attempt to alert young people to the risks of facial injury as a consequence of drinking and fighting, 200 oral and maxillofacial surgeons recently visited secondary schools throughout the country. It will be important to study the effects of this intervention.

The survey by the British Association of Oral and Maxillofacial Surgeons indicated that, whereas "four times more men than women sustained facial injuries in assaults, in the home the reverse was true." The survey demonstrated the alarming fact that nearly "half of all facial injuries sustained in assaults on women occurred in the home, presumably by members of the immediate family, and almost half these were associated with alcohol consumption by the victim or assailant."

It is an inescapable conclusion that alcohol drinking and assault are the "major factors responsible for serious facial injuries in young adults." It is interesting to note that "the effect of alcohol in increasing vulnerability to injury may be more important than its effect on aggression." The surgeons conclude that "the most beneficial strategy may be to target 13-14 year olds and educate them about the dangers of excessive alcohol consumption and its association with assaults and road accidents."