Alcohol dependence: the biggest alcohol and health issue in Europe

The bulk of the harm associated with alcohol harm in Europe arises from heavy drinking and alcohol dependence, according to a new report from the Canadian Centre for Addiction and Mental Health.

The report examines the large impact of alcohol on mortality in the European Union, and calculates that almost 95,000 men and more than 25,000 women, in both cases aged 15 to 64 years, died of alcohol-attributable causes in 2004. This means that 1 in 7 male deaths and 1 in 13 female deaths in this age category were caused by the consumption of alcohol, with the proportional contribution to morbidity and disability being even higher.

Heavy drinking was responsible for almost 80% of all male alcohol-attributable net deaths and approximately 67% of all female alcohol-attributable net deaths. Alcohol dependence accounted for more than 70% of the overall alcohol-attributable net mortality before age 65, and proportionally more in the younger age groups.

The authors state that given the burden of alcohol dependence in the EU, it is surprising that less than 10% of Europeans living with alcohol dependence receive treatment. This lack of mental-health care is alarming, they say, since several effective treatment options are available. Increasing treatment coverage is a realistic goal, and would provide measurable results in lowering alcohol-related harms including mortality, even in the short term.

To assess the impact of increasing the number of people with alcohol dependence treated in the EU, the authors modeled the effect of increasing the percentage of people with alcohol dependence who are also treated to 40%. They found that if 40% of all people with alcohol dependence in the EU were treated with pharmacotherapy, the result would be a reduction of 10,040 male deaths and 1,700 female deaths in just the first year. This decrease is substantial, and represents a decrease of 13.3% of alcohol-attributable deaths of men and almost 9.3% of alcohol-attributable deaths of women. Almost the same effect could be reached if brief interventions would be given in hospitals, i.e. to problematic drinkers with other diseases or injuries already present and thus at elevated risk for mortality.

Given the substantial health burden attributable to alcohol dependence in the EU, the authors conclude that alcohol policy should strive for an integrated package of various forms of effective prevention measures, such as taxation increases, limitations on availability, and bans on advertising, supplemented by interventions for problem drinkers and people with alcohol dependence.

The report was written by Jurgen Rehm and Kevin Shields, with WHO Europe supporting the calculations of alcohol-attributable harm. The report was funded by the pharmaceutical company Lundbeck A/S.

‘Alcohol consumption, alcohol dependence and attributable burden of disease in Europe’.

Permission to reprint front cover of the report given by the Canadian Centre for Addiction and Mental Health