Reducing individual and societal harm of excessive alcohol use Impact of the current treatment gap for alcohol dependence Professor Peter Anderson, MD, MPH, PhD, FRCP Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands Ins@tute of Health and Society, Newcastle University, England Utrecht, 1 November 2013
Disclosure I do not receive any kind of financial support from the pharmaceu@cal or alcohol industries or founda@ons or organiza@ons directly or indirectly sponsored by them.
1. Societal harm from alcohol 2. Individual harm from alcohol 3. Poten@al for reducing harm done by alcohol 4. Treatment gap between need and help 5. Reducing treatment gap
The concept is that drinking exists within a con@nuum, with a right hand tail. There are no dichotomies between people who are or who are not heavy drinkers. 35 30 % of popula9on
25 20 15 10
5 0 -‐10 0 10 20 30 40 50 60 70 80 90 100 110 120 Alcohol consump9on per day
In fact, you need no more than heavy drinking to define alcohol use disorders and alcohol dependence .
Number of diagnos9c criteria for alcohol dependence
US survey data 8 7 6 5 4 3 2 1 0 0
50
100
150
200
Alcohol consump9on g/day Rehm et al 2013
US NESARC data on 26,546 adults Rubinsky et al 2013
US NESARC data on 26,546 adults Rubinsky et al 2013
1. Societal harm from alcohol 2. Individual harm from alcohol 3. Poten@al for reducing harm done by alcohol 4. Treatment gap between need and help 5. Reducing treatment gap
Risk factors for disability adjusted life years, world, 2010
Source: Lim et al 2012
1990
2010
Source: Lim et al 2012
Propor@ons of alcohol-‐aZributable deaths to all deaths for people aged 15–64 living in the EU in 2004.
Rehm et al 2012
WHO 2013
Social costs due to alcohol EU 2010 (€155 billion)
41,4 74,1
12,6 27,7
Crime Traffic accidents Health Produc@vity
Rehm et al 2012
Costs of alcohol to Australian society (Billions of dollars)
23,5 25 20 15 10
12,1
5
Plus harm to others than the drinker Harm from drinker only
0
Social costs
Source: LasleZ et al 2010
1. Societal harm from alcohol 2. Individual harm from alcohol 3. Poten@al for reducing harm done by alcohol 4. Treatment gap between need and help 5. Reducing treatment gap
Alcohol-‐aZributable deaths by disease groups for people aged 15-‐64 years living in EU in 2004. Total deaths: 138,000 Other 3% Cancer 19% Injuries 32%
CVD 8% Liver cirrhosis 28%
Mental Disorders 10%
Source: Rehm et al 2012
Interna@onal Agency for Research on Cancer: Alcohol is a causal agent for cancers of: ! Oral cavity, pharynx, and larynx ! Oesophagus ! Liver ! Colon ! Rectum ! Breast
In brackets, increased risk at 20g/day compared with not drinking 7
Rela@ve risk
6 5 4 3
Oral cavity & Pharynx (86%) Larynx (43%) Oesophagus (39%) Breast (25%) Liver (19%) Rectum (9%) Colon (5%)
2 1 0
10
20
30
40
50
60
70
80
90
Grams alcohol consump@on per day (10 grams = 1 drink) Source: Corrao et al 2009
100
Rela@ve risk of breast cancer by alcohol consump@on Source: Allen et al 2009
Alcohol-‐aZributable deaths by disease groups for people aged 15-‐64 years living in EU in 2004. Total deaths: 138,000 Other 3% Cancer 19% Injuries 32%
CVD 8% Liver cirrhosis 28%
Mental Disorders 10%
Source: Rehm et al 2012
Alcohol in small regular doses can reduce the risk of ischaemic events, in par@cular ischaemic heart disease. This effect can be achieved at doses of 5g a day, is moderated in overweight individuals, and disappears with just one episode of binge drinking (60g, six drinks, on one occasion) a month.
Source: Anderson 2013
32000
Liver disease
28000
Deaths due to increasing consump@on
Cancer CVD
24000
Median consump9on →
20000 16000
Deaths due to decreasing consump@on
12000 8000 4000 0 -‐4000 -‐8000
1
2
3
4
5
6
7
8
12 16 20 24 32 40 48
Deaths prevented or caused by daily alcohol consump@on for adults living in England in 2006 compared to actual median alcohol consump@on of 13g/day. Source: Nichols et al 2012
Alcohol-‐aZributable deaths by disease groups for people aged 15-‐64 years living in EU in 2004. Total deaths: 138,000 Other 3% Cancer 19% Injuries 32%
CVD 8% Liver cirrhosis 28%
Mental Disorders 10%
Source: Rehm et al 2012
Life@me risk of death from alcohol-‐related injury per 100 male Australian drinkers, by number of standard drinks per occasion (one drink contains 10g alcohol) and frequency of occasions.
Source: Na@onal Health and Medical Research Council, Australia, 2009
Life@me risk of dying from alcohol-‐related death by gram alcohol/day or /week for Australian men and women. Source: Na@onal Health and Medical Research Council, Australia, 2009
1. Societal harm from alcohol 2. Individual harm from alcohol 3. Poten@al for reducing harm done by alcohol 4. Treatment gap between need and help 5. Reducing treatment gap
70
Distribu9on of daily alcohol consump9on, men aged 15-‐64 years living in EU
60
% of popula9on
50 40 30
Netherlands EU
20 10 0 0
