Breaking the vicious circle of determinants and consequences of harmful alcohol use.

Abstract

Heavy drinking has been known for centuries to be a health hazard and cause of death. Efforts to quantify the disease burden associated with different risk fac-tors clearly demonstrate that hazardous and harmful alcohol drinking is one of the leading risk factors and is respon-sible for 4% of the global disease burden (1). This enormous health burden, with its numerous social problems associated with disorders attributable to alcohol use, is distributed unevenly: poor and underprivileged groups are often at higher risk and are deprived of health and social interventions that can help to alleviate individual and family distress. According to the results of the Com-parative Risk Assessment (CRA) within the Global Burden of Disease (GBD) study, alcohol is the main risk factor for ill-health in low mortality developing countries, where alcohol consumption is on the rise (2, 3).In countries with high levels of alcohol consumption and hazardous patterns of drinking, the impact of alcohol use on overall mortality and morbidity can be substantial. The article by Nicholson et al. in this issue (pp. 812–819) demonstrates a linear relationship between frequency of drink-ing and binge drinking and long-term all-cause mortality trends in men in the Russian Federation. Whereas cultural norms related to alcohol consumption and overall drinking patterns have probably not changed significantly in the recent past, mortality fluctuations in the Russian Federation — which are partly attributed to alcohol consump-tion — are dramatic. As discussed by Nicholson et al., other factors could be involved in these relationships, and a broad understanding of hazardous drinking patterns includes aspects other than just binge drinking. Social and economic factors are powerful determi-nants of alcohol and drug use (4, 5), and enormous social changes experienced by the Russian population (6) have affected the broad context of drinking and risks