Time for coordinated action on alcohol

Abstract

How many drinks did you have last week? Perhaps you shared a bottle of wine on a couple of evenings, or had a few glasses of beer with friends after work. Nothing unusual in that. Alcohol is the world's favourite drug. WHO estimates that in 2000 there were 2 billion alcohol users, compared with 1·3 billion smokers and 185 million users of other psychoactive drugs. For more than 90% of adults in the UK, alcohol is their preferred recreational drug. For most people no health problems result, and there are some health benefits. But increasing numbers drink more than they should more of the time. In developed regions of the world, alcohol use is the leading cause of disability in men (and the tenth largest in women). In developing regions, alcohol is the fourth largest cause of disability in men. Is it time for the health-care profession to give higher priority to alcohol-related illness? WHO's Executive Board certainly thinks so, identifying alcohol as a priority for action and approving a draft resolution proposed by Canada, China, the Czech Republic, Denmark, and Russia, to be adopted by the World Health Assembly in May. While acknowledging that “alcohol consumption raises complex issues”, the resolution concludes that “overwhelmingly, data show its high contribution to the global burden of disease through its damaging effects across all sectors of society as the direct or underlying cause of many illnesses and accidents, violence and impaired health. Young people are particularly likely to abuse alcohol. Special attention needs to be paid to the messages conveyed in information relating to alcohol, including marketing and advertising…”. Last week the UK Prime Minister's Strategy Unit released its Alcohol Harm Reduction Strategy For England. Young people who drink to get drunk (one definition used in the report of binge drinking) are particularly targeted. With another definition of binge drinking as those who drank more than double the recommended daily guidelines on at least one occasion in the past week, the report estimates that 5·9 million adults (most aged under 25 years) are binge drinkers. The costs of this pattern of drinking include increased risks of accidents, alcohol poisoning, violence (becoming a victim or committing violent offences), unwanted and/or unsafe sex, inability to work the next day, and resources use in emergency departments. Binge drinking is by no means a British phenomenon. A US Institute of Medicine report (see Lancet 2003; 362: 1126–27) documented an alarming rise in binge drinking in those under 21 years, and the Australian state of Queensland has gone so far as to introduce a law banning some drinking games and promotions in bars. What can health-care professionals do to help? In the UK, the Government's strategy is to set up an alcohol communications group to work with the Department of Health leading to a white paper on public health later this year. In the meantime, the Academy of Medical Sciences has issued a report (Calling time: the nation's drinking as a major public health issue, March, 2004) proposing a population-based approach to reducing drinking. Calling time demands that the Government takes the lead to reduce everyone's alcohol consumption, which contrasts with the Government's present approach, which is to target, in particular, the high-risk groups of binge or chronic drinkers. The Royal College of Physicians favours the Academy's approach over the Government's strategy, pointing out that “one third of the population is drinking at potentially hazardous levels”. However, it is primary-care services that are best placed to identify and manage alcohol-related problems. We agree with the charity Alcohol Concern that those in primary-care settings need to be further trained to ask about drinking habits and to provide relevant information. But training and educational materials cost money, on which the Government's strategy fails to provide details. Dr Clare Gerada, speaking for the Royal College of General Practitioners, said “the RCGP is concerned it [the Government's strategy] will not make a significant impact without the resources necessary to fund change”. A coordinated funded strategy on alcohol involving primary-care providers is needed, which is what we do not yet have. Targeting binge or chronic drinkers is a start, but cannot be done without support from properly funded relevant health professionals.