Unrecorded Alcohol Consumption Research Articles

Unrecorded alcohol consumption in Lithuania: a modelling study for 2000-2021.

The aim of the study was to estimate unrecorded alcohol consumption in Lithuania for the period 2000-2021 using an indirect method for modelling consumption based on official consumption data and indicators of alcohol-related harm. Methodology employed for estimating the unrecorded alcohol consumption was proposed by Norström and was based on the country's 2019 European Health Interview Survey and indicators of fully alcohol-attributable mortality. The proportion of unrecorded alcohol consumption was estimated as 8.30% (95% CI 7.7-8.9%) for 2019 in Lithuania. The estimated total (recorded and unrecorded) alcohol per capita consumption among individuals 15years of age and older in 2019 was 12.2 L of pure alcohol, 1.01 (95% CI 0.94-1.09%) L of which is likely unrecorded. The lowest unrecorded alcohol level was estimated for 2009 and 2014, while 2018 had the highest level (i.e. 9.33% of total alcohol per capita consumption). Unrecorded alcohol consumption in Lithuania is likely to be modest when compared to recorded alcohol consumption, the latter of which still remains a major challenge to public health.

Impact of macroeconomic parameters on alcohol consumption in Russia

Background: A high level of alcohol consumption, a significant share in the structure of unrecorded alcohol consumption, as well as changing economic cycles, make Russia a convenient object for studying the influence of the level of income of the population on the level of alcohol consumption. Aims: to study the relationship between macroeconomic parameters and alcohol consumption in Russia at the population level. Methods: A comparative analysis of the dynamics of the main macroeconomic indicators (gross domestic product (GDP), Gini coefficient) and the level of alcohol sales, the level of alcohol consumption, the level of consumption of unrecorded alcohol in Russia in the period from 1990 to 2015 has been carried out. Results: GDP is positively correlated with alcohol sales (r = 0.45; p <0.021), negatively correlated with the general level of alcohol consumption (r = -0.68; p <0.000), as well as with the consumption of unrecorded alcohol (r = -0.79; p <0.000). The Gini coefficient is positively correlated with the level of alcohol sales, although this relationship is not statistically significant (r = 0.4; p <0.063). No relationship was found between the Gini coefficient and the overall level of alcohol consumption (r = 0.04; p <0.871), as well as the consumption of unrecorded alcohol (r = -0.13; p <0.576). Conclusions: a positive relationship was found between income and the sale of alcohol, as well as a negative relationship between income and consumption of unrecorded alcohol at the population level. The data obtained substantiate the need for synchronous indexation of excise taxes on alcohol as incomes of the population grow in order to reduce the economic availability of alcohol.

Alcohol consumption among adults in Vietnam: prevalence, patterns, and its determinants

ABSTRACT Introduction and Aims This study describes the prevalence and drinking patterns of alcohol consumption among adults (aged 15+ years) and explores the association between sociodemographic factors and alcohol consumption in Vietnam. Design and Methods A cross-sectional representative survey of 5,200 respondents from 12 provinces was conducted in 2015. Multivariate logistic regression models were fitted to analyze the association between sociodemographic factors (age, gender, education, marital status, income, religion) and alcohol consumption patterns. Results Nearly three-quarters of males (77%) and one-quarter of females (23%) were current alcohol drinkers. In the multivariate analyses, being male (aOR = 10.9, 95%CI = 8.01–14.8, p < .01), being head of the household (aOR = 1.43, 95% CI = 1.2–1.8, p < .01), being married (aOR = 1.22, 95%CI = 1.1–1.4, p < .01), having college degree (aOR = 1.3, 95% CI = 1.07–1.5, p < .01), higher income (aOR = 1.5, 95% CI = 1.3–1.6, p < .001) were positively associated with current drinking. Older respondents (aOR = 0.44, 95% CI = 0.4–0.6, p < .01) were less likely to be current users of alcohol. Discussion and Conclusions Recorded alcohol was more frequently consumed by younger age groups and in urban areas, while consumption of unrecorded alcohol was higher in rural areas and among low-income households. Targeted policy efforts are needed to reduce the health risk of alcohol consumption among rural and older populations.

The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations.

The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use. Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide. Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined. Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.

Cross-sectional study on the characteristics of unrecorded alcohol consumption in nine newly independent states between 2013 and 2017

ObjectivesAs unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the...

Impact of Macroeconomic Parameters On Alcohol Consumption in Russia

Background: A high level of alcohol consumption, a significant share in the structure of unrecorded alcohol consumption, as well as changing economic cycles, make Russia a convenient object for studying the influence of the level of income of the population on the level of alcohol consumption. Aims: to study the relationship between macroeconomic parameters and alcohol consumption in Russia at the population level. Methods: A comparative analysis of the dynamics of the main macroeconomic indicators (gross domestic product (GDP), Gini coefficient) and the level of alcohol sales, the level of alcohol consumption, the level of consumption of unrecorded alcohol in Russia in the period from 1990 to 2015 has been carried out. Results: GDP is positively correlated with alcohol sales (r = 0.45; p &lt;0.021), negatively correlated with the general level of alcohol consumption (r = -0.68; p &lt;0.000), as well as with the consumption of unrecorded alcohol (r = -0.79; p &lt;0.000). The Gini coefficient is positively correlated with the level of alcohol sales, although this relationship is not statistically significant (r = 0.4; p &lt;0.063). No relationship was found between the Gini coefficient and the overall level of alcohol consumption (r = 0.04; p &lt;0.871), as well as the consumption of unrecorded alcohol (r = -0.13; p &lt;0.576). Conclusions: a positive relationship was found between income and the sale of alcohol, as well as a negative relationship between income and consumption of unrecorded alcohol at the population level. The data obtained substantiate the need for synchronous indexation of excise taxes on alcohol as incomes of the population grow in order to reduce the economic availability of alcohol.

Unrecorded alcohol consumption in Thailand: Prevalence, geographical variation, relationship with socioeconomic factors and related consequences.

Information on unrecorded alcohol consumption in Southeast Asia and Thailand is lacking. The primary objective of this study was to estimate the prevalence of unrecorded alcohol (including illegally produced alcohol and untaxed cross-border alcohol) consumption among past-year drinkers in Thailand. The secondary objectives were to examine the geographical variation of unrecorded alcohol consumption, effects of socioeconomic factors on unrecorded alcohol consumption and the association between unrecorded alcohol consumption and alcohol-related consequences. This study analysed data from the 2017 Smoking and Drinking Behavior Survey. The prevalence of unrecorded alcohol consumption was estimated. Associations of interest were tested using multivariate logistic regression. Overall, 12.3% of past-year drinkers consumed any unrecorded alcohol. The prevalence was highest in the north (24.8%) and lowest in the central region (7.4%). In multivariate analysis, living in the north was associated with consumption of any unrecorded alcohol and illegally produced alcohol, whereas living in the south was associated with untaxed cross-border alcohol consumption. The lowest education and income group had the highest likelihood of consumption of any unrecorded alcohol and illegally produced alcohol, but the lowest likelihood of untaxed cross-border alcohol consumption. Consumption of unrecorded alcohol was associated with a higher chance of alcohol-related consequences. This study estimated the prevalence of unrecorded alcohol consumption among Thai drinkers and demonstrated the geographical variation in the prevalence and types of unrecorded alcohol consumed. We also found heterogenous associations between socioeconomic factors and each type of unrecorded alcohol.

Drinking and acquisition of unrecorded alcohol across educational groups in Sweden.

It is estimated that 18.5% of total alcohol consumption in Sweden in 2018 was unrecorded. However, little is known about the socio-economic profile of consumers of unrecorded alcohol. The aim of this study was to elucidate this issue by analysing data from a unique Swedish national repeated cross-sectional alcohol use survey. Individual-level information on alcohol consumption and socio-economic status (SES) for the years 2013-2018 was retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample comprised 64 375 respondents aged 25-74 years. SES was measured by educational level. We used three educational groups: (i) low (<10 years); (ii) intermediate (10-12 years); and (iii) high (13+ years). We included indicators of the following sources of unrecorded alcohol consumption: travellers' import, smuggled alcohol, home production, internet and illicit home-distilling. We estimated adjusted SES-specific means of the various forms of unrecorded consumption. The means were adjusted for the effects of age, sex and region. There were no significant educational differences in the total of unrecorded alcohol consumption; the same holds true for home-production and internet. However, with respect to smuggled and home-distilling, a statistically significant educational gradient was observed with the lowest educational group scoring approximately four times higher than the highest. Our findings suggest that there are no differences across educational groups in the consumption of unrecorded alcohol as a whole. However, consumption of smuggled alcohol and illicitly distilled spirits is elevated in the low educational group.

Reducing the Global Burden of Alcohol-Associated Liver Disease: A Blueprint for Action.

Alcohol-associated liver disease (ALD) is a major driver of global liver related morbidity and mortality. There are 2.4 billion drinkers (950 million heavy drinkers) and the lifetime prevalence of any alcohol use disorder (AUD) is 5.1%-8.6%. In 2017, global prevalence of alcohol-associated compensated and decompensated cirrhosis was 23.6 million and 2.5 million, respectively. Combined, alcohol-associated cirrhosis and liver cancer account for 1% of all deaths worldwide with this burden expected to increase. Solutions for this growing epidemic must be multi-faceted and focused on both population and patient-level interventions. Reductions in ALD-related morbidity and mortality require solutions that focus on early identification and intervention, reducing alcohol consumption at the population level (taxation, reduced availability and restricted promotion), and solutions tailored to local socioeconomic realities (unrecorded alcohol consumption, focused youth education). Simple screening tools and algorithms can be applied at the population level to identify alcohol misuse, diagnose ALD using non-invasive serum and imaging markers, and risk-stratify higher-risk ALD/AUD patients. Novel methods of healthcare delivery and platforms are needed (telehealth, outreach, use of non-healthcare providers, partnerships between primary and specialty care/tertiary hospitals) to proactively mitigate the global burden of ALD. An integrated approach that combines medical and AUD treatment is needed at the individual level to have the highest impact. Future needs include (1) improving quality of ALD data and standardizing care, (2) supporting innovative healthcare delivery platforms that can treat both ALD and AUD, (3) stronger and concerted advocacy by professional hepatology organizations, and (4) advancing implementation of digital interventions.

The alcohol advertising ban in Norway: Effects on recorded alcohol sales.

Although bans or restrictions on alcohol advertising are recommended as one of the three most effective and cost-effective policies to curb alcohol consumption, the best evidence to support this is indirect. The aim of this study was to examine whether the complete ban on alcohol advertising in Norway in 1975 had any effect on total alcohol sales. Annual time series of recorded alcohol sales (1960-2006) were analysed. Autoregressive integrated moving average interrupted time series techniques were used to model the effect of the advertising ban, adjusting for alcohol prices and wages. The autoregressive integrated moving average analyses showed a negative and statistically significant effect of the ban on total recorded alcohol sales, suggesting an immediate and lasting reduction of 7.4% (P= 0.002). The complete ban on alcohol advertising in 1975 in Norway reduced recorded alcohol sales. This suggests that the ban had a protective effect by reducing total alcohol consumption. The conclusion remains tentative because of possible effects of unrecorded alcohol consumption and marketing on social media and satellite TV channels.

Effect of affordability of alcohol on the level of alcohol consumption in Russia

To study the relationship between the affordability of alcohol and the level of its sale, the total level of consumption, as well as the consumption of unrecorded alcohol in Russia in the post-Soviet period.

Exploring the relationship between drinking preferences and recorded and unrecorded alcohol consumption in Russian regions in 2010–2016

BackgroundIn recent years, Russia has seen a decline in alcohol consumption per capita (APC) accompanied by a significant reduction in the share of spirits in total APC. Our aim was to investigate regional variation in alcohol consumption and the association between the share of spirits in APC, and recorded and unrecorded APC. MethodsData on recorded APC were taken from Rosstat. Our estimates on unrecorded APC were based on the guidelines of the Ministry of Health of the Russian Federation and data on alcoholic psychoses and mortality from external causes (546 observations for 78 regions from 2010 to 2016). We estimated fixed effects models with the dependent variables of recorded and unrecorded APC of the population 15+. Independent variables included share of spirits in recorded APC, vodka prices, average income, duration of alcohol sales hours, and others. ResultsDuring the 2010–2016 period, recorded APC varied by regions from 1.1 to 17.8 litres; unrecorded – from almost zero to 21 litres; the share of spirits in recorded APC – from 20.6% to 89.3%. A 1% increase in the share of spirits was attributed to a 0.2% increase in recorded APC and to a 2.1% increase in unrecorded APC. Various factors were related to regional APC: vodka prices (with elasticity coefficient −0.46 for recorded and 1.67 for unrecorded APC); income (0.23 for recorded and −2.23 for unrecorded APC); duration of sales hours (−0.9 for unrecorded APC); and shares of working age and of urban population. ConclusionTaking into account a strong correlation between the share of spirits in the recorded APC and consumption of recorded and unrecorded APC, the price of spirits should be increased. In the regions with pronounced preference for spirits, stricter availability restrictions on the alcohol sales are needed, along with strict control of shadow markets.

Is There a Need for Alcohol Policy to Mitigate Metal Contamination in Unrecorded Fruit Spirits?

Unrecorded alcohol comprises all types of alcohol that is not registered in the jurisdiction where it is consumed. In some countries in Central and Eastern Europe as well as the Balkans, the majority of unrecorded alcohol consumption may derive from the home production of fruit spirits. Some studies found a high prevalence of lead and cadmium in such spirits. This article provides a quantitative comparative risk assessment using the margin of exposure (MOE) methodology for lead and cadmium, compared to ethanol, for unrecorded fruit spirits. For average concentration levels, the lowest MOE (0.8) was calculated for ethanol (alcohol itself). For lead, the MOE was 13 for moderate daily drinking and 0.9 for the worst-case scenario. For cadmium, the MOE was 1982 for moderate daily drinking and 113 for the worst-case scenario. The results of this study are consistent with previous comparative risk assessments stating that ethanol itself comprises by far the highest risk of all compounds in alcoholic beverages. Regarding metal contaminants, the risk of cadmium appears negligible; however, lead may pose an additional health risk in heavy drinking circumstances. Strategies to avoid metal contamination in the artisanal home production of spirits need to be developed.

Unrecorded Alcohol Consumption in Seven European Union Countries

Introduction: Unrecorded alcohol, that is, alcohol not reflected in official statistics of the country where it is consumed, contributes markedly to overall consumption of alcohol. However, empirical data on unrecorded alcohol consumption are scarce, especially in high-income countries. This study measures the contribution of unrecorded alcohol in 7 member states of the European Union. Methods: Two categories of unrecorded consumption were assessed in general population surveys (reducing alcohol related harm Standardized European Alcohol Survey; n = 11,224): home-made alcohol and cross-border shopping. Country-specific logistic regressions were used to link respondent characteristics to odds of acquisition of unrecorded alcohol. Total per capita alcohol consumption was estimated under different assumptions of calculating unrecorded alcohol consumption. Results: Individuals with higher drinking levels were more likely to acquire unrecorded alcohol in all 7 countries. In some countries, male sex and more affluent social class were also positively linked to acquisition of unrecorded alcohol. There was a substantial contribution of unrecorded alcohol to overall consumption in 5 out of 7 member states (Croatia, Finland, Greece, Hungary, Portugal), but not in Poland or Spain. In Greece, up to two-thirds of all alcohol consumed was estimated to be unrecorded. Conclusion: Unrecorded alcohol contributes to overall consumption even in high-income countries, and thus needs to be monitored. In monitoring, as many categories of unrecorded alcohol as possible should be clearly defined (e.g., surrogate alcohol) and included in future surveys.

Perception of alcohol policies by consumers of unrecorded alcohol - an exploratory qualitative interview study with patients of alcohol treatment facilities in Russia

BackgroundOver the last decade Russia has introduced various policy measures to reduce alcohol consumption and alcohol-related harm at the population level. Several of these policies, such as higher pricing and taxation or restrictions of availability, may not work in the case of unrecorded alcohol consumption; they may encourage consumers to switch to unrecorded alcohol and even increase consumption. In the present qualitative interview study we explore the perception of the recently implemented alcohol policies by patients diagnosed with alcohol dependence in two Russian cities in the years 2013–2014 and shed light on possible entry-points to prevention.MethodsSemi-structured in-depth expert interviews were conducted with 25 patients of state-run drug and alcohol treatment centers in two Russian cities in 2013 and 2014. The interviews were analyzed using thematic content analysis.ResultsAll of the interviewed participants have consumed unrecorded at some point with the majority being regular consumers, mostly switching between recorded and unrecorded alcohol depending on the situation, as predominantly defined by available money and available sources of alcohol. Low price and high availability were reported as the main reasons for unrecorded consumption. Participants voiced a general mistrust of the recently implemented alcohol regulations and viewed them largely as ineffective. They expressed particular concerns over price increases and restriction of night sales of alcoholic beverages. Substantial shifts within the unrecorded alcohol market were reported, with a decreasing availability of home-made beverages in favor of alcohol surrogates in the form of non-beverage alcohol, medicinal and cosmetic compounds. At the same time consumption of home-made alcoholic beverages was seen as a strategy to avoid counterfeit alcohol, which was frequently reported for retail sale.ConclusionsDespite the alcohol policy changes in the last years in Russia, consumption of unrecorded alcohol remained common for people with alcohol dependence. Reduction of availability of unrecorded alcohol, first and foremost in the form of cheap surrogates, is urgently needed to reduce alcohol-related harm. Implementation of screening and brief interventions for excessive alcohol consumption in various contexts such as primary healthcare settings, trauma treatment services or the workplace could be another important measure targeting consumers of unrecorded alcohol.

The connection between per capita alcohol consumption and alcohol-specific mortality accounting for unrecorded alcohol consumption: The case of Finland 1975-2015.

Unrecorded alcohol consumption has increased strongly in Finland after 1995 when the country joined the European Union. This development may have rendered alcohol sales less trustworthy as a proxy for population drinking, and less powerful as predictor of alcohol-related harm. The study aims to test this contention by analyzing the association between recorded and unrecorded alcohol consumption on the one hand, and alcohol-specific mortality on the other. We analysed age-standardised rates of alcohol-specific deaths for the working-age (15-64 years) population. For alcohol consumption, we used (i) alcohol sales in litres of 100% alcohol per capita, and (ii) estimated unrecorded consumption in litres of 100% alcohol per capita. The data spanned the period 1975-2015. As the data were cointegrated, the relations between mortality and the alcohol indicators were estimated through time-series analysis of the raw data. A one litre increase in alcohol sales was associated with an increase in alcohol-specific deaths of 7.590 deaths per 100 000; the corresponding figure for unrecorded consumption was 9.112 deaths per 100 000. Both estimates were statistically significant (P < 0.001), but the difference between them was not significant (P = 0.293). Although recoded consumption captured the main feature of the trends in alcohol-specific mortality, it accounted for only half of its marked increase in 1975-2007, while unrecorded consumption explained the remaining part. Our study confirms previous findings that recorded alcohol consumption is an important determinant of alcohol-specific mortality in Finland. A more novel insight is the importance of unrecorded consumption in this context.

Is there any difference between the health risk from consumption of recorded and unrecorded spirits containing alcohols other than ethanol? A population-based comparative risk assessment

Alcohol-attributable mortality in certain countries of Central and Eastern Europe (CEE) remains higher than in their western neighbours. The effect of unrecorded alcohol consumption, including home-made fruit spirits have been suggested as an explanation. Besides ethanol, recorded and unrecorded spirits frequently contain other aliphatic alcohols (OAAs). Our aim was to ascertain whether there is any difference in the amounts of OAAs in recorded and unrecorded spirits, and thus the health risk associated with their consumption. The concentrations of ethanol and OAAs in recorded (n = 119) and unrecorded (n = 87) spirits were determined by gas chromatography and used in a Monte Carlo type probabilistic simulation to assess the risk based on average consumption level, consumption by regular drinkers and chronic heavy drinkers. The concentrations of OAAs in unrecorded spirits were significantly higher [median: 9896.1 mg/L, interquartile range (IQR): 7898.3-12 634.6 mg/L] than those in their recorded (median: 975.6 mg/L, IQR: 136.9-4006.7 mg/L) counterparts. Besides ethanol, methanol also posed a health risk at each consumption level. The risk associated with exposure to OAAs was higher only in chronic heavy drinkers consuming unrecorded spirits. These findings reinforce the importance of action to address the risks associated with consumption of recorded and unrecorded spirits.

Unrecorded alcohol in East Africa: A case study of Kenya

Alcohol misuse contributes substantially to the global morbidity and mortality burden. Unrecorded alcohol, alcohol that is purchased by means which precludes regulation, represents a substantial proportion of the alcohol consumed in East Africa. In Kenya, homebrew also known as traditional brew, has been linked to several fatalities and hospitalizations. Previously banned, the Kenyan government recently legalized homebrew in an effort to regulate and reduce its harm. Despite legalization, however, homebrew continues to be endemic. In this paper, we examine the scope and harm associated with unrecorded alcohol in Kenya, and discuss current policies and interventions aimed at reducing production and consumption of unrecorded alcohol in the Kenyan context that reflect its culture, politics, environment and resources.

Examining characteristics of recorded and unrecorded alcohol consumers in Kenya

BackgroundDue to media reports of several deaths, consumption of unrecorded alcohol (i.e., alcohol brewed at home) has emerged as a public health threat in developing countries like Kenya. Empirical data on this issue, however, is scarce. This investigation compared demographic characteristics of Kenyans who drank recorded (regulated) and unrecorded alcohol.MethodsWe examined all respondents who consumed alcohol in the past month (N = 718) on the 2015 nationally representative Kenya STEPwise survey. Descriptive statistics and bivariate logistic regression examined proportion of respondents consuming unrecorded alcohol, and social demographic factors associated with unrecorded alcohol consumption, respectively.ResultsThe sample was primarily male (86%), married (64%), middle class or higher (64%), with an average age of 37 years. Participants reported an average of 2.5 drinking events and 4.3 binge-drinking occasions per month. Overall, 37% of our sample consumed unrecorded alcohol. Compared to those with incomplete primary education or lower, individuals who completed primary education or above were less likely to report consuming unrecorded alcohol (OR = 0.22, 95% CI: 0.12–0.43). Compared to poorest and poor respondents, those identifying as middle class or above were less likely to consume unrecorded alcohol (OR = 0.47, 95% CI: 0.29–.78). Current smokers (OR = 2.19, 95% CI: 1.34–3.60) and those with higher binge drinking occasions in the past month (OR = 1.03, 95% CI: 1.004–1.07) were significantly more likely to consume unrecorded alcohol.ConclusionKenyan adults who consume unrecorded alcohol engage in more binge drinking occasions, smoke, and have lower levels of education and socioeconomic status. It is vital that health promotion interventions aimed at reducing unrecorded alcohol consumption be tailored and targeted to individuals with low socio-economic status in Kenya.

Distilled Spirits Overconsumption as the Most Important Factor of Excessive Adult Male Mortality in Europe.

To explain comprehensively variations in adult male mortality rate in Europe, and in particular, high mortality in some East European countries with particular focus on specific patterns of alcohol consumption. Per capita distilled spirits consumption is found to be the strongest determinant of the adult male mortality rate in Europe as soon as the unrecorded alcohol consumption is taken into account. It turns out to be much stronger than the other tested significant determinants such as per capita health expenditures, smoking prevalence, consumption of hard drugs and per capita consumption of vegetables and fruit. Ordinary least squares (OLS) multiple regression with adult male mortality rate as a dependent variable, and various indicators of alcohol and drug consumption as well as logarithm of gross domestic product (GDP) per capita, logarithm of total per capita health expenditures, latitude (climatic factors), per capita fruit and vegetable consumption, smoking prevalence as independent factors. Per capita distilled spirits consumption turns out to be the strongest determinant of the adult male mortality rate in Europe as soon as the unrecorded alcohol consumption is taken into account. It turns out to be much stronger than the other tested significant determinants of the adult male mortality rate such as per capita health expenditures, smoking prevalence, consumption of hard drugs and per capita consumption of vegetables and fruit. Still, higher per capita wine consumption has turned out to be a marginally significant determinant of the higher adult male mortality rate in some tests. Latitude, beer and soft drug consumption have turned out insignificant in this study. Spirits consumption is a major risk factor of adult male mortality, with significantly greater impact compared to beer and wine. Therefore, reduction in distilled spirits consumption in hard liquor drinking areas should be a major target in health policy.