Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
3.1 - Health impacts
It is important to consider both the short-term and long-term health impacts of the harmful consumption of alcohol, as both result in significant morbidity and mortality. The typical effects of moderate alcohol consumption are those on the brain, such as feelings of relaxation, wellbeing and loss of inhibitions. However, as intake increases, pleasant effects are lessened by adverse effects such as drowsiness, loss of balance, nausea and vomiting, and other more serious harmful effects such as aggressive behaviours, unconsciousness, kidney failure and increased risk of accidents and injury [18]. Overall, more people die from the acute effects of alcohol than the long-term or chronic effects.[18]
Alcohol consumption accounts for 3.2% of the total burden of disease and injury in Australia: 4.9% in males and 1.6% in females.[19]
It should be noted that although this percentage is lower than the contribution from tobacco smoking (7.8%) and high body mass (7.5%), there remains some debate over the method to calculate the disease burden attributable to alcohol. That the Australian figure may be an underestimate is suggested by the higher reported burden of disease from alcohol for New Zealand (10% for men and 4% for women).[20]
Alcohol has been causally linked to more than 60 different medical conditions.[13] In Australia, alcohol was linked to 3430 deaths per year and 85,435 disability-adjusted life years (DALYs) per year.[3]
In the 10 years between 1992 and 2001, more than 31,000 Australians died from alcohol-attributable injury and disease – a greater number died from acute (usually in the context of acute intoxication) rather than chronic conditions (often related to longer term dependence on alcohol).
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Table 3: Deaths and burden (DALYs) attributable to alcohol by specific cause, Australia, 2003
| Specific cause | Deaths | DALYs | ||
|---|---|---|---|---|
| Number | Proportion of total (%)Number | Number | Proportion of total (%)Number | |
| Alcohol abuse | 918 | 0.7% | 34,116 | 1.3% |
| Suicides & self-inflicted injuries | 553 | 0.4% | 12,245 | 0.5% |
| Road traffic accidents | 396 | 0.3% | 11,121 | 0.4% |
| Oesophagus cancer | 368 | 0.3% | 4,594 | 0.2% |
| Breast cancer | 184 | 0.1% | 4,152 | 0.2% |
| Other | 1,012 | 0.8% | 19,207 | 0.7% |
| Total harm | 3,430 | 2.6% | 85,435 | 3.2% |
Source: Begg et al. 2005
The most common cause of death due to intoxication was road crash injury, and among the chronic conditions alcohol-related liver cirrhosis accounted for the majority of deaths.[21]Deaths from acute causes are most common among young people, particularly those aged 15–29
years, while deaths from alcohol-attributable chronic diseases are more common among people aged
over 45 years.
More males than females died from both acute and chronic alcohol-attributable conditions [21.]
Over half a million hospitalisations were caused by risky and high-risk drinking in Australia in the eight years between 1993/94 and 2000/01.[21] The most numerous conditions among these hospitalisations were for alcohol dependence (87,186), injuries caused by assault (76,115), road crash injuries (47,167) and attempted suicide (20,374). As many as 10,094 hospitalisations were attributed to some form of ‘alcoholic overdose’ from very high blood alcohol levels, including alcohol poisoning and aspiration vomitus. Overall, the majority of hospitalisations were for acute conditions (67.8%).[21]
Future projections of the leading causes of disease burden predict that the proportion due to alcohol will remain stable and within the top 14 leading causes among Australian males by 2023 (see Fig. 7). The proportion of disease burden caused by anxiety and depression is also expected to remain stable by 2023, while ischaemic heart disease and lung cancer are expected to decline. Type 2 diabetes is predicted to be the leading cause of disease burden among Australian males by 2023.
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Figure 7: Leading causes of burden (DALYs) in males, Australia, 1993 to 2023
Source: Begg et al. 2007[19]
At low levels of consumption, alcohol may also have some benefits – various studies have found reductions in some forms of heart disease (particularly in middle-aged and older males) and ischaemic stroke (in older females), diabetes, gallstones and dementia.The extent and even the existence of such benefits remain controversial.[22, 23] In terms of population, health, heart disease and stroke are the most important of these potential benefits. Nearly all the potential benefits are confined to males over the age of 45 and women past menopause, and can be gained with a drinking pattern of as little as one drink every second day. Since alternative means of preventing heart and vascular disease are available, the clinical consensus is that people need not take up or maintain drinking for health benefits.
Drinking during pregnancy
Recent data show that 59% of Australian women drank alcohol at some time during their pregnancy and that 14% reported drinking five or more drinks in a sitting in the three months prior to pregnancy – 58% during the first and second trimester and 54% in the third trimester.[18] Maternal alcohol consumption can result in a spectrum of harms to the fetus. Although the risk of birth defects is greatest with high, frequent maternal alcohol intake during the first trimester, alcohol exposure throughout pregnancy (including before a pregnancy is confirmed) can have consequences for the development of the fetal brain. It is not clear whether the effects of alcohol are related to the dose of alcohol and whether there is a threshold above which adverse effects occur.[24] This uncertainty is reflected in policy regarding alcohol use in pregnancy within Australia and overseas.[25] Although the risks from low-level drinking (such as one or two drinks per week) during pregnancy are likely to be low, a ‘no-effect’ level has not been established, and limitations in the available evidence make it impossible to set a ‘safe’ or ‘no-risk’ drinking level for women to follow in order to avoid causing harm to their unborn baby.In 2005–2006 there were a total of 145,000 drug treatment episodes recorded in Australia, of which 56,000 (or 39%) were for alcohol problems.[15] While this figure is high, it is perhaps relatively low given the estimated 585,000 Australians who drink at levels considered to be high risk to health in the long term, many whom might be considered the potential target group for treatment.[15] Females accounted for 31% of alcohol treatment episodes in 2005–2006. Persons aged 20–29 years received 22% of treatment episodes. For persons aged 10–19 years receiving treatment, the proportion treated for alcohol problems has increased from 15% to 23% between 2001–2002 and 2005–2006.
The interactions between other drugs (tobacco, illicit and prescription) and alcohol are complex. Australian studies reveal a close association between heroin overdose and alcohol consumption at harmful levels at the time of overdose. Australian research has also found that among cannabis users, alcohol was almost universally used on a regular basis, with most users consuming alcohol at harmful levels. There are also parallels in aetiological research regarding the uptake of one psycho-active substance increasing the likelihood of use of others. There has also been some work done regarding parents’ attitudes and behaviour as a factor in influencing tobacco, alcohol and other drug use. For all of these substances, it is important that prevention efforts focus on delaying the uptake of regular use. This paper does not attempt to deal with the obvious crossover between mental health issues and the harmful consumption of alcohol, and the increasing problem of poly-drug use, but any preventative action needs to bear these factors in mind.