There is more evidence than ever before of serious health risks from alcohol but despite this the overall trend in the world from 2005 to 2025 is of a significant rise in liquor consumption. This is the conclusion of the World Status report on Alcohol 2018 prepared by the WHO and released in September 2018.
The per capita annual pure alcohol consumption at the world level increased from 5.5 litres of pure alcohol (age group 15 plus) in 2005 to 6.4 litres in 2016 and is projected to rise again from 2016 to 2025. However, the global trend is much lower than the very fast rate of growth of liquor consumption in India.
In India the per capita annual pure alcohol consumption more than doubled from 2.4 litres in 2005 to 5.7 litres in 2016.This is projected to increase to about 8 litres in 2025 when for the first time since records are available the average consumption in India is projected to be higher than the world average of 7 litres.
According to the report, in 2016 the use of alcohol resulted in some 3 million deaths (5.3 per cent of all deaths) worldwide and 132.6 million disability-adjusted life years (DALYs). Mortality resulting from alcohol consumption is higher than that caused by diseases such as tuberculosis, HIV/AIDS and diabetes. Among men in 2016, an estimated 2.3 million deaths and 106.5 million DALYs were attributable to the consumption of alcohol. Women experienced 0.7 million deaths and 26.1 million DALYs attributable to alcohol consumption.
This report tells us that in 2016, of all deaths attributable to alcohol consumption worldwide, 28.7 per cent were due to injuries, 21.3 per cent due to digestive diseases, 19 per cent due to cardiovascular diseases, 12.9 per cent due to infectious diseases and 12.6 per cent due to cancers. About 49 per cent of alcohol-attributable DALYs are due to noncommunicable and mental health conditions, and about 40 per cent are due to injuries. Among those between 20 and 29 years, 13.5 per cent of all deaths are attributed to alcohol.
The report tells us that health and social harms from drinking alcohol occur through three main interrelated mechanisms: 1) the toxic effects of alcohol on diverse organs and tissues in the body (resulting, for instance, in liver disease, heart disease or cancer); 2) development of alcohol dependence whereby the drinker’s self-control over his or her drinking is impaired, often involving alcohol-induced mental disorders such as depression or psychoses, and 3) through intoxication – the psychoactive effects of alcohol in the hours after drinking.
According to research works consulted for preparing this status report alcohol consumption has been shown to increase the risk of HIV/AIDS by increasing the risk of transmission (resulting from an increased risk of unprotected sex ) and by increasing the risk of infection and subsequent mortality from tuberculosis and lower respiratory infections by suppressing a wide range of immune responses via multiple biological pathways, particularly in people who engage in heavy episodic drinking or who chronically consume large amounts of alcohol .
Coming to cancer the report says that there is an established causal link between alcohol use and cancer development in the oropharynx, larynx, oesophagus, liver, colon, rectum and the female breast. The risks are generally higher for females than males. Even moderate alcohol intake, corresponding to daily consumption of no more than 25 grams of pure alcohol, has been shown to increase the risk of developing female breast cancer.
This report informs us that the causal relationship of alcohol consumption and liver diseases is well established, and alcohol has been shown to have an ability to cause hepatocellular damage through ethanol metabolism-associated mechanisms and malnutrition. Alcohol is one of the most frequent causes of liver disease; alcohol-involved subtypes of liver disease include alcoholic hepatitis, steatosis, steatohepatitis, fibrosis and cirrhosis. Acute alcoholic hepatitis and liver cirrhosis are associated with high mortality (which can reach 50 per cent in acute alcohol hepatitis), and the median survival time of patients with advanced liver cirrhosis can be as low as 1–2 years.
Giving an example from China the report mentions the Beijing 302 Hospital which is a large hospital treating patients from most parts of China, including over 40 000 patients per year with liver disease. Those treated for liver disease at the hospital are thus reflective of trends in liver disease in China. In the period 2002- 2013, the distribution of types of liver disease changed at the hospital, with the proportion of alcoholic liver disease (ALD) more than doubling. Most of the patients with ALD (about 98%) were male. A study reporting this remarked that “the number of patients with ALD is rising at an alarming rate in China”.
The WHO report refers to expansive literature which shows that alcohol intoxication can increase dysphoria, cognitive dysfunction, impulsivity and intensity of suicidal ideation. People have approximately seven times increased risk for a suicide attempt soon after drinking alcohol, and this risk increases to 37 times after heavy use.
The alcohol-attributable fraction for suicide was estimated to be as high as 18 per cent. It is also known that the presence of AUDs (Alcohol Use Disorders) at least doubles the risk of having depression.
This report points out that the potential effects of alcohol include impairment in attention, cognition and dexterity (which are important for such activities as driving a car); aggressive impulses and loss of behavioral control (important for criminal violence); and alcohol poisoning (which can be fatal).
Further, this report tells us that alcohol poisoning is a consequence of drinking large amounts of alcohol in a short period of time. Drinking too much in a short period of time can affect breathing, heart rate, body temperature and gag reflex and may result in coma and death. In comparison with other psychoactive substances, alcohol is among the most lethal in terms of how close the amounts used for psychoactive effects are to the median amount that is lethal. While poisoning clusters from contaminated alcohol often receive global press coverage, poisoning with ordinary beverage alcohol – usually in concentrated form such as distilled beverages – is an everyday reality in many societies, although it is often under-recorded in health statistics.
However, the alcohol industry and its lobbyists have worked overtime to ensure that massive adverse impacts of alcohol consumption are not reported adequately. A recent study led by scientists at the London School of Hygiene and Tropical Medicine and Sweden’s Karolinska Institute had concluded that the alcohol industry “uses denial, distortion and distraction to mislead people about the risks of developing cancer from drinking, often employing similar tactics to those of the tobacco industry.” However, the WHO says that drinking alcohol is a well-established risk factor for a range of cancers including tumors of the mouth, liver, breast, colon and bowel, and the risk of cancer rises with the level of alcohol consumed.
Although the highly adverse impacts of alcohol consumption are very well-known, the alcohol industry has been trying for quite some time to somehow spread the myth that moderate levels of consumption are not a problem.
An extensive study based on 195 countries which was published in the prestigious medical journal The Lancet (August 2018) concluded clearly that not even one drink a day is safe.
Max Griswold, lead author for a group of over 500 experts said, “There is no safe level of alcohol,” “Overall, the health risks associated with alcohol rose in line with the amount consumed each day.” Compared to abstinence, just one drink a day can lead to 1,00,000 additional deaths each year.
The writer is a freelance journalist who has been involved with several social movements and initiatives.