ReviewAlcohol and public health
Introduction
Alcoholic beverages have been used in human societies at least since the beginning of recorded history. Fermented drinks were prepared and consumed in most parts of the world before the European colonial expansion, which changed the cultural position of alcohol nearly everywhere.1 New forms of alcoholic beverages were introduced, and a product prepared within the household and community was gradually transformed into an industrial commodity available at any time and virtually any place. As part of the contemporary dynamic of globalisation, this process continues today in much of the developing world.
Accompanying the near ubiquity of alcoholic beverages in human history has been a lively appreciation of the social and health problems caused by drinking. Whether in Greece, Palestine, or China, ancient texts speak eloquently about such problems. Every major world religion has at least some strands that counsel abstinence from alcoholic beverages. In most countries where Protestant Christianity was strong, substantial temperance movements in the 19th century at first sought individual pledges to abstain and eventually pressed for national prohibition. When these movements lost momentum, a new compromise was reached: alcohol was no longer viewed as a threat to all, but rather to a small subclass of “alcoholics”, or in today's technical terms, people who were alcohol dependent. It became the task of health professionals, among others, to cure alcoholism, and the task of science to discover its basis as a key to treatment and prevention.
Scientific attention to alcohol problems has accelerated during the past 30 years, when substantial advances have occurred in our understanding of drinking problems as well as their prevention and treatment. In this review our discussion of these advances is organised into three subtopics: the epidemiology of alcohol's role in health and illness; the treatment of alcohol use disorders as part of the public health response; and prevention and policy research. We do not cover here the substantial advances in neuroscience and genetic studies in recent years, since these are reviewed elsewhere2 and as yet have little relevance for public health approaches to alcohol problems.
In our review of the evidence, we have emphasised both the medical and public health implications of alcohol use. Whereas medical approaches are appropriate responses to alcohol problems in health care settings, they need to be complemented by population-based public health interventions to address the broad dimensions of alcohol problems at the level of communities and nation states.
Section snippets
Alcohol and health outcomes
It has long been known that alcohol consumption is responsible for increased illness and death.3 Recent research has contributed substantially to our understanding of the relation of drinking to specific disorders, and has shown that the relation between alcohol consumption and health outcomes is complex and multidimensional. Alcohol has been shown to be causally related to more than 60 different medical conditions,4 in most but not all cases detrimentally. Not only volume of consumption, but
Treatment of alcohol-use disorders
When a diagnosis indicates that an individual has a mental or behavioural disorder related to alcohol use, several important clinical decisions must be made about the type, setting, and intensity of the intervention. Among heavy drinkers without evidence of severe alcohol dependence, an intervention in primary care aimed at the reduction of drinking to moderate levels of consumption may suffice. By contrast, chronically alcohol-dependent people and other drinkers with high levels of alcohol
Policy research and options
Published evidence on prevention programmes and policies for reducing alcohol-related problems has been substantially strengthened in recent years. Studies in the field now include well-designed experimental trials not only of programmes aimed at individuals, but also of community-oriented approaches107 and even of national policies.108 Unfortunately, the cultural coverage of the research is somewhat restricted: policy and prevention research tends to be particularly strong for English-speaking
References (145)
- et al.
Selected major risk factors and global and regional burden of disease
Lancet
(2002) - et al.
Drinking pattern and mortality: the Italian risk factor and life expectancy pooling project
Annals Epidemiol
(2001) Intoxication and bad behaviour: understanding cultural differences in the link
Soc Sci Med
(2001)Effectiveness of brief interventions to reduce alcohol intake in primary health care populations: a meta-analysis
Prev Med
(1999)- et al.
Naltrexone as an adjunctive treatment for older patients with alcohol dependence
Am J Geriatr Psychiatry
(1997) - et al.
Effects of fluoxetine and Ca-acetyl-homotaurinate on alcohol intake in familial and nonfamilial alcohol patients
Curr Ther Res
(1992) - et al.
Comparison of acamprosate and placebo in long-term treatment of alcohol dependence
Lancet
(1996) - et al.
Alcohol and developing societies: a public health approach
(2002) Neuroscience of psychoactive substance use and dependence
(2004)Alcohol and longevity
(1926)
The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease—an overview
Addiction
The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms
J R Soc Med
On the emerging paradigm of drinking patterns and their social and health consequences
Addictions
World Health Report 2002: reducing risks, promoting healthy life
Alcohol
Alcohol-related mortality and morbidity
Alcohol Res Health
Alcohol and breast cancer in women: a pooled analysis of cohort studies
J Am Med Assoc
A meta-analysis of alcohol drinking and cancer risk
Br J Cancer
Exploring the relation of alcohol consumption to risk of breast cancer
Am J Epidemiol
The quantification of drug-caused mortality and morbidity in Australia 1998
Estrogen, alcohol and breast cancer risk
J Steroid Biochem Mol Biol
Alcohol dehydrogenase 3 genotype modification of the association of alcohol consumption with breast cancer risk
Cancer Causes Control
Glutathione S-transferase M1 and T1 genetic polymorphisms, alcohol consumption and breast cancer risk
Br J Cancer
Alcohol and coronary heart disease: a meta-analysis
Addiction
Alcohol consumption and coronary heart disease morbidity and mortality
Am J Epidemiol
Alcohol and the cardiovascular system: molecular mechanisms for beneficial and harmful action
Alcohol Health Res World
Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors
BMJ
How much alcohol and how often? Population based case-control study of alcohol consumption and risk of a major coronary event
BMJ
Alcohol volume, drinking pattern, and cardiovascular disease morbidity and mortality: is there a U-shaped function?
Am J Epidemiol
Alcohol and sudden cardiac death
Br J Psychiatry
Beer binging and mortality: results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study
BMJ
Average volume of alcohol consumption, patterns of drinking and risk of coronary heart disease—a review
J Cardiovasc Risk
Influence of drinking on cardiovascular disease and cardiovascular risk factors—a review
Addiction
Alcohol drinking patterns and myocardial infarction
Am J Epidemiol
Binge-trinken in Europa: definitionen, epidemiologie und folgen [Binge drinking in Europe: definitions, epidemiology, and consequences]
Sucht
Public health consequences of the J-curve hypothesis of alcohol problems
Addiction
Per capita alcohol consumption and ischaemic heart disease mortality
Addiction
Alcohol and crime
The share of violence attributable to drinking
J Substance Use
Effects of alcohol on human aggression: validity of proposed mechanisms
Statistical power analysis for the behavioral sciences
Influence of drinking on cardiovascular disease and cardiovascular risk factors—a review
J Stud Alcohol
Biological bases of addiction and aggression in close relationships
Alcohol, benzodiazepine-GABA receptor complex and aggression: ethological analysis of individual differences in rodents and primates
J Stud Alcohol
Acute alcohol intoxication and neuropsychological functioning
J Stud Alcohol
Alcohol and aggression: a social information processing analysis
J Stud Alcohol
Modification of affective consequences of alcohol: a comparison of social and solitary drinking
J Abnorm Psychol
Alcohol and crimes of violence: present issues
Int J Addict
Drinking and violence—a cross-cultural comparison of alcohol consumption and homicide rates in 14 European countries
Addiction
The anti-alcohol campaign and variations in Russian mortality
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