Conference Coverage

Big drinkers face newly appreciated massive health burden



– Individuals who regularly consume alcohol in quantities defined by the World Health Organization as “very high risk” face a daunting and yet widely underappreciated health burden, Rainer Spanagel, MD, observed at the annual congress of the European College of Neuropsychopharmacology.

Dr. Rainer Spanagel chair of the department of psychopharmacology at the Central Institute of Mental Health in Mannheim, Germany

Dr. Rainer Spanagel

He cited a recent study led by Jürgen Rehm, PhD, of the Centre for Addiction and Mental Health in Toronto in which the investigators estimated the prevalence of what the WHO has defined as a “very-high-risk drinking level” among people aged 15-65 years in 13 E.U. countries. The researchers then went on to determine the associated annual risk of disease and injury, as well as the effects on life expectancy.

“The numbers are so shocking that you have to take it seriously,” said Dr. Spanagel, chair of the department of psychopharmacology at the Central Institute of Mental Health in Mannheim, Germany.

Nearly 2 decades ago, the WHO defined very-high-risk level of alcohol consumption as more than 100 g/day of ethanol for men and more than 60 g/day for women. That translates to a threshold of 7.1 and 4.3 standard drinks – a 12-ounce beer, 5-ounce glass of wine, or 1.5-ounce serving of liquor – on a daily basis.

“This WHO categorization of drinking risk levels has been pretty much ignored in clinical trials and epidemiologic studies until 3 or 4 years ago,” according to Dr. Spanagel.

The study by Dr. Rehm and his colleagues suggests this has been a serious mistake. By using data from the WHO’s Global Information System on Alcohol and Health, as well as from clinical trials, the investigators determined that the prevalence of this level of alcohol consumption was less than 1% overall across 13 European countries. However, rates varied markedly: in excess of 4% in Ireland and more than 3.5% in the United Kingdom, compared with less than 0.5% in Germany, Sweden, Denmark, Finland, Hungary, and the Netherlands. The Czech Republic came in at about 3%, while Italy, Spain, France, and Austria had rates of more than 0.5% but less than 1%.

The investigators estimated that the risk of disease or injury associated with this very-high-risk drinking level was 13.5% per year. Based on data from nine E.U. countries, Dr. Rehm and his colleagues found that a very-high-risk level of alcohol consumption caused nearly 54% of all cases of hepatic cirrhosis in those countries, 41% of esophageal and oral cancers, and 44% of pancreatitis.

Life expectancy in the European Union stands at 80.6 years. The investigators calculated on the basis of comprehensive French national mortality data that very-high-risk level alcohol intake resulted in a 22-year reduction in life expectancy, compared with the general population. By comparison, all cancers considered together resulted in 10 years of life lost.

Dr. Spanagel is editor in chief of the journal Addiction Biology, in which this study appeared (Addict Biol. 2018 Jul;23[4]:961-8).

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