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Zurich Open Repository and Archive University of Zurich University Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2012 Alcohol consumption, alcohol dependence, and attributable burden of disease in Europe: Potential gains from effective interventions for alcohol dependence Rehm, Jürgen ; Shield, K D ; Rehm, M X ; Gmel, Gerhard ; Frick, Ulrich Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-64919 Monograph Originally published at: Rehm, Jürgen; Shield, K D; Rehm, M X; Gmel, Gerhard; Frick, Ulrich (2012). Alcohol consumption, alcohol dependence, and attributable burden of disease in Europe: Potential gains from effective inter- ventions for alcohol dependence. Toronto: CAMH. Alcohol consumption, alcohol dependence and attributable burden of disease in Europe Potential gains from effective interventions for alcohol dependence jürgen rehm kevin d. shield Maximilien X. Rehm Gerrit Gmel Ulrich Frick Alcohol consumption, alcohol dependence and attributable burden of disease in Europe: Potential gains from effective interventions for alcohol dependence ISBN: 978-1-77114-046-1 (PRINT) ISBN: 978-1-77114-047-8 (PDF) ISBN: 978-1-77114-048-5 (HTML) ISBN: 978-1-77114-049-2 (ePUB) Printed in Canada Copyright © 2012 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review 2 1 or professional work. 20 4- 0 / 5 Website: www.camh.net 67 4 Alcohol consumption, alcohol dependence   and attributable burden of disease in Europe:   Potential gains from effective interventions for alcohol dependence    Authors: Jürgen Rehm,1‐6* Kevin D. Shield,1,3* Maximilien X. Rehm,7 Gerrit Gmel,1,8 Ulrich Frick9  * JR and KS share first authorship.    Affiliations  1  Centre for Addiction and Mental Health (CAMH), Toronto  2  Institute for Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany   3  Institute of Medical Science, University of Toronto, Canada  4  Dalla Lana School of Public Health (DLSPH), University of Toronto, Canada  5  Department of Psychiatry, University of Toronto, Canada   6  PAHO/WHO Collaborating Centre for Mental Health and Addiction  7  Faculty of Arts and Sciences/Politics and Governance, Ryerson University, Toronto, Canada  8  Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland  9  Dept. Healthcare Management, Carinthia University of Applied Sciences, Feldkirchen, Austria    Corresponding author: J. Rehm, CAMH, 33 Russell Street, Toronto, ON, M5S 2S1, Canada  Competing interests: The authors have declared that no competing interests exist.  Funding: This work was supported by an unrestricted contract from Lundbeck A/S. In addition, WHO  European Region supported the calculations of alcohol‐attributable harm; and the methodology for  determining alcohol‐attributable fractions was developed as a result of the Comparative Risk  Assessment of the Global Burden of Disease 2005 study.  Acknowledgments: The authors would like to thank Peter Anderson, Peter Iversen and Uli Wittchen for  their very helpful comments on an earlier version of this manuscript. Thanks also go to Julie Grayson for  English copy editing, and to Michelle Tortolo and Christine Vrbanac for referencing the multiple versions  of this manuscript.   1 TABLE OF CONTENTS    ALCOHOL CONSUMPTION, ALCOHOL DEPENDENCE  AND ATTRIBUTABLE BURDEN OF DISEASE IN  EUROPE:  POTENTIAL GAINS FROM EFFECTIVE INTERVENTIONS FOR ALCOHOL DEPENDENCE..............................1 FOREWORD....................................................................................................................................................7 WAKE‐UP CALL FOR EUROPE’S DRINKING PROBLEM.................................................................................................8 Dealing with Europe’s drinking problem.................................................................................................8 Why has Europe got it so wrong?...........................................................................................................8 Enter the pharmaceutical business.........................................................................................................9 References............................................................................................................................................10 EXECUTIVE SUMMARY.....................................................................................................................................11 ABBREVIATIONS USED.....................................................................................................................................14 THE AIM OF THIS BOOK..................................................................................................................................15 TRADITIONAL PATTERNS OF ALCOHOL CONSUMPTION IN EUROPE...........................................................................16 KEY INDICATORS OF ALCOHOL CONSUMPTION IN EUROPE......................................................................................18 Drinking status and volume of drinking................................................................................................18 Table 1: Key alcohol consumption indicators...................................................................................................20 Deriving indicators for alcohol consumption........................................................................................22 Measures of alcohol consumption: definitions and procedures......................................................................22 Adult alcohol consumption in 2009......................................................................................................23 Figure 1: Adult consumption in litres...............................................................................................................24 Table 2: Adult consumption and drinking patterns..........................................................................................25 Time trends in consumption.............................................................................................................................27 Figure 2: Adult consumption in litres since 2000..............................................................................................27 Patterns of drinking..............................................................................................................................28 Figure 3: Global patterns of drinking (2005).....................................................................................................29 Heavy drinking occasions......................................................................................................................29 Table 3: Frequency of drinking by country.......................................................................................................30 ALCOHOL‐ATTRIBUTABLE BURDEN OF DISEASE IN EUROPE.....................................................................................31 Acknowledgment..................................................................................................................................31 Relationships between alcohol, disease and injury..............................................................................32 Methodology for deriving the alcohol‐attributable burden..................................................................32 The problem of time lag........................................................................................................................33 Alcohol‐attributable mortality..............................................................................................................34   3 Deaths due to alcohol consumption.................................................................................................................35 Figure 4: Regional variations in proportions of deaths.....................................................................................35 Figure 5: Country variations in the proportions of deaths...............................................................................38 Table 4: Deaths by disease categories..........................................................................................................39 Figure 6: Proportion of deaths for major disease categories...........................................................................40 Potential Years of Life Lost (PYLL) due to alcohol.............................................................................................42 Figure 7: Regional variations in the proportion of PYLL....................................................................................42 Figure 8: Proportion of PYLL for major disease categories...............................................................................43 Alcohol‐attributable disability and burden of disease..........................................................................44 Years of Life Lost Due to Disability (YLD)..........................................................................................................44 Figure 9: Alcohol‐attributable YLD to all YLD, by region...................................................................................45 Burden of disease due to alcohol.....................................................................................................................45 Figure 10: Alcohol‐attributable DALYs to all DALYs, by region.........................................................................46 Figure 11: Proportion of alcohol‐attributable DALYs to all DALYs....................................................................48 Table 5: Alcohol‐attributable DALYs by disease categories..............................................................................49 Figure 12: Proportions of alcohol‐attributable burden of disease in DALYs.....................................................50 Health harms to others due to alcohol consumption...........................................................................50 Table 6: Alcohol‐attributable mortality and disease caused by harms to others.............................................52 THE CONTRIBUTION OF HEAVY DRINKING...........................................................................................................53 Table 7: Alcohol‐attributable mortality and disease........................................................................................54 ALCOHOL DEPENDENCE: PREVALENCE AND ASSOCIATED HARM..............................................................................55 Definition of alcohol dependence.........................................................................................................55 Prevalence of alcohol dependence.......................................................................................................56 Table 8: People affected with alcohol dependence, by country.......................................................................58 Mortality and burden of disease of alcohol dependence as a disease category in 2004......................60 Table 9: Deaths, PYLL and DALYs lost due to alcohol dependence...................................................................61 The overall health burden attributable to alcohol dependence as a risk factor...................................63 Quantifying the mortality burden of AD...............................................................................................65 Comparing alcohol‐attributable mortality...........................................................................................66 Figure 13: Mortality attributable to alcohol consumption and AD...................................................................66 OVERALL BURDEN AND SOCIAL COSTS OF ALCOHOL DEPENDENCE...........................................................................69 Burdens attributable to AD...................................................................................................................69 Figure 14: Burdens of AD, after incidence........................................................................................................70 Figure 15: Burdens of persistent AD.................................................................................................................71 The social cost of alcohol and AD.........................................................................................................72 Figure 16: Social costs of alcohol in the EU, 2010............................................................................................72 THE MEDICAL TREATMENT SYSTEM FOR ALCOHOL DEPENDENCE.............................................................................74 Proportion of people with AD in treatment..........................................................................................74   4 Treatment in the EU: reduction of drinking as a goal...........................................................................75 Table 10: Characteristics of ADT systems.........................................................................................................77 INTERVENTION SCENARIOS...............................................................................................................................79 Do interventions affect survival?..........................................................................................................80 Effectiveness of ADT on reducing consumption....................................................................................82 Table 11: Assumptions for modelling interventions.........................................................................................84 The statistical model for estimating intervention effects.....................................................................85 The distribution of abstainers and drinkers..........................................................................................85 Figure 17: Alcohol consumption in men with AD, before and after intervention............................................86 Figure 18: Alcohol consumption in women with AD, before and after intervention........................................87 Deaths avoided due to interventions....................................................................................................88 Figure 19a: Deaths avoided in men..................................................................................................................88 Figure 19b: Deaths avoided in women.............................................................................................................88 Figure 20a: Deaths avoided in men..................................................................................................................89 Figure 20b: Deaths avoided in women.............................................................................................................90 Figure 21a: Deaths avoided in men (as a proportion of all deaths)..................................................................91 Figure 21b: Deaths avoided in women (as a proportion of all deaths).............................................................91 CONCLUSIONS FOR ALCOHOL POLICY.................................................................................................................92 WEB APPENDIX 1: ADULT ALCOHOL CONSUMPTION.............................................................................................95 WEB APPENDIX 2: ESTIMATING THE ALCOHOL‐ATTRIBUTABLE BURDEN....................................................................97 Modelling average consumption..........................................................................................................97 Deriving alcohol‐attributable fractions from exposure and RRs...........................................................98 Step 1: Calculation of AAFs by country, age, and sex...........................................................................98 Defining age categories....................................................................................................................................98 Countries included in the analysis....................................................................................................................98 Sources for modelling risk relations.................................................................................................................98 AAFs for chronic and infectious diseases (except ischemic heart disease).......................................................98 AAFs for ischemic heart disease.......................................................................................................................99 Estimating AAFs for low birth weight...............................................................................................................99 Estimating AAFs for injuries..............................................................................................................................99 Estimating AAFs due to heavy drinking..........................................................................................................101 Estimating confidence intervals for the AAFs.................................................................................................102 Step 2: Application of the AAFs to region‐specific mortality, PYLL, YLD and DALYs data...................102 Estimating mortality and morbidity................................................................................................................102 WEB APPENDIX 3: SOURCES FOR DETERMINING RISKS FOR DISEASE CATEGORIES.....................................................104 WEB APPENDIX 4: CONFIDENCE INTERVALS FOR ESTIMATES OF MORTALITY............................................................106 WEB APPENDIX 5: STANDARDIZED MORTALITY PER 100,000..............................................................................107   5 WEB APPENDIX 6: ALCOHOL‐ATTRIBUTABLE PYLL.............................................................................................108 WEB APPENDIX 7: ALCOHOL‐ATTRIBUTABLE YLD..............................................................................................109 WEB APPENDIX 8: ALCOHOL‐ATTRIBUTABLE DALYS..........................................................................................110 WEB APPENDIX 9: ALCOHOL‐ATTRIBUTABLE DEATHS, BY REGION.........................................................................111 Central‐West and Western Europe: alcohol‐attributable deaths.......................................................111 Central‐East and Eastern Europe: alcohol‐attributable deaths..........................................................111 Nordic countries: alcohol‐attributable deaths....................................................................................112 Southern Europe: alcohol‐attributable deaths...................................................................................112 WEB APPENDIX 10: ALCOHOL‐ATTRIBUTABLE DALYS........................................................................................113 Central‐West and Western Europe: alcohol‐attributable DALYs........................................................113 Central‐East and Eastern Europe: alcohol‐attributable DALYs...........................................................113 Nordic countries: alcohol‐attributable DALYs.....................................................................................114 Southern Europe: alcohol‐attributable DALYs....................................................................................114 WEB APPENDIX 11: ESTIMATING HARM TO OTHERS, BY COUNTRY........................................................................115 Figure 22a: Alcohol‐attributable deaths caused by harms to others..............................................................115 Figure 22b: Alcohol‐attributable DALYs caused by harms to others..............................................................116 WEB APPENDIX 12: PREVALENCE OF ALCOHOL DEPENDENCE, BY COUNTRY............................................................117 WEB APPENDIX 13: PREVALENCE OF ALCOHOL DEPENDENCE, BY REGION...............................................................118 WEB APPENDIX 14: ALCOHOL‐ATTRIBUTABLE MORTALITY..................................................................................119 WEB APPENDIX 15: PROPORTION OF MORTALITY BY REGION...............................................................................120 Central‐West and Western European Region.....................................................................................120 Central‐East and Eastern European Region........................................................................................121 Nordic Countries.................................................................................................................................121 Southern European Region.................................................................................................................122 WEB APPENDIX 16: TREATMENT ACCESS FOR PEOPLE WITH AD...........................................................................123 WEB APPENDIX 17: ESTIMATING INTERVENTION EFFECTS....................................................................................124 WEB APPENDIX 18: ALCOHOL‐ATTRIBUTABLE DEATHS PREVENTED BY TREATMENT..................................................125 European Union Estimates..................................................................................................................125 Regional Estimates.............................................................................................................................127 REFERENCES................................................................................................................................................131     6 Foreword  Alcohol remains Europe’s favourite drug. While overall alcohol consumption in Europe has  remained relatively stable over recent years, it still contributes to a substantial burden of disease and  premature deaths. Along with smoking and obesity, alcohol is a leading preventable cause of ill health.  Further, although overall per capita consumption of alcohol is relatively stable, this conceals variation  between countries: alcohol consumption has increased in some Northern and Eastern European  countries compared to reductions in traditionally wine‐drinking countries. In addition to the health  consequences, alcohol contributes to a wide range of social and criminal justice costs—placing a  considerable burden on the European economy.  This report provides a timely and comprehensive review of the relationship between alcohol  consumption and harm in Europe. While European alcohol strategies have typically focused on reducing  alcohol misuse through controls on availability, marketing and price, and drunk‐driving  countermeasures, this report highlights the considerable potential to reduce alcohol‐related harm  through wider implementation of individually directed interventions for people with alcohol  dependence. There is now a considerable evidence base which supports the effectiveness and cost  effectiveness of brief interventions, and a range of specialist treatment for people with alcohol use  disorders. However, this report highlights the current gap between evidence and practice. Less than 10%  of people with alcohol dependence receive treatment in Europe; and yet alcohol dependence accounts  for a substantial proportion of all harm associated with alcohol.  Rehm and colleagues provide a compelling case for action in Europe—at both an individual  country level and a pan‐European level to make treatment for alcohol dependence more widely  available. The current patchwork of services for people with alcohol dependence has resulted from a  lack of strategic direction and a failure to exploit knowledge we already possess on what works in  helping people to reduce or stop drinking alcohol. Many European countries have no national or  professional guidelines to inform clinicians and commissioners of health care.  Increasing the proportion of people with alcohol dependence who gain access to effective  treatment must now be a Europe‐wide priority. In doing so, one must not underestimate the potential  challenges including training for health professionals and costs of implementation. However, given the  proven cost‐effectiveness of treatment for alcohol dependence, such investment is likely to yield  significant cost savings as well as reduced human suffering.  Colin Drummond, MD, FRC Psych   Professor of Addiction Psychiatry, National Addiction Centre, Institute of Psychiatry,   King’s College London, London, UK   7

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ISBN: 978-1-77114-047-8 (PDF) Authors: Jürgen Rehm,1-6*Kevin D. Shield,1,3* Maximilien X. Rehm,7 Gerrit Gmel,1,8 Ulrich Frick9. * JR and KS
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Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.