a product message image
{' '} {' '}
Limited time offer
SAVE % on your upgrade

Page 1

Interventions for alcohol dependence in Europe: A missed opportunity to improve public health J端rgen Rehm, Kevin D Shield, Maximilien X. Rehm, Gerrit Gmel, Ulrich Frick TU Dresden, CAMH Toronto


Line of argumentation • Alcohol consumption is high in Europe, with considerable public health burden • Alcohol dependence plays a key role in creating this burden, with most of it due to heavy drinking • Treatment interventions for alcohol dependence can reduce the public health burden markedly • The current alcohol policy strategies should be supplemented by increase of alcohol dependence treatment rates


Total adult per capita alcohol consumption (recorded and unrecorded) in 2005

WHO, 2011


High exposure, high burden of mortality and disease • For men between ages of 15 and 64, 1 in 7 deaths in 2004 were caused by alcohol (clearly premature deaths given the life expectancy in Europe) • For women of the same age category, 1 in 13 deaths in 2004 were caused by alcohol • The proportion are even higher for burden of disease attributable to alcohol (years of life lost to premature deaths or disability)


How many deaths are attributable to alcohol dependence? 25 Men

Women

Total

Percentage of deaths

20

15

10

5

0

Men Women Total

5

Alcohol-attributable 16.1% 8.5% 13.6%

Alcohol-attributable (net) 13.9% 7.7% 11.8%

Heavy drinking 11.1% 5.3% 9.2%

Alcohol dependence 10.7% 3.7% 8.4%

Rehm et al. 2012. Alcohol consumption, alcohol dependence, and attributable burden of disease


What does this mean? • Most of the burden of alcohol stems from heavy drinkers (about 77% of the net burden, 67% of the overall burden), i.e., women drinking >40 g/day and men drinking >60 g/day • Alcohol dependence accounts for 71% of the net burden and 62% of the total alcohol-attributable burden • In other words, alcohol dependence causes the majority of mortality burden of alcohol • For burden of disease in DALYs, this proportion is much higher

6

Rehm et al. 2012. Alcohol consumption, alcohol dependence, and attributable burden of disease


Number of deaths avoided over one year in men by treatment for AD in the EU in 2004 by five different treatment modalities

Rehm et al., 2012 Alcohol consumption, alcohol dependence, and attributable burden of disease


Number of deaths avoided over one year in women by treatment for AD in the EU in 2004 by five different treatment modalities

Rehm et al., 2012 Alcohol consumption, alcohol dependence, and attributable burden of disease


Why is alcohol dependence treatment successful? It reduces level of consumption either to abstinence or by sizable reduction of heavy drinking. Relative gain in risk for mortality of reducing by three drinks/day for different levels of drinking

Typical risk curve for alcohol (e.g., liver cirrhosis mortality) 35

60

30

50

Reducing from 14 to 11 drinks per day reduces the mortality risk about 10 times as much as reducing from 3 to 0 drinks/day

25 40 20 30

RR for mortality 15

20 10 10 5 0 0

9

5

10

15

20

0 3

4

5

6

7

8

9

10 11 12 13 14 15 16 17 18 19 20


Alcohol policy should be supplemented by increasing treatment rates • Current alcohol policy recommendations by WHO and public health authorities are dominated by prevention (WHO best buys: taxation increases, availability restrictions, marketing ban) • Alcohol policy should additionally comprise changes to increase treatment rates

– For ethical reasons, but – also for public health reasons!


Profile for Georgina Carr

Professor Juergen Rehm: Interventions for alcohol dependence in Europe  

'Interventions for alcohol dependence in Europe: A missed opportunity to improve public health' was presented by Professor Juergen Rehm of D...

Professor Juergen Rehm: Interventions for alcohol dependence in Europe  

'Interventions for alcohol dependence in Europe: A missed opportunity to improve public health' was presented by Professor Juergen Rehm of D...