Professor Frank Murray, Consultant Gastroenterologist and chair of national alcohol policy group, RCPI, speaks about alcohol-related harm in Ireland at Alcohol Action Ireland's conference "Time Please... For Change".
Slide 16 SURVIVAL TIMES IN CIRRHOSIS In a prospective cohort study of 257 patients with compensated cirrhosis of different etiologies, median survival for all patients (including those who developed decompensation) was approximately 9 years, while it was significantly lower in patients who developed a decompensating event (ascites, jaundice, encephalopathy or hemorrhage), in whom the median survival was only 1.6 years. Gines et al. Hepatology 1987; 7:122
Alcohol-related harm in Ireland - a health perspective
Alcohol in Ireland. Major health burden. Major economic burden. Major opportunity. Prof Frank Murray Registrar RCPIConsultant Gastroenterologist/Hepatologist, Beaumont Hospital/RCSI, Dublin 9
Policies that reduce the availability of alcohol though: Price increases or Reducing outlets and hours of saleHave been shown to be effective
• Europe is the heaviest drinking region in the world• Alcohol is the main cause of liver disease in Europe• The prevalence of alcoholic liver disease is rising in Ireland
Problems addressing the alcohol problem in Ireland!!!!• Drinking alcohol can be harmless, in contrast to cigarettes• Alcohol is strongly rooted in our society• The alcohol industries receive the majority of their turnover in UK from harmful and hazardous drinkers
Alcohol in Europe• Europe is the highest drinking region in the world• 200,000 deaths per year• Cost €125 billion per year. 1.3% of GDP• Third commonest cause of premature death and disability• Main cause of liver disease and death
DALY (Disability adjusted life year)• The sum of the life years lost due to premature death or years lived in disability
Alcohol cause huge health problems• WHO: – 4% of global mortality – 5% of global DALY• Europe worse – 7% mortality – 12% of DALY
Alcohol cause huge health problems• Worse in males: 17% of DALYs( vs 4%)• Worst in young males• Alcohol cause 35% of deaths aged 35- 50
Alcohol responsibility for many youth deaths• 25% of male• 10% of female
Main cause of alcohol DALY• Liver disease• 75% men• 85% women
• There is a direct correlation between amount of alcohol consumed and cirrhosis mortality
CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension
SURVIVAL TIMES IN CIRRHOSIS Decompensation in cirrhosis Shortens Survival 100 80 Median survival Median survival ~ 9 years ~ 9 years 60 All patients with cirrhosisProbability of survival 40 20 Decompensated Median survival Median survival cirrhosis ~ 1.6 years ~ 1.6 years 0 0 20 40 60 80 100 120 140 160 180 MonthsGines et. al., Hepatology 1987;7:122
There is a big human cost here• Ill and dying patients• Often young• Often little opportunity to change• Families
Does not end there• Absenteeism• Loss of professional performance• Domestic violence• Unhappiness
3 main types of alcohol misuse• Hazardous• Harmful• Dependent drinking.
Hazardous drinking• Drinks over the recommended weekly limit of alcohol• 21/17 units for men and• 14/11 units for women.• It is also possible to drink hazardously by binge drinking, even if within weekly limit.
Harmful drinking• Drinks more than the recommended weekly maximum amount of alcohol and experiences health problems that are directly related to alcohol.• Cirrhosis• depression• an alcohol-related accident, such as a head injury• acute pancreatitis (inflammation of the pancreas)• high blood pressure• some types of cancer• heart disease
Dependent drinking• Both physically and psychologically addictive• Become dependent on it• Feels unable to function without alcohol• Consumption of alcohol becomes an important, or sometimes the most important, factor in their life• Can experience withdrawal symptoms (both physical and psychological) if they suddenly stop drinking alcohol.
Binge drinking• 4 (female)• 5 (male)• units in 2h – or• 8 (male)• 6 (female)• units in 24 hours• Rapidly increasing in prevalance
So most alcohol consumption is mostly drunk safely?…..• 75% of alcohol consumed in UK is by hazardous and harmful drinkers in the UK
Absolute risk of death from alcohol- related disease
Options• Do nothing• Do “something”• Take thought-through series of steps. Leads to immediate health social and political gains
Systematic reviews and meta-analyses. Proven policies.• Policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm.• Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm.
Key messagesA substantive evidence base of systematicreviews and meta-analyses inform alcoholpolicy
Making alcohol moreexpensive and lessavailable are highly cost-effective strategies to reduceharm
• Banning of alcohol advertising• Drink-driving countermeasures• Individually-directed interventions to drinkers already at risk are also cost-effective approaches
School-based education doesnot reduce harm, but publicinformation and educationprogrammes can increaseattention to alcohol on publicand political agendas
If more stringent alcohol policiesare not put into place, globalalcohol-related harm is likely tocontinue to increase
Actions• Reduce number of outlets dramatically• Increase cost-minimum unit pricing• Expand and enforce legislation re alcohol consumption in public and public order offences• All of proven international proven benefit
Successful legislated constructive social changes in Ireland• Smoking ban• Reduction in alcohol driving limit• Cycling helmets
RCPI alcohol group• RCPI established a national policy group to address the health and social burden of alcohol in Ireland.• The policy group brings together experts from a wide range of medical specialist bodies to speak with one voice on the issue of alcohol, to support• Propose practical solutions backed up by a robust, international evidence base• Focused on reducing the harm caused by alcohol to health and society.
Policies that reduce the availability of alcohol though: Price increases and Reducing outlets and hours of saleHave been shown to be effective