Alcohol consumption and its effects on mental health in the UK and Ireland

Alcohol consumption and its

effects on mental health in the

UK and Ireland

Maastricht University

Faculty of Health, Medicine and Life Sciences

Maastricht

Student: Una Daly

Student Number: I6079543

Module: Healthy Lifestyles in Europe

Module Code: 2014-300-EPH2011

Module Coordinator: Ester Slits

Date: February 2015

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Contents

Abstract.....................................................3

Introduction.................................................3

Methods......................................................6

Google Scholar..............................................7

PubMed......................................................7

PsycINFO....................................................7

BioMedCentral...............................................7

Definitions.................................................7

Results......................................................8

Discussion...................................................9

Conclusion..................................................11

Bibliography................................................13

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Abstract

It is a well-known fact that lifestyles and health outcomes go

hand and hand. Across the European area, health professionals

are becoming more and more concerned with studying the effects

of relationships with substances, food and habits both at

individual and population level. Alcohol consumption is at an

all-time high in the UK and Ireland. At the periphery of the

European area, these two countries sometimes exhibit trends

that are quite separate from that of the rest of Europe, but

very similar to each other. Research has demonstrated that, as

a mind altering substance, alcohol does have some effect on

mental health and this is evident in instances of both

consumption of large and of small amounts. Surveys such as

“The health and lifestyle survey” in the UK and proposals such

as “Towards a Framework for Implementing Evidence Based

Alcohol Interventions” by the Health Service Executive in

Ireland seek to investigate the burden of the issue and deduce

constructive methods of dealing with this burden. This

literature review will investigate these and similar documents

3

to compare the effect that alcohol has on mental health in the

UK and Ireland.

Introduction

Mental health and illness have more recently been viewed as a

partial outcome of an individual’s lifestyle. Diet, activity

level and use of substances have all been proven as both

contributing and protective factors in whether an individual

develops mental illness, and a change in lifestyle can

certainly be used to promote improved mental health. The topic

of this paper will address the issue of alcohol consumption

and the impact that it has on the mental health of the

populations of two countries in the EU, namely the United

Kingdom and the Republic of Ireland. The reasoning behind the

selection of these two countries is to investigate if, being

separated by sea to the rest of Western Europe, they exhibit

any differing trends to those exhibited in the EU overall.

As illustrated below, alcohol consumption in Ireland stands at

11.6 litres per capita for those aged 15 and over, and in the

UK this amount is a slightly lower 10.6 litres (OECD, 2015).

This indicates in Ireland higher than the EU average of 10.7

and in the UK slightly lower consumption. Alcohol consumption

at harmful levels can be attributed to many different

avoidable risks including violence, injuries and suicide as

well as being a major contributory factor in cancers and heart

and liver diseases. The only three countries which display

consumption higher than Ireland are Estonia 12.3, at Austria

at 12.2 and France at 11.8.

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Fig. 1 (OECD, 2015)

As the above graph also shows, the numbers reflected today are

in stark contrast to consumption in the 1970s. Ireland,

although it has peaked at 14.5 litres in 2005, as shown a much

welcomed decline in recent years, and while the UK does not

display any marked differences in the last 10 years, it

contrasts greatly from 20 years ago. All things considered,

though both countries would have shown greater than average

consumption in the context of the EU27, they are both showing

declines in more recent times.

Within the WHO European region, 22% of suicides are linked to

the consumption of alcohol (WHO, 2015). This is a shockingly

grave statistic, and every avenue that can be explored to

decrease this number must be exhausted. Below is a graph that

outlines the number of cases of suicide per 100,000 population

5

in the UK and Ireland. The European average stood at 12 per

100,000 in 2010 (EuroSafe, 2013).Again, Ireland displays a

much higher level here, 11.7, than the UK who are at 6.7.

However, these figures are still below average for the whole

area, which means that there are countries with a much higher

suicide attributable burden, such as Hungary at 22 and

Slovenia at 18.6 (OECD, 2015).

Fig. 2 (OECD, 2015)

According to research conducted in 2011, the largest portion

of disability in the UK can be attributed to mental illness,

which overall comprises 23% of the entire disease burden

(Personal Social Services Research Unit, London School of

Economics and Political Science, 2011). The same study

estimates that 6.6 million people over the age of 18 are

hazardous drinkers and further 2.3 million could be classed as

“harmful”. This evidence suggests an illness burden of

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epidemic proportions, however it has yet to be seen whether or

not alcohol consumption, more than any other lifestyle factor,

is correlated with this burden. As we can see below, in the

graph of burden of disease attributable to 20 risk factors in

the UK, the highest proportion of the disability adjusted life

years related to alcohol use are represented by mental and

behavioural disorders (Murray, 2013). Another study conducted

in Ireland in 2001 showed that of 31 deaths related to

suicide, 28 of these were male and 16 had alcohol in their

systems (Bedford, O''Farrell, & Howell , 2006).

Fig. 3 (Murray, 2013)

With this in mind, three research questions have been selected

for this research paper: What are the mental health effects of

alcohol consumption? Are the mental health effects of alcohol

consumption more or less prevalent in the UK and Ireland than

other countries in the EU? Is there sufficient evidence and

information available and preventative measures in place, and

what, if anything, needs to be done going forward?

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Following this introduction a short method section will

outline the way in which research will be conducted and

clarify the definitions that will be used in this paper.

Subsequently, the results section will describe the findings

of this research. There will then be a discussion on these

results, which will include recommendations on how to address

problems that currently exist and the answers to the research

questions. Finally, the conclusion of this paper will

recapitulate the most important findings.

Methods

It has been decided that this research will take the form of a

literature review. This will allow for a systematic appraisal

of all available data in relation to the research questions

posed, with a view to providing a better understanding of the

topic overall.

To facilitate ease of remote research, it was decided that

online sources only would be used for this literature review.

Google Scholar, PubMed, BioMedCentral and PsycINFO were chosen

as databases, and searches were conducted using the terms

“Alcohol” “Mental health” “UK”/ “Britain” and “Ireland”. To

isolate the most recent information and evidence, only results

from 2010 to 2015 were used during the Google Scholar and

PubMed searches. This was not deemed to be necessary in the

PsycINFO and BioMedCentral searches, as very few results

appeared and each one could be studied for evidence. Only

8

those texts written in English language were selected for this

paper. Furthermore, databases such as the OECD and WHO and

websites of the HSE and NHS have also been used for the

empirical data utilised during this research.

Alcohol + mental

health + UK +

Ireland

Full

text

online

Since

2005

Since

2010

Journal

Article

Google

Scholar

49,600 17,500 14,400

PubMed 9,508 5,146 2,008 1,500

PsycINFO

Alcohol + Mental + Health + Britain: 9 results

BioMedCentral

Alcohol + Mental + Health + UK + Ireland: 245 results

Definitions

In the context of one study, “hazardous” drinking was defined

as the intake of 21 – 50 units of alcohol for men and 14 – 35

units for women (Personal Social Services Research Unit,

London School of Economics and Political Science, 2011).

“Harmful” drinking was described as being in excess of 50

units for men and 35 units for women. This fits with the

numbers quoted by public health lobbies such as Drink Aware,

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who work in collaboration with different stakeholders such as

the UK and Irish governments, the alcohol industry and local

community organisations to reduce levels of harmful drinking

in both countries (MEAS, 2015).

Results

It is clear from the above graphs that Ireland has a higher

than average level of alcohol consumption than that of the EU

overall, and that the UK has around the same. There has,

however, been much improvement in the level of consumption in

Ireland in recent years and if this trend is maintained then

it can only lead to a higher level of health in the general

population. A point worth noting is that those who abstain

completely from alcohol consumption have similar mental health

outcomes as those who drink more frequently. Studies have

repeatedly shown that moderate drinkers (those who drink from

once per month to three times per week) experience better

mental health overall (Velten, et al., 2014). This may suggest

that there is a social aspect to the drinking culture which

may be lacking in those who do not drink.

Contrary to previous assumptions surrounding the issues of

alcohol use and mental illness, social exclusion seems to be

the main outcome of this comorbidity. Those who suffer from

mental illness and whose drinking is excessive are unable to

participate in their communities, are more likely to be

unemployed or to become homeless than those who do not use

alcohol excessively (Todd, et al., 2004). In fact, studies

have shown that 10% – 20% of homeless people suffer from 10

severe mental illness in conjunction with substance abuse

which in turn puts them at risk of a much shorter life

expectancy and all other associated social issues faced by

those who are homeless. In Ireland, many homeless shelters and

hostels refuse to allow those service users who are either

intoxicated or intending to consume alcohol on the premises

entry, which increases their chances of sleeping outside.

Another outcome observed in research is that there is some

evidence to suggest that alcohol abuse is a predictor of

future dangerousness in those who have already been convicted

of violent crimes. This may be an intrinsic factor in those

who are already mentally ill and not those whose mental

illness has been caused by their alcohol use (Gunn, 1982),

however it must be considered that violent assaults and

accidents are also outcomes of hazardous alcohol consumption

alone. It is advisable that during incarceration, those with

mental illness and/ or alcohol dependency should be offered

treatment to reduce the possibility of re- offending on

release.

Perhaps the most important factor, and one already well

documented, is that in most self-reports, men are much more

likely to partake in hazardous or harmful drinking. It is not

only a risk to their mental health, but also their physical

health and may have a ripple effect on families. A study cited

in the introduction of this paper, regarding blood alcohol

levels in those who died from accident or suicide, reports on

an increase in suicides in Ireland, particularly in males

younger than 30 (Bedford, O''Farrell, & Howell , 2006). It

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draws a link between this increase and the increase in alcohol

consumption during this time. This would suggest that during

alcohol screening that it would also be prudent to screen for

mental illness in men, or if a mental illness exists then

investigating the level of alcohol consumption (with a view to

lowering it in the cases of hazardous or harmful drinkers) is

advisable, however it also highlights that many suicides are

impulsive in nature. While it is accepted that consuming

harmful or hazardous quantities of alcohol does increase the

risk of suicide exponentially, it may not necessarily mean

that an underlying mental illness is also a factor.

Considering the above information, while the UK and Ireland

are geographically close, they show slightly differing numbers

in terms of both alcohol use and the outcomes for mental

health. While the numbers may at times seem high, they do not

seem to reflect larger issues than other parts of the EU. As

demonstrated above, Eastern Europe consistently displays far

higher numbers of suicides, and although high levels of

alcohol consumption are observed in many different countries

they do not necessarily have particularly high suicide rates.

It may be more effective to observe differences in effect

which is posed by gender, rather than between countries, since

men seem to consume more alcohol and are more likely to commit

suicide.

Discussion

It has been claimed that wealthier societies are much more

willing to accept the risks that are associated with harmful

voluntary behaviours such as the consumption of alcohol (Rehm,12

Lachenmeier, & Room, 2014). This could be an indicator as to

why, even though health effects both mental and physical and

social exclusion are all evident, the UK and Ireland seems to

have had an increasing level of consumption over the last 20

years. Regarding this point, what is also interesting to note

is that less wealthy societies have a much lower suicide

attributable burden relating to substance use (Ferrari,

Norman, Freedman, Baxter, & Pirk, 2014). Along with this

acceptance of alcohol is an almost inappropriate relationship

between governments and the alcohol industry (Mackenbach,

McKee, & Anderson, 2013). In Ireland there has been a push to

ban alcohol advertising at sporting events, however both

sporting bodies and the government have joined the alcohol

industry in the argument against this on the grounds that

sporting events would not be possible should funding be lost

from the alcohol industry. The claim here is that this would

ultimately lead to poorer health.

Within the EU, 38% of the population suffer from one or more

mental illnesses per year. The financial cost of this burden

equates to almost eight hundred billion euro per year, which

includes both medical and non-medical costs (Velten, et al.,

2014). When it is considered that lifestyle factors such as

alcohol consumption could be at play here, then it is of

utmost importance that public health professionals deal with

this growing problem. The WHO has advised that through

lowering the consumption of alcohol and facilitating

cooperation between addiction and mental health services a

reduction in the harm will come about (WHO, 2015). One report,

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conducted by the London School of Economics, has advised that

the brief intervention method (in primary care) can result in

a 12.3% reduction in this consumption. Brief intervention

involves screening by primary healthcare workers in settings

such as an accident and emergency department or GP surgery

when the patient presents for reasons other than harmful or

hazardous alcohol consumption. However, it is also accepted

that around 20% of those engaging in both hazardous and

harmful behaviour are missed during screening. As outlined

above, it is advised that a more targeted approach when

screening those deemed to be most at risk, and utilizing

practice nurses instead of GPs to conduct screening will

result in higher success rates and lower costs (Personal

Social Services Research Unit, London School of Economics and

Political Science, 2011).

In answer to the research question “What are the mental health

effects of alcohol consumption?” it has been outlined that

alcohol consumption is prevalent in of 22% of suicides. It is

not known if this is a causative factor, or if individuals

would have portrayed suicidal tendencies prior to alcohol

consumption. As to the question “Are the mental health effects

of alcohol consumption more or less prevalent in the UK and

Ireland than other countries in the EU?” although there is

some evidence to suggest that Ireland with a slightly higher

than average level of alcohol consumption, and the UK with

around the same as that of the EU, this is not correlated with

the average burden of suicide. Research in the UK has,

however, shown that the country is struggling with both social

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exclusion and violent crime as a result of alcohol and mental

health issues co- morbidity.

Finally, in relation to the question “Is there sufficient

evidence and information available and preventative measures

in place, and what, if anything, needs to be done going

forward?” the answer is slightly less concise. It is clear

that while there are issues the available evidence is not

sufficient to combat them. Public health agencies are

attempting to cooperate with stakeholders such as the

government, community based organizations (for example local

health centres) and even the alcohol industry themselves in

order to promote responsible drinking and improved awareness

of mental health issues. Another combative measure that has

been discussed in the UK and that is currently being put into

practice is the utilization of the alcohol industry in

lowering the available alcohol in the market by eight billion

units (one unit equaling one gram of alcohol). This will be

done in three different ways: raising the price of drinks that

have a higher alcohol content, changing the way that alcohol

is advertised and marketed and using consumer behaviour

patterns to identify how alcohol sales are affected by product

location and the layout of shops (Mackenbach, McKee, &

Anderson, 2013). It is thought that these strategies will both

bring about enormous public health benefits and set a good

example to other European countries, in the hope that they

will follow suit. A further way in which to bring about a

decrease in mental illness and mortality related to socio

economic circumstances (for example alcohol related diseases)

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is to increase spending in welfare. This has been previously

used in Finland and Sweden, where it was found that this was a

more effective method than increasing spending in health.

Studies have shown that this apparent effectiveness is due to

the fact that if welfare spending is increased, there are

better social supports in place, individuals feel more secure

and population confidence in government is also increased

(Karanikolos, et al., 2013). This is a sentiment that has been

echoed by the Global Burden of Disease Study in 2010, who

claim that disorders related to alcohol use (for example,

self-harm) have increased which may be due to the adverse

effects of the European financial crisis (Murray, 2013).

Finally, in the case of adolescent health, social media has

proven to be instrumental in raising awareness and influencing

more positive behaviour. In the UK, the Department of Health

has started to utilize online marketing campaigns to bring

about social changes as over 40% of teenagers are online daily

and of these almost half remain online for thirty minutes to

an hour (Nicholas, 2010). It has also been shown that young

people are more comfortable searching for advice and

information online relating to all kinds of health behaviour.

As in the case of Drink Aware, this type of information can

help to improve attitudes towards alcohol use and ultimately

lead to a decrease in harmful and hazardous drinking.

Conclusion

While much is known about the co- morbidity of alcohol misuse

and mental illness, it has yet to be clarified how much one is

attributable to the other. In addition to this, alcohol use is

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often expressed as a part of substance use and not on its own.

This can make it difficult to ascertain whether alcohol or

other substances are causative factors in different mental

illnesses or if misuse is as a result of an existing mental

illness. Furthermore, in the UK and Ireland, alcohol is the

only mind altering substance that has not been criminalised so

it needs to be taken as a separate case. In the case of

illegal drugs, true use is often not stated by the user for

fear of prosecution so it cannot truly be known what effects

they have.

It is also apparent that financial austerity has had an impact

on both health systems and social systems in Ireland, the UK

and indeed across Europe. As economies in Europe are now

beginning to improve following the global financial crisis,

steps must be taken to ensure increases in health spending

occur in order to increase access to health care and restore

public confidence in both societies. This will in turn

decrease morbidity and mortality relating to alcohol use and

improve mental health for all.

Finally, a point that cannot be stressed enough is that males

consume far more alcohol than females and are far more likely

to succeed in committing suicide. This needs to be addressed

as a matter of urgency. Reduction in alcohol consumption and

more targeted screening will surely lead to a decrease in the

numbers of male suicides in Europe.

It is clear from this research paper that further study of

this topic is needed. The effects of alcohol on mental health

are certainly apparent in aspects both medical and social,

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however in order to tackle the problem, it is advisable that

public health bodies (such as Drink Aware) do more in order to

mobilise all stakeholders to action.

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