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Alcohol - Health and Economic Impacts
Richard A. Yoast, Ph.D., DirectorAMA Dept. of Public Policy
& Primary Prevention
Tuesday, September 16,2008American Council on Alcohol
ProblemsNational Meeting, Springfield IL
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Who drinks?What are the impacts?
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NSDUH Survey, 2002Alcohol - the Drug of Choice Among 12-20 Year
Olds
Chart2
10.97.94.5
25.217.612.5
38.728.218.2
Alcohol
Cigarettes
Marijuana
Grade
Percent using in past month
Sheet1
Past Month
Grade
8th10th12th
Alcohol10.925.238.7
Cigarettes7.917.628.2
Marijuana4.512.518.2
Sheet1
Alcohol
Cigarettes
Marijuana
Grade
Percent using in past month
Sheet2
Sheet3
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Drinking among Americans 12 or older (2007) NSDUH51.1% are
current drinkers (last 30 days) = est. 126.8 million people56.6% of
males, 46 % of females (ages 18 to 25: 57.1% of females, 65.3% of
males) 3.5% of 12 or 13 year olds14.7% of 14 or 15 year olds29.0%
of 16 or 17 year olds 50.7% of 18 to 20 year olds68.3% of 21 to 25
year olds Binge drinking (last 30 days): 23.3%= 57.8 million
peopleHeavy drinking: 6.9% = 17 million peopleCurrent adult use
decreased with age:63.2% of ages 26 to 29 47.6 % of ages 60 to 64
38.1% of ages 65 or older.
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U.S. Youth 2005 YRBS Sizeable youth population engaging in risky
alcohol-related behaviors (last 30 days) 43.3% grades 9 -12 (50% of
12th graders) had at least one drink25.5% binged (5 or more drinks
in a row) 28.5% rode 1 or more times with drinking driver9.9%
(19.2% of 12th grade males) drove after drinking23.3% of currently
sexually active students drank or used other drugs before last
sexual intercourse
[CDC MMWR June 9, 2006]
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Underage DrinkingNegative consequences costs the US: $62 billion
per year (medical costs, lost productivity & quality-of-life
costs due to motor-vehicle crashes, violence, property crime,
suicide, burns, drowning, fetal alcohol syndrome, high-risk sex,
poisonings, psychoses & dependency treatment).
[Miller TR, Levy DT, Spicer RS, Taylor DM. Societal costs of
underage drinking. J Studies Alcohol and Drugs 67: 519-528,
2006.]
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Acute Health and Safety Consequences of Alcohol Use in the
Younger Populationalcohol poisoningmotor vehicle crashesrisky
sexual behaviorssuicide attemptsdrowningother drug usesignificant
contributor to injury in adolescencea role in more than 50% of
traumatic brain injuries in adolescentsviolence
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Early Onset - Not BenignAge at which young people begin using
alcohol has decreased over the last 35 years; On average, youths
now take their first drink at the age of 12 years.
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Early Alcohol Involvement associated with poorer behavioral
measures of thinking abilities of youth.MemoryLearning
StrategiesVisual Spatial AbilitiesAttentionassociated with under
activation in several brain regions during cognitive tasks (frontal
and prefrontal,parietal, cingulate)
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Alcohol and Neuroanatomical Findings with YouthSmaller
hippocampus in adolescenceGreater responsivity to alcohol cuesScore
worse than non-users on vocabulary, general information, memory,
memory retrieval and at least three other testsSignificant
neuro-psychological deficits exist in early to middle adolescents
(ages 15 and 16) with histories of extensive alcohol use
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Alcohol-related chronic symptoms or medical conditions in
youthAppetite changesWeight lossEczemaHeadachesSleep
disturbanceSerum enzymatic markers of liver damage are elevated in
alcohol-abusing adolescents.
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What Do We Need to Learn?Are these deficits permanent?How long
do they last?Can we speed recovery?To what extent are
neurocognitive and neuroanatomical differences present before
alcohol use starts?Which children are most vulnerable to these
adverse alcohol consequences?Withdrawal may impact different
abilities than use.
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Youth/young adult drinking
Alcohol a leading contributor to the main cause of
deathinjuryfor people under age 21 (ca. 5,000 deaths/yr related to
underage drinking) - result of motor-vehicle crashes, unintentional
injuries from other causes, homicides, and suicides. Faden V.B.,
Goldman M. (Co-Chairs), NIAAA Interdisciplinary Team on Underage
Drinking Research. Alcohol development in youth a multidisciplinary
overview: The scope of the problem. Alc Res & Health
28(3):111-120, 2004/2005.
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Drinkers: Less Active Brains
Comparing two 20 year old females. Top view of brain, two inches
above ears
Note differences in back of brain
Healthy Control Alcohol-Dependent
Colored areas show active brain areas during memory task.Source:
Tapert SF, Brown GG, Kindermann SS, Cheung EH, Frank LR, Brown SA
(2001). fMRI Measurement of Brain Dysfunction in Alcohol-Dependent
Young Women. Alcoholism: Clinical and Experimental Research. 25
(2):236-245.
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Source: Tapert SF, Brown GG, Kindermann SS, Cheung EH, Frank LR,
Brown SA (2001). fMRI Measurement of Brain Dysfunction in
Alcohol-Dependent Young Women. Alcoholism: Clinical and
Experimental Research. 25 (2):236-245.
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College Age Drinkers: Reduced Brain Function
Healthy Controls
Alcohol Dependent
Spatial Working Memory response
Simple Attention response
These are pictures of the brain taken from fMRI. They brain
images non-alcoholic and alcoholic youth, a top view looking down,
just above ear-level. The warm colors show parts of the brain that
were active for the memory task given during the scanning session.
Cool colors show parts that were not very active during this
task.
You can see that the overall pattern of activation is similar,
but not identical, patterns between groups.
Next, youll see a statistical comparison of the alcoholics
versus nonalcoholics patterns.
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Neurocognitive Impact of AlcoholPre-natal: fetal alcohol
effectsMiddle Adolescence: fewer learning strategies, memory
impairmentLate Adolescence: attentional decrement, visuospatial
impairmentAdults: Prolonged abuse has harmful to liver, lungs,
pancreas, kidneys, endocrine system, immune system, cardiovascular
system, and brain.
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BUT - If drinking onset is delayed by 5 years, a childs risk of
serious alcohol problems later in life is reduced by 50%.
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Alcohol Drinking PatternsBinge drinking For women, 4 or more
drinks during a single occasion. For men, 5 or more drinks during a
single occasion. Heavy drinking For women, more than 1 drink per
day on average. For men, more than 2 drinks per day on average.
Excessive drinking includes heavy drinking, binge drinking or
both.
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Dietary Guidelines for Americans If you drink alcoholic
beverages, do so in moderation, For women: no more than 1 drink/day
(7/week) For men: no more than 2 drinks/day (14/week)
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Dietary Guidelines for Americans Those who should not drink any
alcohol:Pregnant or trying to become pregnant. Taking prescription
or over-the-counter medications that may cause harmful reactions
when mixed with alcohol. Under the age of 21. Recovering from
alcoholism or unable to control amount. Have medical condition that
may be worsened by alcohol. Driving, planning to drive, or
participating in other activities requiring skill, coordination,
and alertness.
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Immediate Health Risks of Excessive UseUnintentional injuries:
traffic injuries, falls, drownings, burns, firearm injuries.
Violence, including intimate partner violence (2/3 of incidents)
and child maltreatment. Risky sex: unprotected, multiple
partners,increased risk of sexual assault can lead to unintended
pregnancy or sexually transmitted diseases. Miscarriage &
stillbirth: lifelong physical & mental birth defects among
children Alcohol poisoning: unconsciousness, low blood pressure
& body temperature, coma, respiratory depression, or death.
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health problems that might be alcohol inducedcardiac arrhythmia
dyspepsia liver disease depression or anxiety insomnia trauma
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Signs of possible alcohol problemschronic illness that isn't
responding to treatment as expected, such as: chronic pain diabetes
gastrointestinal disorders depression heart disease
hypertension
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Long-Term Health Risks of Excessive UseDevelopment of chronic
diseases, neurological impairments & social problems:
Neurological problems, including dementia, stroke and
neuropathy.Cardiovascular problems, including myocardial
infarction, cardiomyopathy, atrial fibrillation and
hypertension.Cancer of the mouth, throat, esophagus, liver, colon,
and breast - risk increases with increasing amounts of alcohol.
Risks greatly increased among smokers.
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Long-Term Health Risks of Excessive UseLiver diseases,
including: Alcoholic hepatitis. Cirrhosis - among 15 leading causes
of all deaths in US For persons with Hepatitis C virus, worsening
of liver function & interference with treatment medications
used Other gastrointestinal problems, including pancreatitis and
gastritis Social problems, including unemployment, lost
productivity, family problems, street violence, alcoholic riots
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The Shape of U.S. DrinkingSome overviews
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Hazardous U.S. Alcohol Consumption Rogers & Greenfield,
1999
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Drinking Volume Partitioned by 6 ContextsTOTAL37%HAZARDOUS1984
& 1995 National Alcohol Surveys; Clark, 1988; Greenfield et al,
2000
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Major costs of alcohol (1990)
Total cost: $98.6 BILLIONHealth care: $10.7 billionIndirect
costs: $70.2 billion:Mortality: $33.6 billionMorbidity: $36.6
billionCrime: $5.8 billionAuto crashes: $3.9 billionIncarceration:
4.8 billion
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Economic Costs of alcohol and other drug abuse are increasing;
$277 billion in 1995Sources: Rice et al. 1990; Robert Wood Johnson
Foundation, 1993; National Institute on Drug Abuse & National
Institute on Alcohol Abuse and Alcoholism, March 1998.Billion
Dollars
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Alcohol in Primary CarePatients with all stages of alcohol
problems frequently seen in clinical settings (McDonald, 2004).
Patients screened in 22 primary care practices: 9% at-risk
drinkers, 8% problem drinkers, 5% alcohol-dependent. ( Manwell
1998): Binge drinkers compared to other primary care patients:
higher rates of related problems (injury, hypertension), 1.5 times
more primary care visits, higher per patient costs (psychiatry,
emergency room, drugs) (Mertens 2005)
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Alcohol, Injury & Acute CareEmergency Departments~ 110
million visits/yr, ~ are injuriesalcohol problems: 15 to 30%
Trauma Centers~ 3 million visits/yr, all are injuriesalcohol
problems: 40 to 60% Dan Hungerford, CDC
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The Spectrum of Alcohol Useheavysevereconsumption
nonenoneconsequences RiskyLower riskAlcohol Use
DisordersAbstinenceHarmful,
abuseProblemAlcoholismDependenceUnhealthy Use
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Age at Onset of DSM-IV Alcohol Dependence
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REASONS FOR DRUG TREATMENT: 72% involve alcoholSource: Treatment
Episode Data Set, DHHS/SAMHSA, Sept 2000
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Distribution curve, e.g. consumption of a drug Number of
peopleLevel of consumptionLow HighManyFew
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The main problemBinge Drinking
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Binge Drinking, Current DrinkersNaimi et al, JAMA, 2003
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Alcohol Dependence among Binge Drinkers example New MexicoNew
Mexico, BRFSS, 2002Dependent 7%Non-dependent 93%
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Percent of Alcohol Consumed by Frequent Bingers, Infrequent
Bingers, and NonbingersAdults 21+ Years OldSource: National
Household Survey, 1998Frequent bingers: 6% of population, drink 56%
of the alcoholOverall, bingers: 16% of population, drink 75% of the
alcohol
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Binge Drinking, by Average Alcohol Consumption, 2001 Binge
EpisodesBinge Drinkers
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5+ Drinks Especially Increase Bad OutcomesImpaired driving
(Naimi, JAMA, 2003)Unintentional injuries (Anda, JAMA, 1988)SIDS
(Iyasu, JAMA, 2002)Violence (Rossow, Addiction, 1996)Unintended
Pregnancy (Naimi, Pediatrics, 2003)Sexually transmitted diseases
(Lauchli, AEP, 1996)Myocardial infarction (Rehm, Am J Epidemiol,
2001) Meningitis (Imrey, Am J Epidemiol, 1996)
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Risk of Injury, by Usual Number of DrinksCollege Alcohol Survey,
1999
Injured II
022.358640273900
19.638352960810.0192
215.994320554620.059
313.471978618630.1008
411.776497118540.1466
59.546479579150.1789
66.364319719460.2427
73.750104401670.3084
82.647623820380.2898
9+4.45168295339+0.3258
&A
Page &P
Population
Population Percent
Shifted Pop. Percent
Get hurt or injured
Usual Number of Drinks
Populaiton Percentage
Probablity of Getting Injured
Alcohol Overdose
22.358640273947.99131378940
9.638352960813.47197861860.0044
15.994320554611.77649711850.0016
13.47197861869.54647957910.0056
11.77649711856.36431971940.005
9.54647957913.75010440160.0071
6.36431971942.64762382030.0066
3.75010440164.45168295330.0181
2.64762382030.0127
4.45168295330.0132
&A
Page &P
Population Percent
Shifted Pop. Percent
Alcohol Overdose
Usual Number of Drinks
Population Percentage
Probability of Alcohol Overdose
Figure 2. Usual College Student Drinking and Risk of Alcohol
Overdose
Sheet1
DrinksPopulation PercentUnplanned SexUnprotected SexGet hurt or
injured5+ Problems
112.396.033.231.923.06
220.5612.496.375.97.74
317.3220.738.7610.0814.78
415.1425.1412.5414.6622.85
512.2732.3614.8417.8933.54
68.1836.7619.2624.2738.6
74.8244.3221.9530.8453.17
83.442.2221.5928.9849.2
9+5.7249.6221.0232.5859.43
5+ Problems
22.358640273947.99131378940
9.638352960813.47197861860.0306
15.994320554611.77649711850.0774
13.47197861869.54647957910.1478
11.77649711856.36431971940.2285
9.54647957913.75010440160.3354
6.36431971942.64762382030.386
3.75010440164.45168295330.5317
2.64762382030.492
4.45168295330.5943
&A
Page &P
Population Percent
Shifted Pop. Percent
5+ Problems
Usual Number of Drinks
Population Percent
Probability of Experiencing 5+ Problems
Figure 3. Usual Drinking in the College Student Population and
Risk of 5+ Alcohol Problems
Sheet5
DrinksPopulationPopulation PercentShifted Pop. PercentAlcohol
Overdose
0267722.358640273947.99131378940.380000
111549.638352960813.47197861860.389.638352960813.471978618636.625741251151.1935187505
2191515.994320554611.77649711850.3831.988641109223.552994237121.556836214889.5013781007
3161313.47197861869.54647957910.3840.415935855728.6394387372153.5805562516108.8298672012
4141011.77649711856.36431971940.3847.105988474125.4572788775179.002756201596.7376597344
511439.54647957913.75010440160.3847.732397895318.7505220079181.38311200271.2519836298
67626.36431971942.64762382030.3838.185918316215.8857429216145.106489601660.365823102
74493.75010440164.45168295330.3826.25073081131.161780673299.7527770818118.4147665581
83172.64762382030.3821.1809905621080.4877641360
95334.45168295330.3840.06514657980152.24755700330
11973302.5641025641156.91973607281149.7435897436596.2949970768553.4485926668
0.518633026
Sheet4
DrinksPopulationPopulation PercentShifted Pop. PercentAlcohol
Overdose
0267722.358640273947.9913137894000
111549.638352960813.47197861860.00440.42408753030.5927670592
2191515.994320554611.77649711850.00160.25590912890.1884239539
3161313.47197861869.54647957910.00560.75443080260.5346028564
4141011.77649711856.36431971940.0050.58882485590.318215986
511439.54647957913.75010440160.00710.67780005010.2662574125
67626.36431971942.64762382030.00660.42004510150.1747431721
74493.75010440164.45168295330.01810.67876889670.8057546145
83172.64762382030.01270.33624822520
9+5334.45168295330.01320.58762214980
119734.7237367412.8807650547
5/10003/1000
3.12109746932.0750104402
3/10002/1000
Sheet2
DrinksPopulationUnplanned SexUnprotected SexGet hurt or
injuredPopulation PercentShifted Pop. Percent5+ Problems
0267722.358640273947.99131378940*.100
111546.033.231.929.638352960813.47197861860.03062.9493360064.1224254573
2191512.496.375.915.994320554611.77649711850.077412.37960410929.1150087697
3161320.738.7610.0813.47197861869.54647957910.147819.911584398214.1096968178
4141025.1412.5414.6611.77649711856.36431971940.228526.909295915814.5424705588
5114332.3614.8417.899.54647957913.75010440160.335432.018892508112.5778501629
676236.7619.2624.276.36431971942.64762382030.38624.566274116810.2198279462
744944.3221.9530.843.75010440164.45168295330.531719.939305103123.6695982628
831742.2221.5928.982.64762382030.49213.02630919570
9+53349.6221.0232.584.45168295330.594326.45635179150
11973178.156953144688.3568779754
178/100088/1000
118.734987054264.6872797127
Sheet3
DrinksPopulationPopulation PercentShifted Pop. PercentGet hurt
or injured
0267722.358640273947.9913137894000
111549.638352960813.47197861860.01921.85056376852.5866198948
2191515.994320554611.77649711850.0599.43664912726.9481332999
3161313.47197861869.54647957910.100813.57975444759.6228514157
4141011.77649711856.36431971940.146617.26434477579.3300927086
511439.54647957913.75010440160.178917.07865196696.7089367744
67626.36431971942.64762382030.242715.44620395896.4257830118
74493.75010440164.45168295330.308411.565321974413.728990228
83172.64762382030.28987.67281383110
9+5334.45168295330.325814.50358306190
11973
108.397886912255.3514073332
108/100055/1000
74.656168044841.6224171052
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Obstacles to change &A New Framework
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Structural Obstacles Alcohol not treated as a drug, food or
carcinogen - by law FDA cant review or control alcohol Federal
Trade Commission - protection of youth?: uses alcohol industry data
on advertising to kids youth prevention campaign uses alcohol
industry materialsGovernment & private foundations rarely fund
research on alcohol industry, rarely support advocacyNo national
media campaign since 1980s/ except DUI Government agencies fear
reprisals if they counter industry economic interests or
messagesCourts consistently support industry rights to free speech
over parental rights and needs of children unrestricted
advertising
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Common Misperceptions:Most understand alcoholism is a disease,
but dont know that like diabetes and other chronic diseases, it can
be treated and controlled if not cured & may be relapsing Dont
understand concept of alcohol problems as amenable to change we
look only for alcoholism and see the rest as social, not health
problems myths about alcoholics applied to all problem
drinkers]
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Common Misperceptions:Old information: no effective treatment,
prevention doesnt work, drinking never changes for better or worse,
laws have no impactMany hold beliefs fostered by alcohol industry,
mass media & culture: problems due to individual choice &
irresponsibility failure to change is individual failure alcohol
problems are not health problems -only social, personal
failings
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ObstaclesMedical and public health communities fail to address
alcohol use disorders as mainstream health issue focus on
individuals, social disruption, particular alcohol problems rarely
as larger health problemMedia & government focus only on
social, not health impacts.Heavy publicity for research on positive
health impacts of alcohol (are they finding what theyre looking
for?) - summarized by media as drinking is good for you
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Underlying dynamicsMuch of public health community accepts
alcohol industry expertise in determining and discussing health
issues legitimizes their self interest & perspectives on
problemsAlcohol industry and the policies they support focus on
individual choice & punishment ignore their own role,
environmental, even governmental roles in promoting problems
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Consequencesphysician & other health professional paralysis
leading to inaction and silence (lacking clear medical/health
framework; rely on own feelings, behaviors, experience) Alcohol
problems & research treated as discreet, unconnected issues
(DUI, FAS/FAE, alcoholism, violence, injury) not usually part of
most medical practice concernsAlcohol is a leading preventable
cause of cancer and violence often ignoredAlcohol related violence,
injury, death are not seen as expressions of health or drug
problems-attributed to individual excess, misbehavior or
accident
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Furthermore, the alcohol industryespecially emphasizes intent,
personal responsibility, personal enjoyment of intoxication, and
lower risk situations ignores alcoholism, alcohol use disorders,
negative consequences of any type save impaired driving,
connections between these problems and their products and
behaviors
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A better framework for thinking. Research (J-curve) makes it
clear thatFor some people, some times, in some situations, low
level alcohol use is relatively risk free and might be
beneficialFor everyone, risk & harm rise with the level of
consumption (volume, frequency)In some people, some situations,
some occasions - any use is risky and more consumption even more
harmful
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But over all:
Regardless of why, when, where or how someone drinks, whatever
they think or choose to do, alcoholalways acts as a drug, is a
carcinogen, and consumption is never risk free. Alcohols impact on
the body is systemic and no one and no organs are free of its
impacts however small.The most common forms of health problems
related to alcohol are not due to, related to or even precursors of
alcoholism (dependence) binge drinking affects more people and is a
better indicator of problems, and is amenable to change
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All alcohol associated problems -Are connected (impaired
driving, FAS/FAE, violence, accidents and injury, dependence, binge
drinking, underage drinking, football riots, domestic violence,
vandalism, etc., etc.) Related to alcohol consumption Related to
alcohols impact on the body (especially the brain) (In that sense
its like tobacco and many illicit drugs.)For some people, some
situations, some health conditions and some circumstances or
occasions, risk begins from the initial intake of alcohol and harm
rises with consumption (amount, frequency).
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A health framework for alcohol:In most peoples daily lives, the
times at which they can drink at low risk levels and the
circumstances under which they can do so are extremely limited Many
can never drink without high-riskEveryones consumption carries a
risk for the drinker and the non-drinker (of causing harm to
themselves, the people around them and the society they live in.The
greater the consumption (amount, frequency, number of drinkers),
the greater the potential for harm.
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European Charter - Ethical principles1. All people have the
right to a family, community and working life protected from
accidents, violence and other negative consequences of alcohol
consumption. 2. All people have the right to valid impartial
information and education, starting early in life, on the
consequences of alcohol consumption on health, the family and
society. 3. All children and adolescents have the right to grow up
in an environment protected from the negative consequences of
alcohol consumption and, to the extent possible, from the promotion
of alcoholic beverages.
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European Charter - Ethical principles
4. All people with hazardous or harmful alcohol consumption and
members of their families have the right to accessible treatment
and care. 5. All people who do not wish to consume alcohol, or who
cannot do so for health or other reasons, have the right to be
safeguarded from pressures to drink and be supported in their
non-drinking behaviour.
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Summary of 10 strategies for alcohol action1. Educate people,
beginning in early childhood, of the health, family and social
consequences of alcohol consumption and effective measures to
prevent or minimize harm 2. Promote public, private & work
environments protected from accidents, violence & other
negative consequences of alcohol consumption. 3. Establish &
enforce effective anti-drink-driving laws. 4. Promote health by
controlling availability & influencing alcohol prices (e.g.
through taxes). 5. Strictly control (keeping existing limitations
or bans) direct & indirect alcohol advertising - ensure that no
advertising specifically addresses young people (e.g., by linking
of alcohol to sports).
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10 strategies for alcohol action6. Ensure access to effective
treatment & rehabilitation with trained personnel, for people
with hazardous or harmful alcohol consumption and their family
members. 7. Foster awareness of ethical and legal responsibility
among those marketing or serving alcohol, strictly control product
safety, implement measures against illicit production & sale.
8. Enhance societys capacity to deal with alcohol through training
of professionals in different sectors, & strengthening
community development and leadership. 9. Support nongovernmental
organizations and self-help movements - specifically those aiming
to prevent or reduce alcohol-related harm. 10. Formulate
broad-based programs in Member States, with clear outcome targets
and indicators; monitor progress; ensure periodic updating based on
evaluation.
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U.S. Best Practices Comprehensive ApproachEnforce MLDARestrict
hours or days of saleRestrict the number of sales outletsIncrease
alcohol taxesImplement effective countermeasures for alcohol
impaired driving reverseImplement advertising restrictions
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Representation ofEnvironmental Model
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For More Information
ContactRichard Yoast, [email protected]
Problematic alcohol consumption is not a benign condition that
resolves with age.Putting it all together
4. Parietal and frontal regions were under-activated in alcohol
dependent young women relative to controls*Differential
sensitivity: These regions may be particularly sensitive to ethanol
effects*Developmental differences: Parietal and frontal regions may
be affected earlier in the course of alcohol dependence-we know
that these are the last regions to myelinate during human brain
development into adolescence and ages at which youth may well be
drinking harmful amounts
Consistent with adult studies in that decrements in functioning
are apparent in group comparisons; not severe; not in all
subjectsDevelopmental differences: less impairment of cognitive
flexibility; less severity; but drinking before myelination &
pruning are complete may cause more damage but may allow
possibility for future recoverability with abstinencePutting it all
together
4. Parietal and frontal regions were under-activated in alcohol
dependent young women relative to controls*Differential
sensitivity: These regions may be particularly sensitive to ethanol
effects*Developmental differences: Parietal and frontal regions may
be affected earlier in the course of alcohol dependence-we know
that these are the last regions to myelinate during human brain
development into adolescence and ages at which youth may well be
drinking harmful amounts
Consistent with adult studies in that decrements in functioning
are apparent in group comparisons; not severe; not in all
subjectsDevelopmental differences: less impairment of cognitive
flexibility; less severity; but drinking before myelination &
pruning are complete may cause more damage but may allow
possibility for future recoverability with abstinenceFigure legend.
The triangle schematically displays the spectrum of alcohol use,
from abstinence or no use and lower risk use, which are the most
common patterns of alcohol use, to risky use, problem drinking, and
the less common but more severe alcohol use disorder diagnoses. In
progressing from lower risk use through dependence, consumption and
consequences increase. Clinicians and public health practitioners
should be concerned with the categories encompassed by the dashed
line, unhealthy alcohol use. 44% drink >12/yr, 22% past drnk
or