Within the 45-64 age group, there is a marked increase in alcohol consumption among women, writes MUIRIS HOUSTON
WHEN IT comes to alcohol consumption we are well used to hearing about the harms of binge drinking, especially among younger people. Indeed, a Health Research Board report published last week revealed a 30 per cent increase in alcohol-related offences in 2003-2007. And while it has been appropriate to focus on young people in recent campaigns against alcohol abuse, it has meant that the longer term effects of drinking to excess have been largely forgotten.
With the latest analysis of data from the Survey of Lifestyle, Attitudes and Nutrition in Ireland – Slán 2007 – in today's Irish Times, we see a welcome, albeit disturbing, emphasis on a different pattern of harmful drinking. It shows that more than half the Irish population engages in chronic drinking that, if not tackled, has serious consequences for their physical health. And it is women and older people who are especially in the firing line.
When drinking patterns are analysed over the three Slán surveys carried out since 1998, the proportion of older drinkers who consumed alcohol in the previous week has increased. Within the 45-64 age group, this increase is most marked among women. In contrast, younger people drink more episodically, tending to binge drink to excess. In 2007, some 10 per cent of drinkers reported drinking in excess of the recommended weekly limit (21 standard drinks for men and 14 for women).
But it is the results of the Audit-C scores (see panel) that should make us all pay attention. Unlike other measures, the Audit-C identifies respondents with harmful drinking patterns who are not alcohol-dependent. Over half of drinkers (56 per cent) in Slán 2007 had positive Audit-C scores, with findings consistent across all social classes. Some four in 10 women had harmful drinking patterns, while for men, seven in 10 were drinking at a level that needs to be tackled.
According to Dr Karen Morgan, lecturer in psychology at the Royal College of Surgeons in Ireland and research manager of Slán 2007, the results suggest the greatest harm to health is that of excessive drinking over time and not just binge drinking. She says we should be concerned about the more chronic effects of alcohol such as cirrhosis of the liver, breast cancer and high blood pressure.
The Republic’s alcohol-related problems cost Irish society in excess of €2.65 billion in 2003 and this burden of alcohol harm has significantly increased in the past 15 years. In 2005, an estimated 28 per cent of emergency admissions to Irish hospitals were alcohol-related. Figures from 2007 show the number of alcohol-related deaths in Ireland have doubled in recent years.
This increase occurred alongside a 90 per cent rise in the number of alcohol-related injuries. The extent of alcohol-related harm depends not only on the amount of alcohol consumed, but also the manner in which it is consumed. Binge drinking and drinking to intoxication are linked to an increased risk of acute harm, including accidents, injuries, suicide and violence.
However, drinking above the recommended weekly limit is linked to increased risk of long-term harm, such as high blood pressure, cancer and cirrhosis. It is expected that Ireland will see a sharp increase in the number of people dying from alcohol-related illnesses in the next 20 years. And it is non-dependent drinkers who account for most of the morbidity and mortality linked to drinking.
So, what can be done to address the problem? Health professionals have a key role – it has been reported that for every eight people who receive simple alcohol advice, one will reduce drinking to lower-risk levels.
There is evidence of an effective approach from a 2005-2006 initiative by the Irish College of General Practitioners and the HSE. The Alcohol Aware Practice Service Initiative demonstrated that primary care can be effective in the area of alcohol problem management and that patients do benefit. At least one-third of patients screened in the programme made significant progress, while a further one-third made “positive” progress.
Rolande Anderson and his colleagues recommend that the Audit-C measure be used as the initial screening tool for patients and note the questions constituting the Audit-C can be easily integrated into any consultation.
“This report prompts us all to think about our drinking patterns and how they might be harmful to our health. We need to increase awareness of potential harm and encourage responsible drinking. This will require understanding the complexities of drinking patterns for different groups of the population and tailoring public health messages accordingly,” Dr Morgan says.
The Slán research was a collaborative project involving NUIG, ESRI, RCSI and UCC. Project director Prof Hannah McGee, professor of psychology at RCSI, says it is important to establish which intervention campaigns will work and to find out what messages will speak to the different types of drinker.
“Like Irish changes to workplace smoking and drink driving, alcohol-related change will take time and will be achieved in part through public attitude change and in part through changes in the wider environment to support more responsible drinking,” she reckons.
The importance of this report from Slán 2007 cannot be overstated. The finding that the majority of drinkers with a positive Audit-C score are not aware that their drinking maybe harming their health must be acted on. This is particularly true of middle-aged and older drinkers – their perceptions of “safe” drinking limits and the health risks of excessive consumption need to be explored and targeted.
The drink audit
Audit-C, the Alcohol Use Disorders Identification Test – Consumption, examines frequency, volume and binge drinking. GPs use the following questions to assess if a person is drinking at a level that could cause medical problems.
1. How often do you have a drink containing alcohol?
2. How many alcoholic drinks do you have on a typical occasion when you are drinking?
3. How often do you have six or more (standard) drinks on one occasion?
- The Audit-C is scored on a scale of 0-12 (scores of 0 reflect no alcohol use). Unlike other measures, the Audit-C will identify many patients who are not alcohol-dependent, but who have a pattern of hazardous drinking.