Loosening the Grip: a handbook of Alcohol Information 9th


Chapter 2 Alcohol and Its Costs



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Chapter 2 Alcohol and Its Costs

Alcohol Epidemiologic Data System, Lakins NE, Williams GD, Yi H-y. Apparent Per Capita Consumption: National, State, and Regional Trends, 1977–2004. Surveillance Report No. 78. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2006. (20 refs.)


This surveillance report on 1977-2004 apparent per capita alcohol consumption in the US is the 20th in a series produced by the NIAAA. The following are highlights from the current report on consumption trends through 2004. In the country, per capita consumptio of alcohol from all kinds of beverages combined was 2.23 gallons, representing a 0.5 increase over 2003. This increase is attributable to an increase in wine and spirits, and a decline in beer. Between 2003 and 2004, there were increases in 35 states and a decrease in 15. In terms of regions of the country, there was a 1.4% increase in the Northeast, a 0.9% increase in the West, a 0.5% increase in the South and a 0.9 percent decrease in the Midwest. There has been an increasing trend in alcohol consumption since 1999.I For the country to meet the Health People 2010 objectives, or per capita consumption will be no more than 1.96 gallons of ethanol, there will need to be about a 2 percent decrease from 2005 through 2010. Data is presented in 21 tables, figures and tables. Copyright 2006, Project Cork

Alcohol Epidemiologic Data System, Newes-Adeyi, G, Chen CM, Williams GD, Faden VB. Trends in Underage Drinking in the United States, 1991–2003. Surveillance Report No. 74. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2005. (36 refs.)


This surveillance report, prepared by the Alcohol Epidemiologic Data System (AEDS), National Institute on Alcohol Abuse and Alcoholism (NIAAA), presents trends in underage drinking by youth aged 12-20 years between 1991 and 2003. This is the first of a series of reports to be published biennially on underage drinking and related attitudes and risk behaviors. Data for this series are compiled from three separate nationally representative surveys, the National Survey on Drug Use and Health (NSDUH), the Monitoring the Future (MTF) survey, and the Youth Risk Behavior Survey (YRBS). The report highlights use prevalence, drinking patterns, alcohol-related attitudes and alcohol-related risk behaviors. Data is presented in tabular format. A table showing differences among survey data sources is appended. (Contains 33 figures and 15 tables.). Public Domain

Alcohol Epidemiologic Data System, Yi H-y, Hoy AK, Chen MC, Williams GD. Trends in Alcohol-Related Fatal Traffic Crashes, United States, 1982–2004. Surveillance Report No. 76. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2006. (9 refs.)


This is the 21st annual surveillance report from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) on trends in alcohol-related fatal traffic crashes. The report describes the methodology including several changes introduced with this report. The following are highlights from the current report with the latest data for 2004. Alcohol-Related Traffic Crash Fatalities: In 2004, about 16,919 persons died in alcohol-related traffic crashes, which constituted 39.5 percent of the total traffic crash fatalities. The number of alcohol-involved drivers in fatal traffic crashes was 11,838 for male drivers and 2,286 for female drivers. These numbers represent about 28.0 and 14.9 percent of the total male and female drivers involved in fatal traffic crashes, respectively. Alcohol-related traffic crash fatalities per 100 million vehicle miles traveled, 100,000 registered vehicles, 100,000 licensed drivers, and 100,000 population, were 0.57, 6.96, 8.51, and 5.76, respectively. The proportion of alcohol-related traffic fatalities varied across States, ranging from a low of 25.5 percent (Utah) to a high of 52.2 percent (Rhode Island). Blood Alcohol Concentration (BAC) Testing and Results: In 2004, the BAC testing rate for drivers killed in traffic crashes for the nation as a whole was 74.3 percent. The rate varied widely across States, ranging from a low of 37.6 percent (Iowa) to 99.6 percent (North Carolina). The BAC testing rate generally remained low for surviving drivers (31.2 percent for the nation as a whole). The percentage distribution of BAC values peaked at 0.10-0.14 grams per deciliter (g/dl) for drivers under age 21 and at 0.15-0.19 g/dl for all other age groups. About 78 percent of drivers with positive BAC results had BAC scores of 0.10 g/dl or higher at the time of their crashes. If the legal BAC limit were lowered to 0.08 in all States, a total of 85 percent of the BAC-positive drivers would have been considered legally intoxicated. Young Drinking Drivers: In 2004, about 22.5 percent of young drivers under age 21 in fatal traffic crashes were involved with alcohol, which is slightly lower than that for drivers ages 21 and older (24.8 percent). Drivers ages 21 to 24 continued to have the highest proportion (39.1 percent) of alcohol involvement. Trends in Alcohol-Related Fatal Traffic Crashes: The proportion of alcohol-related traffic fatalities declined from 59.6 percent in 1982 to 39.5 percent in 2004. Drivers' alcohol-involvement in fatal traffic crashes declined from 40.7 to 24.5 percent between 1982 and 2004. The decline was greater for drivers under age 21 (from 43.7 to 22.5 percent) than for drivers ages 21 and older (from 39.9 to 24.8 percent). One of the Healthy People 2010 objectives is to reduce alcohol-related motor vehicle crash deaths to 4.8 per 100,000 population. To achieve this goal, the rate must decrease by 17 percent from 2005 through 2010. Data is presented in 13 tables and 7 figures. (Copyright 2006, Project Cork)

Alcohol Policy Center, Center for Science in the Public Interest. Beer Consumption and Tax Fact Sheet. Washington DC: Center for Science in the Public Interest, 2004. (25 refs.)

Canfield DV, Hordinsky J, Millett DP, Endecott B, Smith D. Aviation—Prevalence of drugs and alcohol in fatal civil aviation accidents between 1994 and 1998. Aviation, Space, and Environmental Medicine 72(2): 120–124, 2001. (8 refs.)
Background: The use of drugs and alcohol in aviation is closely monitored by the FAA Office of Aviation Medicine's (OAM's) Civil Aeromedical Institute(CAMI) through the toxicological analysis of specimens from pilots who have died in aviation accidents. Method: Frozen specimens received from local pathologists were tested and the results entered into a computer database for future analysis. The data were sorted based on the class of drug, controlled dangerous substance schedules II, and I controlled dangerous substance schedules Ill-V, prescription drugs, over-the-counter drugs, and alcohol. Results: Specimens from 1683 pilots were analyzed between 1994 to 1998. Controlled dangerous substances, CDS, (schedules I and II) were found in 89 of the pilots analyzed. Controlled dangerous substances (schedules III-V) were found in 49 of the pilots tested. Prescription drugs were found in 240 of the pilots analyzed. Over-the- counter drugs were found in 301 of the pilots analyzed. Alcohol at or above the legal limit of 0.04% was found in 124 pilots. No abused drugs were found in Class 1 air transport fatal pilots. Conclusion: This research supports the very low incidence rate of drugs found in the FAA random drug-testing program. Over-the-counter medications are the most frequently found drugs in fatal aviation accidents and many of these drugs could impair a pilot's ability to safely fly an aircraft. This data is helpful to the FAA in developing programs to reduce the usage of dangerous drugs and identify potentially incapacitating medical conditions that may cause an accident. Data collected from this research can be used to evaluate the effectiveness of the FAA drug-testing program. (Copyright 2001, Aerospace Medical Association)

Cherpitel C, Borges GLG, Wilcox HC. Acute alcohol use and suicidal behavior: A review of the literature. Alcoholism: Clinical and Experimental Research 28(5 Supplement 1): 18S–28S, 2004. (87 refs.)


Background: Both acute and chronic use of alcohol are associated with suicidal behavior. However, the differing relationship of each component of alcohol use and possible causal mechanisms remain unclear. Methods: This article reviews and summarizes associations between acute alcohol consumption (with and without intoxication) and suicidal behavior (both completed suicide and suicide attempts) among adults 19 years and older, as presented in literature published between 1991 and 2001. Possible mechanisms and methodologic challenges for evaluating the association are also discussed. An application of a research design (the case-crossover study) that has the potential for addressing the effects of acute alcohol use over and above usual or chronic use is presented. Results: The majority of articles reviewed were restricted to descriptive studies that documented the prevalence of suicide completers or attempters who tested positive for alcohol use. A wide range of alcohol-positive cases were found for both completed suicide (10-69%) and suicide attempts (10-73%). Common methodologic limitations included the lack of control groups (for evaluating risk conferred by alcohol use), selection and ascertainment bias, and small sample sizes. The results of the case-crossover pilot study indicated substantially higher risk of suicide during or shortly after use of alcohol compared with alcohol-free periods. Conclusions: Although there is a substantial literature of published studies on acute alcohol use and suicidal behavior, the majority of studies focus on completed suicide and report prevalence estimates. Findings from such studies are subject to several possible sources of bias and have not advanced our knowledge of mechanisms in the association between acute alcohol use and suicidal behavior. The case-crossover design may help to overcome some limitations of these studies and facilitate evaluation of associations and possible causal mechanisms by which acute alcohol use is linked to suicidal behavior. (Copyright 2004, Research Society on Alcoholism)

Children of Alcoholics Foundation. Children of Alcoholics in the Medical System: Hidden Problems, Hidden Costs. New York: Children of Alcoholics Foundation, 1990. (47 refs.)


The Children of Alcoholics Foundation launched the first major study of the effects of parents' alcohol abuse on their youngsters' health care patterns, utilization rates and costs of their medical care. The Foundation hypothesized that children from alcoholic families as compared with other children, would have greater health care usage, including more frequent admissions to hospitals, longer hospital stays and higher health care costs. The study population consisted of dependent children of adults who were in treatment for alcoholism or related disorders between 1984-1986 and youngsters from other families. The data was based on claims filed by 1.6 million subscribers under group policies carried by Independence Blue Cross and included analysis by admission rates, length of hospitalizations and financial costs of inpatient, short procedure unit and home health care. Findings from this comparative study indicate the negative effect of parental alcoholism on children and raise many broad concerns. Of primary importance are the physical and mental health problems parents' alcoholism causes children. A second concern is the cost of health care for individuals in alcoholic families in terms of dollars and in personal suffering. A third issue is the cumulative burden of the financial costs of parental alcoholism on the entire health care system. The report concludes with recommendations for health care providers, prevention and education programs, employers and insurers to provide early intervention, services and referrals in order to prevent children's problems and reduce their health care costs. Also included is an agenda for future research to expand understanding of the negative impact of parental alcoholism on children's health and to improve our ability to help these vulnerable youngsters. Copyright 1990, Children of Alcoholics Foundation, Inc.

Driscoll TR, Harrison JA, Steenkamp M. Review of the role of alcohol in drowning associated with recreational aquatic activity (review). Injury Prevention 10(2): 107–113, 2004. (66 refs.)


Objective and design: To assess the role of alcohol in drowning associated with recreational aquatic activity by reviewing the English language literature published up to October 2003. Results: Alcohol is widely used in association with recreational aquatic activity in the United States, but there is minimal information regarding the extent of use elsewhere. A priori and anecdotal evidence suggests that alcohol is an important risk factor for drowning associated with recreational aquatic activity. Specific studies provide good evidence supporting this, but the extent of increased risk associated with alcohol use, and the attributable risk due to alcohol use, is not well characterised. Drowning appears to be the overwhelming cause of death associated with recreational aquatic activity with alcohol detected in the blood in 30%-70% of persons who drown while involved in this activity. The few relevant studies on degree of increased risk suggest persons with a blood alcohol level of 0.10 g/100 ml have about 10 times the risk of death associated with recreational boating compared with persons who have not been drinking, but that even small amounts of alcohol can increase this risk. The population attributable risk seems to be in the range of about 10%-30%. Conclusions: Alcohol consumption significantly increases the likelihood of immersions resulting in drowning during aquatic activities. However, more information is required if appropriate prevention activities are to be planned, initiated, and evaluated. This includes better information on alcohol use, and attitudes to alcohol use, in association with recreational aquatic activity, and the nature and extent of increased risk associated with alcohol use. Evaluation of interventions Is also needed.

Foster SE, Vaughan RD, Foster WH, Califano JA. Alcohol consumption and expenditures for underage drinking and adult excessive drinking. Journal of the American Medical Association 289(8): 989–995, 2003. (46 refs.)


Context: Although estimates of the amount and proportion of alcohol consumed by underage and adult drinkers have been reported, more accurate estimates are possible and the economic impact has not been explored. Objectives: To provide accurate estimates of underage and adult excessive drinking and to describe consumer expenditures linked to underage and adult excessive drinking. Design and Setting Information was obtained from national data sets, including 1999 versions of the National Household Survey of Drug Abuse, the Youth Risk Behavior Survey (YRBS), the Behavior Risk Factor Surveillance System (BRFSS), 2000 US Census, and national data on consumption and consumer expenditures for alcohol, published by Adams Business Research. Participants: A total of 217192 persons aged 12 years or older across 3 data sources. Main Outcome Measures: Amount as a proportion of total alcohol consumed and proportion of consumer expenditures on alcohol among underage (12-20 years) and adult excessive (greater than or equal to21 years) drinkers. Results: The proportion of 12- to 20-year-olds who drink was estimated to be 50.0% using data from the YRBS; the proportion of adults aged 21 or older who drink was estimated to be 52.8% using data from the BRFSS. The estimated total number of drinks consumed per month was 4.21 billion; underage drinkers consumed 19.7% of this total. The amount of adult drinking that was excessive (>2 drinks per day) was 30.4%. Consumer expenditure on alcohol in the United States in 1999 was $116.2 billion; of that, $22.5 billion was attributed to underage drinking and $34.4 billion was attributed to adult excessive drinking. Conclusion: These data suggest that underage drinkers and adult excessive drinkers are responsible for 50.1% of alcohol consumption and, 48.9% of consumer expenditure.

Glavan FH, Caetano R. Alcohol use and related problems among ethnic minorities in the United States. Alcohol Research & Health 27(1): 87–94, 2003. (39 refs0


Alcohol use patterns and the prevalence of alcohol-related problems vary among ethnic groups. This article reviews the main research findings on the alcohol consumption patterns and related problems of the four main ethnic minority groups in the United States: Hispanics, Blacks, Asian Americans, and Native Americans. Comparison data are often given for Whites, who make up the majority group in the United States. Among the elements thought to account for these ethnic differences are social or cultural factors such as drinking norms and attitudes and, in some cases, genetic factors. Understanding ethnic differences in alcohol use patterns and the factors that influence alcohol use can help guide the development of culturally appropriate alcoholism treatment and prevention programs. Public Domain

Gentilello L. Alcohol interventions in trauma centers: The opportunity and the challenge. Journal of Trauma 59(3 Supplement): S18–S20, 2005. (22 refs.)


To combat America’s injury epidemic, trauma care systems have steadily improved over the past 30 years; such improvements include the development of highly successful Level I and Level II trauma centers throughout the United States. However, these improvements in care have not reduced the incidence of trauma-related deaths that occur at the scene (approximately 50%). These numbers will change only when prevention efforts are increased. Alcohol is a significant factor in trauma cases. Of more than 20 million adults requiring emergency department care for injuries in the year 2000, it is estimated that 27% would screen positive for alcohol use disorders or intoxication. Of more than 150,000 trauma-related deaths per year, nearly one half the unintentional trauma—two thirds of overall mortality—is attributable to motor vehicle crashes. Thus, consider these dismal statistics. For more than 20 years, alcohol has been consistently linked in 40% to 50% of deaths resulting from motor vehicle crashes; 20% to 70% of deaths caused by occupational and domestic incidents, fires, and drowning; and approximately 50% to 60% of deaths attributable to intentional injuries. In addition to these depressing statistics, commonly abused drugs such as marijuana and cocaine have been implicated in 18% of motor vehicle crash-related fatalities. Despite significant overall improvement in trauma care—including documented increases in survival rates and decreases in long-term morbidity—trauma professionals have devoted little effort to preventing a major cause of severe injury and repeat injury: the misuse of alcohol and drugs. One medical center, Harborview Medical Center, a Level I regional trauma center for the northwestern United States (an area encompassing four states and one fourth of America’s landmass), has had a long standing interest in breaking this lethal chain of events. In association with Harborview’s Injury Prevention Center and federal research funding, it has investigated various components of the alcohol-induced injury epidemic and has tested the validity of proposals for intervention and prevention. On the basis of these intervention trials and those conducted elsewhere, brief alcohol (and, to a lesser extent, drug abuse) counseling sessions have reduced recidivism by 50% and have significantly reduced the number of binge drinking episodes and drinks consumed per week.

Greenfield TK, Graves KL, Kaskutas LA. Alcohol warning labels for prevention: National survey findings. Alcohol Health and Research World 17(1): 67–75, 1993. (33 refs)


After November 1989, Federal law required health warning labels on all alcoholic beverage containers sold in the United States. The authors report the results of a project designed to examine the effectiveness of warning labels as a reminder of the hazards of drinking. They found little evidence to indicate changes in behavior attributable to warning labels, except for limiting drinking when about to drive and an increase in conversations about drinking and pregnancy among women of childbearing age. As the behavioral outcomes may not yet be widespread enough to be clearly detectable, longer monitoring is needed. Public Domain

Hingson R, Heeren T, Jamanka T, Howland J. Age of drinking onset and unintentional injury involvement after drinking. Washington DC: National Highway Traffic Safety Administration, 2001. (25 refs.)


This study assessed whether persons who begin drinking at younger ages are more likely to report unintentional injuries under the influence of alcohol. A national survey conducted for the National Institute on Alcohol Abuse and Alcoholism in 1992, asked 42,862 respondents questions about when they started drinking and unintentional injuries under the influence of alcohol. The current study used data from that survey and found that, respondents who started drinking before age 14, compared to those who started at age 21 or older, were 5 times more likely to have been injured under the influence of alcohol ever in their lives, and 3.2 times more likely in the past year, after controlling for drug use, smoking, family history of alcoholism and other characteristics associated with age of drinking onset. They were 3.0 times more likely to have ever been injured under the influence of alcohol and 2.0 times more likely in the past year, even after further adjusting for personal history of alcohol dependence and frequency of heavy drinking which were also related to early drinking onset. (Copyright 2002, Project Cork)

Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students age 18–24: Changes from 1998 to 2001. Annual Review of Public Health 26:259–279, 2005. (83 refs.)


Integrating data from the National Highway Traffic Safety Administration, the Centers for Disease Control and Prevention, national coroner studies, census and college enrollment data for 18-24-year-olds, the National Household Survey on Drug Abuse, and the Harvard College Alcohol Survey, we calculated the alcohol-related unintentional injury deaths and other health problems among college students ages 18-24 in 1998 and 2001. Among college students ages 18-24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18-24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others. (Copyright 2005, Annual Reviews)

Hingson R, Winter M. Epidemiology and consequences of drinking and driving. Alcohol Research & Health 27(1): 63–78, 2003. (30 refs.)


Alcohol is a major factor in traffic crashes, and crashes involving alcohol are more likely to result in injuries and deaths than crashes where alcohol is not a factor. Increasing blood alcohol concentrations (BACs) have been linked to increased crash risk. Male drivers, particularly those ages 22 to 45; people with drinking problems and prior drinking and driving convictions; and drivers who do not wear safety belts are disproportionately likely to be involved in alcohol–related fatal crashes. Alcohol–dependent people are over–represented in all alcohol–related traffic crashes, as are those who begin drinking at younger ages. Though there are more than 82 million drinking–driving trips in a given year at BACs of 0.08 percent and higher (and 10 percent of drinking–driving trips are at BACs of 0.08 percent and higher), there are only 1.5 million arrests for drinking and driving each year. Despite overall marked reductions in alcohol–related traffic deaths since the early 1980s, there has been little reduction since the mid–1990s, and alcohol–related traffic deaths have increased slightly in the past 3 years. (Public Domain)

Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future, National Results on Adolescent Drug Use. Overview of Key Findings, 2006. Bethesda MD: National Institute on Drug Abuse, 2006.


This is a summary of the key finding from the Monitoring the Future's 2006 survey of 8th, 10th, and 12th graders in respect to alcohol and other drug use, levels of perceived risk, and approval/disapproval of different substance use, as well as trend in drug use, with data from 1991-2006 provided. This overview provides information on general trends as well as data for specific drugs. This survey identified declines in use of several drugs (marijuana, any illicit drug other than marijuana, hallucinogens other than LSD, amphetamines and methamphetamines, as well as a decline in alcohol use. Among those whose use has held steady were LSD, cocaine, heroin, narcotics other than heroin, and three of the so-called club drugs (ketamine, Rohypnol, and GHB) as well as anabolic steroids. Increased drug use was found for ecstasy, OxyContin, Vicodin, and the inhalants. The findings are summarized in 13 tables.

Kerr, WC, Greenfield TK, Bond J, Ye Y, Rehm J. Age, period, and cohort influences on beer, wine, and spirits consumption trends in the U.S. National Alcohol Survey. Addiction 99(9): 1111–1120, 2004. (32 refs.)


Aims: To estimate the separate influences of age, period and cohort on the consumption of beer, wine and spirits in the United States. Design: Linear age-period-cohort models controlling for demographic change with extensive specification testing. Setting US general population 1979-2000. Measurements: Monthly average of past-year consumption of beer, wine and spirits in five National Alcohol Surveys. Findings: The strongest cohort effects are found for spirits; cohorts born before 1940 are found to have significantly higher consumption than those born after 1946, with especially high spirits consumption for men in the pre-1930s cohorts. Significant cohort effects are also found for beer with elevated consumption in the 1946-65 cohorts for men but in the pre-1940 cohorts for women. Significant negative effects of age are found for beer and spirits consumption, although not for wine. Significant period effects are found for men's beer and wine consumption and for women's spirits consumption. Increased educational attainment in the population over time is associated with reduced beer consumption and increased wine consumption. Conclusions: Changing cohort demographics are found to have significant effects on beverage-specific consumption, indicating the importance of controlling for these effects in the evaluation of alcohol policy effectiveness and the potential for substantial improvement in the forecasting of future beverage-specific consumption trends, alcohol dependence treatment demand and morbidity and mortality outcomes.

Kung HC, Pearson JL, Liu XH. Risk factors for male and female suicide decedents ages 15–64 in the United States—Results from the 1993 National Mortality Followback Survey. Social Psychiatry and Psychiatric Epidemiology 38(8): 419–426, 2003. (50 refs.)


Background: Few controlled studies have examined possible gender differences in risk factors for suicide. This paper examined the associations of certain risk factors with suicide among males and females aged 15-64, and the variation in the associations by gender. Methods: A case-control study was constructed from the 1993 National Mortality Followback Survey in the United States. Information concerning age, race, education, living arrangement, marijuana use, excessive alcohol consumption, access to a firearm, depressive symptoms, and mental health service utilization was collected via death certificate and proxy respondent. Decedents between the ages of 15 and 64 who died by suicide were compared with those who died of natural causes. Logistic regression analysis was used to examine the associations between risk factors and suicide in males and females. Results In comparison to those who died of natural causes, we found that marijuana use, excessive alcohol consumption, and access to a firearm increased the odds of suicide for both genders. For male decedents, the presence of depressive symptoms was more frequently reported for the suicide decedents in the 45-64 age group, and the proportion of mental health service use was higher among suicide decedents who did not complete high school. For female decedents, depressive symptoms were related to suicide in all age groups, and the use of mental health services was more frequent in the suicides of the 15-29 and 45-64 age groups. Conclusions: The risk factors of marijuana use, excessive alcohol use, and firearm accessibility in the last year of life increased the odds of suicide in both genders. When compared to natural deaths, depressive symptomatology was common in female suicide decedents, whereas it was only associated with older age among male suicide decedents. The interactions of mental health service use with demographic factors suggested possible gender differences in suicide risk associated with severity of mental disorders, as well as the likelihood of treatment seeking.

Manning WG, Keeler EB, Newhouse JP, Sloss EM, Wasserman J. The taxes of sin: Do smokers and drinkers pay their way? Journal of the American Medical Association 261(11): 1604–1609, 1989. (29 refs)


We estimate the lifetime, discounted costs that smokers and drinkers impose on others through collectively financed health insurance, pensions, disability insurance, group life insurance, fires, motor-vehicle accidents, and the criminal justice system. Although nonsmokers subsidize smokers' medical care and group life insurance, smokers subsidize nonsmokers' pensions and nursing home payments. On balance, smokers probably pay their way at the current level of excise taxes on cigarettes; but one may, nonetheless, wish to raise those taxes to reduce the number of adolescent smokers. In contrast, drinkers do not pay their way; current excise taxes on alcohol cover only about half the costs imposed on others. Copyright 1989, American Medical Association.

Midanik LT, Chaloupa FJ, Saits R, Toomey TL, Fellow JL, Dufour M, et al. Alcohol-attributable deaths and years of potential life lost—United States, 2001. MMWR 53(37): 866–870, 2004. (10 refs.)


In 2001, excessive alcohol use was responsible for approximately 75,000 preventable deaths and 2.3 million YPLLs in the United States. The majority of these deaths involved males (72%), and the majority of the deaths among males involved those aged >35 years (75%). Approximately half of the total deaths and two thirds of the total YPLLs resulted from acute conditions. Moreover, the BAC level used in this analysis for defining an alcohol-attributable injury death (>0.10 g/dL) is higher than the BAC level used by the National Institute for Alcohol Abuse and Alcoholism (8) to define binge drinking (>0.08 g/dL); as a result, all of the injury deaths were attributable to binge alcohol use (i.e., >5 drinks per occasion for men: >4 drinks per occasion for women). The 2.3 million YPLLs for excessive drinking is approximately half of the total YPLLs that were caused by smoking in 1999, the most recent year for which this estimate is available (10), even though mortality attributable to tobacco use is nearly six times higher than that attributable to excessive drinking. This difference exists because many AADs, particularly those caused by injuries, primarily affect youth and young adults, and deaths attributable to tobacco use are uncommon in this population.

Miller TR, Lestina DC, Smith GS. Injury risk among medically identified alcohol and drug abusers. Alcoholism: Clinical and Experimental Research 25(1): 54–59, 2001. (23 refs.)


Background: Although nonfatal injury prevalence is higher among substance abusers than in the general population, few studies have estimated the injury risk for clinically recognized substance abusers. The extant studies, moreover, analyze rates of visits for injury treatment rather than rates of injury events. This study estimates the excess risk of medically treated and hospitalized nonoccupational injury for people under age 65 with medically identified substance abuse problems and private health care coverage. Method: We conducted a retrospective cohort study by using medical claims data from Medstat Systems, Inc., with a longitudinal database of health care claims for 1.5 million people with health care coverage from 70 large corporations. Claims histories for anyone who had an alcohol-related or drug-related primary or secondary diagnosis during 1987 to 1989 were analyzed. A random sample was selected from the remaining people without a substance abuse diagnosis in their medical records. Injury rates were compared among groups. We used logistic regression to estimate odds of medically treated and hospitalized injury, controlling for demographics. Results: Medically identified substance abusers had an elevated risk of injury in a 3-year period; alcohol and drug abusers had the highest risk (58%), followed by drug-only abusers (49%), alcohol-only abusers (46%), and controls (38%). Alcohol and drug abusers were almost four times as likely to be hospitalized for an injury in a 3- year period when compared with controls. Injury risks were elevated substantially more for female then male substance abusers. Conclusions: This study greatly improves on available information about the risk of injury for drug and multiple-substance abusers. Medically identified substance abusers, especially adult women, have a higher probability of injury, more hospitalized injuries, and more injury episodes per person injured than non-abusers. More aggressive identification and subsequent treatment of female substance abusers appear warranted. (Copyright 2001, Research Society on Alcoholism.)

Miller TR, Levy DT, Spicer RS, Taylor DM. Societal costs of underage drinking. Journal of Studies on Alcohol 67(4): 519–528, 2006. (91 refs.)


Objective: Despite minimum-purchase-age laws, young people regularly drink alcohol. This study estimated the magnitude and costs of problems resulting from underage drinking by category -- traffic crashes, violence, property crime, suicide, bums, drownings, fetal alcohol syndrome, high-risk sex, poisonings, psychoses, and dependency treatment -- and compared those costs with associated alcohol sales. Previous studies did not break out costs of alcohol problems by age. Method: For each category of alcohol-related problems, we estimated fatal and nonfatal cases attributable to underage alcohol use. We multiplied alcohol-attributable cases by estimated costs per case to obtain total costs for each problem. Results: Underage drinking accounted for at least 16% of alcohol sales in 2001. It led to 3,170 deaths and 2.6 million other harmful events. The estimated $61.9 billion bill (relative SE = 18.5%) included $5.4 billion in medical costs, $14.9 billion in work loss and other resource costs, and $41.6 billion in lost quality of life. Quality-of-life costs, which accounted for 67% of total costs, required challenging indirect measurement. Alcohol-attributable violence and traffic crashes dominated the costs. Leaving aside quality of life, the societal harm of $1 per drink consumed by an underage drinker exceeded the average purchase price of $0.90 or the associated $0.10 in tax revenues. Conclusions: Recent attention has focused on problems resulting from youth use of illicit drugs and tobacco. In light of the associated substantial injuries, deaths, and high costs to society, youth drinking behaviors merit the same kind of serious attention. (Copyright 2006, Alcohol Research Documentation)

Muller R; Klingemann H, eds. From Science to Action? 100 years later - Alcohol Policies Revisited. London: Springer, 2004. (Chapter refs.)


The papers incorporated were drawn from a meeting celebrating the 100th anniversary of the Swiss Institute for the Prevention of Alcohol and Other Drug Problems. The book includes a 'smargardsbord' of 15 papers that cover various aspects of alcohol policy. The volume is organized into five sections: International perspective, history, action, the ethics and politics of policies, and in conclusion, Swiss alcohol policy over the last century. Among the subjects discussed are the relationship of alcohol policy to the public good, alcohol policy in the European Union, a review of harm reduction and its objectives, and historical review of alcohol policies in industrial countries. There is also discussion of the relationship of price decrease and spirits consumption, the relationship of consumption levels and drunkenness in different countries, as well as a commentary on the increasing influence of the alcohol industry, the resistance to policies that might decrease sales and support of educational programs with little impact. Copyright 2004, Project Cork

Mukamal KJ, Mittleman MA, Longstreth WT, Newman AB, Fried LP, Siscovick DS. Self-reported alcohol consumption and falls in older adults: Cross-sectional and longitudinal analyses of the cardiovascular health study. Journal of the American Geriatrics Society 52(7): 1174–1179, 2004. (27 refs.)


OBJECTIVES: To assess the cross-sectional and longitudinal associations between alcohol consumption and risk of falls in older adults. DESIGN: Cross-sectional and longitudinal analyses. SETTING: Four U.S. communities. PARTICIPANTS: A total of 5,841 older adults enrolled in the Cardiovascular Health Study, an ongoing, population-based, prospective cohort study, participated. MEASUREMENTS: Self-reported alcohol consumption at baseline, self-reported frequent falls at baseline, and the 4-year risk of falls of participants who denied frequent falls at baseline. RESULTS: Cross-sectional analysis indicated an apparent inverse association between alcohol consumption and risk of frequent falls (adjusted odds ratio in consumers of 14 or more drinks per week=0.41; 95% confidence interval (CI)=0.14-1.17; P for trend=.06), but longitudinal analysis indicated a similar 4-year risk of falls in abstainers and light to moderate drinkers but a 25% higher risk in consumers of 14 or more drinks per week (95% CI=3-52%; P for trend=.07). Similar results were found in analyses stratified by age, sex, race, and physical activity. CONCLUSION: Consumption of 14 or more drinks per week is associated with an increased risk of subsequent falls in older adults. Cross-sectional studies may fail to identify this risk of heavier drinking, perhaps because older adults at risk for falls decrease their alcohol use over time or because heavier drinkers at risk for falls tend not to enroll in cohort studies. However, because this study relied upon annual reporting of falls, further prospective studies should be conducted to confirm these findings. (Copyright 2004, American Geriatrics Society)

National Institute on Alcohol Abuse and Alcoholism. Tenth Special Report to U.S. Congress on Alcohol and Health. Washington, DC: U.S. Government Printing Office, 2000.


This in the 10th Special Report to the U.S. Congress on Alcohol and Health, mandated by the legislation that created the National Institute on Alcohol Abuse and Alcoholism. The intent is to summarize the knowledge base. It covers a range of topics from epidemiology, to genetics, neuroscience, toxicology, prevention, and treatment. The overview of current research is divided into eight chapters: Chapter 1 deals with drinking over the life span, and includes Issues of biology, behavior, and risk. Chapter 2 focuses on alcohol and the brain, neurosciences and neurobehavior. Chapter 3 considers genetic and psychosocial influences. Chapter 4 focuses upon medical consequences. Chapter 5 addresses prenatal alcohol exposure. Economical and health service issues are addressed in Chapter 6. Chapter 7 addresses prevention. and is followed by treatment research. Copyright 2001, Project Cork

Neumark YD, Van Etten ML, Anthony JC. “Alcohol dependence” and death: Survival analysis of the Baltimore ECA sample from 1981 to 1995. Substance Use & Misuse 35(4): 533–549, 2000. (26 refs.)


Objective: Evidence is provided about the association between "alcohol-use disorders" and the 14-year risk of death in a community sample. Most prior descriptions of this association come from treatment samples. Method: 3, 481 adult household residents were recruited into the NIMB Baltimore Epidemiologic Catchment Area survey and interviewed in 1981. The Diagnostic Interview Schedule (DIS) was employed to assess alcohol drinking and other drug-taking behaviors, and to determine fulfillment of DSM-III criteria for "alcohol abuse" and/or "dependence" diagnoses. Participants were followed-up in 1993- 1996, by which time 24% of the sample had died. Median age of death was estimated for persons with and without alcohol disorders, and for "heavy" and "nonheavy" drinkers. Cox proportional hazards models adjusted for the influence of age, sex, race, "drug-use disorders, " and tobacco smoking. Results. "Alcohol abuse" and/or "dependence" was associated with a higher risk of death and a younger median age of death (adjusted relative risk = 1.3, p = .016). ''Heavy" alcohol consumption was also associated with a significantly elevated risk of death. The DIS diagnosis of "alcohol use disorder" helped predict mortality over and above a prediction based solely upon "heavy drinking" (p < .01). Conclusions: These findings indicate that the observed increased risk of death associated with "alcohol dependence" is not limited to cases severe enough to have been treated but is also present among cases in the household population. (Copyright 2000, Marcel Dekker, Inc.)

Office of Applied Studies. Results from the 2005 National Survey on Drug Use and Health. National Findings. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (NSDUH Series H-30, DHHS Publication No. SMA 06-41194)


This is the first report based on the 2005 National Survey of Drug Use and Health, an annual survey conducted by the Substance Abuse and Mental Health Services Administration. It is the primary source of information on the use of alcohol, tobacco, and illicit drugs among the US population age 12 and older. The report is organized into nine chapters. Following an initial introduction setting forth the highlights of the report, the first chapter summarizes the nature of the survey, how the data is presented, and other sources of survey data and reports. Chapters 2 through 4 deal with illicit drug use, alcohol use, and tobacco use with data on use patterns by age, gender, racial and ethnic groups, geographic area, employment status, association with other substance use, and relation to driving. Chapter 5 provides data on the initiation of use of the major drug classes. Chapter 6 provides information related to prevention efforts: perceptions of risks associated with use, perceived availability, attitudes toward peers' substance use, parental attitudes toward use, exposures to prevention efforts, and parental involvement. Chapter 7 sets forth information on treatment, risk factors for abuse and dependence, treatment history, and the needs for specialty treatment. Chapter 8 addresses the prevalence of co-occurring psychiatric illness, with discussion of the prevalence of different mental disorders, treatment history in both the adult and adolescent (age 12-17) populations. The concluding chapter discusses trends in substance use among adolescents and young adults. The Report is accompanied by seven appendices, with information on methodology, statistical analysis, references, and selected prevalence tables. Data is presented in 146 figures and tables. (Copyright 2006, Project Cork)

Office of Applied Studies. The DAWN Report. Disposition of Emergency Department Visits for Drug-Related Suicide Attempts by Adolescents: 2004. Issue 6. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (3 refs.)


The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. This brief report presents findings related to adolescents seen in emergency departments for suicide attempts. In 2004 there were over 15,000 such among those age 12-17. These attempts involved an average of 1.7 drugs. Almost three-quarters of these were serious enough to warrant an admission to a hospital of transfer to another. Of those admitted, most involved alcohol in combination with another drug. Pain medications were involved in about half of the attempts; antidepressants or other psychotherapeutic medications were involved in over 40%. (Copyright 2006, Project Cork)

Office of Applied Studies. Results from the 2006 National Survey on Drug Use and Health. National Findings. Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (NSDUH Series H-32, DHHS Publication No. SMA 07-4293)


This the report of an annual survey of drug use and related health issues in the general population. available online

Office of Applied Studies, Wright D, Sathe N. State Estimates of Substance Use from the 2003–2004 National Surveys on Drug Use and Health. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (DHHS Publication No. SMA 06-4142, NSDUH Series H-29)


This report presents State estimates for 22 different measures of substance use or mental health problems based on the 2003 and 2004 National Survey in Drug Use and Health (NSDUHs). It is an ongoing survey of the civilian, noninstitutionalized population in the US, age 12 years or older. Separate estimates were produced for four age groups: 12-17, 18-25, 26 or older, and 12 or older. For each measure, States have been ranked into quintiles or fifths. Highlights for different parameters is provided. For example, for illicit drug use the lowest rate is in Mississippi (5.8%) and the highest in Alaska (11.8%). While there was no overall change in the national rate of illicit drug use, there were over-all declines in four states, and declines among youth in six States. Rates for alcohol use as well as particular drug use are provided, as well as attitudes toward use and the danger it presents. In addition there is information on rates of dependence, abuse and perceived treatment needs. Nationally in all age groups, 7.6% were classified with dependence or abuse. Wisconsin had the highest rate (11.3%) while Alabama and North Carolina shared the lowest rate (6%). Data is presented in 58 tables. ('Copyright 2006, Project Cork)

Pirkola SP, Suominen K, Isometsa ET. Suicide in alcohol dependent individuals: Epidemiology and management (review). CNS Drugs 18(7): 423–436, 2004. (138 refs.)


The association of alcohol dependence with suicidal behaviour is well established although complex. On the basis of epidemiological and clinical evidence, alcohol dependence is known to increase the risk for suicidal ideation, suicide attempts and completed suicide. However, this risk is modulated by a wide variety of factors including sociodemographic, clinical, treatment-related and life situational characteristics as well as current drinking status and the effect of inebriation. Treatment and management of patients with alcohol dependence and concomitant suicidal communication or suicide attempts is crucial, as is the recognition of these patients in emergency and other healthcare service contacts. The treatment strategies cannot be based on evidence derived from randomised clinical trials as such data do not exist. They must rather be based on current knowledge of risk factors for suicidal behaviour, efficacy of treatment for alcohol dependence or relevant co-morbid conditions and problems known to be common in treatment settings. In this article, we review the essential literature on the epidemiological and clinical research in the areas of alcohol dependence and suicidal behaviour. On the basis of current data and clinical experience, we suggest the following principles be followed in the management of alcohol-dependent individuals: (i) suicidal threats or communication by alcohol-dependent individuals in emergency and other contacts should be taken seriously; (ii) other mental disorders should be well evaluated, a consequent treatment plan initiated and follow-up arranged; (iii) appropriate and up-to-date pharmacological treatment should focus on both reducing the amount of drinking and treating symptoms of other mental disorders; (iv) psychotherapeutic efforts should be focused on emerging symptoms of both alcohol use and other mental disorders; and (v) known epidemiological and clinical risk factors, adverse life events in particular, should be recognised and taken into account. (Copyright 2004, Adis International Ltd)

Porter RS. Alcohol and injury in adolescents. Pediatric Emergency Care 16(5): 316–320, 2000. (15 refs.)


Objective: To determine the frequency of alcohol ingestion in adolescent victims of major trauma and determine whether alcohol ingestion is associated with increased injury severity or death. Methods: Subjects were all patients between 12-25 years of age treated at Pennsylvania trauma centers in 1996 who were reported to the state trauma database. Data on age, mechanism of injury (E-code), blood alcohol concentration (BAC), Injury Severity Score (ISS), and survival mere obtained from the state database. BAC positive and negative patients within three groups: ages 12-17, 18-20, and 21-25, were compared to determine any difference in death rate, injury severity or type of injury, Results: 4309 patients aged 12-25 were reported to the state in 1996, 2724 (63.2%) underwent testing for BAC, with 883 (32.5%) of those tested being positive. Testing positive were: 93/726 (12.8%) between 12-17 years old, 249/844 (29.5%) between 18-20 years old, and 542/1154(47.0%) between 21-25 years old. 567/884 (64.1%) of those testing positive had BAC greater than or equal to 100 mg/dl. There were no statistically significant differences in mean ISS or death rate between BAC negative and BAC positive patients in either of the age groups. Regression analysis also showed no relationship between mortality and either the presence of alcohol or the actual level of BAC. Other regression analysis demonstrated a slight downward trend for ISS with increasing intoxication, which was statistically significant at P < 0.01. Conclusions: Alcohol ingestion is found even in early adolescent trauma patients and is seen to increase throughout the teenage years, occurring in over one-quarter of patients 18 to 20 years of age. Suspicion must be high that ingestion of alcohol has occurred in adolescent trauma. Further efforts should be made to improve the rate of testing in late adolescents, to ensure adequate identification of an alcohol-exposed patients and enable educational interventions. No significant differences in mortality were seen between alcohol positive and negative patients, but there was a trend to decreased injury severity with the presence of alcohol. (Copyright 2000, Williams & Wilkins)

Rehm, J, Gmel G, Sempos CT, Trevisian M. Alcohol related morbidity and mortality (review). Alcohol Research and Health 27(1): 39–51, 2003. (125 refs.)


Alcohol use is related to a wide variety of negative health outcomes including morbidity, mortality, and disability. Research on alcohol-related morbidity and mortality takes into account the varying effects of overall alcohol consumption and drinking patterns. The results from this epidemiological research indicate that alcohol use increases the risk for many chronic health consequences (e.g., diseases) and acute consequences (e.g., traffic crashes), but a certain pattern of regular light-to-moderate drinking may have beneficial effects on coronary heart disease. Several issues are relevant to the methodology of studies of alcohol-related morbidity and mortality, including the measurement of both alcohol consumption and the outcomes studied as well as study design. Broad summary measures that reflect alcohol's possible effects on morbidity, mortality, and disability may be more useful than measures of any one outcome alone. (Public Domain)

Roizen R. How does the nation's "alcohol problem" change from era to era: Stalking the social logic of problem-definition transformation since repeal. IN: Tracy SW; Acker CJ, eds. Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800-2000. Amherst MA: University of Massachusetts Press, 2004. pp. 61-87. (126 refs.)


At the beginning of the 20th century alcohol stood considerably higher on the social/political agenda than it has since. For one, post Prohibition repeal, the national attention was faced with the Great Depression, growing fascism abroad, and before long, World War II. This chapter considers the changes in perceptions of alcohol problems from era to era. The current understanding might be attributable in significant measure to AA and educational and policy initiatives such as the National Council on Alcoholism and Yale School of Alcohol Studies, which emerged of the 1940s and early 1950s and posited alcoholism not alcohol as the central problem. In the mid-1970's there was another shift in the alcohol paradigm, with a returning attention to alcohol, which emerged as part of a public health approach and was marked by the rise of MADD, attention to underage drinking, which is described in part as moving 'forward into the past.' Copyright 2005, Project Cork

Storer RM. A simple cost-benefit analysis of brief interventions on substance abuse at Naval Medical Center Portsmouth. Military Medicine 168(9): 765–768, 2003. (9 refs.)


To determine the impact of brief interventions on substance abuse at the Naval Medical Center Portsmouth, a retrospective review of all admissions in fiscal year 2001 was conducted. Patients receiving brief interventions had significantly lower readmission rates (12.6%) than those not receiving interventions (29.4%). For Internal Medicine patients, this difference was most pronounced: 15.4% as opposed to 40.0%. The average cost of a second admission was $17,834.31 overall but $23,690.78 for Internal Medicine specifically. The lower readmission rate associated with brief interventions represents a benefit of $606,366.54 saved at a cost of $31,508.50 for a cost-benefit ratio of 19:1. The data indicate a cost avoidance opportunity of $713,372.40 if all identified substance abuse patients received interventions. Perhaps most significant, the gap between expected and identified substance use disorders (37% vs. 25%) suggests 3,400 unidentified persons who could benefit from interventions. This represents an additional cost avoidance opportunity of $10,200,000.00. (Copyright 2003, Association of Military Surgeons of the United States)

Torgoff M. Can't Find My Way Home: America in the Great Stoned Age, 1945-2000. New York: Simon & Schuster, 2005


This book is a combination of cultural history and memoir. Weaving together first-person accounts and historical background, the author tells the stories of those whose lives became synonymous with the drug culture, from Charlie Parker, Allen Ginsberg, Timothy Leary, and John Belushi to ordinary people who felt their consciousness "expanded" or who plumbed the depths of addiction. He also examines the broader impact of drugs on society and politics, from the war on drugs to the recovery movement, and the continuing debate over drug policy. From bebop and Beat generations to the psychedelic 1960s, Vietnam, the cocaine-fueled disco era, the crack epidemic, and the ecstasy-induced rave culture, illegal drugs are seen as having profoundly shaped America's cultural landscape. Interviews with the obscure and celebrated provide color and detail. Here's Herbert Huncke, the unapologetic hustler and heroin addict who lurked on the periphery of '50s bohemian scene and turned up as a character in William Burroughs' pulp memoir Junkie, or the Woodstock MC Wavy Gravy, and others caught up in a wave of experimentation and excess. The '70s leads to the cocaine craze, which begets drug wars (with casualties on both sides), Just Say No, the crack epidemic, and rave culture. This describes the cultural history at how drugs have entered the American mainstream. Copyright 2006, Project Cork

Wilsnack RW, Kristjanson AF, Wilsnack SC, Crosby RD. Are US women drinking less (or more)? Historical and aging trends, 1981–2001. Journal of Studies on Alcohol 67(3): 341–348, 2006. (73 refs.)


Objective: Women's alcohol consumption in the United States has aroused increased public concern, despite a scarcity of evidence of any major increases in women's drinking. To help resolve this apparent inconsistency, we examined patterns of historical and age-related changes in U.S. women's drinking from 1981 to 2001. Method: In national surveys of women in 1981, 1991, and 2001, we measured the prevalence of 12-month and 30-day drinking, heavy episodic drinking (HED; six or more drinks per day), and subjective intoxication. Using these data, we analyzed time and age trends for six 10-year age groups in each survey, taking into account effects of repeated observations and possible covariates (ethnicity, marital status, and education). Results: Women's 12-month drinking did not change significantly between 1981 and 1991, but it became more prevalent in the total samples between 1991 and 2001. Among 12-month drinkers, however, 30-day abstinence increased from 1981 to 2001 (particularly among women drinkers ages 21-30). From 1981 to 2001, HED declined (particularly among women drinkers ages 21-30), but intoxication became more prevalent (particularly among women drinkers ages 21-50). Drinking, HED, and intoxication became consistently less prevalent with increasing age. Conclusions: Among drinkers, increases in 30-day abstinence and declines in HED suggest that recent alarms about women's drinking may have been overstated. The contrast of lower rates of HED but increased reports of intoxication may indicate that women are more alert to alcohol's effects now than in earlier decades. (Copyright 2006, Alcohol Research Documentation, Inc.)

World Health Organization. Global Status Report on Alcohol 2004. Geneva: WHO 2004. Yoon YH, Stinson FS, Yi HY, Dufour MC. Accidental alcohol poisoning mortality in the United States, 1996–1998. Alcohol Research & Health 27(1): 110–118, 2003. (38 refs.)


The Global Status Report on Alcohol 2004 is the second global status report on alcohol published by WHO. This report provides an update on the global picture of the status of alcohol as a factor in world health and seeks to document what is known about alcohol consumption and drinking patterns among various population groups. The report consists of two parts. Part I consists of a description of alcohol consumption and beverage preferences, an overview of unrecorded alcohol consumption, traditional/local alcoholic beverages, and case examples. There is also data on drinking patterns, with the discussion of those who are abstainers, heavy drinkers, and youth drinkers. Another section deals with the consequences of alcohol use in terms of the health effects (direct biochemical effects, intoxication, alcohol dependence, wholly alcohol-attributable diseases, diseases with a contributory role, beneficial health effects of alcohol consumption, coronary heart disease as a chronic condition where alcohol has harmful and beneficial consequences, depression, diseases related mainly to chronic alcohol consumption, and acute phenomenon, traffic accidents, injuries, suicide, interpersonal violence) and the global burden of disease. The next portion addresses the consequences of alcohol use, including social problems associated with alcohol use, in respect to the workplace, family, poverty, domestic violence; and the consequences of alcohol use, in terms of both economic and social costs. Part II of the report consists individual country profiles for all Member States for which sufficient data were available. The profiles bring together information on each of these indicators: trends in adult per capita consumption as well as prevalence/drinking patterns data, information regarding traditional and/or locally brewed alcoholic beverages, unrecorded alcohol consumption, health and social problems, including morbidity and mortality from alcohol-related causes, and the social and economic costs of alcohol abuse. (Public Domain)

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