Professor Frank Murray, Consultant Gastroenterologist and chair of national alcohol policy group, RCPI, speaks about alcohol-related harm in Ireland at Alcohol Action Ireland's conference "Time Please... For Change".

1. Alcohol in Ireland.
Major health burden.
Major economic burden.
Major opportunity.
Prof Frank Murray
Registrar RCPI
Consultant Gastroenterologist/Hepatologist,
Beaumont Hospital/RCSI,
Dublin 9

2. Policies that reduce the availability
of alcohol though:
Price increases
or
Reducing outlets and hours of
sale
Have been shown to be effective

3. • Europe is the heaviest drinking region in
the world
• Alcohol is the main cause of liver disease
in Europe
• The prevalence of alcoholic liver disease
is rising in Ireland

4. Problems addressing the alcohol
problem in Ireland!!!!
• Drinking alcohol can be harmless, in
contrast to cigarettes
• Alcohol is strongly rooted in our society
• The alcohol industries receive the majority
of their turnover in UK from harmful and
hazardous drinkers

5. Alcohol in Europe
• Europe is the highest drinking region in
the world
• 200,000 deaths per year
• Cost €125 billion per year. 1.3% of GDP
• Third commonest cause of premature
death and disability
• Main cause of liver disease and death

6. DALY (Disability adjusted life
year)
• The sum of the life years lost due to
premature death or years lived in disability

7. Alcohol cause huge health problems
• WHO:
– 4% of global mortality
– 5% of global DALY
• Europe worse
– 7% mortality
– 12% of DALY

8. Alcohol cause huge health problems
• Worse in males: 17% of DALYs( vs 4%)
• Worst in young males
• Alcohol cause 35% of deaths aged 35-
50

9. Alcohol responsibility for many
youth deaths
• 25% of male
• 10% of female

10. Major disease burdens attributable
to alcohol

11. Main cause of alcohol DALY
• Liver disease
• 75% men
• 85% women

12. • There is a direct correlation between
amount of alcohol consumed and
cirrhosis mortality

13. CIRRHOSIS AND PORTAL HYPERTENSION
Cirrhosis
and
Portal Hypertension

14. SURVIVAL TIMES IN CIRRHOSIS
Decompensation in cirrhosis
Shortens Survival
100
80 Median survival
Median survival
~ 9 years
~ 9 years
60 All patients
with cirrhosis
Probability of
survival
40
20
Decompensated Median survival
Median survival
cirrhosis ~ 1.6 years
~ 1.6 years
0
0 20 40 60 80 100 120 140 160 180
Months
Gines et. al., Hepatology 1987;7:122

15. Mortality due to cirrhosis in Ireland

16. There is a big human cost here
• Ill and dying patients
• Often young
• Often little opportunity to change
• Families

17. Does not end there
• Absenteeism
• Loss of professional performance
• Domestic violence
• Unhappiness

18. 3 main types of alcohol misuse
• Hazardous
• Harmful
• Dependent drinking.

19. Hazardous drinking
• Drinks over the recommended weekly limit
of alcohol
• 21/17 units for men and
• 14/11 units for women.
• It is also possible to drink hazardously by
binge drinking, even if within weekly limit.

20. Harmful drinking
• Drinks more than the recommended weekly
maximum amount of alcohol and experiences
health problems that are directly related to alcohol.
• Cirrhosis
• depression
• an alcohol-related accident, such as a head injury
• acute pancreatitis (inflammation of the pancreas)
• high blood pressure
• some types of cancer
• heart disease

21. Dependent drinking
• Both physically and psychologically addictive
• Become dependent on it
• Feels unable to function without alcohol
• Consumption of alcohol becomes an
important, or sometimes the most important,
factor in their life
• Can experience withdrawal symptoms (both
physical and psychological) if they suddenly
stop drinking alcohol.

22. Binge drinking
• 4 (female)
• 5 (male)
• units in 2h
– or
• 8 (male)
• 6 (female)
• units in 24 hours
• Rapidly increasing in prevalance

23. So most alcohol consumption is
mostly drunk safely?…..
• 75% of alcohol consumed in UK is by
hazardous and harmful drinkers in the UK

24. Absolute risk of death from alcohol-
related disease

25. Adult alcohol consumption

26. Heavy episodic drinking of at least 60g
of pure alcohol in last 7 days (women)

28. Irish consumption
• 11.9 litres of alcohol per adult (>15y) in
2010
• Over half Irish drinkers have a harmful
drinking pattern
• Much more affordable

29. Irish costs of alcohol
• €3.7 billion
• Healthcare €1.2 billion (8% of total)
• Approx 2,000 hospital beds per night
• 7% of GP costs
• 30% of Emergency Department costs

31. Fundamental problem in Ireland
• Too much alcohol
• Binge drinking
• Availability
• Number of outlets
• Opening hours

32. Availability

33. Supermarkets
• Promotions
• Special offers
• Packaging in larger units
• Not quarantined, all over the shop

34. Concerts

36. Sports sponsorship

38. Under-age drinking

39. Marketing towards young people

40. Options
• Do nothing
• Do “something”
• Take thought-through series of steps.
Leads to immediate health social and
political gains

41. Systematic reviews and meta-analyses.
Proven policies.
• Policies regulating the environment in
which alcohol is marketed (particularly its
price and availability) are effective in
reducing alcohol-related harm.
• Making alcohol more expensive and less
available, and banning alcohol
advertising, are highly cost-effective
strategies to reduce harm.

42. Key messages
A substantive evidence base of systematic
reviews and meta-analyses inform alcohol
policy

43. Making alcohol more
expensive and less
available are highly cost-
effective strategies to reduce
harm

44. • Banning of alcohol advertising
• Drink-driving countermeasures
• Individually-directed
interventions to drinkers already
at risk
are also cost-effective approaches

45. School-based education does
not reduce harm, but public
information and education
programmes can increase
attention to alcohol on public
and political agendas

46. If more stringent alcohol policies
are not put into place, global
alcohol-related harm is likely to
continue to increase

47. Actions
• Reduce number of outlets dramatically
• Increase cost-minimum unit pricing
• Expand and enforce legislation re alcohol
consumption in public and public order
offences
• All of proven international proven benefit

48. Successful legislated constructive
social changes in Ireland
• Smoking ban
• Reduction in alcohol driving
limit
• Cycling helmets

49. RCPI alcohol group
• RCPI established a national policy group to
address the health and social burden of
alcohol in Ireland.
• The policy group brings together experts from
a wide range of medical specialist bodies to
speak with one voice on the issue of alcohol,
to support
• Propose practical solutions backed up by a
robust, international evidence base
• Focused on reducing the harm caused by
alcohol to health and society.

50. Policies that reduce the availability
of alcohol though:
Price increases
and
Reducing outlets and hours of
sale
Have been shown to be effective