Monday 1 November 2010

David Nutt’s report on the harmful effects of alcohol should prompt the government to adopt evidence-based protection strategies

Alcohol is more harmful than heroin or crack, according to a study published in medical journal the Lancet.

The report, which is co-authored by former UK chief drugs adviser Professor David Nutt, ranks 20 drugs on 16 measures of harm to users and to wider society. Each drug was scored for harms including mental and physical damage, addiction, crime and costs to the economy and communities.

Tobacco and cocaine were judged to be equally harmful, while ecstasy and LSD are among the least damaging.

The modelling exercise concluded that heroin, crack and methylamphetamine, also known as crystal meth, were the most harmful drugs to individuals, but alcohol, heroin and crack cocaine were the most harmful to society.

When the scores for both types of harm were added together, alcohol emerged as the most harmful drug, followed by heroin and crack. The system ranked alcohol three times more harmful than cocaine or tobacco. Ecstasy was ranked as causing one-eighth the harm of alcohol.

The findings run contrary to the government's long-established drug classification system, but the paper's authors argue that their system - based on the consensus of experts - provides an accurate assessment of harm for policy makers.

The authors concur with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy.

Prof Nutt told the BBC: ‘Overall, alcohol is the most harmful drug because it's so widely used. Crack cocaine is more addictive than alcohol but because alcohol is so widely used there are hundreds of thousands of people who crave alcohol every day, and those people will go to extraordinary lengths to get it.'

He said it was important to separate harm to individuals and harm to society.

Christian Medical Fellowship has regularly contributed to the debate on the dangers of alcohol misuse.

Currently 37% of the population drinks more than the recommended number of units of alcohol per week. The NHS bill for alcohol abuse is an estimated £2.7bn a year and the most recent figures show hospital admissions linked to alcohol use have more than doubled in England since 1995.

Alcohol was the main or secondary cause of 207,800 NHS admissions in 2006/7, compared to 93,500 in 1995/96. The figures include hospital admissions for a specific alcohol-related condition – such as liver disease, but also admissions where alcohol is a contributory factor but not the main cause – such as falls due to drunkenness.

According to the World Health Organisation, alcohol has the third largest burden of disease globally.

Christian Medical Fellowship has previously backed Chief Medical Officer Sir Liam Donaldson in his call for a minimum price for alcohol. Under this proposal, no drinks could be sold for less than 50 pence per unit of alcohol they contain. The proposed measure would add around £1 a month to the drinks bill of a moderate drinker – but more for those heavy drinkers who were at risk. After ten years such a move would lead to 3,400 fewer deaths and 100,000 fewer hospital admissions a year.

In combating the epidemic of alcohol misuse the government needs to embrace solutions that are properly evidence-based. The previous government’s education-based 'sensible drinking' strategy for countering alcohol misuse is not evidence-based, but is rather built on the false presuppositions that an intemperate minority contribute the bulk of alcohol-related problems in the community and that people make rational and objective decisions about their drinking.

Research shows clearly that alcohol-related morbidity and mortality are directly related to the quantity of alcohol consumed by a population, which in turn is directly related to the availability and acceptability of alcohol in that population. Price is the major determinant of alcohol consumption, and taxation is a very effective preventive tool.

The so-called prevention paradox is based on the observation that, while very heavy drinkers do incur more alcohol related problems, they are a small minority. Alcohol-related problems occur much less frequently amongst the moderate majority, but this population is very large indeed. So, the mathematics of a lower problem rate amongst a very large number of people can still result in a larger overall number of problems than does a high rate amongst a very small number.

In other words, the people who are not recognised as misusing alcohol often contribute the bulk of alcohol-related problems in a community. The paradox is that prevention of alcohol problems in a population can therefore require us to give as much attention to the moderate majority as the intemperate minority.

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