Monthly Archives: February 2015

Sugar detox for Lent time!

So today is Ash Wednesday and for those of the Christian faith that means the beginning of Lent, a traditional time of giving something up.  Well booze is obviously off the agenda 😉 and I’m pleased to say that since the beginning of 2015 I have succeeded in weaning myself off of the nicotine lozenges so am now nicotine free YIPEE!!  I’ve been drinking caffeine free for a good couple of years so that’s a no-go too.

So that only leaves one substance – SUGAR.  As you know sweet treats have been a massive way of rewarding myself since I started on this journey.  Although I am eating way less than I was in the early days I am aware that once again I’m not role-modelling great behaviour to my kids when I’m quietly snarfing chocolate every night and we ALL need to eat less sugar in this house.  It’s time for a sugar detox!!

So it is with great trepidation that I bought the new book of Davina McCall’s called Davina’s 5 Weeks to Sugar-Free which is described on Amazon as ‘yummy, easy recipes to help you kick sugar and feel amazing’ and if you’d like a copy you can get it here.  She has been criticised as she uses honey and maple syrup in her cooking/recipes but that seems eminently sensible to me because if I tried to deprive my 7 and 8 year old of all sugar there would be a mutiny!!  And I wouldn’t be too happy either as a resident sweet tooth 😀

Over the next 6 weeks I’ll write an update post once a week on a Wednesday to let you know how we’re getting on but I’m expecting it to be a bit bumpy and I’m going to have to find a new way to treat myself that doesn’t resort to reaching for the biscuit barrel!!

For today if I can’t  have sugar I’ll have make do with thoughts of a mutiny involving Johnny Depp 😉

johnny depp

 

Longer working hours can lead to ‘risky’ drinking, say researchers

This research was published in the British Medical Journal and then picked up by The Guardian in January.  The study analysed behaviour of more than 400,000 people and found longer working hours can lead to ‘risky’ drinking.

An overview of studies covering more than 400,000 people showed that individuals who exceed 48 working hours per week are likelier to consume “risky” quantities of alcohol, they said.

The paper, published in the British Medical Journal, reported that long working hours boosted the likelihood of higher alcohol intake by 11% overall.

People who worked 49-54 hours a week ran a 13% higher risk of developing a “risky alcohol use” habit compared to counterparts who worked a 35-40-hour work week.

Those working 55 hours or more were 12% more at risk.

“Risky” alcohol use was defined as more than 14 units per week for a woman and more than 21 for a man – levels that have been linked to a higher risk for liver and heart disease, cancer, stroke and mental disorders.

An alcohol unit is the equivalent of a third of a pint of medium-strength beer, half a 175ml (six fluid ounces) glass of red wine with 12% alcohol by volume, or a 25ml shot of whisky,

The findings add statistical backing to anecdotal evidence for a link between excessive work and alcohol abuse, the authors said.

More than a dozen developed economies were covered by the research, including Belgium, Britain, Canada, Denmark, Finland, France, Germany, Japan, New Zealand, Spain, Sweden, Taiwan and the United States.

“This meta-analysis supports the longstanding suspicion that among workers subjected to long working hours, alcohol can seem like a fast acting and effective way to dull work-related aches and pains and smooth the transition between work life and home life,” Cassandra Okechukwu of the Harvard School of Public Health wrote in an editorial.

Long working hours have previously been linked to cardiovascular disease, depression and anxiety.

The increased risk of developing a “risky” drinking habit from over-work was small in absolute terms, Okechukwu said. Also, having a job was associated with a lower prevalence of alcohol consumption and a higher chance of recovery from alcohol misuse than being unemployed.

Even so, the risk should be taken seriously.

“Any exposure associated with avoidable increases in disease or health damaging behaviour, or both, warrants careful examination,” said Okechukwu.

“Indeed, these findings could add impetus to further regulation of working hours as a public health intervention.”

Cross addiction anyone?  Workaholic and potential alcoholic go together in my mind as a natural fit in the same way that a drug addict uses crack and heroin – an upper and a downer.

Existing alcohol tax revenue to combat ‘crippling’ levels of harmful drinking in ‘Booze Britain’

A slice of the existing tax on alcohol should be used to tackle soaring levels of alcohol abuse which are “crippling the nation’s heathcare budgets”, councils are urging.

The Local Government Association (LGA), which represents almost 400 local authorities in England and Wales, who are responsible for public health, is calling for the Government to divert a fifth of the current total annual duty on alcohol to councils, so they can save the public sector billions of pounds and improve people’s lives. This £2 billion is less than a tenth of the £21 billion annual national ‘bill’ for the harm caused by excessive drinking; covering healthcare, crime and lost work productivity.

These proposals are contained in a key LGA report published in January, which is called ‘Tackling the causes and effects of alcohol misuse‘. This forms part of the LGA’s campaign ‘Investing in our nation’s future‘, which sets out what the next government needs to do in its first 100 days after May’s General Election by radically devolving power to local areas. The campaign outlines a raft of measures, which, if implemented, would save the public purse £11 billion, tackle the country’s housing crisis, ensure every child had a place at a good school, reduce long-term unemployment, address the pothole backlog and improve the nation’s health.

Devolving a portion of income from alcohol tax to councils, who are spearheading the public health campaign against alcohol abuse, would enable them to support and expand a range of innovative council initiatives. These include working with the local drinks industry to reduce the number of outlets selling high and super-strength alcohol; mapping alcohol impact when considering licensing applications; and supporting a multitude of recovery programmes.

Evidence clearly demonstrates that early intervention in tackling alcohol abuse saves the taxpayer money. For every £1 invested in specialist alcohol treatment, £5 is saved on health, welfare and crime costs.

The LGA is therefore calling for local authorities to be able to use the money to undertake much more work, for example, in schools and colleges to raise awareness; invest more in supporting town and city centres to create places where people can drink moderately and sensibly; work with the courts and the police to divert alcohol misusers with mental health problems away from the criminal justice system to free up police time; and put more resources into licensing and trading standards teams.

Councils spend about 30 per cent (£830 million a year) of their entire public health budget on drug and alcohol misuse – more than any other service. However, they say this is as much as they can afford and it is not nearly enough to tackle a national crisis. There are an estimated 1.6 million people dependent on alcohol in England alone but only 6.4 per cent of dependent drinkers access treatment.

Cllr Izzi Seccombe, Chair of the LGA’s Community Wellbeing Board, said: “Alcohol abuse is costing the country a staggering £21 billion a year, which is placing a huge strain on the NHS. Councils are being forced to spend almost a third of their entire public health budget on tackling drug and alcohol misuse.

“We need a radical approach to this crippling national problem that tackles the blight of alcohol dependency, helping sufferers to escape from its effects.

“By taking a portion of existing VAT we would raise billions which would help transform the lives and futures of people – including the country’s two million odd dependent drinkers – rather than simply swelling the Treasury’s coffers.

“This extra money would be a massive boost in the battle to combat alcohol dependency. It would help tackle head-on the debilitating problems often associated with the condition, such as liver failure, cirrhosis, cancer and mental health issues like depression.

“Councils are doing everything they can to curb alcohol dependency at a local level. This involves ground-breaking health and alcohol strength reduction programmes. The extra money would enable them to ramp up their efforts and really make a major impact on tackling this condition.”

Professor Sir Ian Gilmore, a former President of the Royal College of Physicians and world-renowned liver specialist, said:

“This call for action from the LGA has brilliantly captured the current burden of alcohol harm in this country and the opportunity for properly resourced local initiatives to reduce it. There will always be areas where national policies will be most efficient and effective, such as setting a minimum unit price, and others, such as tackling the local night-time economy, where local government is best placed to act. Let’s work together to make sure there is coordinated national and local action for evidence-based policies to make our health better and our streets safer.”

There are also some great case studies highlighted as part of the LGA media release and I really support their strategy.  If public health is now being devolved to local govt then they need to have the funding support to put in place strategies and policies to support the increasing burden of health issues caused by this substance which the NHS have to fund.  What do you think?

Still banging the alcohol minimum unit pricing drum

An article in The Telegraph last month raised the subject once again of alcohol minimum unit pricing (MUP).  Although there has been a great deal of media coverage of the subject already each new article appears to come at it from a different angle and so adds to our knowledge base of the surrounding issues and context.

This one takes the approach of the impact on A&E depts saying ‘put up drink prices to stop A&E crisis, says doctors‘ and has some suitable shocking statistics to go with it.

Leading doctors are calling for an end to cheap alcohol in an attempt to resolve the hospital accident and emergency crisis.

In a letter to The Telegraph, 20 senior health professionals are calling for a 50p minimum unit price for alcohol, which they say could tackle a culture of “excessive alcohol consumption”.

Latest figures show that 20 per cent of A&E attendances are alcohol related.

The figures rises to 80 per cent during peak weekend periods on Friday and Saturday nights. Each year, more than one million hospital admissions in England are alcohol related.

Over the last decade, such admissions in those aged between 15 and 29 have risen by almost 60 per cent.

The doctors write: “The current A&E crisis is being compounded by the failure of policymakers to tackle the impact of excessive alcohol consumption.

“However, successive governments have failed to enact evidence-based policies that would save lives and ease pressure on the health, policing and criminal justice systems.”

They say: “A 50p minimum unit price for alcohol, regulation to protect children from alcohol marketing, improved alcohol labelling and the establishment of alcohol care teams with specialist consultants and nurses are simple measures, none of which would punish responsible drinkers, that must be adopted urgently in order to reduce pressures on A&E departments.”

Figures released last week showed that the NHS was experiencing its worst emergency performance in a decade. In the two weeks over Christmas, almost 21,000 patients waited between four and 12 hours on trolleys.

In some areas, the Red Cross and St John Ambulance services were being called upon to help, while fire engines and police cars were being used as makeshift ambulances.

At one point at least 14 hospitals had declared a ”major incident’’ which allows trusts to call in extra staff and ask for help from outside agencies.

Firstly I agree with all that these doctors are asking for and have to believe that the heat on govt and noise about this issue is getting louder and harder to ignore.  Secondly, A&E’s and hospitals in general have been under the cosh for years and this ‘worst winter bed crisis in a decade’ call is unsurprising.  But as I write a winter bed crisis is not a novel phenomena and if the funding of the NHS is becoming more stretched and resources more scarce then the govt should be acting to help take the pressure off by taking the call for MUP by senior medical professionals seriously.   How bad does it have to get before the non-medical politicians of govt  listen to the people who’s job it is to diagnose and treat such issues?

Capture-Bonding

So it seems appropriate on Valentine’s Day to talk about capture-bonding or Stockholm syndrome.

Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and sympathy and have positive feelings toward their captors, sometimes to the point of defending and identifying with the captors. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.

Stockholm syndrome can be seen as a form of traumatic bonding which describes “strong emotional ties that develop between two persons where one person intermittently harasses, beats, threatens, abuses, or intimidates the other.” One commonly used hypothesis to explain the effect of Stockholm syndrome is based on Freudian theory. It suggests that the bonding is the individual’s response to trauma in becoming a victim. Identifying with the aggressor is one way that the ego defends itself. When a victim believes the same values as the aggressor, they cease to be perceived as a threat (from wiki)

So why am I discussing this psychological phenomena today of all days?  It’s because many of us use the analogy of booze being like an initially loving, but turned bad, boyfriend or abusive partner.  When I was in the depths of my drinking I saw booze as my best friend, someone that I could not possibly live without despite all the trouble I ended up getting myself into because of this substance.  When we are active in our drinking we defend it, can’t see that it might be a threat to us and that we are a victim to our addiction.  We are alcohol’s captive.

How many times did I say to myself the morning after nights out that because nothing bad had happened we were okay.  It was okay for me to carry on drinking.  A lack of abuse as an act of kindness.

Our thinking becomes so warped and our loyalty so strong that we ignore the signs right in front of us as to the real danger posed by our own behaviour when under the influence of booze.  We can only see this with the benefit of distance and sober hindsight (thanks Mrs D).

So I say to you today, if you are reading this and booze is dictating your life, if you are prioritising drinking over other elements of your life (which I was) you can break free.  You do not need to continue the destructive dance with booze and there are many of us out here online who are only too happy to help if you reach out.

Love yourself today and in the ultimate act of self-care set yourself free  <3

‘Alcohol saturated’ areas soar as measures fail to dilute late-night drinking culture

This was a news article in The Telegraph that was published in late December looking at how ‘alcohol saturated’ areas have soared as measures fail to dilute late-night drinking culture.

The number of towns and cities which are officially “saturated” with alcohol has rocketed by a third in just two years.  Home Office figures revealed there are now 208 “cumulative impact areas” blighted with so many pubs, bars and nightclubs local councillors are refusing to grant any more licences. There were just 160 in 2012, a 30 per cent increase.  Official figures disclosed the total number of alcohol premises licences in England and Wales is at a high, with 204,300 or more than 2,000 more than when the Coalition came to power.

The number of takeaways and other late-night eateries holding late licences to cater for revellers has also reached a new peak.  There were 87,700 with a “late night refreshment” licence – required to serve hot food between 11pm and 5am – a surge of 1,200 in a year and more than 6,000 more than there were five years previously.

Police have expressed concern that trouble often flares as binge drinkers leave the clubs and bars and queues at kebab shops and other fast food joints since the Labour government relaxed licensing laws in 2003.

The Local Government Association said the figures showed alcohol laws needed a total overhaul, and demonstrated how measures created in a series of licensing Acts have proved too unwieldly to be effective.

The cumulative impact areas are an official category used by local authorities, which are also known as “saturation zones” or “stress areas”.  They are used to designate areas where alcohol-fuelled disorder or public nuisance is so severe that no new drinking establishments will be allowed, and existing premises will be banned from extending their hours or other capacity.  In England and Wales overall the total number of alcohol licences – held by establishments and landlords – has topped 800,000 for the first time.

There were 204,300 premises licences in force at the end of March, up 300 on the previous year and 15,400 club licences, a small fall year-on-year.  There were 581,000 “personal” licences held by pub and club managers and others, up nearly 34,000, marking a change in the way licences operate.  There was also a significant rise in the number of supermarkets licensed to sell alcohol around the clock.  At the end of March 2,200 supermarkets and stores held 24 hour licenses, up 100 year-on-year.

The number of pubs and clubs with the controversial licence to serve all day remained static at 1,000, while there was a fall in other categories such as hotels.

Professor Sir Ian Gilmore, chairman of the Alcohol Health Alliance, expressed concern about the figures.  “We are awash with outlets selling cheap drink,” he said.  “I don’t think actually the general public is in favour of this and I don’t think they know what to do about it.  “It beggars belief you can buy a bottle of wine at a garage at 2am in the morning.

“The whole direction of policy is in deregulation, to make alcohol an ordinary product just like soap powder rather than realising it is a drug of dependence”

Sir Ian said clubs staying open until 5am in the morning selling alcohol were not the problem.  “The problem is supermarkets, convenience stores, small shops and petrol stations selling cheap drink. That is driving this problem.”

The data also revealed how measures originally intended to combat binge drinking are having little impact.  There were no “early morning alcohol restriction orders” in force at the end of March anywhere in England and Wales.  They were created in 2003 to allow town halls to restrict alcohol sales in their areas between midnight and 6am if there was a problem with drink-related disorder.  Another Home Office measure allowing local authorities to impose a “late night levy” on licensed premises has only been taken forward in one city.  Newcastle City Council imposed a £300,000 charge on its city centre venues to help pay for the impact of revellers.  But nowhere else in the country has made use of the legislation, which was introduced with fanfare by the Coalition in the Police Reform and Social Responsibility Act 2011.  Police receive 70 per cent of the levy and the rest can go to fund other activities such as council marshals and cleaning.

Ann Lucas, chairman of the Local Government Association’s safer and stronger communities board, said: “This document reinforces the LGA’s position that licensing is in need of reform.  “Councils want to use every tool in their armoury to protect residents, but these figures show that not every tool is easy to use.  Councils are being hamstrung by the current systems for implementing early morning restriction orders and late night levies, which are unwieldy, bureaucratic, and extremely costly and time consuming.  Local authorities are forced to hold numerous hearings, and call scores of witnesses as a result of multiple representations by the alcohol industry.  However, residents, who do not have access to expensive lawyers, struggle to be heard because of the number and complexity of forms that they must fill out.

She went on: “Late night levies must be introduced across councils’ entire areas, which makes it extremely difficult to target them effectively.  There is a better way, such as allowing councils to revoke personal licences where a licence holder has behaved irresponsibly or inappropriately.  At the moment, there is no central database of licence holders so a person who has been barred from running a premises in one area can simply move to a neighbouring area and restart their business.  Equally valuable would be enabling councils to set licence fees locally, thereby ending ‘subsidy’ to industry – which amounts to well over £150 million since the Licensing Act was introduced a decade ago.  This is money that could be spent on providing businesses with advice on how to better comply with their licences and taking action against those who wilfully ignore that responsibility.”

More booze available 24/7 yet no increase in nursing and medical staff to combat the fall-out of this late night drinking culture when it all goes ‘pete tong’ …… and the might of the alcohol industry squashes any dissenting voice with it’s sheer financial power.

Veronica Valli and I (8) discuss Step 3

So Veronica and I got together on Skype to continue our discussions about the 12 steps today discussing Step 3.

As a reminder Step 3 reads: Made a decision to turn our will and our lives to the care of God as we understood him.

This is an in-depth discussion on what Step 3 actually means and how to apply it to your life. It’s an easy and straight-forward step that is immediately followed by the Step 4 inventory which I’ll post up in two weeks.

As you hear in the discussion I get caught up in the semantics of GOD but she says that this can mean Group of Drunks or Good Orderly Direction – both of which are true of where I came from and what I am now trying to achieve.

We’ll be back in two weeks to discuss Step 4 🙂

Veronica Valli is an Addictions Therapist and the author of Why you drink and How to stop:http://www.amazon.com/Why-You-Drink-H…

2013 How to Stop Cover 960x1280

Binge drinking significantly disrupts immune system

It was reported in the Daily Mail last month that a single episode of binge drinking significantly weakens and disrupts the body’s immune system, according to research.

Scientists gave four or five shots of vodka to 15 healthy male and female volunteers with an average age of 27.  Blood tests after 20 minutes showed that their immune system initially ramped up.But the levels of infection-fighting white blood cells had plummeted when they tested them again after two hours and five hours, the journal Alcohol reports.  There were also higher levels of a type of protein called cytokines that tell the immune system to become less active.

The researchers, from the University of Maryland and Loyola University, said that as well as increasing the risk of injuries, binge drinking impairs the body’s ability to heal afterwards. While it is well known that binge drinking alters behaviour, study co-author Elizabeth Kovacs said: ‘There is less awareness of alcohol’s harmful effects in other areas, such as the immune system.’   Previous studies have found that binge drinking delays wound healing, increases blood loss and makes us more prone to pneumonia and other infections.

immune system

Our immune systems are usually taking a battering in the winter anyway so why not give yours a rest and either remain or go alcohol free for some time?  I’ve definitely seen an improvement in my health and have had very few colds and viruses since I stopped that are all signs to me that my immune system is recovering 🙂

Edited to add 4th May 2015:

Also according to Everyday Health, drinking too much will weaken your immune system because alcohol can “wear away the linings of your mouth and oesphagus, making it easier for viruses and bacteria to enter your body and for cold or flu to take over.”

 

Feeling like a deviant?

There was an article in the Daily Mail pre-Christmas looking at the issue of how you hide the fact that you don’t drink but let everyone think that you do at a social function or work event without looking and feeling like a deviant.
DEVIANT??  I take issue with that word and here is the definition: ‘different from what is considered to be normal or morally correct’.  Normal or morally correct ……..
It was an interesting enough read and their top tips included:
  • Using health-related excused like ‘alcohol gives me migraines’.
  • Buying a drink but then not drinking it.
  • Buying a round of drinks for colleagues.
  • Saying ‘I’ve got an early morning’ or ‘I’m not drinking tonight instead of ‘I don’t drink’
  • Pretending you are trying to lose weight.
  • Volunteering to be the designated driver.

What struck me was the phrase included that became the title of this post:

Drinking can be a big part of workplace culture, and being viewed as an outsider for any reason can hurt you professionally,’ said the study’s lead author Dr Lynsey Romo, of North Carolina State University.  ‘In our study, we interviewed successful professionals who don’t drink,’ Dr Romo said. ‘We found they felt being a non-drinker was a form of deviance.’  However workers reported they didn’t want to miss out on the career opportunities that come from networking and socialising.  Sometimes, attending functions was a requirement of their job. 

‘Non-drinkers developed a variety of strategies to attend social events without making themselves, their co-workers, or their clients feel uncomfortable,’ Dr Romo added.  The researchers found most non-drinkers didn’t announce the fact that they were not drinking because they didn’t want to draw attention to themselves. 

Not wanting to be seen as judgemental or ‘holier-than-thou’ some would buy an alcoholic drink but not drink it, in order to fit in with their colleagues.  The research shows there is perceived pressure to conform to social norms in the workplace, the researchers argued.

This work highlights a challenge facing many non-drinking adults,’ Dr Romo said.  ‘It’s something that organisations and HR departments may want to take into consideration.  HR departments who have historically been worried about problem drinkers, should also consider the needs of non-drinkers, she added.  They should make sure non-alcoholic beverages are available at happy hours or host social activities that don’t centre around drinking, she said.  She concluded: ‘If employers want their employees to achieve their full potential, they need to foster an environment that encourages their employees to be themselves.’

The research was published online the Journal of Applied Communication Research.

This article made me laugh and then I got pretty annoyed.  OK it’s the Daily Wail and so some of the irritation is in their way of presenting news stories but it was more than that.  When did it become not okay for someone not to drink alcohol?  Why should our not drinking make anyone feel uncomfortable?  You would rather us drink so that you feel comfortable even though we have chosen not to and are happy with that choice?  What kind of f**ked up logic is that?

Why has drinking become the default for normal?  Why is there an assumption that non drinkers would be judgemental or ‘holier than thou’?  It sounds like drinkers projecting their issues on to the non-drinkers from where I’m sitting.  This stigmatisation of alcohol dependence and the choice to not drink needs to change and fast.

At 17 months into alcohol free living I’m not ashamed of the fact that I’ve stopped drinking or that I am an alcoholic.  I’m getting pissed off with hiding it and keeping quiet just so everyone else feels okay.  I am not a deviant!!  <Rant over>

Lifetime-risk of alcohol-attributable mortality WHO report

At the beginning of 2015 the World Health Organisation (WHO) published a report looking at the lifetime risk of alcohol attributable mortality.  This is a report on mortality risk based on alcohol consumption levels in seven European countries, and on implications for low-risk drinking guidelines.

You can read the full report here.  Within this post I will just share the discussion part of the research findings:

If the threshold for alcohol-attributable lifetime mortality risk is chosen to be 1 in 1,000, which seems to be the standard for other voluntary risks in modern high-income societies, then drinking 20g* pure alcohol per day exceeds this threshold for both sexes.  This result is consistent for the different European countries examined in the main analysis and both sensitivity analyses.Even if a considerably more lenient lifetime mortality threshold of 1
per 100 was introduced, the guidelines for women would recommend values lower than
20g of pure alcohol per day and those for men less than 30g per day.  However, there does not seem to be a good justification for such high thresholds, since alcohol use is a voluntary behaviour, i.e., neither necessary as part of diet nor as part of any needs to survive.  The present results corroborate the finding, that overall modern high-income societies accept higher thresholds for mortality risks from alcohol use compared to other voluntary risk factors (19), which is also reflected in current lower risk drinking guidelines in Europe.
 
As indicated above, two different sensitivity analyses were carried out.  The first was based on sex-specific mortality risks, and the second took into consideration competing risks in a more conservative way.  Both of these scenarios to test the stability of our finding arrived at similar conclusions for the average levels of drinking to reach predetermined acceptable
thresholds, while for higher use levels, the differences between scenarios grew. It should be stressed, that lifetime mortality risk associated with drinking at higher levels (e.g., 50g pure alcohol per day and above) would be similar or exceed the lifetime risk of smoking (115, 116) 11.   So if you are drinking 4 cans of beer/cider or 2/3 of a bottle of wine a day (depending on ABV) or over 6 shots of spirits every day the lifetime risk is similar to or exceeds that of smoking ……
(11 This does not mean that the deaths of current drinking in Europe exceed the deaths of smoking for two reasons: 1) A smaller proportion of the population drinks 50g or above compared to the prevalence of smoking. 2) The analyses here are restricted to 75 years of age. Many of the smoking attributable deaths occur later than this age.)**
It would be an interesting exercise to base low risk drinking guidelines on in voluntary risk.
From the sparse research on mortality and morbidity caused by others’ drinking from Australia, it seems that even the yearly risks of current drinking patterns in this country
would exceed lifetime acceptable risk thresholds for involuntary behaviour.  Thus, for the year 2008, an Australian study (117) found a yearly burden of 367 deaths and almost
14,000 hospitalizations due to drinking by others, indicating a yearly risk of higher than 1 in 100,000 for mortality, and about 0.5 per 1,000 for hospitalizations, clearly much
higher than the usually accepted involuntary risk thresholds stated above (i.e., 1 in 1,000,000 lifetime; see also (17, 89)).
As these mortality and morbidity risks of current drinking on others than the drinker
by far exceed acceptable risk, this could be reflected in devising guidelines for alcohol based on involuntary risk.  In fact, alcohol-attributable mortality to others (i.e., involuntary risk considerations) could be used as a benchmark for national alcohol policies.  Such a benchmark would contribute to the initiation of effective policies to reduce not only the risks to non-drinkers, but to reduce the risk to the drinkers as well.
Given the main causes of involuntary risk to others, the following areas
should be highlighted:
  • Measures to reduce alcohol-attributable injury in traffic.
  • Measures to reduce alcohol-attributable injury at the workplace.
  • Measure to reduce alcohol-attributable violence.
  • Measures to reduce drinking in pregnant women.
In addition to specific measures, some general measures such as increase in taxation or reduction of availability have been shown to be effective in reducing alcohol- attributable injury including violence (118, 119).
In assessing mortality risk and health burden due to alcohol consumption, one should not overlook that the burden of alcohol goes well beyond the health field, including such social consequences to those around the drinker and to the wider society as crime, lost productivity, family problems, child neglect or abuse, and social marginalisation (120).
An Australian study found that the reported tangible costs from out-of- pocket expenses and time lost because of others’ drinking were of much the same magnitude as the costs to health, social and legal systems of dealing with problems from drinking (117).  While it may prove hard to integrate the metrics of social burden with those of health burden, they underline the necessity to change our negligent attitude towards alcohol use and its risks.
Overall, while we found that societies accept much higher lifetime mortality risk for alcohol use compared to other risk factors, both for voluntary risk to the drinker and for involuntary risk to others, the reasons for this acceptance are not fully understood (19).
It may be related to lack of knowledge about the true risks of alcohol, especially for cancer, or to historical vagaries, as alcohol use has neither been integrated into food regulations as an ordinary food item, nor into international conventions which exist for all other psychoactive substances, nor has there been a public health action similar to tobacco
after the repeal of prohibition (for more details see (19)).
However, as current evidence clearly indicates an exceptional role for alcohol use, with higher mortality risks being accepted than for other behavioural and non- behavioural risk factors, we may well rethink acceptable risk for alcohol, and this rethinking could be reflected in new low-risk guidelines.
*In the UK one unit of alcohol contains 7.9 grams, in Australia one standard drink contains 10 grams whereas in the US one standard drink contains 14 grams.  That means 2 units should be the limit in the UK to fit the WHO guidance although they actually state that this exceeds thresholds for both sexes.
** I’m not sure I agree with this for the UK.  There are 10 million smokers, so 17% of the population, and from the Health Survey for England findings for alcohol in 2013:

  • 18% of men drank at an increased risk of harm (between 21 and 50 units per week), and 5% drank at higher risk levels (more than 50 units per week).
  • 13% of women drank at increased risk levels (between 14 and 35 units per week), and 3% drank at higher risk levels (more than 35 units per week).

So I would say the risk for smoking and drinking IS the same.

I hope the Chief Medical Officer is consulting this WHO report as she reviews our current alcohol guidelines and recommendations ….