Alcohol harms – what are they, and what is our role?

As with all drugs, alcohol misuse can lead to a wide variety of problems, ranging from severe dependency and life-threatening health conditions to hangovers or conflict with friends and family. Alcohol harms can affect both individuals and wider society. Alcohol-related violence or nuisance, for example, affects people other than the drinker. Ill-health rarely affect just the individual concerned: it may have a devastating impact on families, and the social costs of treating alcohol-related health conditions run into the billions every year. That is why alcohol harms are not solely a matter of individual choice, but an issue for society more widely.

Alcohol is associated with over 60 medical conditions, including a number of cancers. The consequences of heavy drinking are not limited to liver disease, but can also include hypertension, mental health problems, nutritional deficiencies and stroke. The UK currently has some of the highest levels of liver disease globally, and – unlike the rest of Europe – those levels are increasing.

In England alone, around 337,000 hospital admissions every year are caused directly by alcohol. If we include all admissions where alcohol is a probable factor, the figure is closer to 1 million. This costs the NHS around £3.5 billion annually.

The UK Chief Medical Officers recommend that anyone wanting to keep their health risks to a minimum should not consume more than 14 units of alcohol a week regularly, and should always have a few days each week when they don’t drink. Recent research confirms that if drinkers stick to around the CMO guidelines, then the risk of any health condition linked to alcohol is very low.

However, around 20% of the population drink at hazardous, harmful or dependent levels. Drinking these amounts increases the risk of a range of conditions, as well as potentially having knock-on effects in terms of mental health, wellbeing and productivity. It is often difficult to get a sense of how much you are drinking, and we may often drink more than we assume. The best way to check whether you are drinking at levels that pose a risk to health is to complete an online drinking test or even just to keep a drinking diary for a week or two.

The effects of alcohol-related violence can be devastating and costly. Alcohol is associated with around half of the violent crime reported each year. This includes both violence in public places and violence in the home. A recent review of domestic homicide reviews found that alcohol was identified as an issue in 69% of all cases.

Alcohol is also associated with antisocial behaviour and public nuisance. Recent surveys have found that up to 79% of respondents have experienced harm as a result of someone else’s drinking. Of course, this is partly an issue of wider behavioural norms: most people can drink without become a burden to those around them. However, when people do behave antisocially, alcohol can make things much worse.

Defining alcohol dependence is complex: the boundary between different types of drinking problems is often blurred, and one can be drinking very harmfully without being dependent. Nevertheless, in cases where people lose control of their drinking and are consuming at very high levels, the effects on individuals and those around them can be catastrophic. Public Health England estimate that there are around 600,000 dependent drinkers in England alone, and 200,000 children living with a dependent carer. Without support, many of these individuals and families will face a future of acute suffering and, in worst cases, tragedy.

There is no simple solution to alcohol dependence. It involves both preventing people who drink heavily from sliding into even more problematic patterns of consumption, and it involves providing adequate treatment and support for individuals and families affected by dependence. At the moment, less than 20% of dependent drinkers are getting the support they need: a figure which needs to rise significantly.

A study in 2003 estimated that alcohol costs the UK economy around £21 billion per year. This includes £11 billion in crime costs; £7 billion in lost productivity and £3.5 billion in costs to the NHS. This figure is now dated, and other estimates put the figure much higher. Of course, alcohol brings in large tax receipts (about £10 billion per year) and creates considerable employment. It is unrealistic to imagine a world in which alcohol creates no costs at all – or to ignore the benefits that it can create in terms of social wellbeing or employment. However, the cumulative health costs of alcohol and the personal and social harms caused by heavy or dependent drinking, can be enormous. A great many of these are preventable through effective regulation, changing social norms, and proper support for individuals affected.

That is why we need effective, evidence-based policy and practice to reduce alcohol harms, as well as better understanding of how those harms arise and can be prevented.

Further resources

Public Health England: The public health burden of alcohol – evidence review