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  • Alcohol consumption, alcohol dependence and attributable burden of disease in EuropePotential gains from effective interventions for alcohol dependence

    jrgen rehmkevin d. shield

    Maximilien X. Rehm Gerrit GmelUlrich Frick

  • Alcohol consumption, alcohol dependence and attributable burden of disease in Europe: Potential gains from effective interventions for alcohol dependence

    ISBN: 978-1-77114-046-1 (PRINT)ISBN: 978-1-77114-047-8 (PDF)ISBN: 978-1-77114-048-5 (HTML)ISBN: 978-1-77114-049-2 (ePUB)

    Printed in Canada

    Copyright 2012 Centre for Addiction and Mental Health

    No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisherexcept for a brief quotation (not to exceed 200 words) in a review or professional work.

    Website: www.camh.net 4675

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    -201

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  • Alcoholconsumption,alcoholdependenceandattributableburdenofdiseaseinEurope:

    Potentialgainsfromeffectiveinterventionsforalcoholdependence

    Authors:JrgenRehm,16*KevinD.Shield,1,3*MaximilienX.Rehm,7GerritGmel,1,8UlrichFrick9

    *JRandKSsharefirstauthorship.

    Affiliations

    1 CentreforAddictionandMentalHealth(CAMH),Toronto

    2 InstituteforClinicalPsychologyandPsychotherapy,TechnischeUniversitt,Dresden,Germany

    3 InstituteofMedicalScience,UniversityofToronto,Canada

    4 DallaLanaSchoolofPublicHealth(DLSPH),UniversityofToronto,Canada

    5 DepartmentofPsychiatry,UniversityofToronto,Canada

    6 PAHO/WHOCollaboratingCentreforMentalHealthandAddiction

    7 FacultyofArtsandSciences/PoliticsandGovernance,RyersonUniversity,Toronto,Canada

    8 EcolePolytechniqueFdraledeLausanne,Lausanne,Switzerland

    9 Dept.HealthcareManagement,CarinthiaUniversityofAppliedSciences,Feldkirchen,Austria

    Correspondingauthor:J.Rehm,CAMH,33RussellStreet,Toronto,ON,M5S2S1,Canada

    Competinginterests:Theauthorshavedeclaredthatnocompetinginterestsexist.

    Funding:ThisworkwassupportedbyanunrestrictedcontractfromLundbeckA/S.Inaddition,WHO

    EuropeanRegionsupportedthecalculationsofalcoholattributableharm;andthemethodologyfor

    determiningalcoholattributablefractionswasdevelopedasaresultoftheComparativeRisk

    AssessmentoftheGlobalBurdenofDisease2005study.

    Acknowledgments:TheauthorswouldliketothankPeterAnderson,PeterIversenandUliWittchenfor

    theirveryhelpfulcommentsonanearlierversionofthismanuscript.ThanksalsogotoJulieGraysonfor

    Englishcopyediting,andtoMichelleTortoloandChristineVrbanacforreferencingthemultipleversions

    ofthismanuscript.

    1

  • TABLEOFCONTENTS

    ALCOHOLCONSUMPTION,ALCOHOLDEPENDENCEANDATTRIBUTABLEBURDENOFDISEASEIN

    EUROPE:POTENTIALGAINSFROMEFFECTIVEINTERVENTIONSFORALCOHOLDEPENDENCE.............................. 1

    FOREWORD ....................................................................................................................................................7 WAKEUPCALLFOREUROPESDRINKINGPROBLEM.................................................................................................8

    DealingwithEuropesdrinkingproblem.................................................................................................8 WhyhasEuropegotitsowrong?...........................................................................................................8 Enterthepharmaceuticalbusiness.........................................................................................................9 References ............................................................................................................................................10

    EXECUTIVESUMMARY.....................................................................................................................................11 ABBREVIATIONSUSED.....................................................................................................................................14 THEAIMOFTHISBOOK ..................................................................................................................................15 TRADITIONALPATTERNSOFALCOHOLCONSUMPTIONINEUROPE ...........................................................................16 KEYINDICATORSOFALCOHOLCONSUMPTIONINEUROPE......................................................................................18

    Drinkingstatusandvolumeofdrinking................................................................................................18 Table1:Keyalcoholconsumptionindicators ................................................................................................... 20

    Derivingindicatorsforalcoholconsumption ........................................................................................22 Measuresofalcoholconsumption:definitionsandprocedures ...................................................................... 22

    Adultalcoholconsumptionin2009 ......................................................................................................23 Figure1:Adultconsumptioninlitres ............................................................................................................... 24 Table2:Adultconsumptionanddrinkingpatterns .......................................................................................... 25 Timetrendsinconsumption............................................................................................................................. 27 Figure2:Adultconsumptioninlitressince2000.............................................................................................. 27

    Patternsofdrinking ..............................................................................................................................28 Figure3:Globalpatternsofdrinking(2005)..................................................................................................... 29

    Heavydrinkingoccasions......................................................................................................................29 Table3:Frequencyofdrinkingbycountry ....................................................................................................... 30

    ALCOHOLATTRIBUTABLEBURDENOFDISEASEINEUROPE .....................................................................................31 Acknowledgment ..................................................................................................................................31 Relationshipsbetweenalcohol,diseaseandinjury ..............................................................................32 Methodologyforderivingthealcoholattributableburden..................................................................32 Theproblemoftimelag........................................................................................................................33 Alcoholattributablemortality..............................................................................................................34

    3

  • Deathsduetoalcoholconsumption................................................................................................................. 35 Figure4:Regionalvariationsinproportionsofdeaths..................................................................................... 35 Figure5:Countryvariationsintheproportionsofdeaths ............................................................................... 38 Table4:Deathsbydiseasecategories .......................................................................................................... 39 Figure6:Proportionofdeathsformajordiseasecategories ........................................................................... 40 PotentialYearsofLifeLost(PYLL)duetoalcohol ............................................................................................. 42 Figure7:RegionalvariationsintheproportionofPYLL.................................................................................... 42 Figure8:ProportionofPYLLformajordiseasecategories ............................................................................... 43

    Alcoholattributabledisabilityandburdenofdisease ..........................................................................44 YearsofLifeLostDuetoDisability(YLD) .......................................................................................................... 44 Figure9:AlcoholattributableYLDtoallYLD,byregion................................................................................... 45 Burdenofdiseaseduetoalcohol ..................................................................................................................... 45 Figure10:AlcoholattributableDALYstoallDALYs,byregion ......................................................................... 46 Figure11:ProportionofalcoholattributableDALYstoallDALYs .................................................................... 48 Table5:AlcoholattributableDALYsbydiseasecategories .............................................................................. 49 Figure12:ProportionsofalcoholattributableburdenofdiseaseinDALYs..................................................... 50

    Healthharmstoothersduetoalcoholconsumption ...........................................................................50 Table6:Alcoholattributablemortalityanddiseasecausedbyharmstoothers ............................................. 52

    THECONTRIBUTIONOFHEAVYDRINKING ...........................................................................................................53 Table7:Alcoholattributablemortalityanddisease ........................................................................................ 54

    ALCOHOLDEPENDENCE:PREVALENCEAND

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