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Risk-free drinking only a fantasy - WHO

Our Medical Advisory Panel suggested to highlight this article on alcohol in Health Watch this week, as this being the X'mas season when parties galore, there is no better time to focus attention of the public to the adverse effects of drinking.

The drinker's dilemma

The Individual's drinking and degree of risk

Eating and drinking season is on Table laid, glasses kept ready. But think before you drink.

There is now evidence for a potential health benefit for at least some people start drinking small amounts. On the other, appraisal of the full range of alcohol-related consequences suggests that entirely risk-free drinking exists only as a fantasy.

A given drinking occasion may provide immediate gratification through alcohol's effect as a mood modifier, as an anodyne or intoxicant, or as a facilitator of sociability. Conversely, the drinking occasion may bring with it conflict, injury or social opprobrium, and could make a small contribution to a death from cancer many years later.

The dilemma facing the drinker is calculating and balancing the probabilities of all the possible pleasures against the possible pains.

The main questions which need to be answered in considering risks for the individual drinker are:

Is there a threshold level below which there is no significant risk?

At low levels of consumption, do the benefits outweigh the risks of adverse consequences?

Does the risk of adverse consequences increase more or less proportionately with the rise in consumption, or do the consequences rise more steeply at high consumption levels?

Adverse social consequence of drinking

Experience of two or more adverse consequences from drinking. Alcohol consumption (drinks per day) and per cent subject reporting two or more consequences. Canadian National Survey Data (Source: Room et al 1994)

National surveys

In a number of national surveys respondents have been asked about the harmful effect of their drinking on different areas of their lives such as friendships, employment and finances.

The results are consistent. For each life area the proportion reporting harm rises fairly steadily with rising alcohol consumption with no clear threshold below which drinkers are exempt from harm.

Accidents and violence

Road traffic crashes: driver BAC and relative crash risk plotted separately for different drinking frequencies. Grand Rapids data re-analysed US national data. (Source: National Highway Traffic Safety Administration 1992)

Similarly, there is no clear threshold to the relationship of blood-alcohol level and traffic crashes. The same is true for associated deaths, with road traffic mortality rising increasingly steeply as blood-alcohol level rises.

Experience of assault by someone who has been drinking. Alcohol consumption (drinks per day) and percentage of subjects reporting that over the previous 12 months they had been 'pushed, hit or shoved by someone who had been drinking'.

Findings plotted separately by frequency with which subjects have consumed five or more drinks on an occasion. (Canadian National Survey data1994)

Respondents in a US health survey who drank five or more drinks on an occasion at least once a month were much more likely than others with the same overall volume of drinking to have been assaulted by another drinker; but even for those who did not drink this much on a single occasion, the probability of being assaulted by another drinker rose in line with volume of drinking.

The relation between amount of drinking and death from violence (suicide, fights, accidents) is particularly strong among young people.

Individual drinking level and overall mortality

There is no doubt that relatively heavy drinking of alcohol has a substantial adverse effect on physical heath. But rather than the sum of all these risks resulting in a straight-line relationship between the individual's level of drinking and mortality, a J-curve relationship between alcohol consumption and overall mortality has been a repeated (though not universal) finding in studies since the 1920s.

This means that usually the finding is of an elevated mortality among abstainers as compared with light drinkers.

This is almost entirely due to a reduced risk of coronary heart disease (CHD).

In a minority of studies, mortality for the lightest drinking category is also slightly elevated compared with somewhat heavier drinkers.

The deaths in most of the drinking and mortality studies are dominated by deaths among older men. Studies of different sex, ethnic, or socio-economic groups often do not produce the same results as those of older Western males.

A Japanese study suggested that relationships between alcohol and total mortality reported in studies of Western populations may not hold for Japanese populations, where the incidence of CHD is much lower and where the incidence of stroke, which is positively related to consumption, is much higher.

Adverse effects - the essential conclusion

The evidence presented in this section is clearly incompatible with any idea that alcohol is a problem only for a small minority of the population who can be tidied away and classified as 'alcohol abusers'.

Rather, alcohol problems are a highly significant public health issue affecting very large numbers of people and the quality of life and the functioning of society as a whole.

Countries which at present have low problem rates would do well to protect their relative advantage rather than allowing complacency to result in unguardedness.

Courtesy: Alcohol Policy and the Public Good - WHO Study

Wheelchair gift to centenarian

What a happy occasion it was for this American couple Don Bennion and Marlene last Saturday (December 18) when they were able to gift a wheelchair to this 104 years centenarian M. P. Mary Nona in the HealthWatch coordinated Prof. Colvin Goonaratna Centenarian Study.

The presentation took place at the Malwana Home of the centenarian in Kelaniya, amidst her family gathering which included fourteen children, grand and great grandchildren.

Mr. and Mrs. Bennion who are volunteer members of the Latter Day Saint (LDS) Charities of the United States, which together with the Wheelchair Foundation of the States made the donation.

Mr. Bennion, a retired electronic engineer in Utah in the States said this was the first time in his life he was meeting a centenarian. The oldest person he had met upto now had been a 90 years uncle of his.

Mr. Bennion who feels honoured to have been able to gift a wheelchair to this centenarian is amazed at her health status even at this centenarian stage in her life, where she can clearly see without glasses, and thinking not impaired.

The Bennions greatly admired the way the centenarians children and young grandchildren were caring and looking after her. They felt this is something that should be emulated by families in the developed world.

Mr. Bennion said, "what a blessing it is to have a centenarian in a family, and the rare opportunity to have to care for them and look into their needs. There is nothing greater on this earth than human life."

The Bennions highly commended the HealthWatch coordinated Prof. Colvin Goonaratna Centenarian Study project.

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