Clinical Review

ABC of mental health: Addiction and dependence—II: Alcohol

BMJ 1997; 315 doi: (Published 09 August 1997) Cite this as: BMJ 1997;315:358
  1. Mark Ashworth,
  2. Claire Gerada

    Prevalence of alcohol related problems

    Alcohol exacts a huge toll on the nation's physical, social, and psychological health. Consumption doubled between 1950 and 1980, during which time the relative price of alcohol halved. Since then consumption has flattened off

    As with any drug of addiction, there are four levels of alcohol use.

    Social drinking—Only about 10% of the population are teetotal.

    At risk consumption—This is the level of alcohol intake that, if maintained, poses a risk to health. The Health of the Nation gives “safe” levels of consumption—21 units a week for men and 14 units for women. These levels are exceeded by a sizeable minority of the population—28% of men and 11% of women.

    Problem drinking—At this level, consumption causes serious problems to drinkers, their family and social network, or to society. About 1-2% of the population have alcohol problems.

    Dependence and addiction—The characteristics of dependence apply to alcohol as to other drugs—periodic or chronic intoxication, uncontrollable craving, tolerance resulting in dose increase, dependence (either psychological or physical), and a detrimental result to the person or society. There are about 200 000 dependent drinkers in the United Kingdom.

    Alcohol related problems

    • 33 000 premature deaths a year in England and Wales are related to alcohol consumption

    • 300 of these deaths are the direct result of alcoholic liver damage (the true figure is probably many times higher but is hidden by underreporting on death certificates)

    Alcohol consumption is associated with

    • 80% of suicides

    • 50% of murders

    • 80% of deaths from fire

    • 40% of road traffic accidents

    • 30% of fatal road traffic accidents

    • 15% of drownings

    Alcohol consumption contributes to

    • 1 in 3 divorces

    • 1 in 3 cases of child abuse

    • 20-30% of all hospital admissions

    People lacking the liver enzyme acetaldehyde dehydrogenase experience extremely unpleasant reactions on exposure to alcohol because of accumulation of …

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