Alcohol and mental health

The World Health Organization (WHO) ranks risky and harmful alcohol consumption as a key risk factor for disease burden and premature mortality. The harmful use of alcohol causes more than 200 disease states, injuries and intoxications, some of which are 100% attributable to alcohol, which means that they cannot even develop if a person does not drink alcohol, while in other conditions alcohol is an additional cause, such as . traffic accidents due to drunk driving, suicide or cancer. Exposure to alcohol poses a risk of developing certain types of cancer: cancer of the oral cavity and pharynx, larynx and esophagus, cancer of the liver, colon, rectum and breast, which experts associate mainly with excessive alcohol consumption, the more often and the more alcohol we drink, the greater the risk of the occurrence of cancer.

Slovenia is one of the countries where alcohol is traditionally integrated into the life of the average citizen, in terms of alcohol consumption and the health consequences of alcohol use, we have been ranked in the infamous top of the EU countries for decades. The high availability of alcohol and society's attitude towards alcohol are also problematic in our country, which is excessively tolerant of public intoxication. The drinking habits of adult Slovenians are still problematic today, one in ten inhabitants of Slovenia between the ages of 25 and 64 drinks alcohol excessively, and one in two gets high-risk drunk at least once a year. The increase in drinking among women aged 25-34 is worrisome.

In 2014, there were 804 deaths (635 men, 169 women) in Slovenia due to causes directly attributable to alcohol (one hundred percent attributable to alcohol), which represented 4.3% of all deaths in the country. More than half of these people died before the age of 65, which represents premature death. 79% of all deaths were men, the age-standardized mortality rate was 4.6 times higher for men than for women. The most common causes of alcohol-related deaths were alcoholic liver disease (59%) and alcohol-related mental and behavioral disorders (27%). The problem of mortality due to alcohol is more extensive than we can actually monitor. These statistics do not include those cases where alcohol is only one of the risk factors for disease or the cause of death (e.g. cancer, deaths due to driving under the influence of alcohol, suicides and murders related to alcohol, etc.). In 2014, a total of 3,545 cases of hospitalization were recorded in Slovenia exclusively due to the consequences of harmful alcohol use; among these, the most common were hospitalizations for alcohol-related mental and behavioral disorders (72%) and alcoholic liver disease (23%). On average, at least two people die every day in Slovenia, and 10 people are admitted to hospitals every day due to diseases and conditions that are proven to be the result of exclusively risky or harmful alcohol use. All of these deaths and hospitalizations, which affect men more, could be entirely prevented by simply drinking alcohol within the limits of relatively low-risk drinking and/or abstinence.

The attitude towards alcohol among young people is also problematic in our country. Slovenian youths are exposed to more frequent drinking of alcoholic beverages and higher alcohol concentrations compared to the international average, which in turn also affects their health. In 2014, as many as 5% of all hospital cases due to directly attributable causes of alcohol were among young people under the age of 19, which means that in 184 cases there was such alcohol poisoning in a person aged 19 or younger that it was necessary hospital treatment to prevent complications or even death.

Alcohol has a toxic or a harmful effect on the central nervous system in all periods of our lives and depending on the concentration and duration of exposure causes changes in the brain. Exposure to alcohol before birth can also cause mental retardation in children (spectrum of fetal alcohol disorders), and it can lead to dementia in adults. Researchers are finding that the brains of children and adolescents are more sensitive to the damage caused by alcohol exposure compared to adults. Greater sensitivity is the result of developmental changes, especially the maturation of the brain.

Repeated harmful use of alcohol leads to alcohol dependence syndrome or addiction, this process can start already in childhood and adolescence. Adolescents represent a particularly vulnerable group due to biological and behavioral changes. It is generally known that adolescents are more inclined to take risks, and peer pressure in society, which permissive and even encourages drinking in public, creates the conditions for early first contact with alcohol and more frequent drinking among adolescents. Childhood and adolescence are key to the development and adoption of behavioral patterns, including those related to lifestyle and drinking patterns. The earlier the first use of alcohol presents a greater risk of alcohol-related problems later in life, or in other words, the earlier the contact with alcohol, the greater the risk of addiction and other mental problems. Restricting access to alcohol can protect children and adolescents, provide them with a safer environment and teach them that alcohol is neither appropriate nor necessary during childhood and adolescence. With a more consistent implementation of the Alcohol Restriction Act, children and young people in particular could be better protected. Despite the legal ban on the sale and serving of alcohol, minors too often have access to alcohol without problems, by purchasing alcohol, for example at some gas stations, bars, they access alcohol even more often at friends' and at home. Advertising and covert advertising of alcoholic beverages, which is intended for young people as a target group of potential new buyers and drinkers of alcoholic beverages, is particularly problematic, especially e.g. near schools or at events aimed at young people.

Harmful use of alcohol leads to various mental disorders, the most common of which are acute alcohol poisoning, alcohol dependence syndrome, alcohol withdrawal syndrome, alcohol withdrawal delirium, alcohol psychotic disorder, amnestic syndrome and dementia, alcohol fetal syndrome, concurrent mental disorders, e.g. depressive or anxiety disorders and a higher risk of suicide and other forms of violence.

According to NIJZ estimates, in Slovenia in the years 2011-2014, the average medical costs associated with drinking alcohol amounted to €153 million per year, with some additional costs (e.g. traffic accidents, domestic violence, criminal acts - theft, vandalism) €234 million, these costs do not include e.g. costs of reduced productivity and costs arising from the mental suffering of loved ones, especially children.

Managing the problem of the consequences of harmful alcohol use is more effective when there is a wider social consensus. Among the most successful measures of the alcohol policy, which have been proven to reduce alcohol-related harm, the WHO ranks care for road safety (prevention of driving under the influence of alcohol), limiting the availability of alcohol (e.g. introduction of licenses for the sale of alcohol, restrictions on sales by hours and days, certain below age limit for buying alcohol and drinking alcoholic beverages), tax and price measures to reduce the affordability of alcohol (e.g. increase of minimum tax rates, determination of the minimum price of alcohol, prohibition of special and promotional prices, additional taxation for mixed carbonated alcoholic beverages), restriction of market communication of alcoholic beverages, increasing the responsibility of service staff, early identification and treatment of high-risk drinkers and short counseling programs, treatment of mental and behavioral disorders and other diseases and conditions caused by drinking alcohol. Such measures are also supported by the Slovenian public. The inhabitants of Slovenia largely support measures to limit alcohol consumption: 77% support the measure to prevent driving under the influence of alcohol (measure 0.0), 79% support the introduction of licenses for the sale of alcohol, 62% support setting a minimum price for alcohol, 57% support a complete ban advertising of alcoholic beverages. In the adoption of effective alcohol policy measures, Slovenia lags behind the most advanced countries in Europe and is ranked 16th among 29 European countries in terms of the extent of the introduction of effective measures, while it is at the very top of Europe in terms of the extent of consequences due to the harmful use of alcohol.

Sources:

1. Lovrečič B. Alcohol and cancer. 2016, Isis 25(4): 39-42.
2. Lovrečič B, Lovrečič M. Slovenians and alcohol. 2015 Isis, 24(8/9):50-3.
3. Lovrečič B, Lovrečič M. Alcohol consumption and drinking habits in the period 2000-2010: comparison between the EU and Slovenia. 2013 Isis, 22: 70-5.
4. Lovrečič B (editor), Lovrečič M (editor). Alcohol consumption and health indicators of risky and harmful alcohol use. Slovenia, 2014. Ljubljana: National Institute for Public Health, 2016. http://www.nijz.si/sl/poraba-alkohola-in-zdravstveni-kazalniki-tvegane-in-skodljive-rabe-alkohola
5. Lovrečič B, Lovrečič M. Alcohol. In: Tomšič S. (ed.), et al. Challenges in improving behavioral style and health: a decade of CINDI research in Slovenia. National Institute of Public Health; 2014, 63-9.
6. Lovrečič B. Adolescent brains and alcohol. 2014 Isis, 23(7): 16-8.
7. Lovrečič B, Lovrečič M. Occasional excessive drinking of alcohol in adolescents and its consequences on the brain. 2010 Isis, 19(5): 63-4.
8. Roškar M, Blažko N, Kerstin Petrič V, Radoš Krnel S, Lovrečič M, Lovrečič B, et al. Alcohol policy in Slovenia: opportunities for reducing harm and cost. Ljubljana: National Institute of Public Health, 2016. http://www.nijz.si/sites/www.nijz.si/files/publikacije-datoteke/alkoholna_politika_v_sloveniji_priloznosti_za_zmanjsevanje_stroskov_in_skode_f.pdf

Prepared by: Mercedes Lovrečič, Barbara Lovrečič