Public pay price of alcohol abuse

By REBECCA WALSH


First off it's the teenager assaulted after a drunken brawl. He's semi-comatose with a possible head injury. It's hard to make sense of anything he says.

Next up, two teenagers injured in a drink-drive car accident. Both 15, they have been drinking at a party, gone home and then sneaked out for a joy ride. A bit later comes the garrulous elderly alcoholic. He's recently had a heart attack and after his latest drinking binge has chest pain and isn't sure if it's serious.

It's a typical Friday night at the emergency department of a small North Island town.

About a third of the people seen by Dr Peter Jones at Auckland City Hospital are there because of alcohol.

The emergency medicine specialist says alcohol is largely ignored by medical staff as a reason people turn up at hospital because it is so common. The same attitude is seen in the media and the general public.

"Everyone is really hot on P, a year ago it was Fantasy. All of these drugs are minuscule in cost compared to alcohol," Dr Jones says.

Each year Auckland City Hospital's emergency department handles about 1500 cases where people have overdosed. Between 700 and 800 are alcohol overdoses - compared with less than 200 a year combined for GHB (Fantasy) and other drugs such as Ecstasy, speed and P.

A study published in the New Zealand Medical Journal this year found 35 per cent of injured patients who attended the emergency department at Auckland Hospital in December 2000 reported they had been drinking.

The risk of sustaining an injury is 2.8 times greater when alcohol is consumed.

And medical care is not cheap.

A person who comes in with a head injury, "just because they went out and got drunk and fell over," may need x-rays - about $50 a pop - through to a stay in the intensive care unit, about $3500 a night.

And although alcohol is often the reason a person ends up in hospital, it may not be recorded as such. Often there are a complex set of reasons a person develops a particular condition such as heart disease. (In 1999 there were just 168 alcohol-related deaths recorded.)

Still, those working in the health sector say better recording would give a clearer picture of the real cost.

Economist Brian Easton, in a report last year, estimated that $655 million was spent each year on public health as a result of alcohol misuse.

In its annual report for 2002, the Alcohol Advisory Council says the estimated cost of alcohol-related deaths is $5.5 billion a year, while alcohol-related injury and illness is estimated to cost $6.6 billion. Productivity losses, including absenteeism, is estimated at $1.8 billion a year.

Chief executive Dr Mike MacAvoy says the figures are based on factors such as what a person contributes in terms of tax and productivity over their lifetime.

Given that 85 per cent of New Zealanders enjoy a drink and only 2 to 5 per cent become chronically dependent on alcohol, what is the problem?

A just-published Ministry of Health survey shows that the problem is that one in six New Zealand adults have drinking patterns which put them at high risk of future damage to their physical and mental health. Men are twice as likely to have "hazardous" drinking habits. And that is ultimately going to cost the taxpayer.

People who regularly drink to excess are at risk of a range of chronic conditions from cirrhosis of the liver, heart disease and pancreatic disease to increased anxiety levels, depression and memory problems. Studies have also shown it increases the risk of breast cancer.

Drinking during pregnancy can result in a child with foetal alcohol syndrome.

Dr MacAvoy points out too often people associate alcohol abuse with an old man drinking out of a brown paper bag but "the average person who manages to survive in society, stay in their job, stay out of court, still may cause us a lot of harm".

At the same time he acknowledges there are positives associated with alcohol, particularly "the sense of relaxation, conviviality and sociability" it creates.

Studies have found that drinking a moderate amount of alcohol - and it is not restricted to wine - has health advantages for middle-aged and older people.

Professor Ian Simpson, head of school at the Auckland Medical School, says those who drink a moderate amount daily - about three standard drinks for a man and two for a woman - reduce their risk of heart disease and strokes as alcohol helps thin the blood.

It can also delay the onset of type 2 diabetes because alcohol sensitises the cells, particularly in muscles, to the effect of insulin.

A major American study of 500,000 people found moderate alcohol use reduced all causes of death when compared with those who didn't drink at all.

But Professor Simpson, who is also a member of the medical advisory committee for the Beer Wine and Spirits Council, says a healthy lifestyle is an important part of the mix.

"If you don't want to have a heart attack or stroke and you drink moderately and think that's going to save you, but you still smoke, well you are a fool."

Overseas studies show genes probably account for 40 to 60 per cent of the risk of developing alcohol dependency.

When it comes to treatment a third of people are estimated to be successful, a third stay the same and the rest get worse.

Although treatment is now mainly community focused, some people argue there is not a great enough range of help available.

Dr Peter Adams, of the School of Population Health at Auckland University says there is greater recognition that alcohol misuse involves degrees of severity and is not confined to being an alcoholic, or not.

Drugs that reduce people's desire to drink are being tested overseas. More work is also being done to help junior doctors identify patients with alcohol and drug problems.

Professor Sally Casswell, director of the Centre for Social and Health Outcomes Research and Evaluation at Massey University, says studies show overwhelmingly that early intervention is effective.

Often it is as simple as a doctor or health worker, spending a few minutes asking about a person's alcohol consumption and offering basic information.

Professor Casswell says people are also often embarrassed to ask about someone's drinking, believing it's not really their business.

The cost to the community means it's everybody's business.




COSTS

An estimated $655 million is spent a year on health costs (hospital and non-hospital) as a result of alcohol consumption.

Alcohol-related injury and illness is estimated to cost $6.6 billion a year.

Productivity losses, including absenteeism, are estimated to cost $1.8 billion a year.

About 24 people are admitted to hospital each day with an alcohol-related condition or because alcohol was involved.

One in six adults have patterns of drinking that put them at risk of future physical or mental negative effects from alcohol.

It is estimated 20 per cent of all deaths in the 15-34 age bracket are attributable to alcohol.

KEY HEALTH EFFECTS

In the immediate term:

Increased injury risk, including assault, domestic violence, drowning, motor accidents (about a quarter of all fatal road deaths involve alcohol).

Increased risk of sexually transmitted diseases and unplanned pregnancies.

Long-term effects of heavy drinking:Increased risk of a number of diseases, involving the liver, heart, pancreas, brain, central nervous system and the digestive system.

Increased risk of some forms of cancer, for example breast cancer.

Heavy drinkers are more prone to depression and suicide.

Inhibits sexual drive and can cause testicular shrinkage, irregular menstruation and premature menopause.

Up to 5 per cent of drinkers become chronically dependent on alcohol.

Heavy drinkers die earlier than moderate drinkers or people who don't drink.

CALORIE COUNT

A glass of dry white wine (100ml) is the equivalent of about 89 calories.

A 330ml can of beer (standard, draught, lager) is about 122 calories.

A nip of spirits (20ml) is about 42 calories, add 200ml of soft drink and it totals about 126 calories.

Figures from the New Zealand Drug Statistics Report 1999/2000, the Alcohol Advisory Council, economist Brian Easton, the Ministry of Health, Crop and Food Research

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