Drugs and harm to society

David Nutt and colleagues1 point out the extent of harm that alcohol does to individuals and to society. In countries with an established market economy, alcohol accounts for 10·3% of disability-adjusted life-years2 (second only to tobacco, with 11·7%).

Relevant also in recessionary times, alcohol has been estimated to cost the UK economy £55·1 billion3 annually (amounting over 15 years to the entire UK deficit). We believe the most important message from this study is therefore the urgent need for more action on the harm caused both to the individual and to society by alcohol.

The UK coalition government has established morbidity and mortality amenable to treatment as central to its outcomes-based health service reforms.

With regard to public health and social policy, the British Society of Gastroenterology suggests that an outcomes-based policy focused on amenable mortality is especially applicable to alcohol, given its leading contribution to disability and life-years lost. We think a taskforce of willing stakeholders, from all sides of the debate, should establish goals to be achieved in terms of alcohol-attributable mortality and morbidity, and devise a range of evidence-based policies, monitor their effectiveness annually, and adjust them until the nationally determined outcome is achieved. As much debate has focused on disagreement about methods, members should start agnostic on this point or leave their prejudices at the door and be required simply to establish and then deliver outcomes. Although the effects of alcohol range far beyond the liver, deaths from alcohol-attributed liver disease would be an appropriate metric by which to judge progress.
Secondary care also deserves greater focus. The approach to patients who make contact with secondary care with alcohol-related problems is typically nihilistic. Nurse-led multidisciplinary teams can have a marked effect on successful rehabilitation, with reduced alcohol intake, improvement in liver function tests, and reduced admissions to hospital.4 Further clinical trials of pharmacological agents such as baclofen that might help with alcohol addiction are also urgently needed.
The effect of alcohol on health is an international problem, but the UK now has worse statistics for liver disease mortality than other European countries. This issue needs a much more humane, positive, and coordinated approach from politicians, clinicians, and the media.
We declare that we have no conflicts of interest

1 Nutt D, King LA, Phillips LDon behalf of the Independent Scientific Committee on Drugs. Drug harms in the UK: a multicriteria decision analysis. Lancet 2010; 376: 1558-1565. Summary | Full Text | PDF(334KB) | CrossRef | PubMed
2 Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349: 1436-1442. Summary | Full Text | PDF(54KB) | CrossRef | PubMed
3 House of Commons Health Committee. Alcohol: first report of session 2009—10. London: Stationery Office, 2010.
4 Ryder SD, Aithal GP, Holmes M, Burrows M, Wright NR. Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit. Clin Med 2010; 10: 435-440. PubMed