Urgent Global Action is Needed to Address Alcohol and Drug Consumption
The WHO stresses that there is no safe level of alcohol consumption.

Romania, Georgia and Czechia have the highest alcohol consumption rates in the world while, in the best-case scenario, only 14% of those who abuse alcohol have access to treatment.

These are some of the insights from the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries. 

Around 400 million people lived with alcohol and drug use disorders, with 209 million of these being people with alcohol dependence.

Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres.

In Romania, the average daily pure alcohol consumption per capita was a staggering 36.9 grammes, the highest in the world. Georgia (31.1g), Czechia (28.8) and Latvia (28.4) – all in the European region – were not far behind.

Despite Australia’s hard-drinking image, its drinkers averaged 21.9 g per capita per day, the third highest in the West Pacific region after Laos (25) and the Cook Islands (22.9). 

In the region of the Americas, Canada (21.5) and the USA (20.8) topped the list. In Africa, South Africa (19) had the highest alcohol consumption, while Thailand (17) was the highest in the South East Asia region. Alcohol consumption was low in the Muslim-dominated Eastern Mediterranean region, topped by the United Arab Emirates (5).

Severe harms; ‘No safe level’

“Substance use severely harms individual health, increasing the risk of chronic diseases, mental health conditions, and tragically resulting in millions of preventable deaths every year. It places a heavy burden on families and communities, increasing exposure to accidents, injuries, and violence,” wrote WHO Director-General Dr Tedros Adhanom Ghebreyesus in the report’s foreword. 

Dr Vladimir Pozniak, WHO’s head of alcohol, drugs and addictive behaviours

“The level of alcohol consumption per capita among drinkers amounts to an average of 27 grammes of pure alcohol per day, which is roughly equivalent to two glasses of wine, two bottles of beer or two servings of spirits,” Dr Vladimir Pozniak, WHO’s head of alcohol, drugs and addictive behaviours, told a media briefing this week.

Of all deaths attributable to alcohol in 2019, an estimated 1.6 million deaths were from non-communicable diseases (NCDs), including 474,000 deaths from cardiovascular diseases and 401,000 from cancer.

Some 724 000 deaths were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence. 

Another 284 000 deaths were linked to communicable diseases. For example, alcohol consumption has been shown to increase the risk of HIV/AIDS as people are more likely to have unprotected sex, and increase tuberculosis and lower respiratory infections by suppressing a wide range of immune responses.

The highest proportion (13%) of alcohol-attributable deaths in 2019 were young people aged 20-39 years.

Globally, almost a quarter (23.5%) of all 15 to 19 year olds were current drinkers, with the highest rates in the European region (45.9%) followed by the Americas (43.9%).

Pozniak stressed that “there is no risk free levels of alcohol consumption”.

“The WHO has not produced guidelines [on safe alcohol consumption] because the diversity of countries, the diversity of populations, their exposure to alcohol, are so different, that to come up with universal levels of risks would be an unmanageable task,” said Pozniak.

“It’s advisable to consult with a health professionals on the risks associated with level or pattern of consumption, taking into consideration the individual characteristics of a person [such as] pre-existing disorders or current health conditions because the risks varies substantially, depending on all these factors.”

Lack of treatment options

The total alcohol per capita consumption decreased slightly from 5.7 litres in 2010 to 5.5 litres in 2019. But the world is far from reaching the Sustainable Development Goal (SDG) target 3.5 by 2030 of reducing alcohol and drug consumption and improving access to quality treatment for substance use disorders.

Although effective treatment options for substance use disorders exists, treatment coverage is incredibly low. 

The proportion of people in contact with substance use treatment services ranged from less than 1% to a maximum of 35% in 2019. This was even lower for alcohol-related treatment, with up to 14% of people who needed it, accessing treatment.

 “Most of the 145 countries that reported data did not have a specific budget line or data on governmental expenditures for treatment of substance use disorders. Although mutual help and peer support groups are useful resources for people with substance use disorders, almost half of responding countries reported that they do not offer such support groups for substance use disorders,” according to the WHO.

“Stigma, discrimination and misconceptions about the efficacy of treatment contribute to these critical gaps in treatment provision, as well as the continued low prioritisation of substance use disorders by health and development agencies.”

A significant number of countries reported interference from the alcohol industry in their efforts to develop effective alcohol policies, according to the report. Industry interference was highest in countries that were effectively increasing the price of alcohol.

“Industry interference was most frequently reported in the African Region (62.1%). However, across all income groups, between 42% and 50% of countries pointed to this interference as a barrier to move forward,” it notes.

Actions for progress

To accelerate progress towards achievement of SDG target 3.5 and reduce the health and social burden attributable to substance use, the WHO recommends action in eight areas.

These include increased awareness through a coordinated global advocacy campaign, and the re-commitment to implement the Global Alcohol Action Plan 2022-2030 with a focus on the SAFER package.

It also calls for increased capacity of health and social care systems to deal with substance abuse, more training of health professionals, better monitoring and research and more engagement with civil society organisations, professional associations and people with lived experience.

Image Credits: Stanislav Ivanitskiy/ Unsplash.

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