Alcohol abuse costs society an estimated $250 billion per year in health care, public safety, and social welfare expenditures. Given this enormous impact, it will remain a major health problem until public understanding improves, according to a team of researchers who analyzed prevention and treatment programs.
"Many types of programs have improved, but about 5 percent of adults still abuse alcohol or are alcohol dependent. Another 20 percent misuse alcohol enough to be at risk of accidents," said lead author Thomas Babor, PhD, MPH, of the University of Connecticut. "Such problems persist in part because we view them as moral failures or disease, rather than interactions between alcohol, drinkers, and their environments."
"The health of the population can best be served not by discovery of a miracle cure but rather by improvement and more efficient allocation of existing services," said Babor. "We need to focus on early identification, case management, and organized systems of care that serve the health needs of the community."
Babor and colleagues from the California Endowment, the University of Washington, and the University of Kentucky, Lexington, evaluated the effectiveness of alcohol treatment programs. According to the researchers, simple approaches have yielded great results, yet seldom are implemented. For example, nearly half of the internists in the United States do not ask patients how much they drink. Many controlled trials, however, show that five minutes of physician-delivered advice effectively reduces the quantity and frequency of patient drinking. The report appears in the November/December issue of the American Journal of Health Promotion.
In one study, following a brief physician intervention, alcohol consumption by males who drank heavily declined 35 percent over nine months, compared with a 14 percent decline among patients who were not cautioned. Brief interventions appeal economically too. For each dollar invested in them, health care payors could save an estimated $1.40 over two years, according to one simulated model.
The researchers found that some types of individual treatments, including 12-step programs and pharmacological agents, have become increasingly available and effective. Insurance coverage limitations, provider shortages, and perceived stigma of treatment act as barriers.
"At the population level, alcohol and drug abuse prevention programs often fail due to lack of interest in them," said Babor. The researchers cite several approaches that work better, including raising the drinking age, higher taxes on liquor and beer, fewer hours of sale, advertising restrictions, and societal disapproval of drunk drivers.
In one study involving 17 industrialized nations, an evaluation from 1970 to 1983 showed a 16 percent higher rate of alcohol consumption in countries where broadcast ads for alcohol were permitted. Those countries suffered a 10 percent higher rate of auto fatalities.
"History shows that public attitudes toward alcohol use and its availability are important determinants of long-term trends," said Babor. "Without public support for reasonable restrictions on its availability, individual-level interventions alone are unlikely to be effective."
Partial support for the research was provided by a grant from the Robert Wood Johnson Foundation to the senior author.
The American Journal of Health Promotion is a bimonthly peer-reviewed journal dedicated to the field of health promotion. For information about the journal call (248) 682-0707 or visit the journal's website at www.healthpromotionjournal.com .
Posted by the Center for the Advancement of Health < http://www.cfah.org >. For information about the Center, call Petrina Chong, < pchong@cfah.org > (202) 387-2829.
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American Journal of Health Promotion