Alcohol abuse: health effects, economic costs and impact on the younger generation:

By Dr. Daya Hewapathirane-February 25, 2020, 8:23 pm
Continued From Yesterday

Medically, alcoholism is considered both a physical and mental illness. Alcohol use can affect all parts of the body, but it particularly affects the brain, heart, liver, pancreas and immune system and result in varied health ailments. Someone with a parent or sibling with alcoholism is three to four times more likely to become an alcoholic themselves. The magnitude of the increasingly severe problem of alcohol is reflected in the rising incidence of hospital admissions due to alcohol related diseases. Consumption of alcohol over a period results in fatty changes of the liver which later transforms to cirrhosis with liver cell degeneration, and accumulation of fluid in the abdomen followed by degeneration of the brain. Sri Lanka has the second highest incidence of cirrhosis in the world.

The Centre for Disease Control and Prevention (CDCP) identifies 54 acute and chronic conditions associated with alcohol. Alcohol consumption causes degeneration of the heart muscle, and heart failure causing alcoholic cardiomyopathy. High blood pressure and increased cholesterol are also consequences of high consumptions. Also, acute and chronic gastritis and formation of gastric ulcers, and acute and chronic pancreatitis with endless abdominal pain and immense suffering are consequences of regular boozing. In addition, there is progressive degeneration of the brain leading to deterioration of intellectual functions social behaviour resulting in dementia.

The negative consequences of alcohol on people other than the drinker include injuries and deaths from road traffic accidents, harm from interpersonal violence, aggression and crime, harm to families that include psychological distress, pain and suffering from domestic violence, marital separation and divorce, child and household neglect, poverty, and, harm to the developing foetus. Apart from an unhealthy population with reduced productivity hindering the development of the country, a considerable proportion of national health expenditure must be spent to treat alcohol related diseases.

There is a paucity of published studies on the economic impact of alcohol and its related conditions in Sri Lanka. In 2015, a study was conducted by the National Authority on Tobacco and Alcohol, Sri Lanka Medical Association, Country office of the World Health Organization (WHO), and Health Intervention and Technology Assessment Programme, Thailand as part of the WHO SEARO initiative on introducing and capacity building on Health technology Assessments among South East Asian countries. In this study, an attempt was made to estimate the economic costs of alcohol use in Sri Lanka in the year 2015. According to this study, the overall direct health care costs attributable to alcohol include government expenditure and out-of-pocket private expenditures associated with outpatient and inpatient visits including clinic visits. The frequency of clinic visits per year and the cost borne by the government providing such services for each person were taken as the direct costs for outpatient care.

According to the Centre for Disease Control and Prevention (CDCP) there are 54 acute and chronic disease conditions attributable to alcohol consumption. Owing to the sparsity of data on conditions of many of these diseases, the 2015 study referred to above, focused only on 8 types of cancers and 19 noncommunicable diseases. In this study, the direct healthcare costs of alcohol-related cancers were estimated at US $25.67 million, which was 36% of the overall direct and indirect costs of alcohol-related cancers. The inpatient care costs contributed more than half (US$ 14.96 million) of the direct cost. Both morbidity and mortality were considered under indirect costs. Overall, the costs related to cancers of the upper aerodigestive tract (lip, oral cavity and pharynx and oesophagus) was UD$ 61.14 million, which accounted for 85% of the total cost of alcohol related cancers.

In the 2015 study, direct and indirect economic costs of alcohol related noncommunicable diseases and other conditions including different forms injuries, drowning and homicides were taken into consideration. Road injury costs was the most significant contributor to the total economic costs of alcohol related conditions other than cancer, amounting to US$ 251 million, which was 30.8% of the overall cost of these conditions. Alcoholic liver disease, alcoholic gastritis and duodenitis, self-harm, alcohol use disorders and alcohol associated lower respiratory tract infections were the other significant contributors to this cost. The proportion of direct cost of ischemic heart disease and alcoholic gastritis and duodenitis were considerably high compared to their indirect cost component. This demonstrates the high economic burden imposed on the health care system by these conditions. The indirect cost of alcoholic liver disease was considerably high depicting the nature of high premature mortality with the condition.

Economic Cost of Alcohol Consumption

In 2015, the total economic cost of alcohol use in Sri Lanka was estimated at US$ 885.85 million, of which direct cost amounted to US$ 388.35 million (44%) while indirect costs were US$ 497.49 (56%). The loss of productivity due to premature mortality was the highest cost category which amounted to US$ 388.86 million, being 44% of the overall cost. The next highest cost was the inpatient care cost of US$ 293.75 million. When specific disease conditions are considered, the economic costs of the cancers of the lip, oral cavity, pharynx and oesophagus amounted to US$ 61.14 million which reveals that Sri Lanka has one of the highest incidences of cancers of the lip, oral cavity and pharynx. These are commonest cancers among Sri Lankan males. Alcohol related cancers of the liver and colon cost US$ 1.63 million and 2.65 million respectively. Therefore, addressing alcohol use should be a major aspect of prevention of cancers in Sri Lanka. Road injuries accounted for US$ 251.28 million, being 28.5% of the total economic cost. Preventing such injuries need cooperation of many sectors other than health. This underlies the importance of multi-sectoral involvement in addressing alcohol related harm.

Spending on purchasing alcohol, absenteeism and private expenses due to alcohol related conditions can exacerbate and perpetuate poverty. In a study conducted in Sri Lanka examining the link between alcohol and poverty, some men revealed that their alcohol expenditure was greater than their income. Another study showed that the two lowest income categories spent more than 40% of their income on concurrent use of tobacco and alcohol. Therefore, alcohol use and its consequences should be a major dimension in developing and implementing policies for alleviation of poverty in Sri Lanka.

Sri Lanka provides free healthcare to all its citizens. People have the choice of seeking treatment in the government or the private sector for health services. The state sector is by far the largest provider of health services. The direct costs of in-patient care for alcohol related conditions, excluding private out of pocket expenditure amounts to about 40% of the recurrent health expenditure of the state health sector in 2015. This is a substantial cost, which underlies the importance and the priority required for effective initiatives to prevent or minimize alcohol abuse in the country. In 2015, the government excise tax revenue from alcohol was less than the estimated total economic cost of alcohol to the government. In 2015, alcohol related conditions imposed a significant economic burden to Sri Lanka, with indirect costs (56% of total) exceeding the direct costs (44%).

Several types of costs were not included in the 2015 study estimations. These include the opportunity costs of spending on purchasing alcohol products, costs of disease prevention and screening programmes, out of pocket expenditure by patients seeking services of the private sector, transport costs borne by the patient, enforcement and judicial costs and cost of property damage and insurance. Spending on drugs and devices which sometimes need to be purchased by the patients while obtaining treatment from the state sector was also not included in the estimate of out of pocket expenditure.

The economic cost of presenteeism (reduction in productivity despite working) due to alcohol related illness which has been taken into consideration in some studies was also not calculated. Furthermore, intangible costs of the effects of alcohol were not included in the analysis. Studies show that intangible cost may account for 20% to 27% of the total cost of alcohol. Recently, a study in Scotland found that the intangible cost accounted for 78% or the largest component of the total cost of alcohol use. The intangible costs in this study included costs of "pain, grief and suffering to the casualty, relatives and friends, and, for fatal casualties, the intrinsic loss of enjoyment of life, excepting consumption of goods and services". The costs of alcohol related violence, suicides too were not included.

Saving the Younger GenerationTargeting adolescents and young adults is regarded as an important step to reduce the harm of alcohol abuse. Increasing the age at which alcohol can be purchased, the banning or restricting advertising of alcohol can be among alternative ways of reducing the harm of alcohol dependence and abuse. Credible, evidence based educational campaigns in the mass media about the consequences of alcohol abuse cane be useful. Guidelines should be made available for parents to prevent alcohol abuse amongst adolescents.

Our young people should be informed that too much alcohol affects the central nervous system and how the brain functions. They should know that it affects perception, thinking, and coordination. It impairs judgment, reduces inhibitions, and increases aggression. Those who abuse alcohol are more likely than others to engage in high risk, thoughtless, or violent behaviors. Anyone who have developed alcohol related problem should be strongly encouraged to seek treatment.

An NGO titled Alcohol and Drug Information Centre (ADIC) in Sri Lanka, was established in 1990 and obtained Approved Charity Status in 1992. ADIC drawing funds from many international and local sources, works for the reduction in demand for alcohol, tobacco and other drugs in Sri Lanka. It believes that through scientific and evidence-based research and investigations, and a participatory approach involving the community and all stakeholders, it is possible to make people realize that whatever drug, at whatever level is an impediment to human happiness. ADIC advocates for effective policy formulation for alcohol, tobacco and other drugs control. Its annual alcohol industry profile reports provide trend analysis of the Sri Lankan situation of alcohol consumption, sales, revenue and the industry in general.

A comprehensive approach is required in the development of well conceived, realistic short and long-term plans and programs to manage the problem, with the active involvement of the community at large, and all stakeholders connected with the problem. Such plans and programs should be based on in-depth research pertaining to alcohol use and abuse, related motives and varied consequences. Enforcement of existing policies and formulation of new alcohol control strategies in Sri Lanka are vital. Saving the younger generation from alcohol abuse should be a high priority consideration in planning against alcohol abuse. Overall consequences of alcohol abuse, in particular its serious harm to the physical and mental development of the younger generation, should be a necessary component in school curriculum on social studies.

Future research should focus on identifying the individual-level characteristics of drinkers, their average volume of total consumption, patterns of drinking such as binge drinking and alcohol use disorders among drinkers in the rural, semi urban and urban settings, and in places where alcohol related problems have shown an increasing trend in recent years. Problems encountered in implementing control strategies and alternative ways to resolve them are important considerations. Such information will facilitate the development of realistic plans initially aimed at minimizing the problem and eventually to contain this increasing serious national problem.

(CONCLUDED)