Abstract
Although alcohol has existed almost as long as human existence, its consumption and abuse can have many detrimental effects. Alcohol has been associated with a wide variety of injuries, both intentional and unintentional, and can lead to physical, verbal, and sexual violence as well as family dysfunction. The role of alcohol advertising and media plays a role in alcohol’s contribution to society, and youth may be more heavily influenced than adults. Moreover, alcohol has psychological, social, and physical consequences in addition to a direct impact on health. A number of methods may be advantageous for lifestyle medicine practitioners targeting this issue, including prevention strategies for alcohol misuse, increased legal reinforcement, screening and brief intervention, public campaigns, and media advocacy.
‘Alcohol consumption causes more than 60 types of diseases in addition to a variety of injuries . . .’
Introduction
Alcohol use has been dated as far back as 10 000
Alcohol consumption has been long identified as a risk factor for injuries and chronic diseases. Alcohol causes an estimated 3.8% of all global deaths, which is equivalent to 1 in 25 deaths. In addition, alcohol accounts for 4.6% of global disability-adjusted life years. 3 According to the World Health Organization, there are about 2 billion people worldwide who consume alcoholic beverages and 76.3 million with alcohol use disorders. Alcohol consumption causes more than 60 types of diseases in addition to a variety of injuries, including about 20% to 30% of esophageal cancer, liver cancer, liver cirrhosis, homicide, epileptic seizures, and motor vehicle accidents worldwide. 4
In addition to its impact on health, alcohol also affects the economy. The economical cost associated with alcohol ranges anywhere from approximately 1% to 6% of the gross national product in many countries. 4 In 2005, alcohol dependence and abuse cost the United States approximately $220 billion, which is more than the cost associated with cancer and obesity. 2
This article reviews the various consequences of excessive alcohol consumption. It also explores associations between alcohol and injuries, psychosocial behaviors, family dynamics, youth, physical health, and media. In addition, it presents a number of strategies aimed at reducing alcohol misuse.
Methodology
This article provides an overview of alcohol use and its impact on society on both microscopic and macroscopic levels. A literature search was conducted using key phrases including “alcohol,” “family,” “injury,” “aggression,” “mortality,” “economy,” “media,” “health,” “youth,” “social impact,” “psychological impact,” “dependence,” “prevention,” and “management.” PubMed, Medline, and the local health science library were the main databases used for literature search. Given that the consumption of alcohol is a prevalent social phenomenon, a strict scientific literature review cannot provide the full scope of alcohol consumption and its impacts. Therefore, a number of gray literature pieces were also reviewed using Google, newspaper articles, social media Web sites, and governmental resources.
The information was separated into distinct groups, and various aspects of alcohol consumption were reviewed and presented. These topics, as presented in the present article, include media, health, psychosocial effects, family dynamics, youth, unintentional injuries, and intentional injuries.
Alcohol Consumption, the Media, and Its Contribution to Society
The effect of the media on alcohol consumption cannot be underestimated. On average, youth spend more than 7 hours per day using various media, including the TV, computer, Internet, video-game console, or cell phone. 5 In the United States, more than $5 billion is spent on advertisements involving alcohol, and a considerable amount can be found in online videos. 5 Youth can be easily influenced by media. In a study involving nearly 2000 South Dakota youth, media exposure to alcohol among students in grade 6 was found to be a strong predictor of drinking behavior and intentions 1 year later. Youth in the 75th percentile of alcohol marketing exposure had a predicted probability of drinking that was 50% greater than that of youth in the 25th percentile. 6
Across all ages, television remains the predominant media form. 5 Among 10- to 17-year-olds, the likeability of alcohol commercials was determined by specific elements such as humor, animation, and popular music featured in the advertisement. 7 Alcohol use by characters in movies, television shows, and commercials can increase its social acceptance; through direct imitation and identification with the onscreen characters, alcohol use is promoted. In 1 experiment, young adult male pairs were assigned to watch a movie clip for 1 hour with 2 commercial breaks. Those in the group where alcohol was portrayed in the media consumed an average of 1.5 glasses more in the period of 1 hour than those in the group with no alcohol portrayed. 8
Although television is a dominant media form, advertisements for alcohol take many forms. Outdoor advertising for alcohol near schools can result in significant alcohol use among youth. One study examined the effect of 931 alcohol advertisements within 1500 feet of 63 Chicago school sites. An increase in intentions to use alcohol was demonstrated despite whether or not the individual was previously exposed to alcohol. 9
A key point about media influence is that no one is immune. A systemic review of prospective cohort studies involving more than 13 000 individuals 10 to 26 years of age found that alcohol advertisements, including print and broadcast media, had a significant influence on drinking behaviors. Baseline non-drinkers were considerably more likely to become drinkers with greater alcohol advertisement exposure. 10
Despite the numerous costs and concerns associated with alcohol consumption, the alcohol industry does make a number of positive contributions to society. Consider the retail, advertising, tourism, and hospitality industries involving alcohol that are a substantial source of revenue and employment. 11 In 2008, the alcohol industry was responsible for approximately $388 billion in total US economic activities. It generated $91 billion in wages and more than 3.9 billion jobs for US workers. 12
Alcohol contributes strongly to government revenue in the form of taxation and excise duty. In 2002, alcohol generated close to 24 billion euros in excise duties alone for national governments in the European Union. 11 In the United Kingdom and Ireland, alcohol tax revenue contributes to almost 0.7% of GDP. 13 In the United States, the alcohol industry pays more than $21 billion in direct tax annually. 11
Where alcohol retail is controlled directly by the state, sales become a source of net profit for the government. 11 In the state of Maryland, even an increase of 10 cents per alcoholic beverage sale could raise government revenue by as much as $214.4 million. This fund can in turn create and preserve jobs in other sectors, such as social services, public safety, education, and other important state services. 14 These economical contributions to society can become significant barriers to limiting alcohol misuse at the government and policy-maker level.
Alcohol and Health
The effect of alcohol on health has been studied extensively. It appears as though research suggests a biphasic effect of alcohol. Whereas the overall risk associated with a high level of alcohol consumption far exceeds its benefits, a lower level of alcohol consumption may be less harmful.
A meta-analysis based on 123 previous studies found that excessive alcohol consumption increases risks of liver cirrhosis, neoplasms of the upper-respiratory and digestive tracts, and hemorrhagic stroke. Weaker but significant associations were also found between alcohol and liver cancer, breast cancer, colorectal cancer, essential hypertension, and chronic pancreatitis. 15 Another study with a focus on alcohol and cancer risk echoed these findings and concluded that at an intake level of 25 g per day, there was increased cancer risk in the oral cavity, esophagus, pharynx, larynx, stomach, colon, rectum, liver, breast, and ovary. 16 A study across the United States, Japan, and Korea found that there was a linear dose-response relationship between alcohol and hypertension. In men, there was a relative risk of 1.57 at 50 g pure alcohol per day and 2.47 at 100 g. For women, there was a protective effect at a consumption level of less than 5 g/d, after which there was a relative risk of 1.81 at 50 g and 2.81 at 100 g. 17
Proponents of alcohol argue that the effect of alcohol is not all negative. There is evidence that there is a J-shaped relationship between alcohol and coronary heart disease, such that consumption of 20 g/d is associated with a relative risk of 0.80, whereas intake of up to 72 g/d can be cardioprotective.18,19 However, there is increased risk of coronary heart disease at a consumption rate of 89 g or greater.18,19 Alcohol can also be protective against type 2 diabetes. In men, consumption of 22 g/d is most protective and becomes deleterious at more than 60 g/d. 20 In women, consumption of 24 g/d is most protective and becomes deleterious at more than 50 g/d. 20 Moderate amounts of alcohol (less than 40 g/d in men and 20 g/d in women) intake can also be protective against metabolic syndrome. 21
Alcohol and Psychosocial Effects
Alcohol itself may not necessarily lead to deviant behavior, but can act as a catalyst on individuals exhibiting certain traits such as hypermasculinity, impulsivity, and antisocial behavior. For example, alcohol consumption has been linked to sexual aggression. Sexually aggressive dates were more likely than other dates to include heavy alcohol use.22,23 More than 300 000 women are raped in the United States each year, and approximately 55% to 74% of acquaintance sexual assault incidents involve alcohol use by the perpetrator, the victim, or both. 22
Because of the pharmacological effects of alcohol, intoxicated individuals have a reduced capacity to attend to multiple stimuli and to look beyond the most salient aspects of the immediate situation. 23 People with a higher blood alcohol concentration (BAC) tend to lose more inhibition and become more aggressive. 23 For example, an intoxicated man may be aware of a woman’s sexual cues but may have trouble perceiving the less salient and ambiguous inhibitory intentions of her resistance to sexual advances. 24 Alcohol limits attention and perception, thereby enabling people who are conflicted about risky sex to temporarily forget about their conflict and give in to risky behavior. 25 Alcohol is commonly viewed by the public as a substance that increases sexual arousal and contributes to both consensual and nonconsensual sexual activities. Although studies have found that alcohol decreased penile tumescence and vaginal blood volume and increased latency to orgasm for both men and women, the belief that consuming alcohol elicits certain sexual behaviors may be consistent only in those with such alcohol expectancies.24,25
The impact of alcohol use on the behavior of young adults has many practical implications for health and social well-being. Among 780 college freshmen between the ages of 18 and 25 years, a drinking problem was found to be positively associated with intimate partner violence, especially among the male gender. 26 Numerous studies found that alcohol was linked with early sexual experiences among pregnant and parenting adolescents as well as lack of condom use, especially for first-time sexual intercourse events. 25 In a sample of 115 young male social drinkers, more than 50% reported perpetration of at least 1 incident of sexual assault, and more than 25% disclosed that their most severe kind of perpetration was attempted rape or incapacitated/forcible rape. Of these people, almost one half consumed alcohol before every single act of perpetration, and another 28% reported alcohol use prior to some sexual assault incidents. The typical amount of alcohol consumption was high at 6 to 7 drinks. Furthermore, approximately 70% of perpetrators reported no or inconsistent condom use during the assaults. Beyond the implications of the brutal assault violence itself, the sexual assaults were unprotected as well, leading to unwanted pregnancies and sexually transmitted diseases. 22
Perhaps alcohol affects behavior through its interference with risk perception. One study tested women’s perception of risk and behaviors in a hypothetical situation that could lead to establishing a relationship but also possible sexual aggression. The women in the alcohol group of the study rated male characters in the scenario much more positively and anticipated less risk compared with the non-alcohol group. 27 This finding lends more support to the idea of women’s vulnerability to sexual aggression while under the influence of alcohol. An epidemiological study of 23 980 women across 199 colleges in the United States found that 4.7% of participants reported being raped, and a staggering 72% of the victims reported that they were intoxicated. 28
Another way in which alcohol leads people to be less inhibited in acts of aggression includes both verbal and physical abuse. One Canadian study examined alcohol-related victimization in adults aged 18 to 76 years. Verbal victimization was more likely to be committed by women, whereas physical victimization was more likely to be committed by men. Younger individuals who consumed alcohol were also more prone to both verbal and physical victimization especially with episodes of heavy drinking. 29
Alcohol use can also lead to workplace aggression and encourages risk-taking behavior. Each year, 16 million workers are harassed, 6 million are threatened, and more than 2 million are assaulted. Results from numerous studies across multiple disciplines, including criminology, ethnography, and epidemiology, have consistently found an association between alcohol and aggression. One American study found that the percentage of drinking days during the preceding year was positively associated with both victimization and perpetration of verbal and physical aggression in the workplace. 30 Another study included 2484 municipal workers from 3 cities in the United States. The authors found that increased alcohol use at work was associated with increased antagonistic behaviors such as criticizing coworkers, going against supervisors’ instructions, not completing an assigned task, and intentionally doing an assigned job incorrectly. Furthermore, alcohol use was positively related to the frequency of violent episodes witnessed at work.30,31
Alcohol and Family Dynamics
Alcohol addiction is one of the leading causes of family dysfunction, resulting in many negative consequences. 32 Compared with families wherein there is no consumption of alcohol, families that consume alcohol are prone to higher levels of conflict, impaired problem solving, hostile communication, and lower levels of cohesion. Families with alcohol consumption also have a distorted family hierarchy, and there is also more role confusion and role reversal. 33 More than 40% of the US adult population has been exposed to alcoholism in the family in some form: they grew up with or married an alcoholic or problem drinker or had a blood relative who was either an alcoholic or problem drinker. Furthermore, alcohol has a significant impact on marriage stability. Independent of age, 55.5% of separated or divorced adults had been exposed to alcoholism in some family members. Nearly 38% of separated or divorced women had been married to an alcoholic, and only 12% of women managed to stay in their marriages despite their partners being alcoholics. 34
Parenting plays a significant role in affecting children’s behaviors. There are 2 types of parenting pertaining to alcohol: alcohol specific and non–alcohol specific. Alcohol-specific parenting includes the modeling of parental drinking behavior and the development of alcohol expectancies. In this parenting style, the parent-child relationship interactions are particularly important in the development of alcohol abuse and dependence. In contrast, non-alcoholic-specific influences such as neglect and problematic parent-child interactions generally promote deviant behavior, aggressiveness, and antisocial behavior. 35
Approximately 14 million adults in the United States abuse alcohol, and 1 in every 4 children is exposed to alcohol abuse or dependence in the family. 36 The children of alcoholics can be affected at various stages of their life span. Issues can start as early as infancy with problems such as fetal alcohol syndrome. In childhood, emotional problems and hyperactivity issues begin to surface. During adolescence, conduct problems may be noted. Finally, in adulthood, they may become alcoholics themselves, continuing to perpetuate this disruptive family cycle. 37 Adult children of alcoholics tend to have more difficulty trusting others, acknowledging their needs, and identifying and expressing their feelings. They also have excessive feelings of responsibility, helplessness, and depression and are often more concerned over their own alcoholism or fearful of becoming an alcoholic. Sadly, adult children of alcoholics are also less likely to reach out to others and more likely to have been sexually abused. 38
On the biological scale, children of alcoholics tend to exhibit increased physiological stress, anxiety, and tension than the children of non-alcoholics. Because their basal levels of stress, anxiety, and tension are above average, alcohol consumption among these individuals reduces stress much more than it does among children without alcoholic parent(s). They are also less sensitive to alcohol’s intoxicating effect, as evidenced by their reduced body sway, cortisol secretion, and subjective reports of intoxication. Children of alcoholics also experience more of alcohol’s rewarding effects compared with others. This may be secondary to their enhanced β- endorphin and EEG responses to alcohol that are hypothetically related to positive reinforcement mechanisms. 39 Collectively, reduced impairments and enhanced rewarding aspects are predictive of future problems and reflect a significant vulnerability to alcohol addiction.
Together, these findings suggest that not only does parental alcohol abuse affect the behavior of children but also that there is a physiological and genetic influence. If we are to adequately treat the children of alcoholic parents, understanding these 2 components is crucial.
Alcohol and Youth
Youth have greater vulnerability to alcohol than adults. Being both physically smaller and younger, they lack the experience of drinking and its effects. 40 Moreover, young people’s perception of alcohol can be influenced by normative assumptions about teenage drinking, and the observation of drinking by parents, peers, and models in the mass media. 41 In Europe, more than 9 out of 10 students who were 15 to 16 years old admitted that they had drunk alcohol at some point in their life. 41 More than 1 out of 8 students in this age group also reported being drunk at least once in their life, and more than 1 in 6 reported having more than 5 drinks at a sitting at least 3 times in the preceding 30 days. 40
Drinking by adolescents and young adults is associated with automobile-related injuries, suicide, depression, poor academic performance, loss of memory, fighting, property damage, relationship instability, date rape, unprotected sex, increased risk of sexually transmitted diseases, and unplanned pregnancies.40,42 A study of 371 adolescent alcohol consumers found that people with alcohol disorders were more likely to be sexually active, to have a greater number of partners, and to initiate sexual activities at slightly younger ages. 43
Combining the greater vulnerability to the effects of alcohol with the numerous negative consequences of adolescent alcohol consumption, adolescents pose a great issue to the health care system. For example, a US study examining youth who were hospitalized for assault injuries found that alcohol or drugs were involved in 54% to 66% of the cases. 44 Although adolescents may think that they are simply having fun like the others they have observed consuming alcohol, they should be made aware that perhaps the principle of “less is more” plays a stronger role than “anything in moderation” when considering the safety of their alcohol consumption.
Alcohol and Unintentional Injury
Although alcohol is a substance of common consumption in North American culture, it is also a substance commonly noted in relation to accidental, or unintentional, injury. For example, a significant proportion of motor vehicle accidents are associated with alcohol consumption and cost approximately $51 billion annually. 45 In 2008, alcohol-impaired driving accounted for 32% of all traffic fatalities in the United States, averaging 1 death every 45 minutes. 46 This prevalence is thought to be a result of the pharmacological effects of alcohol that interfere with the driver’s decision making, information processing, and reaction time. 47 Drinking and driving is associated with sensation seeking, such as disinhibition and impulsivity; road rage perpetration; and victimization; this differs from cases of sensation seeking through simple speeding, where the driver looks for thrill and adventure.25,48 Drivers are also less likely to use seatbelt restraints when impaired. 49 In 2007, 81% of drivers in collisions without seatbelt restraints were either injured or suffered fatally, whereas only 53% of people who used seatbelts were harmed. 50 Considering the collective effect of these behavioral changes, impaired drivers are at a great risk of inflicting injury, either to themselves or others.
There is extensive evidence showing that BAC as low as 0.02% impairs driving-related skills. 51 An average man only needs to consume about 6 standard drinks without food in 90 minutes to reach a blood alcohol limit of 80 mg/100 mL (0.08%). 52 Among young drivers aged 16 to 20 years old, a BAC level increase of 0.02% doubles the relative risk of fatal single-vehicle accident injury, and among those aged 35 years and older, a BAC level between 0.08% and 0.10% increases the relative risk of a fatal single-vehicle accident injury to 11.4. 51 Moreover, alcohol consumption caused injury in a nonlinear dose-response manner. For motor vehicle injuries, the odds ratio increased by 1.24 per 10 g of alcohol consumption to 52.0 at 120 g. 53 For people driving while intoxicated, there is greater risk associated with those who consume large volumes of alcohol on a regular basis, with the risk being the greatest for those who drank more than 6 drinks per day and who had more than 1 occasion of drinking 8 or more drinks in 1 sitting in the preceding year.54,55
A case-control study in British Columbia, Canada, examined alcohol-related versus non-alcohol-related accidents and reported that most alcohol-related unintentional injuries were associated with motor vehicle accidents. Comparing the 2 groups, the alcohol-related accidents group had an increased risk of injury collision (odds ratio = 1.32), an increased risk of vehicle damage severity for write-off vehicles (odds ratio = 4.24), and an increased risk of fatal collision (odds ratio = 4.70). Combined with alcohol use, inappropriate and excessive speeding was one of the most devastating road safety problems. This study clearly demonstrated that there was an increased risk of injury and fatality to drivers and occupants in alcohol-related motor vehicle accidents. 49
Looking beyond the impact of alcohol on the road, a study based on Finnish adults examined trends of death from unintentional injury occurring between 1971 and 2008. There was a significant increase in men’s alcohol poisoning deaths, especially since 2003. In 2008, alcohol poisoning was the second leading cause of death among men, and the age-standardized death rate (per 100 000 person-years) was 18 years of age. The rate of women’s death from alcohol poisoning was low. There was only 1 case in 1971, but the increase was clear during the study period with a total of 5 cases in 2008. 56
Another study assessed outdoor recreational fires and alcohol use. The study found that being intoxicated while in an environment with outdoor recreational fires was associated with higher mortality. Furthermore, the study reported a higher rate of medical complications among intoxicated individuals, including increased inpatient management, length of stay, wound infections, number of procedures, total body surface area burned, and total area requiring grafting. 57
Evidence suggests that among individuals who consume up to 1 drink per day, there is an increased likelihood that they have had more than 5 heavy drinking episodes in the preceding year. This association suggests that the overall risk of injury may increase with increasing volumes of alcohol consumption. In addition, at a given volume level, the risk also increases with the frequency of heavy drinking episodes.54,55 Future research to flesh out the details of this association for a true understanding of this correlation, is warranted.
Alcohol and Intentional Injuries
Not only is alcohol associated with unintentional injury, but numerous studies also suggest that alcohol is closely associated with intentional injury. A New Zealand study found that at least 31% (20 447) of violent crimes involved alcohol consumption prior to committing the offence.58,59 In 50% of the 489 homicide cases that occurred over a 10-year span, either a suspect or victim was under the influence of alcohol. Among 19 388 cases of family violence, 34% of the alleged offenders consumed alcohol. Furthermore, 20% of the 3652 cases of sexual offences analyzed involved alcohol misuse prior to the crime. Given the frequent delay in identifying and apprehending alleged sexual offenders, this estimate is conservative; police estimate that, in reality, 1 in 3 offenders was under alcohol influence. 59 A French study found that 40% of people involved in public physical altercations reported consuming alcohol within 2 hours prior to the incident. In addition, 25% of nondomestic violence, 35% of domestic violence, 32% of intentional material damage, and 20% of thefts were preceded by consumption of alcohol by the perpetrator. 60
Injuries related to violence account for 12% of alcohol-related disease. Among the 27 million emergency department visits for injuries, 1.37 million were a result of assaults. A case-crossover analysis involving data from 15 countries analyzed the risk of injury from drinking 6 hours prior to an event of injury that was related to either violence or nonviolence. The study found that the relative risk for a violence-related injury was 5 times greater than injuries from other causes. 61
Data from the World Health Organization collaborative study on alcohol and injury across 10 different emergency departments around the world also found that the risk of injury increased with the consumption of even a single drink 6 hours prior to the event. This risk increased 10-fold with the consumption of 6 or more drinks. 62 A review study in hospital emergency departments across both developed and developing countries reported similar findings and reported that injured patients were more likely than noninjured patients to have alcohol in their system and report drinking prior to the injury. 63
Comparing people who consumed alcohol 6 hours prior to an injury with those who consumed alcohol 1 week prior to the injury, the odds ratio was 20.7 for violence-related injury and 5.7 for all other injuries. Overall, people were more likely to be involved in intentional injuries than unintentional injuries. 64 In addition, a meta-analysis across 7 countries examining alcohol involvement in violence-related injuries found an attributable risk of 43% from drinking within a 6-hour period before an injury and 27% from an individual’s usual heavy drinking pattern. Men were at greater risk, but no age-specific differences were found. 62
Among the mechanisms that provide insight into the relationship between alcohol and violence, 3 have already been alluded to. First, there is a direct pharmacological effect causing impairment of cognitive function, which may lead an intoxicated individual to lose inhibition and misinterpret stimuli as provocation. The second mechanism involves preformed social perceptions and expectations related to alcohol use, such that alcohol can reduce the perception of the responsibility of the perpetrator. Finally, the preconceived notions related to alcohol can automatically promote violent thought and moderate an individual’s aggressive behavior based on how intoxicated one thinks he or she is as opposed to being based on the actual amount they consume. In effect, this allows alcohol to partially exert a placebo effect on the consumer. 60
Preventing Alcohol Misuse
Although alcohol is both a social lubricant, means of revenue, and integral part of our culture, the negative consequences to alcohol misuse cannot be dismissed. To maintain the integrity of alcohol consumption, numerous methods may be used.
Legal Means
Given the increased incidence of violence and aggression related to alcohol consumption, along with the implications for health and behavior, increased legal reinforcement is critical. This is especially true in the case of alcohol-associated motor vehicle injuries, where sustained police attention clearly reduces alcohol-related casualties. Strict traffic laws benefit the community by removing dangerous drivers from the road and serves as a warning to others that impaired driving is not tolerated. 49 However, when dealing with criminal charges, police face many obstacles that serve as deterrents to charging offenders with impaired driving, including the time required in processing charges, insufficient staff to process impaired drivers, and the belief that impaired drivers would plead to a lesser offence such as careless driving. As a result, police officers often issue violation tickets or 24-hour prohibitions instead of bringing impaired driving charges.49,65 Increasing legal reinforcement and establishing tougher laws may prevent risk of death from future alcohol-related motor vehicle collisions.
Screening and Brief Intervention
Brief intervention targets hazardous drinkers who do not seek help for alcohol-related problems, and it aims for reduction in consumption and related harms. These interventions can range from single 5-minute sessions given by primary care physicians to multiple motivational counseling sessions delivered by trained specialists. A meta- analysis evaluated outcomes in more than 5800 patients and found that brief interventions could significantly reduce alcohol consumption, with this benefit continuing 1 year after the intervention. Patients who received brief intervention consumed 38 g less alcohol per week than the control group who did not receive a brief intervention. 66 Brief intervention is also effective among young people. A study of 94 adolescents receiving brief motivational interviews in the emergency department for injury associated with drinking revealed that at a 6-month follow-up visit, patients in the experimental group reported fewer drinking-and-driving episodes and alcohol-related injuries compared with the control group. 67
Public Awareness
Making the public aware of the negative consequences of consuming alcohol is very important. Although the general public can list numerous negative consequences of smoking, many people are unaware of the repercussions of alcohol consumption because of its acceptance and role in our society. For instance, the prevention of drinking and driving depends on drivers knowing and being motivated to avoid the numerous consequences associated with this illegal act. 68 According to a Canadian survey in 2002, almost half of the respondents were unaware of the driving suspension length for a first conviction under criminal law. In addition, many drivers thought that a small amount of alcohol would not impair their driving performance; 11.3% of respondents drove while impaired at least once in the preceding 2 months. On a provincial basis, on average, drivers with blood alcohol levels that exceed the legal limits account for approximately 2.5 million motor vehicle trips per year.49,65
Perhaps, as a result of inadequate knowledge, drivers were not able to take the appropriate preventive measures necessary. Numerous campaigns such as Mothers Against Drunk Driving (MADD) often use fear appeals but lack details on how to change the maladaptive behavior. When public awareness campaigns are used, they should be rooted in best practices in health communication science and be of sufficient duration and intensity to have the desired effect.
Media Advocacy
Schools should advocate for alcohol education programs that incorporate principles of media education. Youth need to be taught how to deconstruct alcohol ads and become more resilient to their powerful influence. 5 One study suggested that a 28% reduction in alcohol advertising would lower adolescent monthly alcohol participation from 25% to as low as 21%. As for binge drinking, the projected reduction would be from 12% to as low as 8%. In contrast to a decrease in advertising, studies suggest that a complete ban on alcohol advertising could reduce the monthly levels of drinking by 24% and binge drinking by about 42%. 69 Another study found that a complete ban on alcohol advertising would reduce alcohol-related life years lost by 16.4%. 70
Other Prevention Strategies
Prevention programs aimed at preventing alcohol-related injuries can be targeted toward reducing overall alcohol exposure, which should in turn reduce injuries related to alcohol. One effective method of managing alcohol-related problems is to target individuals and groups that have not yet become heavy drinkers. 55 Involvement in prosocial activities related to the school or community can protect some adolescents from abusing alcohol by exposing them to an environment in which alcohol is not needed to “break the ice.” They may have a more stable self-concept and would be less likely to turn to unconventional behaviors to define themselves. 25
Conclusion
Alcohol has existed for almost as long as human history and has become a traditional component of many cultures and lifestyles. Yet alcohol consumption and abuse can have many detrimental effects. There is clear association between alcohol consumption and injuries of all types, and its role in motor vehicle collisions and the injuries that result is undisputed, even when consumed in small amounts. Alcohol abuse can lead to physical, verbal, and sexual violence and can cause a wide array of family dysfunctions. It can also lead to addiction, which itself leads to many psychological, social, and physical consequences. Most important, alcohol has a direct impact on health and can lead to numerous devastating diseases.
Although the perceived benefit of alcohol being a social interaction catalyst is appreciated, the lifestyle medicine practitioner cannot overlook its potential harmful effects. There are a number of effective prevention strategies available to counter alcohol misuse. Increased legal reinforcement is an effective way to limit alcohol consumption by using negative reinforcement. Screening and brief intervention can help reduce alcohol use for those who are alcohol dependent. Public campaigns are fundamental to helping society recognize the risks of alcohol misuse. In addition, media advocacy has an important role in modifying the promotion of alcohol to the general public and especially to young adults who may not have developed appropriate attitudes, behaviors, and cognition toward alcohol.
Lifestyle medicine can help emphasize that although alcohol can be enjoyed as part of a social circumstance and has minimal harmful effects at lower doses, it has the potential to destroy individual lives and reduce the quality of life in society. Future research should assess the long-term effects of low-dose alcohol consumption to assess if alcohol has a cumulative effect similar to the effects of heavy alcohol consumption. It should also be noted that although alcohol consumption leads to certain vulnerabilities, these vulnerabilities are not prescribed and can be overridden. Lifestyle medicine can adopt screening protocols for alcohol abuse and binge drinking and help patients recognize the potential for injury resulting from the consumption of alcohol. While recognizing that alcohol bans might not be feasible, the physician can help patients moderate their alcohol use and exercise caution in their consumption to prevent injuries and other health consequences resulting from alcohol misuse. Physicians are uniquely positioned to make a difference in the lives of their patients when it comes to alcohol use. The need for intervention is great.