Aims: The aim of the study was to assess the cumulative evidence on the effectiveness of brief alcohol interventions in primary healthcare in order to highlight key knowledge gaps for further research. Methods: An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare published between 2002 and 2012. Findings: Twenty-four systematic reviews met the eligibility criteria (covering a total of 56 randomized controlled trials reported across 80 papers). Across the included studies, it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effective- ness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in tran- sitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness. Conclusion: This overview highlights the large volume of primarily positive evidence supporting brief alcohol intervention effects as well as some unanswered questions with regards to the effectiveness of brief alcohol intervention across different cultural settings and in specific population groups, and in respect of the optimum content of brief interventions that might benefit from further research.

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The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews.

Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.

The Risks Associated With Alcohol Use and Alcoholism

Extending the treatment options in alcohol dependence: a randomized controlled study of as-needed nalmefene.

Alcohol is one of the world’s top three priority areas in public health. Even though only half the global population drinks alcohol, it is the world’s third leading cause of ill health and premature death, after low birth weight and unsafe sex, and greater than tobacco. In Europe, alcohol is also the third leading risk factor for disease and mortality after tobacco and high blood pressure. This report presents the latest literature overview of effective alcohol policies, and includes data from the European Union, Norway and Switzerland in the areas of alcohol consumption, harm and policy approaches. The data presented were collected from a survey in 2011.

Alcohol in the European Union: Consumption, Harm and Policy Approaches

OBJECTIVES To assess the efficacy and safety of varenicline (Chantix) for the treatment of alcohol dependence. Varenicline is a partial α4β2 nicotinic acetylcholine agonist approved by the Food and Drug Administration for smoking cessation. It has reduced drinking in animal studies and in small studies of humans who were both heavy drinkers and smokers. This is the first multisite clinical trial of varenicline in a population of smokers and nonsmokers with alcohol dependence. METHODS Men and women (n = 200) meeting the criteria for alcohol dependence were recruited across 5 clinical sites. Patients received double-blind varenicline or placebo and a computerized behavioral intervention. Varenicline was titrated during the first week to 2 mg/d, which was maintained during weeks 2 to 13. RESULTS The varenicline group had significantly lower weekly percent heavy drinking days (primary outcome) (adjusted mean difference = 10.4), drinks per day, drinks per drinking day, and alcohol craving compared with the placebo group (P < 0.05). The average treatment effect on alcohol use was similar for smokers and nonsmokers. Varenicline was well-tolerated; adverse events were expected and mild. CONCLUSIONS Varenicline significantly reduced alcohol consumption and craving, making it a potentially viable option for the treatment of alcohol dependence.

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A double-blind, placebo-controlled trial assessing the efficacy of varenicline tartrate for alcohol dependence.

Aims To describe three aspects of the epidemiology of alcohol‐attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation Design epidemiological and population health modeling Setting Europe Participants Based on country‐specific aggregate statistics Measurements Exposure: country‐specific adult per capita consumption triangulated with survey data; outcomes: mortality statistics Findings The absolute risk of dying from an alcohol‐attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10g alcohol per day, the first data point Over 2/3 of all alcohol‐attributable deaths occurring amongst the 20–64 year old population of the European Union (minus Cyprus and Malta) occur in the 45–64 year olds About 25% of the difference in life expectancy between western and eastern Europe for men aged 20–64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns Conclusions Any reduction in the dose of alcohol consumed, at least down to 10g/day, will reduce the annual and lifetime risk of an alcohol‐related death There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact Policy should strive to reduce alcohol‐related health inequalities, with the specific recommendations for policy depending on the cost‐effectiveness of interventions related to the epidemiological profile of the country or region under consideration Fortunately, there are evidence‐based policy options that reduce the amount of alcohol consumed and many alcohol‐related harms with immediate effect, that reduce the risk of an alcohol‐related death in middle age, and that would help to close the health gap between eastern and western Europe

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1360-0443.2010.03326.x

Ben Taylor

Papers

Epidemiology and alcohol policy in Europe