Urgent action is
needed to tackle the sharp rise in alcohol-related deaths
30 January 2023
Deaths caused directly by alcohol are rising sharply in the UK, and other conditions exacerbated by alcohol use are projected to increase. Behaviour change during the Covid-19 pandemic coupled with difficulties accessing already limited services are leading drivers of this rise. Now, there is the added stress of the cost-of-living crisis, which is likely to result in increased use of alcohol as a coping mechanism.
Liver disease is not the only potential negative health outcome of excessive alcohol consumption – strokes, heart attacks and certain cancers are among the health conditions exacerbated by alcohol – but this is not widely understood, and therapies, both medicinal and more holistic, are lacking.
Here we propose three interventions to help prevent any further increase in alcohol-related deaths: greater public awareness that excessive alcohol consumption contributes to a range of conditions, not just liver disease; more investment in medicines for alcohol-use disorders; and social prescribing to prevent and manage multimorbidity in people with alcohol-use disorder. These actions target different elements of the alcohol harm spectrum, encompassing prevention and treatment. As health systems deal with the Covid-19 backlog, managing alcohol-related risk factors must not be deprioritised if we are to avoid larger waves of disease and mortality.
Deaths linked to alcohol are rising sharply and include a range of conditions
There were 9,641 deaths caused directly by alcohol in the UK in 2021, a rise of 7% compared to 2020 and 27% compared to 2019. These are substantial increases given that rates between 2012 and 2019 were relatively stable. Data from the Department for Health and Social Care (DHSC) shows that people who were already drinking at higher levels before the pandemic were most likely to have increased their alcohol consumption in 2020. These individuals thus also increased their risk of developing complications associated with alcohol. Research commissioned by the National Institute for Health Research (NIHR) suggests that, if these consumption patterns persist, there could be a sharp rise in additional cases of alcohol-related diseases, and thousands of extra deaths as a result.
Alcohol consumption may also be contributing to other causes of death that are not alcohol-specific. Alcohol is known to increase the risk of the development and progression of conditions including haemorrhagic stroke, oesophageal varices, and certain cancers. Excess mortality is currently running at around 4,000 extra deaths each month, and increased alcohol consumption may be a contributing factor.
Three ways to help reduce alcohol-related disease and death
Although alcohol consumption and associated morbidity and mortality has been a persistent issue in the UK, the imperative for action has never been clearer. Public health levers such as regulation and pricing are important at national levels. To complement these strategies, three actions are proposed to achieve and sustain health improvements in high risk drinkers – those consuming more than 14 units of alcohol per week.
- Increase public awareness that liver disease is not the only health impact of alcohol
The wider impact of alcohol on conditions such as atrial fibrillation and stroke are rarely communicated. We have previously written about the link between alcohol consumption and cancer, and we believe there are opportunities for simple public health campaigns that could have a meaningful impact on the overall level of alcohol consumption in the UK. More targeted messaging can then be directed to those identified as higher risk drinkers by GPs and other healthcare professionals. Indeed, raising public awareness of the full range of alcohol-related harms was identified by the World Health Organization as a way for governments to support reducing harmful alcohol consumption.
- Promote investment in therapeutics for alcohol-use disorders, especially for patients with moderate/severe liver disease
Medication is one treatment option for alcohol-use disorder, although only 12% of patients receive relevant medication in the first year after diagnosis with alcohol dependence. Only four medications are licensed for the treatment of alcohol dependence in the UK, and the modest performance of these drugs plus a lack of clinical guidance are major barriers to use. To make matters worse, these medications are generally not suitable for patients with liver disease. Other drugs that were not initially designed for managing alcohol consumption, such as baclofen, are being trialled in patients with alcohol-related liver disease, and consensus guidelines for off-label use have been developed.
However, there are limited, if any, new therapeutic pipelines emerging from pharma companies, who may see alcohol-use disorder as a condition that is challenging and of limited business value. One potential option is for governments to incentivise companies to invest in this public health need by subsidising targeted biomedical research and trials. This may also improve access to any product brought to market by removing the link between development and final cost. Ultimately, new, more effective pharmacological treatment options are needed for alcohol-use disorder, to increase utilisation and improve patient care.
- Implement social prescribing to prevent and manage multimorbidity in people with alcohol-use disorder
As highlighted in our recent report, three mental health conditions – depression, dementia, and cognitive impairment – contribute to the multimorbidity burden in approximately one third of people living with four or more conditions. The National Academy for Social Prescribing (NASP) recently reported that 63% of adults entering drug and alcohol services stated they needed support from mental health services and 17% had problems related to housing.
Social prescribing links patients to community-based schemes with the aim of supporting overall health and wellbeing. This non-medical intervention is designed to exist alongside more traditional treatments, and has the potential to address some of the often complex social needs of people with alcohol-use disorder. Such programmes appear to be especially salient at the present time given the cost-of-living crisis, which may well result in increased stress and use of alcohol as a coping mechanism. Realigning services to manage the totality of an individual’s health-related need is likely to result in greater improvements in overall health and prosperity.