A talk given for Cafe Scientifique on 1st May 2012 by Prof Roger Wiliams CBE, Institute of Hepatology & Foundation for Liver Research

1. Salisbury Café Scientifique
1st May 2012
Combating the harms of excessive drinking in the UK
Institute of Hepatology & Foundation for Liver Research
Professor Roger Williams, CBE

2. Latest figures on hospital admissions, deaths & costs
2008 – 2009 945,469 hospital admissions
- 47% increase over 5 yrs
2008 9,031 deaths, majority from cirrhosis,
females 34%, 8 & 7-fold increase in
35 – 44 age group since 1998
2006 – 2007 2.7 billion cost to NHS (78% hospital/OP)
55.1 billion total societal cost
(Moriatry KJ. Frontline Gastroenterology. 2010; 2: 77-81)

3. Adults > 16 yrs – drinking behaviour
Men % Women %
Hazardous** Men >21 <50 units/wk
31 20
Women >14 <35 units/wk
Harmful** Men >50 units/wk
9 6
Women >35 units/wk
Dependent+ Scoring of Alcohol
9 4
Dependence Questionnaire
** General Household Survey, 2006
+ Adult Psychiatric Morbidity Survey, 2007

4. BBC News
’Wealthy areas head alcohol table’
Hazardous drinking is rife in affluent middle class
– Runnymede 26.4%, Surrey Heath 26.0%
Harmful drinking is highest in poorest areas
– Manchester 8.8%, Liverpool 8.1%

5. Male & female alcohol consumption & cirrhosis
Males Females
Cumulative total
917 kg 570 kg
alcohol consumption
Percentage developing
cirrhosis 33% 63%
(Marbet UA, et al. J Hepatol. 1987; 4(3): 364-72)

6. Drinking amongst children aged 11 – 15 yrs
(Annual survey across 264 English secondary schools)
One-third consuming >15 units a wk
= 178,560 children
31% of children in drinking vs 5% in non-drinking
households
(NHS Information Centre 2008)

7. Screening for excess alcohol consumption
• Blood tests – SGOT, AST, MCV identify misuse in
two thirds of hospital patients but only 25% in
primary care
• Audit – Alcohol use disorders identification test
self administered 10 questions on consumption
(3), drinking behaviour (4) & dependence (3)

8. Effective management of the social health
and economic problems caused by alcohol
requires a much broader collaborative
approach, led ultimately by Government if
alcohol consumption in the population as a
whole is to be reduced.
(Stubbs MA, et al. Clin Med. 2011; 11(2): 189-93)

9. Overall alcohol consumption reduced
IF AFFORDABILITY
ACCESS
ADVERTISING
ARE RESTRICTED

10. 2009 – 2010
£17.6 million – Government expenditure
on alcohol awareness
£600 – 800 million – Drinks industry on
promoting consumption

11. Effects of changes in alcohol controls
Alcohol Change in
consumption indicator
1917 Denmark: increase -76% DTs cases -93%
in spirits & beer taxes Alcohol deaths -83%
1955 Sweden: abolition +25% DTs cases +438%
of alcohol rationing
1969 Finland: beer +46% Alcohol deaths +58%
purchases grocery stores
1985-88 Russia: anti- -25% Alcohol deaths -54%
alcohol campaign Male suicides -37%
(Source: Alcohol related harm – a growing crisis, time for action! R. Room, 2005)

12. Obesity in the UK
Rate rising sharply-
2009 65% ♂ & 50% ♀ overweight or obese
> 16 yrs 24% in obese category BMI > 30 (kg/m2)
2 - 16 yrs 17% ♂ & 16% ♀ obese
75% of obese individuals have NAFLD
NAFLD prevalence in population 20 – 30%

13. Deceased Donor Transplants
April 2010 - March 2011. Total No: 689
Alcoholic Cirrhosis 134
HCV Cirrhosis 90
Primary Biliary Cirrhosis 43
Primary Sclerosing Cholangitis 52
Acute Hepatic Failure 77
(incl. Paracetamol overdose 25)
(Data from NHSBT, 2011)

14. Organ donors and liver transplants
per million population (2010)
Organ donors Liver transplants
(incl. LDLT)
Spain 32.0 20.7
France 23.8 16.9
Italy 21.6 16.9
Germany 15.8 15.7
UK 16.4 11.5
U.S.A. 25.0 19.8
(Data from the Transplant Committee of the Council of Europe. 2012)