The recent Swedish study categorized its main direct costs into: health care, social services, and crime [ 31 , p.
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The most recent Australian study by Collins and Lapsley [ 28 ] subtracts welfare and adds costs of work defaults and road accidents, elsewhere covered under crime. To the extent this is true, those around the drinker—family, friends, victims, bystanders—are not much out of pocket for the actual costs which are measured—though they do contribute to paying them as taxpayers. Typically these costs, primarily from early deaths, are the largest or second-largest component of cost of alcohol calculations [ 31 , p. The other category is intangible costs, in which a cost is assigned to pain and suffering, and more generally a diminished quality of life.
The inclusion of both these categories in cost of alcohol estimates is controversial [ 31 , pp. An early death or disability due to alcohol results in the reduction of net resources wealth used in paying for funeral expenses, health costs or legal proceedings — in essence direct costs. Likewise, there are likely to be substantial intangible costs of living with a heavy drinker. A substudy of the Swedish cost of alcohol study estimated the loss in terms of QALYs for those who reported someone close to them or living in their household having a drinking problem, finding a significant decrement among those sharing a household with someone with a drinking problem.
Assigning the standard costing used in Swedish economic studies to the QALYs, the estimated intangible cost to those sharing a house was These results underline a point made in the cost of alcohol study for England and Wales [ 33 ]. Although it was able to quantify costs only for the first three categories, it insisted on noting the fourth as an important category.
Domains of social costs of alcohol according to [ 33 ]. There are several sources of this lacuna in the cost of alcohol studies.
Often as in the English study even costs in the welfare system are omitted. As Johansson et al. Beyond this, it may be that a social-cost approach may not be the best way to quantify such harms. Mainstream cost of alcohol studies often provide some subdivisions of the costs. For instance, Collins and Lapsley [ 28 , pp. But no attempt is usually made to split costs to others from costs to the drinker. In terms of direct costs excluding productivity losses from early deaths , Collins and Lapsley estimate that, of the social costs of alcohol, 9.
This rough estimation does not specify who is bearing these costs.
The adverse effects on the other can be in terms of mental or physical health, of safety or security, or tangible or intangible costs. The effects can be as described by the other, and noted by a bystander or interested party, or as recorded in agency records.
The data can be drawn from multiple sources, which do not necessarily share common definitions or frames of reference. Thus the harms that are measured are not necessarily mutually exclusive—though an interesting question, of course, is what can be said about overlap and potential doublecounting? Harm to an individual can occur in many forms, and can be measured in various metrics. For instance:. The fact of an occurrence, for instance, a death or a traffic crash, can be viewed as an indicator of harm for the person affected. Thus a count of deaths, or of years of life lost YLLs short of a full life, is one kind of metric of harm to the individual.
The frequency and intensity of such harms can also be indicated by the respondent, for instance by asking how often it happened, and whether the adverse effect was a lot or a little. For harms where it is possible, a monetary measure of the amount of harm can be calculated. This can be measured in various frames of reference, depending on the harm: e. The definition of causation which will be commonly used in such studies is an epidemiological one [ 4 ]: would the adverse event have happened in the absence of the drinking?
The drinking is thus neither necessary nor sufficient for the event to have occurred, and other factors will often have also played a causal role. But, viewed from a policy perspective, the definition answers the crucial question: would removing the drinking have prevented the adverse event? All of these metrics of harm and means of assessing causality have a substantial base in the research literature.
But all are the subject of continuing debate and discussion, as scientists continue to endeavour to improve concepts and measurement. One frame is that of surveys of the general population; the other is that of agency records, such as police and ambulance files, hospitalisation and emergency department records, alcohol treatment agency casefiles, and mortality records. Each frame has its own characteristics, advantages and drawbacks.
Mapping the Social Consequences of Alcohol Consumption
The advantage of the population survey is that in principle it is inclusive of the whole range of experience in the population, including lesser problems which would never come to official attention. The drawbacks include that really serious adverse effects are not very common, and it would take a very large sample of the population to cover them adequately.
The picture of adverse effects drawn from a population survey is thus going to be dominated by the milder end of the continuum of severity of effects. A second drawback is that it is increasingly impossible to get an adequate representation of the whole population in a sample survey.
Marginalised people are often missing from a sample based on households, and increasingly young adults are missing from survey samples defined by having a landline telephone. Also, response rates have fallen as populations have found themselves bombarded not only with research surveys but also with telemarketing masquerading as a survey. Agency records have the advantage that they are likely to give a good picture of the more serious end of the continuum of severity.
Alternatively, if there is a required tick-box concerning this, the box will be filled out, but its validity may be questionable. What is recorded may also be shaped by how the staff member wants to present their daily work to their supervisors and others who may use the records. Looked at through the general-population frame, alcohol problems are fairly dispersed, and, for most of those with problems, the problems are relatively mild.
On the other hand, in populations showing up in institutional frames— hospitals, the police, social welfare agencies—the problems are often more serious and cumulative. Particularly in alcohol treatment agencies, those with alcohol problems are also often highly marginalized—much less likely to be in the workforce, to be stably housed, to be in a family relationship [ 35 ].
The challenge for future work in the field, then, is not only to develop better measurement of problems as they are manifested both through agency windows and through the general population window, but also to develop study designs which chart and limn in the connections.
When and under what circumstances does the risk increase that a minor annoyance on the street will turn into a serious event?
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We need to know more about the scope and magnitude of these problems at both ends of the spectrum of severity, and we need to know what lies between these extremes: the circumstances and prevalence of adverse effects which are not cataclysmic, but which also cannot be shrugged off. We need to know more about the natural history of relationships where the drinking of at least one person has an adverse effect on others.
When do relationships persist despite heavy drinking and when do they lapse? To what extent and under what circumstances are drinkers responsive to efforts at social control from others in a social relationship? These kinds of questions suggest how inherently social and interactional is the study of the harmful effects of drinking on others, and of efforts by the other or by third parties to prevent or reduce the harm.
Drinking is usually a social activity, and drinkers interact with and affect those in their social environment. Generally, provisions for those seeking such help are presently an add-on to services for those with alcohol problems. A fuller and more concrete understanding of the harms to others from drinking is also important in designing prevention programs and policy initiatives to reduce the harms from drinking. It also has a potentially important role in policy debates about public health approaches to alcohol problems.
Some will argue that what the drinker does to his or her own body and mind is private rather than public business. This paper draws on a paper by R. National Center for Biotechnology Information , U. Published online Apr Find articles by Jason Ferris. Find articles by Janette Mugavin. Find articles by Claire Wilkinson. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC.
H Klingemann G Gmel
Keywords: alcohol, harm to others, interpersonal problems, effects of drinking. Introduction Drinking often results in harm not only to the drinker, but also to others around the drinker. Drinking and its burden in a global perspective: policy considerations and options.
The global distribution of average volume of alcohol consumption and patterns of drinking. Laranjeira R. E Hinkly. Changes in life expectancy in Russia in The mids. V Shkolnikov , M Mckee , Leon. Introduction: Social consequences of alcohol — the forgotten dimension? Harald Klingemann , Gerhard Gmel.
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These effects may range from loss of inhibition with only one drink to making someone "stumbling drunk" to acute alcohol poisoning with loss of consciousness and difficulty breathing. Acute alcohol poisoning usually occurs in situations of rapid alcohol intake such as shots, funneling, keg stands and drinking games. Even after someone passes out their BAC blood alcohol concentration can continue to rise from the alcohol still in their stomach.
Medical attention is critical to prevent serious injury or death. Women are affected by alcohol to a greater degree than men. They become more impaired than men when drinking the same amount of alcohol due to their higher percentage of body fat--alcohol is water soluble, so there is a greater concentration of alcohol in a woman's bloodstream after drinking.
Because women tend to be smaller than men, alcohol is less diluted upon reaching the brain than in larger individuals.