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Issues Alcohol use has been shown to impact on various forms of liver disease, not restricted to alcoholic liver disease. Approach: We developed a conceptual framework based on a narrative review of the literature to identify causal associations between alcohol use and various forms of liver disease including the complex interactions of alcohol with other major risk factors. Based on this framework, we estimate the identified relations for 2017 for the USA. Key Findings: The following pathways were identified and modelled for the USA for the year 2017. Alcohol use caused 35 200 (95% uncertainty interval 32 800–37 800) incident cases of alcoholic liver cirrhosis. There were 1700 (uncertainty interval 1100–2500) acute hepatitis B and C virus (HBV and HCV) infections attributable to heavy‐drinking occasions, and 14 000 (uncertainty interval 5900–19 500) chronic HBV and 1700 (uncertainty interval 700–2400) chronic HCV infections due to heavy alcohol use interfering with spontaneous clearance. Alcohol use and its interactions with other risk factors (HBV, HCV, obesity) led to 54 500 (uncertainty interval 50 900–58 400) new cases of liver cirrhosis. In addition, alcohol use caused 6600 (uncertainty interval 4200–9300) liver cancer deaths and 40 700 (uncertainty interval 36 600–44 600) liver cirrhosis deaths. Implications: Alcohol use causes a substantial number of incident cases and deaths from chronic liver disease, often in interaction with other risk factors. Conclusion: This additional disease burden is not reflected in the current alcoholic liver disease categories. Clinical work and prevention policies need to take this into consideration. [ABSTRACT FROM AUTHOR] more...

Introduction: Nationally representative studies of the combined impact of drinking and body mass (BMI) on mortality outcomes are unavailable. We investigate whether both act together to elevate risk of all‐cause or liver mortality. Methods: We obtained self‐reported histories of drinking and BMI from 129 098 women (mean age 47.2 years) and 102 568 men (mean age 45.6 years) ≥18 years interviewed from 1997 to 2004 in the National Health Interview Survey and related these data to the deaths that occurred by 31 December 2006 (women = 8486; men = 7819 deaths). Death hazards among current drinkers in different BMI groups were adjusted for age, education, race and smoking. Results: Obese (≥30 kg m−2) adults with consumption of >40 g day−1 (women) or >60 g day−1 (men) pure ethanol were at risk of increased mortality from all‐cause and chronic liver disease (P trend <0.0001). For heavy drinkers with BMI ≥30 kg m−2, each 5 kg m−2 higher BMI was associated with an elevated all‐cause mortality in men (hazard ratios 1.27, 95% confidence interval [CI]: 1.16–1.40) and women (1.12, [1.02–1.24]). The excess risk due to interaction was more pronounced in men (7.30, [3.60–11.00]) than women (2.90, [0.50–5.30]). Discussion and Conclusions: Obesity and excess alcohol are both related to all‐cause and liver mortality—the latter with evidence of a supra‐additive interaction between the risk factors. The presence of both factors in the same population and their impact should inform treatment, public health policies and research. [ABSTRACT FROM AUTHOR] more...

The scientific evidence for low-risk drinking guidelines was examined in a narrative review focusing on three points: definition of exposure, the best way to select outcomes and risk relations and how to determine thresholds. With respect to exposure, at least two dimensions should be incorporated: average volume of alcohol consumption and patterns of irregular heavy drinking occasions. Mortality should be selected as the most severe outcome, and a disaggregated approach should be adopted incorporating the regional demographic and cause of death structure. Finally, our plea is for establishing a general threshold for acceptable risk on a societal level rather than ad hoc specific committees setting norms for specific risks. Acceptable thresholds will be different if the risk is to oneself or to others.[Rehm J, Patra J. Different guidelines for different countries? On the scientific basis of low-risk drinking guidelines and their implications. Drug Alcohol Rev 2012;31:156-161] [ABSTRACT FROM AUTHOR] more...

Introduction and Aims. Alcohol retail monopolies have been established in many countries to restrict alcohol availability and thus, minimise alcohol-related harm. The aim of this study was to estimate the impact of the privatisation of alcohol sales on the burden and direct health-care, law enforcement costs and indirect costs (lost productivity due to disability or premature mortality) in Canada. Design and Methods. Simulation modelling. International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse were used. All burden and costs were compared with the baseline taken from the aggregate Cost Study on Substance Abuse in Canada 2002. Results. If all Canadian provinces and territories were to privatise alcohol sales we assume that consumption would increase from 10% to 20% based on available Canadian literature. Under the 10% scenario the costs would increase from 6% ($828 million) and under the 20% scenario costs would increase 12% ($1.6 billion). This increase is substantially greater than the tax and mark-up revenue gained from increased sales, and represents a net loss. Discussion and Conclusions. Alcohol-attributable burden and associated costs will increase markedly if all Canadian provinces and territories gave up the government alcohol retailing systems. For public health and economic reasons, governments should continue to have a strong role in alcohol retailing. [Popova S, Patra J, Sarnocinska-Hart A, Gnam WH, Giesbrecht N, Rehm J. Cost of privatisation versus government alcohol retailing systems: Canadian example. Drug Alcohol Rev 2012;31:4-12] [ABSTRACT FROM AUTHOR] more...

Introduction and Aims. Alcohol is an established risk factor for liver cirrhosis. It remains unclear, however, whether this relationship follows a continuous dose-response pattern or has a threshold. Also, the influences of sex and end-point (i.e. mortality vs. morbidity) on the association are not known. To address these questions and to provide a quantitative assessment of the association between alcohol intake and risk of liver cirrhosis, we conducted a systematic review and meta-analysis of cohort and case-control studies. Design and Methods. Studies were identified by a literature search of Ovid MEDLINE, EMBASE, Web of Science, CINAHL, PsychINFO, ETOH and Google Scholar from January 1980 to January 2008 and by searching the references of retrieved articles. Studies were included if quantifiable information on risk and related confidence intervals with respect to at least three different levels of average alcohol intake were reported. Both categorical and continuous meta-analytic techniques were used to model the dose-response relationship. Results. Seventeen studies met the inclusion criteria. We found some indications for threshold effects. Alcohol consumption had a significantly larger impact on mortality of liver cirrhosis compared with morbidity. Also, the same amount of average consumption was related to a higher risk of liver cirrhosis in women than in men. Discussion and Conclusions. Overall, end-point was an important source of heterogeneity among study results. This result has important implications not only for studies in which the burden of disease attributable to alcohol consumption is estimated, but also for prevention. [Rehm J, Taylor B, Mohapatra S, Irving H, Baliunas D, Patra J, Roerecke M. Alcohol as a risk factor for liver cirrhosis: A systematic review and meta-analysis. Drug Alcohol Rev 2010] [ABSTRACT FROM AUTHOR] more...

Introduction and Aims. Recent data suggest increasing prescription opioid and decreasing heroin use among street drug users, yet little is known on possible differential use characteristics and outcomes associated with these drugs. [While we recognise that, correctly, these populations would need to be labelled as opioid 'abusers' or 'non-medical users', we rely on the simpler terms 'use' and 'users' for the population under study within the wider context of them being engaged overall in illicit opioid use activities.] This study compared drug use, health, and socio-economic characteristics between heroin (H)-only, prescription opioid (PO)-only and mixed heroin and prescription (PO&H) users in a Canadian multi-site cohort of illicit opioid and other drug users (OPICAN). Design and Methods. Data from the most recent (2005) multi-component assessment of the H-only (n = 94), PO-only (n = 304) and PO&H (n = 86) cohort sub-samples were analysed. Based on bivariate analyses of variables of interest, a multinomial logistic regression analysis (MLRA) model was computed, comparing PO-only and PO&H groups to the H-only reference group, respectively. Results. H-only users were found in two of the seven study sites. Based on the MLRA, PO-only and PO&H users, compared to H-only users, were more likely to: be older, use benzodiazepines and cocaine, use drop-in shelters and less likely to use walk-in clinics. PO-only users were also more likely to: be white; receive legal income; use drugs by non-injection; have physical health problems; and use private physician services. Discussion and Conclusions. Our study underscores the increasing prevalence of PO compared to heroin use in the study population. Differences between PO-only and H-only users were more pronounced than differences between PO-only and PO&H users. PO-only use may be associated with lowered health risks and social burdens, yet concerns regarding polysubstance use and drug sourcing arise. Challenges for targeted interventions are discussed. [ABSTRACT FROM AUTHOR] more...

Use of illegal drugs is an important behavioral risk factor for burden of morbidity in developed countries. The objective was to estimate the number of diagnoses in acute care hospitals, psychiatric hospitalizations, admissions in specialized treatment, and number of days in treatment attributable to use of illegal drugs for Canada in 2002. The number of diagnoses in acute care hospitals, psychiatric hospitalizations, and hospital days were obtained from the Canadian Institute for Health Information (CIHI). Number of admissions and number of days in specialized inpatient and outpatient treatment of illegal drug dependency were obtained from provincial ministerial officials or drug addiction program coordinators. Except for effects of maternal use of drugs of addiction on the newborn, and suicide, drug-attributable fractions (DAFs) were estimated directly from available statistics in published literature. There were 61,026 illegal drug-related diagnoses in acute care hospitals, 1,517 psychiatric hospitalizations, and 139,773 admissions to specialized treatment attributable to illegal drug use in Canada. The largest contributors were mental and behavioral disorders due to psychoactive substance use in acute care hospitals, and drug psychoses in psychiatric hospitalizations. Length of stay amounted to 352,121 days in acute care hospitals, 31,508 days in psychiatric hospitals, and 2,851,829 days in specialized treatment. Drug use constitutes a major contributor to burden of morbidity in Canada. Compared to 1992, the total number of illegal drug-attributable days in 2002 increased, especially in acute hospitals by a factor of 9.6. A mixture of prevention and harm reduction measures is proposed to reduce the burden of morbidity associated with drug use. [Popova S, Rehm J, Patra J, Baliunas D, Taylor B. Illegal drug-attributable morbidity in Canada 2002. Drug Alcohol Rev 2007;26:] [ABSTRACT FROM AUTHOR] more...