Wednesday, June 12, 2013

Insult to the brain caused by alcohol

I attended the Research-to-Practice Seminar on the topic on Foetal Alcohol Spectrum Disorder (FASD) a few days ago. Professor Elizabeth Elliott AM, Professor Paediatrics & Child Health, Children’s Hospital Westmead gave a great overview of the topic and research on this disorder.

Given the level of alcohol related problems reported in the media in recent years Prof Elliott fittingly discussed aspects of FASD framed in part against broader societal issues involving alcohol consumption.

We know risks associated with the consumption of alcohol during pregnancy are not insignificant. Kenneth Lyon Jones and David W. Smith in 1973 first described facies and facial features (including microcephaly small palpebral fissures, a flat nasal bridge, a smooth or indistinct philtrum, a thinned upper lip, and flattening of the midface).

Insult to the brain caused by alcohol can also include epi-canthal folds, as well as low-set or mildly malformed ears. Fetal alcohol syndrome more generally reflects the way in which alcohol affects central nervous system development, as well as the growth of the heart, eyes, legs, arms, teeth, ears, palate, and external genitalia.

Kids and school-age children may have problems with learning, low tolerance for frustration, inadequate social boundaries and difficulty reading. Teenagers can have continuous learning problems, depression, anxiety and inappropriate sexual behaviour.

At the same time I've been pondering over whether we as a society consume more alcohol now than say 10 years ago? And does this corelate with harm?

In Sydney, a day hardly goes by if we don't hear reports about another alcohol-related incident (often violent) – does it follow that if a population drinks more, then there are more heavy drinkers and therefore there is more harm from alcohol. Similarly if a population drinks less, is there less harm?

An assumption has been the overarching link between levels of alcohol consumption in a population and rates of harm - something that has been demonstrated repeatedly. So when per-capita alcohol consumption goes up, rates of alcohol problems go up with them.

Recently, however, these trends have begun to diverge in a number of places. In Sweden, per-capita consumption of alcohol has fallen in the last five years; while harm rates have remained fairly stable. In England, harm rates have increased sharply since 2004 despite a steady decline in per-capita consumption levels. 

And a similar pattern is emerging in Australia. Over the last decade or so, data from the Australian Bureau of Statistics have shown almost no change in the amount of alcohol consumed per person in Australia. In 2000/01, it was 10.15 litres of pure alcohol, while in 2010/11 it was 9.99 litres. In contrast, rates of alcohol-related harm are increasing.

Recent studies in Victoria of both adults and young people have found sharp increases in a range of problems from alcohol. This includes rates of alcohol-related hospitalisations, presentations at emergency departments due to intoxication, late-night assaults, domestic violence involving alcohol and alcohol treatment.

And a national study of alcohol-related harm between 1995 and 2006 found increases in alcohol-related hospitalisations in all states.

Perhaps changes to population level alcohol availability particularly impact risky or marginalised drinkers, those likely to experience harm from their drinking. Studies also show heavy drinkers respond to price changes and that increasing alcohol taxes reduces death and injury.

So it may be that population-level policy solutions still make the most sense, even as population-level consumption and harm rates drift apart. There are still a lot of questions we need research to address: whose drinking is shifting and why? Are particular policy changes likely to improve or exacerbate the recent harm increases? Are there particular demographic or sub-cultural groups of the population that research and policy should be targeting?

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