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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Alcohol
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Patterns of Drinking
Results from the 2001 National Household Survey of adults 14 years and over found:
■ 8.3% (M: 11%; F: 5.6%) reported drinking alcohol on a daily basis
■ almost 40% (M: 46%; F: 33%) consumed alcohol at least once a week
■ 35% (M: 29%; F: 40%) consumed alcohol less often than once a week
■ 8% (M: 7%; F: 9%) were ex-drinkers
■ almost 10% (M: 7%; F: 12%) had never drunk a full glass of alcohol
■ 90% of 20–29 year olds were current drinkers
Contrary to common perceptions, Aboriginal and Torres Strait Islanders:
■ are more likely to be non-drinkers or exdrinkers
■ are less likely to drink on a weekly (33% compared with 49% of the
general population) or occasional (29% versus 32%) basis; and
■ are more likely to drink at high or very high risk levels on the occasions
they do drink alcohol (82% versus 28%), compared to the general population
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Benefits and Harms
Model estimates of potential benefits and harms:
Benefits
There is good evidence that < 1 standard drink a day for women, and 1–2 a
day for men helps prevent heart disease from middle age onwards. The benefit is
attributable to alcohol per se, rather than the beverage type consumed. Heavier
drinking not only confers no additional benefit, but substantially increases risk of
harm. Cardiac protection needs to be assessed against the physiological changes
of ageing (e.g. reduced tolerance to alcohol’s effects, interaction with prescribed
medications). Any benefits can be equally achieved through a healthy lifestyle. There
is no evidence that low risk drinking in younger adulthood helps prevent the onset
of cardiovascular disease in later life.
Harms
Most drinkers (73%) generally consume alcohol in ways considered a low health
risk. However, harmful/hazardous alcohol use and dependence is estimated to cost
the Australian community $7.6 billion in direct and indirect costs. Single episodes
of alcohol intoxication contribute to 67% of potential years of life lost (PYLL) due
to premature alcoholrelated mortality.
Alcohol contributes to over 3,000 deaths per year, and is implicated in:
■ 7% of all male and 2% of all female deaths
■ 50,000 hospitalisations
■ 20–40% of acute general and psychiatric hospital presentations
■ 18% of all injuries presenting to emergency departments
■ 50% of assaults
■ 44% of fire injuries
■ 34% of falls and drownings
■ 30% of car accidents
■ 16% of child abuse
■ 12% of suicides; and
■ 10% of industrial accidents
Studies suggest that 15–32% of patients presenting to general practice drink at atrisk levels. However, fewer than half of all patients routinely undergo screening
for alcohol use.
The australian alcohol guidelines: Health Risks and Benefits provide an evidence base
for promoting individual and population health in relation to alcohol consumption.
The guidelines emphasise the link between ‘how much’ and ‘how often’ alcohol is
Alcohol
consumed, where the risks are described according to three levels (low, risky and
high risk), and two timeframes (short-term and long-term).
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Effects of Alcohol Consumption
Blood Alcohol Concentration (BAC) is a reasonable guide to level of intoxication
(see Table 2). BAC indicates the amount of alcohol in the bloodstream in grams of
alcohol per 100 ml blood. A BAC of 0.05 means a person has 0.05 g of alcohol
per 100 ml of blood (or a BAC of 0.05% = 11 mmol / L). A person of average build
will metabolise alcohol at a constant rate of around one standard drink per hour.
One standard drink (see Table 3) per hour will cause a rise in BAC of 0.01% to
0.02% in an hour; however:
■ Small females will have higher blood peak levels than large males for the
same volume consumed
■ High tolerance to alcohol may result in faster metabolism (hence more
rapid reduction in BAC)
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Table 2: Correlation between BAC and behavioural/motor impairment
How Alcohol Affects The Body
Alcohol is absorbed into the bloodstream via small blood vessels in the walls of
the stomach and small intestine. Within minutes of drinking alcohol, it travels from
the stomach to the brain, where it quickly produces its effects, slowing the action
of nerve cells. Approximately 20% of alcohol is absorbed through the stomach.
Most of the remaining 80% is absorbed through the small intestine.
Alcohol is also carried by the bloodstream to the liver, which eliminates the alcohol
from the blood through a process called “metabolizing,” where it is converted to
a nontoxic substance. The liver can only metabolize a certain amount at a time,
leaving the excess circulating throughout the body. Thus the intensity of the effect
on the body is directly related to the amount consumed.
Alcohol
When the amount of alcohol in the blood exceeds a certain level, the respiratory
(breathing) system slows down markedly, and can cause a coma or death, because
oxygen no longer reaches the brain.
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Measuring Consumption: the ‘Standard Drink’
The ‘standard drink’ concept was designed to assist consumers to monitor their
alcohol consumption. One Australian ‘standard drink’ contains about 10 grams
(12.5 millilitres) of alcohol. See Table 3–2 for common standard drink equivalents.
Whilst legislation requires alcohol producers to label the number of standard drinks
in a container, variation in size and type of glass in different environments (e.g.
homes, licensed environments) may make it difficult to estimate the actual number
of drinks consumed.
A standard drink is a notional drink that contains a specified amount of pure
alcohol and it is usually expressed as a certain measure of beer, wine or spirits.
The purpose of this review is to compare European standard drink measures; review
consumers’ understanding of standard drinks; and describe the use of standard
drinks in drinking guidelines, alcohol surveys and labelling.
The results of a 2014 Italian survey conducted by the Istituto Superiore di Sanità as
part of RARHA indicate that there is variation in the number of grams of alcohol
in a standard drink among European countries. The most common value is 10g,
which is used by 11 countries, followed by 12g, which is used by five countries. It
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can be difficult for drinkers to estimate what exactly constitutes a standard drink. A
review of the evidence indicates that while there seems to be awareness of the term
‘standard drink’, understanding of what it actually means is limited. Drinkers are
not able to define standard drinks accurately. They tend to overstate the appropriate
volumes, leading them to overpour drinks and underreport levels of consumption.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Ciattion: http://wwwassets.rand.org/content/rand/blog/2016/05/conversations-at-rand-a-
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This confusion over standard drinks can have serious consequences. It can affect the
precision and reliability of the results of surveys of self-reported alcohol consumption
and we know that surveys of self-reported consumption result in estimates of per
capita consumption well below the level calculated from alcohol sales data. In terms
of low risk drinking guidelines drinkers may interpret them in terms of numbers
of drinks that correspond to levels of intake that are smaller or larger than those
intended by the standard drink definitions included in the guidelines. Regarding
the challenging issue of drinkers’ inability to accurately gauge their consumption
in standard drinks, one potential way to deal with this issue is to place serving
size information on alcoholic beverage containers. Labelling drink containers with
their alcohol content in terms of standard drinks would better equip all drinkers
to follow the advice of health educators.
What’s a standard drink?
A standard drink is a measure of alcohol consumption representing a hypothetical
beverage which contains a fixed amount of pure alcohol. A standard drink varies
in volume depending on the alcohol concentration of the beverage, for example,
a standard drink of spirits takes up much less space than a standard drink of beer,
but it always contains the same amount of alcohol and therefore produces the same
amount of drunkenness. For example, in the United States, a standard drink contains
about 14 grams of alcohol. This roughly corresponds to a 12-US-fluid-ounce (350
Alcohol
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ml) glass of beer, a 5-US-fluid-ounce (150 ml) glass of 12% wine (no longer the
norm, however), or a 1.5-US-fluid-ounce (44 ml) glass of a spirit.
Citation: http://alcoholthinkagain.com.au/Portals/0/documents/publications/Alcohol%20
and%20Health/ata_standarddrink_a4_beer.png
Different countries define standard drinks differently. For example, in Australia, a
standard drink contains 10 grams of alcohol, but in Japan, it contains nearly 20
grams. In addition, a standard drink is often different from normal serving size in
the country in which it is served. Labeling is usually required to give an indication
of alcoholic content of a serving. Australia requires that “the label on a package of
an alcoholic beverage must include a statement of the number of standard drinks
in the package”
A standard drink is not usually the same as a glass of wine or beer poured in a pub
or at home. One standard drink in New Zealand contains 10 grams of pure alcohol.
The standard drink measure is a simple way for you to work out how much alcohol
you are drinking. The law requires all bottles, cans and casks of alcoholic drinks to be
labelled with how many standard drinks they contain. Look at the label for wording
about standard drinks or for a standard drinks image. The number inside the image tells
you approximately how many standard drinks in a container.
Citation: http://www.alcohol.org.nz/sites/default/files/images/Std%20drink.png
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The number of standard drinks in different alcoholic drinks varies. It depends on
the size of the container and the amount of alcohol it contains.
Check the standard drinks on the label to work out how many drinks you are
serving out of each bottle, can or cask.
For example, if a standard drink label on a bottle of wine says it contains eight
standard drinks, and that bottle has only filled four big glasses, each of those glasses
contains approximately two standard drinks or 20 grams of alcohol.
The term “standard drink” was used in the United Kingdom in the first guidelines that
published “safe limits” for drinking, but this was replaced by reference to “alcohol
units” in the 1987 guidelines and that term has been used in all subsequent UK
guidance. A unit of alcohol is defined as 10 millilitres (8 grams) of pure alcohol.
This definition is independent of the strength (% ABV) and amount (volume) of
any individual alcoholic beverage. The number of units of alcohol in a bottle or
can (and, optionally, the number of units in a typical serving) are indicated on the
drink container. Typical servings deliver 1–3 units of alcohol.
Why are standard drinks important?
■ Looking at labels and counting standard drinks is a reliable way of knowing
how much alcohol you are drinking.
■ Counting glasses, bottles, or cans of alcohol can be misleading because
each one may contain varying amounts of alcohol.
■ Whereas one standard drink always contains the same amount of alcohol
(10 grams) despite the container size or alcohol type.
■ An average person’s liver can only break down around one standard drink
of alcohol per hour.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
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Alcohol
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How are standard drinks calculated?
The formula to work out the number of standard drinks in an alcoholic drink is:
Amount of drink in litres (the volume of the container) multiplied by the percent
by volume of alcohol (%) multiplied by 0.789 (which is the density of ethanol at
room temperature) equals the number of standard drinks.
For example a 500ml bottle of beer which is 5% alcohol by volume:
■ 0.5 multiplied by 5 multiplied by 0.789 equals 1.97 standard drinks
■ 0.5 x 5 x 0.789 = 1.97 (approx 2 standard drinks)
Table 3: Standard drink (SD) equivalents
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Identifying ‘At-risk’
Drinking Levels Most people tend to be low-risk drinkers, and experience few
problems related to their use of alcohol, most of the time (see Figure).
Citation: http://www.health.gov.au/internet/main/publishing.nsf/content/E5203E6D5CBAA69
6CA257BF0001E02ED/$File/aodgp.pdf
Groups at High Risk for Alcohol-related Harm
The NHMRC identified groups who are particularly susceptible to alcohol-related
harm, including:
Young people (up to 18 years) and young adults (19–25 years)
Young people’s patterns and levels of drinking place them at significant risk of harm
compared with the community in general. Whilst alcoholrelated deaths amongst
older people can be attributed to long-term hazardous or harmful patters of use
(Chikritzhs et al., 1999), approximately 25–33% of 14–24 year olds drink in a
high-risk manner (Chikritzhs et al., 2000), increasing the likelihood of serious harm,
injury or death due to acute conditions resulting from alcohol intoxication. Between
1990 and 1997, 52% of all serious alcohol-related road injuries were sustained by
people aged 15–24, with a further 23% of injuries sustained by 25–34 year olds.
Risk of harm amongst young people is increased due to their:
■ smaller physical size
■ fewer social controls
■ peer values and norms that condone intoxicatedn behaviour
■ risk of overdose due to lack of tolerance