The link between alcohol and mental health geert.dom@uantwerpem.be
Evolution health-care Mental Health & Non-Communicable Communicable desease Substance use disorders desease (MH & SUD) Disability (Years Disability Mortality (Years Lived with Disability Adjusted Life Years Life Lost YLL) YLD) (DALY)
Whitefort et al. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013; 382: 1575 – 86
GBD 2010 study wrapping-up MH & SUD fifth leading cause of DALY’s lost. MH & SUD first cause of YLD (years lived with disability). MH & SUD : mortality (YLL) estimate for 2010 equivalent of 232.000 deaths >> 81.1% of these due to SUD (Alcohol).
GBD 2010 versus 1990 The total burden of MH & SUD increased by 37.6%; from 133.6 million to 183.9 million DALY’s from 1990 to 2010. The total burden of MH & SUD as a proportion of all-cause DALYs increased from 5.4% in 1990 to 7.4% in 2010. Parallels population growth and changing age-structure. No major increases in mental disorder prevalence. !!Except: Alcohol, opioid, and cocaïne dependence. Increased notably between 1990 and 2010.
Alcohol: a European problem?
Total adult per capita alcohol consumption (recorded and unrecorded) in 2005* 8 Total refers to recorded + unrecorded; 2005 refers to average 2003 – 2005 for recorded and 2005 for unrecorded WHO, 2011
Alcohol dependence in the EU 5.4% of men age 18 – 64 and 1.5% of women in this age category are estimated to be affected by alcohol dependence This corresponds to almost 11 million people Over all age categories, the prevalence is estimated to be 4.8% for men, 1.3% for women and about 12 million people in the EU 9 Rehm et al. Alcohol consumption, alcohol dependence and attributable burden of disease in Europe: Potential gains from effective interventions for alcohol dependence. Centre for Addiction and Mental Health. Canada, 2012
AUD DALY’s varies more than ten-times between regions
Europe takes the lead Alcohol-attributable burden of disease in DALYs as a proportion of all DALYs, by sex and WHO region (2004) 17.3 11.6 4.4 AFR=African region; AMR=American region; EMR=eastern Mediterranean region; EUR=European region; SEAR=southeast Asian region; WPR=western Pacific region 11 Rehm et al. Lancet 2009;373:2223 – 2233 DALY=disability-adjusted life year
Brussel | 12 13/12/2013
Ranking of mental diseases In Million € Tobacco Alcohol Depression Dementia Psychoses Anxiety Stroke Headache Brain injury MS 0 50,000 100,000 150,000 200,000 Effertz, T., Mann, K., European Neuropsychopharmacology (2012) 13
Social costs of alcohol in the EU, 2010 (billion € ) Crime – police Crime – defensive 17,6 18.8 Crime – damage Traffic accidents damage 11,3 15,1 Health Treatment/prevention 7,5 Mortality 12,6 Absenteeism 45,2 Unemployment 21,4 6,3 Alcohol Comparator Report based on Anderson & Baumberg, Alcohol in Europe, 2006: total tangible costs to the EU € 155.8 billion (lower limit: € 107.9 billion; upper limit: € 287.7 billion) in 2010, equivalent to 1.3% of GDP (0.9 – 2.4%) Rehm et al. Alcohol consumption, alcohol dependence and attributable burden of disease in Europe: Potential gains from effective interventions for alcohol dependence. Centre for Addiction and Mental Health. Canada, 2012
Figure 2. Difference in life expectancy among 124,971 women with recent onset mental illness in Denmark, Finland and Sweden compared to the general population. Nordentoft M, Wahlbeck K, Hällgren J, Westman J, et al. (2013) Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden. PLoS ONE 8(1): e55176. doi:10.1371/journal.pone.0055176 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0055176
Proportion of deaths within major disease categories in the EU which was alcohol-attributable, for people 15 – 64 years of age, 2004 100% 78% 76% 80% 60% 40% 40% 37% 40% 19% 20% 11% 10% 9% 8% 7% 6% -14% -6% 0% -20% Cancer IHD Other Mental and Liver cirrhosis Unintentional Intentional cardiovascular neurological injury injury diseases disorders Men Women IHD=ischaemic heart disease 16 Rehm et al., 2012 APC
Alcohol and mental illness Extremely high levels of comorbidity Psychiatric & somatic). Alcohol major contributory factor development and E.g. Mood & anxiety (stress) disorders and Suicide
Environment: Stress – ECA Age onset first genes intoxications - availability ) Brain circuitries Alcohol Use Psychiatric disorder disorders
Dijkhuizen & Dom EPA CME comorbidity
Comorbidity = negative outcome alcohol Mood disorders Stress: current & Early Childhood
Suicide Approximately 1,000,000 people die by suicide in the world every year. It is estimated that there are 10 – 40 attempted suicides for each completed suicide. This ratio is higher among adolescents and decreases with age. Up to 90% of individuals who complete suicide meet the criteria for a psychiatric disorders. Comorbidity with psychiatric disorders is high.
AUD = Chronic disorders Complex Multifactorial aetiology: Biol x Env. X Gen. x .. Treatment: symptomatic & behavioural Long term ….varying expression during lifetime Alcohol Use disorders, diabetes, Hypertension, ….. Treatment: Problems ! small to medium effect-sizes / compliance quality
Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project Proportion of individuals consulting any type of formal health services in the previous 12 months, according to 12-month mental disorder status Mental health state Unweighted, n Weighted, % 95% CI Overall sample 21,425 6.4 5.9 – 6.8 No 12 month mental disorders 19,349 4.3 3.9 – 4.7 Any disorder 2,076 25.7 23.3 – 28.1 Any mood 972 36.5 32.5 – 40.5 Any anxiety 1,325 26.1 23.1 – 29.1 Any alcohol disorder 209 8.3 3.8 – 12.8 Only one 12 month mental 1,435 19.6 17.1 – 22.2 disorder More than one 641 40.0 35.0 – 45.0 In 2004 in Europe, 37% of persons with a mood disorder and 26% of persons with an anxiety disorder were consulting formal health services in the previous 12 months, whereas this was only 8% for persons with an alcohol use disorder!! CI=confidence interval Alonso et al. Acta Psychiatr Scand Suppl 2004; 420: 47 – 54
Number of deaths avoided over one year in men by treatment for AD in the EU in 2004 by five different treatment modalities 18.000 16.000 Proportion of people with AD treated 10% 14.000 Proportion of people with AD 12.000 treated 20% 10.000 Proportion of people with AD treated 30% 8.000 Proportion of people with AD treated 40% 6.000 4.000 2.000 0 Pharmacological MI/CBT higher MI/CBT BI hospital 1 BI hospital 2 treatment effectiveness Proportion of people with AD treated 10% 2.459 1.020 1.217 995 2.472 Proportion of people with AD treated 20% 4.980 2.051 2.452 2.000 4.994 Proportion of people with AD treated 30% 7.564 3.105 3.698 3.014 7.563 Proportion of people with AD treated 40% 10.040 4.160 4.985 4.051 10.196 AD=alcohol dependence; MI=motivational interviewing; CBT=cognitive ‐ behavioural therapy; BI=brief interventions Rehm et al Eur Neuropsychopharm 2013
Quality Treatment for Health Conditions Health care practitioners provide evidence- based care only about half the time (E.McGlynn, et al., NEJM, 2003) Alcohol dependence 11% Hip Fracture 23% Diabetes 45% Low back pain 69% Prenatal care 73% Breast cancer 76%
Specifically alcohol use disorders Large treatment gap: to little, to late Poor implementation of quality (i.e. evidence based interventions, guidelines) Lack within the training health care professionals (i.e. MD, nurses, psychologists,..)
So we need.. Coordinated action: Research Treatment guidelines. Educational programs Policies >> large scale (European)
EUROPEAN FEDERATION OF ADDICTION SOCIETIES EUROPEAN FEDERATION OF ADDICTION SOCIETIES The MAP The MAP Iceland Sweden Finland Norway Russia Lithuania Ireland Holland Poland UK Germany Belgium Czech Rep. Luxembourg Hungary Austria Switzerland Romania Slovenia France Croatia Bulgaria Serbia Italy Portugal 2 or more Societies Spain Greece 1 Society Societies to be confirmed
conclusion Alcohol use & alcohol use disorders are (chronic) brain disorders & extremely prevalent and extreme high personal & societal cost. EUROPEAN PROBLEM Alcohol major contributable factor within the development and course of psychiatric disorders. Alcohol = mental health
www.eufas.net Prof. dr. Geert Dom geert.dom@uantwerpen.be Tel. 0032 (0) 478 93 87 67 www.europsy.net
alcohol-dependent healthy male male 42 years old 43 years old
Brussel | 40 13/12/2013
Alcohol and mortality in Russia: prospective observational study of 151 000 adults. Lancet 2014
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