Transcript Alcohol - Addressing Alcohol Abuse in Mongolia

Addressing Alcohol Abuse in
Mongolia
Sean Armstrong
Coordinator – Mongolia
Medecins du Monde
Description of the talk
• What is alcoholism?
• What is the scope of the problem in
Mongolia?
• Alcohol-related harm, what is it and its
impact.
• Strategies for addressing alcohol abuse
and related harm.
• The effect of the Mongolian context
What is alcoholism?
• Definitions please…
Alcohol Abuse DSM IV
• A maladaptive pattern of substance use leading to
clinically significant impairment or distress, as
manifested by one (or more) of the following,
occurring within a 12-month period:
– recurrent substance use resulting in a failure to fulfill major
role obligations at work, school, home (e.g. neglect of
children or household)
– recurrent substance use in situations in which it is physically
hazardous (e.g., driving an automobile while impaired by
substance use)
– recurrent substance-related legal problems (e.g., arrests for
substance-related disorderly conduct)
– continued substance use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance (e.g., arguments
with spouse about consequences of intoxication)
DSM IV
Alcohol Dependence DSM IV
•
A maladaptive pattern of substance use, leading to clinically significant
impairment or distress, manifested by three (or more) of the following,
occurring at any time in the same 12-month period:
– Tolerance:
• a need for increased amounts of the substance to achieve intoxication
• markedly diminished effect with continued use of the same amount of substance
– Withdrawal
• Characteristic withdrawal syndrome for the substance
• The same (or a closely related) substance is taken to relieve or avoid withdrawal
symptoms
– The substance often taken in larger amounts or over a longer period than was
intended
– A persistent desire or unsuccessful efforts to cut down or control substance use
– A great deal of time is spent in activities to obtain, use or recover from effects of
the substance
– Social, occupational or recreational activities are given up or reduced
– Substance use is continued despite knowledge of a persistent/recurrent physical
or psychological problem (e.g., continued drinking despite recognition that an
ulcer was made worse by alcohol consumption)
DSM IV
So What is Alcoholism?
• The medical versus the behavioral
• There is agreement that later stages of the
disease are definitively disease-like
• However, screening tools (Callahan)
developed by Sociologists are stronger
while those developed by doctors (DSM
III) are more sensitive
• Over time, drinking habits change!!!!
Jellinek’s “Types of Alcohol Abuse”
• Symptoms and psychological but no
dependence = Alpha
• Medical symptoms but no physical
dependence = Beta
• Symptoms and physical dependence =
Gamma
• Physical dependence but no symptoms =
Delta
• Binge drinking = Epsilon
• Over time, drinking habits change!!!!
Jellinek, EM. (1960). The Disease Concept of Alcoholism
What is the scope of the problem in
Mongolia
• Drinking problems are compared
internationally on the basis of several key
indicators: Total consumption (L/year),
Consumption among the top quartile of
heaviest drinkers, Percent abstaining, Type
of alcohol consumed, Percent binge drinking
(weekly)
• These comparison approach the issue from
the medical perspective
What is the scope of the problem in
Mongolia
• Total consumption: 9L / per person over 15
years of age (or 2 as listed on WHO website)
– Recorded versus unrecorded? Most former Soviet
countries underreport by almost half
• Consumption among top quartile of drinkers:
86% of alcohol
• Percent Abstaining: 38.2% of the population
versus 20.8% in Russia (Means 17L / Drinker,
among 10 highest internationally)
What is the scope of the problem in
Mongolia
• Type of alcohol consumed: In Mongolia
over 70% of the market is vodka, as
opposed to Russia where it is 50%
• Percent binge drinking weekly: 18% of
men, 6% of women (higher than in Russia
and with Latvia among highest in world)
• Mongolia is at risk for several “Types of
Alcohol Abuse”
Alcohol Related Harm: What is it
and what is its impact
• Alcohol is related to disease
• Alcohol is related it social problems
• The cost to society can be determined
using statistical models
• Demographic changes often have their
root in alcohol related issues as well
Alcohol Abuse and Disease
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Binge drinking, common in Russia, leads to increased cardiovascular disease (CVD) mortality,
particularly sudden cardiac death (scientific evidence indicates that alcohol abuse can injure the
myocardium and cause a dangerous arrhythmia) (Leon et al.2005).
Many Cancers, such as Liver Cancer, Stomach Cancer, are significantly correlated to Alcohol
abuse.
In terms of morbidity, the prevalence of mental disorders in heavy users is twice as high as in the
general population.
Among other behaviors that compound the alcohol problem in Russia are drinking alcoholic
substances not intended for consumption, such as perfume and medicine, and days-long binging
(McKee 2005).
Sources: McKee M. Suzcs S. Sarvary A. Adany R. Kiryanov N. Saburova L. Tomkins S. Andreev E. Leon DA. The composition of surrogate
alcohols consumed in Russia. [Journal Article] Alcoholism: Clinical & Experimental Research. 29(10):1884-8, 2005 Oct.
Malyutina S. Bobak M. Kurilovitch S. Gafarov V. Simonova G. Nikitin Y. Marmot M. Relation between heavy and binge drinking and all-cause and
cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study. [Comparative Study. Journal Article. Research Support, Non-U.S. Gov't]
Lancet. 360(9344):1448-54, 2002 Nov 9.
Alcohol-related harm
• An examination of the many factors
involved can demonstrate an effect on:
crime, disability, absenteeism, family,
violence, injury, neonatal, infectious
disease (sexual behavior and
immunosuppression), traffic accidents,
NCDs/health care, and poverty
Alcohol–related HARM: the
cost to Europe
Crime damage
€6bn
Traffic
accidents
damage
€10bn
Health
€17bn
Crime defensive
€12bn
Crime - police
€14bn
Unemployment
€14bn
Treatment/
prevention
€5bn
Mortality
€36bn
Absenteeism
€9bn
Total tangible costs – €125bn
Report on Alcohol in Europe (Anderson and Baumberg), June 2006
The Affects on Life Expectancy
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Life expectancy at birth for men
fell by over 6 years in Russia
between 1989 and 1994.
Data from the World Health
Organization (WHO) show that it
is working-age mortality that has
led reductions in life expectancy
Russian adults also experience
lower healthy life expectancy
Russian women live
approximately 11 years longer
than Russian men.
In 2003, cardiovascular diseases,
cancer, and injuries accounted for
78 percent of deaths
Strategies for addressing alcohol
related harm
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Pricing and Taxation
Regulating the Physical Availability
Modifying the Drinking Context
Drinking-Driving Countermeasures
Regulating Alcohol Promotion
Education and Persuasion Strategies
Treatment and Early Intervention Services
The effect of the Mongolian context
• Major difference between males and females in
mortality rates (12.49/10,000 versus
9.64/10,000) is due to injuries/violence (25%
versus 8%)
• Over 60% of all domestic violence and almost
50% of all divorces are alcohol-related
• 80% of those in prison are there for alcoholrelated issues
• 1 Point of Sale for every 270 people in Mongolia,
the most in the world
Alcohol Consumption Among
Young People in Mongolia
And yet the legal drinking age is 21!
Mongolian Ministry of Health. (2006). EPIDEMIOLOGICAL STUDY ON PREVALENCE OF ALCOHOL
CONSUMPTION, ALCOHOL DRINKING PATTERNS AND ALCOHOL RELATED HARMS IN MONGOLIA