CARL O'BRIEN
Irish people are among the heaviest consumers of alcohol in Europe. One in four deaths of young men aged 15 to 34 is attributed to alcohol, and it is costing the health service millions each year. So what can we do about it?
STANDING IN the kitchen, Charlotte O’Sullivan saw her son’s face in bright daylight for the first time in months. She began to panic. “His skin was turning yellow,” she says. “It was awful. I’d never seen anything like it. He said to me, ‘I’m dying.’ I didn’t believe him. I told him of course he wasn’t but that he needed to get help . . . He was young and he was ill, but we never thought his life was at risk.”
Her son, Sammy Lundy, had retreated from his friends and family. He would stay in the sitting room of the family home all day with the curtains closed and the lights off, drinking cans of beer or cider. It was as if a darkness had descended on him, his mother says.
In the beginning he would have four or five cans a day; later it could be anything up to 12. It helped him to sleep, he said, though his mother believed there was another reason: he was drinking to drown out disturbing thoughts and voices in his head.
Sometimes he could be delusional, believing he was related to gangland figures or that the Garda was after him. Psychiatric services had diagnosed him as having anger-management problems.
Frightened by his deterioration, his mother decided the next day to call an ambulance when she was out. Sammy had always refused to seek medical help, but this time it didn’t matter. He needed help, whether he wanted it or not.
When she arrived at the house, however, the door was open and the lights were on but there was no sign of him. She drove around the area, looking for him, as her sense of dread grew deeper. A short time later, his body was found in the front garden of a house around the corner. He was 26.
In the coroner’s court a few months later, the assistant State pathologist Dr Margaret Bolster found that Sammy had died from liver disease. He was deeply jaundiced, with an enlarged liver showing signs of steatosis (fatty deposits) and early cirrhosis (scarring).
This damage is reversible if the person stops drinking. But if a person continues, permanent scarring of the liver can develop, which is irreversible.
“It’s quite frightening the amount of damage one can do to one’s liver in a relatively short time of drinking excessively,” Bolster says. “Five pints per day will lead you to severe liver disease and sudden death at any time. You can do this damage in four years of consistent heavy drinking.”
SAMMY’S STORY isn’t uncommon. Most days at coroners’ courts around the country, drink is mentioned alongside the names of cases due to be heard that day.
Deaths linked to such drugs as cocaine attract headlines in the media, but alcohol-related deaths rarely do. Often they simply aren’t reported.
Yet the number and nature of these deaths are frightening. The Health Research Board published a report this week that showed the number of people dying from alcohol consumption is increasing and young men are most likely to be the victims.
Six hundred and seventy-two people died from alcohol-related poisoning between 2004 and 2008, with the numbers increasing from 125 in 2004 to 150 in 2008. In addition, there were 3,336 deaths among alcohol-dependent people during the same period who died in circumstances with strong links to alcohol. The principal causes were suicide, stroke, cancer and liver disease.
The Health Research Board’s senior director, Dr Suzi Lyons, says that Irish people are among the biggest drinkers in Europe and significant numbers consume alcohol in a way that is harmful to their health by, for example, binge drinking.
“What we cannot do in this paper is estimate the social cost of premature mortality, the detrimental effect on the family and the burden on society,” she says.
But the cost in terms of young lives is clearer. Figures compiled by the Department of Health’s chief medical officer show that one in four deaths in young men aged 15 to 34 is due to alcohol, compared with one in 12 deaths as a result of cancer and one in 25 deaths due to circulatory disease.
“We can no longer afford to ignore the fact that so many more of this country’s young people are dying from alcohol than anything else,” says Fiona Ryan, director of the lobby group Alcohol Action Ireland. “We need to stop turning a blind eye to the all-too-high price we all pay for alcohol in this country.”
THE PREVALENCE OF alcohol means it is seen as a relatively benign drug. But what is the real danger it poses to the typical drinker?
Light to moderate drinking can have a beneficial effect in that it helps prevent heart disease and stroke, according to the World Health Organisation. “However, the beneficial cardio-protective effect of drinking disappears [if there is occasional] heavy drinking,” it says.
Bolster says that even a weekend of heavy drinking can cause fatty changes to the liver that increase the risk of sudden death. The fatty changes, which are the first stage of liver disease, are reversible once consumption of alcohol stops. However, the second stage of liver disease – cirrhosis – is irreversible.
Consumption of alcohol above the recommended ipper limit of 21 units per week for men, and 12 to 14 units per week for women, even for a few months, can lead to fatal consequences, she says. When you consider that a large glass of wine or a pint of beer contains about three units, these are worrying figures for many who consider themselves modest drinkers.
In tackling the problem of overconsumption, there are a few simple solutions. One of the most effective ways to curb drinking, especially among young people, is to raise taxes. “Yet not enough countries use these and other effective policy options to prevent death, disease and injury attributable to alcohol consumption,” the World Health Organisation says.
In Ireland, alcohol-control policies are relatively weak and have remained a low priority for successive governments.
There has been plenty of talk about tackling alcohol abuse but little meaningful action. There have been two strategic task force reports on alcohol, but the key recommendations to increase prices, reduce the number of places it can be bought and tighten controls on advertising remain largely unimplemented. For example, plans to strictly regulate the marketing of alcohol by the Fianna Fáil-Progressive Democrats government were ditched in favour of allowing the industry to regulate itself.
The benefits of even a modest reduction in alcohol consumption would be significant.
Prof Joe Barry, co-author of a study published in the
Irish Medical Journal , estimates that the total cost of hospital inpatient beds allocated to those with alcohol-related problems is more than €850 million over five years. His study estimates that if Irish people halved their alcohol consumption, the costs to the exchequer for hospital beds would drop by up to €80 million a year.
Highlighting the dangers of alcohol isn’t an easy sell, though. The Health Research Board says there is no published evidence that school-based programmes are resulting in a reduction in alcohol-related harm, while it is probable that education campaigns and warning labels are not reducing alcohol-related harm.
“The main issue is that the public thinks of alcoholics primarily,” says Barry. “But most people who die of alcohol-related causes are not alcoholics but, rather, are heavy drinkers. This is an important take-home message.”
SAMMY’S MOTHER, Charlotte, is determined her son will not have died in vain. She sometimes feels guilty that she didn’t act sooner to help address the dangers posed to Sammy by alcohol, but she also feels let down by the health authorities.
The underlying issue for Sammy was his undiagnosed mental-health problems. Yet when she went for help, she felt the psychiatric services didn’t take his condition seriously enough. In addition, because he was over 18, she was unable to make him get medical attention or treatment.
“I know the drink killed him, but that was just the end process of what started to kill him, his mental-health problems,” Charlotte says. “If he had got the help he needed, he would still be alive today. I firmly believe that. What does it take for someone to sit up and take notice? There are lots of young people out there like Sammy who need some help.”
Five pints per day will lead you to severe liver disease and sudden death at any time
