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Abstract
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Tomáš Formánek and colleagues have used the Czech national registers to shed light on the contribution of alcohol and substance use disorders to the risk of mortality following a range of physical health conditions. The scope is impressive, and while the general results of increased mortality are unsurprising, the magnitude of 10-40 life-years lost for most of the physical health conditions they investigated is both compelling and concerning.
Some of this excess mortality can be attributed directly to the use of alcohol and other substances. Direct negative effects have been observed for alcohol and other substances on most organ systems, including the heart, liver, and pancreas. However, several other factors also contribute to the excess mortality. Of the WHO-defined major risk factors for early mortality, tobacco smoking and sedentary lifestyle are overrepresented in populations with substance misuse. Living in deprived areas, living under poor conditions, and social isolation have been linked to excess mortality, and such situations are common for people with substance misuse. Substance misuse is further associated with prejudice and stigma, reducing the likelihood of seeking medical care and of receiving adequate care once contact has been established. Finally, it is also likely that both common and severe mental illness have a role in the excess mortality.
The study by Formánek and colleagues clearly indicates that something needs to be done. The question becomes what can be done and how. Seeing as so many different factors can increase the risk, a stepped approach is probably necessary. The first step will be prevention through legislation, which requires political will. For many years, alcohol has become less socially acceptable; for example it is no longer considered appropriate to drink in workplaces. Continuing this move away from alcohol consumption being perceived as normal may be an important path, and public alcohol advertisement or sponsorships of sporting teams should be banned. In this light, the increasing normalisation of cannabis use is of concern.
Language: en |