Adverse Consequences of
Drinking

Adverse consequences of drinking include social, legal, and medical problems that occur as a result of alcohol consumption. As noted earlier, one does not have to be dependent on alcohol to experience detrimental effects of drinking; even isolated episodes of intoxication can result in traffic accidents or falls that lead to serious injury or death.

Morbidity and Mortality

Vital statistics that capture health consequences of drinking provide an economical method of monitoring trends in the prevalence of certain adverse alcohol-related effects. Through its Alcohol Epidemiologic Data System, NIAAA's Division of Biometry and Epidemiology regularly produces surveillance reports on U.S. trends in alcoholrelated morbidity and mortality. The National Hospital Discharge Survey (NHDS) also serves as a source of data on alcohol-related morbidity (Caces et al. 1991). Only those patients diagnosed as having diseases directly caused by alcohol use, such as alcoholic cirrhosis of the liver, are counted in NHDS reports. Diseases or injuries indirectly attributable to alcohol are not reported in these figures, thus underestimating the total effect of alcohol on hospitalization in the United States. Department of Veterans Affairs and other Federal hospitals are excluded from the NHDS, as are hospitals having an average length of stay of 30 days or more. Rates are based on patients aged 14 and older and may reflect multiple discharges for patients hospitalized more than once in the same year. Up to seven discharge diagnoses per patient are listed; estimates are limited to diagnoses directly related to alcohol, that is, specific alcohol use disorders (alcohol psychoses, alcohol dependence, and nondependent alcohol abuse) and chronic alcoholic liver disease and alcoholic cirrhosis.

Caces et al. (1991) found that approximately 28,452,000 discharge episodes for persons aged 14 and older from short-stay hospitals were reported for 1989. Of these, approximately 379,000 (1.3 percent) had a first-listed alcohol-related diagnosis; nearly three times as many, approximately 1,022,000 (3.6 percent), had an alcoholrelated diagnosis among the seven diagnoses listed. Assessment of NHDS data collected between 1979 and 1989 indicates that the percentage of hospital discharges involving patients

with a principal alcohol-related diagnosis remained fairly constant during this 10-year period. In contrast, the percentage of patients with any mention of alcohol-related morbidity started to increase in 1984. It is not clear, however, whether this increase was related to an actual increase in alcohol-related morbidity among hospital patients or to a greater awareness among physicians of alcohol-related morbidity.

The primary chronic health hazard associated with alcohol use, cirrhosis of the liver, contributes significantly to death as well as illness.

These findings may represent an underestimation of the prevalence of alcohol use disorders among hospitalized persons. In an effort to more closely examine such prevalence rates, UmbrichtSchneiter et al. (1991) administered two screening instruments for alcohol abuse (the CAGE and the SMAST, see Chapter 13, Screening and Brief Intervention) to subjects on admission to a large teaching hospital, and compared the screening results with the patients' discharge summaries (the source frequently used to study the hospitalized population). Findings indicated that only 1.4 percent of subjects carried an alcohol-related primary diagnosis at discharge, and another 6 percent had been given a secondary (but no primary) alcohol-related diagnosis; an additional 15 percent of the subjects screened positive for alcohol abuse but had no discharge diagnosis consistent with the screening result. Using these methods, the prevalence rate was found to be 22.4 percent rather than the 7.4 percent suggested by analysis of discharge data alone. It is noteworthy, however, that screening instruments are used to detect potential or developing alcohol problems in individuals; these instruments are not used to establish a diagnosis. Moreover, the CAGE and SMAST do not differentiate current and past alcohol problems. The authors concluded that medical care could be improved and prevention strategies implemented if screening for alcohol problems were done routinely in hospitalized persons.

The primary chronic health hazard associated with alcohol use, cirrhosis of the liver, contributes significantly to death as well as illness (see Chapter 8, Effects of Alcohol on Health and Body Systems). Cirrhosis was ranked as the