Drinking patterns, dependency and life‐time drinking history in alcohol‐related liver disease

Abstract

Aims To examine the hypothesis that increases in UK liver deaths are a result of episodic or binge drinking as opposed to regular harmful drinking. Design A prospective survey of consecutive in-patients and out-patients. Setting The liver unit of a teaching hospital in the South of England. Participants A total of 234 consecutive in-patients and out-patients between October 2007 and March 2008. Measurements Face-to-face interviews, Alcohol Use Disorders Identification Test, 7-day drinking diary, Severity of Alcohol Dependence Questionnaire, Lifetime Drinking History and liver assessment. Findings Of the 234 subjects, 106 had alcohol as a major contributing factor (alcoholic liver disease: ALD), 80 of whom had evidence of cirrhosis or progressive fibrosis. Of these subjects, 57 (71%) drank on a daily basis; only 10 subjects (13%) drank on fewer than 4 days of the week-of these, five had stopped drinking recently and four had cut down. In ALD patients two life-time drinking patterns accounted for 82% of subjects, increasing from youth (51%), and a variable drinking pattern (31%). ALD patients had significantly more drinking days and units/ drinking day than non-ALD patients from the age of 20 years onwards. Conclusions Increases in UK liver deaths are a result of daily or near-daily heavy drinking, not episodic or binge drinking, and this regular drinking pattern is often discernable at an early age.

Impact of minimum price per unit of alcohol on patients with liver disease in the UK

“…We have previously reported a mean of 114 cl alcohol/week in patients with alcohol-related cirrhosis. 8 A French study found a mean consumption of 165 cl/week in patients with cirrhosis and 248 cl/week in patients of an MUP on liver-related mortality. The mean intake of 145 cl alcohol/week in our harmful drinking patients with liver disease compares with a mean of 71.4 units for the harmful category of drinkers from the General Lifestyle Survey (2009) 30 used in the Sheffi eld model.…”

“…The study was performed in two cohorts by trained fourth-year medical students using validated alcohol assessment tools, as previously reported. 8 The main study cohort (n=204 in fi nal analysis) was recruited from 16 December 2012 to 1 April 2013 (excluding weekends and university holidays), when undergraduate student researchers were available to attend clinics and liver wards. Researchers had no knowledge of the underlying liver diagnosis before they approached patients.…”

“…Data are not structured so as to be able to compare drinking levels between alcohol-related liver disease (ALD) and other types of liver disease; the alcohol consumption in low-risk and hazardous drinking patients with ALD does not reflect lifetime drinking patterns, which have been reported for some of this cohort previously. 8 these values against the prices/unit obtained from patient questionnaires (questions on weekly expenditure and drinking diary) in order to confi rm that the fi gures we obtained were realistic and corresponded to the price range of alcohol in the shops. This proved to be the case, with prices corresponding closely to either average or lowest possible prices in different categories of drinking hazard.…”

“…8 Patients were classifi ed into the drinking grades used by the Offi ce for National Statistics for England and Wales 2 and the Sheffi eld Alcohol Policy Model. 5 With one unit of alcohol in the UK equal to one centilitre (cl) of pure alcohol, the grades were: moderate or low risk (0-14 cl and 0-21 cl alcohol/week for women and men, respectively), hazardous (15-34 cl and 22-49 cl alcohol/week) and harmful (≥35 and ≥50 cl alcohol/ week).…”

Acceptability of screening for early detection of liver disease in hazardous/harmful drinkers in primary care

“…Adding to the confusion is the growing awareness of the role of binge or episodic drinking in ALD, 36,37 which contradicts other reports that it is a steady pattern of drinking daily or near daily heavy drinking which is particularly hazardous. 38 This is likely compounded by confused messages in the popular media 39 and a dearth of widespread and consistent GP-based education and counselling. 40 Possibly arising from this confusion, participants described the difficulty of knowing what they were meant to adhere to in terms of safe drinking, relying instead on very individual definitional criteria and safe drinking guidance grounded in their own beliefs and experiences, and this has been noted elsewhere.…”