Mourning after: young drinkers face epidemic of early death

Analysis: Growing prevalence of binge drinking among women and the young has led to a huge increase in alcohol-related deaths in Britain

Going out to the pub is the single most popular social pastime in Britain. Even for those who never prop up a bar, drinking is enjoyed by adults of all ages, all classes and both sexes. Alcohol is the most widely used social lubricant, helping us to relax, reducing our inhibitions and enhancing enjoyment.

But there is a price for drinking and our livers are paying it. Deaths due to excessive drinking have doubled in 20 years, mostly due to chronic liver disease and cirrhosis. The rise has been particularly steep since the early 1990s and the signs are that it is accelerating.

In the year to 2001, the death rate rose faster than in any year since 1979, the latest figures reveal. They were published yesterday by the Office for National Statistics (ONS).

More worryingly, the age of the victims is getting younger. Death rates from alcohol- related diseases have tripled among both men and women aged 25-44 between 1979 and 2000. A decade ago the peak age for deaths was in the early 70s for both men and women. Latest figures for 1998-2000 show the peak age has now dropped to the late fifties.

Men have always been heavier drinkers than women and die from the effects of alcohol in greater numbers, but women are catching up. Death rates among women in 1998-2000 were only slightly below those among men in 1991-93. Peter Goldblatt, chief statistician for ONS, said: "Women are about 10 years behind."

The ONS figures show deaths from alcohol-related diseases grew from 2,506 in 1979 to 5,543 in 2000. But the damage wreaked on the body by drinking is not the only way in which alcohol can hurt. Alcohol can kill in many other ways, contributing to road and other accidents and violence. The charity Alcohol Concern estimates total deaths caused by drinking at 33,000 a year.

For people who take care when they drink, the potential damage they might be doing to their bodies is the most important consideration. But here, the message is not simple. Unlike tobacco, there is no clear antithesis between alcohol and health. Smoking causes fatal diseases but drinking, in moderation, can protect against them.

On balance, people who drink up to the recommended limits of three units a day for men and two units for women are likely to live longer than the teetotaller – a unit being half a pint of beer, a glass of wine or a measure of spirits. The main reason is the protective effect of moderate amounts of alcohol against heart disease.

But a quarter of men and 17 per cent of women drink above these limits and a small proportion – one in 16 of both sexes – drinks very heavily indeed. The heavy drinkers are the ones taking a gamble with their livers and their lives.

An hour is needed for the liver to metabolise a half-pint of beer or the equivalent. After a heavy drinking session, 12 hours might pass before it gets back to normal. If the liver does not get the rest it needs it suffers gradual but progressive damage, which results ultimately in cirrhosis. That is why doctors recommend "drink holidays" – not holidays for drinking but holidays from drinking. One or two drink-free days a week can stop the liver from becoming overloaded. More than 85 per cent of all deaths from alcohol-related disease are caused by chronic liver failure and cirrhosis

Like smoking, heavy drinking is a form of slow suicide. The damage to the liver is cumulative and cirrhosis can take decades to develop. ONS researchers say the recent rapid increase in deaths reflects changes in drinking habits from 20 or 30 years ago. The accelerating death toll is almost certainly linked to the doubling of the consumption of alcohol between 1950 and 1979.

Although drinking overall has continued to increase, the proportion of heavy drinkers has remained largely unchanged since then, according to ONS. Between 1988 and 2000, the proportion of men drinking more than 51 units a week – equivalent to more than 25 pints – has remained at 6 to 7 per cent. The number of women who indulge in heavy drinking has risen sharply, with 6 per cent downing more than 26 units a week in 2000, up from 4 per cent in 1988.

Some researchers believe the amount of alcohol drunk only partly explains the rise in deaths. The style of drinking, the type of alcohol, changing habits in the young and other factors affecting the liver, such as infection, may all play a part.

A prime suspect is the growth of binge drinking, which campaigners say is now at epidemic levels. A survey in the late 1990s found a million men and 190,000 women said they got drunk at least once a week – and those were the ones who admitted it. When asked what they meant by drunk, most said "not in control".

Worries over binge drinking have focused on the increased risk of accidents to people when drunk and led the Government to alter its advice on safe drinking from a weekly to a daily limit for the number of units. The aim was to discourage those who thought that by saving their units up to the weekend and downing them in one session they were getting the maximum bang from the government-prescribed dose.

Binge drinking might also be behind the rise in cirrhosis. The switch from beer to wine since 1980, the popularity of cocktails and the predilection for spirits among the heaviest drinkers may also impose an extra burden on the liver.

In addition to alcohol, cirrhosis can be caused by viral infection and research has shown a rise in the number of people infected with hepatitis C over the past 40 years. The infection is easily passed among drug users via shared needles and the virus is thought to speed the development of liver failure among drinkers. The ONS says that drug use in the late 1960s to early 1980s may therefore be starting to contribute to increased alcohol-related deaths in those now aged from 40 to 60.

But alcohol is the main killer and it is striking at ever- younger ages. The greatest increases in death rates were among those born since the middle of the 20th century. The death rate for men aged 45-64 from alcohol-related diseases exceeded that for the over-65s for the first time in 1996 – and is now 30 per cent above it. For each succeeding generation the risks are growing.

"Recent trends in alcohol mortality", Health Statistics Quarterly, Spring 2003, ONS.