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Epidemiology for public health - ISS

Alcohol Prevention Day 2023

Alcohol consumption is responsible for approximately 1 million deaths each year in Europe, and for 5.1% of years of life lost worldwide. Growing scientific evidence on the negative health effects of alcohol has helped build consensus on the need to address the hundreds of conditions that are known to be wholly or partially attributable to even moderate alcohol consumption. In 2021, almost 8 million people in Italy were risky drinkers, 3.5 million were binge drinkers and 750,000 consumed alcohol at levels that were harmful to their health, but were not receiving treatment under the national health system. Publicly-funded diagnostic, treatment and rehabilitation services were only offered to 63,000 people with alcohol dependence, that is 8.5% of all the individuals who actually needed them. The most vulnerable groups included women, minors and the elderly. These are some of the findings of the assessment prepared by the National Observatory on Alcohol (Osservatorio Nazionale Alcol - ONA) of the Istituto Superiore di Sanità (ISS), in accordance with the mandate set out in the Prime Ministerial Decree of 3 March 2017, using the information and data presented in the Ministry of Health’s annual report to the Parliament, pursuant to Law n.  125 of 2001. The findings were published in the ISTISAN 23/3 report “Alcohol epidemiology and monitoring in Italy and its Regions. An assessment by the National Observatory on Alcohol of the impact of alcohol consumption for the implementation of the activities of the National Alcohol and Health Plan and the National Prevention Plan. 2023 report”, and presented during the 2023 Alcohol Prevention Day (APD) event on 19 April 2023.

 

Supported and funded by the Ministry of Health, Alcohol Prevention Day, now in its twenty-second year, was held and promoted in close cooperation with the Italian Alcohology Society (SIA), the Italian Association of Local Alcohol Support Clubs (AICAT) and Eurocare. It provides a forum to discuss the main initiatives undertaken throughout the year (whether promoted by the Ministry of Health or carried out in collaboration with SIA, AICAT and Eurocare), and especially during the month of April, which is Alcohol Awareness Month. Through the WHO technical and scientific advisory groups and collaborating centres, and in cooperation with the Regional Alcohol Centres and services, APD ensures the availability of data, experiences and materials aimed at developing and fostering a suitable culture of prevention based on the highest possible levels of health protection, awareness and personal and social responsibility, and on combating “fake news”.

 

Further reading:

  • The ISTISAN 23/3 report “Alcohol epidemiology and monitoring in Italy and its Regions. An assessment by the National Observatory on Alcohol of the impact of alcohol consumption for the implementation of the activities of the National Alcohol and Health Plan and the National Prevention Plan. 2023 report” (pdf 1.2 Mb, in Italian)

During the APD event, the ONA presented documents and materials aimed at developing and fostering a suitable culture of prevention based on the highest possible levels of health protection, awareness and personal and social responsibility:

 

Fact sheet: Risky drinkers

In 2021, one year after the start of the SARS-CoV-2 pandemic, the number of risky drinkers in Italy dropped to 7.7 million. More specifically, 20.0% of male drinkers and 8.7% of female drinkers exceeded the low-risk drinking levels recommended by the national guidelines. The observed reduction (-12.7% among men, and -7.4% among women) means that the proportion of risky drinkers was back to pre-pandemic levels, but still high. As for the most vulnerable groups, about 1,370,000 people aged 11-25 years (including 620,000 minors) were risky drinkers (18.6% of males and 12.8% of females); alarmingly, prevalence among underage girls continued to rise and was on par with that recorded in their male counterparts (7.7%). Prevention programmes should urgently be promoted in schools that (in line with WHO recommendations) are not inspired by the “responsible drinking” model, as this has proved ineffective and unsuitable for minors.

Read the Factsheet on “Risky drinkers” (pdf 919 kb, in Italian).

 

Fact sheet: Binge drinkers

In 2021, about 3.5 million people in Italy engaged in binge drinking, most of them males of all ages: that included over 24,000 11-15 year olds (1.0% of males, 0.7% of females) and over 58,000 16-17 year olds (5% of males, 4.2% of females), i.e. about 83,000 minors who should not even be allowed to buy or have access to alcoholic drinks. Despite showing a decline on the previous year, binge drinking figures were roughly back to pre-pandemic levels, especially among women. Among men, however, they fell to the lowest level in ten years. Alcohol consumption between meals dropped for the first time in the last decade (among men and women), but not enough to meet the reduction targets set out in the Prevention plans, especially with regard to minors, women and the elderly. Effective measures are therefore needed to reduce harmful drinking, through better communication of the risks of alcohol consumption, to combat “fake news” and misinformation on both traditional media and social media, and to raise alcohol awareness among minors by exclusively promoting the “zero consumption” model. Other urgent measures include: providing healthcare workers with adequate information and training on early identification and brief intervention; promoting compliance with the law by establishments licensed to sell and serve alcohol; and tighter controls to enforce the prohibition on selling and serving alcohol to minors. Read the Factsheet on “Binge drinkers” (pdf 1.1 Mb, in Italian).

 

Fact sheet: Harmful drinkers

The number of harmful drinkers in Italy fell to 750,000 in 2021, from 830,000 in 2020. This reflects a decrease among men, because the number of female harmful drinkers rose for the fourth year in a row to 300,000. Although consumption at harmful levels is indicative of an Alcohol Use Disorder (AUD) “requiring treatment” (according to the DSM-5 manual), 91.5% of harmful drinkers had no access to any form of treatment, even when this was urgently needed. The performance of the network of alcohol addiction services of the national health system is currently affected by the lack of inclusion in the Ministerial Decree 71/22, aimed at the reorganization of territorial healthcare bodies, of the departments of mental health and dependencies; as the matter stands, the following and most recent Ministerial Decree 77 envisaged the reorganization of assistance territorial structures only as “recommended” (and not compulsory) services of Community Houses with serious problems of management. Read the Factsheet on “Harmful drinkers” (pdf 919 kb, in Italian).

 

Fact sheet: Young people and alcohol

In 2021, about 1,370,000 people aged 11-25 years consumed alcohol at levels that could put their health at risk (18.6% of males and 12.8% of females). Prevalence was declining, but remained well above the target of 0% set for minors. In addition, 11.4% of males and 6.4% of females engaged in binge drinking. Clearly more needs to be done to ensure compliance with the law and enforce the prohibition on selling and serving alcohol to minors (Law n. 189 of 2012), based on their well-known inability to metabolize alcohol. In 2021, 620,000 minors (16.5% of males and 14.2% of females) were risky drinkers, who required identification and motivational counselling to help them become more aware of the risks and harmful effects of alcohol. Among young people aged 18-20 years, 72.3% of males and 62.2% of females consumed alcohol, 300,000 were risky drinkers and 279,000 were binge drinkers. About 450,000 21-25 year olds were risky drinkers (19.9% of males and 10.9% of females), and 424,000 were binge drinkers. A national strategy is urgently needed that is line with both the goals of the EU Parliament Resolution for a zero-alcohol strategy and the WHO’s long-standing recommendation that young people and their environments should be alcohol-free. Read the Factsheet on “Young people and alcohol” (pdf 794 kb, in Italian).

 

Fact sheet: Women and alcohol

The number of female risky drinkers had been rising steadily since 2014, and reached about 2,450,000 in 2021. Alcohol consumption between meals, which has become increasingly common among women, returned to pre-pandemic levels (21.7%). The prevalence of all risky drinking behaviours showed no sign of reduction: that included risky drinking (8.7%, peaking at 29% in 16-17 year olds), binge drinking (3.6%, or 3.5 million, peaking at 11.4 % in 18-24 year olds), and excessive daily consumption (6.1%, peaking at 29% in 16-17 year olds). Among women over 65, 8.4% were risky drinkers, 9.9% consumed alcohol between meals, 7.6% drank excessively on a daily basis, and 1.1% engaged in binge drinking. Among women over 85, 6.8% were risky drinkers, 6.3% drank excessively every day, 5.9% drank between meals and 0.8% were binge drinkers. Despite decreasing with age, the above prevalence rates remained within a consistent range even in the oldest age groups, which are often overlooked by prevention strategies. Read the Factsheet on “Women and alcohol” (pdf 853 kb, in Italian).

 

Fact sheet: Alcohol and the elderly

In 2021, about 2,600,000 people aged over 65 years (31.7% of males and 8.4% of females) were risky drinkers. The number of elderly women consuming alcohol was on the rise again after falling during the pandemic, as prevalence rates continued to climb back to pre-pandemic levels. The percentage of male risky drinkers remained around 30%, also in the over-85 age group (29.7%). Among men over 85, 20.5% drank between meals, 29.2% drank excessively every day and 4.1% were binge drinkers; as for women in the same group, 6.8% were risky drinkers, 6.3% drank excessively on a daily basis, 5.9% consumed alcohol between meals and 0.8% were binge drinkers. The elderly also accounted for the largest proportion of harmful drinkers (2.3% of males and 1.3% of females) not yet under the care of specialist health services and professionals of the national health system, despite being most likely to come into contact with a doctor. These findings suggest that the elderly may require more targeted prevention. Read the Factsheet on “Alcohol and the elderly” (pdf 597 kb, in Italian).

 

Fact sheet: Alcohol and hospitals

Only 3,777 (4.5%) of the 83,000 binge drinkers aged under 18 years (the legal age to drink alcohol in Italy) were seeking medical attention. As many as 72% of all people admitted to emergency departments were discharged back to their homes after acute treatment, due to the lack of referral protocols for further assessments. Emergency department and hospital admissions for conditions/with a diagnosis wholly attributable to alcohol rose on the previous year by 20.2% and 4.2%, respectively. Although access to emergency departments and availability of hospital beds were no longer limited due to the COVID-19 emergency, only a small proportion of the most vulnerable binge drinkers (minors, women, the elderly) were using the alcohol detoxification services of the national health system. Emergency department admissions, and hospital admissions and discharges, for chronic conditions and acute intoxication were on the rise again. Read the Factsheet on “Alcohol and hospitals” (pdf 841 kb, in Italian).

 

Fact sheet: Alcohol dependence and Alcohol Use Disorders (AUDs)

In 2021, the national health system was still unable to cater for the large number of harmful drinkers with alcohol use disorders, by effectively identifying them and ensuring access to the relevant diagnostic and treatment services. Only 8.5% of the 750,000 drinkers who required treatment for alcohol-related problems were under the care of local addiction services, which were unavailable during the COVID-19 lockdown and already suffering from resource and staff shortages. This leads to severe stigmatization of both existing users of publicly-funded services and individuals who, despite seeking treatment, are not using them. Systematic programmes for early identification in the general population are indispensable, and so is specific training for general practitioners, paediatricians and occupational doctors. It is essential to ensure that protocols are in place for prompt referral to the network of specialist social and healthcare services, which should be reorganized and provided with updated and uniform nationwide guidelines on prevention, treatment and rehabilitation. This is to guarantee equal support for people and families struggling with alcohol dependence. A National Alcohol and Health Plan is urgently needed that involves a radical overhaul of the treatment service network and the models to be implemented in both hospitals and the community. Read the Factsheet on “Alcohol dependence and Alcohol Use Disorders” (pdf 1.1 Mb, in Italian).

 

Fact sheet: Preventing harmful alcohol use (OECD-Italy)

Based on current consumption patterns in Italy, OECD simulations estimate that diseases and injuries caused by drinking more than 1-1.5 drinks per day lead to treatment costs equal to 0.7% of health expenditure and a reduction in the workforce productivity. Consequently, Italy’s GDP is estimated to be 0.7% lower on average between now and 2050, excluding any impact on the alcohol industry. Due to a lower GDP, and to maintain a constant public debt-to-GDP ratio, Italy has to raise additional revenues equivalent to an increase in tax of EUR 27 per person per year. Read the Factsheet on “Preventing harmful alcohol use (OECD-Italy)” (pdf 1.1 Mb, in Italian).

 

Page published: 3 May 2023

Written by: Emanuele Scafato, Claudia Gandin, Silvia Ghirini, Alice Matone, Rosaria Russo, Simonetta Di Carlo, Antonella Bacosi, Laura Martucci, Chiara Fraioli, Michele Sciotti for the “Centro Servizi Documentazione Alcol” of the National Observatory on Alcohol, National Centre for Addictions and Doping.

For more information: e-mail: alcol@iss.i