The Burden of Medical Complications of Alcohol Use Disorders

Globally, alcohol use accounts for a higher proportion of deaths in men than in women. In Australia, alcohol use contributed to the burden of 30 other diseases and injuries including 8 types of cancer and chronic liver disease. In general, younger peoples’ burden of alcohol-related illness and death come predominantly from an accident (e.g., from road traffic accidents and falls) or self-inflicted injury (e.g., suicide or attempted suicide), while in older Australians added morbidity and mortality from alcohol are attributed primarily from chronic conditions such as liver cirrhosis and cancer.  

Alcohol use disorder (AUD) is associated with more than 60 physical comorbidities and in general the risk of alcohol-related comorbidity increases in a dose-response manner. Some of the medical comorbidities are: 

Table 22.1: Short term and long-term effects of alcohol use

Short Term Health Effects of AUDs
  • Accidents
  • Intentional and unintentional injuries
  • Poisonings
Chronic Medical Comorbidities
  • Cardiovascular diseases (e.g., hypertension, cardiac dysrhythmias, and alcohol-related cardiomyopathy)
  • Gastrointestinal disorders (e.g., alcohol-related hepatitis, liver cirrhosis, pancreatitis, and gastrointestinal bleeding)
  • Musculoskeletal disorders such as osteoporosis
  • Neurologic disorders including Wernicke-Korsakoff’s syndrome, cerebellar degeneration, alcohol-related brain injury, myopathy, and peripheral neuropathy)
  • Infections (e.g., commuity acquired pneumomnia, tuberculosis (TB), sexually transmitted infections, HIV/AIDS)
  • Nutritional disorders (e.g., thiamine deficiency)
  • Metabolic disorders (e.g., hypoglycaemia and diabetes mellitus)
  • Endocrine deficiencies (e.g., reduced fertility, hypogonadism, osteoporosis)
  • Cutaneous problems (e.g., porphyria, psoriasis, eczema)
  • Cancers including liver cancer, mouth, larynx, pharynx, oesophagus, bowel, breast, skin cancer

Do health benefits from alcohol use exist?

No level of alcohol use is currently known to have health benefits. The suggestion of alcohol’s potential for a cardiovascular protective effect from low doses of alcohol (so-called “J curve”) comes from studies that suffered from methodological biases. Most recent studies of large populations, including meta-analyses, that addressed abstainer bias found that alcohol has no health benefits and increasing intake of alcohol is associated with shorter life expectancy. The suggestion of health benefit contributes to a cognitive bias that validates continued alcohol use for persons with AUDs. This negatively impacts public health efforts to reduce the harms of alcohol use at the societal level. In the treatment of AUDs, it is, therefore, relevant to address the health benefit myths, social context of AUD and health risks. 

Chapter Recommendation Grade of recommendation
22.1 It is recommended to advise patients that alcohol use has no beneficial health effects, and there is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex. A