End-stage liver disease crisis in teen drinkers
Expert warns of dangers of cheap, strong alcohol as number of young patients with cirrhosis rises
Published 16/06/2013 | 05:00
LIVER disease caused by drink is now a major crisis in this country with three main groups increasingly developing cirrhosis, a life-threatening condition. Men and women in their 20s who have binged on cheap strong beer, cider and spirits since their teens, 40-something men who are heavy daily pint drinkers and professional women who curl up on the couch each night with a bottle of chilled Chardonnay are all at risk.
Dr Stephen Stewart, consultant hepatologist and director of the Centre for Liver Disease in the Mater Hospital, says we have to increase the price of drink, curb the widespread availability of alcohol, which is on sale everywhere from supermarkets to garage forecourts, and end the incessant promotion of alcohol, particularly sponsorship of sport, if we want to stop the liver disease epidemic.
When Dr Stewart came back to Ireland in 2010 after 10 years away completing a doctorate in liver disease caused by drink and working as a liver transplant doctor, he was profoundly shocked by what he found.
"The biggest difference between us and countries like France is that in Ireland, in Scotland and in England, the incidence of mortality from cirrhosis of the liver is dramatically increasing while in other countries it is going down. I now spend significantly more time managing young people with life-threatening alcohol-related problems than I did in 1999," he explains.
That means he is treating young men and women in their mid-20s for late-stage liver disease. Cirrhosis can be well advanced before it is diagnosed and occurs when substantial amounts of scar tissue replace normal tissue in the liver. Symptoms include fluid build-up in the legs, fatigue, yellowing of the skin, itching, profuse nosebleeds, bleeding from enlarged veins, weight loss, muscle wasting, stomach pain, frequent infections and confusion. There's also an increased risk of liver cancer.
"You do not develop alcohol cirrhosis in six months or a year or even two years. Really, it takes a minimum of seven or eight years of drinking to develop cirrhosis. So if I am seeing people in their mid-20s, then they started drinking heavily in their mid-teens," he says.
Dr Stewart is a member of the Royal College of Physicians of Ireland Policy Group on Alcohol and is speaking at a crucial stage of long-signalled reform on alcohol, driven initially by former junior minister Roisin Shortall and now being brought to a Cabinet sub-committee this week by junior health minister Alex White.
"There's already signs of the Government weakening on the issue in the face of aggressive lobbying by the drinks industry and other groups including sports organisations. It's already clear that sports minister Leo Varadkar is pushing for time to allow sporting organisations to adjust to alternative revenue streams in the event of a ban on sponsorship of sports events by drinks companies.
Though Dr Stewart believes there is a proven link between alcohol sponsorship and young people drinking earlier and heavier, it is the price of drink which he says the Government must act upon.
He points to a report by the National Drug Related Deaths Index which focuses on deaths in alcohol-dependent people. It found that in 2008, there were 88 deaths every month which were directly attributable to alcohol.
The same report also showed that between 2004 and 2008, alcohol caused nearly twice as many deaths as all other drugs combined.
It also plays a major role in suicide, especially among young men. A 2006 study showed that more than half of all people who died from suicide had alcohol in their blood. From 2000 to 2004, alcohol was estimated to be the major contributing factor in 823 suicides.
"In an average week, I would see some young people who have been drinking heavily from their mid-teens coming in with end-stage liver disease. They have been drinking very cheap, high-strength ciders and spirits since they were teenagers. Then I would see another group who are not as chaotic and haven't been drinking in such a pathological way who are maybe a little older but who drink every day and then drink all day on a Saturday and Sunday.
"Another group I would see are holding down a job and going home in the evening. If it is a man, they are having a few pints with the lads Monday through Thursday and then on Friday, Saturday and Sunday having eight to 10 pints. They tend to present a little bit older, maybe in the 40s or 50s.
"Then, also, there is another typical population that has really increased over the last 10 or 15 years. That is the middle aged, employed, middle-class woman who has got into the habit of drinking wine every evening and has got into the habit of cocktails and shots at the weekend. But basically the problem is the drinking at home every day," he states.
He paints a devastating portrait of the type of medical problems he is tackling among young people.
"These are the emergencies. That's the 25 to 40-year-old group coming in with the end stage of liver disease. When they come in, it's complicated. They don't just have one problem but four or five. They may be vomiting blood. They may have clotting problems. They may be septic. They have jaundice. They have ascites [fluid in the abdomen] and they spend a long period in our intensive care unit and use up a lot of financial resources and our expertise."
He points to a change in our drinking culture. He believes we used to have a "festival culture" – drinking at weekends, bank holidays and vacation. Then we embraced a European-style of drinking small amounts all the time and at home. But instead of replacing our 'festival' culture, it was just added on.
"Personally I believe the biggest problem is the availability of cheap, strong alcohol. If we could do one thing it would be to increase the minimum price of the unit of alcohol. That would work immediately. The beauty of increasing the price is that it has an impact straight away.
"Look at yourself. When you go to a country on holiday that has very cheap alcohol, you drink more. When you go to countries like Sweden or Norway, where alcohol is expensive, you drink less.
"There is no relationship quite like the price of alcohol versus the consumption. Canadian research found that when British Columbia introduced a 10 per cent increase in the average minimum price for all alcoholic beverages, there was a 31.72 per cent reduction in alcohol attributable deaths," Dr Stewart says.
He rails against the constant availability of alcohol at every turn. "There are three issues, pricing, availability and promotion. The availability of this strange and dangerous product in shops, at petrol stations, beside the nappies in supermarkets. Some of the supermarkets are basically alcohol sales outlets that just happen to sell some food," he says.
Dr Stewart would like to see a return to people drinking in pubs, which he believes is far safer than drinking in the home.
"The pub and the publican acted as a safety net. A move away from home drinking and back to pub drinking would be a move in the right direction," he says.
He is a sports fan himself but says there is incontrovertible evidence of linkage between damaging drinking and sports sponsorship by drinks companies.
"Firstly, sport is a great agent for health in this country. People are sport crazy. To link alcohol with that is defective and counter-intuitive. We have evidence that alcohol promotion through sport encourages the young to start drinking and encourages young people who are already drinking to drink even more," he argues.
Sports minister Leo Varadkar is keen to ensure a sponsorship ban does not affect the viability of events such as the IRFU's bid to host the Rugby World Cup in 2023 and is seeking to delay an outright ban.
But according to Dr Stewart, in 10 years' time, we will look back at the sponsorship of sport by drinks companies with the same incredulity with which we now look back on the sponsorship of sports events by cigarette firms.
A report from the Irish Cancer Society which found that Irish men are more at risk of getting and dying from cancer than women stated that among the major contributory factors was that men drink more than women as well as smoke more, exercise less, have worse diets and higher levels of obesity.
Men don't go to the doctor as quickly as women if they find something wrong and as a result, have higher mortality rates from cancers.