Alcohol can be described as a psychoactive substance with dependence-producing properties and is responsible for a considerable burden of death, disease and injury in Ireland. A recent report by the Health Research Board provides an overview of the current situation in Ireland regarding alcohol consumption and harm and trends over time as well as outlining the available policy responses to alcohol-related harm.1 The data in this report were based predominantly on published Irish literature and existing information systems.

Alcohol consumption in Ireland

Ireland has a high level of alcohol consumption and many Irish people engage in harmful drinking patterns. In 2014, Irish drinkers consumed 11.0 litres of pure alcohol each. This is equal to 29 litres of vodka, 116 bottles of wine or 445 pints of beer. As 20.6% of the adult population abstain from alcohol completely, those who drink alcohol consume even greater quantities. Survey data from 2013 indicate that drinkers in Ireland consume alcohol in an unhealthy pattern: 37.3% of drinkers engaged in monthly risky single-occasion drinking (RSOD), more commonly known as binge drinking, in the previous year; 54.3% of drinkers had a positive score on the AUDIT-C screening tool; 6.9% scored positive for dependence, which indicates that there were somewhere between 149,300 and 203,897 dependent drinkers in Ireland in 2013. At least three-quarters of the alcohol consumed was done so as part of a binge-drinking session.

There has been a shift from consuming alcohol in on-trade premises to consuming alcohol bought from the off-trade, which is reflected in Irish licence data. Between 1998 and 2013, the number of pub licences in Ireland decreased by 19.1% (from 10,395 to 8,402). During the same period the combined number of wine and spirits off-licences increased by 377% (from 1,072 to 5,116). In 2013, there was one licence per 197 adults aged 18 years and over.

Alcohol-related harm in Ireland

Alcohol-related morbidity

Alcohol-related morbidity was analysed using data from the Hospital In-Patient Enquiry (HIPE) scheme. The analysis included all alcohol-related discharges that were either wholly attributable (alcohol is a necessary cause for these conditions to manifest) or partially attributable (alcohol must be a component cause). The number of wholly attributable alcohol-related discharges increased from 9,420 in 1995 to 17,120 in 2013, an increase of 82%, with males accounting for 72.4% of discharges and females accounting for 27.6% of discharges. In 2013, alcohol-related discharges accounted for 160,211 bed days or 3.6% of all bed days that year, compared with 56,264 bed days or 1.7% of the total number of bed days in 1995. The mean length of stay increased, from 6.0 days in 1995 to 10.1 days in 2013, which suggests that patients with alcohol-related diagnoses are becoming more complex in terms of their illness. Alcoholic liver disease was the most common chronic alcohol disease, accounting for approximately four-fifths of all alcohol-related chronic diseases in 2013. The rate of these discharges increased from 28.3 per 100,000 adults aged 15 years and over in 1995 to 87.7 in 2013, an increase of 210%. The most pronounced increase was among 15‒34-year-olds, albeit from a low base.

The number of discharges with a partially attributable alcohol condition increased between 2007 and 2011 by 8.8%, from 52,491 to 57,110. The estimated cost to the health system in 2012 of dealing with inpatients with either a wholly or partially alcohol-attributable condition was €1.5 billion, which accounted for 11.0% of all public healthcare expenditure that year. The majority of these costs (77.4%) were associated with discharges with partially attributable alcohol conditions. This excludes the cost of emergency cases, GP visits, psychiatric admissions and alcohol treatment services.

Alcohol-related mortality

Alcohol mortality data from the National Drug-Related Deaths Index (NDRDI) were analysed for 2008‒2013. There were 6,479 alcohol-related deaths between 2008 and 2013. In 2013, there were 1,055 deaths, which is an average of 88 deaths per month or three deaths per day. Overall, 73.2% were aged under 65 years, which may be described as of working age. From 2008 to 2013, medical causes accounted for 4,462 (68.9%) of alcohol-related deaths, poisonings accounted for 1,045 (16.1%), and traumatic causes accounted for 972 (15.0%) of alcohol-related deaths, with a similar pattern for males and females.

Alcohol and the workplace

In Ireland, alcohol is associated with harm in the workplace. According to the National Alcohol Diary Survey 20132, unemployed people were twice as likely as employed people to have a positive DSM-IV score for dependence. Among those who were unemployed, 1.4% reported that they had lost their job as a result of their alcohol consumption; when the experience among this representative sample is applied to the unemployed population, it is possible that 5,315 people on the Live Register in 2013 had lost their job due to alcohol use. The survey also indicated that 4.2% of employed respondents reported that they had missed days from work due to their alcohol use in the 12 months prior to the survey. On average, each of these respondents missed 3.3 days. Based on 2013 employment figures, we can extrapolate that of the 1,869,900 persons in employment, 78,536 missed work in the previous year due to alcohol. If we assume that the average daily cost is €159.32 per person, this suggests that the direct cost of alcohol-related absenteeism was €41,290,805 in 2013. This estimate does not include the costs associated with reduced productivity at work or the cost of alcohol-related injury at work. Of those who reported missing work due to alcohol, 82.6% engaged in monthly binge drinking and 40.8% scored positive for alcohol dependence.

Conclusion

The data presented in this overview indicate that harmful drinking has become the norm in Ireland. The health of Irish people would improve if we reduce overall alcohol consumption and address risky drinking patterns. There is a comprehensive body of international evidence regarding the most effective policies to reduce alcohol-related harm. These include making alcohol more expensive, restricting its availability and reducing its promotion. The new Public Health Alcohol Bill contains these evidence-based measures and needs to be implemented without delay.

1. Mongan D and Long J (2016) Overview of alcohol consumption, alcohol-related harm and alcohol policy in Ireland. Dublin: Health Research Board. https://www.drugsandalcohol.ie/25697/
2. Long J and Mongan D (2014) Alcohol consumption in Ireland 2013: analysis of a national alcohol diary survey. Dublin: Health Research Board. www.drugsandalcohol.ie/22138