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What is the morbidity and mortality associated with alcoholism?

A curious fact about health care in the past 50 to 70 years has not been the great technological developments that have sprung up but the general eradication of many of the infectious diseases that once took a devastating toll on the younger and older populations. Although the most dramatic improvements in morbidity and mortality in human history are attributed to improved hygienic measures (potable water, plentiful noninfected food, vaccine programs, proper waste management), the last half century has improved on those foundations to the point where the most dangerous diseases are now associated with a largesse of resources.

The total burden of disease related to chronic alcohol use accounts for 7% in North America.

The leading cause of death, cardiovascular disease, is clearly associated with our changing lifestyle, which is now largely sedentary and given to overconsumption. Cancer, the second leading cause of death, is also due to lifestyle issues, which includes not only tobacco, but also diet and exposure to environmental carcinogens as well. Thus, alcohol-related morbidity and mortality may be considered to be in good company, as there are 85,000 deaths annually attributed to its overuse, at least half from accidents directly related to it, whereas the other half from diseases associated with it. This number may seem large, but it pales in comparison to cardiovascular disease and cancer. It is another curious fact that cancer and cardiovascular diseases associated with lifestyle choices are not viewed with the same "jaundiced eye" as those associated with alcoholism.

The total burden of disease related to chronic alcohol use accounts for 7% in North America. Worldwide, the burden can be broken down into the following problems:

• Cirrhosis: 32%

• Motor vehicle accidents: 20%

• Traumatic brain injury patients that have been drinking: More than 50%

• TBI patients are three times more likely to sustain a second head injury. After their second TBI, they are eight times more likely to sustain a third head injury.

• Mouth and oropharyngeal cancers: 19%

• Esophageal cancer: 29%

• Liver cancer: 25%

• Breast cancer: 7%

• Homicides: 24%

• Suicides: 11%

• Hemorrhagic stroke: 10%

• Leading cause of death among persons under 44

A standard drink is defined as one 12-ounce beer, one 5-ounce glass of wine, or one mixed drink containing 1.5 ounces of spirits (80 proof); the relative risk for the noted maladies with consumption of four or more drinks daily is as follows:

• Cirrhosis: for men, 7.5; for women, 4.8

• Injuries: for men, 1.3

• Ear, nose, and throat cancer; esophagus cancer; liver cancer: for men, 2.8; for women, 3

Drinking more than one standard drink daily appears to increase the risk of breast cancer in women. Recent data suggest an increase in coronary calcification with moderate alcohol consumption in young adults. Binge drinking exacerbated this effect. Binge drinking is defined as four drinks in a row in women and five drinks in a row in men. In men 18 to 25 years old, 60% report that they binge drink. This activity significantly increases the risk of injury, the risk of acquiring a sexually transmitted disease, the risk of assault, the risk of unwanted pregnancy, and the risk of harming an unborn child (see Questions 75 and 76). Half of all violent crimes are alcohol or drug related, and 60% to 70% of domestic violence incidents involve alcohol. A strong association exists between alcohol and tobacco use. People who start smoking early are more likely to develop problems with alcohol, and those who develop alcohol-related problems will have a harder time quitting smoking.

Half of all violent crimes are alcohol or drug related, and 60% to 70% of domestic violence incidents involve alcohol.

Epidemiological the basic science of public health, having to do with epidemiology.

Antisocial personality disorder (ASPD) an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture is pervasive, inflexible, and most often has an onset in late adolescence.

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