Worldwide Health Consequences of Alcohol and Drug Use

Alcohol use is a major contributor to disabilities and premature deaths.

Posted Oct 09, 2019

In an important study published in Lancet Psychiatry, an international group of researchers led by Louisa Degenhardt estimated the worldwide health burden resulting from alcohol and drug use based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study, 2016. Although it is well known that alcohol and other substance use is associated with disabilities and premature death, the results of this study indicate that it is a major contributor to the overall disease burden. In addition, there are differences in the patterns of death and disabilities caused by alcohol and other substances in different countries around the world.

This study examined the health burden related to alcohol, opiates, marijuana, amphetamines, and cocaine use. Tobacco use was not addressed.

In order to quantify the effects of alcohol and other substance use, the research team calculated disability-adjusted life years (DALYs), a commonly used measure of disease burden. DALYs take into account both years living with disability and years lost as a result of early death. 

The results of the study demonstrated that of the substances examined, alcohol was by far the biggest contributor to the global disease burden. In 2016, 4.2 percent of all DALYs could be attributed to alcohol use. This resulted from the direct effects of alcohol (e.g., road accidents, self-harm, and interpersonal violence) as well as increases in medical illnesses caused by alcohol (e.g., cardiovascular disease and cancers).

The other drugs combined were responsible for 1.3 percent of all DALYs worldwide. This increase in deaths and disabilities was largely due to the direct effects of the drugs, including an increase in drug use disorders particularly opioid use disorder, and an increase in conditions associated with IV drug use (e.g., chronic liver disease and HIV/AIDS).

The investigators also examined the relationship between sociodemographic variables in different countries and the influence of alcohol and other drugs on deaths and disabilities. To do this, they used a measure called the sociodemographic index (SDI), which is based on income per capita, mean years of education of those aged 15 years and older, and total fertility rate.

The effects of alcohol use on DALYs varied dramatically worldwide. Generally speaking, the disease burden resulting from alcohol use was higher in countries with low SDI than in countries with higher SDI. However, a particular country’s culture and attitude towards alcohol also appear to play a major role in the acceptability and availability of alcohol.

The effect of drug use on DALYs also varied dramatically worldwide, but the pattern was different from that seen with alcohol. Whereas alcohol-associated DALYs were higher in countries with lower SDIs, DALYs resulting from use of other drugs were higher in countries with higher SDI.

The effect of alcohol, marijuana, and opiates on premature deaths and disabilities worldwide is remarkable. The magnitude of this effect would be substantially greater if deaths and disabilities from cigarette use were also considered. Policies exist that if implemented could substantially decrease the use and, therefore, harm from alcohol and other substances. These policies include increased taxation and regulation of availability and marketing. However, such policies are often politically unpopular even though they have been effective in reducing the use of cigarettes.

Recently, much attention has been directed toward the development of personalized medicine where treatments can be targeted to individuals based on specific characteristics of their individual genetics, disease, or condition. Just as important from a public health perspective will be implementing effective policies and treatments targeting alcohol and substance use. Such policies would save lives and decrease the overall costs of healthcare. Investing in both of these directions makes sense.

This column was written by Eugene Rubin, M.D., Ph.D., and Charles Zorumski, M.D.


GBD 2016 Alcohol and Drug Use Collaborators. (2018). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 5: 987-1012.