The Scale of the Problem

The population of the European Union is in the region of 371.5 million. There are 121.6 million adult males, 127.6 million adult females and 66.1 million children aged under 15. The population is divided into approximately 146 million households.

Any idea that in this population it is a rare occurrence to encounter a significant personal problem with alcohol is dispelled by the available evidence, incomplete though it is. (1) However, the scale of the problem depends entirely on how it is perceived and defined. Clearly, alcohol dependence is extremely likely to have an adverse effect on family members as well as the drinker, but it may not be perceived as a significant problem, by children for example, if it is not strongly disruptive of family relationships. Conversely, even occasional intoxication may pose severe problems to family members if, for example, it is associated with violence or parental incapacity.

The diverse range and severities of the social and health problems associated with alcohol makes it impossible to arrive at a precise estimate of the number of families and family members affected by them. How severe or persistent must an adverse consequence of alcohol consumption be in order for it to be perceived by family members as a problem for themselves?

Moreover, even where consequences of consumption such as violence, divorce and family break-up, and behavioural problems in children are clearly problematic for those involved, information is extremely limited and uncertain. The contribution of alcohol to such problems is not normally routinely assessed and recorded in official statistics.

The reality that underlies these difficulties is that everywhere alcohol problems in families tend to have a character of the shameful secret. The families themselves may be reluctant to volunteer the fact that their problems are alcohol related, and the health or social workers involved with them may not think or wish to ask. However, some information is available for some Member countries.

The population at risk

One way of assessing the potential scale of the problem is to estimate the population at risk of alcohol problems in relation to the prevalence of heavy drinking and alcohol dependence.

The large majority of European adults consume alcohol at least occasionally. In the EU as a whole non-drinkers comprise around one in ten men and one in five women, the proportions of non-drinkers being lowest in Denmark and highest in Ireland - 2.1% men and 6.1% women in Denmark and 24.5% men and 36.3% women in Ireland. (2) An unknown but probably substantial proportion of non-drinkers are ex-drinkers, some of whom stopped drinking as a result of experiencing alcohol problems.

Heavy drinking and alcohol dependence

Substantial proportions of adult Europeans regularly consume excessive amounts of alcohol, i.e. quantities known substantially to increase the risk of experiencing health or social problems. Smaller but still substantial proportions of Europeans experience the signs and symptoms of alcohol dependence. (3) In some countries alcohol abuse and dependence may often result in the breakup of the family. In others, presumably those in which divorce/separation are less socially acceptable, high proportions of people even with severe alcohol problems remain married. For example, in Portugal around 70% of people treated for alcohol dependence are married. In Spain 66% of such patients are married, and 80% of them have an average of 2.5 children which is higher than the average of the general population. The number of people affected by problem drinkers is thus extremely large.

There is a lack of consistent terminology in the EU in regard to problematic alcohol consumption, and authoritative and consistent statistics of the numbers of problem drinkers or alcohol dependents are not available for the European Union as a whole. However, estimates have been provided by a number of member states.

In Austria there are around 1 million problem drinkers and 400,000 alcohol dependents. In Belgium, it is estimated that there are around 300,000 problem drinkers. Figures for Denmark show that 14% of men and 8% of women exceed the recommended consumption limits (252g and 168g pure alcohol per week for men and women respectively). In Finland, based on a screening test for alcohol problems, 22% of men and 5% of women are classed as "risky drinkers". Around 250,000 Finns are alcohol dependent, equivalent to one in ten of all alcohol consumers.

29.5% of men and 11.1% of women seen by general practitioners in France are excessive drinkers (over 28 drinks per week for men and 14 drinks per week for women) who are at risk of alcohol-related disease or already ill. It is estimated that over 5 million French adults fall into this category. Two million French adults are alcohol dependent.(4)

In Germany, around 16 per cent of 18-59 year olds (7.8 million) are drinking at 'dangerous' levels and altogether there are around 6.6 million problem drinkers. Luxembourg had around 9000 problem drinkers (out of a population of approximately 413,000). In Portugal there are an estimated 1,700,000 alcoholics and problem drinkers, that is, approximately 21% of the adult population. In Spain, there are around 3 million male and around 235,000 female problem drinkers or alcohol dependents.

In Ireland around 23 per cent of men and 5 per cent of women exceed the recommended 'sensible limits' of regular consumption, and 8 per cent of men and 2 per cent of women report signs of alcohol dependence.(5)

In the Netherlands, up to 25 per cent of young and early middle-aged men and 2 to 3 per cent of women exceed the "sensible limits" of regular consumption.

In Norway, the normal estimate is that ten per cent of the adult population experience alcohol abuse or dependence, that is around 300,000 people.

In Sweden, 10 per cent of adult men and 3 to 6 per cent of adult women are "heavy drinkers". There are an estimated 300,000 "alcohol abusers" of whom 50,000 to 100,000 are "heavy abusers".

In the United Kingdom, 7 per cent of men and 2 per cent of women currently report symptoms of alcohol dependence.

If UK percentages are applied to the European Union as a whole, then there are around 8.5 million alcohol dependent adult men and around 2.5 million alcohol dependent adult women. If on average, each problem drinker adversely affects only one other family member or other person, then 22 million people in the Union are either problem drinkers or adversely affected by another's drinking.

This is of course an extremely crude method of estimating the numbers of problem drinkers and those affected by them, and it clearly underestimates the scale of the problem. Firstly, the estimate is of those currently experiencing alcohol dependence: the lifetime prevalence of dependence is likely to be substantially higher. For the total adult population, the lifetime prevalence of alcohol abuse and dependence is more likely to be in the region of 14 per cent. This gives a figure of over 42 million adult Europeans experiencing alcohol abuse or dependence during some period of their lives. If the same assumption is made that each problem drinker affects adversely only one other person, then 84 million people are either problem drinkers or affected by another's drinking. In reality, problem drinkers are likely to affect adversely more than one other person.

Secondly, the UK level of alcohol consumption is significantly less than that of most other EU countries: the UK prevalence of alcohol dependence is therefore likely also to be relatively low. This affects the estimate of the number of children of problem drinking parents. A UK survey found that 4.1% of fathers (living with their partner and with children) have experienced alcohol dependence within the last year. (6)

In Finland, it is estimated that 12 per cent - one child in eight - has experienced harm from excessive parental use of alcohol. (7) If the Finnish estimates are applied to the Union as a whole, then approximately 44.5 million people have grown up or are growing up in a problem drinking household. This number includes 7.9 million children aged under 15 presently living in a problem drinking household.
However, as Finland, like the UK, is one of the less heavy drinking nations in the Union, this figure is probably therefore also an underestimate. A Danish study shows that 7% of 13-19% year olds had at least one parent who had been admitted to a hospital with an alcohol-related diagnosis.(8)

Applying the Danish evidence to the total under-15 population of the European Union gives 4.5 million children living in households affected by alcohol. Since a large proportion of problem drinkers are never admitted to hospital or do not have their illness identified as alcohol-related, this must be taken as a low estimate.

On the basis of the Danish and Finnish estimates (7%, and 12% respectively), the numbers of children (aged under 15) of problem drinking parents is calculated for each member state. The authors are satisfied in taking the estimate based on the Danish medical survey as the lower and that based on the more socially based Finnish survey as the higher limit of the extent of the problem.

Even taking the lower figure, it is evident that there is a very considerable problem, with at least 4.5 million children throughout the European Union living in families adversely affected by alcohol. Almost certainly the actual figure is much higher, as suggested by the upper limit of 7.7 million.

1. G. Edwards et al: Alcohol Policy and the Public Good. Oxford University Press 1994.
2. H. Holder and G. Edwards, Alcohol and Public Policy. Oxford University Press 1995.
3. Unless otherwise stated, information provided by members of the working party. Information was not provided for Greece and Italy.
4. Health in France 1994. French High Committee on Public Health 1996.
5. Smoking, Alcohol and Drug Use in Cork and Kerry. Southern Health Board. 1997.
6. The Prevalence of Psychiatric Morbidity in Private Households. O.P.C.S. survey of psychiatric morbidity in Great Britain, Report number 1, HMSO 1995.
7. See page 60...Finland
8. M. N. Christoffersen: Opvaekst med arbejdsløshed. Socialforsk-ningsinstituttet 1996.
9. The prevalence of Psychiatric Morbidity among adults living in private households. OPCS surveys of Psychiatric Morbidity in Gt. Britain. Report No1. HMSO 1995.