Alcohol Use Disorders (138) Unanswered questions

11 March, 2024

Dear HIFA colleagues. Earlier I shared a link to an edited version of our discussion so far:

This is 35 pages so many of you will not have time to read it. So I have prepared a list (below) of questions that have been raised in our discussion, and which are still (at least partly) unanswered. Here they are, organised under our five themes:

1. Do people understand the health, socio-economic and environmental harms of alcohol? What matters to them? How can they be better informed? How to reduce stigma?

- Are alcohol use disorders are the single most important [medical] cause of harm to others (accidents, violence, gender-based violence).

- Only 1 in 10 people in the UK are aware of the link between alcohol and cancer. What about other countries? What is being done to better inform people?

- What can be done to harmonise conflicting public health messages from different health professionals and different academic institutions, especially regarding the potential benefits of low alcohol consumption? - - How can the health community present a more united front and thereby restore trust and credibility among the general public?

- Do people have adequate access to reliable information about the causes, symptoms, and treatment options for alcohol addiction, in a language they can understand? What information is available for the individual with alcohol use disorder, their loved ones, and the general public?

- How can false beliefs about alcohol be better addressed, individually and collectively?

- There is wide consensus that the term alcoholism should be abandoned as it is stigmatising. Is it time for the National Institute on Alcohol Abuse and Alcoholism to be renamed as the National Institute on Alcohol Use Disorders.

- How can we, as a community, work towards destigmatizing alcohol use disorders and encourage a more informed and empathetic approach to addressing this challenge?

- What can be done to reduce social pressures (especially on young men) to drink large quantities of alcohol?

- What can be done to reduce stigma in some countries against people who do NOT drink?

2. Do health workers have adequate knowledge to prevent and manage alcohol use disorders among their patients? What matters to them? How can they be better informed?

- What guidance have HIFA members found to be helpful to identify and manage patients with Alcohol Use Disorders?

- What information is available about knowledge of alcohol use disorders aamong different health workers in different countries?

- It has been said that evidence-based alcohol care is easy. Is it?

- Brief advice is recognised as a mainstay of management, but has only been mentioned once in our discussion. How can all health workers be empowered to deliver brief advice?

- In some cultures alcohol use disorders are considered by health workers as a moral failing or due to poverty, rather than a medical disorder that can be treated. How can this be addressed?

3. What is the role of the alcohol industry? What can be done to address misinformation from the alcohol industry?

- The alcohol industry downplays the role of alcohol in cancer and other NCDs.How can this misinformation be better addressed?

- The alcohol industry is able to act in LLMICs in ways that are no longer possible in HICs. This could have devastating consequences on public health in LMICs as they face a huge and increasing non-communicable disease burden with very limited healthcare resources. How to address this?

- We found that DrinkAware provided misleading advice. Since we reported this to WHO, the advice has been changed. But questions remain: How many people have been exposed to this advice? Was it deliberate? And why is WHO’s AUDIT test being used as the basis for DrinkAware’s test when WHO itself says that it should only be administered in a clinical setting?

- gave similar misleading advice. Since we reported this to WHO, their advice has been changed. The above questions relating to DrinkAware are applicable also to Auditscreen.

4. Do public health professionals and policymakers have adequate knowledge to prevent and treat alcohol use disorders in their country? What are current national policies and what more can be done to fully implement those policies?

- WHO has a Global Alcohol Action Plan 2022-2030 but this is only available in pre-print. Is there a final version available?

- What does the Global Alcohol Action Plan 2022-2030 say about misinformation by the alcohol industry? I was unable to find anything on this

- HIFA members have shared observations about alcohol consumption in Ethiopia, Indonesia, Malawi, Nigeria, Uganda, UK, Uruguay, Zimbabwe. What about other countries?

5. How can we define and measure alcohol use disorders?

- Is there a universally agreed definition of Alcohol Use Disorders?

- How did WHO calculate there are 280 million people with Alcohol Use Disorders?

- Part of the world use DSM, while other parts of the world use ICD. These references have different terminology and definitions. Which reference is most useful to the practising health worker? Is there potential for DSM and ICD to bridge the gap between the two publications?

Please send your thoughts on any of the above to:

With thanks, Neil

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: