Because of the many complexities highlighted in the preceding section, an extensive accounting of the effects of drinking is well beyond the scope of this paper. Instead, this section attempts to array many of the problems related to excessive alcohol consumption in order to promote the design of relevant policy.
For analytical purposes, alcohol-related problems may be disaggregated into two sub-groups. The first group consists of primary, or internal, effects which directly affect the health of the individual and impose economic costs of lost income or productivity resulting from premature death and illness due to alcohol-related disease and trauma. The second group, which is more difficult to quantify, in characterized by problems with secondary, or external, effects on the individual and on society. The secondary effects include a wide range of social and familial problems, with implications on both the family's physical and financial welfare. To simplify the effects of alcohol consumption, the primary and secondary effects can be broken down into problems related to continuous consumption and those related to intoxication.
The classification proposed by a 1985 World Health Organization study on alcohol divided alcoholrelated problems into two groups: (i) those which may be caused by extended periods of over-consumption and (ii) those which may be caused by periodic intoxication. A general description of the principal causal relationships between alcohol consumption and alcohol-related problems is described in Figure 1.
One aspect not captured by this dichotomization, is the lack of information on the risks associated with the excessive consumption of alcohol; this, in turn, leads to distortions in behavior and increases in consumption which would not occur under perfect information. In many regions, the problems associated with alcohol consumption are more a function of the lack of knowledge of alcohol problems and the lack of a regulatory environment (excise taxes and controls on advertising) than a function of the absolute amount of alcohol consumed. In Africa, for example, the consumption of beer and spirits has only recently become popular due to the rapidly expanding markets. As a result, many groups who previously did not drink alcohol, such as young adults and children, are now increasingly beginning to drink. At the same time, there is a misunderstanding in society toward the consumption of alcohol. In Lesotho, for example, a study of 1133 high school students aged 11-22 found that 50 percent of the students believed moderate drinking was impossible and that the fun of drinking was to get drunk. Anecdotal observations by researchers in Lesotho also suggest that these drinking patterns among the young stems from aggressive advertising directed to adolescents (Meursing and Morojele, 1989).
In general, the number of problems is proportional to the per capita consumption of alcohol in the country. If one accepts the assumption that alcohol-related problems are correlated with the per capita level of consumption within a country, the logical conclusion is that reductions in consumption should result in a decline in alcohol-related problems over time. To frame these relationships, the next two sections will examine global trends in alcohol consumption, followed by a discussion of trends in alcohol related problems.
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