It is well known that consuming alcohol has a number of negative implications on a person’s health, for example, research has suggested it has a link with a range of cancers. Interestingly, a study by Nutt et al. found that alcohol was the most harmful psychoactive substance in the UK in 2010, followed by heroin and crack cocaine.

However, current alcohol-attributable harm estimates often do not consider the harm to other individuals caused by the drinker. When a person consumes alcohol, they can cause harm to others in a number of ways and examples include drink drivers causing collisions, interpersonal violence, and harm to a mother’s unborn child.

In a study focused on Germany, Kraus et al. aimed to identify some of the most severe harms that alcohol use may cause to people other than the drinker. The researchers focused on 3 types of harm caused by drinkers: fetal alcohol syndrome and fetal alcohol spectrum disorders; third-party road traffic fatalities; and interpersonal violence fatalities.

If a woman drinks alcohol during her pregnancy, the baby can develop mental and physical problems which are known as fetal alcohol syndrome (FAS).  FAS is a type of fetal alcohol spectrum disorders (FASD), the name for all the various problems that can affect children if their mother drinks alcohol in pregnancy. In order to estimate the incidence of FAS and FASD, the authors used data on the prevalence of alcohol use during pregnancy and estimations of the quotient for the average number of pregnant women who consumed alcohol per one case of FAS (1 in 13) or FASD (1 in 67) for countries with available data. The incidences of FAS or FASD were then predicted by applying this quotient to the country-specific prevalence of alcohol use during pregnancy.

Alcohol not only causes harm to the drinker but also a substantial amount of harm to other third parties.

Based on the prevalence of alcohol use during pregnancy of 27.6%, using data from the German Health Update Study, it was estimated that 41 children were born with FAS per 10,000 live births and 177 children were born with FASD per 10,000 live births per year in Germany.

In order to estimate the number of third-party road traffic and interpersonal violence fatalities, the authors used cause-of-death statistics and the alcohol-attributable fraction methodology. The authors concluded that alcohol not only causes harm to the drinker but also a substantial amount of harm to other third parties. They found that women drinking during their pregnancies (and the impact on the child) and road traffic fatalities cause more harm than alcohol-related violence.

It was estimated that 1214 of the 2675 third-party road traffic accident deaths were attributable to alcohol. In comparison, a smaller proportion of deaths were caused by alcohol-attributable interpersonal violence. Of the 368 people who died from injuries sustained by interpersonal violence, 55 of the deaths were estimated to be alcohol-attributable.

The authors highlight that although the current study demonstrated the feasibility of estimating health harms to others, improvement is needed. There are a number of things that make the estimation of alcohol-attributable harms difficult – for example, using official crime statistics reporting alcohol’s involvement in interpersonal violence-related deaths is not recommended. This is due to there not currently being an appropriate cut-off that one could assume that an aggressive incident could have been avoided, had alcohol not been involved. Therefore, more research is needed to provide comprehensive estimates.

Targeted measures for particular populations at risk may be a way of helping reduce harm to third parties as well as harm to the drinkers.

In addition, there is a need for the harmful effects of alcohol on others to be recognized as a public health problem. The authors suggest that reductions in the overall rate of drinking would consequently reduce heavy drinking and therefore alcohol-related harms. Targeted measures for particular populations at risk, such as women of childbearing age, may be a way of helping reduce harm to third parties as well as harm to the drinkers. For example, screening for alcohol use in women of childbearing age with preconception health promotion should become a routine part of healthcare.

Previous research has found that enforced legislative measures, such as roadside breath testing, are effective at reducing drink driving. Therefore, there is a need for such measures to be adopted in order to reduce alcohol-related harm to others (and to the drink driving individuals) and help to reduce the number of third party alcohol-related fatalities.

The authors highlight that in order to try to tackle alcohol-related aggression, bar staff could be specifically trained to resolve problem situations safely or psychological harm reduction strategies could be adopted. A study by Giancola concluded that alcohol consumption does not increase aggression in all persons and in all situations. Furthermore, previous research has found that alcohol causes aggression in individuals who have the psychological predisposition, which ultimately leads to the individual having a reduced sense of self-awareness. Therefore, interventions should target persons with aggressive dispositions and teach them skills to remain non-violent when drinking, meaning they will be less likely to cause harm to others.

Therefore, as concluded by Kraus et al., effective prevention is needed to reduce the harm caused to others by those under the influence of alcohol.