A study published this summer on the damage wreaked by alcohol consumption in France makes for sobering reading. If one discounts the Covid-19 pandemic, alcohol is the leading cause of hospitalisation in the country and accounts for 41,000 deaths annually. Only tobacco kills more people.
“Alcohol is a drug, a carcinogenic and toxic molecule that is directly or indirectly responsible for about 60 diseases,” notes the report, which is published by the National Institute of Health and Medical Research (Inserm) under the title “Reduction of damage associated with the consumption of alcohol”.
Diseases caused by alcohol include cirrhosis of the liver and cancers of the liver, colon, breast and upper digestive and respiratory tracts. The authors of the report studied all available scientific literature – some 3,600 documents – over two years. They attributed annual fatalities linked to alcohol thus: 16,000 cancers; 9,900 cases of cardio-vascular disease; 6,800 cases of disease of the digestive tract; 5,400 accidents or suicides; and 3,000 deaths due to mental illness or behavioural problems.
The chief lesson of the report is that there is no safe level of alcohol consumption, says Dr Guillaume Airagnes, a psychiatrist specialising in addiction at the Georges-Pompidou Hospital in Paris and one of 12 co-authors of the Inserm report. "There is no such thing as alcohol consumption that is beneficial to health," he adds.
Past studies which claimed that moderate wine consumption improved health or increased longevity focused on groups with healthy lifestyles, “creating the illusion that alcohol played a protective role”. The Inserm study refutes this so-called “French paradox”.
According to guidelines from the health agency Santé publique France, risk is low if consumption is limited to two glasses of alcohol per day, and less than 10 glasses per week, “meaning there must be days with zero consumption”, says Airagnes.
A glass of wine, half-pint of beer or shot of whiskey contains 10 grams of pure alcohol. The average French adult consumes 27 grams of pure alcohol daily – the equivalent of 2.7 glasses – the report says. In other words, the average French person is already over the recommended guidelines.
Researchers employ the World Health Organization’s Alcohol Use Disorder Identification Test, known by the acronym Audit, to measure usage. It shows that 23 per cent of French adults consume dangerous levels of alcohol, while an additional 7 per cent are alcohol-dependent – in other words, alcoholics. Thus, a staggering 30 per cent of the adult population have an alcohol problem.
“That is huge,” Airagnes admits. “It’s a public health scourge. Half of all accidents, half of all incidents of violence and half of all suicide attempts involve alcohol consumption. Not only does alcohol endanger health on its own, it is implicated in all these other public health issues as well.”
WHO statistics published in 2019 showed slightly higher per capita alcohol use in France than in Ireland, at 11.8 litres of pure alcohol annually in France, compared with 11.3 litres per capita in Ireland.
"There are variations, but the fact is that alcohol is a major problem and one of the main avoidable causes of mortality in all European countries," says Airagnes. "This is true in France, in Europe and in most of the world, with few exceptions."
The majority of people who suffer higher mortality rates because of alcohol are not alcoholics, merely people who drink more than they should, Airagnes says. “Health risks depend on the level of consumption. As one increases consumption, the increased risk is not linear but exponential. Below the recommended guidelines, we consider the health risk to be low. But it goes up very, very quickly.”
The word alcoholic is no longer used a great deal, because of the negative connotation and because there is not a clear-cut line between those who drink more than recommended amounts and those who suffer from “alcohol use disorder”. The main criterion for the latter is that the victim “can no longer control his or her consumption. They become a slave to it,” Airagnes says. “It affects every socio-economic category, men and women, young and old.”
Because only 10 per cent of cases of excessive alcohol use are identified, the vast majority of people endangered by over-consumption are not treated. The Inserm report recommends systematic screening of all patients, using the Audit questionnaire.
Other recommendations include greater transparency regarding the lobbying activities of the alcohol industry, a return to the 1991 Évin law, which banned all advertising or promotion of alcohol, a minimum price for alcohol, fewer licences, limiting the hours when alcohol may be sold and enforcing the ban on sales to minors.
Drink should be taxed in proportion to alcohol content, the report says. Taxes on alcohol currently raise €4 billion annually – one-thirtieth of the cost of alcohol to French society.