Discussing about and doing something about alcohol harms is very important. But in this conversation and work, flawed and harmful concepts are serving alcohol industry interests, instead of the interests of people and communities.
In this opinion article, Mahesh exposes and examines four reasons why the concept of ‘harmful use of alcohol’ is problematic, how it benefits Big Alcohol, and why we all and especially the World Health Organization (WHO) should quit using this concept.

Harmful Use of Alcohol or Harm Due to Use of Alcohol?

It May Not Be a Small Technical Glitch!

We see the wide use of the term ‘harmful use of alcohol’ today, including by the World Health Organization, in addressing harms associated with alcohol use. Doing something about harms associated with alcohol use, such as road traffic accidents, suicides, liver disease and premature deaths, is very important and highly needed. However, this term ‘harmful use of alcohol’ has a technical issue – actually many issues.

The term ‘harmful use of alcohol’, when used in discussing harms from alcohol use, excludes much of alcohol’s real harm from our attention.”

Dr. Mahesh Rajasuriya

1. ‘Harmful use of alcohol’ as clinical diagnosis

First, ‘harmful use of alcohol’ is an official diagnostic label used generally by psychiatrists, and specifically, by the ICD-10 Classification of Mental and Behavioural Disorders, published by the World Health Organization itself! According to ICD-10 label F10.1, ‘harmful use of alcohol’ is the less severe form of the two alcohol use disorders showing a pattern of alcohol use that is causing damage to health. The more severe form, ‘alcohol dependence syndrome’, is characterised by ‘physiological, behavioural, and cognitive phenomena in which the use of [alcohol] takes on a much higher priority’. Obviously, alcohol dependence syndrome is associated with more health and other harms. Unfortunately, and hilariously, the term ‘harmful use of alcohol’ excludes the harm associated with ‘alcohol dependence syndrome’!

2. ‘Harmful use of alcohol’ as concept promoting Big Alcohol myth

Second, the use of the term ‘harmful use of alcohol’ invariably implies that there is ‘non-harmful use of alcohol’ or ‘harmless use of alcohol’! This is a false.

Landmark studies have proven that any amount of alcohol use is harmful, for instance concerning cancer risk, cardiovascular disease risk, and even the brain.

But for Big Alcohol it is a powerful message, the myth of ‘harmful’ and ‘responsible’ use, despite them making billions of dollars (ca. $18 billion according to this study), a significant proportion of their income (38% according to the same study), from people who use alcohol heavily. The alcohol industry loves the idea that the use of alcohol was problematic only in ‘a small proportion of people who cannot handle it responsibly’. This helps them to advertise and promote alcohol with less restrictions; freely recruiting children and youth to be their future loyal customers, many of them contributing to that pot of US$18 billion every year.

The two concepts of ‘harmful use of alcohol’ and ‘responsible drinking’ are of strategic importance to the alcohol industry. They allow them to diffuse attention to their products and practices as cause of alcohol harm, while maintaining cognitive dissonance about alcohol harm, and profiting from heavy users and under-age alcohol users.

3. Distorted recognition of alcohol harms

Third, the harms associated with alcohol use are frequently seen in apparently ‘harmless use of alcohol’ and are significant. For example, consider the death or lifetime disability caused by the driver who took just several drinks at a party and left home late night driving his own car, later knocking down a pedestrian; he could not apply the breaks in time, because alcohol is a central nervous system depressant.

This man probably consumes alcohol once a week or once a month, and has never been seen by others as having ‘harmful use of alcohol’. Even that night, his alcohol use, unless it was a severe binge, would have caused only a small physical harm to his body. His peers might recall and say that his alcohol use that night was not a concern at all. The term ‘harmful use of alcohol’, when used in discussing harms associated with alcohol use, unfortunately, or perhaps strategically, excludes this kind of harm from our attention.

In 2016, a unique report showed the full magnitude of alcohol harms, including social harms. An international group of esteemed researchers found:

  • No other risk factor in the Global Burden of Disease report involves as many types of disease and injury as does alcohol, illustrating the toxicity of alcohol to all tissues and organs of the body.
  • When the social harms are added to the harms to alcohol users, the total harm from alcohol is about double that from tobacco.
  • The types of social harms caused by alcohol are pervasive and include impacts on children and families, unintentional injuries and violence, crime, property damage and adverse economic effects.
Total alcohol harm is twice as big as tobacco harm
When the social harms are added to the harms to alcohol users, the total harm from alcohol is about double that from tobacco.

4. Corporate interests in maintaining ‘harmful use of alcohol’ concept

Fourthly, and finally, whenever this issue is raised, some of the officials and policy makers, including from the World Health Organization itself, keep on saying that they are under immense political pressure to use this term but not the more scientific term ‘harm due to alcohol use’!

This is a real concern where politics and science clash. Or, is it money and science that are conflicting here?

Well, what can we do now? We can start by asking a naive question: Where is this political pressure coming from? Simple! From the agents of the alcohol industry!

Now, we can start talking about real harms caused by the products and practices of the alcohol industry.