Alcohol Use Disorders (145) Harm to others from Alcohol

14 March, 2024

Dear colleagues,

Among the unanswered questions, Neil asked us the following one:

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

At the moment, there appears to be not enough data to answer this question, because we should first estimate the “harm to others” caused by alcohol consumption (not just AUDs) and then compare it to other causes of harm to “others.”

The initial problem is the estimation of “harm to others” caused by alcohol.

Although this issue has been recognized for decades, until recently, no methodologies had been proposed to evaluate it.

The issue of harm to others from alcohol emerged in 1995, with the European Charter on Alcohol, which marked a shift towards a more comprehensive approach to harm caused by alcohol, and included harm to others as well as insisting on the obligation of governments to protect their citizens against it.

In 1996, the WHO took one of the fundamental principles of that charter: “Everyone has the right to a family, community and work life protected from accidents, violence and other negative consequences of alcohol consumption.”

In 2005, when the WHO European Region Alcohol Policy Framework was developed, it included among its guiding principles:

“Each Member State has not only the right but also the obligation to provide a high level of protection to its citizens against alcohol-related harm, particularly with regard to harm caused by the alcohol consumption of others and vulnerable groups.” like when they were children.”

In 2010, this perspective was further strengthened by the 2010 WHO Global Strategy to Reduce the Harmful Use of Alcohol which included the principle that the protection of those exposed to the effects of harmful alcohol use by others should be a priority. integral part of alcohol control policies.

To refer to this issue, several terms were coined: “alcohol harm to others” and related terms such as “negative externalities,” “collateral damage,” and the “second-hand effects” of alcohol consumption.

As I said above, the problem with this topic is “quantification,” since “alcohol harm to others” is broad in scope.

This can be about INDIVIDUALS: family members, other people who have a regular relationship with the drinker (friends, co-workers, neighbors), but also unknown people, as is the case of accidents due to driving under the influence of alcohol.

They can also be COLLECTIVE, and affect the physical and social environment, either at the level of:

- Neighborhood: can make a locality less attractive due to noise levels, nuisance and litter, which are often related to places where people gather to drink in the street

- An entire region or society can be negatively affected by alcohol. This is easier to see in small societies, such as in some indigenous societies with high alcohol consumption.

- A large nation: in the 1950s, at the height of alcohol consumption levels in France, the term "alcoholization" was coined to describe the adverse effects of high levels of consumption on society as a whole .

The study of harm to others can be approached from various points of view:

- an economic perspective, through studies of the “cost of illness”. Given limitations in data availability, this perspective has focused on the costs to the government of institutional responses, rather than focusing on the costs to the family or others in direct contact with the drinker. Some of the ways in which alcohol burdens societies include: decreased work productivity, absenteeism, increased morbidity and mortality, increased pressure on health and social security systems, and finally, harm to the national and family economy.

- Another perspective relates to the number of cases recorded by social response systems that address current social problems (social welfare agencies, housing and family support, police and judicial systems, health systems and agencies: such as ambulance services and emergency services, hospitals, mental health and alcoholism treatment services, and primary care professionals). These records are a primary source of data on the social and health problems of a society.

- A third perspective is the drinker's point of view. While drinkers often recognize the harm or problems they cause others through their alcohol use, sometimes they are not even aware of how their behavior has caused harm to others.

- A fourth perspective is the perspective of the other. A person who, whether known to the drinker or not, is negatively affected by another person's consumption of alcohol.

Furthermore, to measure the harm that alcohol consumption causes to others, there are three big questions to consider:

A) that agencies tend to deal mainly with the most serious cases, leaving aside less serious events.

B) the variety of systems and types of institutions involved in the social response, ranging from government departments, subnational levels and even international organizations; there being no type of coordination between the different levels, so the damage to others is difficult to evaluate.

C) that many of these systems focus on evaluating the individual case and remedying the harm, but do not usually record whether another person's alcohol consumption was a factor in the harm.

At a 2009 WHO meeting in Stockholm, “an international collaborative research initiative on alcohol, health and development” was launched, which included harm to others.

Based on this study, in 2019 the WHO published: Harm to others from drinking: patterns in nine societies, accessible at:

From this publication we have extracted the information for this communication.

The WHO publication constitutes a first look at patterns of harm caused by others' alcohol consumption in nine societies.

The data from the publication provide insight into the extent and distribution of harm at the interpersonal level in the general adult population.

It states that:

- The damage that alcohol consumption causes to others is usually large.

- Two studies have estimated that they are of the same order or greater magnitude than the adverse effects for the drinker. (Nutt, King et al. 2010) (Laslett et al. 2010: 177).

- Harm could be attributed to alcohol consumption by a friend, family member, or acquaintance of the respondent (a known drinker) or a stranger, or both.

- harm to children caused by alcohol consumption by parents and other adults was considered,

- Harm can occur in a variety of contexts: at home; in a traffic accident; in an attack by one group of drinkers on another in a bar or on the street; or as property damage caused by a group of street drinkers at night.

In interpreting the different patterns of responses in the various societies represented, it is considered that the differences may partly reflect cultural differences regarding drinking.

Some consistent patterns identified were the followings:

- Harm caused by strangers was considerably more common than that caused by known drinkers in the three richest societies, which in turn have the highest levels of urbanization (Australia, New Zealand and Chile), but were also significant in Thailand.

- More tangible damages were more common in Thailand and Chile

- Thailand, Sri Lanka and India show the highest rates of harm caused by known drinkers.

- India, Thailand and Australia show high rates of harm from alcohol consumption by anyone, whether known or unknown to the respondent.

- Younger age was the only demographic factor that was consistently associated with greater harm to others from alcohol consumption in almost all countries studied.

There were differences between societies in gender, educational level, and geographic location of alcohol-related harms.

- In four countries, higher education was associated with more harm, and only in India was a lower level of education linked to harm.

- In four countries, people in non-rural regions suffered more harm than those in rural regions. While in Vietnam the opposite happened.

- A common finding was that respondents' alcohol consumption and risky drinking were associated with harm caused by others' alcohol consumption. Respondents who drink are more exposed to harm from others' alcohol consumption.

- Although men tend to be heavier drinkers than women in all countries, a similar or higher percentage of women were observed to experience some harm caused by others' alcohol consumption.

- The highest rates of harm caused by known drinkers were reported in Thailand, India and Sri Lanka, which are among the four lowest countries in per capita consumption and in the proportion of adults who drink alcohol. In these societies, drinking appears to be less socially acceptable, and the harms caused by drinking often appear in intimate relationships, when they "come home."

I hope this information can be useful.

Kind regards,


Dr. Eduardo Bianco

Director, Addiction Training Program (ATP)



HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT