Year. Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends Male 12%

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1 ALBANIA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Last year abstainers 24% Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year Male 12% Female 36% Unrecorded alcohol consumption The unrecorded alcohol consumption in Albania is estimated to be 3. litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. WHO Global Status Report on Alcohol 24 1

2 Chronic mortality Alcohol use disorders SDR per Cirrhosis of the liver Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. Acute mortality.6.5 SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete. Morbidity, health and social problems from alcohol use A study examining the effect of hepatitis B virus (HBV) and alcohol intake suggests that heavy alcohol intake may magnify the effect of HBV on chronic liver disease and chronic hepatitis. 2 The standardized death rates (SDR) per 1 population for chronic liver disease and cirrhosis was.3 in 1996 and.23 in The number of alcohol-related road traffic accidents per 1 population was.22 in 2 and.49 in WHO Global Status Report on Alcohol 24

3 Country background information population Life expectancy at birth (22) Male 67.3 Adult (15+) Female 74.1 % under Probability of dying under age 5 per 1 (22) Male 27 Population distribution 21 (%) Female 23 Urban 43 Gross National Income per capita 22 US$ 138 Rural 57 In Albania, approximately 7% of the population are Muslim. Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 23, The World Health Report 24 References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): Kondili LA et al. The relationships of chronic hepatitis and cirrhosis to alcohol intake, hepatitis B and C, and delta virus infection: a case-control study in Albania. Epidemiology and Infection, 1998, 121(2): European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). WHO Global Status Report on Alcohol 24 3

4 ARMENIA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Last year abstainers 24% Male 12% Female 36% Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year Youth drinking in Yerevan (ever drank alcohol) Male 89.% Female 67.% Survey conducted in the year 2 among 412 students from five higher education institutes in Yerevan, Armenia (age range 17 to 21 years; 54% male and 46% female). Percentages indicate proportion of sample who admitted to drinking alcohol at least once in their lifetime. 2 The survey also found that 21% of the students surveyed reported that they had never tried alcohol. Of those who had drank alcohol, 7% reported drinking once a month or less; however, 27% of these respondents reported binge drinking (five or more drinks in a row) in the last month. Although approximately two thirds of students 4 WHO Global Status Report on Alcohol 24

5 reported that it was okay for them to drink every so often, only 23% admitted to drinking when alone and 28% believed it was okay to occasionally get drunk. 2 Youth drinking in Yerevan (ever binge drank) Male 35.% Female 6.% Survey conducted in the year 2 among 412 students from five higher education institutes in Yerevan, Armenia (age range 17 to 21 years; 54% male and 46% female). Binge drinking was defined as consuming five or more drinks in a row. Percentages indicate proportion of sample who admitted to binge drinking at least once in their lifetime. 2 Unrecorded alcohol consumption The unrecorded alcohol consumption in Armenia is estimated to be 1.9 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. Chronic mortality Alcohol use disorders SDR per Cirrhosis of the liver Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. WHO Global Status Report on Alcohol 24 5

6 Acute mortality SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Morbidity, health and social problems from alcohol use Although alcoholism has never been a widespread problem among Armenians before, these days the picture is changing. Alcoholism in Armenia has recently started to become noticeable especially among young people. During the Soviet rule, the average age of patients at the Yerevan Centre of Narcology was Today, most people in the centre are not older than 35 years. 3 The rate of alcoholic psychosis incidence per 1 population was 1.37 in 2 and 1.63 in The SDR per 1 population for chronic liver disease and cirrhosis was in 21 and in The number of alcohol-related road traffic accidents per 1 population was 1.26 in 2 and.79 in Country background information population Life expectancy at birth (22) Male 67. Adult (15+) Female 73. % under 15 2 Probability of dying under age 5 per 1 (22) Male 39 Population distribution 21 (%) Female 35 Urban 67 Gross National Income per capita 22 US$ 79 Rural 33 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 24 References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): Babikian T et al. An assessment of HIV/AIDS risk in higher education students in Yerevan, Armenia. AIDS and Behaviour, 24, 8(1): Deheryan S. No place for partying: centre for alcohol abuse has difficult job during holidays. ArmeniaNow.com, 9 January 24 ( accessed 24 February 24). 4. European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). 6 WHO Global Status Report on Alcohol 24

7 AUSTRIA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Last year abstainers 11% Male 5.8% Female 16.1% Data from the WHO GENACIS study. National survey conducted in 1993 (age group 2 to 64 years). sample size n = 62; males n = 2937 and females n = Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 13% (males) and 33% (females). Data is for after year Data from a 1993/1994 survey (total sample size n = 11 15; males n = 533 and females n = 5819) show that the rate of current abstainers was 23.3% (total), 13.2% (males) and 32.8% (females). 3 According to a national survey conducted in 23 (total sample size n = 122; aged 15 years and over), the average number of drinks consumed per drinking day was WHO Global Status Report on Alcohol 24 7

8 Heavy and hazardous drinkers (among drinkers) Male 17.3% Female 7.% Data from the WHO GENACIS study. National survey conducted in 1993 (age group 2 to 64 years). sample size n = 62; males n = 2937 and females n = 383. Definition used: average consumption of 4 g or more of pure alcohol a day for males and 2 g or more of pure alcohol a day for females. 3 Data from a 1993/1994 survey (total sample size n = 11 15; males n = 533 and females n = 5819) show that the rate of heavy drinkers (among drinkers) was 18.3% (total), 28.7% (males) and 8.5% (females). Heavy drinking was defined as daily drinkers who drink over 6 g of pure alcohol on average for men and over 4 g of pure alcohol on average for women. The survey also found that the average consumption of pure alcohol was 31.2 g (total), 5.9 g (males) and 13.2 g (females). 3 Heavy episodic drinking According to a national survey conducted in 23 (total sample size n = 122; aged 15 years and over), the average number of times that respondents had consumed the equivalent of one bottle of wine, five pints/bottles of beer or five measures of spirits on one drinking occasion was Youth drinking (drink at least weekly) 34.5% Male 35.9% Female 33.1% HBSC survey 21/22. Data shows proportion of 15-year-olds who report drinking beer, wine or spirits at least weekly. sample size n = According to the 1997/1998 HBSC survey (total sample size n = 1376), 39% of 15-year-old boys and 23% of 15- year-old girls reported drinking beer, wine or spirits at least weekly. 6 Youth drinking (drunkenness) According to the 21/22 HBSC survey (total sample size n = 1298), the proportion of 15-year-olds who reported ever having been drunk two or more times was 37.8% for boys and 34.9% for girls. 5 Alcohol dependence 2.2% A random sample of the general population drawn in 1996 (n = 531). The ratio of male to female alcohol dependence was 4:1. Alcohol dependence was measured as having four positive CAGE answers. The same survey also found that 16 24% of the general population were rated as problem drinkers (two or more positive CAGE answers). 7 8 WHO Global Status Report on Alcohol 24

9 Drunkenness Data from a 1993/1994 survey (total sample size n = 11 15; males n = 533 and females n = 5819) show that 2.8% of males and.6% of females reported experiencing drunkenness once a week. Drunkenness was defined as being very intoxicated and having memory blanks the next day. 3 Traditional alcoholic beverages Cherry liquor and schnapps are consumed. Unrecorded alcohol consumption The unrecorded alcohol consumption in Austria is estimated to be 1. litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 2 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. Chronic mortality Alcohol use disorders SDR per Cirrhosis of the liver Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. WHO Global Status Report on Alcohol 24 9

10 Acute mortality SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Morbidity, health and social problems from alcohol use In a blood sample analysis of all patients (269) involved in a traffic accident and admitted to the Emergency Room of the University Hospital of Trauma Surgery in Innsbruck, alcohol was the most commonly found drug in all groups (drivers: 36.9%, passengers: 15.1%, cyclists: 29.4%, pedestrians: 18.2%), with a mean BAC (blood alcohol concentration) high above the legal limit at the time of the study in Austria of.8 g/l (drivers: /- 54 g/l; passengers: /- 71 g/l; cyclists: /- 51 g/l; pedestrians: /- 25 g/l). The percentage of alcohol users was highest in drivers. 8 A study of 42 victims of ski accidents found that 2% of the samples were positive for alcohol. The prevalence of alcohol was significantly higher among male accident victims. 9 The number of alcohol-related accidents dropped slightly from 2574 cases in 2 to 2559 cases in 21, and 6.5% of all fatalities were alcohol-related. 1 The number of alcohol-related road traffic accidents per 1 population was in 2 and in Austria records the highest liver cirrhosis mortality rates in Europe with 47.1 deaths per 1 men and 15.1 deaths for 1 women. 12 The SDR per 1 population for chronic liver disease and cirrhosis was in 21 and in Alcohol consumption during methadone maintenance treatment (MMT) often becomes a problem. A group of 68 patients undergoing MMT were investigated. A set of risk factors for problematic alcohol use ( alcohol indicators ) was set up consisting of patients account and laboratory parameters. 52% of patients were positive for these alcohol indicators and 32% of patients fulfilled more severe criteria for alcohol abuse. While patients without alcohol indicators showed an improvement of liver parameters over time, those with alcohol indicators suffered a considerable deterioration, indicating that alcohol consumption had increased WHO Global Status Report on Alcohol 24

11 Country background information population Life expectancy at birth (22) Male 76.4 Adult (15+) Female 82.2 % under Probability of dying under age 5 per 1 (22) Male 6 Population distribution 21 (%) Female 4 Urban 67 Gross National Income per capita 22 US$ Rural 33 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 24 References 1. Preliminary results from the Gender, Alcohol and Culture: An International Study (GENACIS Project). International Research Group on Gender and Alcohol (for more information please see 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): Uhl A, Springer A. Studie über den Konsim von Alkohol und psychoaktiven Stoffen in Österreich unter Berücksichtigung problematischer Gebrauchsmuster Repräsentativerhebung 1993/1994. Vienna, Datenband, Bericht des LBISucht, Health, food and alcohol and safety. Special Eurobarometer 186/Wave 59.. European Opinion Research Group, Currie C et al., eds. Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 21/22 survey. Copenhagen, WHO Health Policy for Children and Adolescents (HEPCA), Health Behaviour in School-aged Children: a WHO Cross-National Study (HBSC) International Report. Copenhagen, World Health Organization, Rathner G, Dunkel D. Incidence of alcoholism and problem drinking in Austria. Wiener Klinische Wochenschrift [The Middle European Journal of Medicine], 1998, 11(1): Kurzthaler I et al. Alcohol and/or benzodiazepine use in injured road users. Human Psychopharmacology: Clinical and Experimental, 23, 18(5): Barnas C et al. The effects of alcohol and benzodiazepines on the severity of ski accidents. Acta Psychiatrica Scandinavica, 1992, 86(4): Witheridge J. Drinking and driving. Questionnaire 22. London, British Beer and Pub Association, European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). 12. Alcohol consumption and harm in the UK and EU. Institute of Alcohol Studies Fact Sheet, Rittmannsberger H et al. Alcohol consumption during methadone maintenance treatment. European Addiction Research, 2, 6(1):2 7. WHO Global Status Report on Alcohol 24 11

12 AZERBAIJAN Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Last year abstainers 24% Male 12% Female 36% Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year In a recent general population survey of subjects 1 years and older, 54.1% of the survey participants reported present use of alcohol. Of these, 61.5% were males and 38.5% were females. The survey also found that 1.8% of drinkers reported drinking 4 6 times per week and 1.7% reported drinking at least daily. 2 Alcohol dependence The number of registered alcoholics is about 32 (.8% of adult population). 3 Unrecorded alcohol consumption The unrecorded alcohol consumption in Azerbaijan is estimated to be 1.9 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. 12 WHO Global Status Report on Alcohol 24

13 Chronic mortality SDR per Alcohol use disorders Cirrhosis of the liver Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. Acute mortality SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete. Morbidity, health and social problems from alcohol use In a recent national survey (total sample size n = 2), 282 respondents (14.1% of all respondents, 26.1% of alcohol users) noted the different problems that they encountered as a result of their drinking. The most widespread problems were as follows: family disputes (3.4%), health problems (36%), problems with law and order authorities, including problems connected with traffic police and administrative punishment (16.2%), problems at work (7.4%) and other problems (9.5%). 2 The rate of alcoholic psychosis incidence per 1 population was.35 in 21 and.16 in WHO Global Status Report on Alcohol 24 13

14 The SDR per 1 population for chronic liver disease and cirrhosis was in 1999 and in 2. 4 The number of alcohol-related road traffic accidents per 1 population was 1.17 in 2 and 1.1 in 21. Country background information population Life expectancy at birth (22) Male 63. Adult (15+) Female 68.6 % under Probability of dying under age 5 per 1 (22) Male 8 Population distribution 21 (%) Female 7 Urban 52 Gross National Income per capita 22 US$ 71 Rural 48 In Azerbaijan, approximately 94% of the population are Muslim. Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 23, The World Health Report 24 References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): General population survey report on drug abuse. Baku, National Focal Point of Drug Information System, Hasan-zada N. Substance abuse problems in Azerbaijan Republic. 4. European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). 14 WHO Global Status Report on Alcohol 24

15 BELARUS Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Note: No beverage specific data available between 198 and Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Last year abstainers 3% Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year Male 2% Female 4% Unrecorded alcohol consumption The unrecorded alcohol consumption in Belarus is estimated to be 4.9 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. WHO Global Status Report on Alcohol 24 15

16 Chronic mortality SDR per Cirrhosis of the liver Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. Acute mortality SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Morbidity, health and social problems from alcohol use In 1995, of the 8611 minors who committed crimes in Belarus, 1761 of them committed the crimes while being drunk. Comparing with data from 1991, where 25.8% of crimes were committed in a drunken state, in 1995, this figure rose to 27.3%. 2 The rate of alcoholic psychosis incidence per 1 population was in 21 and in The SDR per 1 population for chronic liver disease and cirrhosis was in 2 and in The number of alcohol-related road traffic accidents per 1 population was 7.37 in 2 and 6.82 in WHO Global Status Report on Alcohol 24

17 The statistics on incidence of alcoholism and alcoholic psychosis, number of patients admitted to hospitals for alcoholism and alcoholic psychosis as well as a level of alcoholic beverage consumption per capita in Belarus from 197 to 1999 were analysed. Using correlation, factor and cluster analyses, a strong positive correlation was found between the incidence of alcoholic psychoses and level of vodka consumption per capita. The incidence of alcoholism correlates positively with a total level of alcohol consumption. 4 A study of trends observed in Belarus during found a positive and statistically significant effect of per-capita vodka consumption on the cancer mortality rate. According to the analysis, a 1% increase in the percapita vodka consumption entails a.58% growth in the breast cancer mortality rate and a.66% growth in the oesophagus cancer mortality rate. This study is proof to the fact that a substantial share of breast cancers and of oesophageal cancers are brought about by consumption of strong alcoholic beverages. 5 A study of trends in the rate of suicides, as observed in Belarus in found that the rate of suicides tends to be more responsive in the per-capita spirits consumption versus that of the total quantity of consumed alcohol. There was a statistically significant relationship found between the rate of suicides and the per-capita consumed vodka. 6 Country background information population Life expectancy at birth (22) Male 62.6 Adult (15+) Female 74.3 % under Probability of dying under age 5 per 1 (22) Male 14 Population distribution 21 (%) Female 1 Urban 7 Gross National Income per capita 22 US$ 136 Rural 3 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 24 References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): Juvenile criminality and the system of justice in Belarus. Belinfocenter: the rule of law ( accessed 24 February 24). 3. European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). 4. Razvodovskii IuE. Alcoholism and alcoholic psychosis in Belarus in Zhurnal Nevropatologii I Psikhiatrii Imeni S. S. Korsakova, 22, 12(1): Razvodovskii IuE. Alcohol and malignant neoplasm. Problemy Sotsialnoi GigienyI I Istoriia Meditsiny, 23, November December(6): Razvodovskii IuE. Suicides and alcohol consumption rate. Problemy Sotsialnoi GigienyI I Istoriia Meditsiny, 23, July August(4): WHO Global Status Report on Alcohol 24 17

18 BELGIUM Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Last year abstainers 18.9% 21 national survey of subjects 15 years and above. Subsample males n = 4483 and females n = Male 11.5% Female 25.8% Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 14% (males) and 27% (females). Data is for after year Heavy episodic drinkers (at least monthly) 2.1% Male 32.6% Female 8.4% 21 national survey of subjects 15 years and above. Subsample n = 9148; males n = 4414 and females n = Data shows percentage of population who has consumed at least once a month six or more drinks on the same day WHO Global Status Report on Alcohol 24

19 The same survey also found that 8% of the sample drank once or twice weekly and that 12% (15% of males and 9% of females) were daily drinkers. 1 According to a national survey conducted in 23 (total sample size n = 173; aged 15 years and over), the average number of times that respondents had consumed the equivalent of one bottle of wine, five pints/bottles of beer or five measures of spirits on one drinking occasion was Youth drinking in Brussels (have drunk alcohol) 47.7% Male 52.8% Female 42.7% A survey on the use of alcohol and drugs among 213 young people aged 12 to 22 years in Brussels. 4 Youth drinking in the Flemish region (drink at least weekly) 39.2% Male 44.7% Female 33.6% HBSC survey 21/22. Data shows proportion of 15-year-olds in the Belgium Flemish region who report drinking beer, wine or spirits at least weekly. sample size n = Corresponding numbers for the French region of Belgium (total sample size n = 1381) were 28.4% (total), 35.6% (boys) and 22.4% (girls). 5 According to the 1997/1998 HBSC survey (total sample size n = 1559), 38% of 15-year-old boys and 22% of 15- year-old girls from the Flemish-speaking region of Belgium reported drinking beer, wine or spirits at least weekly. 6 Youth drinking among university students (alcohol dependence) 3.6% Male 5.9% Female 1.6% A 1995/1996 survey studying the prevalence of alcohol abuse and dependence according to DSM-IV criteria in first year university students (total sample size n = 3564). The same survey also found that the rate of alcohol abuse was 1.5% (total), 18.5% (males) and 3.7% (females). 7 WHO Global Status Report on Alcohol 24 19

20 Youth drinking (drunkenness) According to the 21/22 HBSC survey (total sample size n = 23), the proportion of 15-year-olds in the Flemish region who reported ever having been drunk two or more times was 37.1% for boys and 26.4% for girls. In the French region (total sample size n = 1381), the rates were 32% for boys and 23.8% for girls. 5 Alcohol dependence (among drinkers) 7% 21 national survey of subjects 15 years and above. Subsample males n = 3653 and females n = Male 9.5% Female 3.6% In a recent survey of 2316 randomly selected patients in an adult primary care population (18 years or older) probable alcohol abuse/dependence was detected in 1.1% of the sample population. 8 Unrecorded alcohol consumption The unrecorded alcohol consumption in Belgium is estimated to be.5 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 2 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. Chronic mortality Alcohol use disorders.8 Cirrhosis of the liver SDR per Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. 2 WHO Global Status Report on Alcohol 24

21 Acute mortality SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Morbidity, health and social problems from alcohol use In a survey of 211 weekend drivers injured in car crashes, 35.5% had positive test results in screening for alcohol. For the majority of those with positive findings for alcohol (72%), hospitalization in a general hospital unit or intensive care unit was necessary. There seems to be a consistent association between the consequences of the weekend crashes and the use of alcohol. 9 According to official statistics for the year 2, 8.5% (4168) of all injury accidents were alcohol-related, whereas 1.2% (949) of all accidents causing death or serious injury were alcohol-related. 1 In a large-scale study (n = 3518) designed to assess the academic performance of college freshmen in relation to alcohol abuse or dependence, of the 51 students who met criteria of alcohol dependence, 62.5% failed in their first year, compared to 5% among students who did not report these drinking problems. 11 The SDR per 1 population for chronic liver disease and cirrhosis was 1.81 in 1996 and in The number of alcohol-related road traffic accidents per 1 population was 44.2 in 1998 and in population Life expectancy at birth (22) Male 75.2 Adult (15+) Female 81.5 % under Probability of dying under age 5 per 1 (22) Male 6 Population distribution 21 (%) Female 5 Urban 97 Gross National Income per capita 22 US$ Rural 3 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 24 References 1. Belgium Health Interview Survey Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): Health, food and alcohol and safety. Special Eurobarometer 186/Wave 59.. European Opinion Research Group, Lambrecht P et al. Midelengebruik in de Hoofdstad. De Hoofdstad van Middelengebruik. Brussels, Free University, WHO Global Status Report on Alcohol 24 21

22 5. Currie C et al., eds. Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 21/22 survey. Copenhagen, WHO Health Policy for Children and Adolescents (HEPCA), Health Behaviour in School-aged Children: a WHO Cross-National Study (HBSC) International Report. Copenhagen, World Health Organization, Aertgeerts B et al. Prevalence of alcohol abuse and alcohol dependence according to DSM-IV criteria in first year university students. Nederlands Tijdscrift Voor Geneeskunde, 1999,143(52): Annseau M et al. High prevalence of mental disorders in primary care. Journal of Affective Disorders, 24, 78(1): Schepens PJ et al. Drugs of abuse and alcohol in weekend drivers involved in car crashes in Belgium. Annals of Emergency Medicine, 1998, 31(5): Witheridge J. Drinking and driving. Questionnaire 22. London, British Beer and Pub Association, Aertgeerts B, Buntinx F. The relation between alcohol abuse or dependence and academic performance in first-year college students. Journal of Adolescent Health, 22, 31(3): European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). 22 WHO Global Status Report on Alcohol 24

23 BOSNIA AND HERZEGOVINA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Lifetime abstainers 72.9% Male 55.% Female 86.6% Data from the 23 World Health Survey. sample size n = 126; males n = 432 and females n = 594. Sample population aged 18 years and above. 1 Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 12% (males) and 36% (females). Data is for after year Heavy and hazardous drinkers.1% Male.3% Female.% Data from the 23 World Health Survey. sample size n = 126; males n = 432 and females n = 594. Sample population aged 18 years and above. Definition used: average consumption of 4 g or more of pure alcohol a day for men and 2 g or more of pure alcohol a day for women. 1 WHO Global Status Report on Alcohol 24 23

24 According to the 23 World Health Survey (total sample size n = 27; males n = 195 and females n = 75), the mean value (in grams) of pure alcohol consumed per day among drinkers was 4.8 (total), 6.3 (males) and 1.3 (females). 1 A survey of non-manual workers in Sarajevo (males n = 112 and females n = 74; age group 2 to 65 years old) found the rate of heavy drinking to be 18.1% among males and 8.2% among females. Heavy drinking was defined as consuming more than 2 ml of alcohol per day. 3 Heavy episodic drinkers 1.2% Male 2.9% Female.% Data from the 23 World Health Survey. sample size n = 126; males n = 432 and females n = 594. Sample population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Youth drinking (lifetime abstainers) 73.5% Male 56.4% Female 89.9% Data from the 23 World Health Survey. sample size n = 111; males n = 52 and females n = 59. Sample population aged 18 to 24 years old. 1 Youth drinking (heavy episodic drinkers).8% Male 1.8% Female.% Data from the 23 World Health Survey. sample size n = 111; males n = 52 and females n = 59. Sample population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data. Unrecorded alcohol consumption The unrecorded alcohol consumption in Bosnia and Herzegovina is estimated to be 3. litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts) WHO Global Status Report on Alcohol 24

25 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. Chronic mortality Alcohol use disorders SDR per Cirrhosis of the liver Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. Acute mortality SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Morbidity, health and social problems from alcohol use The SDR per 1 population for chronic liver disease and cirrhosis was in 199 and 17. in In a study of 6 adolescents from Tuzla and Sarajevo Cantons, it was found that more prevailing suicidal idea occurrence was observed in alcohol abusers (36.6%) in comparison to non-abusers (17.6%). 5 WHO Global Status Report on Alcohol 24 25

26 Country background information population Life expectancy at birth (22) Male 69.3 Adult (15+) Female 76.4 % under Probability of dying under age 5 per 1 (22) Male 2 Population distribution 21 (%) Female 15 Urban 43 Gross National Income per capita 22 US$ 127 Rural 57 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 24 References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): Zec S et al. Nutrition in pre-war Sarajevo. European Journal of Clinical Nutrition, 1995, 49(Supplement 2):6 1. In: WHO Global NCD InfoBase. Geneva, World Health Organization. 4. European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). 5. Licanin I et al. Suicidal thoughts related to psychoactive substance abuse among adolescents. Medicinski Arhiv, 23, 57(4): WHO Global Status Report on Alcohol 24

27 BULGARIA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Last year abstainers Male 32.1% Female 65.1% 1997 household survey designed to be representative of the Bulgarian population aged 18 years or higher. sample size n = Data from the 1994 Sofia Heart Study found that spirits (rakia) accounted for around 5% of alcohol consumed, beer for around 3%, and wine for around 2%. Men reported an average of less than three drinking days per week and an average consumption of 65 g alcohol on these days; 17% of men reported excess alcohol consumption of 4 g/day and 12% of 6 g/day. The percentages and thresholds for excess alcohol consumption in women were 5% (2 g/day) and 2% (4 g/day). In relation to the increased risk of ischaemic heart disease from non-drinking causes, 3% of men and 67% of women aged over 45 reported themselves as non-drinkers. 2 Data from a nationwide nutrition survey conducted in 1998 found that 54.1% of working adult males and 32.1% of working adult females were alcohol consumers. The corresponding figures for the unemployed were 36.4% for males and 14.1% for females. The mean average daily intake of alcohol (in grams) for working adult males and females (among drinkers only) were 44.8 (males) and 21.6 (females), respectively. 3 Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 12% (males) and 36% (females). Data is for after year WHO Global Status Report on Alcohol 24 27

28 Heavy drinkers Male 18.2% Female.8% 1997 household survey designed to be representative of the Bulgarian population aged 18 years or higher. sample size n = 155. Heavy drinking was defined as consumption of 56 g of ethanol a week or more, equating to 8 g a day or more. 1 The same survey also found that of those men reporting that they drink on several days per week, 7% report regularly drinking the equivalent of 16 g of alcohol per drinking occasion. 1 Youth drinking (alcohol consumers) 16% Male 21% Female 12% Data from the 1999 European School Survey Project on Alcohol and Drugs (ESPAD) survey. sample size n = 5391, males n = 2434 and females n = 2957; age group 15 to 16 years. Alcohol consumer was defined as lifetime use of 4 times or more. 5 Youth drinking (binge drinkers) 11% Male 15% Female 6% Data from the 1999 ESPAD survey. sample size n = 5391, males n = 2434 and females n = 2957; age group 15 to 16 years. Binge drinking was defined as consuming five or more drinks in a row three times or more in the last 3 days. 5 Youth drinking (drunkenness) In the 1999 ESPAD study of subjects 15 to 16 years old (total sample size n = 5391; males n = 2434 and females n = 2957) the proportion of subjects who reported being drunk three times or more in the last 3 days was 8% (total), 12% (males) and 4% (females). 5 Traditional alcoholic beverages Traditional alcoholic drinks are rakiya (a fruit brandy, often plum) and boza (a type of beer made with grain, usually millet). Unrecorded alcohol consumption The unrecorded alcohol consumption in Bulgaria is estimated to be 3. litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts) WHO Global Status Report on Alcohol 24

29 Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor. Chronic mortality Alcohol use disorders SDR per Cirrhosis of the liver Mouth and oropharynx cancers Ischaemic heart disease Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. Acute mortality.25.2 SDR per Falls Intentional injuries Accidental poisonings Road traffic accidents Source: WHO Mortality Database Morbidity, health and social problems from alcohol use Male death rates from cirrhosis in Bulgaria have more than trebled in a period of 25 years. Although alcohol is only one of the factors accounting for the high level of premature mortality of the Bulgarian population, it seems likely that it is an important one, and one that is amendable to a concerted policy response. 1 WHO Global Status Report on Alcohol 24 29

30 There is a growing concern regarding the large-scale alcohol abuse seen among children and youngsters in Bulgaria. There have been growing reports of children seeking medical aid for alcohol poisoning. Equally disturbing is the fact that these children, even at such a young age, are already showing signs of potentially being dependent on alcohol. A 1995 sociological survey carried out among 28 secondary school students found that 8% used spirits frequently. 6 The rate of alcoholic psychosis incidence per 1 population was.18 in 21 and.27 in The SDR per 1 population for chronic liver disease and cirrhosis was in 21 and 15.4 in The number of alcohol-related road traffic accidents per 1 population was 5.78 in 2 and 5.42 in Country background information population Life expectancy at birth (22) Male 68.8 Adult (15+) Female 75.6 % under Probability of dying under age 5 per 1 (22) Male 17 Population distribution 21 (%) Female 15 Urban 67 Gross National Income per capita 22 US$ 179 Rural 33 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 24 References 1. Balabanova D, McKee M. Patterns of alcohol consumption in Bulgaria. Alcohol and Alcoholism, 1999, 34(4): Georgieva L. Risk factor surveillance for coronary heart disease in Sofia, Bulgaria [dissertation]. Cambridge, Open University, 21. In: Georgieva L et al. Bulgarian population in transitional period. Croatian Medical Journal, 22, 43(2): Petrova S, ed. Dietary and nutritional status survey of the population in Bulgaria, March Sofia, National Center of Hygiene, Medical Ecology and Nutrition, Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 21, 7(3): Hibell B et al. The 1999 ESPAD Report. The European School Survey on Alcohol and Other Drugs: Alcohol and Other Drug Use Among Students in 3 European Countries. Stockholm, Council of Europe, Anguelova JT. Youth of Bulgaria: some problems and risks during the transition period. Background paper prepared for the Regional Monitoring Report No. 7 Young People in Changing Societies. UNICEF, European health for all database. World Health Organization, Regional Office for Europe ( accessed 26 February 24). 3 WHO Global Status Report on Alcohol 24

31 CROATIA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Note: Data on spirits not available from 1987 to 1991, therefore total alcohol consumption has not been calculated for that time period. Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 23 Lifetime abstainers 22% Male 11.7% Female 28.7% Data from the 23 World Health Survey. sample size n = 987; males n = 398 and females n = 589. Sample population aged 18 years and above. 1 Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 12% (males) and 36% (females). Data is for after year In a national study conducted between (total sample size n = 548; aged years old), it was found that 5% of the total sample drank beer daily and 12% of the total sample drank wine daily. The study also noted regional differences in alcohol consumption patterns. For example, the most significant geographic difference was found in wine consumption: 46% of the population from Split region drink wine more than four times a week versus 12.9%, 6.8% and 3.2% in Rijeka, Zagreb and Osijek regions, respectively. 3 WHO Global Status Report on Alcohol 24 31

32 Heavy and hazardous drinkers 2.9% Male 4.4% Female 1.9% Data from the 23 World Health Survey. sample size n = 987; males n = 398 and females n = 589. Sample population aged 18 years and above. Definition used: average consumption of 4 g or more of pure alcohol a day for men and 2 g or more of pure alcohol a day for women. 1 According to the 23 World Health Survey (total sample size n = 736; males n = 347 and females n = 389), the mean value (in grams) of pure alcohol consumed per day among drinkers was 6.5 (total), 1.9 (males) and 2.6 (females). 1 Heavy episodic drinkers 4.3% Male 1.% Female.4% Data from the 23 World Health Survey. sample size n = 987; males n = 398 and females n = 589. Sample population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Youth drinking (lifetime abstainers) 15.5% Data from the 23 World Health Survey. sample size n = 57; males n = 27 and females n = 3. Sample population aged 18 to 24 years old. 1 Male 11.7% Female 16.7% According to the 1999 ESPAD survey (total sample size n = 362, males n = 1961 and females n = 1641; age group 15 to 16 years), the rate of alcohol consumers was 18% (total), 24% (males) and 1% (females). Alcohol consumer was defined as lifetime use of 4 times or more. 4 In a 1998 study of a representative sample of Croatian high school students (total sample size n = 2823), it was found that 62.2% of students had consumed alcohol in the month preceding the survey and 47.1% had successively five or more drinks in a day. 5 The same survey also found that 82.2% of students had consumed alcohol in the last 12 months before the survey and that 88.3% were lifetime users. 6 A study of school students (28 pupils in primary school and 232 pupils in secondary school) found that 5.83% of the primary school students and 28.81% of secondary school students consumed alcohol. Among students in the last two years of secondary school, 41.4% reportedly consume alcohol WHO Global Status Report on Alcohol 24

33 In a 2 study of 775 Zagreb University medical students (136 were non-medical students), it was found that about half of the medical students reported regular alcohol consumption on a monthly (37%), weekly (9.5%), or daily (3.4%) basis. Furthermore, 15% reported regular monthly, and 2.8% regular weekly intoxications. 8 Youth drinking (drink at least weekly) 29.6% HBSC survey 21/22. Data shows proportion of 15-year-olds who report drinking beer, wine or spirits at least weekly. sample size n = Male 35.9% Female 24.8% In a 21 survey of 244 elementary and high school students (115 boys and 1254 girls; age range years) in Zagreb, Croatia, the rate of lifetime prevalence of alcohol use was found to be 89.7%. Most of the students (59%) consumed alcohol occasionally ( once or several times a month) and only 3% consumed alcohol daily. 1 Youth drinking (heavy episodic drinkers) 4.6% Male 9.6% Female.% Data from the 23 World Health Survey. sample size n = 57; males n = 27 and females n = 3. Sample population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data. According to the 1999 ESPAD survey (total sample size n = 362, males n = 1961 and females n = 1641; age group 15 to 16 years), the rate of binge drinking was 12% (total), 15% (males) and 7% (females). Binge drinking was defined as consuming five or more drinks in a row three times or more in the last 3 days. 4 Youth drinking (drunkenness) According to the 21/22 HBSC survey (total sample size n = 1446), the proportion of 15-year-olds who reported ever having been drunk two or more times was 38% for boys and 21.4% for girls. 9 In the 1999 ESPAD study of subjects 15 to 16 years old (total sample size n = 362; males n = 1961 and females n = 1641) the proportion of subjects who reported being drunk three times or more in the last 3 days was 7% (total), 9% (males) and 3% (females). 4 Alcohol abuse In a study comparing alcohol use among adolescents in urban and rural areas (research covered 6 adolescents of equal gender and age distribution), it was found that alcohol use was more common in urban areas (62.4%) than rural areas (37.6%). 11 A study of 368 (157 men and 211 women) displaced persons found the rate of current alcohol dependence (according to CAGE) to be 6.5% among men and 8.1% among women. Alcohol dependence comorbid to posttraumatic stress disorder (PTSD) was more often found in men than in women; 69.6% of men with PTSD had alcohol dependence, whereas only 11.7% of women with PTSD had alcohol dependence. 12 WHO Global Status Report on Alcohol 24 33