"These numbers are high," says Dr. Jurgen Rehm, one of the authors of the study published in this week’s edition of the Lancet. "And they’re only getting higher as more people drink in higher volumes and more frequent patterns."

Amy Minsky of Canwest News Service writes that the researchers attribute the recent global increase in part to greater consumption by women.

"Plus, production is more widespread and marketing has globalized," Rehm said, adding that the effect of alcohol on the human body is better understood and can be more easily linked to causes of death.

"The public doesn’t always recognize an alcohol-related death," he added. "It’s not like if your neighbor dies of lung cancer, and you assume he was a smoker. Nobody ever assumes that their neighbor’s breast cancer was because she was a drinker."

Most diseases that are commonly associated with alcoholism—such as cirrhosis of the liver—constitute a minority of alcohol-related deaths, said Rehm.

Alcohol can influence several hormonal systems in the body, causing various diseases such as mouth and throat, colorectal and breast cancers, as well as strokes.

A woman who has three drinks per day on average increases her risk of getting breast cancer by about 15 percent, said Rehm. "That means that (perhaps) only one in 20 cases of breast cancer is due to alcohol consumption. And that’s why the public ignores alcohol as a carcinogen."

The report noted alcohol consumption also leads to accidental, premature deaths.
"When you have more people drinking more alcohol, you get more people who are risk-prone," said Rehm. "You have more people on our highways, drunk driving, and more people drunk while snowmobiling or boating. Accidents and deaths will happen."

Separate data from the Centre for Addiction and Mental Health published in 2006 found 3,892 deaths attributable to alcohol in Canada, or 1.8 percent of all Canadian deaths. The three biggest contributing factors were unintentional injuries, cancers and digestive diseases.

While the Canadian figure is lower than the world percentage, the global numbers are bolstered by areas such as Europe, where one in 10 deaths is directly attributable to alcohol, and Russia, where about one in seven deaths can be directly linked to alcohol.
The study found that globally, alcohol consumption worked out to about 12 units per person per week on average. A unit is comparable to a small can of beer, glass of wine or a one-ounce shot of liquor.

"But globally, the vast majority of adults abstain from liquor," said Rehm. "So the drinkers are actually drinking about twice as much."

The Canadian consumption is calculated at almost nine units per person per week. By contrast, in Europe it is 21.5 units per week.

"The public disregards a lot of what alcohol does to the system," said Rehm.

Burns said he was "shocked" by the number of suspensions, which he described as "totally unacceptable." He added, "The last thing anyone wants to see is schoolchildren staggering drunk in the street.”

"Alcohol abuse and binge drinking, particularly among young people, is an ever increasing problem in our society. It is quite shocking to learn this behaviour is not just restricted to town centers on Friday and Saturday nights, but has now made it into our schools as well,” he said.

"If children are getting so drunk on a regular basis it is affecting their schooling then serious action needs to be taken by both head-teachers and the parents. Harsh discipline needs to be brought to bear both inside and outside the school. The issuing of suspensions in these cases is totally justifiable and that needs to be backed up with further punishment at home," Burns added.

The statistics cover the academic years from 2003-04 to 2007-08 but no details are available on whether the students involved were under the influence of alcohol on their school premises.

Suspension and expulsion figures for the 2008-09 school year will be published in the coming weeks.

"It may seem intuitive that cheaper alcohol can lead to higher intoxication levels and related consequences—such as fighting, drunk driving, sexual victimization, injury, even death—especially among the vulnerable college student population," said Ryan J. O’Mara, a graduate research fellow at the University of Florida and corresponding author for the study.

"Nonetheless, ‘drink specials’ and other alcohol discounts and promotions remain a common feature of college bars in campus communities in the United States. This study’s results challenge assertions sometimes made by the management of these establishments that drink discounts are innocuous marketing practices intended only to attract customers to better bargains than those provided elsewhere."

"What makes this study unique," added John D. Clapp, professor and director of the San Diego State University Center for Alcohol and Drug Studies, "is that it was one of the first to examine this relationship at the bar-patron level using methods that carefully examined price—that is, what people actually spent—and biologically measured intoxication."

"Most of this prior research has relied on population-level data, for example, comparing alcohol taxes and alcohol sales at the state level," explained O’Mara. "Our study examines this price-behavior relationship at the individual, or consumer, level in a natural drinking setting. We did this study in college bars because previous research has shown that young adults are more sensitive to alcohol price changes than older populations who generally have more disposable income."

O’Mara and his colleagues collected data on 804 patrons (495 men, 309 women) exiting seven bars adjacent to a large university campus on four consecutive nights during April 2008 in the southeastern United States. The data included anonymous interview and survey information, breath alcohol concentration (BAC) readings, as well as each patron’s expenditures per unit of alcohol consumed, based on self-reported information given regarding the type, size, number, and cost of consumed drinks.

"We estimated each patron’s cost per gram of ethanol (pure alcohol) consumed at a bar," said O’Mara. "For example, one male participant consumed five 12-ounce bottles of a domestic beer (4.2% ethanol), or approximately 56 grams of ethanol. He paid $5.00 for all of these drinks, so we calculated that he spent about nine cents per gram of ethanol consumed at a bar.”

“His BAC upon leaving the bar district was just above 0.08, the presumptive legal limit for driving in the US. We found that increases in cost per gram of ethanol were associated with lower levels of intoxication. For example, patrons with the lowest level of intoxication, a BAC of less than 0.02, paid on average $4.44 for a standard drink or 14 grams of ethanol versus patrons with the highest level of intoxication, a BAC of more than 0.16, who paid $1.81 per drink."

In other words, researchers found that for each $1.40 increase in the average price paid for a standard drink, the patron was 30 percent less likely to leave the bar district with a BAC above 0.08. Essentially, higher alcohol prices were associated with less risk of being inebriated when driving away from a bar.

"In our current economic recession," said O’Mara, "it is quite possible that some people with little disposable income are highly sensitive to alcohol price changes. A future study should seek to determine which specific populations are most vulnerable to drink discounting at bars."

He added that he is skeptical that bars and nightclubs that cater to college students would voluntarily eliminate drink discounts. "I suspect their primary aim is to generate revenue," O’Mara said, "which unfortunately conflicts with protecting public health and safety."

Clapp agreed. "Bars often argue that college students cannot afford to drink at ‘regular’ prices and thus inexpensive alcohol is a business necessity," he said. "Moreover, bar owners often argue such cheaper drinks do not result in drunkenness or other problems. This study suggests otherwise. Students will purchase more expensive alcoholic drinks and, when they do, become less intoxicated. It would seem from a both a business and public-health standpoint, inexpensive drinks are a problem."
 

The study is being called the first to try to measure the likelihood someone will drive after binge drinking. It suggests a need for stepped-up efforts to prevent bars and restaurants from serving people after they’re intoxicated, according to its authors at the Centers for Disease Control and Prevention.

The researchers focused on 14,000 binge drinkers—people who said that at least once a month they had five or more drinks on a single occasion. About 12 percent said they had gone driving within two hours of their last bout of heavy drinking.

Of those drivers, more than half got behind the wheel after drinking in a bar, restaurant, or other licensed establishment. And half of the drivers who left an establishment said they had seven or more drinks; a quarter said they’d had at least 10.

Some people can handle alcohol better than others, and eating food or drinking over several hours can soften alcohol’s impact. But 10 drinks is a lot, said James Fell of the Pacific Institute for Research and Evaluation, a national research organization focused on alcohol policy. "Almost everybody’s going to be intoxicated after 10 drinks," said Fell, who was not involved in the study.

Nearly every state has a law that in theory prohibits licensed establishments from selling alcohol to drunk patrons. But most states don’t have enough enforcement personnel to stop in on bars and watch for over-serving of customers. "These are among the most disregarded laws in the country," said study leader Dr. Timothy Naimi, an epidemiologist with the CDC’s alcohol program.

"The drinking location is really important," said Naimi. "We’re trusting these licensed establishments to serve responsibly, and more than half of the intoxicated people who drive have been drinking in these places."