Second-Hand Alcohol Abuse: A Public Health View of a Personal Choice

We are all aware of the concept of second-hand smoke – the ill effects of smoking on people and the environment other than the smoker; but have you considered second-hand alcohol?

It is a "thing," and a new article in BMC Medicine at least provides an introduction to the concept.

Much of the health literature about the harmful effects of alcohol reflect concerns about the drinker. So, who are affected by second-hand alcohol? First, there is a small fraction of those abusing alcohol [1] that are pregnant mothers, who give birth to babies suffering from fetal alcohol syndrome or fetal alcohol spectrum disorder. The second group is individuals involved in motor vehicle accidents with alcohol-impaired drivers. The third group is individuals experiencing violence secondary to alcohol “fueled” aggressive behavior. 

The study was conducted in Germany, so the findings and conclusions are limited by cultural proclivity towards drinking, differences in automobiles and speed limits, and violent behavior towards family or strangers. The reason you can apply these cultural or societal “grains of salt,” is because the actual data of the harm of second-hand alcohol is fuzzy – that in part is the study’s message, there is a lot we do not know. Here is what they reported:

• Forty-one children will have Fetal alcohol syndrome (FAS), and another 177 will be on the fetal alcohol spectrum (FASD) for every 10,000 live births. If there was a similar rate in the US that would represent 16,500 with FAS and 70,800 with FASD. Two very quick caveats, most studies utilize self-reported alcohol use, and there is a lot of reasons for a mother to minimize their reporting; and FAS and FASD remain somewhat enigmatic, the signs and symptoms of the syndrome are not clear – that is by the way why it is considered a syndrome, rather than a disease.
• The authors attributed impairment by alcohol as a factor in 45% of traffic fatalities. If the percentage held it would be 17,500 of the 38,000+ traffic fatalities in the US in 2015. Again, the number remains fuzzy, it is 8-fold greater than the reported association of alcohol with traffic accidents in Germany; and in Germany, the cutoff or blood alcohol level (BAL) is lower than in the US, 0.5g/L versus 0.8g/L. 
• Their calculation of alcohol-related interpersonal violence is another estimate, in large part because the evaluation of BALs is not a routine part of police investigations of violence, and because some forms of violence, especially among “domestic partners” may go unreported. The Germans crime statistics documented the presence or absence of alcohol in about 54% of their reports, of those reports roughly 30% involved alcohol. (That is 16% of the total “violent acts.”) It is impossible to even make an educated guess at the US number as our violent crimes definition include burglary and motor vehicle theft.

The authors believe that their study demonstrates the feasibility of making estimates and measures of the harmful effect of second-hand alcohol. They make a case for more research to provide better information. There is no doubt that the impact of alcohol-impaired behavior extends beyond the drinker. But another goal is to shift our perspective and add these real problems to the tally of alcohol’s economic and sociologic impacts in the same way that second-hand smoke became a public health, not a personal issue. Interestingly, the recommendations are eerily similar to those for tobacco, pricing policies, education, screening pregnant women for alcohol use, more roadside alcohol checkpoints. 

[1] The criteria for what constitutes abuse remains controversial, so let that go for the moment. “For women, low-risk drinking is defined as no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week.” 

Source: Quantifying harms to others due to alcohol consumption in Germany: a register-based study BMC Medicine DOI: 10.1186/s12916-019-1290-0