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Abstract
Alcoholic beverages, and the problems they engender, have been familiar fixtures in
human societies since the beginning of recorded history. We review advances in alcohol
science in terms of three topics: the epidemiology of alcohol's role in health and
illness; the treatment of alcohol use disorders in a public health perspective; and
policy research and options. Research has contributed substantially to our understanding
of the relation of drinking to specific disorders, and has shown that the relation
between alcohol consumption and health outcomes is complex and multidimensional. Alcohol
is causally related to more than 60 different medical conditions. Overall, 4% of the
global burden of disease is attributable to alcohol, which accounts for about as much
death and disability globally as tobacco and hypertension. Treatment research shows
that early intervention in primary care is feasible and effective, and a variety of
behavioural and pharmacological interventions are available to treat alcohol dependence.
This evidence suggests that treatment of alcohol-related problems should be incorporated
into a public health response to alcohol problems. Additionally, evidence-based preventive
measures are available at both the individual and population levels, with alcohol
taxes, restrictions on alcohol availability, and drinking-driving countermeasures
among the most effective policy options. Despite the scientific advances, alcohol
problems continue to present a major challenge to medicine and public health, in part
because population-based public health approaches have been neglected in favour of
approaches oriented to the individual that tend to be more palliative than preventative.