酒精与健康以及物质使用障碍治疗问题全球现状报告（英）-334正式版-WN8

GlobalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisordersGlobalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisordersGlobalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisordersISBN978-92-4-009674-5(electronicversion)ISBN978-92-4-009675-2(printversion)©WorldHealthOrganization2024Somerightsreserved.ThisworkisavailableundertheCreativeCommonsAttribution-NonCommercial-ShareAlike3.0ꢀIGOlicence(CCꢀBY-NC-SAꢀ3.0ꢀIGO;/licenses/by-nc-sa/3.0/igo).Underthetermsofthislicence,youmaycopy,redistributeandadapttheworkfornon-commercialpurposes,providedtheworkisappropriatelycited,asindicatedbelow.Inanyuseofthiswork,thereshouldbenosuggestionthatWHOendorsesanyspecificorganization,productsorservices.TheuseoftheWHOlogoisnotpermitted.Ifyouadaptthework,thenyoumustlicenseyourworkunderthesameorequivalentCreativeCommonslicence.Ifyoucreateatranslationofthiswork,youshouldaddthefollowingdisclaimeralongwiththesuggestedcitation:“ThistranslationwasnotcreatedbytheWorldHealthOrganization(WHO).WHOisnotresponsibleforthecontentoraccuracyofthistranslation.TheoriginalEnglisheditionshallbethebindingandauthenticedition”.AnymediationrelatingtodisputesarisingunderthelicenceshallbeconductedinaccordancewiththemediationrulesoftheWorldIntellectualPropertyOrganization(/amc/en/mediation/rules/).Suggestedcitation.Globalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisorders.Geneva:WorldHealthOrganization;2024.Licence:CCꢀBY-NC-SAꢀ3.0ꢀIGO.Cataloguing-in-Publication(CIP)data.CIPdataareavailableat/.Sales,rightsandlicensing.TopurchaseWHOpublications,see/publications/book-orders.Tosubmitrequestsforcommercialuseandqueriesonrightsandlicensing,see/copyright.Third-partymaterials.Ifyouwishtoreusematerialfromthisworkthatisattributedtoathirdparty,suchastables,figuresorimages,itisyourresponsibilitytodeterminewhetherpermissionisneededforthatreuseandtoobtainpermissionfromthecopyrightholder.Theriskofclaimsresultingfrominfringementofanythird-party-ownedcomponentintheworkrestssolelywiththeuser.Generaldisclaimers.ThedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplytheexpressionofanyopinionwhatsoeveronthepartofWHOconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedanddashedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement.Thementionofspecificcompaniesorofcertainmanufacturers’productsdoesnotimplythattheyareendorsedorrecommendedbyWHOinpreferencetoothersofasimilarnaturethatarenotmentioned.Errorsandomissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitalletters.AllreasonableprecautionshavebeentakenbyWHOtoverifytheinformationcontainedinthispublication.However,thepublishedmaterialisbeingdistributedwithoutwarrantyofanykind,eitherexpressedorimplied.Theresponsibilityfortheinterpretationanduseofthemateriallieswiththereader.InnoeventshallWHObeliablefordamagesarisingfromitsuse.GraphicdesignandlayoutbyL'IVComSàrl,SwitzerlandContentForeword.....................................................................................................ivAcknowledgements.........................................................................................vAbbreviations..............................................................................................viiiExecutivesummary........................................................................................xiIntroduction...............................................................................................xvii1.Psychoactivesubstanceuse,healthanddevelopment...........................................12.Alcoholconsumption,alcohol-relatedharmandpolicyresponses............................232.1Globalstatusandtrendsinalcoholconsumption(SDG3.5.2indicator)....................262.2Globalstatusandtrendsinthehealthconsequencesofalcoholconsumption............432.3Alcoholpolicies....................................................................................643.Strengtheningtreatmentforsubstanceusedisorders:towardsuniversalhealthcoverage.........................................................................................793.1Treatmentofsubstanceusedisorders..........................................................823.2TreatmentcoverageandServiceCapacityIndex(SCI)forsubstanceusedisorders.....1054.Conclusions:towardsattainmentofSDGhealthtarget3.5...................................119Annexes....................................................................................................129Annex1.Datasourcesandmethods...............................................................131Annex2.Statisticalannexonalcoholandhealth.................................................165Annex3.Statisticalannexontreatmentofsubstanceusedisorders...........................244Annex4.Estimatesofdrug-attributablediseaseburden........................................294References.................................................................................................297iiiForewordPsychoactivesubstanceuse,includingdrugsandproductscontainingalcohol,carriesasignificanthealthandsocialburden.In2019alone,alcoholcaused2.6ꢀmilliondeathsworldwide,andpsychoactivedrugsaccountedfornearly600ꢀ000deaths.Psychoactivesubstanceusealsoresultsinnegativesocialandeconomicconsequencesforcommunities.Assuch,theimpactofsubstanceuseonhealthanddevelopmentisrecognizedinthe2030AgendaforSustainableDevelopment,throughSustainableDevelopmentGoals(SDG)healthtarget3.5,whichcallsforthestrengthenedpreventionofsubstanceuseandtreatmentofsubstanceusedisorders.DrTedrosAdhanomGhebreyesusDirector-GeneralWorldHealthOrganizationThisreportpresentsacomprehensiveglobalupdateonthestatusandprogressaroundthetwokeyindicatorssetoutinSDGhealthtarget3.5:alcoholconsumptionandtreatmentcoverageforsubstanceusedisorders.Itsetsouteightpriorityareaswhereactionneedstobetaken.Despitesomereductioninalcoholconsumptionandrelatedharmworldwidesince2010,thehealthandsocialburdenduetoalcoholuseremainsunacceptablyhigh.Youngerpeoplearedisproportionatelyaffectedbyalcoholconsumption:thehighestproportionofalcoholattributabledeaths–13%–in2019wasamongpeopleaged20-39years.Whilewehaveseenaslightincreaseinthenumberofcountriesadoptingnationalalcoholpolicies,littleprogresshasbeenmadeinimplementingthehigh-impactpolicyinterventionsproventoreducealcohol-relatedharm,suchasimpactfulpricingpoliciesorcomprehensivemarketingandavailabilityrestrictions.TheWHOGlobalalcoholactionplan2022-2030setsoutthese‘bestbuys’andsupportscountriestostrengthenactionsonreducingalcohol-relatedharms,butimplementationeffortsmustbesteppedupurgently.Thereportalsohighlightsanothercriticalgap:accesstoqualityandethicaltreatmentforsubstanceusedisordersisstilllargelylimitedorunaffordableforthosemostinneed.Thisaffectsalmosthalfabillionofpeopleworldwidewholivewithalcoholordrugusedisorders.Stigma,discriminationandmisconceptionsabouttheefficacyoftreatmentcontributetogapsinhealthservicesandlowprioritizationofsubstanceusedisordersbyhealthanddevelopmentagencies.WearenotontracktoachievesignificantprogressforSDGtarget3.5unlessweaccelerateactionnow.WHOremainscommittedtoworkingwithgovernments,internationalpartners,civilsocietyorganizationsand,asappropriate,otherstakeholderstomakerealandmeasurableprogresstowardsthesetargets.Giventheheavyhealthandsocialburdenthatpsychoactivesubstanceusecontinuestohaveonpeople,theirfamiliesandcommunitiesacrosstheworld,effortstoreducepsychoactivesubstanceusemustbeapublichealthpriority.ivAcknowledgementsThisreportwaspreparedbytheAlcohol,DrugsandAddictiveBehavioursUnit(ADA)intheDepartmentofMentalHealth,BrainHealthandSubstanceUse(MSD)oftheWorldHealthOrganization(WHO),Geneva,Switzerland.Thereportwasconceptualizedby,anddevelopedundertheoverallguidanceof,DévoraKestel(Director,MSD)andVladimirPoznyak(UnitHead,ADA)withintheframeworkofWHOactivitiesonglobalmonitoringtoinformprogresstowardsachievementofSustainableDevelopmentGoal(SDG)healthtarget3.5andimplementationoftheGlobalstrategytoreducetheharmfuluseofalcohol.ThedevelopmentofthisreportislinkedtoWHO’sworkontheglobalinformationsystemsonalcoholandhealthandresourcesforthepreventionandtreatmentofsubstanceusedisorders.WithinWHO’ssecretariat,MinghuiRenattheinitialstageandsubsequentlyJérômeSalomonprovidedguidanceandsupporttotheprojectintheirconsecutiverolesasAssistantDirector-General,UniversalHealthCoverage/CommunicableandNoncommunicableDiseases(UCN).ProductionofthisreportwasledbyVladimirPoznyakwhoalsoservedasanexecutiveeditorofthereport.TheWHOstaffinvolvedindevelopmentandproductionofthereportwere:AlexandraFleischmann,DzmitryKrupchankaandDagRekveoftheADAunitatWHOheadquartersinGeneva.IlincaRaduandJiangLongcontributedtothedatacollection,compilationandproductionofthereportintheircapacityasconsultants.JuanTellooftheWHODepartmentofHealthPromotionprovidedtechnicalinputtothedevelopmentofthechapteronalcoholandhealth.BochenCao,HaidongWang,JessicaHoandAnnetMahananioftheWHODivisionofData,Analytics&DeliveryforImpact(DDI)contributedtotheestimatesofalcohol-anddrug-attributablediseaseburdenandprovidedtechnicalinputatdifferentstagesofthereport’sdevelopment.Estimatesofdrug-attributablediseaseburdenwereproducedbyColinMathers.LeanneRiley,ReginaGutholdandMelanieCowanofWHO’sNoncommunicableDiseasesDepartmentprovideddatafromtheWHO-supportedsurveysandtechnicalinputtothereport.KtFriarandCameronDenneyoftheDDIdivisioncreatedthemapsusedinthereport,andPhilippeBoucher,ZoeBrillantesandJovenLarinofthesamedivisionweretechnicalcounterpartsfromtheGlobalHealthObservatoryforupdatingtheglobalinformationsystems.Fortheirsignificantcontributionstoindividualchaptersandannexesweacknowledgethefollowing:Chapter1:RobinRoom,MeganCook,Anne-MarieLaslett,ThomasBabor,VladimirPoznyak.Chapter2:JürgenRehm,KevinShield,DavidJernigan,PamelaTrangenstein,DagRekve,VladimirPoznyak.Chapter3:DzmitryKrupchanka,TomasFormanek,ThomasBabor,VladimirPoznyak.Chapter4:VladimirPoznyak,MaristelaGoldnadelMonteiro,DavidBramley.Annexes:KevinShield,PamelaTrangenstein,AlexandraFleischmann,DzmitryKrupchanka,IlincaꢀRadu.vGlobalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisordersThecollectionofdatawithintheframeworkoftheWHOglobalsurveyonprogressonSDGhealthtarget3.5andthedevelopmentofthisreportwasundertakenincollaborationwiththesixWHOregionalofficesandWHOcountryoffices.KeycontributorstothedatacollectionandcompilationintheWHOregionalofficeswere:WHOAfricanRegion:FlorenceBainganaWHORegionoftheAmericas:MaristelaGoldnadelMonteiro,SohiIvneetWHOEasternMediterraneanRegion:KhalidSaeed,WafaaElsawiWHOEuropeanRegion:CarinaFerreira-Borges,SergeyBychkov,MariaNeufeldWHOSouth-EastAsiaRegion:NazneenAnwarWHOWesternPacificRegion:MartinVandendyck,CarolineLukaszyk,KiraFortune,AmyBestman.ThefollowingcolleaguesfromtheWHOregionalofficesprovidedtechnicalinputatdifferentstagesoftheprojectdevelopment:FlorenceBainganaandChidoRatidzaiRwafaMadzvamutse(AfricanRegion),RenatoOliveiraandMarioZapata(RegionoftheAmericas/PanAmericanHealthOrganization),KhalidSaeedandDaliaElasi(EasternMediterraneanRegion),CarinaFerreira-BorgesandMariaNeufeld(EuropeanRegion),AndreaBruni(South-EastAsiaRegion),MartinVandendyck,XiYinandDanFang(WesternPacificRegion).TechnicaladviceandreviewsduringtheprocessofdevelopmentofthedatacollectiontoolandproductionoftheestimatesincludedinthisreportwereprovidedbymembersoftheTechnicalAdvisoryGrouponAlcoholandDrugEpidemiology,includingSawitriAssanangkornchai,PrinceofSongklaUniversity,Songkla,Thailand;GuilhermeBorges,NationalInstituteofPsychiatry,MexicoCity,Mexico;LouisaDegenhardt,NationalDrugandAlcoholResearchCentre,UniversityofSouthWales,Sydney,Australia;GerhardGmel,UniversityHospitalCentre,Lausanne,Switzerland;GopalakrishnaGururaj,NationalInstituteofMentalHealthandNeurosciences(NIMHANS),Bangalore,India;WeiHao,MentalHealthInstitute,CentralSouthUniversity,Changsha,China;MatthewHickman,UniversityofBristol,Bristol,UnitedKingdomofGreatBritainandNorthernIreland;SusumuHiguchi,KurihamaMedicalandAddictionCenter,Kanagawa,Japan;PiaMäkelä,FinnishInstituteforHealthandWelfare(THL),Helsinki,Finland;IsidoreObot,CentreforResearchandInformationonSubstanceAbuse(CRISA),UniversityofUyo,Uyo,Nigeria;CharlesParry,MentalHealth,Alcohol,SubstanceUseandTobaccoResearchUnit(MASTRU),SouthAfricanMedicalResearchCouncil,CapeTown,SouthAfrica;FlavioPechansky,CenterforDrugandAlcoholResearch,FederalUniversityofRioGrandedoSul,PortoAlegre,Brazil;AfarinRahimi-Movaghar,IranianNationalCenterforAddictionStudies,TehranUniversityofMedicalSciences,Tehran,IslamicRepublicofIran;JürgenRehm,CentreforAddictionandMentalHealth(CAMH),Toronto,Canada;IngeborgRossow,NorwegianInstituteofPublicHealth,Oslo,Norway;EmanueleScafato,NationalCentreonAddictionsandDoping,Rome,Italy;TimStockwell,CanadianInstituteforSubstanceUseResearch,UniversityofVictoria,Victoria,Canada;JallalToufiq,MoroccanObservatoryonDrugsandAddictions,RabatFacultyofMedicine,Rabat,Morocco.TechnicaladviceandinputtothedevelopmentofthereportanditskeymessageswereprovidedbytheeditorialgroupthatincludedHamadAlGhaferi,SchoolofHealthandEnvironmentalStudies,HamdanBinMohammedSmartUniversity,Dubai,UnitedArabEmirates;SawitriAssanangkornchai,PrinceofSongklaUniversity,Songkla,Thailand;ThomasBabor,UniversityofConnecticutSchoolofMedicine,Connecticut,UnitedStatesofAmerica;ColinDrummond,NationalAddictionCentre,InstituteofPsychiatry,PsychologyandNeuroscience,King’sCollegeviAcknowledgementsLondon,London,UnitedKingdomofGreatBritainandNorthernIreland;WeiHao,MentalHealthInstitute,CentralSouthUniversity,Changsha,China;DavidJernigan,BostonUniversitySchoolofMentalHealth,Boston,UnitedStatesofAmerica;EvgenyKrupitsky,BekhterevNationalMedicalResearchCentreforPsychiatryandNeurology,St.Petersburg,RussianFederation;NazariusMbonaTumwesigye,SchoolofPublicHealth,MakerereUniversity,Kampala,Uganda;MariaElenaMedina-Mora,NationalInstituteofPsychiatry,MexicoCity,Mexico;NeoMorojele,FacultyofHumanities,UniversityofJohannesburg,Johannesburg,SouthAfrica;JacekMoskalewicz,InstituteofPsychiatryandNeurology,Warsaw,Poland;PratimaMurthy,NationalInstituteofMentalHealthandNeurosciences(NIMHANS),Bangalore,India;JürgenRehm,CentreforAddictionandMentalHealth(CAMH),Toronto,Canada;RobinRoom,LaTrobeUniversity,Melbourne,Australia;KevinShield,CentreforAddictionandMentalHealth(CAMH),Toronto,Canada.Preparationoftheestimatesonalcoholconsumptionandalcohol-attributablediseaseburdenincludedinthereportwasacollaborativeeffortoftheADAunitintheWHODepartmentofMentalHealthandSubstanceUsewiththeCentreforAddictionandMentalHealth(CAMH),Toronto,Canada.ParticularthanksareduetoKevinShield,JürgenRehm,AshleyWhettlauferandAriFranklin.AngelaMe,ChloeCharpentier,HernanEpsteinandKamranNiazofthefromResearchandTrendAnalysisBranchandGiovannaCampelloandAnjaBussefromthePrevention,Treatment&RehabilitationSectionoftheUnitedNationsOfficeonDrugsandCrime(UNODC)providedtechnicalinputtothechapterontreatmentforsubstanceusedisorders.ThereportwouldnothavebeenpossiblewithoutthecontributionsoftheWHOMemberStatesnationalcounterpartsforimplementationoftheGlobalstrategytoreducetheharmfuluseofalcoholandthecountryfocalpointsnominatedforparticipationintheWHOsurveyonprogressonSDGhealthtarget3.5whoprovidedcountry-leveldataandotherrelevantinformationonalcoholconsumption,alcohol-relatedharm,policyresponsesandservicecapacityfortreatmentofsubstanceusedisorders.WHOextendsitsgratitudetoallcontributorsandreviewersnototherwisestated.WHOinternswhocontributedtotheprocessofdatacollectionandcompilationinclude:SibellaBreidahl,RuchikaJain,LinmiaoJiang,AanisahKhanzadaJiang.Finally,WHOgratefullyacknowledgesthefinancialsupportoftheNationalRehabilitationCentreinAbuDhabi(UAE)andtheGovernmentofNorwayforthedevelopmentandproductionofthisreport.viiAbbreviations15+Populationofthoseaged15yearsandolderAAFAlcohol-attributablefractionAlcoholbyvolumeABVADAlcoholdependenceADH1BAFRAlcoholdehydrogenase1BWHOAfricanRegionAFROAIDSALDWHORegionalOfficeforAfricaAcquiredimmunodeficiencysyndromeAlcoholicliverdiseaseAMRAMRO/PAHOAPCWHORegionoftheAmericasWHORegionalOfficeforAmericas/PanAmericanHealthOrganizationAlcoholpercapitaconsumptionAlcohol-relatedbirthdefectsAutoregressiveintegratedmovingaverageAlcohol-relatedneurodevelopmentaldisorderAge-standardizeddeathrateARBDARIMAARNDASDRASSISTAUDAlcohol,SmokingandSubstanceInvolvementScreeningTestAlcoholusedisorderAUDITBACAlcoholUseDisordersIdentificationTestBloodalcoholconcentrationBodymassindexBMIBrACCAMHCBTBreathalcoholconcentrationCentreforAddictionandMentalHealthCognitive-behaviouraltherapyCost-effectivenessanalysisCEACIConfidenceintervalCMContingencymanagementCVDCardiovasculardiseaseDALYEMRDisability-adjustedlifeyearWHOEasternMediterraneanRegionviiiAbbreviationsEMROEURWHORegionalOfficefortheEasternMediterraneanWHOEuropeanRegionEUROESPADFAOWHORegionalOfficeforEuropeEuropeanSchoolSurveyProjectonAlcoholandOtherDrugsFoodandAgricultureOrganizationoftheUnitedNationsFAOSTATFASFoodandAgricultureOrganizationoftheUnitedNations(FAO)statisticaldatabaseFetalalcoholsyndromeFASDGBDFetalalcoholspectrumdisorderGlobalburdenofdiseaseGDPGrossdomesticproductGENACISGHEGender,alcohol,andculture:aninternationalstudyGlobalhealthestimatesGHOGlobalhealthobservatoryGISAHGNIWHOglobalinformationsystemonalcoholandhealthGrossnationalincomeGSHSGSRAHHAARTHCDGlobalschool-basedstudenthealthsurveysGlobalstatusreportonalcoholandhealthHighlyactiveantiretroviraltherapyHeavycontinuousdrinkingHCVHepatitisCvirusHEDHeavyepisodicdrinkingHIVHumanimmunodeficiencyvirusInternationalAgencyforResearchonCancerInternationalClassificationofDiseasesInstituteforHealthMetricsandEvaluationInternationalHealthRegulationsInternationalNarcoticsControlBoardInternationalWineandSpiritsResearchLowandmiddle-incomecountriesMillenniumDevelopmentGoalsMotivationalenhancementtherapyMotorvehicleaccidentsIARCICDIHMEIHRINCBIWSRLMICMDGsMETMVANCDNoncommunicablediseaseNGONon-governmentalorganizationixGlobalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisordersNSPNeedleandsyringeprogrammeOrganisationInternationaledelaVigneetduVinOpioidagonistmaintenancetreatmentPopulation-attributablefractionPartialfetalalcoholsyndromePurchasingpowerparityOIVOAMTPAFpFASPPPRBSResponsiblebeverageserviceRelativeriskRRSACUSAMHSASCISouthernAfricanCustomsUnionSubstanceAbuseandMentalHealthServicesAdministrationServicecapacityindexSDGsSEARSEAROSESSustainableDevelopmentGoalsWHOSouth-EastAsiaRegionWHORegionalOfficeforSouth-EastAsiaSocioeconomicstatusSTDsSTIsSexuallytransmitteddiseasesSexuallytransmittedinfectionsSTEP-wiseapproachtosurveillanceSubstanceusedisorderSTEPSSUDTBTuberculosisUIUncertaintyintervalsUNUnitedNationsUNODCUNWTOUSDUnitedNationsOfficeonDrugsandCrimeWorldTourismOrganizationUSdollarWHAWHOWIWorldHealthAssemblyWorldHealthOrganizationWineInstituteWPRWPROYLDWHOWesternPacificRegionWHORegionalOfficeforWesternPacificYearsoflifewithdisabilityYearsoflifelostYLLxExecutivesummaryChapter1.Psychoactivesubstanceuse,healthanddevelopmentInviewoftheparticularpropertiesofpsychoactivesubstancesandtheirimpactonhealthanddevelopment,mostpsychoactivesubstancesrequirespecialprovisionsforregulationoftheirproduction,distribution,marketinganduse.Theimpactofpsychoactivesubstanceuseonhealthanddevelopmentisdeterminedbymultiplesocioeconomic,psychosocialandbiologicalfactorswhichneedtobeaddressedineffectiveprevention,treatmentandharmreductionstrategiesandinterventions.Theimpactofalcohol,tobaccoandpsychoactivedruguseonthehealthoftheworld’spopulationisunacceptablyhighbyanymetric,andfortheworkingagepopulationitexceedstheimpactofanyotherriskfactor.Thereisacomplexrelationshipbetweensubstanceuse,alcohol-anddrug-relatedharmsandsocioeconomicstatus,andpeoplewithlowersocioeconomicstatusaredisproportionallyaffectedbyharmsduetosubstanceuse.Substanceusehasasignificantimpactonmentalhealth,andsubstanceusedisordersoꢀenco-occurwithmentalhealthconditionsandworsentheirhealthoutcomes,includingall-causeprematuremortalityaswellasmortalityduetosuicides.Substanceusehasasignificantimpactonthedevelopmentandoutcomesofanumberofmajornoncommunicablediseases,andtheglobalimpactofpsychoactivedrugsandsubstanceusedisordersonnoncommunicablediseaseshastobefurtherexploredanddocumented.InjectingdrugusecontinuestobeanimportantdriverofepidemicsofHIVandviralhepatitisinsomepopulations,andsubstanceuseandsubstanceusedisordersareassociatedwithanincreasedriskofacquiringinfectionsandwithnegativeeffectsontreatmentoutcomes.Substanceuseandsubstanceusedisordersaremajorcontributorstovarioustypesofinjuries,includingtraffic-andviolence-relatedinjuries.Reducingthenumberofglobaldeathsduetoinjuriesrequiresimplementationofeffectivestrategiesandinterventionstopreventinjuriesassociatedwithalcoholanddruguse.Commercialdeterminantsofsubstanceusehavetobeaddressedasapartofcomprehensivepolicyresponsestoreducethenegativeimpactofpsychoactivesubstanceuseonhealthanddevelopmentinpopulations.Chapter2.Alcoholconsumption,alcohol-relatedharmandpolicyresponsesAlcoholconsumptionTotalalcoholpercapitaconsumptionintheworldpopulationdecreasedslightlyfrom5.7litresin2010to5.5litresin2019(relativereductionof4.5%)withthehighestlevelsofpercapitaconsumptionin2019intheWHOEuropeanRegion(9.2litres)andtheRegionofAmericas(7.5litres).xiGlobalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisordersTheCOVID-19pandemichadasignificantimpactonglobalalcoholconsumption,withanestimated10%relativereductionfrom2019to2020butwithdifferent,andsometimesopposite,impactsindifferentcountriesandpopulationgroups.In201956%oftheworld’spopulationaged15+abstainedfromdrinkingalcohol–thenumbersofdrinkersandabstainersintheworldarerelativelystableovertime.Thelevelofalcoholconsumptionpercapitaamongdrinkersamountsonaverageto27gramsofpurealcoholperday,whichisassociatedwithappreciablyincreasedrisksofnumeroushealthconditionsandassociatedmortalityanddisability.In2019,17%ofpeopleaged15+yearsand38%ofcurrentdrinkersengagedinheavyepisodicdrinkingor“bingedrinking”(consumingatleast60gofpurealcoholononeormoreoccasionsinthelastmonth),whilecontinuousheavydrinkingwashighlyprevalent(6.7%)amongmen.Trendsintotalalcoholpercapitaconsumption(APC)differbetweenWHOregionswithasubstantialdecreaseinEuropeandamarkedincreaseinAPCinSouth-EastAsiasince2000.InallWHOregionsgenderdifferencesinalcoholconsumptionaresignificantwithnomajorchangesovertimeglobally.In2019theprevalenceofalcoholconsumptionamong15–19-year-oldswasunacceptablyhighworldwide(2