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Binge drinking –

an innocent indulgence,
or a hangover too many?

Autor For many of us the busy festive season will have meant a few drinks at Christ-
mas parties or on New Year’s Eve. The ongoing stressors of daily life mean it
Reece Hodgson
can be easy to reach for a ‘medicinal’ alcoholic beverage to aid with unwinding.
Senior Risk Management Specialist
But exactly how harmful is binge drinking to our health? And how honest are
rhodgson@munichre.ca
we with our levels of consumption?

Heavy drinking has been endemic in British society over many centuries and
can be a part of many social and work practices. Concerns about alcohol
misuse are nothing new. In the mid 18th century, a gin appetite swept through
London, and was viewed at the time as being behind much of the capital’s
crime. In 1751 the ‘Gin Act’ was passed to reduce consumption in response.
Today there is a new concern about the extent and consequences of alcohol
misuse. The shorthand for these varied concerns is binge drinking. However,
this term can be confusing.

What is binge drinking?

The amount of alcohol someone needs to drink for it to be classed as ‘binging’


is not that clearly defined. The marker used by the National Health Service1 and
Office for National Statistics is drinking more than double the government’s
lower risk guidelines for alcohol in one ‘session’.

The government advises that people should not regularly drink more than the
lower risk guidelines of three to four units of alcohol for men and two to three
units of alcohol for women. ‘Regularly’ means drinking every day or most days
of the week.

Binge drinking is classified as more than double the daily recommended


amount for both males and females respectively. Therefore for men, this is
drinking more than eight units of alcohol (about three pints of strong beer) and
for women, drinking more than six units of alcohol, (equivalent to two large
glasses of wine.)

What are the effects of binge drinking?

Binge drinking contributes to a range of acute and chronic health conse-


quences, including injuries. Research has explored the relationships between
the risk for alcohol related morbidity and mortality and both the overall
amount of alcohol consumed and the pattern of drinking.
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Binge drinking

Studies reveal that binge drinking:

Increases the risk of coronary heart disease (CHD)2

−−Has a causal relationship with stroke and sudden cardiac death3

−−Increases the risk of liver, bowel, breast, mouth, pharyngeal, oesophageal


and laryngeal cancer: alcohol causes around 4% of cancer cases in the UK
every year4

−−Could increase the risk of contracting female breast cancer by around


1.5 times5

On a positive note, studies show that when compared with abstinence from
alcohol, low to moderate average consumption is associated with a lower risk
of CHD incidence and mortality6. For example, men and women who drank
one to two drinks per day on five or six days per week had one-third the risk
of major coronary events. However, for higher levels of consumption, the risk
relationship was found to reverse.

How much alcohol do we really drink?

Whether responding to a health and lifestyle survey or completing an applica-


tion for life insurance, there has long been a suspicion that people under-report
the amount of alcohol they consume. In 2013, a team of researchers at Univer-
sity College London (UCL) sought to measure the gap between reported and
actual alcohol consumption in England.

The researchers found that as many as three-quarters of people in England


may be drinking above the recommended daily alcohol limit, an amount much
higher than previously thought7. The finding, which also uncovers high levels
of binge drinking, is based on the discrepancy between alcohol sales and the
amount people say they drink in surveys.

International estimates suggest people can underestimate their alcohol intake


by around 40 to 60%8. The researchers estimate that the proportion of adults
estimated to be binge drinkers in England increased:

−−By 20% in men, pushing the overall estimate up to 52%9

−−By 28% in women, pushing the overall estimate up to 56%10

Which of us is drinking more?

When examining the data for weekly units of alcohol consumed by region,
people in the North West, North East, Yorkshire and the Humber are the
biggest drinkers.11 Weekly consumption of alcohol is the lowest in the West
Midlands and East of England, though still comes close to recommended
limits.
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Binge drinking

Women, especially those on high incomes and those living in the South of
England, are most likely to be binge drinkers, as are high earners generally and
also those in deprived areas, for reasons that are not understood.12

A research report on ‘Adult outcomes of binge drinking in adolescence’


concluded that adolescent binge drinking is a risk behaviour associated with
significant later adversity and social exclusion.13 Those who drink a lot in
their teens and early 20’s are up to twice as likely as light drinkers to be binge
drinking 25 years later.14

Previous studies have also shown that ‘older age’ drinking is a worsening
problem. In England, 28% of men and 14% of women over 65 now drink alcohol
more than five times per week15. Heavy drinking in this age group is strongly
linked with depression and anxiety and longer-term health problems.16

Should these findings be factored into our underwriting assessments?

If the under-reporting findings from the study conducted by UCL are taken
literally, you could even make a case for considering whether to factor up the
alcohol consumption disclosures made by applicants for insurance. Particu-
larly those in certain risk categories such as high earners or those in deprived
areas, as previously mentioned.

The inherent challenge will always be attempting to price lifestyle risks that
rely on self-reporting. If as an industry we do consider the factoring up
approach, then it may be possible to more accurately price for these risks
accordingly.

What should underwriters look for?

Underwriting anyone with a history of alcohol misuse can prove difficult.


Information is often scant or unreliable and sometimes the only way to do this
with reasonable success is determining clues from the evidence presented,
such as raised liver enzymes or recurrent gastric problems. From an underwrit-
ing perspective, additional clues that may assist when looking for signs of
heavy drinking, particularly binge drinking, could include:

−−A history of adolescent binge drinking

−−High earners, particularly females in the South of England

−−Residing in deprived areas

−−The over 65’s, especially those with mental and chronic health problems

−−Inconsistent alcohol consumption disclosures when comparing current and


previous applications/tele-interviews and the alcohol levels mentioned on
hospital letters and medical examinations.
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Binge drinking

These additional factors may help indicate an individual is more likely to be


a binge drinker and as a consequence, at a much higher risk of developing
cancer, stroke and cardiovascular disease.

What is the future?

Looking ahead, as an industry, evidence would strongly suggest the need for
more robust information about national alcohol consumption from many
sources, including alcohol sales and surveys of consumption. Simply increas-
ing everyone’s alcohol disclosures, for example, by 40% at time of underwriting
seems rather a blunt and inaccurate method to apply.

If certain groups are under-reporting their alcohol consumption, more research


to identify which groups and why would be helpful. It is also worth considering
whether people tell health professionals what they think they want to hear
rather than the complete truth?

This UCL study usefully highlights the important point that survey data alone
cannot provide the full picture on alcohol consumption, or other issues, and it
is clear we should continue to draw on our own experience of alcohol related
risks from claims and non-disclosure data.

When reliable data regarding national alcohol consumption does become


available, insurance application design could include enhanced lifestyle ques-
tions to capture specific drinking habit histories. With knowledge of age,
gender, occupation, location and health, more precision could then be brought
into pricing the individual risk accurately.

With national alcohol consumption being higher than officially thought,


Munich Re’s view is that underwriters need to apply caution more than ever,
and use all data and experience at our disposal to underwrite these risks
accordingly.

Literature

1 http://www.nhs.uk/Livewell/alcohol/ 7, 9, 10, 11, 12


Boniface S, Shelton N. How is
Pages/Bingedrinking.aspx. alcohol consumption affected if we
Copyright 2013, Re-used with the per- account for under-reporting? A
mission of the Health and Social Care ­hypothetical scenario. Eur J Public Health
Information Centre. All rights reserved. 2013;23:1076-81.

2, 3, 6
Alcohol-Related Morbidity and 8 World Health Organization –
­Mortality – Jürgen Rehm, Ph.D., Gerhard Global Status Report on Alcohol 2004
Gmel, Ph.D., Christopher T. Sempos,
Ph.D., and Maurizio Trevisan, M.D., M.S. 13 Adult outcomes of binge drinking in
­ dolescence: findings from a UK national
a
4 http://www.cancerresearchuk.org/ birth cohort – R M Viner, B Taylor
cancer-info/healthyliving/
alcohol//1/2014 14 http://www.ias.org.uk/resources/

factsheets/binge_drinking.pdf
5 http://www.nhs.uk/Livewell/alcohol/

Pages/Effectsofalcohol.aspx 15 NHS Information Centre (2011) Statistics


© 2015 Copyright 2013, Re-used with the per- on Alcohol: England, 2011 [NS]. Office for
Münchener Rückversicherungs-Gesellschaft mission of the Health and Social Care National Statistics.
Königinstrasse 107, 80802 München, Germany Information Centre. All rights reserved.
16 A Qualitative Study of Alcohol, Health
and Identities among UK Adults in Later
Life – Graem B. Wilson, Eileen F S Kaner,
Jonathan Ling, Karen McCabe &
­Catherine A Haighton.
NOT IF, BUT HOW