Who’s most likely to die from alcohol poisoning, and what do they drink?
A new study led by researchers at the National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, has explored the circumstances of death and characteristics of fatal alcohol poisoning cases. The study, published in Drug and Alcohol Review, examined deaths from acute alcohol poisoning in Australia, 2011–2022.
Key findings:
- Alcohol is the seventh leading risk factor for mortality, disease, and disability.
- While lower prevalence drugs, may be well known to present a risk of overdose and death, this is not necessarily recognised for alcohol, which is much more widely used.
- The ‘typical’ case profile of deaths due to alcohol poisoning was a longstanding heavy drinker with a preference for spirits.
- The average blood alcohol concentration (BAC) was more than six times the legal driving limit but showed enormous variation. No arbitrary concentration may be deemed lethal.
- People with clinically significant diseases may be at increased risk of alcohol poisoning.
“While we know that alcohol is a leading cause of mortality, we wanted to determine who is dying from acute alcohol poisoning. Are these inexperienced drinkers with a low tolerance or seasoned users with long histories of alcohol problems, perhaps receiving treatment for alcohol dependence? What types of alcohol were being consumed before the fatal event?” says lead author Professor Shane Darke.
891 cases were identified in this study, with an average of 49 years. Nearly three-quarters were men. A long history of alcohol use problems was noted in 71%. Only seven people were in a treatment programme at the time they died. In 58%, death was attributed solely to acute alcohol toxicity but to a combination of alcohol toxicity and underlying disease in 42%, most commonly heart disease. There was evidence of sudden collapse in a quarter of cases, and a fifth had inhaled vomit after heavy drinking. The average BAC was 0.33 g/100 mL, more than six times the legal driving limit of 0.05. BACs ranged up to more than 0.9 g/100ml. Spirits were the most common beverages being consumed before death. Cases of death due to combined toxicity and disease had lower BACs, suggesting that in the presence of significant disease, there is greater susceptibility to the effects of alcohol. The rate of alcohol poisoning deaths increased by 8% a year.
The study found that while the ‘typical’ case was a long-standing, heavy spirits drinker. BACs showed enormous variation, and no arbitrary concentration may be deemed lethal. “In terms of who died, these were overwhelmingly older people, with long histories of alcohol problems. Indeed, less than a quarter were aged under 40 years,” says Professor Darke. The most commonly consumed form of alcohol immediately preceding death was spirits. This is consistent with the profile of long-standing heavy drinkers, with a preference for beverages with a high alcohol content and lower cost.
“These findings demonstrate that alcohol can be fatally toxic and needs to be better understood by the wider public, particularly as the rate has increased,” says co-author Associate Professor and Clinician Dr Julia Lappin. While lower prevalence drugs, such as heroin, may be well known to present a risk of overdose and death, this is not necessarily recognised for alcohol, which is much more widely used. Despite their long histories of alcohol-related problems, almost none were in treatment for their alcohol problems at the time of death. At least some of these people may have survived if they could have been engaged in a treatment program.
Furthermore, this study emphasises that people with clinically significant disease may be at increased risk of alcohol poisoning due to factors such as an increased vulnerability to cardiac arrhythmia, reduced lung capacity, and a reduced ability to metabolise alcohol due to liver disease. Clinicians treating those with known alcohol problems need to be aware of these health problems, not all of which are directly alcohol-induced, and treating those issues may reduce the risk of death due to alcohol toxicity.
* Shane Darke, Johan Duflou, Amy Peacock, Agata Chrzanowska, Wing See Yuen, Michael Farrell, Julia Lappin
A copy of the publication can be accessed here.