• Alcohol
• Cannabis
• Cocaine and Crack
• Ecstasy and Amphetamines
• Heroin and Opioids
• Psychotropic Medicines
• NPS
• Tobacco and Electronic Cigarette
• Gambling

Overview

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Alcohol is a liquid substance of natural origin (ethyl alcohol) obtained by fermentation of sugar-rich plants or by distillation. Alcohol is used in alcoholic beverages, which are consumed for their euphoric and disinhibiting effects. Alcohol is not digested: it passes directly from the digestive tract into the bloodstream. Within minutes, the blood carries it to all parts of the body. Its use can lead to a strong psychological and physical dependence with withdrawal syndrome, which can lead to hallucinatory delirium tremens. The toxic effects are multiple: cirrhosis of the liver, liver cancer, cardiovascular diseases, cancer of the upper aerodigestive tract, etc.

Production/supply

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Wine accounts for 54.1% of the total quantities of pure alcohol sold (compared to 22.9% for beer and 21.5% for spirits). Based on the population aged 15 years or older, the total quantities of pure alcohol sold in 2020 represent on average the equivalent of 2.3 standard glasses of alcoholic beverages per person per day (one standard glass contains 10 g of pure alcohol).
Compared to the early 1960s, the consumption of alcoholic beverages (in pure alcohol equivalent) has been more than halved in France, mainly due to the decrease in wine consumption.
Relative prices for all alcoholic beverages remained roughly stable between 2000 and 2010 but increased by 6.5% between 2011 and 2019.

Reference

• Palle C. Les évolutions récentes de la consommation d'alcool en France et ses conséquences. [Recent changes in alcohol use in France and their consequences.] Paris, OFDT, 2020, 20 p.

Use

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In the adolescent population

Among secondary school students

Alcohol is the main psychoactive substance first used in adolescence. In 2018, six out of ten secondary school students stated that they had already drunk an alcoholic beverage at least once in their lives (60.0%). In addition, the level of lifetime use among the younger students was twice as high as in the rest of Europe at age 11 (15%), and 1.5 times higher at the age of 13 (34%). Nevertheless, an exceptional section of the EnCLASS survey (National Adolescent Health and Substance Use Survey in Middle and High Schools) conducted in the first quarter of 2021 among 14-15-year-olds (ninth-grade students or year 10 of secondary school in the UK) shows that the proportion of those who have never drunk alcohol has doubled, from 16.8% to 35.9% between 2018 and 2021.

References

• Spilka S., Philippon A., Le Nézet O., Janssen E., Eroukmanoff V., Godeau E. Alcohol, tobacco and cannabis use among ninth grade students (14-15-year-olds) in 2021. Tendances, OFDT, 2022, no. 148, 4 p
• Spilka S., Le Nézet O., Janssen E., Brissot A., Philippon A. 20 years of developments in drug use among adolescents in Europe. Tendances, OFDT, 2021, no. 143, 8 p.

In 2018, less than one in ten middle school students reported having experienced alcoholic drunkenness (9.3%), a proportion that rises to 16.4% among ninth-grade students in 2021. While the years at middle school constitute a period of experimentation and the spread of legal uses, high school is a time when practices are established and intensified: in 2018, 41.5% of high school students reported that they had had an episode of heavy episodic drinking, which consists of drinking at least 5 glasses of alcohol on a single occasion in the month preceding the survey. The circumstances of alcohol use are strongly differentiated by social background and gender in adolescence.

References

• Spilka S., Godeau E., Le Nézet O., Ehlinger V., Janssen E., Brissot A., Philippon A., Chyderiotis S. Alcohol, tobacco and cannabis use among French school students in 2018. Tendances, OFDT, 2019, no. 132, 4 p.
• Douchet M.-A., Neybourger P. Alcool et soirées chez les adolescents et les jeunes majeurs. [Alcohol and parties among adolescents and young adults.] Tendances, OFDT, 2022, no. 149, 8 p.

17-year-olds

In 2017, the ESCAPAD Survey (Survey on Health and Use on National Defence and Citizenship Day) on 17-year-olds revealed that alcohol remains the most widely used substance in their lifetime, although the continuous decline in its distribution over the last decade continued (85.7% vs 89.3% in 2014 and 92.6% in 2008). At the age of 17, alcoholic beverages are still very common: two thirds of young people have drunk them in the past month (66.5% vs 72.0% in 2014). Regular use (10 times a month) is down by almost 4 points (8.4% instead of 12.3% in 2014).

With regard to heavy episodic drinking, 44.0% of young people reported episodes of this behaviour in the last month in 2017. This was in comparison to 48.8% in 2014. Repeated heavy episodic drinking (at least three episodes during the month) also decreased (16.4%, compared to 21.8% in 2014), while so-called ‘regular’ heavy episodic drinking (at least ten times) concern, as in 2014, only a very small proportion of adolescents (2.7%).

Reference

• Spilka S., Le Nézet O., Janssen E., Brissot A., Philippon A., Shah J., Chyderiotis S. Drug use in 17-year-olds: analysis of the 2017 ESCAPAD survey. Tendances, OFDT, 2018, no. 123, 8 p.

In the adult population (18-75 years)

Between 2014 and 2017, according to the Santé Publique France Health Barometer, the proportion of the population aged 18 to 75 years reporting that they had drunk alcohol in the past year remained stable (86.5% in 2017). Of the total population in this age group, 10.0% of respondents declared that they drank alcohol on a daily basis, with this type of use occurring almost exclusively among people over 50. Whatever their age, women are less likely to drink overall, and this difference is all the more pronounced when the frequency of use is high (15.2% of men drank daily compared with 5.1% of women). The prevalence of drunkenness in the past year appears to be one of the only indicators of alcohol use that was trending upwards between 2014 and 2017, and whose level rose sharply over the whole period 2000-2017 (from 14.0% to 20.7%, including 28.6% among men and 13.2% among women in 2017). 16.2% of respondents reported that they had had an episode of heavy episodic drinking in 2017.

Reference

• Groupe Baromètre de Santé publique France 2017. La consommation d'alcool chez les adultes en France en 2017 [Alcohol use in adults in France in 2017]. Bulletin Épidémiologique Hebdomadaire, 2019, no. 5-6, p. 89-97.

Consequences

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The use of alcoholic beverages causes health and social harm. Health harm can be defined as all illnesses and injuries caused by alcohol use. Alcohol abuse can also have negative effects on the social life (relationships with relatives, employment, criminality) of users and the people in contact with them, thus reducing their quality of life and causing harm to the community.

Health harm

Health harm related to alcohol use depends on the amount consumed, the pattern of use, and many environmental and individual factors. These risks can arise when use is chronic, i.e. usually daily, but also when it is episodic.

The risks of chronic use

Chronic alcohol use increases the risk of a number of important diseases. It generally increases with the amount of alcohol ingested (although the level at which the risk of harm is minimal is zero standard drinks per week).

In addition to its role in the onset and development of liver disease and certain cancers, alcohol is also a neurotoxicant, whether consumed episodically or chronically. The appearance of lesions and diseases (peripheral neuropathies, encephalopathies, cognitive disorders) resulting from the latter pattern of use may be the consequence of alcohol abuse but also of withdrawal and their repetition (withdrawal epilepsies). The dependence that can develop in some alcohol users is another manifestation of the toxicity of alcohol on the central nervous system. Moreover, alcohol and depression are often closely related.

Finally, alcohol use by a pregnant woman can cause various disorders, depending on the mother's drinking pattern, her sensitivity to alcohol and that of the foetus, ranging from mild behavioural problems in the unborn child to severe developmental abnormalities (“foetal alcohol syndrome”). The disorders occur mainly in the central nervous system.

Risks associated with episodic use

Consumption of very large amounts of alcohol can lead to an alcohol-induced coma, which in some cases is life-threatening. Alcohol coma occurs on average for an adult at doses above 3 grams of pure alcohol per litre of blood (the lethal dose varies according to the individual and their addiction to alcohol). But most often, in the case of acute intoxication, the harm is the consequence of the loss of control of the intoxicated person, which can result in accidents and immediate danger that can cause trauma or even death to the user or a third party.

Alcohol-attributable mortality and morbidity

The latest figures for alcohol-attributable mortality in France are from 2015: 41 000 deaths per year, of which 30 000 were men and 11 000 women, representing 11% and 4% respectively of adult mortality for those aged 15 years and over.

The largest proportion of cancers caused by alcohol are in the oesophagus and liver. Breast, oral cavity, oropharyngeal, hypopharyngeal and colorectal cancers contribute most to new cases of alcohol-attributable cancers.

Access to care

People with alcohol-related problems can turn to different types of facilities (hospitals, general practitioners, medical and social structures specialising in addiction medicine, self-help associations). Data to monitor recent developments is only available for hospitals and medical and social structures, specialised drug treatment centres (CSAPA).

In terms of hospitalisations, the number of admissions according to the different categories of main diagnoses mentioning alcohol was 246 000 in 2020, of which 44% were for dependence and withdrawal, 38% for acute intoxication and 15% for the long-term effects of alcohol abuse.

The CSAPA receive people with excessive alcohol use, who are most often dependent on it (2/3 of patients) or whose use is harmful or risky. There are 389 CSAPAs in 2022 with estimated new outpatient admissions of approximately 314 000 users in 2019. For 46% of patients seen in CSAPA, alcohol is the most problematic product.

References

• Bonaldi C., Hill C. La mortalité attribuable à l'alcool en France en 2015 [Alchohol-attributable mortality in France in 2015]. Bulletin Épidémiologique Hebdomadaire, 2019, no. 5-6, p. 97-108.
• INSERM. Réduction des dommages associés à la consommation d'alcool. Synthèse et recommandations. [Reducing the harm associated with alcohol use. Summary and recommendations.] Paris, INSERM, Expertise collective, 2021, 138 p.
• Palle C. Les personnes accueillies dans les CSAPA. Situation en 2019 et évolution sur la période 2015-2019. [The people received at the CSAPA. Situation in 2019 and evolution over the period 2015-2019.] Tendances, OFDT, 2021, no. 146, 6 p.

Harm to third parties

Alcohol was involved in 45 121 road traffic bodily injury accidents in 2020, including 2 403 fatal accidents. There were 87 900 convictions for driving under the influence of alcohol in 2019, not including fixed penalty notices, a procedure that allows the prosecutor to propose an intermediate measure between prosecution and dismissal.

Reference

• ONISR. La sécurité routière en France. Bilan de l'accidentalité de l'année 2020. [Road safety in France. Annual accident figures for 2020.] Paris, Observatoire national interministériel de sécurité routière, 2021, 205 p.

Perceptions /opinions

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According to the EROPP survey (Survey on representations, opinions and perceptions regarding psychoactive drugs), alcohol is rarely perceived as a “drug”. Unlike illicit products, only a minority of respondents (10%) perceive it as dangerous from the first time they use it. Daily use was mainly cited as dangerous by 79% of respondents. 56% of the respondents said that offering or drinking alcohol was part of the rules of etiquette. More than a third (36%) never noticed a logo on alcohol bottles warning of the dangers of alcohol for pregnant women. Almost a quarter (23%) of respondents recalled seeing or hearing an advert for an alcoholic drink in the previous week. Finally, nearly a majority of the population (45%) considered it acceptable to have their first alcoholic drink before the age of 18.

Reference

• Spilka S., Le Nézet O., Janssen E., Brissot A., Philippon A., Chyderiotis S. Drugs: perceptions of substances, public policies and users. Tendances, OFDT, 2019, no. 131, 8 p.

Legal framework and recent public policies

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For reasons of tax and public order, the trade and distribution of alcohol has been regulated for several centuries. The legislature’s public health concerns have resulted in the establishment of a relatively recent legal framework (1960 ordinance on the prevention of alcoholism, the 1991 Évin law, the law on hospital reform, relating to patients, health and regions (HPST) adopted in 2009) which is regularly called into question. The public debate pits the discourse of specialists in alcohol prevention and addiction treatment against the demands of winegrowers, producers and distributors, and economic operators, and also divides public opinion.

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