Chemical attack

Sensible drinking limits were defined as a weekly alcohol consumption of less than 21 units for men and 14 units for women in the Government White Paper, 1992. One unit of alcohol is equivalent to half a pint of average strength beer, lager or cider, a small glass of wine or a standard pub measure of spirits.

Alcohol abuse is defined as a pattern of heavy alcohol intake with associated social dysfunction and effects on health. Alcoholism is defined as a craving and/or physical dependence where a person is unable to exercise restrain over drinking despite the consequences. For underwriting purposes, alcoholism is a chronic disease manifested by repeated drinking causing injury to the drinker's health.

Effects of alcohol

Estimates of alcohol-related deaths for England and Wales range from 5,000 to 40,000 per year, and 25% of these deaths result from accidents.

Alcohol causes an increased risk of squamous cancers of the oropharynx, larynx and oesophagus. Heavy alcohol consumption is associated with cancers of the liver, stomach, colon, rectum, lung and pancreas, and may be associated with breast cancer.

The risk of high blood pressure is increased, especially with binge drinking, as is haemorrhagic stroke, coronary heart disease, cardiomyopathies and arrhythmias.

Liver damage is common in people who drink excessive amounts of alcohol. Fatty liver, which is present in 90% of persistently heavy drinkers, is usually asymptomatic. Alcoholic hepatitis occurs in around 40% of heavy drinkers and is often the precursor to cirrhosis. Between 8% to 30% of long-term heavy drinkers develop cirrhosis.

Depression and other psychiatric problems are also complications of excessive alcohol.

Alcoholism is a complex illness causing physiological, psychological and social dysfunction, which may not be easily visible to others, and is especially difficult for the underwriter to evaluate. Individuals who drink excessively are likely to under-estimate their intake on their application and there is often reluctance for doctors to be explicit in any criticism regarding drinking habits, except where there are definite manifestations of alcohol abuse.

Drug dependence

Drug dependence is the development of a state in which a person feels compelled to carry on taking a drug because of the need to get 'high' on it or because they become sick if they stop. Dependence may be physical or psychological depending upon the type of the drug. Abuse of some drugs may be intermittent, resulting in minimal deterioration. In other cases, the user may become dependent on a drug in order to perform at what they consider a satisfactory level ' this is known as psychic dependence.

Mortality and morbidity among drug addicts are high, many attempting suicide during withdrawal, during severe hallucinatory or depressive states while under the influence of drugs, or as a result of secondary mental illness.

Others die suddenly following intravenous drug injection. Acute bacterial infection, active chronic hepatitis and hepatic cirrhosis are also other common causes of death, primarily due to sharing un-sterilised needles. There is also a significant increase in the incidence of HIV infection in individuals with a history of intravenous drug use through using shared needles.

A number of different types of risk groups exist:

n Cannabis: These drugs are widely used in some cultures, are usually smoked and not thought to cause physical dependence. The most common effects are exaggeration of mood ' be it depression, euphoria or anxiety ' followed by drowsiness and sleep. The concern from an underwriting perspective is that the user may progress to using 'harder' drugs.

n Solvents, amphetamines, barbiturates, hallucigens such as LSD, angel dust, ecstasy: Solvents are inhaled ' the most common being glue sniffing and may produce euphoria, dizziness, slurred speech and ataxia. Intoxication may induce vomiting, which if inhaled, can be fatal. Other effects include tissue damage (brain, liver and kidneys) and cardiac arrhythmias. Amphetamines produce temporary stimulation, which is followed by depression, anxiety and irritability. On occasion, they may produce a paranoid psychosis. Ecstasy produces hallucinogenic effects. A number of deaths have been attributed to its use and known complications are over-heating, dehydration, collapse, tachycardia, renal and liver failure.

n Anabolic steroids: These performance-enhancing drugs may be taken orally or injected and are used usually by amateur sports people. The main effects sought from this drug are weight gain, additional muscle power, increased resistance to and recovery time from injury. Complications can include organ damage (heart, kidneys and liver) hypertension and psychiatric disorders.

n Opiates such as narcotics, heroin, morphine, opium, cocaine, crack, pethidine: Morphine, heroin and pethidine are narcotics which all produce physical dependence. Tolerance is rapidly developed and withdrawal symptoms are severe in many instances. Addicts have a high mortality rate primarily from acute illnesses although the presence of HIV and hepatitis should not be underestimated. Cocaine is a stimulant of the central nervous system. Users normally fluctuate between a state of hyper-arousal and the withdrawal symptoms of depression, tremor and muscle pain. It may also be smoked in its pure form ' crack cocaine ' which is even more addictive. Cardiac arrhythmias, cardiac failure and respiratory failure have been noted as causes of death.

Christina Sharples is a life & disability underwriter at Scottish Equitable Protect