WHY WE NEED TO CHANGE OUR DRINKING CULTURE

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OUR DRINKING LANDSCAPE - ALCOHOL IS OVERSUPPLIED AND ADVERTISED HEAVILY

Our drinking landscape has changed considerably over the last 30 years. We have seen increases in the number of places selling alcohol and the types of products available and strategies to advertise them, and reductions in the price of alcohol. 

  • Beginning in 1989, new liquor laws increased the availability of alcohol across NZ [1] -
    • wine and beer became available in supermarkets and grocery stores in 1989 and 1999 respectively [1];
    • the minimum legal age to purchase alcohol was reduced from 20 to 18 years in 1999.
  • The number of places that sold alcohol more than doubled from to 6,300 in 1990 to 14,200 in 2009 [2].
  • Today, around 75% of all alcohol in NZ is sold from off-licences: 43% from bottle stores and 32% from supermarkets and grocery stores [1].
  • More liquor outlets are concentrated in poor suburbs than rich suburbs [3].
  • The increasingly availability of Ready to Drinks (RTDs) has had a huge impact on heavy drinking in New Zealand, particularly among young girls.
  • Alcohol has become more affordable over time [4].  
  • In 2009, it was estimated that $200,000 was spent each day advertising alcohol in New Zealand [5].
  • Within prime-time television viewing in New Zealand, a scene depicting alcohol occurs every 9 minutes [6].
  • New Zealanders spend $85 million per week on alcohol ($4-5 billion per year).

OUR DRINKING CULTURE 

New Zealanders typically drink large amounts of alcohol. Although, overall, we drink less than the Irish and British (and slightly less than Australians), we drink more than Americans, Canadians and South Africans. 

  • In 2016, 474 million litres of alcoholic drinks were available for sale (292 million litres of beer, 109 million litres of wine, 73 million litres or spirits/spirit-based drinks). This equates to 34 million litres of pure alcohol, or 9.4 litres of pure alcohol per person aged 18 and above [7].  To put this into perspective, it is the same as every person aged over 18 years consuming two standard drinks per person every day of the year (i.e. 2 cans of beer (330ml, 4% alcohol) or 2 glasses of wine (12.5%; 100ml) [7]).

  • However, in reality we know that most between 40-50% of all alcohol sold in NZ is consumed in heavy drinking occasions.
  • In 2015/16, 4 in every 5 New Zealand adults (80%) drank alcohol in the past year [8].

  • In 2015/16,
    • around 780,000 adults were hazardous drinkers [8];
    • Almost half (44%) of young men (aged 18 to 24 years) were hazardous drinkers [8];
    • Males (29%) were twice as likely as females (13%) to be hazardous drinkers [8].
    • Young adults aged 18 to 24 years had the highest rate (20%) of weekly binge drinking (six or more drinks standard drinks on one occasion) [8].
  • The percentage of adults with hazardous drinking patterns decreased from 18% in 2005/06 to 15% in 2011. However, since 2011 hazardous drinking has increased every year [8]. In 2015/16 the prevalence was 19% (when measured in standard drinks it is 21%). The largest increases in hazardous drinking has been seen in those aged 35-64 years old.
  • Fewer adolescents are choosing to drink (61% current drinkers in 2007 versus 45% in 2012). However, adolescents who do drink continue to drink large amounts. Of particular concern, young adolescent females in New Zealand may actually be increasing the volume of alcohol they consume when drinking [9].

ALCOHOL IS A KEY CONTRIBUTING FACTOR TO INEQUALITIES

There are a number of factors which give rise to groups in society experiencing more alcohol-related harm than others. Inequities in harm can be driven by our age, where we live and the number of alcohol outlets close to our homes, the socio-economic circumstances we live in, our exposure to racial discrimination and structural barriers that limit our opportunities, as well as our alcohol consumption patterns. 

  • Alcohol is a key contributing factor to health inequalities [10].
  • In 2015/2016, Māori adults were 1.5 more likely to be hazardous drinkers than non-Māori [8].
  • In 2015/16, adults living in the most deprived areas were 1.4 times more likely (25% vs. 19%) to be hazardous drinkers than those living in the least deprived areas [8].
  • Māori are approximately twice as likely as non-Māori to have alcohol use disorders even after taking into account age, sex, education and income [11].
  • Between 2004 and 2007, Maori deaths from alcohol were two and half times greater than non-Maori [12].
  • New Zealand Secondary school students who report experiencing ethnic discrimination are almost twice as likely to report binge drinking as those who do not [13].
  • In 2015/16 43% of Pacific past-year drinkers were hazardous drinkers. Pacific adults who drink were 1.5 times more likely to be hazardous drinkers than non-Pacific drinkers, after adjusting for age and sex [8].  
  • Young Pacific people are less likely to binge drink if they had parental Pacific language use at home and had parents which knew where they were after school and at night time. However, participating in sports teams or a sports club was associated with an increased risk of binge drinking [14].
  • Harms from alcohol are more prevalent among drinkers in drinkers living in the most deprived areas [15].

HARMS FROM ALCOHOL VERSUS OTHER DRUGS

Many people are aware that alcohol causes more harm than many other drugs available in our society. 

  • In a UK study measuring the harm score of different types of drugs, alcohol was found to be the most harmful drug with an overall harm score of 72, followed by heroin (55) and crack cocaine (54) [16]. The study measured -
  • harms to users (e.g., drug specific death and illnesses, dependence and loss of relationships, etc); as well as
  • harms to others (e.g. crime, injury and social costs).

COST OF ALCOHOL TO SOCIETY

Although the tax from alcohol consumption contributes to Government revenue, it does not match the costs of alcohol-related harm to our society. 

  • In 2016, alcohol contributed $950 million of government revenue in the form of excise tax [17].
  • Alcohol misuse is estimated to cost New Zealand society $5 billion each year (expressed in 2008 currency) [18]. This includes costs to individuals such as car insurance, lost wages and medical treatments, as well as cost to the government such as healthcare costs, road crashes, police and justice [18].
  • In comparison to alcohol, the social cost of other drug-related harms and intervention is estimated to be at $1.6 billion (expressed in 2008 currency) [18] and $1.8 billion in 2014/15 [19].
  • 11% of all ACC claims are attributed to alcohol-related injuries [20].
  • 18% of the New Zealand Police budget is spent on alcohol incidents.
  • Alcohol also results in loss of productivity in workplaces and schools -
    • In 2012/13, male drinkers (4%) were 1.6 times more likely to be absent from work or studies than female drinkers (2.5%) [15]; and
    • In 2012/13, male drinkers (6.9%) were 1.4 times more likely to experience negative financial effects due to their drinking than female drinkers [15].
  • Every year, 147,500 adults take one or more days off work or school due to their alcohol use [21]. A total of 84,400 adults have experienced harmful effects on their work, study or employment because of alcohol [21].
  • In 2012, 6% of adolescent drinkers report having their work or school affected in the last year due to alcohol [22]. Among those students living in the most deprived areas, 8% report problems with work or school (exacerbating existing inequities in outcomes) [22].

There are many, many direct and indirect harms resulting from alcohol use. Drinkers should be aware that the harms are both acute and chronic, and don’t just relate to heavy drinking. Lower levels of consumption can also cause significant harm. 

  • There are 60 different medical conditions that are caused by heavy drinking
  • Alcohol is considered a Class 1 carcinogen. This means the strength of the relationship between alcohol and cancer is similar to that of asbestos, arsenic, tobacco smoke, Ionizing radiation, vinyl chloride and ultraviolet radiation A, B & C [23].

  • Around 570 children are born each year in New Zealand with Fetal Alcohol Spectrum Disorder [24].
  • Every year in New Zealand, 802 New Zealanders die younger than expected due to their current drinking behaviours [12] -  
    • Injuries were responsible for 43% of alcohol-related deaths [12];
    • Cancers were responsible for 30% of alcohol-related deaths [25];
    • 27% of alcohol-related deaths were due to a variety of other long-term diseases (e.g. liver cirrhosis) and pneumonia [12];  
    • Twice as many deaths from alcohol are observed in men as women [12].
  • Alcohol and drugs contributed to 29% of all fatal road crashes in NZ in 2016 [26].
  • Among young adults aged between 15 and 29 years, road traffic injuries led to more than half of alcohol-attributable deaths followed by self-inflicted injuries [12].  
  • Among women aged between 30 to 44 years, one in five women (22.8%) died younger than expected due to breast cancers attributable to alcohol use [12].
  • More than a third of these breast cancer deaths in New Zealand are attributable to drinking less that two standard drinks per day on average [27].
  • Alcohol is a major risk factor for suicide [28, 29]. In 2014, over one-third of people who committed suicide had alcohol in their system (and a further 23% had traces of alcohol in their system) [30].  
  • Among those who had attempted suicide and were admitted to an Emergency Department in 1999, 29% of young New Zealanders had some degree of harmful or dependent alcohol use [31].
  • There is no safe level of consumption for adolescents given the irreversible effects of alcohol on brain development. As the amount of alcohol consumed increases, declines in memory recall and learning are shown [32]. Female adolescent brains are particularly vulnerable to the damaging effects of alcohol [33].
  • The more alcohol-related harms a young New Zealander experiences, the less likely they are to finish high school [34].
  • From January 2008 to December 2012 Police received 360,166 calls for types of events that are typically related to alcohol (approximately 72,000 per year).

HARMS FROM OTHER PEOPLE’S DRINKING IS HIGHER THAN HARMS FROM OWN DRINKING

We all bear the costs from alcohol-related harm; some more than others. In many cases, the harm from someone else’s drinking is higher than the costs to the individual drinker. 

  • Alcohol is responsible for a third of all violence (33%) [35], a third of all family violence (34%) [35] half of all sexual assaults (54%) and homicides (49.5%) [36].
  • Over 300 alcohol-related offences are committed every day.
  • Each day 52 individuals or groups of people are either driven home or detained in police because of intoxication.
  • In 2008/09, one in nine New Zealanders reported that they called the police at least once in the past year due to other people’s drinking [37] .
  • A study in 2012 found that the prevalence of self-reported harm from others’ drinking was higher than harm from own drinking (18% vs 12% in the past year) and was higher in women and young people [36].
  • In 2009, alcohol-related presentations accounted for 10% of all presentations in the emergency department on a Saturday, increasing up to 25% during the night shifts (25%) [38].
  • Between 2003 and 2007, half of all alcohol-related traffic injuries in the 15-19 year age group in New Zealand were due to someone else’s drinking; the highest proportion in comparison to other age groups [39].
  • More than one quarter (28%) of respondents in a 2008/09 New Zealand survey indicated that they had at least one heavy drinker in their life; 85% indicated they had experienced a range of harms because of this person’s drinking. Further, 17% of respondents with children reported that their children experienced harm because of the drinking of someone else [40].
  • Seventy-one percent of those sampled reported experiencing at least one harm because of the drinking of a stranger [40].
  • A small study in New Zealand found that Emergency Department staff, in particular nurses, were commonly assaulted by alcohol-affected patients [41].

REFERENCES

1 New Zealand Law Commission. Alcohol in Our Lives: Curbing the harm: A report on the review of the regulatory framework for the sale and supply of liquor. Wellington: New Zealand Law Commission; 2010.

2 Connor JL, Kypri K, Bell ML, et al. Alcohol outlet density, levels of drinking and alcohol-related harm in New Zealand: a national study. Journal of Epidemiology & Community Health 2010: jech. 2009.104935.

3 Pearce J, Day P, Witten K. Neighbourhood provision of food and alcohol retailing and social deprivation in urban New Zealand. Urban Policy and Research 2008;26:213-27.

4 Gunasekara FI, Wilson N. Very cheap drinking in New Zealand: some alcohol is more affordable than bottled water and nearly as cheap as milk. N Z Med J 2010;123:103-7.

5 Sellman D. Submission to the New Zealand Law Commission. Alcohol Action New Zealand 2009.

6 McGee R, Ketchel J, Reeder AI. Alcohol imagery on New Zealand television. Substance Abuse Treatment, Prevention, and Policy 2007;2:6.

7 Statistics New Zealand. Alcohol Available for Consumption: Year ended December 2016. 2017. Retrieved from http://www.stats.govt.nz/browse_for_stats/industry_sectors/alcohol_and_tobacco_availability/Alcohol-available-for-consumption_HOTPYeDec16.aspx [Accessed 27 June 2017].

8 Ministry of Health, Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington: Ministry of Health; 2016. Retrieved from http://www.health.govt.nz/system/files/documents/publications/annual-update-key-results-2015-16-nzhs-dec16-v2.pdf [Accessed 5 July 2017].

9 Jackson N, Denny S, Sheridan J, et al. Uneven reductions in high school students' alcohol use from 2007 to 2012 by age, sex, and socioeconomic strata. Substance Abuse 2017;38:69-76.

10 Smith K, Foster J. Alcohol, health inequalities and the harm paradox: why some groups face greater problems despite consuming less alcohol. Institute of Alcohol Studies 2014.

11 New Zealand Law Commission. Alcohol in Our Lives: An issue paper on the reform of New Zealand's liquor laws. Wellington: New Zealand Law Commission; 2009.

12 Connor J, Kydd R, Shield K, et al. The burden of disease and injury attributable to alcohol in New Zealanders under 80 years of age: marked disparities by ethnicity and sex. N Z Med J 2015;128:15-28.

13 Crengle S, Robinson E, Ameratunga S, et al. Ethnic discrimination prevalence and associations with health outcomes: data from a nationally representative cross-sectional survey of secondary school students in New Zealand. BMC Public Health 2012;12:45.

14 Teevale T, Robinson E, Duffy S, et al. Binge drinking and alcohol-related behaviours amongst Pacific youth: a national survey of secondary school students. The New Zealand Medical Journal (Online) 2012;125.

15 Ministry of Health. Alcohol use 2012/13: New Zealand Health Survey 2013 2015.

16 Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. The Lancet 2010;376:1558-65.

17 The New Zealand Treasury. Financial Statements of the Government of New Zealand for the year ended 30 June 2016. Wellington: The New Zealand Treasury; 2016. Retrieved from http://www.treasury.govt.nz/government/financialstatements/yearend/jun16 [Accessed 5 July 2017].

18 Slack A, Nana G, Webster M, et al. Costs of harmful alcohol and other drug use. BERL Economics 2009:40.

19 New Zealand Drug Foundation. Drug Use in New Zealand. Policy and Advocacy. Retrieved from: https://www.drugfoundation.org.nz/policy-and-advocacy/drugs-in-nz/ [Accessed 5 July 2017].

20 Accident Compensation Corporation,. Public injury prevention programme: Logic to reduce alcohol as a contributing factor to in injury.

21 Alcohol Advisory Council of New Zealand, New Zealand Drug Foundation, Accident Compensation Corporation, et al. Alcohol and Other Drugs in the Workplace - Employer Guide. Wellington: ALAC/NZ Drug Foundation/ACC; 2008.

22 Clark TC, Fleming T, Bullen P. Youth'12 prevalence tables: The health and wellbeing of New Zealand secondary school students in 2012. Auckland: The University of Auckland; 2013.

23 World Health Organization, International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Geneva: WHO/IARC; 1998. Retrieved from http://monographs.iarc.fr/ENG/Classification/latest_classif.php [Accessed 25 July 2017].

24 FASD Working Group. Taking Action on Fetal Alcohol Spectrum Disorder: 2016–2019: An action plan. Wellington: Ministry of Health. 2016. Retrieved from https://www.health.govt.nz/system/files/documents/publications/taking-action-on-fetal-alcohol-spectrum-disorder-2016-to-2019.pdf [Accessed 25 July 2017].

25 Connor J, Broad J, Jackson R, et al. The Burden of Death, Disease and Disability due to Alcohol in New Zealand: Research summary. Wellington: Alcohol Advisory Council of New Zealand; 2004. Retrieved from http://www.hpa.org.nz/sites/default/files/imported/field_research_publication_file/BurdenFull.pdf [Accessed 5 July 2017].

26 Ministry of Transport. Alcohol and Drugs. Auckland: Ministry of Transport; 2016. Retrieved from http://www.transport.govt.nz/assets/Uploads/Research/Documents/Alcohol-drugs-2016.pdf [Accessed 25 July 2017].

27 Connor J, Kydd R, Maclennan B, et al. Alcohol‐attributable cancer deaths under 80 years of age in New Zealand. Drug Alcohol Rev 2017;36:415-23.

28 Pompili M, Serafini G, Innamorati M, et al. Suicidal behavior and alcohol abuse. International journal of environmental research and public health 2010;7:1392-431.

29 Alexander CW, Amy LT, Kelli AK. Effects of alcohol tax and price policies on morbidity and mortality: a systematic review. American journal of public health 2010;100:2270-8 doi:10.2105/AJPH.2009.186007.

30 Rossiter P. Coronial Services of New Zealand 2017.

31 Bennett S, Coggan C, Hooper R, et al. Presentations by youth to Auckland emergency departments following a suicide attempt. International Journal of Mental Health Nursing 2002;11:144-53.

32 Nguyen‐Louie TT, Tracas A, Squeglia LM, et al. Learning and Memory in Adolescent Moderate, Binge, and Extreme‐Binge Drinkers. Alcoholism: Clinical and Experimental Research 2016;40:1895-904.

33 Squeglia LM, Sorg SF, Schweinsburg AD, et al. Binge drinking differentially affects adolescent male and female brain morphometry. Psychopharmacology (Berl) 2012;220:529-39.

34 Silins E, Fergusson DM, Patton GC, et al. Adolescent substance use and educational attainment: an integrative data analysis comparing cannabis and alcohol from three Australasian cohorts. Drug Alcohol Depend 2015;156:90-6.

35 New Zealand Police. National Alcohol Assessment. 2009. Retrieved from https://www.police.govt.nz/sites/default/files/Police-National-Alcohol-Assessment.pdf [Accessed 25 July 2017].

36 Connor J, Casswell S. Alcohol-related Harm to Others in New Zealand: evidence of the burden and gaps in knowledge. The New Zealand Medical Journal (Online) 2012;125:11.

37 Huckle T, Wong K, Parker K, et al. Increased use of police and health-related services among those with heavy drinkers in their lives in New Zealand. N Z Med J 2017;130:102-10.

38 Stewart R, Das M, Ardagh M, et al. The impact of alcohol-related presentations on a New Zealand hospital emergency department. The New Zealand Medical Journal (Online) 2014;127:23.

39 Connor J, Casswell S. The burden of road trauma due to other people's drinking. Accident Analysis & Prevention 2009;41:1099-103.

40 Casswell S, Harding JF, You RQ, et al. Alcohol's harm to others: self-reports from a representative sample of New Zealanders. The New Zealand Medical Journal (Online) 2011;124.

41 Gunasekara FI, Butler S, Cech T, et al. How do intoxicated patients impact staff in the emergency department? An exploratory study. The New Zealand Medical Journal (Online) 2011;124.

 

 

 

 

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