A Tauranga clinic director who has seen alcohol addiction end in death is supporting calls for changes to New Zealand's alcohol laws.
She joins the 20 district health boards who have collectively called for an urgent review and law changes.
The Sale and Supply of Alcohol Act 2012 "has failed in its object to minimise alcohol-related harm", a collective DHB statement said last month.
Alcohol Action NZ chairman and Mount Maunganui GP Tony Farrell has long called for change and said new laws needed to tax alcohol and raise the minimum price, end advertising and sponsorships, reduce licensing hours and increase the drinking age.
Meanwhile, Alcohol Beverages Council executive director Bridget MacDonald said the broad-brush policy interventions were no silver bullet for reducing harmful drinking.
Hanmer Clinic director Jill Knowler said a number of clients died over lockdown from alcohol-related illness.
The clinic worked with people who were highly dependent on alcohol and Knowler said the drug took over an addict's life.
"Over time, [alcohol] increases in importance, and everything in their life that had any semblance of importance starts to decrease."
This was relationships, work, mental and physical health, and behaviour.
Knowler said deaths of addicts tended to come in waves, such as over lockdown.
This could be from the long-term impact on their health, heavy drinking after being sober, and suspected suicide when "they can't see a way through" the shame after a relapse.
She said alcoholism was a relapsing condition which made it difficult for families as there was no guarantee the user would get better.
Knowler said clients would speak about being triggered by seeing alcohol advertisements on television or merely driving past a liquor store.
Clients also said it was easy to find cheap alcohol, which made it "much harder" to stay sober.
She said in New Zealand culture there was a normalisation of drinking, and those who needed to stay off the booze felt judged when they didn't drink.
Alcohol Action NZ chairman and Mount Maunganui GP Tony Farrell said alcohol harm in New Zealand is a "public health crisis", with up to 830,000 risky drinkers.
In general, more than 14 standard drinks per week and more than four at one time is risky drinking.
It caused up to 15 deaths per week.
"Methamphetamine is very harmful and causes up to 20 deaths per year. That's just over a week's worth with alcohol," Farrell said.
He said the substance caused more than 200 medical conditions and up to 3000 babies are born with fetal alcohol syndrome per year.
It's linked to suicide, family violence and was contributing to the overloaded demand for counselling, he said, and cost up to 3 per cent of GDP per year.
Children were injured, neglected and traumatised as a result of alcohol, he said.
The country's overly commercialised alcohol environment was contrary to New Zealand having signed up to the International Convention on the Rights of the Child.
Farrell said tangata whenua - including Māori children - suffered more alcohol harm than non-Māori and a Te Tiriti claim about this was coming.
He said the substance was Aotearoa's most harmful drug because it is not managed in an effective, evidence-based public health environment.
"As a taxpayer, I struggle with the idea that New Zealand pays over $7.85 billion per annum in alcohol-related harm while the industry profits and cynically blocks any measures to make our alcohol environment safer."
Farrell said alcohol advertising and sponsorships - including online - needed to end; licensing hours needed to be reduced to 10am to 9pm for off-licenses and 10am to 1am for on-licenses; alcohol should be taxed and the minimum price should be increased.
He said the drinking ages should also increase to 20, the drink-driving limit should be dropped to 0.2 with more random testing and health warnings should be on labels.
He also wanted to see more treatment opportunities for problem drinkers.
These were evidence-based measures from local and international studies, he said.
"We would expect fewer injuries and accidents, less violence, less suicide, less cancer, and increased productivity across the Bay of Plenty."
Bay of Plenty District Health Board mental health and addictions leader Jen Boryer said the true cost of alcohol was "unquantifiable".
Physical effects ranged from slips to showing up at emergency departments with serious and sometimes life-threatening injuries, she said.
Excessive or sustained drinking can also cause brain and liver damage.
Alcohol, a depressant, impacted someone's mental state and could exacerbate mental health conditions, leading to mood and behaviour changes.
This had "significant" flow-on effects both financially and in relation to someone's reliance on the health system.
Alcohol was linked to "damaging" behaviours like aggression, violence and property damage, which then involved police.
It was also linked to difficulties accessing safe and warm housing, changes in social connectedness, and reduced the ability to work, hold employment or engage in education, she said.
She said figures showed a "significant" number of suicides and attempts happen while people were intoxicated, and alcohol also increased the chances of self-injurious behaviour.
While the true cost was "unquantifiable", alcohol costs at the health board were from assessments, scans, operations, more nurses or security due to non-compliance, and admissions - sometimes lengthy.
Alcohol Beverages Council executive director Bridget MacDonald said the broad-brush policy interventions were no silver bullet for reducing harmful drinking, "as there is no evidence they will work".
She said research showed that reducing hours only really inconvenienced moderate drinkers, and increasing prices doesn't markedly change a heavy drinker's behaviour.
Any future changes to legislation would need to target the misuse of alcohol, she said.
Kiwis were drinking about 25 per cent less than the 1970s and 80s and harmful drinking among younger drinkers was improving, she said.
According to the Ministry of Health, 20 per cent of Kiwis were "hazardous drinkers".
The NZABC supported the formation of the Māori Health Authority, as its focus will bring a targeted approach to Māori wellbeing.
"Independent economists have discredited how the often-quoted 'social cost' figure generated by BERL was derived, noting it omits any social, health or economic benefits, and includes several miscalculations."
She said it was better to direct efforts to developing solutions that tackle harmful drinking and provide people with information, education and targeted support.
"If we genuinely want to tackle harmful drinking and accelerate positive changes, we need to avoid lazy population-based policy."
Instead, she said the root causes for harmful drinking should be addressed, such as underlying social, health or economic factors.
Minister of Justice Kris Faafoi was concerned about the misuse of alcohol and expected the initial scoping of a review of the Sale and Supply of Alcohol Act to begin later this parliamentary term, his spokesman said.
The timing and scope depended on Cabinet's consideration and approval.
The minister has asked his officials to assess whether this was possible to do that within what are already priorities for the Ministry of Justice.
A spokeswoman for Minister of Health Andrew Little said Budget 2019 provided $69 million over four years for existing and to develop new alcohol and other drug services.
This included specialist alcohol and drug services that received $42m over four years. This included new managed withdrawal and aftercare services in Lakes and Tairāwhiti DHBs.
If you or someone you know needs support and treatment to reduce their alcohol intake, call the Alcohol Drug Helpline on 0800 787 797, visit their website, or free txt 8681 for confidential advice.
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• Helpline: 1737
If it is an emergency and you feel like you or someone else is at risk, call 111.
A tavern operating without a duty manager also found in breach.