Learning to live with our national drug

Its social cost is up to $2.4 billion a year and it harms more New Zealanders than any illegal drug. MATHEW DEARNALEY on the Government's alcohol strategy for the next three years.

Alcohol is a potent mind-altering or psychoactive drug - one of the most widely used in the world and an unavoidable feature of life in New Zealand.

In small doses, it can reduce the risk of certain illnesses such as heart disease for some groups of people.

Misused, it can quickly turn into an untamed beast, wreaking havoc through physical and mental health problems, road and drowning deaths, violence, abnormalities in unborn children and impaired work performance.

And although national consumption is markedly lower than at the country's boozy peak of 18 years ago, there has been an upturn since 1997, and binge-drinking is becoming more rife - especially among teenagers.

The social cost alone to New Zealand of alcohol abuse is conservatively estimated at $1.5 billion to $2.4 billion a year.

Health problems from alcohol such as heart and liver damage kill 130 to 150 New Zealanders a year, and drink-driving is responsible for almost a quarter of fatal road accidents.

Alcohol is a suspected ingredient in 25 per cent to 50 per cent of assaults against spouses, while 10 per cent of men and 5 per cent of women reported in a 1996 survey that they had been hit outside the home by inebriated people in the previous 12 months.

No less worrying is the effect on foetal growth, with up to 360 children born each year with impairments caused by drinking mothers, often irreversibly reducing a youngster's lifetime potential.

This is more the combined total of all children born with Down's Syndrome, cerebral palsy and cystic fibrosis.

The Government, in issuing a three-year national alcohol strategy as a key part of its drug policy, is calling on individuals and the community to join official and voluntary agencies in trying to make it work.

Health Minister Annette King says that in all the debates about drugs in New Zealand, it is sometimes possible to lose sight of the fact that the two substances causing the most harm to the most people are legally available - tobacco and alcohol.

How much alcohol do we knock back?


Although the white man and his whisky flask are blamed for introducing alcohol to Maori, who are not believed to have experimented with brewing before European settlement, our forebears were a lot more abstemious than we are.

Annual consumption stayed relatively even between 1880 and 1935, at around one to two litres of absolute alcohol for everyone aged 15 or over.

It then rose sharply to just under five litres in 1950, and peaked at almost 12 litres in 1982-83, before gradually declining to a 8.3 litres in 1997.

Although the 1989 Sale of Liquor Act made alcohol much more readily available, for instance almost doubling the number of outlets in Auckland by 1995, researchers believe consumption was dampened by a sluggish economy.

Auckland University's alcohol and public health research unit also points to a wider regulatory framework, leading to more effective enforcement and host responsibility requirements such as having food and non-alcohol drinks at all on-licence premises.

Although the introduction of alcohol advertising in 1992 could have been expected to increase consumption, the advent the next year of compulsory breath testing on the roads and graduated driver licensing may also have promoted moderation.

But our consumption is increasing again, with Statistics New Zealand recording a 4 per cent increase from 402 million to 418 million litres in the two years to 1999.

New Zealand now ranks 20th in the world for per capita alcohol consumption, just one place behind boozy Australia and one ahead of Britain.

Who drinks alcohol, and why?


Most adult New Zealanders - and a large proportion of those under the legal drinking age of 18 - indulge in alcohol at least on social occasions.

Alcohol is a great softener of inhibitions, its most immediate and noticeable effects being on the brain, although it works throughout the body at the cellular and systematic level and is addictive both physically and mentally.

Health researchers describe it as a psychoactive drug, but it has been a feature of New Zealand life since European settlement, and a symbol of hospitality for many.

On the dark side, people with alcohol problems are almost twice as likely to have some other mental disorders such as antisocial personality conditions, major depressions or schizophrenia.

Almost half of pathological gamblers are believed to have harmful drinking habits, and more than 80 per cent of 100 new arrivals to a prison in a 1994 study met criteria for lifetime alcohol abuse or dependence disorder.

Another study, in the Australian and New Zealand Journal of Psychiatry, found that 32 per cent of men and 6 per cent of women would meet clinical criteria for alcohol abuse or dependence at some stage in their lives.

An estimated 5 to 9 per cent of men, and 1 to 2 per cent of women, wake up with shaking hands and have a drink first thing in the morning.

The Alcohol Advisory Council recommends limits for responsible drinking. What are these?

Men should imbibe no more than six standard drinks of 10 grams of alcohol in each sitting, while women should keep within a four-drink limit.

The alcohol council also says men should drink no more than 21 standard measures a week, while women should set 14 as their upper limit.

One can of beer containing 5 per cent alcohol by volume works out at about 1.5 standard drinks by the council's definition.

Who is at the greatest risk of abusing alcohol?

Those most likely to drink buckets of alcohol at a single sitting are young people, with almost two-fifths of 14 to 18-year-olds surveyed a year ago by the Alcohol Advisory Council reporting they had binged on five or more glasses in the previous fortnight.

A national survey in 1996 by the Auckland University unit found 38 per cent of males aged 18 to 24 and 20 per cent of females from 16 to 24 quaffing more than recommended limits for responsible drinking, at least once a week.

In a more recent Auckland-based survey, unit researchers found that the proportion of 14 to 19-year-olds describing themselves as drinkers actually declined from 82 per cent in 1990 to 66 per cent in 1996, before rising back to 77 per cent in 1999.

The frequency of consumption by this age group fell since 1996, the researchers found, but the number of standard-measure drinks in a typical session had risen to between five and six, up from three to four a decade ago.

Most concerning was a finding that this was largely due to increases among 14 to 17-year-olds, whose average consumption rose from two to three drinks to five to six.

And this was before the legal drinking age was dropped from 20 to 18 in 1999.

Older people are also considered to be at particular risk, particularly if they seek consolation for bereavements and other losses in a bottle, and there is a risk of toxic reactions with prescription medicines.

Maori are another high-risk group. The proportion of Maori who drink is actually lower than that of the general population, and those who drink tend to do so less often. But the median annual volume of absolute alcohol consumed by Maori men is greater, at 9.2 litres, than the 7.4 litres consumed by men in the general population.

A Health Ministry survey in 1999 found that 44 per cent of Maori male drinkers and 29 per cent of females consumed alcohol at hazardous levels.

The strategy paper notes a special responsibility under the Treaty of Waitangi to protect the health of Maori.

More than half of all Pacific Island adults reported in a health survey four years ago that they had not touched alcohol in the past 12 months, but the paper notes that many of those who do drink do so at dangerous levels. It notes that health promotion strategies based on moderation, such as host responsibility, may miss the mark among people from a culture where generosity is paramount.

What is the social cost to New Zealand of all this boozing?

The Government strategy paper notes that alcohol, when used in moderation, can reduce the risk of certain illnesses for some groups and recognises that the alcohol and hospitality industries also contribute significantly to our economy.

Excise tax on alcohol puts about $440 million a year into Government coffers.

But there appears to be a huge social deficit, with Otago University researchers putting the cost of alcohol abuse at $1.5 billion to $2.4 billion a year.

They estimate direct costs such as hospital, accident compensation and law enforcement expenses at between $345 million and $592 million.

Indirect costs from factors such as lost production from premature death and absenteeism are estimated at $1.1 billion to $1.8 billion.

A separate study, of 5000 Aucklanders, calculated that impaired work performance from drinkers turning up the worse for wear costs industry about $41 million a year, while those opting to stay home sick cost their bosses $16 million.

And even the good news about the healthy effects of antioxidants in red wine on our hearts has been taken too far.

The Auckland University researchers are concerned about a significant increase in people saying they are drinking more because they believe it is health-giving.

What action does the strategy propose?


The strategy suggests a study to consider readjusting excise duties to align these strictly with the volume of alcohol rather than types of drinks. This would reduce taxes on spirits and increase those on wine, beer and pre-mixed "alcopop" drinks.

No overall increase in excise duties is recommended, apart from a continuation of the current policy of linking these to inflation.

The document also suggests consideration of more alcohol testing of workers in industries where public safety is at stake, ACC-levy cuts for employers with approved alcohol policies, more breath-testing for drivers, and a body to monitor the marketing of alcohol.

Specific targets have been set to reduce by 2003 the prevalence of binge-drinking among young people including Maori and Pacific youth, the proportion of people assaulted by those who have been drinking, and the rate of alcohol-related road accidents and drownings.

But the strategy refrains, until baseline data can be collected, from setting targets for reducing drinking by pregnant women and from spurring involvement by community groups and educators in battling alcohol abuse.