KEY POINTS:
The Binge Drinking Culture - what can we do about it?
There has been a great deal of recent media attention on youth drinking, binge drinking in particular, and the well known harmful effects of abusing alcohol.
Starting with the infamous "Undie 500" which televised students running wild, fuelled by excess quantities of alcohol, there's been an ongoing series of alarming headlines.
This is not new nor is it peculiar to New Zealand - there are similar alarms sounding around the world. But as pressures grow to "fix" the problem there is a need for informed public debate as to what can be done about it and by whom.
What is binge drinking? The best definition is drinking to drunkenness, that is, to a level where a youth would describe themselves as "wasted". Older adults may discover themselves feeling rather disinhibited, talking loudly and probably behaving out of character.
A well known example of youth binge drinking is seen in the southern states of the US. Every weekend literally thousands of young Americans stream across the US-Mexican border to patronise bars in Tijuana, where the drinking age is 18 in contrast to 21 years in the US.
Many promotions have a fixed entry price covering "all you can drink". About 30 per cent of those who return to the US between midnight and 6am have blood alcohol concentrations much greater than 0.08mg/100ml (New Zealand's legal limit for drivers over 20 years of age).
This provides a classic example of some of the conditions that produce binge drinking.
Reading the history of New Zealand's prohibition in the 1920s shows a similar picture; legal denial led to intermittent binges. The prohibition period was followed by regulations on the sale of alcohol which included 6pm closing of all bars.
That produced a "6pm swill" where drinkers drank as much as possible before the bars shut at 6pm. That's a good way to teach unsafe drinking!
How many drinks over how long did these youths need to get over 0.08/100ml, a level at which most police would agree their driving is impaired?
By my calculations, based on what the researchers found, it would be about 11 of our standard drinks for males and nine for females over a four-hour period.
Why do people binge drink? Coleman (2005) interviewed 64 British 14 to 17-year-olds looking at their motivations for binge drinking based on his definition of "self reported drunkenness".
Their key motivations related to social facilitation and being more relaxed in social settings including "pulling" a sex partner, having a laugh, individual benefits such as "the buzz". Also peer behaviour influences such as wanting to be part of the group, and wider social norms such as the way they saw society at large drinking.
This last reason applies particularly to young people such as students: "If the norm among my peers is binge drinking, then that's what I should do."
A 2003 Alcohol Advisory Council publication Young People and Alcohol and Other Drug Use lists similar statements to the British survey. But with the addition of binge drinking or drug use as a way of coping with psychiatric or personal distress.
What happens if you binge drink? The same Coleman (2005) study reported the main outcomes of British binge drinking for 14 to 17-year-olds were unsafe sexual behaviour, regret over their sexual behaviour, accidents, fighting, hangovers and walking home on their own at night.
Again, anecdotal evidence from schools throughout New Zealand reinforces these findings as young girls report to health clinics or are absent at school on Monday mornings and young males report to the courts.
The drug and alcohol field views consequences simplistically as related to Liver, Lover, Livelihood and Law. Like all simple ways of looking at complex problems this is a pretty good definition.
Liver = health problems such as accidents, indigestion and multiple requests for the morning after pill. Lover = relationship problems such as domestic violence or cheating on partners. Livelihood= problems at work or failure to turn up. Law = drunk driving, assaults and rapes.
As I said at the beginning, the same problems and outcomes are ringing alarm bells around the world. The dilemma is how do we fix the problem, and who will.
Alcohol-related problems are complex and research consistently shows that to have any hope of success they require a multi-faceted, long-term commitment from a wide range of people including politicians, the judiciary, alcohol producers and retailers, parents, friends, communities and those directly affected.
Equally, it's been shown that no one solution, used in isolation, will have a lasting effect - for example, stringent legislation that's not consistently reinforced in the courts or backed by society, is unlikely to change habits or behaviour. This is not a problem that can be solved by more laws - it requires all of us to work together.
What do the young people say will reduce binge drinking? Coleman and Carter (2007) interviewed 40 English binge drinkers and held focus group discussions with binge drinkers aged 18-25 years. Their definition of binge drinking was "drinking enough drinks in a single day or evening to get very drunk".
On the whole most did not classify themselves as binge drinkers and some thought nothing would work to stop their habit.
However, other responses included: Shock tactics that young people could relate to, for example devastating experiences of peers rather than images of diseased livers.
Or witnessing and reflecting on antisocial and embarrassing behaviour, or acknowledging the likelihood and outcomes of regretted sexual experiences. And greater enforcement of not purchasing alcohol or driving when drunk.
So where do we start? There are many good programmes already in place in New Zealand - Host Responsibility training for bar staff, Christchurch's Alcohol Accord, the Clendon youth march, DB's community partnerships, as well as a wide range of well-established programmes in other countries such as The Associated Brewers' Rethinking Drinking project in Australia (see www.rethinkingdrinking.org).
Many are innovative and showing early signs of success. But perhaps the next step is for more publicity about and evaluation of each of these programmes so we find out more about what's working and why.
The challenge therefore, in my view, is not to point fingers at who is most responsible for the problems, or to expect any one group to come up with single-focus remedies. Rather it is to have open, informed discussion about what we, as New Zealanders, want our society to be like and how we collectively will work together to achieve this. And of course to support existing initiatives that appear to be working and to encourage and resource other communities to take the lead in helping solve the issue for themselves.
Finally, the reality is that any product or substance, used inappropriately, can be harmful and that the vast majority of people who drink alcohol do so responsibly and enjoy it as part of social time with friends and family.
It is important that the views of these people are heard alongside others' as we discuss our binge drinking sub-culture and look for solutions.
* Professor Ross McCormick is director of the Goodfellow unit, School of Population Health, University of Auckland. He is medical adviser to the Australasian Association of Brewers.
