'Sophistication' turned into binge-booze culture

Conservative estimates are that 25 per cent of Kiwis have a drinking problem. Photo / Dean Purcell

Opinion

A once-in-a-generation "first principles" review of the liquor laws is being conducted by the Law Commission, headed by former Prime Minister Sir Geoffrey Palmer.

This offers a rare and historic opportunity for legal and social change to influence the country's heavy drinking culture.

As a comparison, the struggle against tobacco and the tobacco industry is instructive as a historical precedent.

Initially there was reluctance by the medical and nursing professions to become embroiled in public debate about tobacco, in part because many doctors and nurses in the 1950s smoked. And because we viewed ourselves primarily as practising health professionals rather than political activists.

However, it has been pressure by clinicians over the past 40 years that has brought about such large social changes in terms of tobacco supply, marketing and sale.

Recent research has revealed the tactics being employed by the liquor industry to prevent effective regulation of alcohol are the same as those used by the tobacco industry.

These tactics are primarily designed to maintain the sale of high volumes of alcohol even in the face of the enormous personal and social damage that heavy use of alcohol is causing. And by emphasising individual responsibility as a key deflecting strategy.

Alcohol is our favourite recreational drug and as in other Western countries it enjoys a status that is fundamentally different to other recreational drugs in this country.

It is a highly commercialised marketable commodity that is available for sale, not infrequently at special discounted prices, 24 hours a day through highly accessible supermarkets and convenience stores virtually throughout the whole country.

However, there is a down side to this free market commercialisation which is driving excessive alcohol use, and this is the enormous personal and social harm.

For too long consuming alcohol has been viewed by many as a benign activity necessary for social competence, rather than accepting that alcohol is a potentially dangerous and addictive recreational substance.

Alcohol is causally related to more than 60 medical conditions. There are more than 1000 deaths each year as a result of alcohol in New Zealand.

About half (49 per cent) of these are due to chronic alcohol-related diseases, especially various cancers (24 per cent). A recent report concludes that the evidence for alcohol as a cause of cancers of the mouth, pharynx, larynx, oesophagus, colorectum (men) and breast is "convincing" and it is a probable cause of cancer of the liver and colorectum in women.

More recently, a definite link with prostate cancer in men has been established.

The other half (51 per cent ) of deaths are due to injuries. Of critical importance is the fact these injuries are disproportionately among young people, which impacts on years of life lost due to alcohol, calculated to be 17,000 a year.

But 25 per cent is a conservative estimate of the number of drinkers aged 16 and over who show a sustained pattern of problematic drinking, which means there are at least 700,000 citizens who could benefit from a therapeutic encounter.

Like passive smoking, these citizens are the cause of considerable collateral alcohol damage within society, both at home and at large.

A visit to any emergency department on a Thursday, Friday or Saturday night, a stroll downtown in most cities after dark during weekends or a visit to a women's refuge or addiction clinic will astound many people.

The sophisticated alcohol culture promised 20 years ago with the Sale of Liquor Act 1989 has turned out to be more of an endemic heavy binge-drinking culture, involving young and old, men and women, Maori and Pakeha and causing widespread health and social problems.

The seminal World Health Organisation sponsored publication, Alcohol: No Ordinary Commodity, provides some of the best scientific evidence available about ways alcohol damage can be reduced in a society.

It demonstrates that alcohol needs to be more effectively regulated to bring about change in the heavy drinking culture, in the same way tobacco has been slowly brought under better control.

In fact, this fundamental approach has been reiterated once again in a Lancet review.

A "5+ solution" based on these two reviews has been outlined by the national group Alcohol Action NZ. This provides the international evidence-based direction for the reform that would reduce the widespread alcohol-related problems and bring about a safer and healthier society:

1. Raise alcohol prices.

2. Raise the purchase age.

3. Reduce alcohol accessibility.

4. Reduce marketing and advertising.

5. Increase drink-driving counter-measures. And treatment opportunities for heavy drinkers should be increased.

We, the representatives, heads and leaders of doctors and nurses recommend this set of policy directives as a guide to the Law Commission's review of the liquor laws:

- Dr Geoffrey Robinson, chief medical officer, Capital and Coast District Health Board and New Zealand President, Royal Australasian College of Physicians.

- Dr Jonathan Fox, chairman Council of Medical Colleges in New Zealand.

- Dr Peter Foley, chairman, Medical Association.

- Nano Tunnicliff, Kerri Nuku-president, Kaiwhakahaere, Nurses Organisation.

- Heather Casey, president, Te Ao Maramatanga, College of Mental Health Nurses.

- Professor Doug Sellman, director, national addiction centre, University of Otago, Christchurch.

- Professor Peter Joyce, dean, University of Otago, Christchurch.

All signatories to this public statement can bee seen at http://www.alcoholaction.co.nz