Getting to Grips with Ireland's Alcohol Problems

on Thursday, 02 December 2004. Posted in Issue 49 The Garda Síochána Bill 2004 (Somone will be watching you!), 2004

November, 2004

Margaret Burns*

Urgent need for responsible attitude to drinkingRecent months have seen the publication of two important reports on alcohol in Irish society - the Report on Alcohol Misuse by Young People, issued by the Oireachtas Joint Committee on Health and Children in June 2004, and the Second Report of the Strategic Task Force on Alcohol, which was published in September. (1)  These documents provide a wealth of information and analysis on the topic of alcohol in Ireland today and put forward a range of recommendations. They merit serious consideration by all concerned about health and social well-being in the newly-prosperous Ireland.

The opening chapters of the Strategic Task Force Report, in particular, present a truly alarming picture of the way alcohol is now used in our society. They highlight both our exceedingly high level of alcohol consumption, with Ireland having the highest per capita consumption of all the main countries in the EU, and the price which Irish society is now paying for the misuse of alcohol.

Consumption

Irish alcohol consumption is summed up in the Task Force\'s comment: "Ireland continues to be amongst the highest consumers of alcohol in the world." (2)  In 2001, of the twenty-five countries now in the EU, Ireland ranked second to Luxembourg with a consumption of 12 litres of alcohol per head of population per annum, as against 14.4 for Luxembourg and, at the other end of the scale, less than 6 for Sweden and Malta.(3)

A truer picture of the level of consumption is obtained by looking at intake for those aged fifteen and over: in 2001 this was 14.4 litres of pure alcohol.  By 2003, consumption had fallen to 13.5 litres, the first time in sixteen years there had been a decline. (4)

In reality, the average consumption per drinker is higher than these figures would indicate, since it is the case that a significant part of the Irish adult population (around 23%) does not drink at all.

The Task Force Report makes clear that cause for concern relates not just to the overall consumption of alcohol among those who drink but to the pattern of drinking  - the frequency of drinking and amount consumed on any one occasion. A 2002 study of a number of European countries showed that: "Ireland had the highest reported consumption per drinker and the highest level of binge drinking". (5) Contrary to popular perception that binge drinking is the preserve of the young, the study showed that among men in the age group 50-64, 60 out of 100 drinking occasions ended up in binge drinking, a figure not very much lower than that for men aged 18-29, for whom it was 65 out of 100 occasions. Overall among men, 58 of every 100 drinking occasions were of binge drinking. Among women, 30 out of 100 occasions were ones where they binge drank; again this pattern was not confined to younger women, with the incidence among women aged 50-64 almost as high as that for women aged 18-29. (6)

These findings are consistent with the findings of The National Health and Lifestyles Surveys of 2002 which showed that 30% of males and 22% of females reported consuming over the recommended limit for \'safe\' consumption - that is, 21 standard drinks for men and 14 for women per week. Again, risky levels of consumption were not confined to younger people: among men aged 18-34 years, 37% were drinking in excess of the recommended weekly allowance, for men aged 55 and over, the figure
was 27%. (7) 

Although in law young people under eighteen are not permitted to drink in public and are only permitted to drink in their home with the express permission of their parent or guardian, the 2002 Lifestyle Survey showed that only 13% of boys and 18% of girls aged 15-17 had never had a drink.(8)  25% of both boys and girls in this study reported they had had a drink in the previous month; among 15-17 year olds, the figures rose to 54% of boys and 48% of girls. (9)

Around 30% of both boys and girls reported having been "really drunk" . Among boys aged 12-14 this was around 19% and among those aged 15 to 17 it was as high as  60%. For girls aged 12-14, the figure was 14% and for 15 to 17 year olds it was 54%. 12% of boys and girls aged 15 to 17 reported being drunk on more than ten occasions. (10)

The Vintners\' Federation of Ireland concluded its submission to the Oireachtas Joint Committee with the comment: "Thousands enjoy - few abuse". (11) The findings of the studies on drinking patterns of Irish adults and young people do not substantiate that claim.

Expenditure

In 1995, Ireland spent the equivalent of nearly 3.3 billion euro of personal income on alcohol. By 2002, expenditure had risen to nearly 6 billion euro, representing 1,942 euro for every person over 15 years. The Household Budget Survey 1999-2000 revealed that, on average, weekly expenditure on alcohol represented 5.5% of total household spending. (12)

\'The Price of Drink\'

Both Reports also draw attention to the price which Irish society is paying for the misuse of alcohol in terms of alcohol-related mortality and morbidity, public disorder offences, family problems, loss of economic productivity.

In relation to health, the Task Force Report notes the finding of the \'Global Burden of Disease\' study, undertaken on behalf of the World Health Organisation and the World Bank, that alcohol is the third most detrimental risk factor relating to ill health and premature death in Europe, with only tobacco and high blood pressure more serious. "Alcohol was a more important risk factor than high cholesterol and being overweight; three times more important than physical inactivity and five times more important than illicit drugs." (13)  Given Irish levels and patterns of drinking, this is a finding of striking significance.

The Report assembles the evidence of the impact of alcohol misuse on the health status of people in Ireland. Between 1992 and 2002, a period when alcohol consumption increased by 37%, there was an increase, in some instances a very marked increase, in deaths from five of the main conditions directly attributable to or associated with alcohol misuse. Over this period, 14,223 people died from these conditions - alcohol acute conditions (alcohol poisoning); alcohol chronic conditions (alcohol dependency and psychosis), cancers related to alcohol, chronic liver conditions, suicide. The increase in mortality for these conditions occurred in the context of a decrease in the overall mortality rate and in the mortality rate for cancers in general. (14)

In 2002, alcohol was a factor in 42% of all cases of parasuicide; in that year also 37% of all deaths from drowning were alcohol related. Alcoholic disorder was the second highest cause for admissions to psychiatric hospital for males and the fourth highest for females. There has been growing public health concern about the possible effects of alcohol on foetal development, yet a recent study of women attending one Irish maternity hospital showed that 85% continued to drink during pregnancy. (15)

Alcohol is estimated to be involved in 40% of road deaths and at least 30% of all road accidents in Ireland. While the overall number of deaths and injuries from road accidents decreased in 2002 from the previous year, the number killed or injured between 9 pm and 4 am, the time most associated with drinking and driving, in fact increased. (16)

Both the Task Force and the Oireachtas Committee draw attention to scientific and medical evidence of the harmful effects of drinking on the developing brains of adolescents.  Alcohol can seriously damage two key brain areas that are undergoing dramatic changes in adolescence with consequences for memory and learning and for the formation of adult personality and behaviour. The negative effects on memory and learning of alcohol are far greater for adolescents than for adults: "Adolescents need only drink half as much to suffer the same negative effects". (17)

Furthermore, children who begin drinking before 15 and young people who drink heavily during later teenage years are significantly more likely to have drinking problems in later life than those who begin drinking at twenty-one. (18)

Another dimension of alcohol misuse in Ireland is the role it plays in generating public order offences. According to a National Crime Council study, cited by the Task Force, alcohol is \'the primary factor\' in these offences, which increased by 161% between 1996 and 2001. In 2002, there were 22,701 offences among adults relating to \'intoxication in a public place\' (an increase of 27% on the previous year), and a further 1,898 among juveniles. However, the full extent of public order incidents  is not reflected in official figures, as is indicated by the fact that over half  the public order incidents observed in the National Crime Council study were dealt with informally by the Gardai. (19)
Both Reports draw attention to a range of other damaging consequences of alcohol misuse for which there are no firm statistical data as to their incidence. However, two studies in 2002 on Irish drinking patterns which allowed respondents to \'self-report\' negative consequences of their drinking showed that significant percentages acknowledged that alcohol was negatively impacting on areas of their life such as work, studies, marriage, family, health, finances, relationships with friends, involvement in fights and accidents.

Young men (18-29 age group) experienced the highest incidence of \'acute\' harm, such as getting into fights because of alcohol (16.1%) or having their work or study negatively affected by their drinking (19.5%). Older men, particularly the 50-64 age group, reported higher levels of chronic harm - damage to health (20.2%) and to homelife/marriage (12.8%).(20)

The Strategic Task Force estimates the financial cost of alcohol-related harm in Ireland as 2.65 billion euro in 2003, equivalent to 2.6% of GNP. This estimate relates to health care costs (433m.); road accident costs (322m.); alcohol-related crime (147.5m.); loss of output (1,050m.); alcohol- related transfer payments (523.3m.); taxes foregone due to lost output (210m.). The  2003 total represents an increase of 12% on an estimate of 2.36 billion calculated for 2001. The Task Force says that these estimates "err on the side of caution and if more comprehensive data were available the figure could be considerably higher." (21)  Such estimates cannot reflect other damage that may not be quantifiable in monetary terms but is of enormous significance: the unfulfilled hopes and ambitions of people; the unrealised educational and work potential; the financial cost to individuals and families; the damage to children in both the short and the long term of a parent\'s drinking; domestic violence; the manifold damages to relationships with friends and family - costs borne by the person who abuses alcohol and the other people directly affected.

Recommendations

{mosimage}The Strategic Task Force makes, in all, seventy-eight recommendations; the Oireachtas Committee a total of twenty-four. There is some overlap in the recommendations from the two bodies, but also a few significant differences.

A key set of recommendations by the Task Force relates to further curtailment of access to alcohol, through, on the one hand, raising alcohol taxes and, on the other, regulating more tightly the physical availability of alcohol - by means of additional controls to prevent the consumption of alcohol by those under eighteen, and better enforcement of existing measures and by restricting any further increase in the number of outlets and times of sales. It makes these recommendations on the grounds that international research shows clearly that raising alcohol taxes and regulating physical availability "are among the most effective policy measures that influence alcohol consumption and related harm". (22) The Oireachtas Committee recommends a significant increase (of between 50% and 100%) in excise duty on pre-mixed, ready-to-drink spirits. It also argues that "every effort should be made" to have
alcohol (as well as tobacco) removed from the Consumer Price Index as soon as possible. (23)

Another set of the Task Force recommendations focuses on "enhancing society\'s capacity to respond to alcohol related harm." The Report speaks of  \'community mobilisation\', which it describes as "an approach that aims to increase public awareness of the particular alcohol problems in a community...and to gain public support for policies directed at preventing or reducing the problem" and which it sees as an important complement to national policies. It draws attention to possible initiatives at community level, some of which have already been undertaken in Ireland, and calls for the extension of these. (24)

It says too that education and training in regard to alcohol issues should be provided for the wide range of professionals, in both the statutory and voluntary sectors, who may encounter alcohol-related problems in the course of their work - health professionals, educators at all levels, Gardai, judiciary, youth leaders, coaches, sports managers. (25)

An important proposal which could potentially produce some interesting initiatives is that there should be further progress at both national and local level in establishing structures and mechanisms to ensure that children\'s and young people\'s voices are represented in the development of services. (26)

In its relation to the promotion of \'alcohol free alternatives\', the Task Force says that these have not been shown to be effective "as a single strategy" but are useful when combined with other community-based approaches. (27)  The Report urges increased investment in the development of alcohol free venues (citing the success of a number of such initiatives), and increased resources too for sporting and other recreational facilities. In addition, it says that there should be an investigation into why non-alcoholic drinks are so expensive, given they are not subject to excise duty. (28)   On this issue, the Oireachtas Committee takes the position that there should be price control on soft drinks sold in licensed premises. (29)

It might be noted that the discussion of ‘alcohol free alternatives\' is limited to provision for young people, with no reference to facilities for adults. In this context, it is worth noting one of the outcomes of an initiative of Barnardos, the children\'s charity, when, as part of its campaign to raise awareness of the impact of alcohol on children, it asked TDs and Senators if they would ‘sign a pledge\' that they would not be photographed with alcohol, or at the opening of a pub or off-license, or hold their ‘constituency clinic\' in a licenced premises. Several members of the Oireachtas replied that while they would be happy to sign up to the first two commitments,  they were unable to agree to the third because there was no alternative location for their clinic. This is indeed revealing of paucity of facilities in many parts of the country.

On public education regarding alcohol, the Oireachas Committee urges a \'hardcore\' advertising campaign to make parents and young people aware of the short and long term dangers of binge drinking. (30) The Task Force Report has a series of recommendation in regard to education about alcohol through a variety of structures and settings. It also calls for the introduction of a health warning label on all alcohol products.(31) However, it issues a \'health warning\' of its own concerning the limitations of information and education programmes, saying that while these "can influence beliefs and attitudes about alcohol", international research shows it is a mistaken expectation to think that they will reduce drinking or related harm. These programmes should not therefore be \'the lead strategy\' in alcohol policy but part of a multi-layered approach. (32)

The Task Force recommendations also cover treatment services. Noting the importance of early intervention in the treatment of alcohol problems, the Report highlights the importance of primary care services, Accident and Emergency departments, health clinics, and workplace health services being able to recognise signs of alcohol problems and respond appropriately. Furthermore, it calls for the expansion and improvement of specialist treatment services throughout  the country. (33)

On the question of the advertising of alcohol, the Oireachtas Committee recommends: "A complete ban to be imposed on all alcohol advertising within a three year period and a complete ban on acknowledgement or credit, including the use of logos on labels, for sponsorship of sports events, clubs or teams, that cater for members under 25 years of age, by any area of the alcoholic drinks industry." (34) In contrast, the Task Force says merely that it is necessary to: "Ensure the proposed legislation to reduce the exposure of children to alcohol advertising, sponsorship and promotions is enacted without delay." (35)

It needs to be asked just how effective will be legislation that aims only to restrict advertising directed at children given the evidence that children are in fact exposed to advertising that is supposedly primarily directed towards adults. Research conducted by the Broadcasting Commission of Ireland, as part of the development of a Code of Advertising for Children\'s Advertising, revealed that children\'s television viewing included programmes that most people would think of as aimed at adults. The Report on the Impact of Alcohol Advertising on Teenagers in Ireland showed that for the young people interviewed, alcohol had a high appeal, being considered stylish, humorous, action-filled and including music that was popular. Alcohol advertising was perceived as promoting a desirable lifestyle, and as helping to improve confidence and social skills. (36)

Responding to the Oireachtas Committee\'s recommendation on advertising, a spokesperson for the Department of Health and Children said that an outright ban was not planned and noted that such a ban would be contrary to EU law on the free movement of goods and services. (37) However, judgments of the European Court of Justice in July 2004, in relation to cases taken against the French Government\'s restrictions on alcohol advertising, suggest that the EU position may not be as clear-cut as is claimed by the Irish Government. (38)

Finally, regarding the implementation of policy, the Oireachtas Committee proposes the establishment of a National Alcohol Control Centre, under the aegis of the Department of Health and Children, "to advise on alcohol control measures" and to "monitor and co-ordinate the implementation of measures" in relation to alcohol. (39)  Meanwhile, the Task Force proposes the establishment of an Independent Research and Monitoring Unit. The work of this Unit would focus on research - into consumption levels, attitudes, behaviours, the effects of alcohol on the population -  and on evaluation of selected alcohol initiatives. (40)    On first sight, at least, this would appear to be potentially a much weaker body than the Alcohol Control Centre envisaged by the Oireachtas Committee.

Conclusions

It was to be expected that Ireland\'s previously low level (by international standards) of alcohol consumption would alter as a result of the rise in personal incomes, the changed role of women in  Irish society, the rise in the disposable income of young people, much of it generated by part-time work, and the fact that the long-standing high incidence of total abstinence was unlikely to continue with the coming of prosperity and a greater secularisation of Irish society.

However, it needs to be asked why the increased consumption should have been characterised by such dysfunctional levels and patterns of drinking? Has prosperity merely allowed unhealthy attitudes and behaviours to surface more strongly?  Is it an indication of a deep spiritual malaise within Irish society?  Is it indicative of an impoverished culture that has been unable to generate more diverse and healthier ways for people to enjoy their leisure time? (In this context it worth reminding ourselves that Irish people are not only better-off financially but are, in general, and particularly among the younger generations, better-educated the ever before. Yet our greatly improved access to formal education seems to have little effect on drinking habits, with studies showing that the better educated, especially among the young, are no less prone to misusing alcohol.)

Whatever the underlying causes, it is clear that there is now a culture prevalent across many sectors of Irish society that condones unhealthy and harmful patterns of drinking. Changing that culture is a formidable challenge.
As Micheal Martin TD, the then Minister for Health and Children, said at the launch of the Report of the Strategic Task Force there is  "a huge task ahead of us"  to bring about the much-needed change in relation to alcohol.(40)

The responsibility for developing a healthy and mature approach to the use of alcohol  rests ultimately with individuals but, as the two recently-published reports make clear, individual attitudes and behaviours are shaped by social context. Both reports rightly draw attention to a range of agencies in society that can serve to bring about more responsible behaviour - parents, schools, youth organisations, workplaces, community organisations, local authorities, the drinks industry itself.
It is notable that neither report gives prominence to the potential role of the Churches.  But, clearly, there is much in both the analyses and recommendations which these documents present that would merit serious attention by Church leaders and members.

However, there is no escaping the crucial role which Government must play. This Government has given a world lead in another area of public health, in the shape of total ban on smoking in the workplace. However, the goal in relation to smoking is unambiguous - to encourage people to give up. In relation to alcohol, it is more complex and nuanced:  as the 1996 National Alcohol Policy puts it, the goal is:  "encouraging moderation, for those who do drink, and reducing the prevalence of alcohol-related problems in Ireland. (42)

Government commitment to promoting moderation and responsibility, in line with the National Alcohol Policy, has been reiterated in a number of Strategy documents issued during the past eight years. (43)   Several positive developments have taken place and the inclusion of alcohol as a \'Special Initiative\' under Sustaining Progress, Social Partnership Agreement 2003-2005, and the establishment of an Inter-departmental Group with responsibility for coordinating measures, are to be welcomed. (44)  Yet there is an inescapable sense that there has been nowhere near a heartfelt and resolute commitment to concerted action across a range of areas. Whether that is because Government has not been sufficiently persuaded of the seriousness of the situation, or whether it is because it is unwilling to confront powerful vested interests - be they the drinks industry or the large part of the Irish population that indulges in or tolerates the excessive consumption of alcohol - is a matter of debate.

The \'huge task\' referred to by the former Minister for Health has faced Irish society for over a decade - but it has actually become greater over that period. One clearly needed measure is the establishment of a National Office which would be given a strong remit and adequate resources not just to \'undertake research\', or to \'evaluate\' or \'monitor\' but to actually ensure that the range of measures that are needed to get to grips with Ireland\'s alcohol problems are actually implemented.

Otherwise, we may well find ourselves in another eight years, still wringing our hands about alcohol abuse and its consequences, still topping the EU league for consumption, still indulging in periodic outbursts of hysteria about alcohol abuse, mainly, of course, by the young, still talking about the need \'to do something\' - and still not doing it. Our new Minister for Health and Children and her colleagues in Government do indeed face a ‘huge task\' in responding adequately to the challenges posed by the findings and recommendations of these two reports.

{mosimage}*Margaret Burns is Social Policy Officer with the Jesuit Centre for Faith and Justice


References

 

1. Strategic Task Force on Alcohol, Second Report, Dublin: Health Promotion Unit, Department of Health and Children, 2004; Houses of the Oireacthtas, Joint Committee on Health and Children, Report on Alcohol Misuse by Young People, Dublin: Stationery Office, 2004. The membership of the Strategic Task Force included representatives of government departments, the Gardai, health services, other state agencies, voluntary organisations, the drinks industry. The Oireachtas Joint Committee was chaired by Batt O\'Keeffe, TD.
2. Strategic Task Force on Alcohol, op.cit., p. 6.
3. Ibid., p. 6.
4. Ibid., p. 7
5. In this study, binge drinking was defined,  "conservatively" in the view of the Task Force, as drinking at least one bottle of wine, or seven measures of spirits, or four pints of beer, on a single drinking occasion.  The countries studied were: Finland, France, Germany, Ireland, Italy, Sweden and the UK.
6. Strategic Task Force on Alcohol, op. cit., p. 55.
7. The National Health and Lifestyle Surveys, Dublin: Health Promotion Unit, Department of Health and Children/ Dublin: Department of Public Health Medicine and Epidemiology, UCD/ Galway: Centre for Health Promotion Studies, NUI Galway, 2003,  p. 31. 
8. Ibid., pp. 31-32.
9. Ibid., pp. 32-33.
10. Ibid., pp.33-34.
11. Oireachtas Joint Committee on Health and Children, op. cit., Appendix 11.
12. Strategic Task Force on Alcohol, op. cit.,  p. 12.
13. Ibid., p. 14.
14. Ibid., p. 15.
15. Ibid., pp. 15-16.
16. Ibid., p. 17.
17. Oireachtas Joint Committee on Health and Children, op. cit., Appendix 2.
18. Ibid.,  Appendix 2 and Strategic Task Force on Alcohol, op.cit., p. 36.
19. Strategic Task Force on Alcohol, op. cit., p. 18.
20. Mats Ramstedt and Ann Hope, "Summary of Irish Drinking Habits of 2002: Drinking and Drinking-Related Harm in a European Comparative Perspective", Strategic Task Force on Alcohol, op.cit., Annex 4, p. 55.
21. Ibid., p. 20.
22. Ibid., p. 30.
23. Oireachtas Joint Committee on Health and Children, op. cit., p. 41.
24. Strategic Task Force on Alcohol, op. cit., pp. 32-3.
25. Ibid., pp. 33-4.
26. Ibid., pp. 34-5. This is line with one of the National Goals of the National Children\'s Strategy, "Children will have a voice in matters which affect them and their views will be given due weight in accordance with their age and maturity". (The National Children\'s Strategy: Our Children - their Lives, Dublin: Stationery Office, 2000, p. 30)
27. Strategic Task Force on Alcohol, op. cit., p. 35.
28. Ibid., p. 36.
29. Oireachtas Joint Committee on Health and Children, op. cit., p. 41.
30. Ibid. p. 42.
31. Strategic Task Force on Alcohol, op. cit., p. 38.
32. Ibid., pp. 38-9.
33. Ibid., pp.40-1.
34. Oireachtas Joint Committee on Health and Children, op. cit., p. 43.
35. Strategic Task Force on Alcohol, op. cit., p. 31.
36. Cindy Dring and Ann Hope, The Impact of Alcohol Advertising on Teenagers in Ireland, Dublin: Health Promotion Unit, Department of Health and Children, 2001.
37. "Proposal to Ban Alcohol Adverts is Ruled Out", The Irish Times,  16 June 2004.
38. Judgments of the European Court of Justice, C-429/02 and C-262/02 (www.europa.eu.int/jurisp).
39.Oireachtas Joint Committee on Health and Children, op. cit., p. 39.
40. www.doh.ie.
41.Strategic Task Force on Alcohol, op. cit., p. 42.
42. Department of Health, National Alcohol Policy, Dublin: Stationery Office, 1996, p. 26.
43. For example, The National Health Promotion Strategy, 2000-2005 (2000); Quality and Fairness: National Health Strategy (2001); The National Children\'s Strategy ( 2000). Even prior to the publication of the National Alcohol Policy the aim of promoting healthier drinking was set out in the first National Health Strategy, Shaping a Healthier Future (1994).
44. Sustaining Progress, Social  Partnership Agreement 2003-2005, Dublin Stationery Office, 2003; Department of the Taoiseach, Sustaining Progress 2003-2005: Progress Report on Special Initiatives, Dublin: Stationery Office, 2004.

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