Alcohol is the new tobacco

Most Australians enjoy alcohol. And we all want to live in a community where the price we pay for enjoying alcohol is bearable. But at present the health, social and economic costs of alcohol in Australia are huge and unacceptable.

Virtually every family in the country has one or more members struggling with a serious alcohol problem or has recently been on the receiving end of the verbal or physical abuse of an intoxicated person. A spate of recent alcohol-fuelled violent assaults, some fatal, received considerable publicity. It shouldn’t be like this.

It’s not as if we don’t know how to keep our favourite drug under reasonable control. Researchers around the world evaluating policies to prevent alcohol problems are in very strong agreement about what works and what doesn’t work. Increasing the price and reducing the availability of alcohol are the two measures best supported by evidence for reducing short-term and long-term alcohol-related problems. Even small changes bring worthwhile benefits.

The evidence for better regulation of advertising and promotion has also been getting stronger for some years.

There are a number of ways to effectively reduce the number of deaths and serious injuries from drink driving and Australia has been well advanced in this area for some years. Hence the road crash death toll per head of population has fallen about 80 per cent since the 1970s. At the time, political leaders trying to introduce the RBT laws faced vigorous and relentless opposition from the drinks industry.

Keeping alcohol and driving apart is not the only reason for the fall in the road toll but it’s been the most important factor. Making sure that people with an alcohol problem who want some assistance can get effective help also contributes to reducing the toll. However, random breath testing certainly changed drinking practices substantially.

Taxation is another area we should now look to reform. We should be taxing alcoholic beverages according to how much alcohol they contain but instead our 40 different alcohol taxes are designed around the different beverage classes. We should also dedicate a tiny proportion of the revenue generated (“hypothecation”) to the prevention and treatment of alcohol problems.

Reducing the availability of alcohol requires having fewer outlets, shorter opening hours and less liberal conditions, or some combination of these. Stronger enforcement of our liquor laws seems to be attractive but it rarely works in practice.

So why does our community still make such a mess with alcohol when we know pretty well what works and what doesn’t? The main reason is that the drinks industry does an excellent job, overtly but more often covertly, of making sure that politicians implement what doesn’t work and don’t implement what does work.

The drinks industry actively promotes mass education campaigns as the first response to any community anxiety about alcohol. The problem is that mass education campaigns have a dismal record on changing alcohol consumption and reducing alcohol related problems. If less risky drinking is ever recorded following a mass education campaigns, it’s usually only a very minor and transient change. Governments are unwilling to spend on the scale that is needed for mass campaigns to work and to retain that commitment for the duration needed.

Government mass education campaigns also have to compete against generously funded pro-alcohol advertising, sponsored by the drinks industry. Even if governments did properly fund mass campaigns and maintain them for years, it would be wrong to think that knowledge necessarily changes behaviour.

Just think of the medical profession. No other group in the community sees as much death, disability and sheer misery resulting from high risk drinking, or knows as much about the damaging consequences of alcohol. But doctors are very high on the list when it comes to occupations at risk of alcohol-related problems.

“Change the drinking culture” is another common refrain. It’s easier to say that than to achieve it, especially via glittering mass education campaigns. In fact, increasing the price and reducing the availability of alcohol are effective ways of changing the drinking culture.

Why does the drinks industry try to undermine effective reforms to reduce the carnage from alcohol? The industry argues that most community members drink responsibly and the majority should not be made to suffer because of an irresponsible minority.

There are a number of problems with this argument. First, the proportion of the community that has a problem with alcohol is not so tiny when we study a community over time. Second, if we think about this problem from the perspective of the alcohol, rather than from the perspective of the individual members of the community, we get a very different answer. The top 10 per cent of heaviest drinkers in a community account for half of all alcohol consumption by that population. Any intervention which manages to reduce high-risk drinking by the top 10 per cent of drinkers inevitably has a big impact on the bottom line of the drinks industry.

Because of this, the drinks industry opposes effective alcohol reforms all over the world. This is a significant industry that generates a good deal of income and employment, both directly and indirectly. It is also a significant source of taxation for the Federal Government, generating almost $4 billion in tax revenues. Few politicians are willing to stand up for the community if that means getting in the way of the drinks industry.

It all sounds a bit depressing, doesn’t it? But we have to remember that the public health David faced an even more powerful Goliath in the form of the tobacco industry some decades ago. Strong, committed and disciplined action slowly tamed the Goliath of tobacco. Let’s hope this can be a useful model for alcohol in Australia.

 

This article first appeared on NewMatilda.com on 27 March 2014.

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Alex Wodak

Dr Alex Wodak AM was the Director of the Alcohol and Drug Service at St Vincent’s Hospital in Sydney from 1982 to 2012. He retired recently and is now a Visiting Fellow at the Kirby Institute, UNSW, and also a Visiting Fellow at the National Drug and Alcohol Research Centre, UNSW. For many years, Dr Wodak was a member of the National Expert Advisory Committee on Alcohol. Dr Wodak lives close to Kings Cross, Sydney.

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