Why alcohol and drug problems continue to be so severe in Australia

The idea that drug abuse is confined to illegal drugs is a mistaken one that is often magnified by the media.

The ravages of ice are terrible but the figures show that more than 90 per cent of deaths due to drugs are caused by the legal ones: tobacco and alcohol.

But don’t expect our mainstream media to remind us of that crucial fact. Alcohol is a pernicious drug that is socially acceptable, even as it destroys lives and shatters families.

So why are our alcohol and other drug problems so severe? And why don’t we see more progress in lessening physical, psychological and social damage?

We need to understand that many people like taking mood-altering drugs. That’s not just an Australian thing nor is it a recent phenomenon. Most cultures have their own drugs of choice and have had for millennia. It would be next to impossible to find a culture anywhere on this planet where no drugs are taken.

In a democracy like ours, people have a right to take prescribed drugs and other legal drugs such as booze and tobacco.

About 19,000 Australians die from a tobacco-related cause every year. That’s more than all the deaths from alcohol, prescription and illicit drugs put together. Up to two out of every three long-term smokers will die from a tobacco-related cause.

Last century there were one hundred million deaths from tobacco worldwide and there are expected to be one billion more this century. Smoking rates in Australia have been dropping steadily for a few decades but the most recent figures show the figures have now steadied. This is despite aggressive policies to discourage young people from starting to smoke and to encourage older smokers to quit.

Cigarette prices in Australia are now the highest in the world and still rising. US and UK smoking rates have been higher than in Australia. Not anymore. The United States and the United Kingdom have weak policies to discourage initiation and quitting, but since electronic cigarettes became popular in the US and UK their smoking rates have plummeted.

Electronic cigarettes are banned in Australia and that ban is strongly supported by every government health department and every major health organisation, with the exception of the college representing our psychiatrists. The use and sale of e-cigarettes is a controversial issue in Australia but don’t expect anything to change soon. The tobacco industry used to be all-powerful and able to block almost any effective policy. Not anymore.

Alcohol is another mass killer. It is estimated to cause about 5000 deaths a year in Australia although that number may be conservative. This is less than tobacco but more than illicit drugs.

But in contrast to smoking, in particular, alcohol causes very severe social and community problems. These are much harder to quantify than the health or economic costs of other drugs.

While it’s clear what is needed to reduce alcohol problems in Australia, the difficulty is threading effective policies through the political maze. Alcohol tax reform is head of the list of effective policies. We need to slowly and gently increase the price of alcohol and base the rate of taxation on the alcohol content rather than the beverage type. We also have too many alcohol outlets open too long and these venues persist in serving alcohol to people who are obviously already drunk.

It’s high time that alcohol advertising, marketing and promotion was properly regulated rather than self-regulated. It’s not all that complicated. But the difficulty is that the drinks industry in Australia today is all-powerful, just like the tobacco industry used to be. Now we are dealing with an alcohol industry that has a significant overlap with large and powerful retailers and the gambling industry.

High and rising inequality makes the task of tackling alcohol problems all the harder as these influential industry groups have become even more powerful as inequality in Australia has increased.

The relentless erosion of the very effective alcohol lockout laws in NSW is a case study in the rollback of successful alcohol policies. Who exactly is funding and organising this slick campaign? We may probably never find out for certain.

Meanwhile, boundaries between prescription and illicit drugs have become much more blurred. There is a large and growing black market for prescription drugs and increasing availability through the Internet.

Clamping down on prescription drugs seems to result in at least some people moving on to the illicit market. It’s clear that Australian doctors, like their counterparts in other countries, have prescribed opioid painkillers to too many patients at high doses for too long.

Some US pharmaceutical companies have been unscrupulous in their aggressive marketing of mood-altering drugs. The US drug overdose epidemic is alarming and continues to get worse.

Similar epidemics, although not quite as bad, have been documented in Canada, the UK and also in Australia.

Expanding and improving drug treatment is probably the most important part of the package of measures required. But expanding and improving drug treatment has never won many votes. However it is vital, and we need some courageous politicians to champion the cause and to offer more assistance to the thousands of Australians affected.

Drug treatment seems like a secondary issue to some but drug abuse is a creeping cancer that is killing people, destroying families and wrecking the health of Australians who can too easily fall into addiction in a society that looks the other way. Denial is not the answer.

Who at a local, state or federal level has the guts to face the problem and commit to doing something effective about it?

As the diminution of the power of the tobacco industry demonstrates, the good news in relation to our current problems with alcohol and other drugs is that, in the world of space and time, few things last forever.

*This article first appeared on www.RossFitzgerald.com