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Appendix 1 Strategies for addressing harmful drinking

Appendix 1
It is assumed that the Commonwealth Department of Health has all the latest statistics and research into the use of alcohol and other drugs, other substances of concern and associated health (physical, psychological and social) problems.

Below is a general summary of information as related to this submission.

Health related factors

  1. Alcohol and other drug related problems are the outcome of a complex interaction of a number of factors.
  2. At a primary prevention level, the overall level of use and associated problems with a particular substance (that has toxic or harmful effects on the body, or marked changes in brain chemistry and thus changes in cognition / consciousness and the ability to assess risky behaviors) is affected by • • •
  • Social Custom and Cultural Practices
  • Its Physiological Effects and the Biological make-up of users
  • Its Availability
  • Its Accessibility
A. Social Custom and Cultural Practices
Some substances are more widely used in some countries. Customs and habits through the centuries and any social concerns about real or perceived harm of various substances used, are reflected in the different drug (and associated laws) adopted by different countries.
There are three main reasons why alcohol and other drugs are used at a personal and community level.

a. religious customs –
the search for ‘god’,wholeness, self identity and reason for existence is a old as time. Mind altering drugs have fore centuries played an important part in religions as people individually and universally continue to seek spiritual answers to life.

b. medicinal purposes – Alcohol and other drugs have been used for thousands of years to treat a broad range of illnesses and disease. The major use of psycho-active drugs have been to alter consciousness to alleviate physical pain (eg anaesthetics for surgery) or mental/ emotional pain, difficulties illness (eg anti-depressants or anti-psychotics)

b. social functioning - the use of certain drugs to decrease inhibitions or relieve tension and thus to increase communication have been part of humankind’s culture for thousands of years. This may strengthen group bonds but sometimes provoke, isolation by excluding certain individuals), aggression or violence.

Cultural attitudes to the substance, level of use, intoxication, abstinence, and associated harm are social determinants affecting use, legal strategies and their enforcement, the formal education of citizens and the informal education via the media and role modeling of family members and other users.
  • In communities with high per capita use of a particular substance, social factors are the predominant reasons for the high alcohol and other drug use and its related problems.
  • In communities where the overall level of consumption of a ‘toxic’ substance is high, the rate of physical health problems in that community is high. eg In countries with high per capita consumption of alcohol there are high rates of physical health problems associated with its use. NB Australia is in the highest 20% per caipta use of alcohol, ranking 32nd out of 180 countries – see table 1 2
  • In communities with low per capital use, individual / personal factors are the primary reasons for the high alcohol and other drug use and their related problems.
  • In communities, where there is high social acceptance of high dose usage or intoxication, there are high levels of alcohol and other drug related problems.
Mass marketing strategies by manufacturers and distributors of alcohol and other substance have developed the sophistication and effectiveness in the last fifty years.

As teenagers represent a market for new customers, and is the time of experimentation with alcohol and other drugs, so capturing this market at his age can also mean gaining life long customers for the particular substance. Adult drinking and drug taking habits are usually well entrenched and stable. It is unlikely that adults who are non-smokers or drinkers will experiment and change their patterns of use.

In looking at different cultures, the level of consumption and associated harm the relationships there are certain principles to accommodate in designing programs aimed at changing community attitudes to alcohol and other legal drug use.

Such principles are:
  • Alcohol and other drug taking is a learnt behaviour.
  • The substance is OK or value neutral i.e. neither good nor evil. Rather each substance needs to be assessed for its positive and negative impacts of its use, the context of use, and associated harmful behaviours.
  • Prohibition of some substances may make them more attractive to some groups
  • Individuals are free to use, or not use within legal limits.
  • Abstinence needs to be respected.
  • Prescription substances need to be used as prescribed.
  • False dichotomies of legal/ illegal use, young/ older age groups use, theirs/ our use can hamper understanding of the complexity of the isues involved
  • High levels of alcohol use (binge drinking) in single occasions is not acceptable.
  • Associated aggression, violence and other behaviours ( eg drink-driving) that are not legally sanctioned are not acceptable.
  • High levels of regular use of harmful substances such as alcohol and tobacco are not healthy
  • Changing behaviours requires a number of key components: information, values clarification (attitude change), skills and support (personal/ peer/ social)
  • Adult learning is affected by people’s personal experiences and knowledge, their family and peer groups, and thus education programs need to address this issue.

a. Physiology / Biological make-up of the user – toxic effects of the substances on the human body are related to the level of consumption, age of user, sex, specific genetic make-up of the individual, and duration of use. Ie there is both acute and chronic harm caused by the substances themselves.

Latest research confirms the toxic effect of two widely available and legal drugs namely alcohol and nicotine.

Of major concern is the latest research into the effects of substances of the developing human being – especially the brain for psychoactive drugs and body organs associated with the route of administration eg mouth, nasal passage and lungs as in inhalation related drug taking behaviours.
  • In the context of this submission, Professor Hickie’s article titled Alcohol on the Teenage Brain3, draws attention to detrimental effects of alcohol on decision making with its associated poor assessment of risk taking behaviours and the increased potential for the development of long term alcohol related problems related to the age young people commence drinking alcohol.
  • This research would support strategies to raise the drinking age to 21 years, if other social factors were favourable. For example, if a society were able to turn back its clock to classify the legally of drugs strictly according to potential for physiological harm, then it is questionable as to whether one would be able to access such substances even on prescription.
  • However for culturally entrenched alcohol and other drug taking behaviours, such strategies such as Prohibition in America, which was successfully in reducing the level of physical related health problems such as liver disease, can have other unwanted side affects. Making a “popular” previous legal drug illegal can create an illegal drug trade with its associated legal and other social harm consequences.
Thus societies have attempted to use other legal, health, economic, production, distribution and strategies to limit the availability and accessibility of harmful substances.

b. Availability – may be affected by political action (legislation governing use and distribution, taxation), techniques and cost of production, environment geographic distribution of the source raw materials
  • Improvements in technology and industrialisation has lead to mass production of concentrated forms of alcohol and other drugs eg the Gin consumption of Britain ten-folded between 1800 and 1825. Nicotine was package into tailor-made cigarettes and substances added to improve its ability to stay alight – it is questionable whether one could have had the time to roll 40 - 60 cigarettes per day whilst performing all the other tasks of daily living including work and caring for one’s family.
  • Improved methods of transportation and preservation, especially improved air and seas travel, have exposed populations to substances not previously part of their use.
  • Legislative strategies have been tried in societies where high per capita consumption created obvious problems. For example Prohibition in America in early 1900’s was a successful strategy in reducing over health related problems in the community such as liver disease. However by making a drug with a long established history illegal, the result was increased crime and legal problems.
  • The Peel Royal Commission in England in 1896 brought legal measures
  • such as no under 16 years drinking and no Sunday trading, at the end of a century which commenced with an ten fold increase in gin consumption in the first quarter of the century.
  • Later the legal age for drinking alcohol was raised to 21 years, as it was in Australia.
  • * With the introduction of conscription for the Vietman war, the voting age was dropped to 18 years, and then legal drinking age to match. Two of the social indicators of the “commencement of adulthood”, thus blurring the Coming of Age between age 21 and 18 years
  • Professor Hickie’s research into the effects of alcohol on young people confirms that age 21 years is a much safer age to commence use of alcohol, given the fact that the brain is still developing in late teen years.
  • This research interestingly confirms observations previous generations have made in settling on age 21 years as a less risky age to start drinking.
  • However, broad successful preventative strategies like these take decades to reach their full effect, by which times the next generations can no longer observe the reasons why the legislation was enacted in the first place. Then the program is often modified or dismantled altogether. Consequently it may be another half century before the reasons for the strategy become fully obvious again. * From a preventative health point of view, raising the drinking age to 21 years would be the simple effective strategy with wide impact and in line with
  • * Later the legal age for drinking alcohol was raised to 21 years, interesting in line with Professor Hickie’s research into the effects of alcohol on young people. With the introduction of conscription for the Vietman war, the legal drinking age in Australia was dropped to age 18 years as was the age to vote, whereby effectively dropping the age of the commencement of adulthood from age 21 to 18 years
  • However legal alcohol and other drug producers and state and federal governments have a complex economic and political relationships which make major legal changes to availability and accessibility very difficult. ie strategies aimed at reducing supply
  • Therefore community development and community education strategies to influence attitudes to alcohol and other drug taking aimed at decreasing demand and minimizing associated harm need to be part of the government’s range of strategies to address the health consequences of alcohol and other drug use and have a higher priority and support.
B. Accessibility – Cost to the user, number and geographic location of legal and illegal outlets for acquisition of the substance, policing number of distribution points etc can affect accessibility.
  • Increased globalisation has made low cost labour sources available thus cutting cost of production thus lower the retail price of certain substances which in turn can lead to increased per capita consumption which in turn increases the related harm. Conversely strategies aimed at increasing the price to the consumer of the substance has been shown to be an effective strategy eg regular price increases via taxation on tobacco.
  • Increased accessibility via number and geographic location of legal and illegal outlets for acquisition of the substance eg increased accessibility with alcohol now available in supermarkets etc.
  • Conversely policing of laws that for associated behaviours or that require sale of certain products to be restricted to adults has also been successful. That is, the perception of being caught and the resultant cost to the ‘offender’ can be a deterrent. eg Random breath testing, policing of the sale of substances to ‘under-age’ users.
  • Taxation has been a effective component in the reduction of smoking behaviour in Australia as has the restrictions placed on its use in certain environments such as restaurants and entertainment venues, work places, health care systems, government and other transport systems.
Conclusion:
  • A range of strategies are needed to address the health and welfare consequences of complex human behaviours such as alcohol and other drug use.
  • Strategies that inform, protect and support children and teenagers are of the highest priority since early use increases the risk of immediate problems as well as long term problems.
  • Teenagers being the target new market for alcohol and other drug suppliers need counter-balancing strategies aimed at delaying the onset of experimentation and regular use of alcohol, tobacco and other harmful substances.
Last modified on Friday, 09 September 2016 18:22