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JFA Murphy
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Wasted- The Years Waiting for an Alcohol Policy
Declan Bedford: Doolin Lecture 1st Dec 2012
Ir Med J. 2012 Nov-Dec;105(10):324
This was the 48th Doolin lecture, the first being Bob O’Connell in 1964. This year’s lecturer Declan Bedford has devoted his entire professional life to the welfare of the public. The IMO president Paul McKeown in his introduction described him as quiet, unobtrusive and very effective. Dr. Bedford’s contribution to road traffic accident mortality will be one of his great legacies. Since 2005, following the introduction of random breath testing, the number of RTA deaths have halved from 400 to 200 per year.
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Throughout his lecture Bedford portrayed the close and complex relationship between Irish society and alcohol. Alcohol is part of our image both nationally and internationally. Some of the most abiding images of US presidential visits to Ireland are of drinking pints in Irish pubs. There is Arthur’s day and jump into Ireland. Alcohol is intertwined with our great sporting occasions and achievements. The famous Ireland vs England rugby match at Croke Park was set against the backdrop of intensive Guinness advertising. All Ireland final day has a strong association with the drinks industry.
We know that excessive alcohol ingestion is bad for us both as individuals and as a society. However our political leaders have been unwilling to tackle the multiple adverse consequences of drink excess. Bedford describes 3 drinking patterns-moderate, harmful and hazardous. Twenty per cent of adults are non-drinkers. Alcohol overindulgence causes 60 medical conditions, social harm, sub-optimal work performance and crime. He provides multiple examples of the downside of alcohol. One adult dies every 7 hours from the harmful effects of alcohol. There is the role of alcohol in suicides. Approximately 2000 acute hospital beds are occupied by patients with alcohol-related disorders. There is an association with oral, upper gastro-intestinal cancers and a wide spectrum of liver disorders. In 1995 the cost was €326 million, today the cost is calculated at €3.7 billion.
The social burden on families and communities is considerable. It is accepted that 100,000 children are affected by their parents’ drinking patterns. One in five adult relationships are damaged by alcohol. Only 30% of adults have 2 or less drinks at an occasion. One in four individuals binge drink weekly. Binge drinking is taking more than double the safe amount in a few hours. It is damaging because the body has to deal with very large levels of alcohol. The number of facial injuries presenting to hospital A/E department is a good surrogate marker of the amount of binge drinking in a community. Children start drinking at a young age. In 1980 teenagers starting drinking at 16 years, now they start at 14 years. A recent survey found that 50% of 15-16 year olds admitted that they had a drink in the previous 30 days. Heavy drinking during the formative years sets up a damaging pattern for the future adult years. The adolescent brain is more vulnerable to the neuro-toxic effects of alcohol. The well-known association between alcohol and crime was highlighted. Alcohol has a role in 50% of violent crimes and murders. It is a major factor in family assaults.
A significant proportion of the lecture was devoted to examining current and future measures to curb alcohol excess. The Government reports and campaigns were outlined. In general the official line has been too soft with use of expressions such as ‘should consider’ rather than directives stating ‘must’. Bedford brought up the relationship between publicans and politicians. The industry constantly tries to emphasise the importance of individual responsibility rather than regulation. The Quality and Fairness document stated that individual alcohol ingestion should be reduced to 9 litres per year. The current consumption is 12 litres per year whereas in 1960 the intake was 4 litres annually. The Government Alcohol Advisory Group 2008 directed the physical separation of the alcohol section in shops and a restriction in sales hours. It was pointed out that there are more outlets for alcohol purchase than for fruit and vegetables. The Report on the National Substance Misuse Strategy 2012 advised that alcohol should be less affordable and less available.
Bedford strongly feels that consumption is closely related to availability and affordability. The solution is further price increase and a reduction in premises where alcohol is sold or served. Minimum pricing is important. ‘Happy Hours’ with low prices must be discouraged. The influence of advertising must be controlled. No TV adverts before 9pm and a reduction in alcohol sponsorship in sport.
The reduction in harm target is to reduce alcohol consumption by 23% to 9.2 litres per year. If as a nation we drank less we would be healthier and physically fitter. Declan Bedford points out that significant social change is possible as demonstrated by the smoking ban. One of his closing slides depicted pigs that could fly.
JFA Murphy
Editor
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Author's Correspondence
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No Author Comments
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Acknowledgement
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No Acknowledgement
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Other References
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No Other References
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