National Alcohol Strategy 2000-2003
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Date of publication: March 2001This is the full text online version of this document. You can also download this publication in PDF format.

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Part Two: Key Issues

Alcohol-related harm is not distributed evenly throughout the community. Patterns of alcohol consumption vary, and the personal, social and economics costs of the misuse of alcohol are borne by some groups more than by others.

In this part, patterns of alcohol consumption and significant alcohol-related harms are discussed. Groups whose patterns of consumption place them most at risk are identified, as are the environments in which alcohol-related harm is most likely to occur.

Total consumption

Discussions about trends in alcohol consumption often use small windows of time as the basis for comparison. Even the choice of quarterly statistical data within a year can affect such comparisons, as there are seasonal variations each year in the amount of alcohol available for consumption. When viewed over a longer term, it is possible to see that consumption ‘spikes’ in either an upward or downward direction are often event-specific, and are not very long-lasting. Thus, before discussing recent trends in alcohol consumption, it is useful to look at trends over a longer period.

Historically, the story of alcohol consumption in New Zealand is one of relatively stable consumption levels from 1880–1935 (with annual consumption levels around 1–2 litres of absolute alcohol per person over 15 years of age); steadily increasing consumption for the next 15 years or so (with annual consumption levels rising from around 2 litres in 1935 to just under 5 litres in 1950); ups and downs for the next decade; rising consumption for the next 20 years, with a steep jump in the early 1980s (with annual consumption levels increasing from just over 5 litres in 1960 to a high-point of just under 12 litres in 1982–83); followed by a gradual decline in consumption from the mid 1980s to the late 1990s (hitting a low-point thus far of some 8.3 litres during 1997). Figure 2 focuses on the trends of the last 50 years.





Based on current levels, New Zealand is ranked 20th in the world in terms of per capita alcohol consumption, one place below Australia, and one above the United Kingdom (Productschap voor Gedistilleerde Dranken 1999).

Before describing the most recent consumption data, which appear to indicate that the downward trend of the last 15 years has plateaued, it is worthwhile recalling the significant changes in how alcohol is made available for consumption, which occurred during this same period.

Following the introduction of the Sale of Liquor Act 1989, the number of liquor licences almost doubled during the 1990s (Figure 3). In addition there was a significant increase in the range of places from which alcohol could be sold. Supermarkets and cafes are just two kinds of outlets that now sell alcohol, in addition to the traditional on- and off-licensed premises such as taverns, restaurants and wholesale outlets.





The 1989 Act also made alcohol much more readily available by removing many of the former restrictions on opening hours, and allowing hours of trading to be set by licence rather than by imposing the same conditions on all. Recent amendments to the Act have further increased availability. These included lowering the minimum legal drinking age to 18 years, removing restrictions on the sale of alcohol on Sunday, and allowing beer to be sold in supermarkets.

Despite its increased availability, as previously discussed, New Zealand has seen a steady reduction in the overall consumption of alcohol, at least until the last few years. In the two years from December 1997 to December 1999 the volume of spirit-based drinks available for consumption more than doubled, reflecting the increased availability of ready-to-drink combinations of spirits and mixers. This, combined with a slight increase in the volume of wine available and a growth in demand for beer with a higher alcohol content, increased the total volume of alcoholic beverages available for consumption from 401.921 million litres in 1997 to 418.029 million litres in 1999 (Statistics New Zealand 1999, 2000). Again, though, it is yet to be seen if this marks the start of a new trend or is another example of a short- term ‘blip’. The year-on-year increase from 1998 to 1999, for example, has been attributed to the
changes in the liquor laws, as well as celebrations associated with the new millennium and America’s Cup yachting regatta in Auckland (Statistics New Zealand 2000).

The most common reasons people give for drinking less are concerns about drinking and driving, a desire to maintain or increase physical fitness, and a perception that it has become more acceptable to drink less. Amongst younger people, having less money to spend on alcohol is also given as a reason for cutting down (Wyllie et al 1996; Grossman et al 1994).



Patterns of consumption

Although total consumption has declined considerably over the past 15–20 years, and in 1996 dropped below the Ministry of Health’s target of 8.7 litres by the year 2000, there is still considerable variation in the amount of alcohol consumed by New Zealanders.

A national survey in 1995 (Figure 4) found that 10% of drinkers drank almost half of the total amount of alcohol consumed – the equivalent of 31 cans of beer each a week (Wyllie et al 1996).3 This level of consumption is well in excess of the Alcohol Advisory Council’s recommended upper limits for responsible drinking.4 The heaviest 5% of drinkers alone were responsible for drinking a third of all alcohol consumed, each one drinking an equivalent of 63 cans of beer a week. These heavier drinkers were predominantly men, in particular young men.

The same survey found that those most likely to consume large quantities of alcohol are the young: 38% of males aged 18–24 years and 20% of females aged 16–24 years drank at or above the Alcohol Advisory Council’s recommended upper limits for responsible drinking on at least a weekly basis (six standard drinks for men and four for women on any one occasion).





Recent survey findings indicate that while between 1994 and 1997 there was a notable decrease in the proportion of young people aged 14–19 who drank alcohol, there was a marked upward trend in the quantity consumed on each typical drinking occasion.

There was also a rise in the frequency of consuming larger quantities, as reported by those aged 14–19 years, accompanied by an increase in problems associated with their drinking (Figure 5) (Alcohol Advisory Council 1997).





Types of alcohol-related harm

While alcohol is embedded in New Zealand culture, and most people manage to drink without harming themselves or others, the fact remains that misuse of alcohol results in considerable health, social and economic costs, which are borne by individuals, families and the wider community. The most significant types of alcohol-related harm include:

• deaths and physical health problems from alcohol-related conditions

• alcohol dependence and other mental health problems

• effects on unborn children

• drink-driving fatalities and injuries

• drownings

• violence both within and beyond the home

• workplace injuries and lost productivity.

Deaths and physical health problems from alcohol-related conditions

Ministry of Health figures indicate that from 1988 to 1996 there were between 130 and 150 deaths each year from alcohol-related conditions. These conditions include heart and liver damage, high blood pressure, some types of cancer and digestive disorders (Ministry of Health 1999b). It is estimated that alcohol-related conditions account for 3.1% of all male deaths and 1.4% of all female deaths in New Zealand (Figure 6).





As well as directly causing deaths, alcohol-related health problems cause distress and disability, and result in a significant and costly use of health services. Alcohol-related hospitalisations are estimated to cost New Zealand more than $74 million each year (Devlin et al 1996).

Some of the most chronic health problems associated with alcohol affect those who consistently drink at hazardous levels. One of the most debilitating of these conditions – Wernicke-Korsakof Syndrome (WKS) – results from a lack of thiamine in the person’s diet, and those who regularly drink at excessive levels are at greater risk of such nutritional deficiencies. Characterised by tiny brain haemorrhages, WKS leaves some affected individuals unable to function independently and in need of long-term institutional care. Fortifying alcoholic beverages, in particular beer, with thiamine has been suggested as one possible means of minimising harm in this at-risk group (Drew and Trusswell 1998; Trusswell 2000).

Besides being more vulnerable to its effects, women are also at risk of additional health problems from alcohol. There is, for example, an increasing body of empirical research linking alcohol with breast cancer, (Smith-Warner et al 1998) and a recent meta-analysis concluded that there is now sufficient evidence to consider alcohol as a cause of breast cancer (Single et al 1999).



Alcohol dependence and other mental health problems

Alcohol is a causative factor in a number of mental health conditions, ranging from episodes of alcohol-induced
psychosis to far more long-term alcohol-related dementia.

Dependence on alcohol constitutes a diagnosable mental disorder in its own right.5 Some overseas studies have estimated that around half of all costs attributed to alcohol involve people who meet international classifications as alcohol dependent (Single et al 1999; Rehm 1999).

When talking about alcohol-related mental health problems, it is important to note that alcohol dependence exists along a continuum, from mild to severe; and that it is not uncommon to find some degree of dependence in the New Zealand population. Studies have found that 5% to 9% of men, and 1% to 2% of women ‘take an alcoholic drink first thing in the morning’, and ‘have hands shake after drinking’ (Wyllie and Casswell 1989; Wyllie et al 1993, 1996). Another study found that 32% of men and 6% of women will meet clinical criteria for alcohol abuse or alcohol dependence over the course of their lifetime (Wells et al 1989). Expressed as a proportion of the total population, this latter study found that almost one in every five people (19%) will fit criteria for alcohol abuse or alcohol dependence
during the course of their lives.

In 1997, there were 158 treatment services throughout New Zealand for people experiencing problems with their drinking. In terms of service utilisation, the highest rates of new admissions to outpatient treatment centres are from the 20–24 and 25–29 age groups. In 1990, 74% of the new admissions to these agencies were male (Hughes 1992).

Although problematic alcohol use is known to co-exist with other mental health problems, very little is known about the prevalence of such ‘dual diagnoses’. One New Zealand study found that people with alcohol disorders were 1.9 times more likely than other people to have another mental disorder. The conditions most frequently associated with alcohol use disorders were antisocial personality disorders and abuse of other substances. Other disorders associated with alcohol abuse include major depression and schizophrenia (Wells et al 1992; Bushnell et al 1994). Anxiety disorders have also been found to be more prevalent among people with alcohol problems than within the population as a whole (Schuckit and Hesselbroack 1994).

Another more recent New Zealand study identified alcohol and/or drug abuse as one of the factors that predispose young people to suicide (Beautrais et al 1996). This finding is consistent with the results of studies conducted overseas (Romelsjo 1995).

Since the opening of casinos in New Zealand there has also been growing interest in the relationship between alcohol and gambling. Two New Zealand studies have confirmed high rates of hazardous or harmful alcohol use amongst problem gamblers, particularly pathological gamblers (Abbott and Volberg 1992, 1996; Sullivan et al 1998). Amongst gamblers identified as pathological, 48% drank in a hazardous or harmful manner, compared with 19% of those whose gambling was considered less serious (Abbott and Volberg 1996). The public health and policy implications of such findings are likely to be more significant if, as some researchers have suggested, expansion of gaming opportunities sees a rise in the number of problem gamblers (New Zealand Gaming Survey 1999; Abbott and Volberg 2000).

Effects on unborn children

Excessive alcohol consumption during pregnancy, particularly during the first trimester, is known to contribute to birth abnormalities such as foetal alcohol syndrome and foetal alcohol effects (FAS/FAE).

Although women who drink heavily while pregnant are more likely than other mothers to have extra risk factors that may affect foetal development (such as poor nutrition and smoking), there is considerable evidence that immoderate maternal alcohol intake can sometimes cause both physical disability and intellectual impairment in newborns (Abel and Hanningan 1995; Larkby and Day 1997; Jacobson 1997; Jacobson et al 1998; Ministry of Health 2000).

It is important to note here, too, that such alcohol-related birth defects can irreversibly reduce a child’s potential. Not only are there abnormalities early in life for a child who suffers from FAS/FAE, but his or her ability to learn, concentrate, remember and exercise sound judgement throughout life can also be impaired. Indeed, there is mounting concern that the long-term harm resulting from prenatal exposure to alcohol may be seen in the educational and correctional systems as well as in the health arena.

The prevalence of FAS/FAE amongst children born in New Zealand is not well known. One report estimates that each year in New Zealand there are up to 360 births of children whose development has been affected by their mother’s drinking during pregnancy (Curtis 1994). This is more than the combined annual total of all children born with cystic fibrosis, cerebral palsy and Down’s Syndrome.

A recent survey of nutrition during pregnancy found that amongst those women who drank alcohol, over a third continued to drink at least weekly during their pregnancies. Of those who continued to drink, a small proportion were drinking at hazardous levels (Watson and McDonald 1999).

Drink-driving fatalities and injuries

Alcohol remains a major factor in road crashes, particularly fatal accidents (Figure 7). Although progress has been made in bringing down the number of crashes that involve drivers affected by alcohol, in the year to December 1999 drinking drivers still contributed to 23% of all fatal motor vehicle accidents and 14% of all injury motor vehicle accidents (Land Transport Safety Authority 2000).6





Drownings

A number of overseas studies have suggested that alcohol is a significant factor in boating fatalities and other drownings. Until recently, however, there was no research on the extent of alcohol-related drownings in New Zealand.

A retrospective study of drownings that occurred in the Auckland area between 1988 and 1997 found that over 80% of people between 15–64 years who drowned had had their blood alcohol level tested as part of the post mortem. Of this group, 40.5% had a positive blood alcohol level, and 31% had a blood alcohol level over 80mg/100mls (the legal limit for adults operating a motor vehicle). An examination of boating-related drownings yielded similar findings. Of those aged 15–64 years for whom blood alcohol levels could be reliably measured, 40% had positive levels, and 24% had levels over 100mg/100mls. Based on these findings, although the raw numbers involved with drownings are fewer, the researchers concluded that the role of alcohol in water-related fatalities is just as important as, if not more important, than the role that alcohol plays in deaths on the roads (Smith et al 1999).



Violence

There is increasing evidence that alcohol is a major contributor to injury through interpersonal violence, especially assaults, violence against partners, and child abuse. Victims can also be more vulnerable to such violence if they are intoxicated themselves.

To take one example, estimates suggest that alcohol contributes to between 25% and 50% of physical assaults against spouses (Department of Justice 1987). Although the majority of perpetrators reject the possibility that alcohol was a contributor to their violence, it is interesting that those surveyed later typically mention it in the explanations they give for such incidents (Leibrich et al 1995). Hence, the Women’s Safety Survey 1996 found that ‘partner’s drinking’ was the most commonly cited trigger for a partner to act violently towards the female respondents (Morris 1997).

Alcohol-related violence also occurs outside the home. A recent representative survey of New Zealanders found that, in the previous 12 months, 10% of men and 5% of women had been assaulted by someone who had been drinking. For young people, the problem was even greater. In one 12-month period almost a quarter of men aged 16–24 years reported that they had been assaulted in an alcohol-related incident (Wyllie et al 1996).

Several studies have gone further and pointed out that greater violence is associated with drinking in bars and other licensed premises, than it is in other types of venues (Homel et al 1991, 1992; Ireland and Thommeny 1993; Stockwell et al 1993).

Such research has emphasised that situational factors play an important role in alcohol-related violence, and that there is a complex relationship between aggressive acts and expectations about the effects of alcohol and the social contexts of drinking (Graham et al 1998; Turning Point 1998).

Accepting that such situational factors appear to have an influence means recognising that there is unlikely to be any direct pharmacological link between alcohol and violence. Rather, from this viewpoint it is suggested that alcohol is more likely to increase aggression by influencing people’s social and cognitive processes, and allowing lesser incidents to escalate into violence Bushman 1997; Deehan 1999).

Workplace injuries and lost productivity

Alcohol misuse manifests itself in a variety of ways in the workplace. These range from the residual effects of use at weekends or after hours, such as hangovers and general fatigue, to intoxication at work due to excessive consumption during working hours.

The degree and significance of impaired job performance due to alcohol misuse will relate both to the effects of drinking and the specific tasks required of the employee (Wiese et al 2000). In safety-sensitive occupations like forestry, for example, even small intakes of alcohol could have a significant impact on performance, and serious implications for safety.

In New Zealand, data are not kept about the role of alcohol in accidents at work. However, with the strengthened legal obligations on employers to provide a safe environment for workers, the inappropriate use of alcohol has been highlighted as one of a number of preventable causes of workplace accidents (Occupational Safety and Health 1996).

Reduced productivity in the workplace due to alcohol misuse represents a significant cost to industry. Based on a study of almost 5,000 Aucklanders, which included about half who were drinkers in paid employment, the cost of alcohol-related lost productivity among the working population of New Zealand was estimated to be $57 million per year. Foremost amongst the costs was the cost of impaired work performance (estimated to be $41 million nationally). Absenteeism accounted for the remaining $16 million (Jones et al 1995). Other research suggests a much higher annual cost, by factoring in ‘downstream’ costs such as loss of production caused by alcohol-related premature deaths, alcohol-related unemployment, and temporary removal from the workforce for treatment for alcohol-related problems or imprisonment for alcohol-related offences (Devlin et al 1996; Easton 1997; Crofton 1987;
Single et al 1998; Collins and Lapsley 1996; Stockwell 1998).

High-risk groups

It is clear that alcohol-related harm is greater amongst some groups than amongst others. As people go through life there are stages at which they seem to be more at risk. The teenage years, young adulthood and later life are all stages at which people are particularly vulnerable. If they also come from the more marginalised groups in New Zealand society, for instance Maori, then their risk factors are compounded.

The underlying and/or presenting reasons why people use alcohol in harmful ways are often complex, but they must not be ignored. While strategies to minimise alcohol-related harm should not be confined to high-risk groups, the significant levels of harm caused by and to these groups, suggest that they are important audiences to target.

Youth

A nationally representative survey of 14 to 18 year olds conducted in March–April 2000 found that almost half of those surveyed had consumed 5 or more glasses of alcohol last time they drank (46%), and half of these – nearly a fifth of all young drinkers – said they drank 9 or more glasses of alcohol last time they drank. Almost two-fifths of all young drinkers (39%) reported that their last binge had been in the previous fortnight (Alcohol Advisory Council 2000).

These latest survey results reflect a deterioration from benchmark figures derived in 1997, at which time nearly all the heavier drinkers and three-quarters of the lighter drinkers had experienced a range of adverse effects from their drinking:

• over half had vomited after drinking

• a third had hurt themselves after drinking

• almost a quarter had got into a fight or an argument

• one in eight had got into a sexual situation they were not happy with

• one in 11 had got into trouble with the law because of drinking (Alcohol Advisory Council 1997).

Another study found that adolescents who reported misusing alcohol were more likely to engage in sexual intercourse at an earlier age, and to have unprotected intercourse, than was the sample as a whole – even when account was taken of risk factors common to both alcohol misuse and early sexual activity. The correlation between alcohol misuse and early sexual activity was found to be particularly strong for girls (Fergusson and Lynskey 1996).

Two other areas of concern regarding youth drinking should be noted. First, a New Zealand study of young people aged between 13 and 24 years who had made a serious suicide attempt revealed that 31% had a history of alcohol abuse or dependence (Beautrais et al, 1996, 1998). Second, a longitudinal study drawing upon over 20 years’ worth of data found that same-sex-attracted young people are at greater risk of experiencing substance abuse problems, including alcohol problems (Fergusson et al 1999).

Young men

In a recent New Zealand health survey, more than 50% of men aged 15 to 24 years reported drinking in a hazardous manner.7





These findings are consistent with earlier studies that showed 70% of men aged between 18 and 24 had exceeded the equivalent of six cans of beer on one drinking occasion at least once a month. Thirty-eight percent reported doing so at least once a week. Overall, this survey found that 10% of drinkers consumed almost half of the total alcohol available for consumption, and that young men aged 18–24 accounted for half of this group of heavier drinkers. As young men aged 18–24 comprise only 9% of the population, they are clearly over-represented amongst heavier drinkers (Figure 8).

Given their typically excessive levels of consumption, it is not surprising that young men report problems with alcohol. In a recent national survey almost a third of men aged between 18 and 24 reported that they felt drunk at least once a week. Over half the men in this age group also reported frequently experiencing other alcohol-related problems including memory loss, getting into fights, having arguments, being absent from work, driving drunk, and feeling ashamed of their behaviour while drunk (Wyllie et al 1996).



Maori

Although the proportion of Maori who drink is lower than that of the population as a whole, and those who do drink do so less frequently, the median annual volume of absolute alcohol consumed by Maori men is greater, at 9.2 litres, than the 7.4 litres consumed by men in the general population (Wyllie et al 1996; Dacey 1997).

A recent national survey found that 44% of Maori male drinkers and 29% of Maori female drinkers consumed alcohol at hazardous levels. Maori drinkers were also more likely than most to drink 5 or more drinks on one occasion (Ministry of Health 1999b).

Maori also reported a higher incidence of problems arising from their own drinking and the drinking of others than did the population as a whole.

One in five Maori men considered their drinking was harming their health to a large or medium extent, and a similar proportion mentioned negative effects on their home life and financial position (Wyllie et al 1996; Dacey 1997).

Alcohol dependence or abuse is the leading cause of admission to psychiatric institutions for Maori men, and the second most common cause of admission for Maori women (Pomare et al 1995). Maori men are 2.7 times more likely to die of an alcohol-related problem than are non-Maori men (Te Puni Kokiri and Kaunihera Whakatupato Waipiro o Aotearoa 1995).

Offenders

There is increasing evidence that misuse of alcohol features in the lives of a significant proportion of the populations within prisons and in community corrections ( All Party Group on Alcohol Misuse 1995; Deehan 1999). For example, a recent national study of the incidence of mental health problems amongst prison inmates found that almost 70% of female inmates, and about 75% of male inmates, had suffered from alcohol abuse or dependence problems at some point in their lives (Simpson et al 1999; Brinded et al 1996).

Screening of 100 new arrivals to a minimum/medium security prison in New Zealand revealed that more than 80% of the prisoners met the criteria for lifetime alcohol abuse or dependence disorder. A high proportion of these offenders also reported problems relating to their alcohol use (Bushnell et al 1994).

There has been little research on the relationship between offenders’ alcohol use and their offending, although some studies indicate that the two are linked (Brown 1986; Welte and Miller 1987; Kerner et al 1997). One New Zealand study of offenders found that 84% had been drinking prior to a violent incident, and of those almost three-quarters had been drinking either at the time of the incident or within the previous half hour (Bradbury 1984).

A Christchurch study found that young people who misused alcohol had significantly higher rates of both violent and property offences. While in part this association reflected the shared risk factors for alcohol misuse and offending, the findings suggest a cause-and-effect relationship between alcohol misuse and greater risk of offending (Fergusson et al 1996).

Emerging awareness of other groups at risk

The higher risk of alcohol-related problems among young people, Maori and offenders has been known for some time. More recent evidence, however, indicates that not only are some other groups in the population, such as young women and older people, at increased risk, but still other groups face particular challenges in relation to alcohol.

Young women

Evidence suggests that there has been an increase in the prevalence of excessive drinking amongst women, especially young women (Aotearoa Women’s Consultancy Group on Alcohol and Other Drugs 1993). There is now a markedly smaller difference between the amount of alcohol consumed by young men and that consumed by young women on a typical occasion. Young women, it appears, may be adopting drinking patterns akin to those of their male counterparts. Consequently, young women are at greater risk of experiencing the alcohol-related problems typically reported by young men (Wyllie et al 1996).

A 1998 national survey found that almost a quarter of women aged 18–19 years who identified themselves as drinkers reported drinking enough to feel drunk at least once a week. The proportion of women who reported feeling drunk once a week in 1998 had increased significantly from 1995 (Field and Casswell 1999a).

Older people

Few reliable data exist on alcohol use amongst older people in New Zealand. According to recent overseas studies, however, one-fifth of older people regularly exceed recommended alcohol consumption limits (National Advisory Committee on Core Health and Disability Support Services 1995; Dent et al 2000).

There are specific features about the way that alcohol interacts with the metabolisms of older people that make this group more vulnerable to its effects. Coupled with the greater use of prescription medicines by senior citizens, such interactive features mean that drinking alcohol at even fairly moderate levels may cause problems for some older people (Khan 1998).

For instance, a significant proportion of injuries to older people result from falls; there is evidence suggesting that heavy alcohol intake among older people leads to a marked increase in falls (Ziring and Adler 1991). The implications of such findings are likely to be greater as New Zealand’s population undergoes rapid structural ageing in the decades ahead.



Pacific peoples

Regrettably, there are also large gaps in our knowledge base about Pacific peoples and alcohol. The lack of meaningful data has often hampered efforts to tailor specific strategies for minimising alcohol-related harm, to meet the needs of Pacific communities.

Nevertheless, some information is beginning to emerge. For example, research that recently examined the place of alcohol in the lives of Tokelauan, Fijian, Niuean, Tongan, Cook Island and Samoan people living in New Zealand revealed hazardous drinking patterns amongst those surveyed:

For most of the participants, the concept of being a drinker related to drinking enough to get drunk. The concept of being a non-drinker included people who never drank and people who drink occasionally. This meant there was less scope for an ‘in between’ kind of drinking; that is, the concept of moderate drinking (Alcohol Advisory Council 1997b).
A 1996/97 health survey found that over half of all Pacific adults reported no alcohol intake in the 12 months prior to the survey. However, among the drinkers, more than a third drank in a manner that put them at risk of future physical or mental health problems. Pacific drinkers (along with Maori) were more likely than other drinkers to have five or more drinks on one occasion (Ministry of Health 1999b).

An earlier study of hospital admissions between 1987 and 1991 found that alcohol and drug abuse or dependence were the most common reasons for the admission of Pacific men, and the third most common reason for the admission of Pacific women (Bathgate et al 1994).

Polydrug users and people with co-existing disorders

People who use more than one drug at a time – for example, people who drink alcohol and take benzodiazepines; or people who drink alcohol and take hallucinogens – often suffer or cause the most serious drug-related harm (Feigelman et al 1998; Marsden et al 2000). The available evidence suggests that alcohol is typically one of the substances consumed in such situations of polydrug use.

For instance, 18% of those sampled in the 1998 National Drug Survey said that their use of cannabis was ‘always’ combined with alcohol, 16% said that it ‘mostly’ was, and a further 25% said that it ‘sometimes’ was (Field and Casswell 1999a).8

There is also an increasing awareness that alcohol abuse or dependence problems often co-occur with other mental health disorders, although the exact prevalence of such ‘dual diagnoses’ is difficult to estimate (Todd et al 1999). In particular, there is thought to be a significant association between depression and certain patterns of alcohol use, and depression is a leading factor for increased risk of suicide by alcoholics (Murphy and Wetzel 1990). Indeed, the weight of international evidence indicates that heavy drinking is a major risk factor for suicidal ideation, suicide attempts and completed suicide amongst youth and adults (Barraclough 1987; Beautrais 2000; Coggan et al 1997; Ministry of Health 1998b).

High-risk environments and events

Just as some groups are more at risk of alcohol-related harm, so some drinking environments appear riskier than others. Identifying locations in which problems are most likely to occur enables better targeting of strategies to reduce such problems.

Licensed venues and other social settings

New Zealanders drink most frequently in their own homes, but research indicates that men drink more heavily in other locations, notably pubs/hotels/taverns, other people’s homes, nightclubs and at sports events. Women drink most heavily in nightclubs (Wyllie et al 1996; Dacey 1997).9

In line with these consumption trends, there is evidence to suggest a disproportionate number of alcohol-related problems are linked to heavy drinking in licensed premises. Although New Zealand has moved away from the notorious ‘booze barns’ of the past, studies of drinking environments have found that typically drinking larger amounts of alcohol in hotels, taverns or clubs is a behaviour predictive of alcohol-related problems, including physical ill-effects, fighting, motor vehicle crashes, and absence from work (Casswell et al 1993).

Public events and activities

Large-scale public events where alcohol is available do not always run smoothly. Ineffective management of alcohol at such events, particularly irresponsible serving of alcohol, can be accompanied by high-risk behaviours like drink-driving, and greater risks of disorderly behaviour, property damage and physical violence. There are steps organisers can take at some controlled events – like sporting fixtures, outdoor concerts and some types of New Year’s Eve celebrations – that can help to minimise such risks (Alcohol Advisory Council 1999). But there will not always be the opportunity to manage alcohol misuse at such events, certainly not at spontaneous events, so there will always be the potential for trouble when alcohol and large numbers of people are together in one place.

Other activities for which drinking alcohol can be a problem include those linked with the traditional New Zealand summer pursuits of boating and swimming. Increased concern is being expressed about the involvement of alcohol in boating accidents, and each year a number of people drown while swimming after drinking.

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3 This national alcohol use survey is due to be repeated during 2000/01. For a recent ‘snapshot’ survey that monitored alcohol intake, see Ministry of Health 1999a.

4 The Alcohol Advisory Council of New Zealand recommends against drinking more than 21 standard drinks per week for men and 14 standard drinks per week for women. A ‘standard drink’ is any drink containing 10 grams of alcohol. Using this definition, one can of beer that contains 5% alcohol by volume is roughly equivalent to 1.5 standard drinks. For the Alcohol Advisory Council’s guidelines, see Working Party on Upper Limits for Responsible Drinking 1995; compare Inter-Departmental Working Group on Sensible Drinking 1995 (United Kingdom); and National Health and Medical Research Council 2000 (Australia).

5 For a useful New Zealand overview, see Stewart 1998.

6 Illustrating how much progress has been made, drinking drivers contributed to 42% of fatal crashes and 22% of all injury crashes in 1990.

7 ‘Hazardous drinking’ is defined as an established pattern of drinking that carries with it a high risk of future damage to physical or mental health. See Ministry of Health 1999b.

8 Interestingly, the number of respondents who said they solely used alcohol fell from 49% in 1990 to 43% in 1998 (Field and Casswell 1999b).

9 Note, however, that this same survey revealed that Maori drank less in their own homes and hardly at all in restaurants. The greater proportion of the alcohol drunk by Maori was consumed at hotels, sports clubs and places of work.

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Other Ministry of Health Strategies

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