Abstract
We have previously outlined strategies to reduce alcohol-related problems amongst young people [1] drawing on the excellent systematic review of effective parenting styles that reduce adolescent alcohol use by Ryan and colleagues [2]. But is the heavy drinking culture that exists in western countries such as Australia and New Zealand primarily a youth issue?
Epidemiological data from the New Zealand Mental Health Survey: Te Rau Hinengaro [3] included a range of alcohol-related measures, including the Alcohol Use Disorders Identification Test (AUDIT), an internationally recognized standard for measuring hazardous drinking, problem drinking and dependent drinking, i.e. heavy drinking. The AUDIT is a 10-question instrument, which examines heavy drinking from the three key dimensions of quantity/frequency of use, problems associated with alcohol, and alcohol dependence features. It is scored out of 40 and the established cut-off score determining heavy drinking is a score of 8 or more [4].
The age distribution of heavy drinking based on AUDIT scores in Te Rau Hinengaro shows that most of the heavy drinkers are adults. Out of the population aged 16 and above only 8.8% of the heavy drinkers are under 20, and a further 21.5% are aged 20–24. At the other end of life, those aged 60–69 made up 3.8% of the heavy drinkers, and those aged 70 or more were 1.9%. The majority of the heavy drinkers (64.1%) are aged 25–59 (personal correspondence J.E.W.).
The media tend to portray the heavy drinking culture as essentially a youth problem. This is partly because of the large amounts of alcohol consumed by youths. For example, the top 10% of the Christchurch Health and Development Study's birth cohort at peak consumption (22–25 years) were each consuming 51 standard drinks on average every week [5]. Heavy drinking amongst young people during this exuberant phase of life often happens in public view and results in a disproportionate number of injury- and violence-related stories that are considered newsworthy.
We know that youths are more vulnerable to acute alcohol-related harm even at the same dose of alcohol. For instance the relative risk of having a fatal crash at a blood alcohol level of 0.05 in a 15–19 year old is five times that in a person 30 years or older [6]. However, of the 1000 or so alcohol-related deaths in New Zealand each year, about a half are the result of chronic disease, and a half of these are cancers [7] including the commonest cancers of breast, prostate and bowel. The media do not usually consider a cancer death in an aging citizen as valuable a news story as a drink-driving death in a young person.
Reducing the large volumes that young people are drinking so that fewer will be harmed in the short term or become chronic heavy drinkers is important, but it is not sufficient overall because the majority of heavy drinkers are not young.
The false perception of the heavy drinking culture being primarily a youth issue has political ramifications. About half the measures in the Alcohol Reform Bill currently proposed by the National-led government in New Zealand are related to youth drinking; measures such as raising the age of purchase, limiting the alcohol concentration of ready to drink (RTD) beverages, strengthening parental provision of alcohol to minors, and strengthening advertising restrictions to under 18 year olds. The most effective measures for reducing the real heavy drinking culture amongst adults (pricing, accessibility, advertising and adult drink-driving) have been largely ignored.