What are the most effective strategies to prevent alcohol problems among young people?. Tim Stockwell Centre for Addictions Research of BC, University of Victoria, British Columbia, Canada. Presentation to MEAS Alcohol and Young People Conference, Dublin, 14th October 2004.
Centre for Addictions Research of BC,
University of Victoria, British Columbia, Canada
Presentation to MEAS Alcohol and Young People
Conference, Dublin, 14th October 2004
1. Mortality 2. Road injuries 3. Patterns of 4. Per capita 5. Violence
and morbidity and fatalities drinkingconsumption
National Drug Research Institute and Turning Point Alcohol and Drug Centre Inc. (www.ndri.curtin.edu.au)
Funded by the National Drug Strategy
The National Drug Research Institute and the Centre for Adolescent Health
The Prevention of Substance Use, Risk and Harm in Australia: A review of the evidence
Funded by the Australian Government Department of Health and Ageing
A Risk and Protection approach to the prevention of harmful drug use across the whole life span….
Prevention is about more than just persuading kids not to get off their heads….
Prevention needs to be about harm reduction as well as use and supply reduction…
Prevention is about regulation and law enforcement,
not just education and persuasion
The health and economic benefits of government prevention policies will reflect the extent to which the most prevalent patterns of harmful drug use have been addressed.
Global Burden of Disease in 2000
Taking account of deaths, life years lost and extent of disabilities caused, tobacco contributes 4.1% of preventable death/disability, alcohol 4.0% and illicit drugs 0.8% ie legal drugs cause more than 90% of population level harm from drugs.
(Rehm and Room, in press)
Young adults contribute disproportionately to the global burden of disease from alcohol, mainly from the acute consequences of drinking
Australian National Drinking Guidelines
On an average day:
Women 2 standard drinks
Men 4 standard drinks
On an occasional day:
Women 4 standard drinks
Men 6 standard drinks
(1 drink=10g alcohol)
% Alcohol drunk in Australia at risk levels for acute and/or chronic harm, 18-24 yr olds
Most national surveys estimates of alcohol consumption rely on the concept of the standard drink…..
Harms caused by alcohol in 15-29 year old Australians, 1992 to 2001
Of 4,365 deaths & 143,464 hospital episodes due to alcohol:
90% hospital episodes
40% young adults at risk,
at least monthly
Regular use caused
10% hospital episodes
15% at risk
Source: National Alcohol Indicators Project, 2003.
Governments will achieve the most enduring benefits by addressing both the distal causes of substance use problems (social and developmental factors) as well as the immediate causes (patterns and settings of use)
Williams et al (2000)
Williams et al (2000)
9,000 Victorian high school children from 194 schools.
2,500 year II students included (age 15 or 16 years).
Risk and Protection Scale (Arthur et al., 2002)
Lifetime and recent drug use (tobacco, alcohol, cannabis, other illicits).
Elevated risk factors for recent substance use,
Victorian School-aged children (n=9,000)
Victorian Department of Human Services, 1999
Social and developmental Risk Status of 2,510 15/16 year olds who ‘binged’ at least once per week (= 5or more drinks on one occasion)
Average Risk 59%
The population level impact of government policy will be determined by the extent to which investment is made in prevention strategies with the strongest evidence-base
Illicit Drugs42 All drug types13
Alcohol38 Cannabis 9
Broad-based31 Pharmaceuticals 6
Ratings of Evidence
High priority for implementation and maintenance
In April 1992 the NT Government charged a levy on alcoholic drinks which raised $18.4 million over 4 years for the prevention and treatment of alcohol problems.
In August 1997 the Living With Alcohol levy was removed and alcohol became cheaper . The program was funded federally until 2002.
A forthcoming paper shows that acute alcohol-caused deaths increased after 1997 compared with adjacent regions of Queensland and Western Australia.
McBride, N. et al (2004) Harm minimization in school drug education: final results of the School Health and Alcohol Harm Reduction Project (SHAHRP),
National Drug Research Institute
Perth, Western Australia
2,300 students from 14 schools allocated to control or intervention programs, 76% follow-up at 32 months.
At follow-up SHAHRP students had:
• 10% greater alcohol related knowledge
• consumed 31% less alcohol
• experienced 23% less harm associated with their own use of alcohol
• experienced 10% less harm associated with other peoples use of alcohol than did the control group.
Cost: $24 per student over two years.
Governments can harness existing community support for some effective strategies – and can lead public opinion on others.
ie Prevention can be popular as well as effective.
2001 NDS Household Survey (n=26,744)
Other Australian surveys