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Smoking and drinking: what's the difference?

Wednesday 16th March 2016

While the Government has been successful in tackling one, is it failing with the other?

 

Image: 123rf

New Zealand has been tackling smoking for years, and it’s working.

The tactic was pretty simple: raise the price, make it harder to buy and supply, and limit where people can smoke in public. On the psychological front, throw in well-rounded support for those wanting to quit, and make the habit uncool.

As it currently stands, the smoking rate is steadily decreasing in every demographic, with youth aged 15–17 years - whose rate has more than halved since 2007 - the starkest example.

So why isn’t the Government doing the same with drinking? Half of all serious violent crimes relate to alcohol, hundreds of children are born with foetal alcohol spectrum disorder each year, tens of thousands of physical and sexual assaults each year involve alcohol, and scores of serious and fatal injury traffic crashes every year relate to alcohol.

Replace the word “alcohol” with “methamphetamine” and it’s fair to assume the issue would come to be viewed as a national crisis. The Government might even throw millions of dollars at the problem. In fact, it did. In 2009, the Prime Minister launched a plan of action to tackle methamphetamine, investing more than $17 million in the project. But as it sits, deaths from P are less than 20 per year compared to about 800–1,000 deaths from alcohol.

Our current tolerance to heavy drinking is not dissimilar to attitudes towards smoking that existed until only recently. Should we start, then, by telling people to stop drinking; the same tactic pursued by anti-smoking campaigns? It’s not quite that simple, says University of Otago professor Jennie Connor.

“The reason that we’re comfortable now telling people not to smoke is that they’ve already stopped smoking. What stopped them smoking had nothing to do with telling them not to do it, it was the environmental interventions and policy.”

Connor can remember when smoking was encouraged in her own profession. “My father went to medical school and when he went to do his final oral exam, he walked into the room and was offered a cigarette.”

Professor Jennie Connor

Photo: John Bollen

The Government’s track record with implementing policies designed to limit the harm caused by alcohol consumption is arguably limited.

In 2010, the Law Commission gave the Government a list of recommendations of how to lower alcohol-related harm. 

Justice Minister Amy Adams says in response, the Government enacted the Sale and Supply of Alcohol Act 2012, the "most significant change" to alcohol laws in decades. It took on board 126 of the 153 recommendations, including giving local councils more control over alcohol availability in their communities. 

“These changes, combined with the other measures in the Act, can be linked to the 22 percent reduction in the total number of public violence and disorder offences occurring in the hours of darkness in the first 10 weeks after the Act came into force. This was 1,258 fewer offences than for the same period the previous year,” she told The Wireless.

But according to two alcohol researchers in New Zealand, the most effective recommendations for lowering harm  - upping the price, restricting alcohol availability nationwide, and banning alcohol advertising - were not implemented.

“If I could have just one thing one thing, it would be decent national alcohol policy. It has to effectively regulate the market place which it isn’t doing,” says Connor.

“Even when we think ‘oh it’s a few stupid brats causing the problem’, it’s actually fostered by our country's approach to alcohol.”


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In response to the 2010 recommendations, the Government said they did not want to “unfairly penalise responsible and moderate drinkers.”

New Zealand has a thriving alcohol industry with some of the best wine and beer in the world. In 2008, the wine industry was estimated to contribute $1.5 billion to GDP and according to the Brewers Guild of New Zealand, beer is a $2.2 billion industry. On the flip side, researchers put the cost of our thriving heavy-drinking culture at between $146.3 million and $16 billion each year [PDF].

In 2012, the alcohol industry pressured the Government over its proposed changes to alcohol regulations. Documents released to the public showed liquor lobbyists met with Justice Minister Judith Collins to try and convince her to dump a law that would have seen the sale of high-strength “ready to drink” beverages (RTDs) in bottle stores stopped. RTDs are commonly consumed by the population most at-risk of dangerous drinking patterns: 18-24-year-olds.

Initially, the Government’s idea was to get rid of all RTDs that had more than five percent alcohol content. That was pushed to six percent and then, oddly, the plan was completely scrapped. “The Government has decided to give the alcohol industry the opportunity to introduce its own measures to limit the harm to young people caused by RTDs, Collins said at the time.

Essentially, we were asking the people profiting the most from RTDs to restrict their own sales. When smoking companies were permitted to regulate their own sale and advertising, we had ads like this:

Cigarette advertisement, 1976

Photo: Stanford School of Medicine

The alcohol industry then set up a voluntary RTD code [PDF] that, as the name suggests, is a not mandatory. However, Robert Brewer, chief executive of alcohol lobby group Spirits New Zealand, says most do comply.

“The good thing about self-regulation,” says Brewer, “is that if someone tries to import RTDs with a higher alcohol content from overseas - I mean you could do that tomorrow - we can put pressure on the retailers not to sell it.

“We keep an eye on these things and people should definitely tell us if they see drinks with alcohol contents higher than the limits set.”

Justice Minister Amy Adams says the Government does not believe the alcohol industry should be completely self-regulated, however, in some cases it is a useful tool. In the case of RTDs, she says self-regulation has “successfully seen the overwhelming majority of large, strong RTDs, which were the subject of considerable public concern, removed from sale.”

One of companies represented by the lobby group is Independent Liquor. It’s owned by the Japanese company Asahi and has a 60 percent share of the local RTD market.

Cigarette advertisement, 1988

Photo: Stanford School of Medicine

The company talks about the marketing success of Vodka Cruisers; a brightly coloured fizzy drink you might serve at a child’s birthday, were it not for the five percent of alcohol in it. Cruisers average at about $1.80 per bottle, less than a bottle of water.   

“Vodka Cruisers have become another of the company’s true success stories. Once languishing in the market, some savvy, research-based marketing has seen them climb in the ratings with Cruisers becoming relevant and popular with the target consumer,” claims the Independent Liquor’s website.

It notes one of the strongest attributes of the RTD is the fact its drinkers think it’s “fashionable” and “cool”, similar rhetoric used in tobacco marketing 25 years ago.

The website goes on to explain that Cruisers are particularly ideal for advertising on social media such as Facebook. Looking at the statistics, this makes sense. About 80 percent of 16 to 24 year olds in New Zealand use Facebook every day; the same age group of people who drink the most.

Last year, The Wireless hit the streets of Wellington to find out what influenced young people's drinking decisions. Anecdotally, cost was a major factor. 

Currently, all alcohol advertising in New Zealand must adhere to a code of standards which fall under four guiding principles: it needs to observe a high standard of social responsibility, encourage moderation in drinking, be directed at audiences 18 years and over, and sponsorship needs to clearly and primarily promote the sponsored activity.

“If there was no promotion of alcohol, this would be a whole different game,” says Jennie Connor.

“The companies have an enormous influence on alcohol policy. Policies that will reduce heavy drinking will really hit them so they push other things that are ineffective. This is going on all over the world, all the time.”

The Drug Foundation provided a list of the events alcohol companies backed in 2010. They were the same events the country’s biggest drinkers were likely to have gone to: Big Day Out, Rhythm and Vines, Laneway, Home Grown, and the Wellington Sevens.

Event sponsorship, especially in sports, was a marketing tool also used by tobacco giants. At one time, tabacco companies were backing formula one racing, cricket, tennis and even the Fifa World Cup.

Here at home, the All Black’s longest serving sponsor is Steinlager, pouring money into the team for nearly 30 years.

But Minister Amy Adams says the direct comparisons between the regulation of tobacco and alcohol are "simplistic and misleading".  

“Tobacco frequently kills its users and those around them, which is why the Government is committed to making New Zealand smoke-free by 2025. Alcohol is used socially and safely by the majority of New Zealanders, but when abused creates serious social harm that we need to address.  They are different problems, calling for different solutions.”

***

There is no safe level of alcohol meaning that, just like smoking, every drink is causing potential harm.

Connor says the harm from heavy drinking far outweighs the harm from smoking, and most of its social costs are still unaccounted for. Perhaps the most compelling evidence emerging in recent years is the link between alcohol and cancer. Alcohol is a group 1 carcinogen. Mouth, throat and bowel cancer are the notable ones but research has also shown that drinking significantly increases the risk of breast and testicular cancer too.  

“Even low doses of alcohol seems to increase the risk of breast cancer,” says Connor. “If you drink a glass of wine when you come home, then have another, that will increase your cancer risk by ten percent. Your breast cancer risk varies, of course, depending on how old you are, but what we don’t know is if you’re banking that risk for later.”

Professor Doug Sellman from the University of Otago says there are over 200 diseases and conditions that are directly alcohol-related including liver cirrhosis and dementia. “Low risk smoking, that is the risk of dying of a smoking-related event or disease, is about five cigarettes per week. Using the same definition of "low risk" for alcohol, low-risk drinking is around two standard drinks a day,” he says.

Even if we limit our heavy drinking habits to just our university years, Sellman says the risks could be irreversible. “There is evidence of damage to the hippocampus from alcohol, one of the key parts of the brain associated with laying down new memories, in young heavy drinkers which may not fully recover.”

Heavy drinking among 18- to 24-year-olds reached a peak of 43 percent in 2007 and has since dropped to about 34 percent, an indication that the cachet attached to being drunk may be lessening its grip.

The Health Promotion Agency (HPA) recently spent $1.2 million on a campaign focused on giving people social permission to ease up on drinking. HPA is funded from a levy on alcohol for its alcohol moderation activities. In the year ending June 2015 that figure was $11,076,000.

Recent research conducted on behalf of Heineken shows the 67 percent of young Kiwis surveyed think that moderating drinking is “cool” and 80 percent respect others when they moderate their drinking. The survey also shows about 54 percent said they were “turned off” by drunken people and 19 percent said they have stayed sober specifically to impress someone they are attracted to.

Heineken used the information to create an ad telling young men that by drinking less, they’ll get more women. 

While the large majority of university students drink, there are some who are bucking the trend. Olivia Forman, a student living in a student hall in Wellington, has decided not to drink at all. “Honestly, I don’t see the benefits in it. I think that I should be in control of my actions and thoughts always.

“It’s not appealing to me; passing out, losing my inhibitions. It’s not part of who I am.”

The 19-year-old’s decision has to do, in part, with the fact that some of her extended family are heavy drinkers who turn abusive when drunk. “I don't want to give myself the opportunity to become that way. I know I wouldn’t but why even risk it?”

Olivia was initially wary of moving into a hall of residence, an incubator for heavy drinking, but was surprised to find a sizable group of others who drank lightly or not at all.  

“I think you naturally surround yourself with people who are like you. I’ve seen people who struggle to say 'no'. I think they feel like these people won't accept them if they don’t drink. I don’t want that to be me.”

***

The implicit and explicit pressure to drink among young people is one of the reasons New Zealand is losing the binge drinking battle. But there is also a very real fear of blaming victims and reinforcing sexist tropes by advising young people, especially women, not to drink. Nothing quite highlighted this better than the backlash to American journalist Emily Yoffe’s article, provocatively titled College Women: Stop Getting Drunk.

Yoffe, who is now the contributing editor of the Atlantic, says after a series of high-profile rape cases in the United States, she was struck by the fact that no one was talking about the common thread: all the young women were intoxicated. “I realised that we’d come to the point where we weren’t giving young inexperienced people advice on how to better reduce the chances of being victims of terrible crimes,” she told The Wireless.  

“It’s the fear of blaming the victim, which I totally understand, but I think it’s possible to hold a somewhat more complicated thought in your mind. If you become a victim of a crime, the person responsible for the crime is the perpetrator. It is also possible to say ‘what are things you can do to reduce your chances of that happening?’”

Emily Yoffe

Photo: Supplied

The piece was published on her birthday in 2013 and she remembers suggesting to her husband that perhaps nobody would see it. Except a lot of people did. While Yoffe is uncertain of the exact number of hits the piece got, it was shared close to 62,000 times on Facebook.

“I have never experienced anything like that and I’m in my fourth decade of journalism. It was instantaneous denunciation, it was international denunciation,” says Yoffe.

“I was prepared for it to be controversial but what was discouraging to me the quality of the attacks. There were so many tweets calling me a c**t. That was the argument; you’re a c**t.”

The overwhelming majority of critics accused Yoffe of blaming the victim and promoting “rape culture” but she feels many missed her point: the perpetrator is always to blame for a crime, but we can keep ourselves safer.

“I got a lot of reaction saying ‘your message is wrong. The message is don’t rape. Stop being a rapist.’ Terrific, yes, I’m all for it but there are bad people who deliberating use alcohol as a tool to harm others.”

New Zealand studies show university students who drink heavily report considerably more unhappy and unwanted sexual experiences than those who drink lightly. About 12 percent of male students and 21 percent of female students experienced “unwanted sexual advances” due to other people’s drinking.

Yoffe wrote a follow-up article, addressing her critics. She admits she would have further stressed the points about the dangers of drinking for young men but, ultimately, stands by her piece and the message in it.

“Smoking used to be sexy and cool. Now it’s repulsive. I think with extreme drunkenness, there needs to be a societal shift where instead of people boasting about how drunk they got, their friends say ‘woah man you puked on my shoes, that is not cool.’”

The trend in New Zealand seems to be moving toward a lower tolerance of drunkeness but it is still hard to imagine heavy drinking ever being completely socially unacceptable. Although we might have said the same thing about smoking 60 years ago when ads like this existed:

Cigarette advertisement, 1952

Photo: Stanford School of Medicine

 

BY THE NUMBERS:
  • Half of all serious violent crimes relate to alcohol (New Zealand Police, 2010)
  • As a country we spent about $85 million on alcohol every week in 2008 (New Zealand Law Commission, 2010)
  •  800 -1,000 yearly deaths from alcohol (Berl 2009; Connor et al, 2013)
  • There are about 60 diseases caused by heavy drinking  (WHO, 2007)
  • Up to 70 percent of all adult presentations at emergency departments on weekends are alcohol related (Jones et al., 2009; Humphrey et al., 2003)
  • Over 500 serious and fatal injury traffic crashes every year relate to alcohol (Ministry of Transport, 2012)
  • At least 600 children are born each year with foetal alcohol spectrum disorder and the figure could be as high as 3,000 (Sellman & Connor, 2009)
  • More than 17,000 years of life per year are lost through alcohol (Connor et al., 2009)
  • Half of the murders, rapes and assaults are undertaken by the perpetrator under the influence of alcohol (Connor et al., 2009)
  • 70,000 physical and sexual assaults each year involve alcohol  (Connor, You, & Casswell, 2009)
  • Alcohol is classed as a group 1 carcinogen along with asbestos, benzene, formaldehyde and gamma-radiation (WHO, 1988)
  • A third of all alcohol-related deaths are attributable to cancer (WHO, 2009)
  • Taxation on alcohol contributed $852 million to Government revenue in 2011, less than 2 percent of total Government taxation revenue of $51 billion.

If you are concerned about your own or someone else’s drinking, call the Alcohol Drug Helpline on 0800 787 797 or visit their website.



Join the discussion »

“Hi, thanks for your comment.

Just looking at the study you linked. Out of the 3,619 patients who were screened, only 297 were eligible to be asked if they had consumed alcohol 4 hours prior to ED (i.e. they had filled out the pre-consent form). Out of that 297, 182 were impact positive meaning alcohol contributed to the reason for attendance. So essentially, out of the people who were asked, 61% were there for alcohol related reasons.

Source for the 17,000 years of life lost: https://researchspace.auckland.ac.nz/bitstream/handle/2292/4700/15843841.pdf?sequence=1”


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