2. Background
Perception that alcohol is an increasing problem in
Australia society
– “Epidemic of binge drinking” (Rudd)
– “Drink until you drop culture” (Scippione)
– “Binge drinking out of control” (AMA)
This presentation will try to summarise the available
data to assess the validity of this perception
– Strengths and weaknesses of various data sources
– Mix of Victorian and national data
– Implications for policy
3. Context
General trend towards more liberalised alcohol
controls nationally
– Victoria typifies the trends
– New acts in 1987 and 1998, steady erosion of restrictions
– Increasing involvement of the big grocery chains in the
packaged liquor market
– Late night trading increasingly prevalent
5. Context
Changes in type of licences
– Expansion of “big box” liquor stores
– E.g. Dan Murphys had 5 stores in 1998, now has ~ 200
– ~ 100 First Choice Stores
– Various states encouraging „small bar‟ licences, although it‟s
not clear how much impact these have had
Increased competition in the packaged liquor
environment has contributed to increasing
affordability of alcohol
6. Context
Carragher, N. & Chalmers, J. (2012) What are the options? Pricing and taxation policy reforms to
redress excessive alcohol consumption and related harms in Australia. Sydney: BOCSAR
7. Implications
Increased affordability of alcohol linked with
increases in consumption and problems in many
previous studies
– Some contestation over the relative impact of price changes
on heavy drinkers, but reasonable evidence that harms
decline with price increases
Outlet numbers and trading hours associated with a
range of harms in Australian and international
studies
– Victorian research shows harm rates at the local level are
strongly associated with outlet densities
8. Trends in alcohol-related harm
Rely largely on proxy measures
– E.g. Late night weekend assaults
– Proportions of various injuries/diseases (e.g. ~40% of
assault hospital admissions etc)
– Single vehicle late night traffic accidents
Some more direct measures
– Alcohol caused ambulance attendances (still relying on
paramedic perceptions)
– Admissions/presentations for alcohol specific conditions
(relying on reliable coding)
9. Trends in alcohol-related harm
Detailed data examined for Victoria (1999-2008)
– Including analyses of trends in different population groups
Broader data presented nationally
– Relying on previously published work
11. Victorian trends
Sharp increases in six separate indicators
– Some evidence of recent plateaus in ambulance
attendances and assaults (although most recent ambo data
shows a further increase)
– Stable trends in alcohol-related deaths and serious single
vehicle night-time traffic accidents
– Road traffic deaths may be held down by ongoing road
safety initiatives, but lack of trend in deaths data raises
questions
– Still: consistent upward trends in 6 of 8 indicators suggestive
of increases in harm in Victoria
12. National trends
Limited data
– NSW data suggests assaults on licensed premises and
assaults flagged by police as „alcohol-related‟ are
declining, although domestic violence is increasing (possibly
due to increased reporting).
– NSW hospitalisations increasing, emergency presentations
stable since 2009 after large increases
– Other states publish limited data
– Last NAIP bulletin covered 1996-2005
– Generally increasing alcohol-related hospitalisations
(particularly in Victoria, Tasmania and NT)
– Generally falling alcohol-related deaths
13. Population sub-groups
Trends in Victorian harm rates examined by
age, sex, rurality and socio-economic status
– No obvious and consistent patterns across outcome types
– E.g. Emergency presentation increasing faster in urban
areas, hospital admissions and violence in rural aras
– Sharp increases for younger Victorians in emergency
data, but not in assault data
– Some (inconsistent) evidence of gender convergence
15. Consumption
Some (mixed) evidence that harms are increasing
Implies changes in amount, pattern or context of
alcohol consumption
Very little objective data on consumption (just
national estimates based on tax), so tend to rely
on survey-based estimates
20. Teenage drinking trends
Replicated in US and many European countries
– Sweden, Finland, Ireland, Norway, Russia etc
– Although not everywhere (e.g. France, Greece, Croatia etc)
No clear explanation for sharp reductions in youth
drinking
– Cultural reaction to heavy drinking parents (cohort born in
1970-80s heaviest drinking cohort)
– Alternative means of entertainment (recent Swedish paper
showed strong –ve association between computer/internet
use and drinking)
21. Teenage drinking trends
No strong evidence that alcohol is being replaced by
other substances
– Declines in: cannabis, amphetamines, ecstasy, opiates and
cocaine
– Use of any illicit drugs has dropped from 20% in 2005 to
15% in 2011
Teenage attitudes to alcohol shifting
– But in line with general population shifts
Small increases in abstention among older young
people
– E.g. 18-24 year olds from 7% (2001) to 12% (2011)
22. Overall Australian trends
Reasonable evidence of increasing rates of harm
– Although not entirely consistent
No measurable increase in consumption
– Total volume is steady as are most measures of risky
drinking
– Some evidence of declining drinking, particularly among
young people
23. Possible explanations for diverging
trends in Australia
Changes in coding practices in health and police
systems
– Mortality trend is flat
– Inconsistencies nationally raise questions
Problems with consumption data
– Per-capita consumption excludes cider
– Survey trends are not necessarily reliable
Something else?
24. Attitude shifts
Clear evidence that public attitudes towards alcohol
are shifting
– Greater media concern
– More worry about alcohol as a problem
– Increased support for restrictions
– Attitude changes not limited to particular subgroups of the
population
25. Drug of ‘most concern’ for the general
community
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2001 2004 2007 2010
Alcohol Tobacco
Meth/Amphetamines Heroin
26. Drug causes the most deaths
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2001 2004 2007 2010
Alcohol Tobacco
Meth/Amphetamines Heroin
28. Media focus of alcohol stories
Azar, White, Bland, Livingston, Room, Chikritzhs, Durkin, Wakefield (submitted) Something’s
brewing: changing trends in alcohol coverage in Australian newspapers 2000-2011
29. Changing attitudes
Changing attitudes to alcohol could influence the
observed trends
– Increase alcohol coding by clinicians/shift police emphasis
on night-time assaults thus pushing up trends
– Contrastingly may make reporting heavy drinking less
socially desirable thus driving down estimates of risky
drinking
However: hard to imagine liver cirrhosis increases of
>50% driven solely by attitude changes
30. Another potential explanation:
diverging consumption
Potential explanation if:
– Overall consumption patterns mask divergent trends for
heavy (↑) and moderate drinkers (↓)
– Harm rates driven by heaviest drinkers
Diverging consumption within a population is
counter to Skog‟s theory of the collectivity of
drinking cultures
– Some evidence in Swedish studies of young people that
trends are not consistent across different drinking groups
31. Is Australian consumption diverging?
Examine changes in the distribution of alcohol
consumption in Australia from 2001 to 2010
– Four waves of large population (14+) survey (n>20,000 per
wave)
– Steady (if poor) response rates and coverage rates of per-
capita consumption
– Consumption data collected using standard (and consistent)
graduated frequency questions
32. Episodic drinking
Are trends in „risky drinking‟ consistent across
differing definitions?
- Compare 5+ with 20+
- Small but significant *increase* in 20+ drinking (9% -
10.5%) & decrease in 5+ drinking (43% - 40%)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2001 2004 2007 2010
20+
5+
33. Episodic drinking
Demographic analyses
– Increases in 20+ drinking for both men and women
– 20+ drinking increasing among older respondents (>30)
– Drinking in general declining among young people
– Biggest increases in 20+ drinking in rural areas (10.6% -
14.8%)
34. Distribution of volume consumed
Examine consumption levels for 20 quantiles of the
population.
– Comparing how much of the total alcohol each quantile
consumes from wave to wave
– Particular interest in shifts at the heaviest end of the
distribution
37. Distribution of volume consumed
There has been some shift in the abstaining
population (17% - 20%)
– Reanalyse volume shifts looking only at drinkers
– More consistent with Skog‟s theory
– The decision whether or not to drink is different to the
decision about how much to drink
Broadly similar results
– Drinking by the lightest 80% of drinkers declined by 3.3%,
by the top 10% increased by 6.4%
38. Summary
Very heavy episodic drinking has increased slightly
in Australia over the past decade, even while
„risky drinking‟ rates are declining
There have been small but consistent shifts in the
total distribution of consumption in Australia over
the same period, with the heaviest drinkers
representing an increasing proportion of total
consumption
39. Summary
Some evidence against the collectivity of drinking
cultures
– Skog‟s theory predicts consumption will shift proportionally
across the distribution
What do these findings mean for population-level
interventions?
– Per-capita consumption is steady, but very heavy drinking
is increasing
– Possible contribution to mismatch between harm and
consumption trends
40. Some caution
These are relatively small shifts and, while
statistically significant, my represent „noise‟ in
the data
– 2013 survey wave available next year for further analyses
Broad issues of interpreting survey data,
particularly on very heavy drinking
– Non-response, recall bias, untrue responses ...
Unlikely to be enough of a shift to explain such
major increases in harms
– Harms tend to be spread widely across the drinking pop‟n
41. Conclusions
Victorian and Australian alcohol trend data
provides a confusing picture
– Some (inconsistent) evidence of harm increases
– Generally stable levels of consumption, which obscure:
• Major reductions in teenage drinking
• Declines in 5+ drinking, particularly among young adults
• Increases in 20+ drinking and drinking by the heaviest drinkers
– Big shifts in attitudes towards alcohol
42. Conclusions
Understanding trends is critical
– Tends to drive the policy debate
• Headlines/media attention tends to focus on change in
problems, not just their level
– Crucial for understanding the impact of policy changes
• E.g. Increased availability of alcohol in Victoria linked to increases in
harm rates, despite limited evidence that consumption has been
affected
Standard national reporting of trends across
diverse outcome measures crucial
– Surveys provide necessary level of detail on
consumption, but reliability an increasing concern
