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Print version ISSN 0042-9686
Bull World Health Organ vol.88 n.9 Genebra Sep. 2010
Governments confront drunken violence
Just five years after relaxing its alcohol licensing laws, the British Government is revisiting this legislation in response to soaring rates of alcohol-related violence. As Angel Desai reports, the problem especially among young people is of growing global concern.
Every Friday and Saturday night our police fight an ongoing battle against booze-fuelled crime and disorder, and our accident and emergency centres handle the casualties, said British Home Secretary Theresa May on 28 July this year as she called for reform of the laws permitting 24-hour drinking in the United Kingdom of Great Britain and Northern Ireland. The previous government had extended drinking hours in 2005 without first dealing with the problems of binge drinking, she said.
Last year there were almost one million violent crimes that were alcohol-related and around half of all violent crime was considered alcohol-related by victims, she said. Nearly 7 million attendances at hospital accident and emergency services are estimated to be alcohol-related, at a cost of around 650 million British pounds sterling (£) per year to the taxpayer ... Overall, the total costs of alcohol-related crime and disorder to the taxpayer are estimated to be between £8 and 13 billion per year.
May said the government would seek to ban shops from selling alcohol at below-cost price and would double the fine for under-age sales, among other measures that would give local authorities more control over pubs and clubs.
Alcohol-related violence is a visible problem in many high-income countries like the United Kingdom, where it is measured. However, the problem is also found in many developing countries where liquor is often brewed illegally, sales are unregulated and violence statistics are not collected. Without proper surveillance it is impossible to know the true extent of the problem.
Every year, the harmful use of alcohol is estimated to kill 2.5 million people, of whom 320 000 are young people aged between 15 and 29 years. Alcohol is implicated in one quarter of all homicides globally.
Studies linking youth violence and harmful alcohol use have been conducted in several countries. In Australia, a report released by the government this year stated that young people aged 1014 years who had engaged in binge drinking in the previous two weeks were five times more likely to have been violent than nonbinge drinkers.
Another study published in Substance Use & Misuse in 2010 compared the consequences of drinking among several European countries. In the Czech Republic, at least 15% of surveyed binge drinkers between the ages of 24 and 32 engaged in physical fights after alcohol consumption. A report released in 2001 showed that 80% of violent crime committed by young people in Estonia has been linked to alcohol abuse. And a study released by the Pan American Health Organization (PAHO) shows that, in Costa Rica, approximately 34% of drinkers between the ages of 18 and 29 engaged in fighting while drinking.
Research from the United States of America in 2003 has shown that about 5000 young people under the age of 21 die from alcohol-related injuries each year. An estimated 1600 (32%) of these deaths are a result of homicide fuelled by alcohol. And in 2005, another American study showed that some 700 000 university students are assaulted each year by other students who have been heavily drinking.
The definition of binge drinking and the size of a standard drink vary widely between and even within countries. The World Health Organization (WHO) currently defines heavy episodic drinkers as adults (aged > 15 years) who consume at least 60 grams or more of pure alcohol at least once a week. This corresponds approximately to six standard alcoholic drinks. The WHO-based Global Information System on Alcohol and Health is currently working on developing international standards for measuring the harmful use of alcohol.
Alcohol consumption varies immensely among countries, different population groups and over different periods of time depending on the political and social environment, says Dag Rekve, from the Department of Mental and Substance Abuse at WHO. The individual drinking pattern of alcohol consumption is very much dependent on the prevalent attitudes to alcohol and existing drinking culture in the country, he adds.
The drinking culture in the United Kingdom, for example, has evolved in surprising ways. In the 1990s the United Kingdom's Youth Justice Board documented a striking cultural change: the appearance of a new breed of drinkers young women who drink heavily and have a tendency towards violence. A 2009 report by the board showed that the number of violent offences carried out by girls aged between 10 and 17 has increased from 2001 to almost 2008. Alcohol is one of the main factors: approximately one in three young women aged 15 to 16 admits that she binge-drinks, the report said.
In countries such as France, public binge drinking is a relatively recent phenomenon which marks a dramatic cultural change as witnessed by the giant cocktail parties (apéro géant) organized through social networks such as Facebook. One of these drinking parties, which was held in the main square of Nantes in May, was attended by around 10 000 people. By the end of the party, a young man had died after falling from a bridge, 41 people were arrested for drunken and disorderly behaviour, theft and violence and 57 people went to the hospital for treatment. Spain also has its own version of these public drinking bouts, called el botellón, which typically last through the night and can run for days.
Giant cocktail parties may be stealing headlines but they are still relatively rare compared to visits to the local pub or club. Increasingly, drinking is moving away from taking place in a controlled, family-oriented setting to night-time settings, says Rekve. Furthermore, some teenagers who are too young to go to bars and clubs will often drink at home and then go out into the streets. This creates more risk for alcohol-fuelled violence.
But what causes young people to drink to excess? Rekve points to a myriad of factors ranging from individual disposition, family environment and peer pressure. Equally important are broader social influences including media glamorization of drinking, alcohol pricing and opening and closing hours.
According to Dr Maristela Monteiro, senior adviser on alcohol and substance abuse at PAHO, easy accessibility of alcohol contributes to excessive drinking in parts of Latin America. The low price, increasing availability, and very few restrictions on alcohol are among some of the reasons why there is high consumption among young people, she says. So it is no surprise that there is an association between youth and violence in the region.
The data needed to inform alcohol policy can be scarce as many countries have unregulated alcohol production. In Latin America for example, informal brewing is pervasive, but ill-monitored. Home-brews such as chichi in Bolivia , cachaça in Brazil and pisco in Peru are popular drinks. The impact of these products on the alcohol market and youth consumption is not yet well understood, says Monteiro.
In South Africa, the problem of youth drinking and violence is also rising. Professor Charles Parry, director of the Alcohol and Drug Abuse Research Unit of the Medical Research Council in South Africa , says that young people's consumption in South Africa is fuelled by many things like exposure to public drunkenness, poor parental role models, poor enforcement of liquor outlet regulations, weakened influence of religious organizations and lack of adequate recreational facilities.
Aside from banning public drinking, what can governments do to address this growing problem? The United Kingdom has introduced some effective interventions to improve safety in night-time environments around pubs and clubs, such as compulsory registration of door supervisors or bouncers. However, there is an inherent tension between economic profit and reducing alcohol violence, according to Professor Mark Bellis, director of the Centre for Public Health at the Liverpool John Moores University in the United Kingdom: Community interventions based on voluntary arrangements are limited because the industry wants to maximize its profits.
One of the biggest challenges for policy-makers is trying to create safer and healthier drinking environments ensuring nights out drinking do not mean routine drunkenness and recognizing that intoxicated individuals are risking their health and safety even after they leave nightlife establishments and go back home.
To address the need for policy guidance, WHO's global strategy to reduce the harmful use of alcohol was endorsed by the World Health Assembly in May 2010. It calls on governments to introduce interventions to prevent easy access to alcohol by vulnerable groups; laws regarding drinking in public places; and policies to reduce the availability of illicit and informally produced alcohol. It also highlights the need to regulate marketing of alcohol to young people, including the use of new techniques such as social media. The endorsement of the global strategy is a huge step forward in tackling the harmful use of alcohol, says Rekve.