Wasted (27 page)

A
2008
HSE
report into alcohol-related harm in Ireland found that between 1995 and 2002, alcohol-related hospital
discharges increased by 92 per cent, while liver disease increased by 148 per cent during a similar 10-year period. The report also found an 85 per cent increase in alcohol-related injuries between
1995 and 2003, with a staggering 133,962 alcohol-related discharges between 1995 and 2004, or just over four per day. These are telling statistics, putting huge pressure on Ireland’s already
stretched health service and underlining the social costs associated with the drunken Irish.

We know also that between 1986 and 2006, the sale of alcohol in Ireland increased across all beverage categories (Hope,
A
. (2007) ‘Alcohol consumption in Ireland
1986–2006’. Health Service Executive—Alcohol Implementation Group). Beer sales increased by 32 per cent while spirits increased over the same period by 46 per cent, although, in a
new trend, the report states that the ‘most dramatic increase by volume was in wine sales with an increase of 8,121,225 litres of pure alcohol representing a 523 per cent increase, although
this was from a relatively low base. The sale of cider increased by 3,195,013 litres of pure alcohol, which represents a 647 per cent increase.’

It’s worth noting, though, that during the 20-year period this report takes account of, Ireland’s population increased by almost 20 per cent. Bearing this in mind, alcohol
consumption per capita increased over the 20 years by 48 per cent, and this increased per adult (persons aged 15 years and over) from 9.8 litres of pure alcohol in 1987 to a high of 14.3 litres in
2001. Figures for 2007 indicated that this level stood at 13.37 litres. The average level of consumption per adult in the
EU
is 10.2 litres of pure alcohol, meaning that
Ireland consistently ranks in the top five of European countries in drinking leagues. The latest figures available for 2008 come from within the industry, and point to a decline in alcohol
consumption of 5.9 per cent in 2008. The report, issued in March 2009, stated that ‘Per adult consumption decreased by 7.3 per cent in 2008, while per capita consumption went down by 7.7 per
cent. These rates are equal to the decline in consumption that was recorded in the entire seven year period between 2001–2007. As a result average consumption levels are back to 1997/98
levels.’

Yet it is unclear whether or not these figures take into account the large amount of alcohol bought in Northern Ireland (taking advantage of lower
VAT
rates) during the
same period, with suggestions that up to 10 per cent of sales had migrated across the border. Emigration out of and migration into Ireland was also higher during that period. With the economic
recession, income over the last year has fallen more sharply than it has done for a decade or so previous. In 2009 the value of the alcohol market in Ireland, despite a 2.9 per cent drop, was still
a staggering €6.9 billion, with the government taking in somewhere in the region of €1 billion in taxes annually. In financial terms, the booze is one of Ireland’s most reliable
cash cows.

One of those at the forefront of trying to get a handle on Ireland’s alcohol epidemic is Prof. Joe Barry, who divides his time between work with the Health Service Executive (
HSE
) and Trinity College Dublin. Prof. Barry was initially lending his expertise as part of the
HSE
drug services, starting in 1991, when the focus was on heroin
and methadone treatment. As time progressed, alcohol was seen more and more as a substance frequently abused, and Prof. Barry’s attention was re-directed. Alcohol consumption in Ireland
peaked in 2001, before coming down in 2002 and 2003, coinciding with an increase in government tax on spirits and cider. Trends show that consumption remained steady up until 2007, when there was
another drop. Prof. Barry points out that while alcohol consumption is lower now than it was at the turn of the noughties, in European comparisons, Ireland still ranks quite high and is not
shifting all that much. The second report of the Alcohol Strategic Taskforce noted that 58 per cent of male drinking in Ireland was binge-drinking. While the bingeing definition is modest by Irish
standards, there is now widespread European consensus that people in Ireland, the
UK
and to a certain extent Northern Europe tend to practise fairly heavy episodic drinking
as opposed to drinking with meals or on occasion. ‘There are a lot of cultural issues in Northern Europe as opposed to Southern Europe,’ says Prof. Barry. ‘In Ireland, we have to
look at what patterns we have here. Europe is so culturally diverse, not just for drinking policy but for many things. You can have some macro-
EU
policies, but with
something that is so culturally specific as alcohol, you have to have locally based national policies as well.’

But the big question is, what are those national policies in Ireland? And is there consensus between the public health lobby, the government and the drinks industries on the extent of the
problem firstly, and the manner in which it should be dealt with? Prof. Barry thinks there is huge disparity between all three sectors on how to tackle Ireland’s drink crisis. The longer that
divided approach remains, the less likely it will be to get a handle on our drinking patterns. ‘There isn’t consensus among what might be called the stakeholders,’ says Prof.
Barry. ‘The drinks industry doesn’t accept the view that there is a relationship between per capita consumption and drink-related harm. The public health and World Health Organisation
view is that a rise in per capita consumption will lead to a rise in drink-related health [problems] and social harm. The industry does not accept that. So therefore they will lobby the government
not to have any change in our drinking levels. The government isn’t unified on this either. The Strategic Taskforce in 2004 recommended that we reduce our overall per capita consumption to
the European average, which at the time would have been an eighteen per cent reduction. So that is the premise on which public health practitioners are working. Minister Harney in the Dáil
last year agreed that we need to reduce our overall consumption.’

I was keen to get the drinks industry view on per capita consumption, so put this point to Kieran Tobin, chair of the Drinks Industry Group of Ireland. On paper, at least, there seems to be a
clear parallel over the last two decades between the rise in per capita consumption and the rise in alcohol-related harm statistics, from liver failure to
A&E
admittances. I asked Mr Tobin whether or not
he
believes a rise in per capita consumption and a rise in alcohol related harm were related.

‘Not necessarily. I don’t believe there is an absolute and direct link between the two. You can have misuse of alcohol at low and medium per capita consumption. If you are saying
that by driving down consumption you are going to do away or reduce alcohol-related harm, we don’t believe that will work. What might happen is as people get more informed and more educated
about alcohol-related issues, then we might see people more careful. That might result in a slight decline. But I don’t think driving down the average consumption will do anything to inform
and educate people. We always work on the basis that the vast majority of people enjoy alcohol in a sensible manner and that alcohol-related harm is not an issue for the vast majority.’

But if studies show that 58 per cent of the adult male population takes part in binge-drinking, then how true is it that the ‘vast majority of people enjoy alcohol in a sensible
manner’?

And in a country of our size, does 133,962 alcohol-related discharges between 1995 and 2004 not signify a widespread problem relationship with alcohol?

If we side-step the drinks industry views for a moment, and assume that reducing per capita consumption is government policy, then it’s worth asking, how does the state currently try to
achieve this policy? With the economy in freefall since 2008, the government is looking to gather all revenue it can to balance the books; therefore, reducing the drinking levels may not be in the
best interests of the Department of Finance, for example. For any government policy to work, there needs to be a clear idea within government on where the responsibility falls to tackle the
issue—be it the Department of Health or Justice. Perhaps the most successful State intervention in the area of alcohol misuse has come in the form of drink-driving campaigns, specifically
with the introduction of random breath testing. This has seen a reduction in deaths on the road. Yet the majority of government legislation on alcohol emanates from the Department of Justice, as
opposed, say, to the Department of Health, meaning that alcohol misuse is still seen primarily as a law-and-order issue as opposed to a health one. ‘The problem is there isn’t really a
national strategy in relation to alcohol as there is, for instance, in illicit drugs,’ says Prof. Barry. ‘So if you are asking me what’s the policy, well, that depends on who you
ask.’

——

I wanted to put some of these issues to the Irish government and hear firsthand what exactly is being done to tackle the issue of alcohol abuse in Ireland. Having heard already
from public health campaigners like Prof. Joe Barry and Dr Chris Luke, from frontline staff in places like the Aislinn Centre, where treatment beds for youngsters are at a huge premium, it was
clear that government in Ireland has a huge role to play. And it’s not as if they can plead ignorance on the issues, with so many government-funded surveys pointing in the same direction.
Having put an interview request to the Department of Health to speak with Health Minister Mary Harney, I was instead directed to the Minister of State at the Department of Health and Children with
special responsibility for health promotion and food safety, namely Minister Mary Wallace. This was the person tasked by the government to comprehensively draw together existing strands of
government thinking and policy and bring about a positive legislative impact on alcohol misuse. I met with Minister Wallace in her office in Leinster House, while her Department advisor Robbie
Breen sat in on the interview. The following is a transcript of our conversation and an indication of government efforts, thinking and insight.

BO’C:

The graphs indicate that the issue of alcohol abuse in Ireland has been steadily rising over the last two decades. Does the government acknowledge that? And what is the
government’s approach to tackling this area?

Minister Wallace:

From our point of view in the Health Promotion Unit we’d be very concerned about the situation and I suppose one of the big steps taken last year was the Intoxicating
Liquor Act. We do feel that the whole availability of alcohol in areas such as off-licences and supermarkets is a problem. The whole increase in the number of off-licences in the country has had a
huge impact. So a couple of things have happened. The fact that people can’t buy drink in these places now past ten p.m.—that has been useful. The price of getting a licence for an
off-licence was one hundred euro, we increased this to three hundred euro, because, again, of this whole forecourt access to alcohol and the presence of alcohol. We’ve also had the separation
of alcohol and food in supermarkets and the removal away from the front door. We see this as very important, because whether we’re talking about alcohol or indeed if you look across all the
addictions, including obesity, the same principle applies. The principle is that the environment in which we all do our business needs to change.

BO’C:

Are the changing of licensing laws and the changing of alcohol placement in shops merely just tinkering around the edges of Ireland’s alcohol problem? For instance, what
are the underlying issues in Ireland that make our society so prone to alcohol abuse, and is government doing anything to tackle those underlying issues?

Minister Wallace:

We would look at the whole issue of advertisement and sponsorship also. The government decided in April 2008 to set up groups to look at these issues. Now, again, when you go
into looking at these issues, things may seem straightforward at the beginning but then you see all the complexities with it. But we would certainly be saying if you look at rugby and the Heineken
Cup and if you look across all the different sports you discover there is alcohol involved in the sponsorship of sport. We would see that as being an issue that we will be having a good look at. We
can talk about statistics all day but one of the big concerns we have is the increase in younger women involved in alcohol and we have a graph we can show you which is actually frightening. In
terms of alcohol-related discharges from hospitals seventy-five per cent will be men, twenty-five per cent will be women. But when you look at the seventeen-year-olds you discover forty-seven per
cent are women and fifty-three per cent young men. The younger women issue as, indeed, the teenagers and the whole youth aspect to alcohol, is becoming more and more of a concern to us.

BO’C:

Just on that, I was in the Aislinn Centre recently in Kilkenny. They tell me they have fourteen beds, and that, as far as they are aware, it is the only residential centre in
Ireland where juveniles under the age of twenty-one can be treated for addiction. When you take out
HSE
-owned beds and probation beds, it leaves four to six beds for the
treatment of children for the whole of Ireland. So, if the government acknowledges there is a rise in alcohol abuse in Ireland, particular[ly] amongst young people, how come there are only fourteen
beds in the whole country to treat young addicts?

Minister Wallace:

Treatment is a big issue across all the sides of it. There is a lot of treatment in communities and I’d be aware of a lot of treatment issues. But the big problem first of
all is the early age with which people are actually starting to drink. One of the most important messages is that I’m not quite sure that parents have embraced the seriousness of a fourteen-
or fifteen-year-old drinking. If I were writing a chapter in any book I would write a chapter on the importance of delaying the first drink. If we could delay it from fourteen to over twenty it
would make such a huge difference. There are people who say to me they can’t understand why their loving child in primary and post-primary school didn’t do as well in the Leaving Cert
and then dropped out of college. They don’t seem to see the link between the impact of alcohol on the young brain. So if there were to be one strong message, I would say the whole importance
of knowing where children are. So government can do
X
,
Y
and
Z
, but way back at the very beginning of it—if I was to
say I have a priority as Minister on the alcohol side—that priority would be the younger teenagers and in relation to the whole delaying issue.