tag:theconversation.com,2011:/fr/topics/alcohol-risks-27726/articlesAlcohol risks – The Conversation2024-02-12T05:53:46Ztag:theconversation.com,2011:article/2232932024-02-12T05:53:46Z2024-02-12T05:53:46ZWhy it’s a bad idea to mix alcohol with some medications<figure><img src="https://images.theconversation.com/files/574811/original/file-20240211-26-dgcv36.jpg?ixlib=rb-1.1.0&rect=40%2C130%2C6669%2C4335&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-taking-prescription-medicine-home-1768003094">pikselstock/Shutterstock</a></span></figcaption></figure><p>Anyone who has drunk alcohol will be familiar with how easily it can lower your social inhibitions and let you do things you wouldn’t normally do. </p>
<p>But you may not be aware that mixing certain medicines with alcohol can increase the effects and put you at risk.</p>
<p>When you mix alcohol with medicines, whether prescription or over-the-counter, the medicines can increase the effects of the alcohol or the alcohol can increase the side-effects of the drug. Sometimes it can also result in all new side-effects.</p>
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Read more:
<a href="https://theconversation.com/hilda-survey-at-a-glance-7-charts-reveal-were-smoking-less-taking-more-drugs-and-still-binge-drinking-223004">HILDA survey at a glance: 7 charts reveal we're smoking less, taking more drugs and still binge drinking</a>
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<h2>How alcohol and medicines interact</h2>
<p>The chemicals in your brain maintain a delicate balance between excitation and inhibition. Too much excitation can lead to <a href="https://www.medicalnewstoday.com/articles/324330">convulsions</a>. Too much inhibition and you will experience effects like sedation and depression.</p>
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<p>Alcohol works by increasing the amount of inhibition in the brain. You might recognise this as a sense of relaxation and a lowering of social inhibitions when you’ve had a couple of alcoholic drinks. </p>
<p>With even more alcohol, you will notice you can’t coordinate your muscles as well, you might slur your speech, become dizzy, forget things that have happened, and even fall asleep. </p>
<figure class="align-center ">
<img alt="Woman collects beer bottles" src="https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Alcohol can affect the way a medicine works.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-group-of-people-standing-around-a-table-with-green-bottles-BeSMeRIrrDQ">Jonathan Kemper/Unsplash</a></span>
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<p>Medications can interact with alcohol to <a href="https://awspntest.apa.org/record/2022-33281-033">produce different or increased effects</a>. Alcohol can interfere with the way a medicine works in the body, or it can interfere with the way a medicine is absorbed from the stomach. If your medicine has similar side-effects as being drunk, those <a href="https://www.drugs.com/article/medications-and-alcohol.html#:%7E:text=Additive%20effects%20of%20alcohol%20and,of%20drug%20in%20the%20bloodstream.">effects can be compounded</a>. </p>
<p>Not all the side-effects need to be alcohol-like. Mixing alcohol with the ADHD medicine ritalin, for example, can <a href="https://www.healthline.com/health/adhd/ritalin-and-alcohol#side-effects">increase the drug’s effect on the heart</a>, increasing your heart rate and the risk of a heart attack. </p>
<p>Combining alcohol with ibuprofen can lead to a higher risk of stomach upsets and stomach bleeds. </p>
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Read more:
<a href="https://theconversation.com/whats-happening-to-us-when-we-get-drunk-51245">What's happening to us when we get drunk?</a>
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<p>Alcohol can increase the break-down of certain medicines, such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0149763421005121?via%3Dihub">opioids, cannabis, seizures, and even ritalin</a>. This can make the medicine less effective. Alcohol can also alter the pathway of how a medicine is broken down, potentially creating toxic chemicals that can cause serious liver complications. This is a particular problem with <a href="https://australianprescriber.tg.org.au/articles/alcohol-and-paracetamol.html">paracetamol</a>. </p>
<p>At its worst, the consequences of mixing alcohol and medicines can be fatal. Combining a medicine that acts on the brain with alcohol may make driving a car or operating heavy machinery difficult and lead to a serious accident.</p>
<h2>Who is at most risk?</h2>
<p>The effects of mixing alcohol and medicine are not the same for everyone. Those most at risk of an interaction are older people, women and people with a smaller body size. </p>
<p>Older people do not break down medicines as quickly as younger people, and are often on <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/medicines-use-older-people/61-polypharmacy-75-years-and-over#:%7E:text=is%20this%20important%3F-,Polypharmacy%20is%20when%20people%20are%20using%20five%20or%20more%20medicines,take%20five%20or%20more%20medicines.">more than one medication</a>. </p>
<p>Older people also are more sensitive to the effects of medications acting on the brain and will experience more side-effects, such as dizziness and falls. </p>
<figure class="align-center ">
<img alt="Woman sips red wine" src="https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&rect=321%2C47%2C7618%2C5249&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Smaller and older people are often more affected.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-drinking-glass-of-wine-I-_Zmz6G6PU">Alfonso Scarpa/Unsplash</a></span>
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<p>Women and people with smaller body size tend to have a higher blood alcohol concentration when they consume the same amount of alcohol as someone larger. This is because there is less water in their bodies that can mix with the alcohol.</p>
<h2>What drugs can’t you mix with alcohol?</h2>
<p>You’ll know if you can’t take alcohol because there will be a prominent warning on the box. Your pharmacist should also counsel you on your medicine when you pick up your script.</p>
<p>The most common <a href="https://adf.org.au/insights/prescription-meds-alcohol/">alcohol-interacting prescription medicines</a> are benzodiazepines (for anxiety, insomnia, or seizures), opioids for pain, antidepressants, antipsychotics, and some antibiotics, like metronidazole and tinidazole.</p>
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<img alt="" src="https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Medicines will carry a warning if you shouldn’t take them with alcohol.</span>
<span class="attribution"><span class="source">Nial Wheate</span></span>
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<p>It’s not just prescription medicines that shouldn’t be mixed with alcohol. Some over-the-counter medicines that you shouldn’t combine with alcohol include medicines for sleeping, travel sickness, cold and flu, allergy, and pain. </p>
<p>Next time you pick up a medicine from your pharmacist or buy one from the local supermarket, check the packaging and ask for advice about whether you can consume alcohol while taking it. </p>
<p>If you do want to drink alcohol while being on medication, discuss it with your doctor or pharmacist first.</p>
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<strong>
Read more:
<a href="https://theconversation.com/ten-reasons-some-of-us-should-cut-back-on-alcohol-70406">Ten reasons some of us should cut back on alcohol</a>
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<img src="https://counter.theconversation.com/content/223293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p><p class="fine-print"><em><span>Kellie Charles was a previous Board Member of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists. </span></em></p><p class="fine-print"><em><span>Associate Professor Tina Hinton has previously received funding from the Schizophrenia Research Institute (formerly Neuroscience Institute of Schizophrenia and Allied Disorders). She is currently a Board member of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists.</span></em></p><p class="fine-print"><em><span>Jasmine Lee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Taking a medicine with alcohol can increase effects like sedation, poor hand and eye coordination, dizziness and poor judgement.Nial Wheate, Associate Professor of the School of Pharmacy, University of SydneyJasmine Lee, Pharmacist and PhD Candidate, University of SydneyKellie Charles, Associate Professor in Pharmacology, University of SydneyTina Hinton, Associate Professor of Pharmacology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921792022-10-27T23:51:32Z2022-10-27T23:51:32Z‘I take it with a pinch of salt’: why women question health warnings linking alcohol with breast cancer<figure><img src="https://images.theconversation.com/files/492025/original/file-20221027-13-3n7rkv.jpg?ixlib=rb-1.1.0&rect=0%2C28%2C6349%2C4191&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Up to <a href="https://adf.org.au/insights/alcohol-breast-cancer/#:%7E:text=There's%20a%20direct%20link%20between%20drinking%20alcohol%20and%20breast%20cancer.&text=In%20Australia%2C%20up%20to%201,cancers%20is%20related%20to%20drinking.&text=But%2C%20many%20people%20just%20don,cancer%20risk%20associated%20with%20drinking.">one in ten</a> cases of breast cancer in Australia is linked to drinking alcohol. Midlife women are already at increased risk for breast cancer because of their age, and <a href="https://www.aihw.gov.au/getmedia/77dbea6e-f071-495c-b71e-3a632237269d/aihw-phe-270.pdf.aspx?inline=true">tend to drink more than younger women</a>. That means this group is at even more risk for breast cancer. </p>
<p>Health authorities have mostly so far dealt with this by telling women not to drink. But does this approach – which positions drinking as an individual’s “problem” based on their own “bad” choices – actually work?</p>
<p>In fact, our recent <a href="https://pubmed.ncbi.nlm.nih.gov/36095014/">study</a> found women aren’t necessarily aware of the link between alcohol and breast cancer. And even when they are, they aren’t always able to “choose” to quit.</p>
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<a href="https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman looks at her wine glass." src="https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488928/original/file-20221010-57785-g8xev5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Women face mixed messages about alcohol and cancer risk.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/adult-people-portrait-woman-3183055/">Image by Thomas Rüdesheim from Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>What women told us</h2>
<p>We wanted to better understand where women sought health information, how they accessed information specific to breast cancer risk as it relates to alcohol, and how they determined whether (or not) such information was trustworthy.</p>
<p>We interviewed 50 “midlife” women (aged 45-64) living in South Australia from different social classes. </p>
<p>Previous <a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">research</a> has shown alcohol consumption performs a range of important functions for women, such as coping, socialising, networking and managing difficulties. Women often feel they cannot necessarily “choose” not to drink in these circumstances.</p>
<p>Women also face mixed messages about alcohol and cancer risk. Some alcohol brands <a href="https://pubmed.ncbi.nlm.nih.gov/26350708/">display pink ribbons</a> in an effort to “raise awareness” about breast cancer. And more broadly, media reports have come and gone over the years about the purported risks or benefits of alcohol for various illnesses.</p>
<p>Many women in our study did not know that alcohol causes breast cancer. But upon hearing about it, they mostly wanted to know more.</p>
<p>One woman told us:</p>
<blockquote>
<p>I didn’t realise there was a link and I went on and interrogated it after that, because I do enjoy a glass of wine. And I wondered, what am I knowingly getting into here […] and to understand how alcohol affects your body, in terms of it increases the estrogen levels, and so that has a link to breast cancer.</p>
</blockquote>
<p>Others thought if knowledge became more common, breast cancer risk messages might more likely be accepted (or, at least, be less likely to be rejected). One woman told us:</p>
<blockquote>
<p>I think sometimes the more information comes out, or the more it’s repeated, the more it becomes common knowledge for people rather than easily dismissed.</p>
</blockquote>
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<a href="https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman drinks champagne." src="https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488926/original/file-20221010-58516-y23r1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Many women in our study did not know that alcohol causes breast cancer.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/woman-drink-glass-wine-alcohol-5943480/">Image by Bastian Riccardi from Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<em>
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Read more:
<a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">'Oh well, wine o’clock': what midlife women told us about drinking – and why it's so hard to stop</a>
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<h2>Questioning the message and the messenger</h2>
<p>But, even if women are aware, the message that alcohol causes breast cancer can be difficult and confusing to hear. In response, trust in the message can waver. As one woman said:</p>
<blockquote>
<p>I do question quite a lot because I do think the media play it up […] I take it with a pinch of salt.</p>
</blockquote>
<p>Messages that seem exaggerated were also off-putting. As one woman put it:</p>
<blockquote>
<p>First of all, you just look at the tone of the way they wrote about things, you’d probably, if you thought it’d been sensationalised, or if they were axe-grinding.</p>
</blockquote>
<p>Indeed, encountering conflicting information in daily life made some public health messages feel less believable to some women we spoke to. Some women instead preferred to rely on “gut feeling” to judge information.</p>
<p>Considering who and what to trust in terms of information about alcohol and breast cancer was key for women. Some want these complexities to be recognised and messages to be delivered in “even-handed” ways. As one woman told us:</p>
<blockquote>
<p>You just listen to it, see if they’re going to be harping on a certain theme, maybe without having any basis for saying so, if they’re trying to push a certain point of view without having any basis or back-up for that. Rather than someone being even-minded about, you know, even-handed about things.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1894%2C1256&q=45&auto=format&w=1000&fit=clip"><img alt="A woman drinks beer outdoors." src="https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1894%2C1256&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488925/original/file-20221010-58076-3ly4qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Health messaging for women around alcohol breast cancer risk must acknowledge the social and commercial factors that encourage alcohol consumption.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/beer-drink-alcohol-woman-girl-bar-4620372/">Image by Engin Akyurt from Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Sceptical of experts</h2>
<p>Some women, especially those living with disadvantage, were more likely to be sceptical of information and information sources, even if it is based on research from experts. </p>
<p>They described needing time to consider messages and judge them as trustworthy, with some feeling research evidence can be skewed to serve different interests. As one put it:</p>
<blockquote>
<p>Well, I know there’s been various research done but I have to admit I tend to be rather sceptical about certain research […] things can be found that really say “Oh, yes, this is what [has been found] and then someone will come along and [say] "No, it’s not like that at all”.</p>
</blockquote>
<p>We found women want to trust clear, consistent and non-judgemental messaging, otherwise distrust in the message and messenger might become the default position. </p>
<p>Health messaging for women around alcohol breast cancer risk must acknowledge the social and commercial factors that encourage alcohol consumption.</p>
<p>Too often, public health messaging asks women to take on the responsibility of reducing their alcohol consumption – without enough recognition that the same women are targeted by alcohol advertising and many <a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">see alcohol</a> as a reliable “friend” in the absence of other social support.</p>
<p>If we don’t acknowledge that, we risk perpetuating the same stigma and blame that drives women to drink in the first place.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/192179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Belinda Lunnay receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Samantha Meyer receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Paul Ward does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our study found women aren’t necessarily aware of the link between alcohol and breast cancer. And even when they are, they aren’t always able to ‘choose’ to quit.Belinda Lunnay, Post-doctoral researcher in Public Health , Torrens University AustraliaPaul Ward, Professor of Public Health, Torrens University AustraliaSamantha Meyer, Associate Professor in Public Health, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1896672022-08-31T20:19:55Z2022-08-31T20:19:55ZCanada’s low-risk alcohol use guidelines have been slashed to 6 drinks per week. Here’s why.<figure><img src="https://images.theconversation.com/files/481979/original/file-20220831-1977-ixc18l.JPG?ixlib=rb-1.1.0&rect=7%2C464%2C4985%2C3023&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Canada's previous low-risk drinking guidelines were much more generous, allowing significantly more drinks per week.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/canada-s-low-risk-alcohol-use-guidelines-have-been-slashed-to-6-drinks-per-week--here-s-why-" width="100%" height="400"></iframe>
<p>New <a href="https://ccsa.ca/update-canadas-low-risk-alcohol-drinking-guidelines-final-report-public-consultation-report">Canadian guidelines</a> for reducing risks to health from alcohol use were released for public comment this week. Key messages include:</p>
<ul>
<li>drinking less alcohol is better for health;</li>
<li>health risks escalate quickly above six standard drinks per week, especially for women;</li>
<li>do not exceed two drinks on any one day to minimize risks;</li>
<li>alcohol is a carcinogen;</li>
<li>alcohol containers should carry prominent health warnings.</li>
</ul>
<p>You may be asking, who took it upon themselves to give this advice to the public and upon what basis? I am a scientist at the <a href="https://www.uvic.ca/research/centres/cisur/">Canadian Institute for Substance Use Research</a> and was a member of the panel that generated this advice. I have also advised or been a panelist on four previous guideline committees over the past 30 years including for Australia, the United Kingdom and Canada. </p>
<p>I try to explain here some of the underlying science and how it has evolved, principally why drinking guidelines internationally have lowered definitions of “low-risk” alcohol use.</p>
<h2>Why have the guidelines changed?</h2>
<p>The new guideline development was led by the Ottawa-based Canadian Centre on Substance Use and Addiction (CCSA) with funding from Health Canada. The previous <a href="https://www.ccsa.ca/sites/default/files/2020-07/2012-Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en_0.pdf">2011 guidelines</a> were far more generous: low-risk drinking was defined as up to 10 standard drinks per week for women and 15 for men. </p>
<figure class="align-center ">
<img alt="A shopping cart with several bottles of liquor in it" src="https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Canada, alcohol containers do not state how many standard drinks they contain.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>A standard drink is a <a href="https://doi.org/10.3109/16066359.2014.955480">mystery to many people</a>, not least because unlike in some other countries (e.g. <a href="https://www.foodstandards.gov.au/consumer/labelling/Pages/Labelling-of-alcoholic-beverages.aspx">Australia and New Zealand</a>) alcohol containers here do not state how many standard drinks they contain. In Canada, a standard drink is defined as 13.45 grams of ethanol, which corresponds to typical serve sizes of average strength beer, wine and spirits: </p>
<ul>
<li>341 millilitres of beer or cider (5 per cent alcohol), </li>
<li>142 millilitres of wine (12 per cent alcohol) or </li>
<li>43 millilitres of spirits (40 per cent alcohol.</li>
</ul>
<p>What has changed in the past 11 years? Why is an expert committee now recommending much lower guidelines? I was also a member of the panel for the 2011 guidelines, which were based upon the simple idea that low-risk drinking was a level that didn’t increase health risks above that of an abstainer. </p>
<h2>Criticism of the old guidelines</h2>
<p>In compiling the 2011 guidelines, we looked at comprehensive reviews of the link between alcohol use and risk of premature death. These almost invariably showed that light and moderate drinkers had less risk than abstainers but, above a break-even point, health risks quickly escalated. Many observational studies have suggested low-volume drinkers are “protected” from heart disease, type II diabetes and some kinds of stroke. This evidence is <a href="https://world-heart-federation.org/wp-content/uploads/WHF-Policy-Brief-Alcohol.pdf">now questioned</a>.</p>
<p>Based on the best quality systematic review available at that time we noted that at two drinks per day for women and three for men, mortality risks were equal to those for abstainers. We recommended at least two days of abstinence a week ending up with the 2011 guideline of 10 drinks per week for women and 15 per week for men.</p>
<p>This approach has <a href="https://doi.org/10.1111/dar.12866">been criticized</a> from many angles. Studies in such reviews are from all over the world, albeit with a North American and European bias, but estimates should be tailored more precisely for any specific country. Another criticism is that estimates of the association between level of alcohol use and death from all causes will be heavily confounded by other lifestyle factors. </p>
<p>A better approach, these critics argue, is to estimate risks from alcohol use for a select number of diseases and types of injury known to be caused by alcohol, such as liver disease, breast cancer, road crash injuries, etc. </p>
<p>When such an approach is used, this break-even point (the point at which potential benefits and risks cancel each other out) is at a much lower level than from the all-cause mortality studies. My colleagues and I <a href="https://www.jsad.com/doi/10.15288/jsad.2020.81.352">recently estimated</a> this would be at about one drink per day, even assuming some protection against heart disease.</p>
<h2>Risk levels</h2>
<p>With the net risk of alcohol-related harm increasing at even low levels of consumption, guideline committees in other countries (such as <a href="https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking">the U.K.</a> and <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">Australia</a>) have resorted to defining an “acceptable” level of risk from alcohol. </p>
<p>For external risks such as from air pollution or radiation from a nuclear power reactor, acceptable risk is generally taken as being an increase in mortality risk of less than <a href="https://doi.org/10.1186/s12916-014-0189-z">one in a million</a>. If an equivalent risk for external factors was taken for alcohol, I calculate that would mean, on the basis of the new guideline risk estimates, not drinking more than one drink every 20 years!</p>
<p>For personal behaviours such as sexual risk-taking, smoking and alcohol use, people are prepared to accept higher levels of risk, for example, up to one in 100.</p>
<h2>New Canadian guidelines</h2>
<p>The new Canadian guidelines followed strict procedures for making as impartial and up-to-date an estimate as possible. Committee members were public health, medical and epidemiology experts who had no financial interests in the manufacture or sale of alcohol. </p>
<p>An independent team used strictly defined search criteria to locate the latest high quality published studies on alcohol risks for health conditions specified by the World Health Organization’s <a href="https://doi.org/10.1016/S0140-6736(18)31310-2">Global Burden of Disease</a> study group. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three cocktails with garnishes: an orange beverage in a wine glass, a red beverage and a yellow beverage in short glasses" src="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinking at the new guideline levels will still shave off two or three months of life expectancy — or about five minutes per drink.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>When these risk relationships were collected and applied to Canadian data on causes of death and life expectancy, it was estimated that lifetime mortality risk from alcohol was less than one in 100 for men and women consuming no more than six drinks per week. Risks were elevated even at two drinks per week, at a risk level just under one in 1,000.</p>
<p>These new guidelines are provided on the basis of the latest science, guided by the principle that citizens have a right to know potential health effects of products. This <a href="https://doi.org/10.15288/jsad.2020.81.284">is especially true</a> for products distributed and sold directly by Canadian governments in most provinces and territories. </p>
<h2>Alcohol and heart health</h2>
<p>The careful review process identified much weaker evidence than before for the hypothesis that low doses of alcohol can protect against heart disease. This finding is also consistent with a <a href="https://world-heart-federation.org/news/no-amount-of-alcohol-is-good-for-the-heart-says-world-heart-federation/">World Heart Federation</a> statement released earlier this year, advising that the science underlying this hypothesis is now highly contested and, at best, extremely weak.</p>
<p>My colleagues and I are keen to see how these new guidelines are received. There is still much more work to be done, including determining the acceptable level of risk from alcohol for most people. We have calculated that drinking at these new guideline levels will still shave off two or three months of life expectancy — or about five minutes per drink. Is this acceptable to most people? It’s a conversation we need to continue.</p><img src="https://counter.theconversation.com/content/189667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Stockwell currently receives funding from:
The Canadian Institute for Substance Use Research at the University of Victoria employs me as a part-time scientist;
The Canadian Institutes for Health Research to estimate the impact of alcohol policies on cancer-related illness;
The Public Health Agency of Canada to model the impacts of alcohol policies on alcohol-related illness and death.
I have previously received grants from many research councils, and government agencies. The latter includes government-owned alcohol distribution and retail agencies in Scandinavia (Systembolaget and Alko) and Canada (BC government) for studies of alcohol and public health. I do not receive funding from alcohol industry sources.</span></em></p>Canada’s new alcohol guidelines cut the number of drinks per week in the ‘low-risk’ category by almost half for women, and by more than half for men. Here’s how researchers came to these conclusions.Tim Stockwell, Scientist, Canadian Institute for Substance Use Research and Professor of Psychology, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1455932020-09-20T11:54:44Z2020-09-20T11:54:44ZFetal alcohol spectrum disorder amid COVID-19: Fewer services, potential boost in rates<figure><img src="https://images.theconversation.com/files/357324/original/file-20200909-24-8g1odx.jpeg?ixlib=rb-1.1.0&rect=49%2C0%2C1228%2C850&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">iStock HR</span> <span class="attribution"><span class="source">(iStock)</span></span></figcaption></figure><p>Fetal alcohol spectrum disorder (FASD) is the leading <a href="https://doi.org/10.1503/cmaj.1040302">developmental disability</a> in Canada. Despite its preventable nature, there is concern among FASD researchers about a potential increase in <a href="https://doi.org/10.1016/S2468-2667(20)30159-6">FASD prevalence rates</a> as a result of COVID-19, in addition to the impact the pandemic is having on the community. </p>
<p>FASD is a lifelong disability affecting people who were exposed to alcohol prenatally. In Canada, <a href="https://doi.org/10.1186/s12889-019-7213-3">more people have FASD than autism spectrum disorder, cerebral palsy and Down syndrome combined</a>. </p>
<p>Current rates are conservatively estimated to be <a href="https://canfasd.ca/topics/prevalence/#1566501610553-4aece41f-3dc2">approximately four per cent</a> in North America. However, FASD is <a href="https://doi.org/10.1093/pch/14.4.231">very challenging to diagnose</a>, and many experts believe that its prevalence is <a href="https://doi.org/10.1001/jama.2017.21896">actually much higher</a>.</p>
<h2>COVID-19 compounds challenges in this community</h2>
<p><a href="https://canfasdblog.com/2020/08/07/life-with-covid-19-from-a-caregivers-perspective/">Anecdotally</a>, we know that individuals with FASD and their families are facing increased challenges as a result of this pandemic. Caregivers are concerned about a lack of supports, disruption in daily routine and mental health challenges. </p>
<p>Canadians with disabilities have drawn attention to their <a href="https://www.ctvnews.ca/health/coronavirus/disabled-canadians-feel-excluded-from-covid-19-messaging-1.4857691">exclusion from COVID-19 messaging</a>, as well to program cancellations and experiences of <a href="https://www.cbc.ca/news/health/covid-19-impact-on-canadians-with-disabilities-1.5525332">social isolation</a>.</p>
<p>While these disruptions can have a negative impact on all individuals, they can have greater consequences for individuals with FASD and their families. People with FASD thrive with <a href="https://www.fasdoutreach.ca/resources/all/0-9/8-magic-keys">consistency and routine</a>, but the pandemic has caused massive changes to our daily lives.</p>
<p>There is also concern about the future impact on mental health. While this body of evidence is still unfolding, parents reported changes in their children’s emotional state <a href="https://doi.org/10.31234/osf.io/5bpfz">in a recent preprint manuscript (a preliminary paper that has yet to be formally reviewed)</a>, including difficulty concentrating, boredom, irritability, restlessness and nervousness. Experiences of parenting stress are also higher during COVID-19 among families reporting these emotional changes in their children. </p>
<p>These findings are concerning, especially for families of individuals with FASD who report higher levels of <a href="https://doi.org/10.3109/13668250.2013.788136">parenting stress</a> compared to families of typically developing children and even those of children with other disabilities.</p>
<figure class="align-left ">
<img alt="Silhouette of a fetus and umbilical cord in a circle." src="https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=599&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=599&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=599&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=753&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=753&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=753&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Increased alcohol consumption during the pandemic may increase rates of FASD.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Little research has been conducted to date on the <a href="https://doi.org/10.1176/appi.ajp.2020.20060780">impact of COVID-19 on individuals with disabilities</a>. However, we cannot ignore the complexities of FASD when talking about the impact COVID-19 has had in Canada, especially in terms of feelings of increased social isolation and the reported <a href="https://doi.org/10.1111/jir.12769">lack of services and unmet needs</a> facing individuals and families during this time. </p>
<h2>Alcohol consumption is on the rise</h2>
<p>In addition to the challenges faced by individuals and their families living with FASD, the COVID-19 pandemic has also drawn attention to concerns about FASD prevention.</p>
<p>Recent global data have suggested that online alcohol sales for beer, wine and spirits have <a href="https://www.port.ac.uk/news-events-and-blogs/news/how-much-more-alcohol-are-we-really-drinking">risen by a staggering 291 per cent</a> during the pandemic, although that figure does not account for any decrease in in-person alcohol sales. The Canadian Centre on Substance Use and Addiction revealed that as many as <a href="https://www.ccsa.ca/sites/default/files/2020-06/CCSA-NANOS-Increased-Alcohol-Consumption-During-COVID-19-Report-2020-en_0.pdf">20 per cent of Canadians</a> have increased their alcohol use during COVID-19, and women report drinking, on average, more drinks per day than recommended in <a href="https://www.ccsa.ca/sites/default/files/2020-07/2012-Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en_0.pdf">Canada’s Low Risk Alcohol Drinking Guidelines</a>. </p>
<p>Common reasons for the increase in alcohol consumption included a lack of a regular schedule, boredom, stress and loneliness. </p>
<p>There is currently no data to quantify if there has been an increase in alcohol use during pregnancy. However, the rise in general alcohol consumption raises concerns about the potential increase in <a href="https://theprovince.com/opinion/op-ed/lorraine-greaves-and-nancy-poole-sex-booze-and-the-three-of-you/wcm/67f23896-cd9b-4443-8138-e602e1e8a291/">alcohol-exposed pregnancies</a>. </p>
<figure class="align-center ">
<img alt="A pregnant woman sitting on a sofa holds up her hand to decline a glass of wine." src="https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Increased alcohol consumption during the pandemic could potentially affect rates of FASD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Alcohol can impact fetal development at any stage of pregnancy. There is no known safe amount, safe time or safe type of alcohol, but women often don’t know they’re pregnant until several weeks along and approximately <a href="https://doi.org/10.1111/j.1728-4465.2014.00393.x">half of all pregnancies are unplanned</a>. </p>
<p><a href="http://www.thinkfasd.ca/">Experts recommend</a> that individuals and couples go alcohol-free if they are pregnant, trying to get pregnant or having unprotected sex, which increases the risk for an unplanned pregnancy. Individuals and couples who wish to continue drinking should use reliable forms of contraception or go alcohol-free until they know they are not pregnant.</p>
<h2>Awareness and understanding are key</h2>
<p>Reducing the number of alcohol-exposed pregnancies is an important step forward in helping to reduce the prevalence of FASD. However, encouraging individuals and couples to go alcohol-free is only one piece of the broader FASD puzzle. The realities of the pandemic have also highlighted the lack of supports and services available for people with FASD and their families. </p>
<p>Addressing FASD in Canada is complex. Supportive policies, effective support and accessible services are all important pieces in a more comprehensive FASD plan, but they are not enough. In order to effectively address this national issue, we need all Canadians engaged and united with awareness and understanding. </p>
<p>A greater public awareness and understanding brings FASD into the spotlight. During <a href="https://canfasd.ca/fasd-awareness-month/">FASD Awareness Month</a>, I encourage Canadians to learn more about FASD, alcohol and pregnancy. Addressing and preventing FASD in Canada is all of our responsibility.</p><img src="https://counter.theconversation.com/content/145593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelly D. Harding works as a Research Associate for the Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD).</span></em></p>COVID-19 is not only disrupting services for people with fetal alcohol spectrum disorder (FASD) and their families, but may also be linked to an increase in rates due to an uptick in alcohol use.Kelly D. Harding, Adjunct Professor, Psychology, Laurentian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1388912020-06-15T14:28:08Z2020-06-15T14:28:08ZToo much alcohol can cause similar effects to dementia – and the two are often confused<figure><img src="https://images.theconversation.com/files/340335/original/file-20200608-176554-11kncyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An avoidable condition.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/alcohol-depression-signs-mental-health-symbol-1027569001">Shutterstock/Lightspring</a></span></figcaption></figure><p>In the UK, 21% of people are drinking more alcohol than they did before the pandemic, according to a <a href="https://alcoholchange.org.uk/blog/2020/covid19-drinking-during-lockdown-headline-findings">recent survey</a>. This follows a <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19roundup20to24april2020/2020-04-24">reported 31% increase</a> in alcohol sales at the start of lockdown.</p>
<p>For while pubs and restaurants were forced to close their doors, off licences were considered <a href="https://www.gov.uk/government/publications/further-businesses-and-premises-to-close/further-businesses-and-premises-to-close-guidance#takeaway-food-and-food-delivery-facilities-may-remain-open-and-operational">essential retailers</a>. And as traditional social gatherings were put on hold, virtual pub quizzes and online parties swiftly replaced them. Twitter hashtags such as #Quarantini and #FurloughMerlot revealed how drinking was, for many, a key element of the pandemic experience. </p>
<p>Some may have turned to alcohol to ease <a href="https://newyork.cbslocal.com/2020/03/20/coronavirus-alcohol-dependence-addiction-substance-abuse/">anxiety</a>, stress or even to <a href="https://www.bbc.co.uk/news/uk-wales-52442936">fill time</a> usually spent at the gym or socialising. But whatever the reason, while most drinkers are aware of the effect that alcohol can have on their livers or waistlines, many do not realise how excessive (and continuous) drinking can cause long-term damage to the brain. </p>
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Read more:
<a href="https://theconversation.com/how-the-coronavirus-is-putting-our-relationship-with-alcohol-to-the-test-135460">How the coronavirus is putting our relationship with alcohol to the test</a>
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<p>Alcohol-related brain damage (ARBD) is an <a href="https://pure.southwales.ac.uk/en/publications/alcoholrelated-neurocognitive-disorders-a-naturalistic-investigation-nosology-and-estimation-of-prevalence-in-the-uk(7cad127b-f1d0-4c8d-b200-d2ed5b8f0f76).html">under-recognised</a> set of <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02618/full">related conditions</a> which involves structural and functional changes to the brain. It can <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/korsakoff-syndrome">impair memory</a>, thinking, planning and reasoning, and cause changes in personality and behaviour. </p>
<p>There is currently a lack of awareness of ARBD amongst the general public as well as clinical specialists, one of whom <a href="https://pure.southwales.ac.uk/en/publications/professional-perspectives-on-supporting-those-with-alcoholrelated-neurocognitive-disorders-challenges--effective-treatment(0849e478-a0af-46d6-a587-a039670b600b)/export.html">told us</a> that recognising and diagnosing cases is a “major issue”. Signs of ARBD may even be confused with appearing intoxicated, while <a href="https://pure.southwales.ac.uk/en/publications/professional-perspectives-on-supporting-those-with-alcoholrelated-neurocognitive-disorders-challenges--effective-treatment(0849e478-a0af-46d6-a587-a039670b600b)/export.html">stigma is also</a> a barrier to recognising and treating people with the condition.</p>
<p>ARBD often starts with mild symptoms but can progress to more severe problems if alcohol is still consumed at <a href="https://www.nice.org.uk/guidance/ph24/chapter/glossary">harmful quantities</a> (defined as 35 units – roughly four bottles of wine – per week for women, and 50 units for men). </p>
<p>Initial signs of ARBD include impulsive behaviour, problems with planning and decision making, and difficulties in forming and retaining new memories. Some may also experience confabulations, which are false or distorted “memories”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=323&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=323&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=323&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=406&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=406&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=406&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Essential service?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/off-licence-55052275">Shutterstock/Happy Stock Photo</a></span>
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<p>Men are more likely to have ARBD, although <a href="https://pure.southwales.ac.uk/en/publications/alcoholrelated-neurocognitive-disorders-a-naturalistic-investigation-nosology-and-estimation-of-prevalence-in-the-uk(7cad127b-f1d0-4c8d-b200-d2ed5b8f0f76).html">studies suggest</a> that women might be more vulnerable to the effects of alcohol as females develop the condition at a significantly younger age than men. In both sexes, those in their mid to late-50s have the highest rates of ARBD, but some cases have been reported under the age of 35.</p>
<h2>Abstinence and recovery</h2>
<p>These symptoms often overlap with some of the signs of dementia, with research suggesting that <a href="https://pubmed.ncbi.nlm.nih.gov/23347747/">up to 24% of all dementia cases</a> are in fact ARBD. But while dementia patients rarely experience improvements in their condition, those with ARBD have the potential to at least partially recover. This makes it vital to distinguish the condition from dementia by considering drinking history and noticing any signs of improvement or stabilisation.</p>
<p><a href="https://www.alzheimers.org.uk/about-dementia/types-dementia/arbd-treatment-support">Treatment</a> for ARBD typically means abstinence from alcohol, followed by rehabilitation. Usually, at least <a href="https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr185.pdf?sfvrsn=66534d91_2">three months without alcohol</a> is needed to see if there are any improvements or signs that the damage might be reversible. There is no agreed “safe limit” once someone has been diagnosed, and any amount of alcohol is likely to cause more damage.</p>
<p>Although ARBD is often <a href="https://pure.southwales.ac.uk/en/publications/alcoholrelated-neurocognitive-disorders-a-naturalistic-investigation-nosology-and-estimation-of-prevalence-in-the-uk(7cad127b-f1d0-4c8d-b200-d2ed5b8f0f76).html">difficult to diagnose</a>, one report in Wales suggests an overall <a href="http://www2.nphs.wales.nhs.uk:8080/SubstanceMisuseDocs.nsf/85c50756737f79ac80256f2700534ea3/8455b3ff0835b96980257dfd0035cde3/%24FILE/Evidence-based%20profile%20of%20alcohol%20related%20brain%20damage%20in%20Wales.pdf">increase of 38.5%</a> of those diagnosed with the condition over a five-year period. </p>
<p>Nor are increases in ARBD restricted to those with poorer socioeconomic backgrounds. They are known to have <a href="https://academic.oup.com/eurpub/article/15/6/587/440068">high rates of the condition</a>, but <a href="https://www.ons.gov.uk/releases/adultdrinkinghabitsingreatbritain2017">recent figures</a> show that those with professional jobs were more likely to regularly drink alcohol compared to those on lower incomes.</p>
<p>Although alcohol may provide a short-term release from the stresses of life – particularly during a pandemic – many drinkers may be developing an unhealthy habit with alcohol that is damaging their brains. But one of the distinctive things about ARBD is that it is a preventable, treatable and potentially reversible condition, if recognised and treated early. </p>
<p>To keep control of alcohol consumption, the <a href="http://www.euro.who.int/__data/assets/pdf_file/0010/437608/Alcohol-and-COVID-19-what-you-need-to-know.pdf?ua=1">World Health Organization suggests</a> trying to maintain a routine as much as possible and focusing attention on the things that can be controlled. Instead of passing time drinking alcohol, this could be replaced by physical activity, which is known to boost the <a href="https://journals.physiology.org/doi/full/10.1152/physrev.2000.80.3.1055?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">immune system</a> and benefit <a href="https://www.karger.com/Article/PDF/223730">mental health</a>.</p>
<p>So before you reach for your #Quarantini cocktail, it is important to consider the longer term effect these kinds of habits might be having – on the brain as well as the liver.</p><img src="https://counter.theconversation.com/content/138891/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bev John has received funding from European Social Funds/Welsh Government, Alcohol Concern (now Alcohol Change), Research Councils and the personal research budgets of a number of Welsh Senedd members.</span></em></p><p class="fine-print"><em><span>Gareth Roderique-Davies has received funding from European Social Funds/Welsh Government, Alcohol Concern (now Alcohol Change), Research Councils and the personal research budgets of a number of Welsh Senedd members. </span></em></p><p class="fine-print"><em><span>Rebecca Ward does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lockdown #quarantinis might seem like a way of getting through, but few realise how much drinking can affect the brain.Rebecca Ward, Senior Research Assistant in Psychology, University of South WalesBev John, Professor of Addictions and Health Psychology, University of South WalesGareth Roderique-Davies, Professor of Psychology, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1397892020-06-03T14:55:19Z2020-06-03T14:55:19ZSouth Africa’s lockdown: a great start, but then a misreading of how society works<figure><img src="https://images.theconversation.com/files/339256/original/file-20200602-133902-hefl0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The ban on the sale of alcohol has been partially lifted, but tobacco remains prohibited. </span> <span class="attribution"><span class="source">Roger Sedres/Gallo Images via Getty Images</span></span></figcaption></figure><p>South Africa’s government is proud that its response to Covid-19 relies on science. It might be prouder if it was also guided by knowledge of how society works.</p>
<p>When South Africa’s Covid-19 lockdown began <a href="https://www.gov.za/speeches/president-cyril-ramaphosa-extension-coronavirus-covid-19-lockdown-end-april-9-apr-2020-0000">on 27 March</a>, opposition from some quarters was inevitable. What was not expected was that the most vehement resistance would be aimed at a <a href="https://www.iol.co.za/business-report/companies/gloves-are-off-as-british-american-tobacco-sa-goes-to-court-over-cigarette-ban-48770972">ban on selling tobacco products</a>. Only around <a href="https://bhekisisa.org/article/2018-12-05-00-how-many-people-in-south-africa-smoke/">1 in 5 South Africans smoke</a> and previous government limits on smoking were not controversial.</p>
<p>The ban generated such heat because, when the government <a href="https://mg.co.za/article/2020-04-23-ramaphosa-announces-gradual-easing-of-covid-19-lockdown-in-south-africa/">began relaxing the lockdown</a>, President Cyril Ramaphosa announced that tobacco sales would be allowed. Then, at the apparent prompting of the minister responsible for lockdown rules, Nkosazana Dlamini-Zuma, <a href="https://mg.co.za/article/2020-04-29-level-four-lockdown-dlamini-zuma-stubs-out-south-africas-hopes-for-a-puff/">the decision was reversed</a>; the ban is still in force.</p>
<p>Dlamini-Zuma has an unfortunate tendency to lecture rather than persuade and her role seems to have turned muttered resentment among some into loud anger, directed not only at the tobacco ban but the <a href="https://businesstech.co.za/news/government/397953/da-to-challenge-irrational-lockdown-rules-in-court/">entire lockdown</a>. And, since the loudest opposition has come from <a href="https://www.dailymaverick.co.za/article/2020-05-28-tobacco-ban-unpacking-dlamini-zumas-defence/">white suburbanites</a>, it has revived the familiar conservative argument that a <a href="https://www.biznews.com/thought-leaders/2017/11/15/nanny-state-sa-tobacco-laws">“nanny state”</a> is telling citizens that it knows more about what is good for them than they do.</p>
<p>This complaint says more about the prejudices of those who make it than reality.</p>
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Read more:
<a href="https://theconversation.com/lockdown-is-riling-black-and-white-south-africans-could-this-be-a-reset-moment-138044">Lockdown is riling black and white South Africans: could this be a reset moment?</a>
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<p>All governments restrict citizens to protect their health and safety: this is why we have traffic lights. And all democracies allow governments to restrict freedoms to protect citizens in an emergency – by, for example, cordoning off areas hit by fire and flood. </p>
<p>The “nanny state” argument expresses a belief that some of us should not be told what to do by those they consider their inferiors.</p>
<p>But this does not mean health measures will be obeyed. It is here that knowledge of society is important.</p>
<h2>Erosion of legitimacy</h2>
<p>Addictive substances harm health. But knowledge of how humans act in society tells us that, precisely because they are addictive. They can be regulated but <a href="https://theconversation.com/legal-highs-need-regulation-not-an-outright-ban-32462">banning them never works</a> since addicts find other ways to feed their addiction. </p>
<p>Besides the oft-quoted <a href="https://www.cato.org/publications/policy-analysis/alcohol-prohibition-was-failure">failure of American prohibition</a>, when white governments in South Africa banned black people from consuming <a href="https://www.jstor.org/stable/183619?seq=1">“European liquor”</a>, this created <a href="https://www.jstor.org/stable/41143613?seq=4#metadata_info_tab_contents">shebeens</a> (speakeasies) which remain a feature.</p>
<p>South Africa’s bans on cigarette and alcohol sales <a href="https://www.fin24.com/Economy/South-Africa/cigarette-ban-is-failing-can-create-lasting-illicit-market-study-20200516">prompted an illicit cigarette trade</a>, <a href="https://businesstech.co.za/news/business/389117/16-liquor-stores-looted-in-the-western-cape-since-lockdown/">the looting of liquor stores</a> and a <a href="https://www.timeslive.co.za/news/south-africa/2020-04-28-pineapple-sales-soar-to-90000-in-a-day-from-10000-amid-booze-ban/">sharp rise in the price of pineapples</a> which were used to ferment beer. Dlamini-Zuma’s belief that the ban will prompt “a sizeable number” of people <a href="https://www.timeslive.co.za/news/south-africa/2020-05-27-this-is-why-we-banned-cigarette-sales-nkosazana-dlamini-zuma-tells-court/">to give up smoking</a> is contradicted by knowledge of society.</p>
<p>This knowledge also tells us that, even among the vast majority who are not addicts, restrictions will fail if they lack legitimacy: people may not like obeying them, but, if they accept they are there for a good reason, they will comply. If they don’t, even thousands of troops will not get them to obey.</p>
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Read more:
<a href="https://theconversation.com/pandemics-dont-heal-divisions-they-reveal-them-south-africa-is-a-case-in-point-134002">Pandemics don’t heal divisions -- they reveal them. South Africa is a case in point</a>
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<p>South Africa’s lockdown rules started with high legitimacy. But it has been eroded and has now dissolved.</p>
<p>The country locked down early, when cases and deaths were <a href="https://www.gov.za/speeches/president-cyril-ramaphosa-extension-coronavirus-covid-19-lockdown-end-april-9-apr-2020-0000">relatively few</a>. This creates a legitimacy problem: people must sacrifice yet they do not see the fatalities and overloaded hospitals which influenced citizens of some European countries. But this problem was largely solved because citizens knew – and feared - what was happening elsewhere.</p>
<p>Legitimacy could have remained high if, like some other countries, South Africa’s had done what early lockdowns are meant to do - cut infections and deaths to a handful.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/339186/original/file-20200602-133875-7t2ddt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339186/original/file-20200602-133875-7t2ddt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=362&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339186/original/file-20200602-133875-7t2ddt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=362&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339186/original/file-20200602-133875-7t2ddt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=362&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339186/original/file-20200602-133875-7t2ddt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=454&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339186/original/file-20200602-133875-7t2ddt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=454&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339186/original/file-20200602-133875-7t2ddt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=454&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cooperative Governance minister Nkosazana Dlamini-Zuma.</span>
<span class="attribution"><span class="source">Luiz Rampelotto/Pacific Press/LightRocket via Getty Images</span></span>
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<p>But this was never an option because the scientists who advise the government insisted that restrictions were not meant to stop the virus transmitting, merely to slow it down so that, when the “inevitable” surge arrived, <a href="https://www.dailymaverick.co.za/article/2020-04-14-lockdown-has-bought-us-time-expert-says-as-sa-bucks-the-trend/">the health system was ready</a>.
They have not been challenged to defend this view because the debate never asks scientists difficult questions. An illustrative example is the claim (which she later clarified) by Professor Glenda Gray, chair of the country’s Medical Research Council, that Soweto’s Baragwanath hospital had <a href="https://www.news24.com/news24/SouthAfrica/News/unscientific-and-nonsensical-top-scientific-adviser-slams-governments-lockdown-strategy-20200516">no malnutrition cases before the lockdown</a>. But it has created a legitimacy nightmare.</p>
<p>By Ramaphosa’s <a href="https://ewn.co.za/2020/05/31/president-s-notes-ramaphosa-s-interview-with-editors">own admission</a>, South Africa did not use its lockdown to establish the testing and tracing capacity which allowed some countries to beat back Covid-19. But, outside Western Cape Province, it restricted cases to about 11 000 and under 200 deaths <a href="https://sacoronavirus.co.za/category/press-releases-and-notices/">by the end of May</a>, figures similar to South Korea’s <a href="https://www.worldometers.info/coronavirus/country/south-korea/">successful fight against the virus</a>. Even in the Western Cape, there are a <a href="https://www.moneyweb.co.za/news/south-africa/south-africas-covid-19-deaths-surpass-700/">few hundred deaths</a>, not the thousands seen elsewhere in the world.</p>
<p>So, the lockdown has been effective enough to ensure that its opponents can demand an end to restrictions without seeming callous. But it has not been effective enough to ensure the drop in infections and deaths which the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance">World Health Organisation</a> – and, initially, the chair of the government’s own <a href="https://news365.co.za/salim-abdool-karims-f/">medical advisory council</a> – say are needed to phase out restrictions.</p>
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Read more:
<a href="https://theconversation.com/coronavirus-corruption-in-health-care-could-get-in-the-way-of-nigerias-response-136913">Coronavirus: corruption in health care could get in the way of Nigeria's response</a>
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<p>The legitimacy which comes from victory over the virus is not available and the official insistence that the restrictions are not meant to stop transmission has handed opponents a good reason to demand that they end even when infections are rising.</p>
<p>Legitimacy has not been eroded among most citizens, who remain deeply concerned about Covid-19. But it has been weakened sufficiently in the policy debate to create an orgy of interest group lobbying for an end to restrictions.</p>
<p>Business began pressing for freedom to operate and has <a href="https://af.reuters.com/article/commoditiesNews/idAFL8N2DE112">largely succeeded</a>. This set off a chain reaction in which, once one lobby wins, the others smell blood and demand that they too be free to operate.</p>
<p>This lobbying has replaced the veneer of science shrouding government decisions: concessions seem based purely on who shouts loudest. Domestic business travel <a href="https://businesstech.co.za/news/government/403657/level-3-lockdown-rules-in-south-africa-here-are-all-the-changes-from-today/">is allowed</a>, which may allow the virus to spread; religious services are opened although they have been <a href="https://www.timeslive.co.za/news/south-africa/2020-03-20-entire-church-congregation-being-traced-in-response-to-coronavirus-in-free-state/">prime spreaders</a> of the virus <a href="https://www.latimes.com/california/story/2020-05-18/mendocino-county-church-service-linked-to-coronavirus-cluster">everywhere</a>; the government has tried to open schools although nearly 2 000 Covid-19 cases are below age 19. Only the tobacco ban remains.</p>
<h2>What’s been missing</h2>
<p>But the legitimacy of measures to fight Covid-19 are more important than ever because the only chance of curbing it is strict observance by businesses and other institutions of health measures.</p>
<p>The government is reduced to doing what it always does when it loses control – telling citizens they must look after themselves. Because people are worried by Covid-19, those who have access to trade unions or other forms of influence may do that. But, if the virus’s spread is stopped, it will be because people fear it, not because they believe that government measures are legitimate.</p>
<p>This might have been avoided if the government paid as much attention to knowledge of society as it says it is paying to science.</p><img src="https://counter.theconversation.com/content/139789/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Friedman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>South Africa’s lockdown rules started with high legitimacy. But it has been eroded and has now dissolved.Steven Friedman, Professor of Political Studies, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1298542020-01-14T13:48:20Z2020-01-14T13:48:20ZHow Prohibition changed the way Americans drink, 100 years ago<figure><img src="https://images.theconversation.com/files/309806/original/file-20200113-103971-1ankvjp.jpg?ixlib=rb-1.1.0&rect=49%2C98%2C2946%2C2236&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prohibition did little to ease Americans' love of liquor.</span> <span class="attribution"><span class="source">AP Photo</span></span></figcaption></figure><p>On Jan. 17, 1920, one hundred years ago, <a href="https://timesmachine.nytimes.com/timesmachine/1920/01/16/106359667.html?pageNumber=1">America officially went dry</a>. </p>
<p><a href="https://www.theguardian.com/theguardian/from-the-archive-blog/2011/may/23/guardian190-prohibition-in-america">Prohibition</a>, embodied in the U.S Constitution’s 18th amendment, <a href="https://www.law.cornell.edu/constitution/amendmentxviii">banned the sale, manufacture and transportation of alcohol</a>. Yet it remained <a href="https://www.history.com/news/10-things-you-should-know-about-prohibition">legal to drink</a>, and <a href="https://www.smithsonianmag.com/history/tiny-french-archipelago-became-americas-illegal-warehouse-during-prohibition-180967868/">alcohol was widely available</a> throughout Prohibition, which ended in 1933.</p>
<p>I am reminded of how easy it was to drink during Prohibition every time I go to the <a href="https://www.omnihotels.com/hotels/bretton-woods-mount-washington/dining/the-cave">hotel in New Hampshire</a> that hosted the <a href="https://www.worldbank.org/en/about/archives/history/exhibits/bretton-woods-monetary-conference">Bretton Woods Conference</a>, which created the modern international monetary system after World War II. The hotel, now known as the Omni Mount Washington Resort, boasts a <a href="https://www.bostonglobe.com/lifestyle/travel/2015/09/12/breaking-law-north-country-speakeasy-the-cave-toasts-its-bootlegging-legacy/VmJPAyqjSfMwdQmH3izJZP/story.html">basement speakeasy</a> called <a href="https://www.omnihotels.com/hotels/bretton-woods-mount-washington/dining/the-cave">The Cave</a> that served illegal liquor during Prohibition. </p>
<p>The last time <a href="http://businessmacroeconomics.com/">I</a> was in The Cave I began wondering, given how prevalent Prohibition-era speakeasies appear to have been, what effect banning alcohol had on consumption rates. </p>
<p>Moreover, are we drinking any more today than we did before prohibition?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=597&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=597&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=597&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bootleggers smuggled bottles of Scotch whiskey in hollowed-out loaves of bread.</span>
<span class="attribution"><span class="source">AP Photo</span></span>
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</figure>
<h2>Consumption begins to drop</h2>
<p>The <a href="http://prohibition.themobmuseum.org/the-history/the-road-to-prohibition/the-temperance-movement/">Prohibition movement began</a> in the early 1800s based on noble ideas such as boosting savings, reducing domestic violence and improving family life. </p>
<p>At the time, alcohol usage was soaring in the U.S. Some estimates by alcohol opponents put consumption at <a href="https://www.neh.gov/humanities/2011/septemberoctober/feature/going-dry">three times what it is today</a>. Activists thought that prohibiting its sale would curb excess drinking. Their efforts were very effective. </p>
<p>But while Prohibition is often portrayed as a sharp change that happened with <a href="https://www.pbs.org/kenburns/prohibition/roots-of-prohibition/">one last national call for drinks</a> just before the stroke of midnight, thousands of towns throughout the country <a href="https://www.neh.gov/humanities/2011/septemberoctober/feature/going-dry">had gone dry well before that</a>. More bans took effect during World War I in an effort to save grain. </p>
<p>So to consider the impact of Prohibition on drinking habits, it’s a good idea to start in the years leading up to it. And given that beer, wine and spirits all have different alcohol content, we’ll use the number of “standard” drinks a person consumes to make our comparison. A <a href="https://www.niaaa.nih.gov/what-standard-drink">standard drink contains</a> about 14 grams of pure alcohol. This is the amount of spirits in a 12 ounce beer, a five ounce glass of wine or a 1.5 ounce shot of hard liquor.</p>
<p>From 1900 until 1915 – five years before the 18th Amendment passed – the <a href="https://pubs.niaaa.nih.gov/publications/surveillance113/tab1_17.htm">average adult drank</a> about 2.5 gallons of pure alcohol a year, which is about 13 standard drinks per week. Consumption fell sharply by 1916, with the average falling to two gallons a year, or 10 drinks a week. </p>
<p>The Prohibition movement and the local dry laws that preceded it appeared to already be having an impact.</p>
<p><iframe id="mjDxu" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/mjDxu/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Drinking rebounds</h2>
<p>Tracking consumption gets a bit trickier after 1920. </p>
<p>Prohibition meant the federal government no longer had a way to measure how much alcohol people were consuming. So to get around the missing information, <a href="https://www.jstor.org/stable/2006862">researchers have used</a> data on arrests for drunkenness, deaths caused by cirrhosis of the liver, deaths by alcoholism and how many patients were admitted to hospitals for alcoholic psychosis. Put together, the numbers <a href="https://www.nber.org/papers/w3675">suggest alcohol consumption</a> dropped sharply in 1920, falling to about one-third of what people drank before Prohibition. </p>
<p>Starting in 1921, however, alcohol consumption rebounded quickly and soon reached about two-thirds of pre-Prohibition levels. One likely reason is that the U.S. experienced a <a href="https://www.u-s-history.com/pages/h1362.html">severe recession in 1920 and 1921</a>. When the economy recovered in 1922 to start the <a href="https://www.forbes.com/sites/timreuter/2014/10/21/how-to-succeed-in-business-and-government-without-really-trying-calvin-coolidge-and-the-roaring-twenties/#518032f31f60">roaring 20s</a> people were more able to afford illegal liquor.</p>
<p>In the decades after Prohibition ended on Dec. 5, 1933, with the repeal of the 18th Amendment, consumption remained relatively subdued. But by the 1960s and ‘70s, Americans were swilling just as much alcohol as in the early 1900s. </p>
<p><a href="https://pubs.niaaa.nih.gov/publications/surveillance113/tab1_17.htm">Today Americans drink on average</a> about 2.3 gallons of pure alcohol a year, which is about 12 standard drinks a week, about the same amount they drank before Prohibition. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Revelers in Chicago celebrate the end of Prohibition in 1933.</span>
<span class="attribution"><span class="source">AP Photo</span></span>
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</figure>
<h2>Prohibition’s legacy</h2>
<p>The era of Prohibition left many legacies. </p>
<p>One result is American’s <a href="http://theconversation.com/why-bland-american-beer-is-here-to-stay-91737">preference for pale bland beers</a>. Drinking also moved from public spaces like <a href="https:/www.doi.org/10.2105/AJPH.2005.065409">saloons into the home</a>.</p>
<p>More negatively, some claim it created organized crime as <a href="https://www.jstor.org/stable/1017691">violence soared</a> and <a href="http://prohibition.themobmuseum.org/the-history/the-rise-of-organized-crime/the-mob-during-prohibition/">mobsters enriched themselves</a>. It also meant states and the federal government, which relied heavily on excise taxes from liquor taxes to fund their budgets, <a href="https://www.pbs.org/kenburns/prohibition/unintended-consequences/">turned to income taxes</a> to help make up for the gap. And ultimately it did not result in a significant or lasting drop in alcohol consumption.</p>
<p>For these reasons, many people believe <a href="https://www.cato.org/sites/cato.org/files/pubs/pdf/pa157.pdf">it was a failure</a>, which should give pause to policymakers and others pushing for a ban on <a href="https://www.who.int/china/activities/banning-smoking-from-the-workplace">smoking</a> or <a href="https://time.com/5685936/state-vaping-bans/">vaping</a>. </p>
<p>And even the person most responsible for drafting Prohibition legislation, U.S. Rep. <a href="https://www.docsteach.org/documents/document/volstead-act">Andrew Volstead</a>, was <a href="https://www.alcoholproblemsandsolutions.org/hypocrisy-prohibition-alcohol-u-s/">no teetotaler</a> himself, suggesting even those who push such bans can’t even abide by them.</p>
<p>So, as an economist, I believe if you want to stop people from doing something injurious to their health, <a href="https://www.ncbi.nlm.nih.gov/books/NBK217454/">raising the price</a> works better than a ban. That’s how the U.S. <a href="https://www.forbes.com/sites/niallmccarthy/2018/07/26/poll-u-s-smoking-rate-falls-to-historic-low-infographic/#79cac19a3351">cut the share of adult smokers</a> from 40% in the 1970s to 16% by 2018.</p>
<p>The 100th anniversary of Prohibition reminds us that bans rarely work. </p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/129854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jay L. Zagorsky does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The era of Prohibition, which began in 1920 and ended in 1933, left many legacies – more modest drinking was not among them.Jay L. Zagorsky, Senior Lecturer, Questrom School of Business, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1288562019-12-16T01:00:39Z2019-12-16T01:00:39ZCap your alcohol at 10 drinks a week: new draft guidelines<figure><img src="https://images.theconversation.com/files/307002/original/file-20191215-123983-6wr9fd.jpg?ixlib=rb-1.1.0&rect=44%2C630%2C4901%2C2604&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Further evidence about the harms of alcohol has accumulated over the past decade since the last guidelines were released.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-leisure-friendship-celebration-concept-happy-611242766">Syda Productions/Shtterstock</a></span></figcaption></figure><p>New <a href="https://online.nhmrc.gov.au/public-consultation/nhmrc-draft-revised-australian-guidelines-reduce-health-risks-drinking-alcohol">draft alcohol guidelines</a>, released today, recommend healthy Australian women and men drink no more than ten standard drinks a week and no more than four on any one day to reduce their risk of health problems.</p>
<p>This is a change from the <a href="https://www.health.gov.au/health-topics/alcohol/about-alcohol/how-much-alcohol-is-safe-to-drink">previous guidelines</a>, released in 2009, that recommended no more than two standard drinks a day (equating to up to 14 a week). </p>
<p>(If you’re unsure what a standard drink looks like, use <a href="https://yourroom.health.nsw.gov.au/games-and-tools/pages/standard-drink-calculator.aspx">this</a> handy reference.)</p>
<p>The guidelines also note that for some people – including teens and women who are pregnant or breastfeeding – not drinking is the safest option. </p>
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Read more:
<a href="https://theconversation.com/drink-drank-drunk-what-happens-when-we-drink-alcohol-in-four-short-videos-100206">Drink, drank, drunk: what happens when we drink alcohol in four short videos</a>
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<h2>What are the new recommendations based on?</h2>
<p>The National Health and Medical Research Council looked at the latest research and did some mathematical modelling to come to these recommendations.</p>
<p>It found the risk of dying from an alcohol-related disease or injury is about one in 100 if you drink no more than ten standard drinks a week and no more than four on any one day. </p>
<p>So, for every 100 people who stay under these limits, one will die from an alcohol-related disease or injury.</p>
<p>This is considered an “acceptable risk”, given drinking alcohol is common and it’s unlikely people will stop drinking altogether. The draft guidelines take into account that, on average, Australian adults have a drink three times a week.</p>
<h2>Why did the guidelines need updating?</h2>
<p>Recent research has shown there is a clear link between drinking alcohol and a number of <a href="http://theconversation.com/four-ways-alcohol-is-bad-for-your-health-92578">health conditions</a>. These include at least seven <a href="https://www.cancercouncil.com.au/2397/about-us/our-annual-reports-and-research-activity-reports/our-position-statements-about-cancer-council-nsw/alcohol-and-cancer2/">cancers</a> (liver, oral cavity, pharyngeal, laryngeal, oesophageal, colorectal, liver and breast cancer in women); diabetes; liver disease; brain impairment; mental health problems; and being overweight or obese.</p>
<p>Some previous research suggested low levels of alcohol might be good for you, but we now know these studies were <a href="https://www.abc.net.au/news/2016-03-22/studies-linking-alcohol-to-health-benefits-flawed-researchers/7264040">flawed</a>. Better quality studies have found alcohol does not offer health benefits.</p>
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Read more:
<a href="https://theconversation.com/health-check-is-moderate-drinking-good-for-me-108921">Health check: is moderate drinking good for me?</a>
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<p>The new guidelines are easier to follow than the previous guidelines, which gave recommendations to reduce both short-term harms and longer-term health problems. But some people found these <a href="https://www.ncbi.nlm.nih.gov/pubmed/24494949">confusing</a>.</p>
<p>Although most Australians drink within the previously recommended limits, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24494949">one study</a> found one in five adults drank more than the guidelines suggested and almost half could not correctly identify recommended limits.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The draft new guidelines are easier to follow than the old ones.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/red-wine-pouring-into-glass-shallow-578684329">sama_ja/Shutterstock</a></span>
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<p>Although women tend to be more affected by alcohol than men, at the rates of consumption recommended in the guidelines, there is little difference in long term health effects so the guidelines apply to both men and women.</p>
<p>The recommended limits are aimed at <em>healthy</em> men and women, because some people are at higher risks of problems at lower levels of consumption. These include older people, young people, those with a family history of alcohol problems, people who use other drugs at the same time (including illicit drugs and prescribed medication), and those with physical or mental health problems.</p>
<p>The guidelines are currently in draft form, with a <a href="https://online.nhmrc.gov.au/public-consultation/nhmrc-draft-revised-australian-guidelines-reduce-health-risks-drinking-alcohol">public consultation</a> running until February 24. </p>
<p>After that, there will be an expert review of the guidelines and the final guidelines will be released later in 2020. There may be changes to the way the information is presented but the recommended limits are unlikely to change substantially, given they’re based on very careful and detailed analysis of the evidence.</p>
<h2>What’s the risk for people under 18?</h2>
<p>The draft guidelines recommend children and young people under 18 years drink no alcohol, to reduce the risk of injury and other health harms. </p>
<p>The good news is most teenagers <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">don’t drink alcohol</a>. Among 12 to 17 year olds, only 20% have had a drink in the past year and 1.4% drink weekly. The number of teenagers who have never had a drink has increased significantly in the last decade, and young people are having their first drink later.</p>
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Read more:
<a href="https://theconversation.com/three-ways-to-help-your-teenage-kids-develop-a-healthier-relationship-with-alcohol-80892">Three ways to help your teenage kids develop a healthier relationship with alcohol</a>
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<p>However, we know teenagers are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960066/">more affected</a> by alcohol than adults. This includes effects on their developing brain. We also know the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960066/">earlier</a> someone starts drinking, the more likely they will experience problems, including dependence.</p>
<p>The idea that if you give teenagers small sips of alcohol it will reduce risk of problems later has now been <a href="https://www.sciencedaily.com/releases/2018/02/180220094247.htm">debunked</a>. Teens that have been given even small amounts of alcohol early are more likely to have problems later.</p>
<h2>What’s the risk for pregnant and breastfeeding women?</h2>
<p>The guidelines recommend women who are pregnant, thinking about becoming pregnant or breastfeeding not drink any alcohol, for the safety of their baby.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-are-the-risks-of-drinking-before-you-know-youre-pregnant-59603">Health Check: what are the risks of drinking before you know you're pregnant?</a>
</strong>
</em>
</p>
<hr>
<p>We now have a much clearer understanding of the impacts of alcohol on the developing foetus. <a href="https://www.nofasd.org.au/alcohol-and-pregnancy/what-is-fasd/">Foetal alcohol spectrum disorder</a> (FASD) is a direct result of foetal exposure to alcohol in the womb. Around <a href="https://www.health.gov.au/sites/default/files/national-fasd-strategic-action-plan-2018-2028.pdf">one in 67</a> women who drink while pregnant will deliver a baby with foetal alcohol spectrum disorder.</p>
<p>Foetal alcohol spectrum disorder is characterised by a range of physical, mental, behavioural, and learning disabilities ranging from mild to severe – and is incurable.</p>
<h2>Worried about your own or someone else’s drinking?</h2>
<p>If you enjoy a drink, stick within these recommended maximums to limit the health risks of alcohol.</p>
<p>If you have trouble sticking to these limits, or you are worried about your own or someone else’s drinking, call the National Alcohol and other Drug Hotline on 1800 250 015 to talk through options or check out <a href="https://hellosundaymorning.org">these resources online</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/128856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector, including education and training for parents on drugs. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She is a member of the board of directors of Hello Sunday Morning.</span></em></p>New draft guidelines recommend limiting alcohol consumption to no more than ten standard drinks per week and no more than four standard drinks on any one day.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1034842018-09-21T12:32:27Z2018-09-21T12:32:27ZFive popular hangover cures, reviewed by experts<figure><img src="https://images.theconversation.com/files/237478/original/file-20180921-129871-ag7c7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ouch! Never again... </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/front-view-teen-tousled-hair-suffering-603751019?src=S6OJ69kZJks47lQZoU5q0A-1-0">Shutterstock.</a></span></figcaption></figure><p>It’s a common misconception that hangovers are mainly the result of dehydration. An evening of heavy drinking can lead to inflammation of the stomach and intestines, poor-quality sleep and the production of toxic substances that lead to vomiting, sweating and an increased heart rate. Research <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14404">also suggests</a> that hangovers can hamper the ability to concentrate and remember information.</p>
<p>What research has not given us, though, is credible evidence for a “hangover cure”. The revels of freshers’ week will have many bleary eyed students reaching for a remedy, so here’s the evidence behind what works – and what doesn’t. </p>
<h2>1: Water</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237457/original/file-20180921-129856-a2fh7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237457/original/file-20180921-129856-a2fh7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237457/original/file-20180921-129856-a2fh7t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237457/original/file-20180921-129856-a2fh7t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237457/original/file-20180921-129856-a2fh7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237457/original/file-20180921-129856-a2fh7t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237457/original/file-20180921-129856-a2fh7t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What have I done?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-ill-bottle-water-concept-poisoning-1173792043?src=2hcXN3neQuE4kq0DymiDKw-1-81">Shutterstock.</a></span>
</figcaption>
</figure>
<p>Dehydration is one of the most frequently reported symptoms of hangover. Alcohol is a diuretic – in other words, it makes us urinate more often. Having around four drinks can eliminate <a href="https://pubs.niaaa.nih.gov/publications/arh22-1/54-60.pdf">between 600 and 1,000mL of water</a> from your body. </p>
<p>Heavy alcohol consumption can also cause sweating, vomiting and diarrhoea, which also cause the body to lose fluids. As a result, dehydration leads to symptoms including thirst, weakness, dry mouth and light-headedness. </p>
<p>Drinking water may relive some of these symptoms, but dehydration is also typically accompanied with electrolyte imbalance. A combination of water and an electrolyte supplement can therefore tackle some of the symptoms of your hangover – but by no means all of them. </p>
<h2>2: The old-fashioned fry-up</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237448/original/file-20180921-129874-16d6a35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237448/original/file-20180921-129874-16d6a35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237448/original/file-20180921-129874-16d6a35.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237448/original/file-20180921-129874-16d6a35.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237448/original/file-20180921-129874-16d6a35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237448/original/file-20180921-129874-16d6a35.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237448/original/file-20180921-129874-16d6a35.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Get in my belly.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/southwellpics/7223905554/sizes/l">The-E/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p>Perhaps one of the most traditional remedies for a hangover is a plate of greasy bacon and eggs. But is the fry-up the holy grail of cures it promises to be? Foods such as bacon, eggs and even broccoli contain an amino acid called “cysteine”, which <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1530-0277.2010.01368.x">scientists claim</a> can decrease the amount of the toxic chemical “acetaldehyde”, which is produced as your body metabolises alcohol. </p>
<p>Acetaldehyde contributes to hangover symptoms such as increased heart rate, nausea and vomiting, but there is very limited research supporting the benefits of certain foods as hangover cures. That said, eating a meal with protein, fat and carbohydrate before alcohol consumption has been shown to slow the absorption of alcohol, so as the old saying goes it may good to “line your stomach”. </p>
<h2>3: Caffeine</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237456/original/file-20180921-129871-1udky7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237456/original/file-20180921-129871-1udky7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237456/original/file-20180921-129871-1udky7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237456/original/file-20180921-129871-1udky7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237456/original/file-20180921-129871-1udky7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237456/original/file-20180921-129871-1udky7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237456/original/file-20180921-129871-1udky7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When coffee doesn’t come through for you.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-woman-laying-on-desk-cup-540038569?src=0y64cIlZNI3UDiOv6CV4EQ-4-24">Shutterstock.</a></span>
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<p>One of the reasons we feel so awful after drinking is down to the effects that alcohol has on our sleep. Alcohol-induced sleep can be shorter and poorer quality, but the tiredness you feel can be reversed by the nation’s favourite stimulant – caffeine. </p>
<p>Evidence suggests that people who regularly drink caffeine <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777290/">develop a physical dependency</a> to the drug, which explains why some people need their morning fix. But for these people, a cup of tea or coffee during a hangover may not be enough to address the deficits in thought processes and reaction times. </p>
<p>There’s also <a href="https://www.sciencedirect.com/science/article/abs/pii/0031938486901976">evidence</a> to suggest that people who don’t usually have caffeine do not have the same effects of improved performance and alertness seen in regular users. </p>
<h2>4: Hair of the dog</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237449/original/file-20180921-129844-pnu471.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237449/original/file-20180921-129844-pnu471.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=481&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237449/original/file-20180921-129844-pnu471.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=481&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237449/original/file-20180921-129844-pnu471.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=481&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237449/original/file-20180921-129844-pnu471.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237449/original/file-20180921-129844-pnu471.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237449/original/file-20180921-129844-pnu471.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Are you sure that’s a good idea?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/elsie/2648558411/sizes/o/">Elsie esq./Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>During a hangover, many people will say “I’m never drinking again” – but others swear by the “hair of the dog” to relieve their symptoms. The fact is, drinking during a hangover can be downright dangerous. Vital organs such as the liver need time to repair the damage caused by a session of heavy drinking. <a href="https://www.nhs.uk/news/lifestyle-and-exercise/avoid-alcohol-2-days-per-week/">Government guidelines</a> recommend that you should avoid alcohol for 48 hours after a heavy drinking session. </p>
<p>What’s more, using alcohol to “cure” a hangover could be indicative of an alcohol use disorder. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264051/">Evidence suggests that</a> getting more frequent hangovers is associated with an increased likelihood of developing problems with alcohol. It’s not clear whether the hangover itself is what causes the problem drinking, or repeated heavy alcohol use. Regardless, as far as hangover cures go, this one is not recommended. </p>
<h2>5: Medicine</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237459/original/file-20180921-129862-13pzxf5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237459/original/file-20180921-129862-13pzxf5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237459/original/file-20180921-129862-13pzxf5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237459/original/file-20180921-129862-13pzxf5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237459/original/file-20180921-129862-13pzxf5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237459/original/file-20180921-129862-13pzxf5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237459/original/file-20180921-129862-13pzxf5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Yeah, no.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/cure-hangover-green-open-blister-pack-238290208?src=snYUgUftCP-zsCZBgnd1jQ-1-0">Shutterstock.</a></span>
</figcaption>
</figure>
<p>Recently it seems more and more pharmaceutical products are being marketed to drinkers which claim to relieve hangover symptoms. These products often claim to work by increasing the speed at which one’s body gets rid of the toxic chemical acetaldehyde. These cures also claim to reduce inflammation and address the chemical changes in our brain causes by alcohol that can impact our thought processes. </p>
<p>It should hardly come as a surprise that there is currently no evidence that any conventional or complimentary medicine can cure a hangover. It is unclear whether this is because these cures do not work or because their effectiveness has not been fully tested. </p>
<p>So, although these popular remedies may offer some relief from the symptoms of hangover, there’s no evidence-based treatment or “cure”. A hangover is a complex combination of physical and psychological symptoms, which are caused by several different processes in the body and brain. </p>
<p>What’s more, few hangover treatments address impairments in concentration, memory and reaction times, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/16260448">the low mood and increased anxiety</a> frequently reported by sufferers. The only surefire way to avoid “the morning after the night before” is to drink alcohol in moderation – or not drink it at all.</p><img src="https://counter.theconversation.com/content/103484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From black coffee to a hair of the dog – here’s the science behind popular hangover remedies.Sally Adams, Lecturer in Health Psychology, University of BathCraig Gunn, PhD Candidate, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/827532017-08-23T05:39:44Z2017-08-23T05:39:44ZBeer, bongs and baby boomers: the unlikely tale of drug and alcohol use in the over 50s<figure><img src="https://images.theconversation.com/files/183066/original/file-20170822-13660-1p7ity1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Baby boomers who drink and take drugs risk a range of physical and mental problems that younger substance users don't necessarily face.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/496022509?src=J4JwkXDIzM9va_WIHJgxBQ-2-62&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>If you ask someone what a typical heavy drinker or drug user looks like, they’re probably more likely to evoke images of Gen Ys with tattoos and piercings than greying baby boomers. </p>
<p>But recent Australian data, outlined in our <a href="http://www.bmj.com/content/358/bmj.j3885">British Medical Journal editorial today</a>, shows rates of alcohol and drug use are actually decreasing among younger age groups, while increasing dramatically in people over the age of 50.</p>
<p>Not only is there a rise in the proportion of older people who regularly drink at risky levels, there are also more older people using cannabis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/maybe-moderate-drinking-isnt-so-good-for-you-after-all-72266">Maybe moderate drinking isn't so good for you after all</a>
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<p>So, it’s not surprising Australia’s <a href="https://www.hcasa.asn.au/documents/555-national-drug-strategy-2017-2026/file">recently released National Drug Strategy 2017-2026</a> identifies older people as a priority group for attention.</p>
<p>The data has implications not only for the health of the over 50s, but also for health professionals that diagnose and manage substance use or misuse, and the complications that can arise from it.</p>
<p>Evidence shows we can no longer view drug and alcohol issues purely as a young person’s concern.</p>
<h2>Why is alcohol and drug use rising in older Australians?</h2>
<p>Low birth rates and extended life expectancy have resulted in large increases in the <a href="https://aifs.gov.au/facts-and-figures/ageing-australia">proportion of older Australians</a> and higher absolute numbers of older people who drink and use drugs.</p>
<p>For example, the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">one in four 50-59 year-olds</a> drinking at risky levels (five or more standard drinks in a single session) corresponds to <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Sep%202016?OpenDocument">about 755,394</a> people.</p>
<p>Baby boomers (born between 1946 and 1964) have <a href="http://www.bmj.com/content/343/bmj.d6761">higher rates</a> of alcohol and drug use than earlier cohorts of older Australians and many continue this use into their older years.</p>
<p><a href="http://nceta.flinders.edu.au/files/3514/1679/0404/EN557.pdf">Improvements in health care and treatments for substance use</a> mean more people survive into old age, drinking and taking drugs for longer.</p>
<p>Older Australians today also have more disposable income than in previous generations, making access to alcohol and drugs <a href="http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712012000300004">more affordable</a>.</p>
<h2>What does the evidence say?</h2>
<p>Our research, using data from the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/about-ndshs/">National Drug Strategy Household Survey</a>, shows high-risk drinking (11 or more standard drinks on a single occasion) in the over 50s increased significantly between 2004 and 2013. People living in regional or remote areas or who smoke tobacco were more likely to drink this way.</p>
<p>The <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">newly released 2016 data</a> indicates this upward trend is continuing even more strongly.</p>
<p><a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">In 2016</a>, 11.9% of 50-59 year olds drank at high-risk levels at least yearly (up from 9.1% in 2013). A total of 5.8% did so at least monthly (up from 4.1%).</p>
<p>Cannabis use among the over 50s <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajag.12357/abstract">more than doubled</a> between 2004 and 2013, from 1.5% to 3.6%. Unmarried men who smoked, drank alcohol, and used other drugs were particularly likely to use cannabis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/remind-me-again-how-does-cannabis-affect-the-brain-40641">Remind me again, how does cannabis affect the brain?</a>
</strong>
</em>
</p>
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<p>There is little reliable data on other illicit drug use in older people. But our data shows older people are using more pharmaceuticals, like <a href="http://onlinelibrary.wiley.com/doi/10.1002/pds.1899/abstract">sedatives</a> and <a href="https://www.mja.com.au/journal/2011/195/5/prescription-opioid-analgesics-and-related-harms-australia">opioids</a>, than before.</p>
<p>And <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">in 2016</a>, 4.1% of 50-59 year olds and 4.5% of people 60 and over used pharmaceutical drugs for non-medical purposes.</p>
<p>Older people often use pharmaceuticals to treat pain (both physical and emotional) or sleep problems. This can also result in balance problems, falls/injuries, reduced ability to function, and even death.</p>
<p>You can find out more about the prevalence of substance use among older Australians in the <a href="http://nadk.flinders.edu.au/">National Alcohol and Drug Knowledgebase</a>.</p>
<h2>Why is all this concerning?</h2>
<p>Growing use of alcohol, cannabis, and prescription drug misuse among older Australians is concerning for a number of reasons.</p>
<p>Older people are more sensitive to the toxic effects of substances such as alcohol. This is because ageing <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">reduces the body’s capacity</a> to metabolise, distribute, and excrete alcohol and drugs.</p>
<p>Older people are also more likely to have <a href="http://nceta.flinders.edu.au/files/3514/1679/0404/EN557.pdf">existing physical or psychological conditions</a>, or to take medicines that may <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">interact</a> with alcohol and drugs.</p>
<p>So older people who use alcohol and/or drugs may be more <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">likely to have</a>: falls and other injuries, diabetes and cardiovascular disease, mental health problems (including suicide), obesity, liver disease, <a href="https://pdfs.semanticscholar.org/b8ed/eefa7da25bb2656bc0335cc6768d62b9f039.pdf">early-onset dementia and other brain injury</a>, sleep disorders, and blood borne diseases.</p>
<h2>Not all older people have problems with drugs and alcohol</h2>
<p>Not all older people who use alcohol and/or drugs have problems. Older people, like other age groups, use alcohol or drugs in many different ways and for many different reasons, as we show with this “<a href="http://nceta.flinders.edu.au/files/7014/1679/1083/EN559.pdf">typology of older users</a>”:</p>
<ul>
<li><p><strong>maintainers</strong> continue with their previously unproblematic use as they get older. But age-related changes (like those already outlined) result in increased harms later in life</p></li>
<li><p><strong>survivors</strong> begin using alcohol/drugs early in life. They have a long history of substance use problems that persist into older age and this often results in other physical and/or mental health problems</p></li>
<li><p><strong>reactors</strong> begin using alcohol/drugs in their 50s or 60s, often due to <a href="http://au.wiley.com/WileyCDA/WileyTitle/productCd-1118993772.html">stressful events</a>, like grief, retirement, marital breakdown, social isolation (<a href="http://press.psprings.co.uk/bmj/august/substancemisuse.pdf">particularly older women</a>), or due to pain.</p></li>
</ul>
<h2>Do treatments work for older people?</h2>
<p>The good news is, research shows substance use treatment is <a href="http://nceta.flinders.edu.au/files/9814/2250/4969/Hunter_2010.pdf">just as effective</a> for older people as it is for younger age groups. </p>
<p>Treatment programs adapted specifically for older people have <a href="http://www.sciencedirect.com/science/article/pii/S1878764915001394">even better outcomes</a>.</p>
<p>This is important, as the number of older people who require treatment for alcohol or drug problems is increasing substantially, <a href="http://press.psprings.co.uk/bmj/august/substancemisuse.pdf">both in Australia</a> <a href="http://www.tandfonline.com/doi/abs/10.1080/13607863.2013.793653?tab=permissions&scroll=top">and</a> <a href="https://academic.oup.com/ije/article/43/2/304/675582/Substance-use-disorders-and-psychiatric">overseas</a>.</p>
<h2>Not everyone gets treatment</h2>
<p>Unfortunately, there are <a href="http://nceta.flinders.edu.au/files/1314/1679/1662/EN561.pdf">barriers</a> that can <a href="http://alcoholresearchuk.org/downloads/finalReports/FinalReport_0085">make it harder</a> for older Australians to access treatment or support.</p>
<p>Health-care practitioners and family members may:</p>
<ul>
<li><p>be reluctant to ask older people “embarrassing” questions about substance use</p></li>
<li><p>not know alcohol/drug use is common in older people, or how to address it</p></li>
<li><p>incorrectly attribute symptoms of problem substance use to “just getting older”</p></li>
<li><p>incorrectly believe older people are too old to change.</p></li>
</ul>
<p>Older people may also be reluctant to seek help because of embarrassment, logistical problems (like a lack of transport), inappropriate treatment services for older people, or they do not know where to turn for help.</p>
<p>To combat these problems, we developed a <a href="https://www.peninsulahealth.org.au/wp-content/uploads/AODPenHealth_150915.pdf">free guide</a> to preventing and reducing alcohol and drug related harm among older people for health and welfare professionals.</p>
<h2>What needs to change</h2>
<p>Health-care services and the aged care sector need to work better together to prevent problem substance use among older people. They also need to provide age-appropriate treatment and harm minimisation services to people who need them. </p>
<p>Clinicians also need to better identify and treat alcohol, cannabis, and prescription drug misuse in their older patients.</p>
<p>Finally, we need more research into the best approaches for helping older people with substance use problems.</p>
<hr>
<p><em>If you would like to talk to a professional about your own or someone else’s alcohol or drug use, contact the free Alcohol and Drug Information Service in your <a href="http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/CA12F53389330BD1CA2577EC007DEAFB/$File/ADIS.pdf">state or territory</a>.</em></p><img src="https://counter.theconversation.com/content/82753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The National Centre for Education and Training on Addiction receives funding from the Commonwealth Department of Health.</span></em></p>More Australians over 50 are drinking and taking drugs than ever before. Here’s why that can be a problem.Ann Roche, Professor and Director of the National Centre for Education and Training on Addiction, Flinders UniversityVictoria Kostadinov, Research officer, National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/814912017-07-27T14:40:35Z2017-07-27T14:40:35ZWhy the South African state needs to lose its fight against marijuana policy reform<figure><img src="https://images.theconversation.com/files/179611/original/file-20170725-28293-1defi3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Thousands of South Africans are calling for the legalisation of marijuana. </span> <span class="attribution"><span class="source">EPA/Nic Bothma</span></span></figcaption></figure><p>South Africa is among many countries facing challenges to their drug control policies, particularly around marijuana, known locally as dagga. The <a href="http://www.sanctr.gov.za/YourRights/TheMedicinesControlCouncil/tabid/176/Default.aspx">Medicines Control Council</a> is developing <a href="http://www.mccza.com/documents/5933cac110.14_Media_Release_Cannabis_Nov16_v1.pdf">guidelines</a> for production for medicinal use and the country’s highest <a href="http://www.cda.gov.za/">drug policy guardian</a> has <a href="http://www.samj.org.za/index.php/samj/article/view/10863%3C/u">recommended</a> broader decriminalisation. </p>
<p>The key battle ground, however, is in the courts. </p>
<p>A new trial the state is likely to expend considerable energy trying to prove that marijuana use is seriously harmful. If this is indeed the substance of its argument, it should lose. The point isn’t whether marijuana causes harm, but whether criminal prohibition is the best way to address those harms.</p>
<p>South African Police Service statistics suggest that most anti-drug activity is against those in possession of small quantities. These are people who are unlikely to play any strategic role in drug supply, and whose deterrence or removal from the market has little prospect of having any impact overall.</p>
<h2>The legal wrangle to date</h2>
<p>The first recent knock to prohibition came in 2016 with a ruling by the Constitutional Court. The court <a href="http://www.saflii.org.za/za/cases/ZACC/2016/21.html">held</a> that the constitutional right to privacy was unjustly violated by parts of the country’s <a href="http://www.gov.za/sites/www.gov.za/files/a140_1992.pdf">drugs and drug trafficking act</a> that allowed a law enforcement officer to stop and search any person, property or vehicle on the grounds of “reasonable suspicion” of violation of the Act. The ruling <a href="http://www.groundup.org.za/article/when-can-police-search-your-home/">meant</a> that police would no longer be able to enter and search private properties without a warrant. </p>
<p>A bigger challenge came from the Western Cape High Court. This case was brought <em>inter alia</em> by <a href="http://www.iol.co.za/pretoria-news/rastafarian-lawyer-in-the-dock-over-dagga-1315010">Gareth Prince</a>. Prince lost a <a href="http://www.saflii.org/za/cases/ZACC/2002/1.html">case</a> in the Constitutional Court in 2002 that sought exemption from the laws on the basis of his Rastafari religion. </p>
<p>Prince’s more recent case sought not just an exemption based on religious freedom, but to challenge marijuana prohibition overall on various grounds – including that it was based on an irrational distinction from alcohol. Ras Prince brought the case with Jeremy Acton, leader of the <a href="https://www.daggaparty.org.za/index-2.html">Dagga Party</a>.</p>
<p>Judge Dennis Davis, for a full bench, <a href="http://www.saflii.org/za/cases/ZAWCHC/2017/30.html">found</a> that the criminalisation of marijuana within the home unjustifiably limited the right to privacy. He concluded that the state had failed to show that criminal prohibition was the least restrictive way to deal with the problems caused by marijuana. The order was suspended for 24 months to allow parliament to amend the relevant laws.</p>
<p>The state quickly indicated its intention to appeal and to continue enforcement without any change. But it seems that several people charged with marijuana crimes have received stays of prosecution pending the outcome of the legal process.</p>
<p>A separate case is about to kick off in Pretoria. Myrtle Clarke and Julian Stobbs, known as the <a href="http://citizen.co.za/news/1581689/everything-you-need-to-know-about-the-dagga-couple/">“The Dagga Couple”</a>, have turned their arrest for possession into a decriminalisation crusade. Their team has raised funds for local and international <a href="https://fieldsofgreenforall.org.za/expert-witnesses/">expert witnesses</a> to help them make their <a href="https://www.fieldsofgreenforall.org.za/images/legal/DC_LEGAL_SUMMARY.pdf">argument</a> that the criminal prohibition of marijuana is irrational, wasteful, and unjustifiably infringes numerous constitutional rights. </p>
<p>This is the first time that the issues will have the chance to be properly aired in court. </p>
<p>It’s long overdue.</p>
<h2>Pattern of arrests</h2>
<p>According to the South African Police Service’s annual <a href="https://www.saps.gov.za/about/stratframework/annual_report/2015_2016/saps_annual_report_2015_2016.pdf">report</a>, there were 259,165 recorded counts of illegal drug possession or dealing in 2015/16. These charges resulted in 253,735 arrests, accounting for almost a sixth of all arrests. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179610/original/file-20170725-31338-1xvauvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179610/original/file-20170725-31338-1xvauvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179610/original/file-20170725-31338-1xvauvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179610/original/file-20170725-31338-1xvauvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179610/original/file-20170725-31338-1xvauvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179610/original/file-20170725-31338-1xvauvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179610/original/file-20170725-31338-1xvauvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Rastafarian lights up during a march for the legalisation of marijuana in South Africa.</span>
<span class="attribution"><span class="source">EPA/Nic Bothma</span></span>
</figcaption>
</figure>
<p>Most drug arrests are made through stop-and-search or roadblock operations. National figures aren’t available but those from two of the nine provinces suggest that a vanishingly small proportion of drug charges (2%-4%) are for dealing as opposed to possession of drugs. Very few drug arrests are made at ports of entry, through special operations, or through the Serious Organised Crime Investigation Units. </p>
<p>Between 65% and 70% of drug charges are for possession of marijuana. The presumption is that possession of over 115 grams (about 4 ounces) constitutes dealing. This means that every year police seek out and charge about one in every 300 people for possession of an amount of marijuana that weighs no more than an apple. </p>
<h2>Criminal prohibition</h2>
<p>It isn’t clear whether criminal prohibition is an effective way to dissuade or help drug users. <a href="https://www.ncbi.nlm.nih.gov/pubmed/26515984">Evidence</a> from other countries suggests that, generally, the greater the perception of risk, the lower the prevalence of use. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/179614/original/file-20170725-12396-1ibb8l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/179614/original/file-20170725-12396-1ibb8l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179614/original/file-20170725-12396-1ibb8l8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179614/original/file-20170725-12396-1ibb8l8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179614/original/file-20170725-12396-1ibb8l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179614/original/file-20170725-12396-1ibb8l8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179614/original/file-20170725-12396-1ibb8l8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>But the strength of this effect is <a href="http://cssdp.org/uploads/2016/09/State_of_the_Evidence_Cannabis_Use_and_Regulation_Sept_7.pdf">debatable</a> to say the least, and it remains far from clear whether a liberalisation in marijuana policy results in a significant increase in its use or in associated harms. The effects of the recent wave of marijuana policy changes in various US states, for example, are still being closely <a href="https://www.washingtonpost.com/news/wonk/wp/2016/10/13/heres-how-legal-pot-changed-colorado-and-washington/?utm_term=.a17c9d60429f">observed</a> and debated. </p>
<p>For people who have highly problematic drug use patterns, there is even <a href="http://beckleyfoundation.org/resource/briefing-paper-incarceration-of-drug-offenders-costs-and-impacts">less</a> consensus that the threat or reality of imprisonment is an appropriate or effective tool for either dissuading or helping them. Other approaches may well do significantly <a href="https://www.researchgate.net/profile/Caitlin_Hughes/publication/249284847_What_Can_We_Learn_From_The_Portuguese_Decriminalization_of_Illicit_Drugs/links/54d406e90cf24647580553bb.pdf">better</a>.</p>
<h2>Decriminalisation</h2>
<p>There are many <a href="http://decrim.idpc.net/">models</a> of decriminalisation. Policies that work in the Netherlands or Colorado might not work in a developing country like South Africa given differences in drug use, drug market and price structures, regulatory capacity and political climates.</p>
<p>The goal must be to find a broadly acceptable balance of a complex range of harms, benefits, and rights in the context of limited resources. </p>
<p>For example, South Africa needs to consider what impact decriminalisation would have on small-scale, informal farmers who <a href="http://www.tandfonline.com/doi/abs/10.1080/0376835032000149252">depend</a> on the crop for their livelihood. Legalising marijuana could mean that they are forced out of the market by large agribusinesses, or falling prices. </p>
<p>On the other hand, prohibition arguably does more to harm the current producers and distributors than consumers. </p>
<p>The right balance won’t be found if marijuana is simply cast as a devastating alien threat to the nation’s children and communities. Instead it needs to be understood as a socially and economically ingrained pastime for which there is clearly considerable popular demand.</p>
<h2>Harm is not enough</h2>
<p>Justifying the criminal prohibition of marijuana is not a matter of proving that it causes harm. Evidence of major harm has not been enough to lead to the criminal prohibition of, for example, alcohol, nicotine, sugar, firearms and unprotected sex. </p>
<p>The case that needs to be made is whether criminal prohibition is effective, proportionate, and the minimally invasive way to address those harms. The state will struggle to prove this. An <a href="http://www.huffingtonpost.co.uk/ann-fordham/drug-policy_b_9819900.html">increasing</a> number of countries have concluded that it is not.</p><img src="https://counter.theconversation.com/content/81491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anine Kriegler receives funding from the National Research Foundation and the David and Elaine Potter Foundation. She contributed as amicus curiae to the Western Cape High Court case mentioned in the article.</span></em></p>If South Africa’s argument in court is that marijuana causes harm, it deserves to lose. The real question it should ask is whether criminal prohibition is the effective way forward.Anine Kriegler, Researcher and Doctoral Candidate in Criminology, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/785972017-05-31T20:15:49Z2017-05-31T20:15:49ZThree charts on: Australia’s changing drug and alcohol habits<p>Australians are using less alcohol, tobacco and other drugs than they did a decade ago, new results from the <a href="http://www.aihw.gov.au/">Australian Institute of Health and Welfare’s</a> (AIHW) National Drug Strategy Household Survey show.</p>
<p>Although the drug of most concern to the general public is methamphetamine, the rate of methamphetamine use has been showing a steady decline since 1998 and, at 1.4%, is now at its lowest point since the survey began, down from 2.1% three years ago.</p>
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<p>So why are people worried? The data over the past several years has shown a decrease in people who prefer to use the lower purity methamphetamine speed and an increase in people preferring to use the more potent crystal form, “ice”. </p>
<p>This trend continues in this survey. The drop in the proportion of people who use methamphetamine overall appears to be driven by fewer people using speed. </p>
<p>With an increase in crystal methamphetamine as the preferred form has come significant increases in harms. </p>
<p>Recent <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/aodts-nmds-2015-16/">treatment data </a>show an increase in treatment presentations - methamphetamine now represents close to 25% of drug treatment episodes - and there has been increases in ambulance call outs, hospital separations and deaths due to methamphetamine.</p>
<p>The trends in methamphetamine use and harms highlight why policies should focus on harms and harm reduction rather than use and use reduction.</p>
<p>In fact, illicit drug use more generally has decreased, mainly driven by a reduction among teenagers, suggesting that fewer young people are trying illicit drugs. This is also continuing a trend seen over the past decade.</p>
<h2>Age of first drug use is on the rise</h2>
<p>Not only are fewer people using illicit drugs, those who do are trying them later. Specifically methamphetamine, cannabis and hallucinogens showed an increase in the age of first use:</p>
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<p>People aged 35-55 years have increased their use of illicit drugs significantly, driven primarily by increases in use of cannabis, methamphetamine and cocaine. We don’t know whether these are people new to using illicit drugs or people who have a history of use who have moved into an older age group.</p>
<p>Traditionally harm reduction messages have been primarily targeted at young people, but an important growing group of people at risk of harms is now those in middle age.</p>
<p>The proportion of people using illicit drugs in their 60s has also been increasing over time. Although the increase is relatively small from 2013 to 2016, people in their 60s have had the largest increase since 2001. This is mostly accounted for by use of pharmaceuticals for non-medical purposes. Careful monitoring of pharmaceutical prescriptions and over-the-counter medicines are part of a harm reduction solution.</p>
<h2>More people report being non-drinkers</h2>
<p>Despite a lot of media interest in illicit drugs, it is still the legal drugs, alcohol and tobacco that cause most harm in the community.</p>
<p>The good news is that there was a decline in drinking that increases risk of harm over a lifetime (such as chronic health problems). For healthy men and women, drinking no more than two standard drinks on any day <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">reduces the lifetime risk</a> of harm from alcohol.</p>
<p>There was no overall change in drinking that increases risk on a single drinking occasion (such as injuries), but younger people under 30 years old showed a significant decline in risky drinking. For healthy men and women, drinking no more than four standard drinks on a single occasion <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">reduces the immediate risk</a> of alcohol-related harm. Alcohol-related incidents also decreased, and the proportion of people who reported never having a full glass of alcohol grew.</p>
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<p>Nearly 94% of 12-15 year olds and 58% of 16-17 year olds did not drink at all, both increases from the previous survey.</p>
<p>There was an increase in the proportion of the population who have never smoked and who are ex-smokers, with a significant increase in teenagers who do not smoke.</p>
<p>Overall, legal and illegal drugs are showing a stable or downward trend in proportion of population who use them over the last decade or more. However, while fewer young people are using, the proportion of people using alcohol and other drugs in the older age groups has increased.</p>
<p><em>CORRECTION: This article was corrected on June 1 to change “a significant decrease in teenagers who do not smoke” to “a significant increase in teenagers who do not smoke.” The Conversation apologies for the error and thanks readers who picked it up.</em></p><img src="https://counter.theconversation.com/content/78597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the public, private and not for profit health sector to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research.</span></em></p>The proportion of population who use legal and illegal drugs has remained stable or trended down. Fewer young people are using, but the proportion of older people using drugs and alcohol has grown.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/722662017-02-03T01:17:24Z2017-02-03T01:17:24ZMaybe moderate drinking isn’t so good for you after all<figure><img src="https://images.theconversation.com/files/155270/original/image-20170201-29896-1o6an62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older adults’ health may mainly reflect wealth and socioeconomic status, not the amount they drink. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/katinalynn/68077608/in/photolist-71V6S-4ec2XT-Mo1X6-ESRdS-4hNmCa-N6f1N-ai39Wh">katinalynn/flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>We generally assume moderate drinking (two standard drinks per day) is good for our health.</p>
<p>This idea comes from <a href="http://link.springer.com/article/10.1007/s11739-010-0346-0">studies</a> over the past three decades showing moderate drinkers are healthier and less likely to die prematurely than those who drink more, less, or don’t drink at all. </p>
<p>I would be glad if this were true. </p>
<p>But our <a href="https://academic.oup.com/psychsocgerontology/article/doi/10.1093/geronb/gbw152/2645642/The-Health-Benefits-of-Moderate-Drinking-in-Older">latest research</a> challenges this view. We found while moderate drinkers are healthier than relatively heavy drinkers or non-drinkers, they are also wealthier. When we control for the influence of wealth, then alcohol’s apparent health benefit is much reduced in women aged 50 years or older, and disappears completely in men of similar age. </p>
<h2>Health, wealth and alcohol intake</h2>
<p>Limited <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2010.01286.x/full">research</a> shows moderate drinking is linked to better health in older adults aged between 55 to 65. But this work failed to account for one of the main factors influencing both health and alcohol use: wealth. </p>
<p>To address this question, we explored whether older moderate drinkers are healthier because of their drinking, or because their wealth affords them healthier lifestyles. </p>
<p>We used data from 2,908 older New Zealanders (average age 65) in the government-funded <a href="http://www.massey.ac.nz/massey/learning/departments/school-of-psychology/research/hart/new-zealand-health-work-and-retirement-study/new-zealand-health-work-and-retirement-study_home.cfm">Health, Work and Retirement Study</a> at Massey University. This is New Zealand’s foremost longitudinal ageing study, spanning ten years, including a representative sample of the population aged 50 and over.</p>
<p>We split the adults aged 50 or older into groups reflecting their average level of drinking, from non-drinkers through to those drinking three or more drinks a day. We also made sure to clearly differentiate “sick quitters” (those who stopped drinking due to poor health) from “lifetime abstainers” (those who have never drunk alcohol).</p>
<p>We first compared the health of these groups and confirmed the trend in previous research: moderate drinkers of both sexes were much healthier than heavier drinkers or non-drinkers. This analysis relied on study participants rating their own health in terms of perceived levels of physical health and limitations in physical activity.</p>
<p>But we also found moderate drinkers of both sexes to be wealthier than heavier drinkers or non-drinkers. And, when we took wealth out of the equation, moderate alcohol use was not linked with better health in men. In women, moderate alcohol use was still linked with a health benefit, but given the few women drinking moderately (4%) this effect was questionable.</p>
<p>Our findings offer little support for a health-protective effect of moderate drinking. Instead, they suggest that older adults’ health and the amount they drink mainly reflect wealth and socioeconomic status. </p>
<p>Perhaps the relationship between alcohol intake and health in older drinkers reflects <em>who</em> is drinking not <em>how much</em> they drink.</p>
<h2>Re-examining moderate alcohol intake</h2>
<p>Thousands of <a href="http://www.who.int/substance_abuse/publications/global_alcohol_report/en/">studies</a> spanning multiple decades show that alcohol use is linked with more than 200 health conditions and is responsible for 6% of deaths worldwide. Scientists are still <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12104/full">looking for a plausible mechanism</a> that would allow alcohol – a <a href="http://monographs.iarc.fr/ENG/Monographs/vol96/index.php">carcinogen</a> and a key predictor of <a href="http://www.sciencedirect.com/science/article/pii/S0140673609607467">sickness and early death</a> – to have a health-protective effect. </p>
<p>Researchers are also <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12828/full">increasingly concerned</a> about the validity of previous claims on the health benefits of moderate drinking. <a href="http://www.sciencedirect.com/science/article/pii/S1047279707000075">Reviews</a> of studies supporting a relationship between alcohol and health show many grouped “sick quitters” (previous drinkers who stopped due to poor health) with those who have never regularly drunk alcohol. The presence of these sick ex-drinkers in analyses makes the health of non-drinkers seem much poorer than that of moderate drinkers. </p>
<p>Many studies also <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12104/full">failed to account</a> for differences between moderate drinkers and other groups on factors known to predict health; moderate drinkers tend to have better wealth, education, physical activity levels and diet. After controlling for such differences as we recently did, there is <a href="http://www.jsad.com/doi/abs/10.15288/jsad.2016.77.185">little evidence</a> that moderate alcohol consumption has a health benefit compared with lifetime abstention or occasional drinking. </p>
<h2>Older adults beware</h2>
<p>Older adults are now a rapidly growing population for whom alcohol use can have <a href="http://link.springer.com/article/10.1007/s11920-012-0292-9">serious ramifications</a> and we must consider any claims of health benefits cautiously. </p>
<p>Compared to younger adults, older adults are at <a href="http://www.tandfonline.com/doi/abs/10.1080/01639360903140106">greater risk</a> of poor health outcomes from drinking alcohol. Older adults process alcohol <a href="http://www.jsad.com/doi/abs/10.15288/jsa.1999.60.103">less effectively</a>, are more likely to have <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2006.00728.x/full">health conditions</a> that alcohol can worsen and to <a href="http://www.sciencedirect.com/science/article/pii/S1543594607000074">use medications</a> that alcohol interferes with.</p>
<p>Yet, <a href="http://journals.lww.com/jan/Citation/2014/01000/The_Baby_Boomers_and_Substance_Use__Are_We.1.aspx">recent research</a> indicates newly retiring baby boomers are drinking more alcohol, more often, than previous generations of retirees. And many older adults still assume moderate drinking is beneficial, some <a href="https://academic.oup.com/fampra/article/25/6/445/481283/Drinking-alcohol-for-medicinal-purposes-by-people">actively drinking for “medicinal purposes”</a>.</p>
<p>Older drinkers are one of the most at-risk populations from alcohol-related harm, yet they are also one of our least understood drinking groups. </p>
<p>If drinking has no benefits for older adults’ health and they are at increased risk of alcohol-related harm, then how much is too much for older adults to drink? My international colleagues and I are trying to answer this question.</p><img src="https://counter.theconversation.com/content/72266/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andy Towers is currently receiving funding from the New Zealand Health Promotion Agency to explore older adults drinking trends and health outcomes. </span></em></p>Baby boomers might not be boosting their health with a glass or two of alcohol a day after all.Andy Towers, Senior Lecturer, School of Public Health, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/674542016-10-24T22:33:52Z2016-10-24T22:33:52ZWomen’s alcohol consumption catching up to men: why this matters<figure><img src="https://images.theconversation.com/files/142989/original/image-20161024-28380-wrtsvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alcohol use is traditionally higher among men than women but new evidence suggests this is changing.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Women are catching up to men in rates of alcohol consumption and this has important implications for how we think about our community response to harmful alcohol use.</p>
<p>Historically, men have been more likely to drink alcohol than women and to drink in quantities that damage their health. However, evidence points to a significant shift in the drinking landscape with <a href="http://www.sciencedirect.com/science/article/pii/S0376871607003559">rates of alcohol use appearing to converge</a> among men and women born more recently. In a bid to quantify this trend, <a href="http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2016-011827">we pooled data</a> from 68 studies in 36 countries with a total sample size of over four million men and women.</p>
<p>All of the studies we looked at reported data on both men’s and women’s drinking across at least two time periods. Some data were available from men and women born in the early 1900s, other data from men and women born in the late 1900s, but each data point represented the ratio of men’s to women’s alcohol use for those born within a specific five-year time window. Taken together we were able to map ratios across the entire period from as early as 1891 right up to the year 2000 and everything in between. </p>
<p>We grouped data according to three broad definitions: any alcohol use (in other words being a drinker or not), problematic alcohol use (binge or heavy episodic drinking) and alcohol-related harms (negative consequences as a result of drinking such as accidents or injuries or a diagnosis of an alcohol use disorder).</p>
<p>What we found was that the gap between the sexes has narrowed over time. Among cohorts born in the early 1900s men were just over two times more likely than women to drink, three times more likely to drink in ways suggesting problematic alcohol use and three-and-a-half times more likely to experience alcohol-related harms. </p>
<p>Among those born in the late 1900s these ratios had decreased to almost one. This means that by the end of the last century men’s and women’s drinking had almost reached parity.</p>
<p>We did not seek to quantify by how much alcohol use is falling among men and/or increasing among women. However, of the 42 studies that showed converging alcohol use, most reported this was driven by increases in the rates of female drinking. </p>
<p>A small proportion (5%) of the individual sex ratios was less than one, the majority of which came from cohorts born after 1981. This suggests women born after this time may, in fact, be drinking at <em>higher</em> rates and in <em>more</em> harmful ways than their male counterparts. </p>
<h2>What’s changed in the last 100 years?</h2>
<p>We don’t have a definitive answer to what has driven the rise in alcohol consumption among women but in many countries around the world we have seen substantial developments in broader social, cultural and economic factors for women and increasingly accepting societal norms around female drinking. </p>
<p>It is likely <a href="https://dx.doi.org/10.2147/SAR.S21343">sex differences in alcohol use are linked</a>, probably in complex ways, to these societal changes. Most people would argue these changes have been positive. However, increased exposure to alcohol for women also means increased exposure to the <a href="http://www.sciencedirect.com/science/article/pii/S0376871615016166">physical and mental health risks associated</a> with drinking too much.</p>
<p>Regardless of the reasons behind these changes, it’s clear alcohol use and associated problems are not problems that only affect men. </p>
<p>This matters because often the focus in the media and public debate is on young men and alcohol. It matters because universal prevention can be an effective strategy to reduce harmful alcohol use among women. It matters because, while women seek treatment for almost every other physical and mental health problem at higher rates than men, women who experience problems related to alcohol generally don’t seek treatment. </p>
<p>The sooner we structure our education campaigns as well as our prevention, early intervention and treatment programs around this notion, the better our community response to harmful alcohol use will be. </p>
<p>We need to ensure education campaigns addressing the harms of alcohol use are <a href="http://www.positivechoices.org.au">designed to appeal to both men and women</a>. We need to target adolescents before drinking patterns are entrenched and deliver high quality, evidence-based <a href="http://anp.sagepub.com/content/50/1/64.abstract">universal prevention and early intervention programs</a>. We need to reduce the structural barriers (such as cost and location) as well as negative attitudes that get in the way of women <a href="http://www.sciencedirect.com/science/article/pii/S0376871614019735">seeking treatment for alcohol problems</a>. </p>
<p>Many of the men and women who are contributing to these changing drinking patterns are only now in their 20s or 30s. We need to keep tracking population trends in drinking as these cohorts age into their 40s, 50s and beyond. We need to keep asking the question: how can we do better to prevent alcohol related harms?</p><img src="https://counter.theconversation.com/content/67454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Slade receives funding from the NHMRC, the ARC and the Australian government.</span></em></p><p class="fine-print"><em><span>Cath Chapman receives funding from the NHMRC and the Australian government.
</span></em></p><p class="fine-print"><em><span>Maree Teesson is a director of CLIMATESchools Pty Ltd. An Australian company that distributes evidence based educational materials to schools. She receives funding from the NHMRC, the Australian government and the NSW government.</span></em></p>Women are catching up to men in rates of alcohol consumption and this has important implications for how we think about our community response to harmful alcohol use.Tim Slade, Associate Professor, UNSW SydneyCath Chapman, Senior Research Fellow, UNSW SydneyMaree Teesson, Professor at the National Drug and Alcohol Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/596032016-07-04T03:03:26Z2016-07-04T03:03:26ZHealth Check: what are the risks of drinking before you know you’re pregnant?<figure><img src="https://images.theconversation.com/files/123706/original/image-20160524-11017-1r9wv6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Almost half of pregnant women in Australia said they drank alcohol before they knew they were pregnant.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>It is <a href="http://alcoholthinkagain.com.au/Alcohol-Your-Health/Alcohol-During-Pregnancy">well established</a> that drinking alcohol during pregnancy can have detrimental effects on the developing foetus. Newborns exposed to maternal alcohol develop a range of behavioural, physical and cognitive disabilities later in life. </p>
<p>However, researchers are now beginning to draw attention to the impact of alcohol around the time of conception and the health of the foetus later in life. The lens of the microscope has been switched to this very specific time point as many mothers will drink in the early stages of pregnancy. </p>
<p>Data from a 2010 National Drug Strategy Household <a href="http://www.fare.org.au/wp-content/uploads/research/Alcohol-Consumption-During-Pregnancy-Final.pdf">Survey</a> showed 47.3% of women consumed alcohol while pregnant before they knew they were pregnant.</p>
<h2>How much do women drink?</h2>
<p>Recent <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365792/">studies</a> show the developing embryo is highly susceptible to environmental changes and the actions of the mother. This time point is <a href="http://www.ncbi.nlm.nih.gov/pubmed/21256208">critical</a> as it is the most active time for cell division and differentiation, with the early embryo containing all the genetic codes and information needed for the future development of the foetus. As such, an optimal environment during this period is just as important as the remaining months of pregnancy and peak organ development.</p>
<p>It is common for women of reproductive age to consume alcohol. A recent survey showed Australian women on average <a href="https://www.mja.com.au/journal/2015/203/3/making-sense-alcohol-consumption-data-australia">reported</a> drinking 3.5 standard drinks a day. This is quite alarming when taking into consideration <a href="http://www.ncbi.nlm.nih.gov/pubmed/17250620">50% of pregnancies</a> in Australia are unplanned, with the average time point of recognition of pregnancy at four weeks.</p>
<p>The Australian <a href="http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/wwtk-hp-leaflet#footnotes">guidelines</a> for reducing the health risks from drinking alcohol state:</p>
<blockquote>
<p>The early stages of pregnancy see the foetus being most vulnerable to structural damage in the first three to six weeks of gestation. If a woman stops drinking before she gets pregnant, she can avoid exposing her baby to alcohol in the early stages of pregnancy. </p>
</blockquote>
<p>However, despite these recommended guidelines, it’s probable women are still consuming high amounts of alcohol prior to the recognition of pregnancy.</p>
<p>With such high rates of unplanned pregnancies and a society that embraces the ritual of a few drinks at the end of a work day, early pregnancy is likely to be the period of highest intake for women who are unaware of their pregnancy. Adding to this, a 100ml glass of wine considered a <a href="http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/content/drinksguide-cnt">standard drink</a> could be very different to what is poured at home.</p>
<h2>What are the risks?</h2>
<p>Clinical studies have not yet tracked the drinking patterns of women prior to the recognition of pregnancy and subsequent health outcomes of the child. However, <a href="http://www.ncbi.nlm.nih.gov/pubmed/24116300">preliminary research</a> through animal models is showing alcohol around conception and very early pregnancy can alter the development of the early embryo and lead to long-term <a href="http://www.ncbi.nlm.nih.gov/pubmed/21177086">consequences</a> for the health of offspring after birth.</p>
<p>Using a mouse animal model, researchers from Finland <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430308/">reported</a> early maternal alcohol consumption during this developmental period caused changes in brain structure of offspring, particularly in an area of the brain important for learning and memory.</p>
<p>Co-author Karen Moritz <a href="http://www.ncbi.nlm.nih.gov/pubmed/25733565">found</a> the equivalent of five standard alcoholic drinks consumed around the time of conception in a rat animal model altered the development of the foetus. The study showed that before the egg implants and any organs start to develop, alcohol consumption causes changes to the embryo. Furthermore, the risk of offspring becoming obese and developing type 2 diabetes in early middle age dramatically increased.</p>
<p>The usual risk factors of these two diseases are attributed to poor diet and lack of exercise, but the results showed exposure to alcohol around conception presents a risk similar to following a high-fat diet for a major proportion of life.</p>
<p>Drawing on <a href="http://fare.org.au/2015/08/conversations-about-alcohol-and-pregnancy/">interviews and focus groups</a>, the Australian Foundation for Alcohol Research and Education reported more than half of women were aware that drinking before pregnancy recognition could harm their foetus. However, most of these women said they had received reassurance from a health professional or peers which alleviated these concerns. With this blanket approach, it’s not surprising women are confused when a clear gap exists between the literature reported and the advice given to women.</p>
<p>The biggest hurdle for researchers now is translating findings from the basic sciences to more sophisticated clinical research. More awareness of the risks is required since women on average are drinking <a href="https://www.mja.com.au/journal/2015/203/3/making-sense-alcohol-consumption-data-australia">more alcohol</a> and at higher rates.</p>
<hr>
<p><em>Update: the last link above has been corrected.</em></p><img src="https://counter.theconversation.com/content/59603/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:k.moritz1@uq.edu.au">k.moritz1@uq.edu.au</a> receives funding from the National Health and Medical Research Council of Australia. </span></em></p><p class="fine-print"><em><span>Diana Lucia does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Recent animal studies show the developing embryo is highly susceptible to environmental changes and the actions of the mother in early stages of pregnancy.Diana Lucia, PhD candidate, Neuroscience, School of Biomedical Sciences, The University of QueenslandKaren Moritz, Associate Professor, School of Biomedical Sciences, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/598592016-05-31T15:22:37Z2016-05-31T15:22:37ZCutting alcohol ads in sport sends the right message to youngsters<figure><img src="https://images.theconversation.com/files/124630/original/image-20160531-1921-ab8fmf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent advert for South Africa's Castle Lager. </span> <span class="attribution"><a class="source" href="http://www.brandcouncilsa.org/case-studies/latest-case-studies/castle-lager-and-brand-union.aspx">Brandcouncil SA</a></span></figcaption></figure><p>An English barbershop owner and his son have embarked on a <a href="http://www.activeeurope.org/images/Outbid_Chang_-_When_a_local_barber_shop_stands_up_to_a_giant_beer_company_.pdf">massive David and Goliath battle</a> to outbid Thai beer Chang as the front-of-jersey sponsor of their local football team. </p>
<p>In what they call the <a href="https://www.indiegogo.com/projects/outbidchang--2#/">#OutbidChang campaign</a> they started a <a href="https://www.facebook.com/hashtag/outbidchang?source=feed_text&story_id=10154136129819898">crowd fund</a> to stop Everton Football Club in the UK from using the beer as its sponsor. Everton FC is the last soccer team in the English Premier League to be funded by an alcohol company.</p>
<p>The father and son duo argues that alcohol sponsorship fuels alcohol harm to children and that in the UK children are more familiar with alcohol brands than with brands of biscuits.</p>
<p>The campaign is being supported by <a href="http://www.bigalcohol.exposed/#campaign">BigAlcohol.Exposed</a> – a global network of non-governmental organisations dedicated to exposing the truth about the unethical business methods of the alcohol industry.</p>
<p>Whether the duo is indeed able to outbid Chang beer remains to be seen – but the cause is a valid one. </p>
<p>The reality is that in 2012, across the globe about 3.3 million deaths – or 5.9% of all deaths – were attributable to alcohol consumption. Alcohol ranks among the top five risk factors for disease, disability and death throughout the world, according to the <a href="http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1">World Health Organisation</a>. </p>
<p>It results in more than deaths than HIV/AIDS and TB, and is the causal factor in more than 60 major types of disease, including neuropsychiatric disorders like epilepsy, gastro-intestinal disorders such as liver cirrhosis, cancer, cardio-vascular diseases and diabetes. </p>
<p>There is no doubt that the abuse of alcohol is harmful. And it is clear that the harm is greater in countries where there is “harmful” or binge drinking. </p>
<p>South Africa is one of these countries. Despite the fact that 65% of adults do not drink, those who do, drink 35 <em>l</em> of absolute alcohol a year. This is among the highest <a href="http://tobaccoecon.org/wp-content/uploads/2014/03/alcohol-advertising-in-south-africa-a-trend-and-comparative-analysis.pdf">in the world</a>.</p>
<p>The expressed aim of any alcohol producing company is to make profit – and to do this the more that is sold, the better. In South Africa the spend on above-the-line advertising in 2012 was R1.8 billion (about US$114 million at current rates). And that excluded sponsorship and other marketing <a href="http://tobaccoecon.org/wp-content/uploads/2014/03/alcohol-advertising-in-south-africa-a-trend-and-comparative-analysis.pdf">opportunities</a>.</p>
<p>In the US alcohol advertisers spent $2 billion on alcohol advertising in measured media – television, radio, print, outdoor, major newspapers and Sunday supplements – <a href="http://www.camy.org/resources/fact-sheets/alcohol-advertising-and-youth/">in 2005</a>.</p>
<p>Because the adverts were placed in media the youth would likely engage with, US youth viewed 45% more beer ads and 27% more liquor ads in magazines than people of legal drinking age. They also watched an average of 2,000 television ads for alcohol per year. </p>
<p>There is <a href="http://www.aafp.org/about/policies/all/alcohol-advertising.html">extensive research</a> showing that young people who are exposed to alcohol advertising are more likely to intend to drink, start drinking at an early age and to drink more than those not exposed. </p>
<h2>Does banning advertising work?</h2>
<p>Unlike many harmful substances, alcohol is legal in most societies, and is freely advertised and promoted. This includes marketing and promoting excessive use, as seen through the creation of the six pack and 12 pack, promoting high rates of use. </p>
<p>But there is evidence that banning the advertising of a product does produce results. </p>
<p>Take tobacco advertising as an example. Cigarettes are more addictive than alcohol. And each year about <a href="http://www.who.int/mediacentre/factsheets/fs339/en/">six million people die</a> prematurely from tobacco-related illnesses. </p>
<p>A recent World Health Organisation <a href="http://apps.who.int/iris/bitstream/10665/156262/1/9789241564922_eng.pdf">report</a> found that in 2010 – seven years after the organisation introduced a tobacco monitoring framework that suggested advertising bans – there were 3.9 billion non-smokers aged 15 years and over in the organisation’s member states, or 78% of the 5.1 billion population aged over 15. This number is projected to rise to 5 billion – or 81% of the projected 6.1 billion population aged over 15 – by 2025 if the current pace of tobacco cessation continues.</p>
<p>And an analysis of advertising spend in 2001, when the tobacco advertising ban came into effect in South Africa, shows that economic growth was only 2.7% and advertising decreased by 7.4%. But by 2002 the adspend was back to the 2001 level as the industry found new ways to promote its product. It continued to grow until 2007 when it was approximately double the amount spent in 2002. </p>
<p>The lesson to learn with banning tobacco advertising is that there will always be products to jump into the breach and the industry will continue to grow.</p>
<h2>Sending the wrong message</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=345&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=345&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=345&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A screengrab of an advert where South African cricketers AB De Villiers and Aaron Phangiso wear gear sponsored by an alcohol brand.</span>
</figcaption>
</figure>
<p>Many argue that, as alcohol is a legal substance, the industry must have the right to advertise. In recognition of the harm that the industry admits that alcohol causes, a voluntary code has been developed that the industry is supposed to adhere to.</p>
<p>This code is published on the web page of the <a href="http://www.asasa.org.za/">Advertising Standards Authority</a> of South Africa. One of the guidelines is that commercial communication may not imply that alcohol consumption is essential to business and/or social success or acceptance, or that refusal to consume is a sign of weakness.</p>
<p>What isn’t clear is how this guidance is interpreted, monitored or enforced. </p>
<p>As a result, for example, a leading beer brand in South Africa <a href="http://www.sab.co.za/sablimited/content/sab-carling-black-label">sponsors</a> several events – both in <a href="http://www.kickoff.com/news/65014/cblc-celebrates-the-voices-of-football-fans">sport</a> and entertainment – as well as many male-dominated cultural activities. One of its competitions – linked to a football event – asked participants to enter by buying a “pack” of beer. </p>
<p>Football is a major preoccupation of young boys. And although the industry argues that is it advertising to adults, all boys are encouraged to participate in and watch these sports. Information about these events is freely available to boys and girls under 18. </p>
<p>A <a href="http://www.tandfonline.com/doi/full/10.1080/10810730490271665">study</a> in the US has found that while 26% of young adults between the ages of 21 and 23 had seen an alcohol advertisement, 23% of 15- to 17-year-olds had also seen the same advert. They also found that young people who could accurately identify alcoholic products and who said they liked the ads were <a href="http://www.tandfonline.com/doi/full/10.1080/10810730490271665">more likely to try drinking</a> or to drink more.</p>
<p>In South Africa all three <a href="http://www.worldofbeer.co.za/content/page/sab-brands">predominantly male national sports</a> – football, rugby and cricket – are sponsored by alcohol.</p>
<p>Although the South African government in May 2015 gazetted a new <a href="http://www.gov.za/sites/www.gov.za/files/38808_gen446.pdf">National Liquor Policy</a> for comment recommending that alcohol advertising be restricted, and sponsorship and promotions associated with alcohol be prohibited, whether this will make it into the final legislation remains to be seen. </p>
<p>Considering South Africa’s high levels of alcohol abuse and harm, this would be a step in the right direction. Whether ordinary South Africans would take a similar stand to the English barbershop owner and his son and crowd fund an outbid campaign against liquor giants is another question.</p><img src="https://counter.theconversation.com/content/59859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Goldstein is affiliated with the Health Promotion Foundation organisation.</span></em></p>Removing alcohol brands as sponsors of sports events could help reduce the trend of young people drinking.Susan Goldstein, Honorary Senior Lecturer at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.