tag:theconversation.com,2011:/uk/topics/ndarc-4126/articlesNDARC – The Conversation2016-10-24T22:33:52Ztag: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/101972012-10-25T00:05:33Z2012-10-25T00:05:33ZHow to reduce opioid overdose deaths in Australia<figure><img src="https://images.theconversation.com/files/16833/original/jkm8ht76-1351035057.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most overdose deaths are due to heroin but an increasing number are due to pain relieving prescription opioid drugs.</span> <span class="attribution"><span class="source">Thomas Marthinsen</span></span></figcaption></figure><p>Once again, overdose deaths from opioids are increasing in Australia. And once again, we are in danger of ignoring effective, evidence-based interventions. </p>
<p><a href="http://ndarc.med.unsw.edu.au/sites/ndarc.cms.med.unsw.edu.au/files/ndarc/resources/NIDIP%20Bulletin%20-%20opioid%20induced%20deaths%20in%20Australia%202008.pdf">According to</a> the National Drug and Alcohol Research Centre, there were 360 opioid overdose deaths in 2007 but 500 in 2008 – a 40% increase. These overdose figures have been carefully checked. </p>
<p>Preliminary figures suggest that there were 612 such deaths in 2009, a 22% increase from 2008, and 705 in 2010, a 15% increase from the year before. Increases in overdose deaths occurred in all of the major states but were most marked in Victoria where such deaths increased 133% from 73 in 2001, to 170 in 2008.</p>
<p>Most of these deaths are due to heroin but an increasing number have recently been due to pain relieving prescription opioid drugs. Most involve men in their early 30s.</p>
<p>And for every fatal overdose, there are many more non-fatal overdoses. Non-fatal overdoses can result in severe physical and mental damage, expensive ambulance call outs and admissions to hospital emergency departments and intensive care units. So the health and financial costs of non-fatal overdoses to individual young Australians and the community are anything but trivial.</p>
<h2>Recent trends</h2>
<p>Heroin is produced from opium and most of the heroin reaching Australia originates from Burma. The last time opium production peaked in Burma was in the mid-1990s. That increase resulted in a glut of heroin in Australia and annual opioid overdose deaths peaked at 1,116 in 1999. </p>
<p>Opium production in Burma decreased 82% from 1,760 metric tonnes in 1996 to 312 metric tonnes in 2005. Annual opioid overdose deaths in Australia fell to 938 in 2000 and then to 386 in 2001. Opioid overdose deaths then remained below 400 until 2008. </p>
<p><a href="http://www.unodc.org/documents/data-and-analysis/WDR2011/World_Drug_Report_2011_ebook.pdf">In recent years</a>, Burma’s opium production has increased 88% from 312 metric tonnes in 2005 to 586 metric tonnes in 2010. If this trend continues, Australia could once again experience the extremely high levels of overdose deaths that occurred in the 1990s.</p>
<p>The shortage of heroin in Australia that began in 2000 (and also affected some other countries) coincided with the sharp decline in opium production in Burma between 1996 and 2005. This decline was probably due to a combination of factors including the retirement of a major Burmese opium warlord (Khun Sa), a shift from outdoor opium cultivation (easily detected by aerial and satellite surveillance) to indoor amphetamine production, increasing consumption of heroin in China en route to Australia and local climatic changes. </p>
<p>Inevitably, some Australian politicians claimed at the time the shortage was due to the then new “tough on drugs” policy; they were less enthusiastic about accepting responsibility for the increase in amphetamine use that followed the heroin shortage.</p>
<h2>Treatment options</h2>
<p>There are several things we can do to address this looming problem. First, we could expand and improve our drug treatment system and reduce the barriers to entering and remaining in treatment. There’s copious high-quality evidence that methadone and buprenorphine treatments are effective and safe. For every $1 spent on these treatments, there’s a community saving of $4 to $7. </p>
<p>Methadone and buprenorphine reduce the excess risk of death among people who inject heroin by about 80%. And a recent study suggests that these treatments reduce the risk of HIV by over 50%. They also reduce property crime substantially. </p>
<p>But most people who enrol in methadone or buprenorphine programs have to pay at least $50 per week from what is usually a very low income. And there’s far more demand than supply of such treatments in most parts of Australia. </p>
<p>What’s more, the treatments are very stigmatised, especially methadone. Many patients enrolled in methadone and buprenorphine treatment complain that staff don’t treat them with respect. Many don’t even bother trying to enter treatment and others leave far too early. </p>
<p>Stigma is one of the nasty side effects of our punitive approach to illicit drugs. The experimental and unapproved drug naltrexone is also advocated by some as something of a panacea but a <a href="http://www.nhmrc.gov.au/your-health/naltrexone-implants">recent NHMRC review</a> concluded that there was insufficient evidence that this drug is effective or safe.</p>
<h2>Safer injecting</h2>
<p>Safe injecting facilities (like the Kings Cross Medically Supervised Injecting Facility) also reduce the risk of fatal and non-fatal opioid overdoses. They mainly cater for the most disadvantaged subset of an already very disadvantaged population of people who inject drugs. </p>
<p>Many of the people who attend the 90 safe injecting facilities around the world have severe physical and mental illnesses, are homeless and very isolated. Many have had little or no previous contact with health or social agencies, including those providing drug treatment. </p>
<p>Safe injecting facilities are only needed near or within large drug markets (where most overdose death occurs) that spill over into surrounding neighbourhoods. Australia only needs a few such facilities in half a dozen major cities in the country. </p>
<p>New South Wales accounts for almost half of Australia’s drug overdose deaths and a fifth of these deaths occur within two kilometres of Kings Cross. Safe injecting facilities also improve neighbourhood amenity so they’re usually very popular with local residents.</p>
<p>Trying to repair the severe and multiple problems that have developed over the many years of injecting drugs takes a lot of time and a lot of effort. People who use drugs, their families and communities often look for a magical quick-fix solution that will instantaneously sort everything out perfectly. So too do our politicians. </p>
<p>Unfortunately, there are no quick fixes. But there are effective and pragmatic interventions that will save hundreds of lives and millions of dollars. What we need to do is ask ourselves if we are ready to think about these interventions for people who are someone’s son or daughter, sister or brother, father or mother.</p><img src="https://counter.theconversation.com/content/10197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Wodak AM is a physician and a Director of Australia21, an independent think tank; President of the Australian Drug Law Reform Foundation; Emeritus Consultant of St Vincent’s Hospital, Sydney; Visiting Fellow of the Kirby Institute, UNSW and; Visiting Fellow of the National Drug and Alcohol Research Centre, UNSW.</span></em></p>Once again, overdose deaths from opioids are increasing in Australia. And once again, we are in danger of ignoring effective, evidence-based interventions. According to the National Drug and Alcohol Research…Alex Wodak, Emeritus Consultant, St Vincent's Hospital, DarlinghurstLicensed as Creative Commons – attribution, no derivatives.