UNDER THE INFLUENCE RESHAPING NEW ZEALAND’S DRINKING CULTURE ISBN 978-0-9582975-8-5 (Paperback) ISBN 978-0-9582975-9-2 (Electronic)

Prepared for The Salvation Army Social Policy and Parliamentary Unit by Bev James, Public Policy & Research Ltd, PO Box 11260, Manners Street, Wellington 6142. Authorised and approved by Commissioner Donald C. Bell, Territorial Commander, as an official publication of The Salvation Army New Zealand, Fiji and Tonga Territory.

‘Under the Influence’ was produced by The Salvation Army Social Policy and Parliamentary Unit, 16b Bakersfield Place, PO Box 76249, Manukau City 2104, New Zealand. Director: Major Campbell Roberts.

This Report is available for viewing or download from: www.salvationarmy.org.nz/socialpolicy

The Salvation Army Social Policy and Parliamentary Unit would like to thank community partner Duncan Cotterill Lawyers for their financial assistance with the production of this report. UNDER THE INFLUENCE RESHAPING NEW ZEALAND’S DRINKING CULTURE

Bev James Public Policy & Research Ltd

The Salvation Army Social Policy and Parliamentary Unit April 2010

UNDER THE INFLUENCE | i ii | UNDER THE INFLUENCE FROM THE FOCUS GROUPS

You’re revered for how much you can drink, get Look at the smoking, smoking isn’t cool. kudos for it, rather than being ostracised … Show what you look like when you’re pissed.

It’s the way we’ve been brought up … Brought Get the outlets to be more vigilant. There should up to drink to get drunk … I learned to drink off be much stricter fines for contravention of liquor my father … To be in with your family, you’ve got licenses … to drink … You’re in crisis, then you have to wait [for Sports clubs are supposedly there to keep you treatment]. There’s three options, death, jail, or healthy but there’s drinking after the game … hang in there and wait. It’s Russian Roulette … Growing up, playing the game and having a few Depression and emotional issues are triggers beers. for drinking … it’s hard to find the right support, When I was drinking, you could drop me and to know it’s OK to ask for help … anywhere in the city and I would know where the There are stereotyped views about who is an nearest place to buy booze was … alcoholic, we need to challenge those … Nobody You pay more for Coke than for beer … is spared …

What slows teenagers down from drinking is The number one thing that’s got to change is they don’t like the taste, all they want is the the culture; it’s normal [to drink], it’s effect and that’s what they get with alcopops … intergenerational …

SOCIAL POLICY AND PO Box 76249, Manukau City 2104 WE PARLIAMENTARY UNIT [email protected] WELCOME NEW ZEALAND, FIJI salvationarmy.org.nz/socialpolicy & TONGA TERRITORY Phone (09) 261 0883 YOUR Mobile 027 450 6944 FEEDBACK Fax (09) 262 4103

UNDER THE INFLUENCE | iii EXECUTIVE SUMMARY

This report presents a summary of findings • market factors, particularly alcohol from 20 focus groups with people who have advertising (including promotions), pricing attended or who are attending Salvation Army and products addiction treatment programmes. The purpose • legislative and regulatory factors, of the focus groups was to learn more about particularly availability, the legal purchase people’s experiences with alcohol and their age and enforcement ideas for limiting the harm that alcohol causes In brief, research shows that culture, family in our society. and peers are all major influences on drinking The report also places the findings from the behaviours: focus groups in the wider context of research • In New Zealand, there is a widespread on environmental influences on drinking cultural acceptance of drinking and it is behaviours. an intrinsic part of much of our social life, What the literature says about influences on for both genders. Young adults are the drinking behaviours heaviest drinkers and most likely to engage A selected overview of literature concerned in risky drinking such as binge drinking and with environmental influences on drinking becoming intoxicated. behaviours identifies the wide range of • There has been extensive international influences that affect when, where, how research on the role of families, particularly and with whom we drink, as well as the parents, in influencing drinking behaviours. links between influences, behaviour and Key influences have been identified as: alcohol-related harm. This literature also parenting practices, parents’ own drinking provides insights into how changes in those behaviour, family conflict, and parental environmental factors—through legislation, supply of alcohol. Often, these factors work policy or practice—can change drinking together as influences. behaviours and impact on alcohol-related • Friends and social networks are significant harm. influences on drinking attitudes and International and New Zealand evidence is that behaviours. Drinking with friends and the following environmental factors influence workmates, associations with playing drinking behaviours and contribute to alcohol- and watching sports, and the presence of related harms: alcohol in social situations is fundamental • the broad cultural context of institutions, to how New Zealanders relax, feel at practices, attitudes and values ease with others and express a sense of • social factors, particularly the family and belonging. International research confirms peer group that one major reason why young people use alcohol is because their peers use it.

iv | UNDER THE INFLUENCE Key aspects of the market influence drinking With regard to the way the legislative and behaviours: regulatory environment influences drinking • An extensive body of research across many behaviour: countries shows that price influences • Both overseas and New Zealand studies alcohol consumption, with higher prices have shown that consumption increases lowering consumption and price reductions when the number and density of liquor increasing consumption. Price increases outlets increase. There appears to be a have also been found to reduce vehicle particular relationship with high outlet crash fatalities, adverse health effects, density and underage drinking. Studies child abuse and other violence. have also found that a higher density • Evidence about the link between exposure of licensed premises is associated with to alcohol advertising and alcohol alcohol-related harm such as increased consumption is mixed, although on rates of homicides and assault, greater balance there is growing evidence that prevalence of drinking and driving, alcohol- alcohol advertising does influence drinking related hospital admissions, child abuse behaviour, including the amount of alcohol and neglect, pedestrian injuries, and consumed, and the age at which young property damage. people start drinking. • International studies have shown longer • The type of alcohol product has an trading hours are associated with higher influence on the drinking patterns of levels of drinking and intoxication and different segments of the population. Since resulting problems with public disorder, the early 1990s, an increasing range of violent assaults, increased alcohol-related alcohol products have emerged on the hospital admissions and increased traffic market. New products such as ready-to- casualties. drink beverages (RTDs) tend to be the • A wide range of studies overseas and in drinks of choice of young people. A growing New Zealand concludes that the purchase body of research argues that RTDs are age does influence young people’s drinking specifically marketed to appeal to young patterns. In particular there is a ‘trickle people, and have been a major contributor down’ effect with those close to the legal to youth initiation into drinking, increases purchase age also gaining access to in the amount and frequency of youth alcohol. Lowering the purchase age has drinking, youth binge drinking, and higher been found to contribute to increased levels of youth intoxication. alcohol consumption levels and heavy drinking, traffic crashes and disorder offences among young people.

UNDER THE INFLUENCE | v • Studies have shown that enforcement is a • social situations critical influence on drinking behaviours. • availability and proximity of alcohol Inadequate enforcement of purchase • alcohol advertising age laws has been found to contribute to early exposure of minors to alcohol and • the price of alcohol underage drinking, as well as increases in Across all the focus groups, the three most intoxicated drinkers. Effective enforcement important influences and triggers were has been found to reduce risky drinking considered to be: personal issues, social and behaviours and alcohol-related harm. peer group influences, and the availability of

What the focus groups said about drinking alcohol. influences Focus group ideas for limiting alcohol- The focus groups broadly agreed that alcohol related harm is embedded in the New Zealand way of life. Focus group participants emphasised that Alcohol consumption is widely accepted as part multiple responses are needed to engage a of social gatherings, celebrations, recreation, wide range of people. In particular, the focus relaxation and reward. groups made clear distinctions between Within a culture that has normalised the moderate drinkers and those for whom alcohol consumption of liquor, there are some strong is a big problem in their lives. They also influences that lead people to drink. The focus distinguished between young people starting groups identified those major influences as: to drink, and adults with well established drinking habits. • family environment Focus group participants made the following • social and peer group suggestions for limiting alcohol-related harm: • availability of alcohol • public education about the impacts of • alcohol advertising and packaging alcohol, with a particular emphasis on • the association of sports with alcohol children and young people • the price of alcohol • increase the range and types of treatment Within these broad range of influences, many • increase the purchase age people experience specific triggers that prompt • restrict alcohol advertising and promotions the desire to drink. Focus group participants and introduce health warnings on product identified the main triggers as: labelling • emotional issues and personal state of • restrict the availability of alcohol mind

vi | UNDER THE INFLUENCE • tightening of liquor licensing and stricter • encourage people to seek help for their enforcement alcohol problems • raise the price of alcohol There was a very clear message that the only • use alcohol excise tax for public education effective response for those dependent on and treatment alcohol is treatment. Those who are alcohol dependent will not significantly alter their • lower legal blood alcohol levels, establish behaviour in response to legislative changes or tougher penalties and increase assessment many non-legislative interventions. and treatment for drink drivers There was strong support across all focus • training, guidelines and voluntary codes groups for increasing the range and of practice for the liquor industry, justice opportunities for assessment, treatment sector, general practitioners, agencies programmes, pre- and post- treatment providing financial assistance, employers support, and also support for families. and sports clubs There was some support for other changes. The focus groups considered the most Most focus groups considered that the number effective responses to be: public education of liquor outlets should be reduced and campaigns, particularly targeted to children that the availability of RTDs should be more and young people, and treatment. tightly controlled. There was also general Although there was widespread support agreement that legislation and enforcement for public education, some focus group need to be strengthened around licensing and participants expressed scepticism about the drink driving. There was general support for effectiveness of social marketing campaigns increasing controls on liquor advertising. for adults. In contrast, all considered that it is The widest divergence of opinion was around necessary to focus on educating children on changing the purchase age. While there was safe drinking behaviours and the effects of strong support for raising the age, there alcohol. Participants considered that schools was also a view that such a change would and sports/recreation organisations catering have little or no effect on underage drinking. to children and young people need to be There was more support for raising prices or actively involved in such education. introducing a minimum price as a means of There was almost universal support for public reducing consumption, particularly amongst education to: young people. However, some saw negative • reduce stigma through raising public consequences for families if income was used understanding about alcohol dependence for alcohol instead of essentials.

UNDER THE INFLUENCE | vii Some thoughts on policy responses • most people who are alcohol dependent The concluding section of this report reflects will be relatively unaffected by most on options focus group participants suggested interventions; the most effective policy for changing the way New Zealand manages responses for them are the provision of alcohol. It also puts those suggestions in the support and treatment. context of the findings from the literature • inter-sectoral responses are likely to be review on the environmental influences on most effective, with central government drinking behaviours. agencies, local government and non- Many focus group suggestions have strong government organisations working resonance with findings from studies together. concerned with the environmental influences • the co-existence of mental health issues on drinking behaviours. For example, in the and alcohol dependence is common; focus groups there was support for: programmes need to address both issues • raising prices or introducing a minimum to assist people’s recovery. price as a means of reducing consumption, • consideration should be given to particularly amongst young people developing a campaign aimed at raising • increasing controls on liquor advertising awareness of alcohol dependency, showing that recovery is achievable and provision • increasing controls on or banning of RTDs of information about the availability of • limiting the availability of alcohol, including treatment reduction in the number of outlets and • regardless of the legal purchase age, there controls on the hours of sale will be underage drinkers; specific policy • strengthening enforcement, especially responses need to be targeted to underage around liquor licensing and drink driving drinkers. International research has found that all • the establishment of voluntary codes of of these measures impact on drinking conduct around alcohol are likely to engage behaviours. the community more widely than a narrow The main policy implications from the focus focus on law enforcement group findings are: • an effective response must be multi- faceted, with consideration given to tailoring responses to different groups and local communities

viii | UNDER THE INFLUENCE UNDER THE INFLUENCE | ix x | UNDER THE INFLUENCE CONTENTS

1. Introduction 2 2. The Focus Groups 5 2.1 The focus group process 5 2.2 Focus group participants 6 2.3 Survey questionnaire 7 3. Influences on Drinking Behaviour 9 3.1 New Zealand’s drinking culture 11 3.2 Family influences on drinking 12 3.3 Peer group influences 14 3.4 Market factors 17 3.5 Legislative and regulatory factors 21 4. Influences and Triggers: What the Focus Groups Said 29 4.1 Family environment 30 4.2 Social and peer group 32 4.3 Availability of alcohol 33 4.4 Appealing advertising 34 4.5 Sports 35 4.6 Price 36 4.7 Emotional issues 37 5. What Should Be Done? 39 5.1 Public Education 40 5.2 Purchase age 43 5.3 Alcohol advertising, promotions and product labelling 44 5.4 Alcohol availability 45 5.5 Licensing and enforcement 47 5.6 Pricing 48 5.7 Alcohol excise tax 49 5.8 Drink driving 50 5.9 Institutional responses 51 6. Treatment 55 6.1 Types of programmes 55 6.2 Pre-treatment support 58 6.3 Post-treatment support 59 6.4 Involvement of families in programmes 60 6.5 Programmes in the justice system 60 6.6 Interface betwen mental health and addictions programmes 61 6.7 Information about help 62 7. The Most Effective Responses 65 8. Suggestions for Change 69 Policy Recommendations 72 References 74 Endnotes 80 Appendix 1: Salvation Army Bridge and Other Alcohol Related Support Programmes 90 Appendix 2: Focus Group Questions 92

UNDER THE INFLUENCE | 1 1. INTRODUCTION

Currently, a review of liquor laws is being This report presents a summary of findings undertaken in New Zealand. To contribute to from the focus groups. To set the focus groups’ that review, The Salvation Army commissioned views and experiences in a wider context, 20 focus groups with people who have this report also presents a selected overview attended or who are attending Salvation Army of literature on the range of environmental addiction treatment programmes, known influences on drinking behaviours. collectively as The Salvation Army Bridge The structure of this report is: Programme.1 • Section 2 describes the focus groups, The purpose of the focus groups was to learn explains why the focus group method was more about people’s experiences with alcohol chosen, and how the focus groups were and their ideas about what can be done to limit conducted. the harm alcohol causes in our society. The • Section 3 provides a selected overview of focus groups explored two broad questions: literature on the range of environmental • what are the influences on and triggers for influences on drinking behaviours. This drinking behaviours? gives a wider context to the focus group • what could be changed to reduce the findings. Research evidence shows that negative impacts of alcohol on people’s a wide range of environmental factors lives? influence drinking behaviours, including The large majority of focus group participants cultural practices and values, the family were alcohol dependent or problem drinkers. and peer group, market factors and They have had specific experiences with legislative and regulatory factors. alcohol, and hold strong views shaped by • Section 4 presents the views of focus those experiences. Consequently, they were group participants on the influences on able to contribute valuable insights into what drinking behaviours and specific triggers influences people to drink, and to drink in risky that have affected them. The focus groups ways. They were also able to suggest what identified the following as major influences needs to happen to engage with and effect on drinking behaviours: family, socialising changes in the most challenging drinking and peer groups, the availability of alcohol, behaviours. The focus groups provided useful alcohol advertising and packaging, the insights into the range of policy responses association of sports with alcohol and the that may be effective in raising public price of alcohol. awareness about the dangers of drinking and • Section 5 outlines the range of responses in controlling drinking behaviours that may that participants consider would reduce develop into problem drinking. the negative impacts of alcohol on

2 | UNDER THE INFLUENCE people’s lives. These responses cover public education, the age at which alcohol should be purchased, alcohol advertising, promotions and product labelling, the availability of alcohol, licensing and enforcement, alcohol pricing, alcohol excise tax, drink driving controls and institutional responses. • Section 6 comments on the options for treatment discussed by the focus groups. This discussion is separated out from the other responses considered in section 5, as participants identified treatment as a key response in addressing the harm that alcohol causes. • Section 7 summarises participants’ views on the most effective responses for limiting alcohol-related harm. • Section 8 concludes with some reflections on the issues and policy responses raised in the focus groups.

UNDER THE INFLUENCE | 3 4 | UNDER THE INFLUENCE 2. THE FOCUS GROUPS

Twenty focus groups were held in eight centres 2.1 THE FOCUS GROUP PROCESS throughout New Zealand during September The first step in setting up and running the and October 2009. The focus groups were focus groups was to send out information arranged through The Salvation Army Bridge about the project to Salvation Army centres Programme as a way of finding out from people with Bridge Programmes to inform them who are alcohol dependent, their views on about the project and its objectives and to how to limit alcohol-related harm. Accessing provide information to be given to prospective participants through the programmes was focus group participants. The project aimed chosen as a way to find out ideas for limiting to include both those currently in a Bridge the harm that alcohol causes from those Programme, as well as some who had attended for whom alcohol is a significant challenge. in the past. After the centres had been Appendix 1 describes the Bridge Programme informed about the project, the researcher and other alcohol-related support services then contacted the centres to arrange times to provided by The Salvation Army. run the focus groups. The focus group method is a qualitative In all, 138 people participated in the 20 focus method useful for illuminating and exploring groups, which were held in the following areas: issues and experiences that are not able • Whangarei (1 focus group) to be done using other methods such as surveys, observation or one-to-one interviews. • Auckland (3 focus groups) Focus groups are not designed to generalise • Waitakere (2 focus groups) findings to a whole population; however, • Manukau (3 focus groups) they do provide a richness of detail and the opportunity for group reflection that other • Hamilton (2 focus groups) methods do not offer. • Wellington (3 focus groups) The group dynamics and interaction shape the • Christchurch (3 focus groups) direction of focus group conversations and in • Dunedin (3 focus groups). this way can provide insights and information Focus group discussions lasted between 60 on the various perspectives and experiences and 90 minutes. They ranged in size from four of the group. The focus group may identify to 14 participants, with most focus groups differences, disagreements or the degree of having 6-8 members. consensus on a topic. Drawing out diverse views is a useful way of gaining further insights At the start of each focus group, the purpose into the issue being examined. of the project was explained. Individuals were assured that they would be treated with respect and that confidentiality would be maintained, with no names or personal details used in any report.

UNDER THE INFLUENCE | 5 It was also explained that it was not the As a consequence of their engagement in purpose of the focus groups to discuss therapeutic programmes, many focus groups personal histories; nor was the purpose to participants had thought carefully about the evaluate any treatment programmes they had individual, institutional, legal, cultural and participated in. societal responses needed to address alcohol- Individuals had the opportunity to ask related harm in society and were therefore able questions about the project and to opt out to articulate their views clearly. Again, they of the focus group before it started or at any were not prompted to focus on any particular time in the focus group process. Almost all of response or intervention. those who were given information about the Detailed notes were taken of all focus group focus groups on the day they were held (over sessions. A summary of each focus group 95 percent) chose to participate. It was made was prepared. Then the range of themes was clear to individuals that their participation was identified across all focus groups. Analysis voluntary and that they could leave the focus included the identification of similarities group at any time if they felt uncomfortable and differences in views, and the degree of with the process. Across all the focus groups, disagreement and agreement on particular only three people left part way through the issues, both within and across the focus discussion. groups. A set of questions was used to guide This report draws extensively on the focus discussions (see Appendix 2). The focus group conversations. Where comments from groups were conducted like conversations. the focus groups are presented in this report, The researcher aimed to establish a relaxed, most are paraphrased rather than verbatim. comfortable environment. Participants were Where specific comments are quoted, they encouraged to raise topics, expand the are indicated in speech marks (“/”). Where discussion along different lines and to return several comments are from a conversation in a to earlier questions or issues as needed. focus group, they are presented with different Focus group questions were framed at a speakers on successive lines. This shows how general level, for example: “What influences the conversation among participants often your drinking habits and behaviours?” built on ideas and developed different points. Prompts were rarely used. Consequently, 2.2 FOCUS GROUP PARTICIPANTS most comments were unsolicited. Although While it is common for focus group participants the views about the influences and triggers not to know one another, in this project the on drinking behaviour reiterated many of the participants were known to one another influences and triggers identified in literature, because of their involvement in The Salvation these views were not prompted by the Army Bridge Programme. Most were currently researcher.

6 | UNDER THE INFLUENCE in a programme, while all but two of the 2.3 SURVEY QUESTIONNAIRE remainder had been through a programme At the conclusion of the focus group in the past. It was common for focus group discussions, participants were asked whether participants to have been involved in more they would complete a short (13-question) than one programme (not always a Salvation confidential survey about various aspects of Army programme). As well as those who were their drinking history and behaviours. They current or former programme participants, were assured that their involvement in the one person was in the pre-programme phase, survey was voluntary. Of the 138 focus group waiting to enter a programme. Another person participants, 106 completed the questionnaire. was a volunteer worker with the programme Their responses are included with discussion and not a programme participant. of the focus group findings in Section 4 The focus group method enabled the project relating to the influences and triggers on to build on the familiarity and common drinking behaviours. knowledge of participants. Those currently As they were drawn from the same focus in programmes had a high level of daily groups, the profile of the survey respondents interaction and were used to discussing issues was similar to the profile of focus group with one another. This familiarity with one participants. More survey respondents were another enabled them to quickly concentrate men (65 percent) than women (35 percent). on the focus group questions and engage in Three-quarters of respondents were aged discussion. 30-60 years. The focus groups covered a wide range of ages, Survey respondents gave information from just under 20 to over 60. Most were aged about their alcohol dependence, providing 30-60 years. More men (88) than women (50) information about past drinking behaviour.3 were involved, although two focus groups Over half (55 percent) reported that when consisted of all women as they were drawn they were drinking, they drank alcohol every from women-only programmes. While most day. Over three-quarters indicated that when participants appeared to be NZ European/ they were drinking, they had drunk seven or Pakeha, Maori and Pacific people were also more drinks in a session.4 The majority had involved. There were a few who identified with been concerned about their drinking, with 40 Indian, Middle Eastern, British, European and percent thinking ‘all the time’ that they should 2 Australian backgrounds. drink less and 23 percent ‘often’ thinking they The large majority of participants were alcohol should drink less. Furthermore, 38 percent dependent, while some were substance reported ‘often’ getting into trouble because of addicts. Some had multiple addictions. their drinking, and 17 percent reported getting into trouble ‘all the time’ because of their drinking.

UNDER THE INFLUENCE | 7 8 | UNDER THE INFLUENCE 3. INFLUENCES ON DRINKING BEHAVIOUR

This section provides a selected overview Consequently, environmental factors that have of literature concerned with the range been found to influence drinking behaviours in of environmental influences on drinking those countries have considerable relevance behaviours. Environmental factors influence for understanding the context, influences on the whole gamut of drinking behaviours, and practices of alcohol use in New Zealand. affecting both the frequency and quantity The literature on drinking behaviours shows of alcohol use. These factors influence the a huge range of influences, and multiple age at which individuals start drinking, factors operating in conjunction with one with whom they drink, what they drink, and another. While genetic factors play a role, where they drink. Environmental factors also environmental factors have a significant impact on what people do when drinking; for influence. This report considers the following example, whether they drink before driving. environmental influences on drinking Environmental factors not only affect actions; behaviours that are well traversed in literature: they also shape individuals’ expectations, • the broad cultural context of institutions, attitudes and values towards alcohol, as well practices, attitudes and values that define as their knowledge of alcohol. In turn, those drinking in New Zealand ideas about alcohol impact on decisions about drinking and drinking practices. • social factors, particularly the family and peer group This is a selected review of a considerable and growing body of evidence. The main studies • market factors, particularly advertising focused on include the United Kingdom, (including promotions), pricing and United States, Canada, Australia and the products European Union. Although those countries • legislative and regulatory factors, differ in their liquor laws, jurisdictions and particularly availability, the legal purchase local and central government arrangements age and enforcement that manage access to liquor, they include Where influences on children and young western developed countries that New Zealand people appear to differ from influences on is consistently benchmarked against in terms adults, these aspects are also considered. For of wellbeing performance. Furthermore, New example, age-related differences have been Zealand shares historical traditions, values and studied in relation to alcohol advertising, the practices relating to alcohol use with Australia, density of liquor outlets, the price of alcohol, United Kingdom, Canada and the United States and the appeal of different alcohol products. in particular. For example, New Zealand and Australia share very similar per capita alcohol Also considered are the links between consumption and patterns of drinking.5 particular behaviours and alcohol-related harm. In analysing the influences on alcohol

UNDER THE INFLUENCE | 9 consumption, much of the literature considers both drinking behaviours and the potential of those behaviours to result in alcohol-related harm. Drinking behaviours such as excessive drinking, binge drinking and intoxication have the potential to result in harm to the individual drinker and to others.

A NOTE ABOUT TERMS USED IN THE LITERATURE

Alcohol has been called ‘no ordinary drinking patterns can include intoxication, commodity’.6 In part, this is because it heavy drinking and binge drinking. is a psychoactive and toxic substance The term problem drinking refers to use of that can result in dependence. In the alcohol that causes problems in people’s literature a continuum of substance use lives, but does not meet DSM-IV criteria for is acknowledged: from no use, to safe a diagnosis of dependence.10 use, to hazardous use, to problem use, to Alcohol dependence happens when dependence.7 drinking takes a high priority in a person’s The literature uses a range of terms to life and he or she has great difficulty describe and define different drinking controlling consumption. Use is continued behaviours and situations, including even though the person is aware of hazardous drinking, problem drinking, associated health or psychological alcohol dependence and alcohol-related problems. Generally the individual harm. While those terms may be used experiences unpleasant withdrawal in slightly different ways, generally a symptoms when not drinking.11 standard terminology is used in the Alcohol-related harm is a widely used term addictions sector. that refers to health and social problems Hazardous drinking is drinking that is that can happen to the drinker and others 8 above safe limits and, while it may not (at the individual or collective levels) in cause problems at present, is likely to which alcohol plays a causal role.12 cause harm in the future.9 Hazardous

10 | UNDER THE INFLUENCE 3.1 NEW ZEALAND’S DRINKING olds had had a drink in the past year. One- CULTURE in-three people who had ever tried alcohol Culture, as a way of life, is a primary and had their first drink when aged 14 years or 16 fundamental influence that shapes how we younger. The Youth ’07 survey of Years 9 to learn to drink, our drinking behaviours, and 13 students found that 71.6 percent of over our attitudes towards alcohol. 8,000 respondents had ever drunk alcohol, and 60.6 percent defined themselves as Compared to most other countries, New currently alcohol drinkers. Over one-third of Zealand has a very high proportion of alcohol the respondents aged 13 years or less reported users. The large majority of New Zealanders that they were currently alcohol drinkers, and drink alcohol, at least occasionally—in the the proportion rose to around three quarters 2007/08 New Zealand Alcohol and Drug Use of those aged 16 and over.17 The earlier Youth Survey, around 85 percent of 16–64 year 2000 survey of over 9,000 secondary students olds had had a drink in the past year, and found that most had their first drink between 61 percent drank at least once a week.13 the ages of 10 and 15, with nearly half having Internationally, the highest proportions of their first drink before the age of 13.18 drinkers are found in Europe, Australia and New Zealand, where between 80 and 90 Not only is alcohol widely accepted and used percent of all adults consume alcohol. This is in our society, there also appears to be a high considerably higher than the United States level of tolerance of risky drinking behaviours (around two-thirds of adults) and Canada such as drinking to excess and binge drinking. (around three-quarters of adults).14 A national survey of individuals aged 12 years and over found that one-third disagreed with In New Zealand the historical association the statement ‘it’s never OK to get drunk’, and of alcohol with male culture, mateship and one-quarter agreed with the statement ‘it’s OK work has been very strong. Drinking has to get drunk as long as it’s not every day’.19 been described by one historian as “the most important and defining ritual of the Young drinkers seem to be especially tolerant male community”.15 Now, drinking is an of risky drinking behaviours. Although around intrinsic part of much of our social life, for two-thirds of men and women in the New both genders. Alcohol is a fundamental part Zealand Alcohol and Drug Use Survey reported of recreation and leisure, celebrations and consuming a large amount of alcohol, at least events. once in a year, the heaviest drinkers were aged 18–24 years. Eight-in-ten of those had The widespread cultural acceptance of drinking consumed a large amount of alcohol on at least is reflected in the young age of using alcohol. one occasion in the past year. The 18–24 age The New Zealand Alcohol and Drug Use Survey group was also the group most likely to drink found that about eight-in-ten 16 and 17 year

UNDER THE INFLUENCE | 11 enough alcohol to feel drunk on at least one Parenting practices 20 occasion in the past year. A range of positive parenting practices—such The 2007-08 ALAC monitor report classed 24 as strong family values, standards and rules, percent of New Zealand’s young people aged monitoring children’s behaviour, supporting 12–17 as binge drinkers.21 This research children and giving rewards for good also found that almost two-thirds of the behaviour—have all been shown to reduce respondents who had got drunk on their alcohol use in adolescence and delay alcohol last drinking occasion stated that they had use. Some research has linked the early age of planned to get drunk.22 That is, they were starting to drink with risk of harm from alcohol ‘drinking to get drunk’. Various researchers when they are older. This research suggests have commented on a culture of intoxication that the later a young person starts to drink, and a ‘determined drunkenness’ typical of the less chance they will have of becoming young people’s drinking behaviours that regular users of alcohol and drinking at higher 25 is part of a global youth consumption and levels. pleasure seeking lifestyle, in which risk taking Parental monitoring appears to be one of the behaviour (not only related to alcohol use) is most directly influential factors on children and 23 usual and expected. young people’s drinking behaviour. Children 3.2 FAMILY INFLUENCES ON whose parents monitor their activities and set DRINKING limits while supporting their independence are less likely to use alcohol, less likely to For many people, the introduction to start using alcohol at an early age, and less alcohol takes place in the family, as it is likely to develop alcohol abuse and alcohol often associated with family events such as dependence. Several studies have provided birthdays, marriages and Christmas. strong evidence that effective parental While there are familial genetic factors monitoring of pre-teens can delay initiation involved in determining drinking behaviours, into alcohol use.26 there are also important familial environmental Good parent-child communication is also factors, and the effects of genetic factors can important in controlling adolescent drinking. be enhanced or reduced by different family A number of studies have identified that influences.24 There has been extensive parents typically have little awareness of the research on the role of parents in influencing amount their offspring consume, however, drinking behaviours. Key influences have been their awareness increases with increased identified as parenting practices, parents’ own communication.27 drinking behaviour and family conflict. Often these factors work together as influences. In contrast, numerous international studies link lack of parental support and poor parental

12 | UNDER THE INFLUENCE monitoring of their children’s activities with parents are more likely than other parents to early debut into drinking and adolescent have teens that are heavy drinkers.35 Other alcohol and other substance abuse.28 There studies have identified that where parents are is evidence that both excessively authoritarian permissive about alcohol use, adolescents are and permissive parenting styles are associated more likely to binge drink.36 29 with substance misuse. Research has also found that children with Family conflict parents who are alcohol dependent are more likely to start drinking early (by age 14), Stressful and high conflict family environments to experience drunkenness by age 17 and have been shown to be associated with to develop alcohol problems themselves. adolescent misuse of alcohol.30 Longitudinal However, the association of drinking problems studies have found that high levels of parent- with early age of starting to drink also exists child conflict and low levels of parental for people without a family history of alcohol monitoring are associated with a greater dependence.37 likelihood of adolescent substance abuse, 31 including multiple substance abuse. Parental supply of alcohol In contrast, quality relationships between One of the factors influencing young people’s parents and their teenagers have been found drinking behaviours is whether their parents to be associated with less drinking among supply them with alcohol. Often, parents teens.32 Having a secure, caring relationship supply their adolescents with alcohol in the and good communication with parents are home, or allow them to take it to social events protective factors against risky drinking.33 as a means of supervising and controlling Higher levels of attachment between parents the amount consumed and to encourage and children have also been found to buffer responsible use by young people.38 the child from the effects of negative drinking Research findings into the influence of parental 34 behaviours of adolescent peers. supply of alcohol are somewhat mixed, Parents’ drinking behaviour showing both positive and negative outcomes. Some research in Australia and the United Children learn their drinking behaviour and Kingdom has indicated that young people are attitudes from parents, who are significant less likely to drink large amounts of alcohol if early role models. Several studies show they get alcohol from their parents, and that that children whose parents drink and hold young people are likely to drink less at home favourable views about drinking are more likely than at a friend’s house.39 However, in other to drink. In part, this is due to the availability research, parental supply of alcohol has been of alcohol in the home, which provides linked to teenagers’ risky drinking behaviour. opportunities for children to try alcohol. Some For example, one longitudinal study of parents’ studies have shown that heavier drinking

UNDER THE INFLUENCE | 13 supply of alcohol to minors in the United States adults. The drinking behaviour and attitudes indicated that early teens with parents who of older siblings towards alcohol act as a role supplied them with alcohol were more likely to model for younger family members. Some increase their alcohol use.40 research has found that teens who start Under the current law in New Zealand, a parent drinking when they are younger than 14 are 45 or guardian is allowed to supply liquor to their more likely to have older siblings. child who is under 18 or to another minor if 3.3 PEER GROUP INFLUENCES it is at a private social gathering.41 One New For all age groups, friends and social networks Zealand study of the attitudes of parents of are significant influences on drinking attitudes 13–17 year olds about the supply of alcohol to and behaviours. Drinking with friends, with minors found that parents generally opposed workmates and in social situations is part of supply to minors, or they favoured responsible how New Zealanders relax, feel at ease with conditions of supply, such as only supplying others and express a sense of belonging. In a small quantities of alcohol, with food and national survey of individuals aged 12 years at home. Most did not approve of giving and over almost one half of current drinkers teenagers drinks to take to an unsupervised agreed that ‘alcohol helps me wind down and party. Those who had supplied alcohol to a relax’. One-fifth of current drinkers agreed that minor said they would only do so if there was ‘having a drink with friends and family gives suitable adult supervision where the alcohol me a sense of belonging’.46 was used.42 Even though many New Zealand parents may Adolescent peer group express cautious attitudes about supplying Although parents are a very important alcohol to minors, nevertheless, parents are influence on their offspring’s drinking important alcohol suppliers for all youth, behaviours, as young people grow up they except Pacific youth. The Youth 2000 research spend less time with their families, and much found that about 60 percent of students have more time with their peers. In our society and easy access to alcohol at home. More than half similar societies such as Australia, drinking of those who drink (54 percent) get alcohol has been historically associated with the from parents.43 Similarly, in the Youth ’07 transition from being an adolescent to adult survey, 54 percent reported that they got status and acceptance into adult society. alcohol from parents.44 Now, drinking still remains central to youth forging an adult identity through rites of Influence of siblings passage such as night clubbing, drinking Research has also shown that drinking by games and experimental use of alcohol.47 siblings, especially older siblings, is important Drinking enhances social experience and is a in influencing alcohol use of teens and young way of being part of and accepted into a social group.48

14 | UNDER THE INFLUENCE A major reason why young people use alcohol their alcohol from friends.55 Another New is because their peers use it, and in some Zealand survey of 1,179 young drinkers aged instances that peer influence becomes peer 12–17 identified friends as the most common pressure to consume alcohol. The drinking source of alcohol for that age group.56 Some attitudes and behaviours of friends is one of of those friends will be 18 and thus legally the strongest predictors of young people’s able to purchase alcohol. Others will be under alcohol use, particularly their initiation into 18, but nevertheless purchasing alcohol for drinking, frequency of drinking and amount themselves (see the discussion in Section 3.5 consumed.49 It appears that young people’s concerning underage purchase of alcohol in drinking behaviours can be driven by their New Zealand). perceptions of what is normal drinking Sports behaviour among their peers.50 Having friends who drink not only simplifies the access to For many New Zealanders, participation alcohol but also provides an environment in sport and watching sport are important where drinking is normal and expected settings for recreation, socialising and behaviour. In contrast, adolescents in peer friendship. There is New Zealand and overseas groups that have negative attitudes towards evidence that sport can affect alcohol use, alcohol report lower alcohol use and fewer both positively and negatively. However, alcohol problems.51 the influence of sport on drinking behaviour appears to vary depending on the type of Australian research shows that young people sport, the level of competition, and the cultural are most commonly supplied their first drink by drinking practices of the country concerned. a friend or acquaintance (43 percent), followed This section reviews some of that research. by their parents (35 percent).52 Similarly, New Zealand research shows that along with Internationally, involvement in sports has parents, friends are an important source of been shown to have considerable health and alcohol. School peers play a large part in wellbeing benefits. With regard to drinking introducing adolescents to alcohol use. Some behaviours, one study in Norway found that young people’s drinking patterns are well participation in sport delayed teens starting established by the time they leave school.53 to drink, and attributed this to the strict rules Among the secondary school students who for use of alcohol in most Norwegian sports 57 took part in the Youth ’07 survey, 53.3 percent clubs. But other research has indicated that obtained alcohol from friends, about the same hazardous drinking is associated with sport. proportion who got alcohol from parents (54 French and Swiss research has reported some percent).54 Friends were the most common evidence for lower alcohol use among elite source of alcohol for secondary school sportspeople, but found alcohol use and risky students in 2000, with 62 percent getting drinking is related to the kind of sport played.

UNDER THE INFLUENCE | 15 Risky drinking appears to be more prevalent than for the population as a whole (17 percent) in team sports.58 Other research in the United and even for the 15–24 age group, which tend States and Europe has shown that excessive to be high alcohol consumers (33 percent)62 alcohol consumption is common for both These rates appear to be considerably sportspeople and their fans.59 higher than more recent measures of high In New Zealand60 and Australia,61 sports alcohol use. For example, 25 percent of New players and sports clubs have a long history Zealanders 18 years and over can be described of association with drinking, including as binge drinkers (consuming seven or more 63 risky drinking behaviours. Generally, drinks on one occasion). sports environments can influence drinking A more useful comparison may be with behaviours including underage alcohol younger age groups that are closer to the ages consumption, levels of consumption and drink of most elite sports people. Studies show driving. The ways that sports clubs provide heavy alcohol consumption is more usual in and manage alcohol, and alcohol sponsoring younger age groups. Binge drinkers are more of sports events and teams constitute an likely to be in the 18–39 year age group,64 environment where many young people and particularly in the 18–24 age group,65 are exposed to alcohol. Also, since elite the peak age of heavy alcohol consumption sportspeople are important role models for where the Ministry of Health reports that eight young people, media reports of their drinking in ten drunk heavily on at least one occasion behaviours may influence young people’s in the last year. For the 18–24 age group, the drinking behaviours and attitudes. Ministry of Health also reports that one in Consistent with overseas studies of drinking three men and one in five women consumed a and sportspeople that show risky drinking large amount of alcohol at least weekly in the 66 behaviours, one New Zealand study that last year. surveyed 1,214 sportspeople found high Work levels of alcohol consumption. This research The workplace is also an important site where also showed that sportspeople’s hazardous social attitudes, expectations and behaviours drinking is associated with driving while around drinking can influence individuals. intoxicated and antisocial behaviour. Australian research has found that exposure Overall, the study found that 68 percent of to a heavy drinking work culture can increase elite-provincial sportspeople, 53 percent of the likelihood of individuals developing risky club/social sportspeople and 50 percent of drinking behaviour. Women employees seem international level sportspeople could be to be particularly vulnerable to workplace classified as hazardous drinkers. These rates influences. This study found that the largest of hazardous drinking are considerably higher percentages of workers who frequently drank

16 | UNDER THE INFLUENCE at high risk levels were in the hospitality the frequency and quantity of drinking, price industry. Those in the mining industry were reductions have also been found to reduce most likely to be involved in infrequent short- vehicle crash fatalities, adverse health effects, term risky drinking.67 child abuse and other violence.73

3.4 MARKET FACTORS Research on price includes analysis of the effects of changes in alcohol excise taxes on A range of market factors have been found to consumption. Reductions in alcohol taxes influence drinking behaviours. Key factors are: and prices have been found to increase sales • price and consumption rates in Finland, Norway • advertising and Switzerland. Increases in alcohol taxes were followed by reductions in consumption • new products in Australia’s Northern Territory, Malaysia and Price Philippines.74 Several countries, including Alcohol in New Zealand has become more Australia, Germany, Switzerland, the United affordable over the past 20 years. Price has Kingdom and Ireland, have introduced a tax been particularly affected by the widespread on RTDs and have reported a subsequent availability of discount drinks and specials.68 decrease in consumption of RTDs. Some An extensive body of research across many of those countries have also reported a countries and using many different methods substitution effect, with consumers switching 75 shows that price does influence alcohol to cheaper alcoholic beverages. Minimum consumption.69 A meta-analysis of 112 alcohol pricing is soon to be recommended studies of alcohol tax or price effects on in the United Kingdom to address the health 76 alcohol consumption concluded that there is impacts of alcohol misuse. “statistically overwhelming” evidence that Some studies have looked at varying effects there is an inverse relationship between of price across population groups and for price and drinking; i.e. a higher price reduces different beverages. One meta-analysis of consumption.70 Price has been found to 112 studies concluded that price affects be one of the top three reasons, along with consumption of all types of alcoholic strength and taste, for the purchasing of beverages, and across the whole population a particular brand of alcohol.71 A rise in of drinkers, from light drinkers to heavy price has also been found to result in some drinkers.77 Other studies have shown that consumers shifting to cheaper alcoholic price can affect drinking to intoxication.78 beverages.72 This may be to retain their But another meta-analysis of 132 studies of consumption level. alcohol demand across 24 countries found As well as leading to overall reductions in differences in price elasticities across types of alcoholic beverages, across different age

UNDER THE INFLUENCE | 17 groups and between women and men. Demand on teens’ drinking.86 One meta-analysis of 132 for beer was found to be less responsive to studies of alcohol demand found that under 18 price changes than demand for wine and year olds were least responsive to price. The spirits. Women tended to be more price author noted that this finding was “counter- sensitive than men.79 intuitive” and suggested that it may relate to Because alcohol has addictive qualities, over 18s consuming a greater share of wine some price inelasticity is expected. One study and spirits, which are more price-sensitive 87 found that the only group that price does beverages than beer. Another study using not appear to have an impact on is the top 5 regression modelling found that beer taxes percent of drinkers.80 Higher prices have been do not reduce young people’s prevalence of found to influence the amounts consumed drinking or binge drinking and suggested that by frequent and heavy drinkers.81 Some this may relate to the price level, rather than to 88 studies even show that price increases have the price rise itself. a greater effect on the behaviour of frequent Advertising and heavy drinkers, than on those who drink In New Zealand, advertising of alcohol is self- moderately.82 regulated through the Code for Advertising Most studies have shown that price has a Liquor that requires advertising to adhere to major impact on young people’s alcohol certain principles. Those principles include consumption, with it dropping significantly in responsibility and moderation in consumption, 83 response to a rise in the price of alcohol. a high standard of social responsibility, and Research has shown a reduction in the hours in which alcohol advertising cannot be frequency of young people’s drinking, heavy shown on television. The Code also states that drinking, binge drinking and underage advertising should not be directed to minors or drinking. Higher prices also appear to have strong appeal to minors.89 delay the age at which young people start Evidence about the link between exposure to to drink.84 Some studies show that cheap alcohol advertising and alcohol consumption drinks promotions, give-aways associated is mixed, although on balance there is growing with alcohol and price specials appear to be evidence that alcohol advertising does associated with young peoples’ increased influence drinking behaviour. A large body of alcohol consumption, binge drinking and research suggests that alcohol advertising drinking and driving.85 that portrays drinking in its cultural context, as Despite the weight of findings indicating young an integrated part of a lifestyle, is particularly people’s sensitivity to the price of alcohol, influential because it resonates with there have been a few studies that show only widespread beliefs and social norms.90 statistically insignificant effects of price rises

18 | UNDER THE INFLUENCE Many studies clearly show a positive link target minors. There is also evidence of some between exposure to alcohol advertising deliberate targeting of ‘entry level drinkers’, and increased consumption. One study such as in United States research, which shows of alcohol control policies and adolescent that alcohol companies have placed their alcohol use in 26 countries concluded that advertising, particularly for beer and spirits, policies controlling the marketing of alcohol where youth are more likely to be exposed to it are associated with lower prevalence and than adults.95 frequency of adolescent drinking, and a higher Several studies have concluded that alcohol 91 age of first alcohol use. Some cross-national advertising contributes to young people’s research showed that countries with partial positive attitudes and expectations about restrictions on alcohol advertising had 16 alcohol use, as well as their decisions and percent lower alcohol consumption rates intentions to drink.96 Some research suggests and 10 percent lower vehicle fatality rates that alcohol advertising that portrays youth compared to countries with no restrictions. lifestyles and identities contributes to Countries with complete bans on alcohol increasing youth alcohol consumption.97 advertising had even greater reductions, with Youth-oriented social networking internet 11 percent lower alcohol consumption rates sites, viral marketing and mobile phone and 23 percent lower vehicle fatality rates technology have all extended the reach of compared to countries with partial restrictions alcohol marketing into youth lifestyles, and 92 on alcohol advertising. expanded the environmental influence of However, other studies have shown more advertising.98 limited impacts of alcohol advertising; for There is evidence that exposure to various example, that advertising affects brand choice types of alcohol marketing increases the 93 but not consumption. One study found that likelihood of underage drinking.99 Research the demand for spirits is more responsive to in the United States has documented the 94 advertising than the demand for beer. large amounts of youth exposure to alcohol The impact of advertising on children and advertising through television, radio, young people’s drinking expectations and magazines and the internet.100 One study behaviours is of particular interest in the that notes the growing body of evidence literature. Many studies argue that because for a positive association between alcohol of the presence of alcohol advertising advertising and alcohol consumption among everywhere, including in promotions and young people looked at alcohol advertising product placement, this does influence on television. It found that certain elements in children and youth, even though alcohol alcohol advertising such as animals, humour, advertising may not deliberately set out to music and celebrities appeal to children and

UNDER THE INFLUENCE | 19 adolescents. The study found that young New products people who drank alcohol more frequently Since the early 1990s, an increasing range of rated alcohol advertisements as more alcohol products that “blur the distinctions likeable and influential than those who drank between traditional alcohol beverage alcohol less often or did not drink. However, categories” have emerged on the market. This the authors cautioned that young people proliferation of new style alcohol products has who are predisposed to drinking may have contributed to a change in the profile of the more favourable attitudes towards alcohol alcohol consumer, away from the traditionally 101 advertising. Other research in the United male, to much more diversified drinking States has shown that sixth graders’ (aged segments based on age, gender and drinking 11–12 years) exposure to beer advertisements styles (such as the weekend drinker).106 A on television, radio, magazines, in-store significant new product is the ready-to-drink displays and promotional items is strongly beverage (RTD), a mix of alcohol (spirits or predictive of grade seven (aged 12–13 wine) and non-alcoholic beverage (such as soft years) intentions to drink as well as drinking drink or fruit juice). behaviour.102 A similar study showed a link New alcohol products tend to be the drinks between exposure of seventh graders to of choice of young people.107 The popularity several forms of beer advertising and alcohol of RTDs among youth is well established use at grade nine (aged 14–15 years).103 in several countries, including the United The strongest evidence for the influence of States, Australia and Scotland. A key concern alcohol advertising on consumption has expressed by health professionals has been come from several longitudinal studies that whether RTDs act as a bridge to stronger look at exposure to alcohol marketing in the alcohol products and lower the age at which traditional media, as well as promotion in young people start to drink alcohol.108 films and branded merchandise. Those studies A growing body of research argues that RTDs have found that advertising has small but are specifically marketed to appeal to young significant effects on whether young people people’s tastes and especially “to embed drink and whether they drink heavily. There alcohol products and consumption into the is also evidence to suggest that exposure lifestyles of young people.”109 Alcohol has to alcohol advertising has more impact on an acquired taste that is usually unpalatable drinking behaviours when it is cumulative.104 to the young and deters them from drinking. New Zealand longitudinal research has also However, RTDs are distinguished by a sweet shown that young people’s recall and positive taste that appeals to the young palate and responses to beer advertising predicts later masks the alcohol.110 A range of research heavier drinking.105 argues that RTD marketing has been a major

20 | UNDER THE INFLUENCE contributor to youth initiation into drinking, by young drinkers aged 12–17 years, at 35 increases in amount and frequency of youth percent.114 The New Zealand Alcohol and Drug drinking, youth binge drinking and higher Use Survey found that RTDs were the most levels of youth intoxication.111 popular drink among 16–17 year olds.115

One Californian study found that underage 3.5 LEGISLATIVE AND REGULATORY drinkers consumed 47 percent of alcopops in FACTORS 2007.112 In Australia, where the popularity of The legislative and regulatory environment RTDs steadily declines after age 18, research controls people’s access to alcohol and how has been conducted on the palatability (taste they use it. There is evidence from several preference) of a range of alcoholic and non- countries and different jurisdictions that alcoholic beverages with 350 12–30 year population-based measures that affect the olds. This study found that a large proportion supply and demand of alcohol do affect of young teens in the study (12–15 year olds) consumption. These controls, which reflect believed that RTDs are packaged to directly societal norms and values around drinking, appeal to them. Among the youngest age also influence people’s attitudes to alcohol. groups, RTDs was commonly the first alcohol For example, the legal purchase age used, and the most preferred. This research establishes social expectations about the age also found that the palatability of the alcohol at which drinking is regarded as acceptable, taste in the pre-mixed drinks increased with and can deter some minors from drinking.116 age—the 12–17 year olds preferred RTDs that The hours of opening and management tasted of soft drinks.113 of licensed premises set the conditions to This overseas research is supported by several shape drinking behaviours such as excessive New Zealand studies. The Youth ’07 study consumption and tolerance of intoxication.117 (Years 9–13 students) found that the most Success or failure to enforce regulations send common type of alcohol consumed by school messages about the acceptability of underage students is beer (consumed by 35.2 percent drinking, intoxication and drink driving.118 of those current alcohol drinkers), closely This section discusses three important areas of followed by ready-made alcoholic drink (34 the legislative and regulatory environment that percent). RTDs were by far the favoured drink influence drinking behaviours: of girls in the study (47.5 percent of current alcohol drinkers) compared to boys (22.3 • controls on the availability of alcohol percent of current alcohol drinkers). Similar • the legal purchase age proportions were found in the ALAC 2007–08 • enforcement Alcohol Monitor, which reported that RTDs were the second most consumed alcohol

UNDER THE INFLUENCE | 21 Availability quantity of drinking. Simply, consumption Availability relates to the policies and increases when the number of outlets regulations that determine and control the increases. Overseas studies argue that a physical presence of alcohol, such as where proliferation of outlets increases public it is able to be purchased and at what times. perception of alcohol as an ordinary, everyday Two aspects of availability are considered for commodity with no particular risks attached their influences on drinking behaviours in the to it. On the other hand, restrictions in following discussion: density of outlets; and availability of alcohol raise the transaction hours and days of sale. costs associated with acquiring alcohol, such as the costs of travel, time and inconvenience. Density of outlets These transaction costs may reduce demand Changes in the law have increased the number for alcohol.121 of places where alcohol can be sold in New It seems that there is a particular relationship Zealand, and increased the density of outlets between high outlet density and underage where people can purchase and consume drinking.122 Where there is a proliferation of alcohol. Especially significant in New Zealand alcohol outlets, children and young people has been the expansion of alcohol into a have high levels of exposure to alcohol as an wider range of retail outlets, particularly easily accessible product.123 supermarkets and neighbourhood liquor stores. One illustration of the proliferation A New Zealand study of the influence of outlet in outlets is that in 1989 New Zealand had density in Auckland on 1,179 young drinkers 6,000 liquor outlets, while after law changes, aged 12–17 years showed not only that almost there were 14,800 liquor outlets in 2004. In one fifth of underage drinkers were purchasing comparison, Australia, with five times New alcohol, but also that those in higher density Zealand’s population had fewer liquor outlets, outlet areas were consuming larger quantities 124 at 12,000.119 of alcohol. This study also emphasised the importance of enforcement of the minimum A clear New Zealand pattern is that the purchase age for controlling alcohol-related highest densities of off-license alcohol outlets harm among young people. are located in the poorest urban areas. Consequently, those most exposed to alcohol Studies in the United States, Australia and are low-income families, Maori and Pacific Europe have found that a higher density of peoples.120 licensed premises is not only associated with greater levels of alcohol consumption, but also Internationally, the density of licensed with alcohol-related harm such as increased premises has been found to be a critical factor rates of homicides and assault, greater influencing the frequency of drinking and prevalence of drinking and driving, alcohol

22 | UNDER THE INFLUENCE related hospital admissions, child abuse and hours have increased, they are associated with neglect, pedestrian injuries and property increased consumption, as well as alcohol- damage.125 These effects are particularly related harm such as violent assaults and noticeable when there has been a major increased traffic casualties.130 shift in availability from tight restrictions to Another systematic review involving 15 studies widespread availability, rather than when there from the United States, Canada, Australia, are minor changes in an environment where United Kingdom, Sweden and Brazil on hours there is already considerable availability of and days of sale found that these had impacts 126 alcohol. on consumption, drinking patterns and There is evidence that limiting the density of damage from alcohol. This review found that liquor outlets is effective in reducing drinking the impacts on consumption included higher and alcohol-related problems.127 However, volumes of high alcohol content beer, wine one United States study of three different age and spirits purchased in licensed hotels during groups based on the National Survey on Drug late trading hours. Younger people frequented Use and Health found different effects for premises with extended opening hours. different age groups. For young adults (18–25 Impacts of longer trading days and hours on years) and adults (26 years and older) lower alcohol-related harm included higher rates alcohol outlet densities reduce the prevalence of alcohol-related vehicle injuries, assaults, of drinking. But for those aged 12–17, outlet homicides and alcohol-related hospital density did not appear to affect prevalence admissions.131 of drinking or binge drinking. The author These studies also provide evidence that suggested that for the youngest age group, restricting trading hours is effective in reducing non-commercial sources of alcohol are more drinking and alcohol related problems.132 128 important than liquor outlets. For example, one United States study of three Trading hours different age groups based on the National Survey on Drug Use and Health found that a Over time, there has been a gradual lifting ban on Sunday off-premises sales reduced of restrictions in trading hours in New drinking prevalence and binge drinking among Zealand; now liquor can be sold at any time. those over the purchase age and also among Internationally, long trading hours have minors.133 been linked to higher levels of drinking and intoxication and resulting problems with public Purchase age 129 disorder. In 1999, New Zealand reduced the age at A systematic review of 49 studies covering which people can legally purchase alcohol Australia, the United Kingdom, Canada and from 20 to 18 years. the United States found that where trading

UNDER THE INFLUENCE | 23 The ‘moral force’ of the legal purchase age The impacts of lowering the legal purchase age clearly affects the decisions of some young on alcohol-related harm among young people New Zealanders to drink. For example, the has been found to include increases in traffic Youth 2000 survey of secondary students crashes, non-injury hospitalisations, suicide, found that 41 percent of non-drinkers did vandalism and juvenile crime.140 134 not drink alcohol because “it’s illegal”. A large number of studies on the impacts of However, the reality is that in New Zealand lowering the purchase age on traffic crashes, 135 minors can readily buy alcohol. In the Youth including meta analyses, have been conducted ’07 survey, 13.6 percent of the secondary in the United States, Canada, Australia and students reported that they bought alcohol. New Zealand.141 From these studies, it is Of those aged 17, one-fifth reported buying now widely recognised that the purchase age alcohol. Over two-thirds of students who does have a significant impact on traffic crash 136 bought alcohol bought it at a bottle store. injuries and fatalities. In particular, those A wide range of studies conclude that the young people bordering the legal purchase purchase age does influence young people’s age (e.g 15–17 year olds) are affected. drinking patterns. In particular, there is a Studies across several jurisdictions show that ‘trickle down’ effect with those close to the a reduction in the purchase age results in legal purchase age also gaining access to increased alcohol consumption and increased alcohol, either through buying it themselves alcohol related harm to young people. Studies or getting it from friends and siblings. Effects also show that when the legal purchase age is of the purchase age on alcohol consumption raised, there are reductions in the involvement levels and heavy drinking among young people of those under the purchase age in traffic has been found in several studies.137 For crashes and reduced heavy drinking among example, a reduction in the purchase age in youth. the United States was found to be linked with One New Zealand study on traffic crashes increased alcohol consumption among young among 15–19 year olds between 1995 and 138 people. 2003 concluded that significantly more Other research has shown a reduction in alcohol-involved crashes occurred among alcohol consumption and alcohol-related harm 15–19 year olds than would have occurred if among underage drinkers with the raising the purchase age had not been reduced to 18 of the purchase age. Primarily conducted in years. The results of this study confirmed the the United States and Canada, these studies findings of other New Zealand research.142 suggest that increasing the legal purchase age Another New Zealand study that assessed from 18 or 19 to 21 reduces youth access to alcohol-related harms and offences from alcohol and alcohol-related harm experienced 1990–2003, which encompassed a period by them.139

24 | UNDER THE INFLUENCE of increasing alcohol policy liberalisation, Enforcement found both changes in drinking behaviour and Enforcement of liquor laws can influence increases in several areas of alcohol-related drinking behaviours in various ways. 143 harm. The 14–15 year age group showed a Inadequate enforcement can undermine the significant increase in disorder offences, which effectiveness of laws and policies. Failure the study attributed to an increase in access to enforce can contribute to increased to alcohol. Changes in drinking behaviours consumption and intoxication, as well as included an increase in 14–15 year old males underage drinking, tolerance of drink driving drinking in some licensed premises, including and alcohol-related violence. sports clubs; and an increase in the amount Effective enforcement is an important means consumed on a typical drinking occasion for of influencing perceptions that violations will 14–15 year old males. Increases in excess be punished.144 Enforcement can also shape alcohol consumption were also observed, attitudes towards drinking and standards with particularly marked increases among of drinking behaviour, control excessive 16–17 year olds in prosecutions for driving consumption and contribute to reducing with excess alcohol. Increases were also alcohol-related harm.145 found in prosecutions for driving with excess alcohol among 18–19 year olds and 20–24 Studies in the United States, United Kingdom, year olds after 1999 (the year the purchase Europe and Australia have shown that age was lowered to 18 years). Increases in inadequate enforcement of purchase age laws alcohol-related harm included increases in the can contribute to early exposure of minors rates of prosecutions for disorder across all to alcohol and underage drinking, as well as 146 age groups. Up to 1999, the largest increases increases in intoxicated drinkers. There were among 18–19 year olds, followed by is also evidence that laws prohibiting sales 16–17 year olds. All age groups had an to intoxicated customers have little deterrent 147 increase in rates of alcohol-related vehicle effect without appropriate enforcement. crashes after 1999, with the largest increase Other studies have found that proper in the 18–19 age group, followed by 20–24 enforcement does influence drinking year olds. This study concluded that alcohol behaviours. Compliance checks of licensed policy liberalisation in New Zealand appears to premises have reduced sales to minors.148 have had a greater influence on the drinking It has also been demonstrated that more behaviour of younger age groups, and their effective enforcement reduces risky drinking exposure to alcohol-related harm. behaviours and alcohol-related harm. For example, one study in Stockholm found that the introduction of measures including

UNDER THE INFLUENCE | 25 stricter enforcement contributed to savings One New Zealand study of an Auckland due to fewer incidents of assaults and regional intervention showed the key role violence.149 Other research shows that of enforcement in community interventions. vigorous enforcement of drink driving laws This intervention involved police, local council reduces alcohol-related crashes.150 This licensing inspectors and health promotion includes evaluations of enforcement of drink workers and focused on monitoring alcohol driving laws in Victoria, Australia, which sales made without age identification, show that community education campaigns media advocacy, direct contact with alcohol and law enforcement substantially reduced retailers, and enforcement strategies to control drink driving deaths, although there was a access by minors to off-license premises. subsequent reversal of the decline.151 There As a result of the intervention sales without appears to be a large number of reasons age identification reduced from 60 percent for mixed success of those measures, such of sales to 46 percent. This study suggested as the complexity of the laws pertaining that improved enforcement can help reduce to drink driving, shortcomings in drink underage drinking and noted “the importance driving education programmes, and specific of the roles of local police and licensing staff in challenges related to enforcement in rural and monitoring and enforcement”.154 remote areas.152 It has also been shown that effective enforcement of liquor laws not only affects drinking behaviours on its own, but is important in making other interventions effective. For example, in the United Sates, evaluation of responsible alcohol service training programmes in bars and liquor stores showed that the programmes had to be combined with the enforcement of liquor laws, as the training programmes alone had little impact on limiting intoxication, purchase of alcohol by minors and preventing drink driving. Enhanced policing of liquor laws in Torquay (England) and partnerships between police, licensees and community groups in Surfers Paradise and Freemantle (Australia) also showed reductions in alcohol-related violence and public disorder. 153

26 | UNDER THE INFLUENCE UNDER THE INFLUENCE | 27 28 | UNDER THE INFLUENCE 4. INFLUENCES AND TRIGGERS—FOCUS GROUPS

their effects, they have been found to affect focus group f the range of drinkers—heavy drinkers, those There’s a million reasons to want to who are alcohol dependent, and also social drink. drinkers.156 focus group l The focus groups broadly agreed that New It was the done thing to do. Zealand culture is a drinking culture; alcohol is embedded in the New Zealand way of life. Alcohol consumption is widely accepted This section discusses the influences and as part of social gatherings, celebrations, triggers that focus group participants said recreation, relaxation and reward. They noted affect drinking behaviours, both their own and that historically, alcohol has been seen as very others’. much part of male culture, associated with While influences and triggers are closely mateship and boys coming of age. However, connected (and terms often used they considered that now for both genders, interchangeably in research on drinking drinking is an accepted rite of passage to behaviours) they refer to different aspects of adulthood. Binge drinking and heavy drinking the way people relate to their surroundings. are widely regarded as acceptable, at least Influences are the broad environmental in some sectors of our society. Many of the conditions and situations that determine focus group participants said that for them, whether people are able to access alcohol, the purpose of their drinking had been to get when they can drink and how much they drink. drunk and this was the accepted norm in their Triggers are more personalised, individual peer group. cues or stimuli that induce people to drink in a Focus group participants identified many particular environment. While two people may influences and triggers on their drinking. Some experience the same environmental factors, felt that anything and everything can be a such as places, people, events or statutory trigger to drink. Three people said that talking controls, the immediate and specific cues that about alcohol (including in a counselling trigger drinking may be different for different situation) triggered the desire to drink. One individuals. For example, environments man said that there have been different provide external triggers, such as the sight or triggers at different times. Socialising was smell of alcohol, others drinking, or alcohol an important influence, with specific triggers advertisements that generate a desire to such as being with friends, or at a barbeque. drink.155 There are also internal triggers, such When he became alcohol dependent he did as feelings and emotions that generate an urge not need a trigger, he would drink at any time. to drink. Even though triggers are personal in Participants also made the point that a lot of

UNDER THE INFLUENCE | 29 people who are alcohol dependent drink on individuals socialise and who they spend their own, so the triggers are often about their time with. state of mind, rather than being with others. • The widespread availability of alcohol in Within a culture that accepts and expects many types of outlets and long opening people to drink on a wide range of occasions, hours. and has normalised the consumption of Of lesser importance, but still identified as liquor, there are some strong influences and relevant influences, were the price of alcohol, triggers that lead people to drink. Often those family upbringing and alcohol advertising. influences and triggers are intertwined, or The wide range of drinking influences and are different facets of a person’s experience. triggers are discussed below. Consequently, the following discussion uses the terms together. The focus groups identified 4.1 FAMILY ENVIRONMENT those major influences and triggers as: Generally, the focus groups thought that the • family environment family environment was one of the strongest • social and peer group influences on drinking as children emulated adults. Sixty-four percent of those focus group • availability of alcohol participants who also responded to the survey • alcohol advertising and packaging identified their family as having at least some • the association of sports with alcohol influence on their decision to start drinking. For over one fifth (22 percent), their family • the price of alcohol was “the most influence”, while for 42 percent • emotional issues and personal state of their family had “some influence”. Family mind influences appeared to be more important for Across all the focus groups, by far the most women than for men. A higher proportion of important influences and triggers were women than men reported their family having identified as: at least some influence on their decision to • Personal issues and problems. Often these start drinking (72 percent compared to 60 are related to family issues, relationships, percent). Women were also more likely to drink money problems or work. They can be at home with family members than men (39 both environmental influences, and more percent compared to 17 percent). A higher immediate triggers that prompt a person to proportion of men than women reported that drink. their family had “very little” or “no” influence on their decision to start drinking (34 percent • Social and peer group influences, compared to 25 percent). particularly the environments in which

30 | UNDER THE INFLUENCE Focus group participants considered that said they followed the influential role of their picking up drinking behaviours from parents fathers as a drinking role model. But a few was common. Families were also important in said that the alcohol-fuelled violence in their the way that they valued alcohol. In most of families made them not want to drink. One the families, drinking alcohol was acceptable, had turned to other drug use because of an and in some it was desirable; it was part of abhorrence of alcohol. However, others said the family’s identity and way of life. Most that seeing parents using alcohol legitimised participants said that in their families there it in their eyes. For many, family drinking was was no talk about alcohol-related harm or associated with role models of usual and understanding of alcoholism. unremarkable behaviour. For many participants, drinking with family was associated with being part of and being focus group j accepted by the family. Alcohol was often an Growing up, I learned to drink off my important part of family occasions such as father. weddings and funerals. Some were exposed To be in with your family, you’ve got to alcohol early in the family environment, to drink. and were encouraged to drink a little, or it focus group g was regarded as fun to allow children to “be I aspired to [drink] because grown ups barman” and pour drinks at parties. Several were doing it. said they were drinking regularly at ages 12- focus group e 14, often because of alcohol being acceptable It’s the way we’ve been brought up and available in their family. to drink. Brought up to drink to get A few talked about the positive experiences drunk. with alcohol in their families. They said that having a few drinks with family while they were growing up was an important means of Participants’ families demonstrated a range of communicating with their parents. They did not drinking behaviours, from those with no use of recall abuse of alcohol, but rather it being part alcohol (a minority), to those in which adults of good times with family. But for others, an were moderate drinkers, through to those abusive or dysfunctional family environment where family members drank heavily. Most was influential in their turning to alcohol to participants were from families where adults cope with problems. drank at least occasionally. In summary, focus group participants Parents’ drinking can either encourage or considered that acceptance of alcohol in discourage use of alcohol. Many of the men the family environment and the drinking

UNDER THE INFLUENCE | 31 practices of older relatives were significant influences on drinking. Specific family focus group b situations that triggered drinking included I’ve never been to a barbeque where family celebrations. For a few, an abusive or there hasn’t been alcohol available. dysfunctional family environment triggered There’s lots of events where alcohol is drinking as a way of coping. the main feature. 4.2 SOCIAL AND PEER GROUP Spending all day at the cricket drinking in the sun. For both men and women in the focus focus group j groups, alcohol has been associated with being with friends and having a good time. Christmas, getting together with friends and family, all happy. Most associated drinking with events and celebrations. Social occasions generally Reunions, people back from overseas. involved drinking. This is similar to the focus group n experiences of many in our society. You’re revered for how much you can drink, get kudos for it, rather than For many, alcohol became part of their image being ostracised. and style. As adults, it was a way of showing that they had made it in their social circle.

As a young person, drinking was a way of The survey results showed the strong influence showing they were no longer a child. Many of that friends have on a person’s decision to the focus group participants started drinking start drinking. Over 80 percent of those who as teenagers with their friends, who were a completed the survey questionnaire reported major influence on their drinking. To drink was that friends had at least some influence on to be cool, to be part of the crowd. One person their decision to start drinking. Friends had said, “It started because I wanted to become a more influence than family on their decision man.” to start drinking, with 41 percent indicating Often, part of acceptance into the group is friends had “the most influence” (compared to drink. For some, alcohol helped them to 22 who indicated that family had “the most to cope with shyness or awkwardness in influence”). The strong influence of friends social situations. Having a drink made them on the decision to drink was very similar for feel more comfortable. One person said: “I both women and men; 83 percent of men and felt out of place not drinking,” and another 81 percent of women reported friends had at commented, “I used to have a glass in my hand least some influence on their decision to start to communicate.” drinking. In the survey, the men indicated that drinking outside the home, or at home with friends was more common for them than for

32 | UNDER THE INFLUENCE the women. Men were most likely to drink in a drink because of specific feelings or emotions bar or pub (28 percent), followed by drinking they had that related to socialising—they felt at home with friends (22 percent). Women inadequate or shy in company and alcohol were most likely to drink at home with family, helped them to relax. rather than out at a bar or pub or at home with 4.3 AVAILABILITY OF ALCOHOL friends. Now that almost all those surveyed were not drinking, the influence of friends was Many of the focus group participants much less; however, more men than women commented that the widespread availability reported still being influenced by their friends of alcohol all week and at all times of the (44 percent compared to 30 percent). day and night is a pervasive influence that is hard to avoid. Local liquor stores, dairies and Drinking is not only associated with recreation supermarkets were seen to be particularly and socialising. It can also be associated with easy sources of alcohol because of the large work. Some of the focus group participants number of them and their long opening hours. got into heavy drinking through drinking with workmates. The end of a working week means having a drink as a reward for working hard. A focus group k few became heavy drinkers through socialising 21 outlets in 8 kilometres. with clients as an expected part of work. Others commented that drinking in work hours It’s so easy to go and pick up. went on unchecked in some workplaces. A few It’s in your face. found the workplace hostile or experienced Big billboards advertising cheap bullying. This led to drinking as a way of drink. coping. Sometimes work had been a positive How do you go shopping? You have influence, limiting the opportunity to drink and to walk through the alcohol display to overcoming boredom, which was a reason why get into the supermarket. some said they had become heavy drinkers. focus group r While social situations provide an influential [Supermarkets] you go in for bread and come out with wine. environment that is conducive to drinking, focus group participants also identified 24-hour dairies. specific triggers in social situations that You can’t go for a coffee only. Most generate or heighten the desire to drink. cafés are licensed. For some, being at events and celebrations When I was drinking, you could drop triggered drinking. As several people me anywhere in the city and I would know where the nearest place to buy observed, actually seeing alcohol at gatherings booze was. makes it hard to avoid drinking. Others used

UNDER THE INFLUENCE | 33 The importance of off-license premises for participants noted the way that supermarkets access to alcohol was demonstrated in the prominently display alcohol and occasionally survey, where respondents reported they had offer free tastings. These practices increase most often bought liquor from supermarkets the visibility of alcohol, and particularly appeal (34 percent of respondents) followed by a local to the senses (sight, taste). Hence, those liquor store (29 percent of respondents). displays can actually trigger a desire to drink. Buying alcohol from dairies and supermarkets Several participants also commented on the was especially the choice of women in the availability of alcohol in cafés as a trigger. focus groups. They said those outlets were 4.4 APPEALING ADVERTISING convenient and relatively discrete, as buying Many focus group participants said that could be done as part of grocery shopping. they were influenced to drink by attractive They also observed that the widespread advertising and product packaging that availability of outlets makes it easy for promises success and popularity. Another someone to hide their drinking by spreading key aspect of the advertising is that it makes their purchases across outlets. Supermarkets alcohol look appetising. Good advertising with online ordering also make it very easy to appeals to the senses. access alcohol. In the survey, the supermarket was clearly the place most favoured by women Masculine, macho advertising such as the for purchasing alcohol (58 percent reported beer slogans “measure of a man’s thirst” and that they had most often bought liquor from “great southern man” appealed to men. Beer a supermarket). In contrast, men were more advertisements with sex appeal and humour likely to purchase from a local liquor store. Across all focus groups there was a strong view that RTDs increase the availability of alcohol focus group p to young people. They believed that RTDs are It makes you feel that you will be good accessible because they are widely available in enough when you drink. on-licenses and liquor stores and easy to drink focus group s as they do not have to be mixed. Furthermore, Makes drinking look glamorous, fun. their sweetness appeals to youth taste. focus group j The widespread availability of alcohol makes Masculine. it easy for people to act on the impulse or Tasty and appetising, looks good. desire to drink as the opportunity is there to purchase. Participants noted that the Better than most ads! visible presence of alcohol in so many places It’s cool to drink. triggers a desire to drink. For example, many

34 | UNDER THE INFLUENCE are also attractive. Women were also attracted 4.5 SPORTS by alcohol advertising, particularly those that Many focus group participants said that they showed alcohol to be a sophisticated choice strongly associated drinking with both playing and a way of achieving social acceptance. and watching sport. Drinking is part of the Focus group participants were of the view that ritual of watching sport, as well as part of alcohol advertisements promote the idea that the after-match environment in clubrooms. it is cool to drink. This imagery is taken further Consequently, sports become an easy way for in television, films and music that portray young people to be exposed to alcohol. In the drinking in a way that makes alcohol desirable experience of several focus group participants, and promote its identification with popular often underage drinking in sporting culture. environments is not well controlled. Advertisements often increase awareness of alcohol and consequently trigger the desire to drink. For some, billboards are a big trigger focus group i because they attract attention and are visible It’s ingraining the whole drinking 24 hours a day. Some participants also found culture. that attractive packaging acts as a trigger. The focus group s packaging of RTDs was cited as deliberately Sports clubs are supposedly there to targeting young teens. Some participants keep you healthy but there’s drinking talked about the power of visual triggers after the game. in advertisements or films when a bottle focus group o is opened or a drink poured. These images Growing up, playing the game and stimulate the urge to drink. having a few beers. Although the focus groups identified appealing advertising as an influence that made drinking acceptable and desirable, the survey showed The focus group participants considered that that overall, the way a drink is promoted sports people are important role models in had almost no influence on the type of the community; consequently their drinking alcoholic drink people bought. Only 2 percent behaviour can be hugely influential on young identified the way a drink is promoted as most people as there is an implication that drinking influencing what they would drink. By far the is associated with success. Also, when sports most important factors influencing the type of people are involved in violence and drink alcoholic drink they would buy was the taste driving associated with alcohol, some in the (most influential for 44 percent of respondents) focus groups considered that such behaviour followed by the price (37 percent). is often seen to be acceptable. Nevertheless,

UNDER THE INFLUENCE | 35 focus group participants were scathing about among focus group participants of all ages that what they saw as harmful drinking behaviour young people are very price driven and this by elite players that is not dealt with seriously was confirmed by the younger people in their by sports people, sports administration and 20s in the focus groups. the justice system. Participants gave several examples of the 4.6 PRICE influence of price on their drinking. One example was the purchase of alcohol from Although very few focus group participants a wholesaler to drink at home before going who responded to the survey identified the to the pub or nightclub later. This practice way an alcoholic beverage is promoted as enables people to fill up on cheap alcohol so having the most influence on the type of drink they can spend less in expensive bars. they bought, in the focus group discussions many participants observed that cheap Young people in particular talked about alcohol is promoted, as supermarket specials, choosing to drink at the bar that offered the discounted drinks in bars, and in competitions best specials for the night, purchasing alcohol giving away free alcohol. They clearly identified that included gifts in the offer, and buying cheap alcohol as a trigger to drink. Specials single cans or bottles rather than larger and promotions were identified as particularly quantities. Focus group participants observed attractive triggers, encouraging people to drink that single cans or bottles of alcohol can be more. Many considered that bar promotions of cheaper than a can of coke, energy drink or cheap drinks are particularly aimed at young water. For example, specials of RTD cans for people. one dollar were regarded as highly attractive. One person said that when someone does not Participants spoke about how drinking have much money, the single can will “top you behaviour can be modified by price. The survey up” until the next drink. also showed that, after taste, price was the second-most important influence on choice of alcoholic drink. focus group l Some participants said that price had been There’s a lot of youth who will club a big influence on the amount they drank, together to buy the biggest bang for although being alcohol dependent they would their buck. not be deterred by price rises. They would focus group r drink no matter what the price; however, if You can buy singles for $1, most their drink of choice was on special they would supermarkets sell single bottles. Even drink more of it. Several participants said a four pack is cheap. that they sought out “loss leader” products You pay more for Coke than for beer. because of the price. There was a general view

36 | UNDER THE INFLUENCE 4.7 EMOTIONAL ISSUES Probably the most widespread trigger, for both focus group d men and women, were internal triggers relating Any emotion really, grief, anger, to emotional issues and personal troubles. For loneliness. some, these personal troubles stretched back focus group p to childhood. The range of both positive and The first thing you turn to to seek negative emotions that would trigger a desire relief from your situation. to drink was extensive, including anger, fear, focus group n worry, boredom, isolation, feeling inadequate, A lot of us are here because we used unhappiness, guilt, rebelliousness, euphoria, alcohol as a crutch. stress, and grief. focus group m It was common to use drinking as a coping It made me feel good about myself, mechanism to deal with or block out self esteem. problems that become overwhelming, such as relationship problems, loss of a loved one, loss of a job, or money worries. Several women and men talked about drinking as a response to childhood sexual and physical abuse. Others have used alcohol to cope with mental illness, particularly depression. Some participants said they used alcohol to deal with boredom when they were young teenagers. Others noticed this pattern among their own teenage children.

UNDER THE INFLUENCE | 37 38 | UNDER THE INFLUENCE 5. WHAT SHOULD BE DONE?

about alcohol, particularly starting with focus group g children; along with more opportunities for As a society, how do we go about treatment. The focus groups identified a need changing our thinking? for preventative interventions, with many focus group b participants citing education as the critical The drinking culture is so ingrained, lever for changing societal attitudes and it’s a long term thing that will take behaviours about alcohol. However, the focus time, but like smoking, it can be groups also emphasised a huge need to widen changed. the range of treatment options and increase focus group d the number of places available in programmes. The number one thing that’s got to Because of the number of issues raised about change is the culture; it’s normal [to treatment, these are discussed separately in drink], it’s intergenerational. the following section 6. focus group e As well as the emphasis on education and Come at it from every angle. treatment, the focus groups traversed a wide focus group j range of views concerning the availability People’s attitudes are the hardest of alcohol, the marketing of alcohol and thing to change, the ‘my choice to legislative changes. drink’ thing. People don’t like being told what to do. This section covers the suggestions for interventions in the areas of: It’s almost a God-given right [to drink]. • public education • purchase age

Very strong views were expressed across all • alcohol advertising, promotions and focus groups that our society’s attitudes and product labelling behaviours towards alcohol need to change. • alcohol availability Many participants considered that changes in • licensing and enforcement cultural norms, attitudes and practices around • alcohol pricing alcohol would be the hardest thing to effect, but a fundamental necessity if the harm and • alcohol excise tax damage caused by abuse of alcohol is to be • drink driving addressed. • the responses of different sectors Across all focus groups, the strongest support to alcohol was for two types of interventions to limit alcohol-related harm: more public education

UNDER THE INFLUENCE | 39 5.1 PUBLIC EDUCATION focus group i The focus groups identified options for public Education about seat belts; that has education about alcohol in relation to two main worked with kids. areas: When we were at school there was no • education of children and young people alcohol education. • social marketing campaigns My kids come home from school and hide my smokes, and ask me why I’m smoking, that makes me feel guilty. focus group s It was also suggested that, as well as schools, Give them the ways to say no. Give sports clubs should take a role in educating them support to deal with alcoholism children and young people about the dangers in their families. of alcohol. Several suggestions were made about how messages on harm minimisation and Children and young people responsible drinking could be conveyed All focus groups regarded the provision of to children. It was generally agreed that information on alcohol to children at primary information must be given in a way that school and intermediate school as important, children relate to, and that does not demonise to give them choices in their lives. Focus alcohol so that the forbidden becomes group participants said the children need an desirable. Some said that education to build alternative view, from what they experience self esteem should be included in alcohol in their families as many are growing up with awareness education. One focus group alcohol and seeing the effects around them. commented: focus group e focus group h We need more factual information for kids. Teach it in schools when they are little, but We can’t just work at the bottom of the cliff. do it the right way. Three focus groups noted that some Learn about alcohol so they can make an campaigns have worked well in schools to informed choice. raise awareness and provide alternative role We had to wait ‘til now [in this programme] models; for example, about smoking, using to learn about it. seat belts, fire safety, nutrition and “stranger danger”. Several participants said that children and young people needed to be given information about where to go for help, either for

40 | UNDER THE INFLUENCE themselves if they have alcohol problems, or to focus group a support them in coping with family members Drink driving ads are too negative, ‘drink with alcohol problems. and drive and you’re a bloody idiot’, they Others suggested that people who have gone don’t have any effect on the alcoholic. through treatment programmes should go into But some are good, they give a plain schools to talk to children. Suggestions were picture of what might happen, the also made for combined alcohol education consequences. They are educative, raise events for parents and children, as well as awareness. using prominent sports people in schools as The kids think they will not crash. role models of responsible drinking behaviour. Depends on who you are, what age you are, One focus group advocated for compulsory whether the ad works. defensive driving courses in schools that include drink-driving education. The non-flashy ones are way more effective than the gruesome stuff. Social marketing campaigns Ads with kids in it, really connect. Sixteen focus groups considered that more public education about the negative impacts of It’s better for ads to give positive alcohol is needed. However, there was mixed messages. support for advertising campaigns such as They should show what alcohol does those run by the Alcohol Advisory Council and to your health, but that wouldn’t have the New Zealand Land Transport Agency. Most stopped me. participants agreed that those campaigns did not affect problem drinkers or those dependent on alcohol, and were more likely to impact focus group l on people who were responsible drinkers. [advertisements need to be] hard One person summed up a common view hitting, straight talking and de- about campaigns as “only effective for those glamorise alcohol. teetering on the edge of having a problem”. The message [must] come from the people who have been through it. Some focus groups engaged in extended discussion about different advertisements, particularly whether they have any impact, and focus group b who they are meant to target. Two different Do the same as for cigarettes, show the focus group conversations are presented harm alcohol can do. below to illustrate the detailed consideration the focus groups gave to the question of public Show people from all walks of life and the education via media campaigns: different kinds of drinkers.

UNDER THE INFLUENCE | 41 The current ads are not effective. I don’t Most participants agreed that current pay attention to them. advertisements did not target young people, and there needed to be much more focus on I like the ALAC ads, but good choices must young people’s drinking, particularly underage be shown, e.g. the sober driver alternative. drinkers. One focus group noted that young The guy swinging the child around is Pacific people need to be reached. Another powerful. focus group suggested that advertisements Some participants thought that advertisements should portray Maori situations such as the were not hard hitting enough because they whanau to appeal to Maori. Some of the did not do enough to de-glamorise alcohol, women participants commented that women or make it appear uncool. Others considered needed more information about the particular that the shocking alcohol-related crash and impacts of alcohol on them, including health violence advertisements de-sensitised people impacts. or sparked a response of denial: “That’s not Across all focus groups there was widespread going to happen to me.” They wanted to see support for a campaign to increase general positive messages that help people identify public understanding about alcohol with and recognise they have a problem. Many dependence and to challenge the stigma considered that humorous advertisements associated with addiction. Many participants would have more impact. considered that alcohol dependence is Some thought that more advertising that still seen as a “self-induced illness”. One emphasises the damage that alcohol can do participant pointed out the irony of common to one’s children, family and friends is more attitudes: “There is admiration for the likely to get heavy drinkers to take notice. heavy drinker and stigma for the alcoholic.” They thought that type of message would get Participants also considered that general through much more strongly than messages awareness among drinkers about their about damage to oneself. own behaviour and the health impacts of A few participants thought that some current alcohol is very low. They said many people messages are confusing. For example, the do not recognise they have a problem. Most advertisement ‘It’s not what we’re drinking, participants said that before they entered it’s how we’re drinking’ was considered to a treatment programme they knew nothing give a mixed message that maybe drinking is about the harmful impacts of alcohol. OK, maybe it’s not. Others commented that Participants thought that if public awareness some of the anti-drink driving advertisements was raised and stigma challenged, this would appeared to glorify reckless driving. encourage more people to seek help. In their view, the stigma of alcoholism makes it

42 | UNDER THE INFLUENCE harder for people to acknowledge they have Two focus groups would like to see popular got problems and to seek help. Comments local television programmes like Shortland included: Street convey messages about reducing focus group m alcohol consumption, reducing stigma and They see an alcoholic as someone in the showing that people can get help. There was park drinking meths, not someone holding a view that local television is too accepting of down a job. New Zealand’s heavy drinking culture in how alcohol is portrayed in story lines. focus group m There’s not an understanding out there One focus group suggested that an annual about what alcohol does. alcohol-free day be introduced, when people are encouraged to abstain for the day or give You’ll find more people come out of the up altogether. It would be an opportunity woodwork, there’s a lot of denial out there. to raise awareness and promote treatment focus group q options. They noted the “quit smoking” days There are stereotyped views about who is and campaigns provided a model that might be an alcoholic, we need to challenge those. usefully adapted to raise alcohol awareness. Nobody is spared. 5.2 PURCHASE AGE Raise people’s awareness of the risks and help them acknowledge they are Fourteen focus groups commented on raising alcoholics. Have celebrities and everyday the purchase age. The purchase age was people saying they are an alcoholic. one of the most debated issues, as these contrasting comments from three different Change public perception and make people focus groups show. The comments also show look at their own drinking. that, regardless of whether participants Three focus groups particularly applauded supported or opposed raising the purchase the Mental Health Foundation’s depression age, there was a widespread view that tougher advertisements and would like to see enforcement of the purchase age is needed, something similar to raise people’s awareness including stronger controls over parents of alcohol dependence and challenge supplying alcohol to minors. stereotypes and stigma. They would like to see focus group d a series of advertisements with both celebrities Raise it, another barrier to the young kids. and with everyday people talking about their Be stricter on parents supplying it to kids, addiction. Participants strongly emphasised it’s no different to a shop keeper selling that those who are alcohol dependent need to alcohol to a minor. be shown as coming from all walks of life, and as being all kinds of drinkers.

UNDER THE INFLUENCE | 43 focus group g the point that young people could vote, go to Changing the age of drinking is easy to war and are able to exercise other legal rights do, but hard to police and the damage has at 18 and so should also have the right to been done. drink. Some were of the view that, rather than Policing the age much more rigorously at raising the age limit, there should be greater the point of sale, especially at dairies, it’s emphasis on responsible drinking messages to not being followed. young people and tighter enforcement of the current law. focus group h Raising it won’t make any difference 5.3 ALCOHOL ADVERTISING, Yes, it will make a slight difference, some PROMOTIONS AND PRODUCT might be delayed LABELLING [enforcement] it’s stricter on age now than Across the focus groups there was a general on intoxication. view that more controls on alcohol advertising should be introduced as participants There was majority support for raising the considered that advertising provides a visual purchase age, mainly because it was believed trigger for drinking. Within that broad view, that increasing the age would act as a barrier suggestions ranged from tighter controls on to very young teens accessing alcohol. Raising some aspects of alcohol advertising, to a the age was also supported as it was regarded complete ban. as possibly reducing alcohol-related offences among young people, such as drink driving and

violence. Some also considered that raising the focus group f age would make it easier for outlets and police I think warnings on packaging would to enforce. be most effective before people are There was some support for keeping the addicted or into drinking. on-license age at 18, but raising the age at off- focus group r license to 20 or 21 years. Others wanted the Look at the smoking, it isn’t cool. age to be raised for both off-license and on- Show what you look like when you’re license. A few also wanted to see the driving pissed. age increased as well, as a way of reducing focus group b drink driving amongst young people. Ban alcohol giveaways, they should give away vouchers to rehab instead. There was still a substantial minority who considered that raising the age would have focus group d a limited effect, although it may deter a few Sports sponsorship, no definitely not, underage drinkers. Several participants made it influences the kids.

44 | UNDER THE INFLUENCE There was strong support in 11 of the 20 focus like to see similar warnings on alcohol groups for a ban on all alcohol advertising. packaging, although many admitted that they There was also widespread support across the smoked and were not influenced by such focus groups for banning alcohol sponsorship messages on cigarette packaging. However, of sports. The latter is seen as particularly some thought that graphic health warnings inappropriate as it is highly visible to children would affect younger drinkers. Some also and young people. Many in the focus groups suggested that an 0800 help line number said that controls on advertising of alcohol should be printed on the packaging. should be the same as those on cigarettes. 5.4 ALCOHOL AVAILABILITY Suggestions were made for controlling the Most focus groups agreed that a lot could promotion of alcohol through: be done to reduce the availability of alcohol, • responsible portrayal of drinking on local although a few participants felt that it was too TV programmes late to reverse the impacts of widely available • reducing the prominent displays of alcohol alcohol. In contrast, a few people suggested in supermarkets; suggestions: that alcohol be banned outright, but this was generally seen to be unworkable and that »» introduce guidelines and a voluntary prohibition would make the situation worse. code of conduct for supermarkets to persuade them to be more responsible Many participants considered that reducing in their alcohol displays availability would help reduce the risk of impulsive drinking, enable better enforcement »» require supermarkets to cordon off (because of fewer outlets and shorter hours) alcohol and only allow those 18 and and help reduce public disorder from drunken over into that sales area behaviour. Many thought that a lot of the • banning alcohol advertising that appears problems with violence now are after the pubs to target or appeal to underage drinkers; close, with people coming on to the streets many focus group participants considered “dead drunk”. that particular products such as RTDs are Suggestions for controlling the availability of aimed at the youth market alcohol included: Several focus groups contrasted the product labelling on alcohol with that on cigarette • Controlling the number of outlets. Key packaging. While alcohol is promoted in suggestions: a glamorous manner, they observed that »» A ban on sales in dairies and cigarette packaging includes public health supermarkets. Across all focus groups warnings and graphic pictures of the damage most participants supported this that cigarettes can do to health. They would option. Several participants voiced

UNDER THE INFLUENCE | 45 particular concerns about young • Reducing hours of sale. Suggestions supermarket checkout staff being were made to close off-licenses at 10 pressured by their (underage) mates pm, to have reduced opening hours on to sell them alcohol. It was considered Sundays, and to reduce the hours of sale in that stopping the sale of alcohol from supermarkets and dairies. supermarkets would help reduce the • Reducing the alcohol content in drinks. opportunities for sale to minors. This measure was regarded as helping to »» Controls on the number of outlets in an reduce availability as people look for the area. highest percentage of alcohol possible to

»» A ban on outlets within a certain get drunk in the shortest possible time. distance of schools. Lowering alcohol content is expected to reduce the social and health damage of »» A ban on alcohol sales in cafes and drinking behaviour as it will take people restaurants associated with public longer to get drunk. Addicts are driven by areas frequented by families, such as alcohol content so it will impact on their libraries and swimming pools. consumption. Some suggested: »» Some would like to see alcohol sales »» Cap the alcohol content in beer to 3.5 controlled in all areas through a trust per cent. structure. »» Reduce the alcohol content of RTDs. Banning of RTDs was widely supported across focus groups. Participants believed RTDs to focus group g be dangerous because people do not regard Far too readily available. them as liquor, they are relatively inexpensive focus group h are easily obtainable. Several participants also Take it out of supermarkets and linked RTDs to drink driving. They said that the dairies, it’s a bad image to children. pre-mixed format and easy to open containers There’s nowhere you can go that made them ideal to drink in vehicles. RTDs doesn’t have alcohol. are seen to be insidious, as “not really” being focus group r about drinking because they do not taste like I can go for a swim at the council pool alcohol, but instead taste sweet which appeals and buy alcohol. to youth. As one person said, “kids think the focus group k taste of alcohol is gross”. The comments of Reduce the opening hours, it would several participants made it clear they consider stop a bit of trouble. RTDs are deliberately marketed to young people:

46 | UNDER THE INFLUENCE focus group s get a liquor license than to get a bar manager’s What slows teenagers down from drinking certificate, while another thought that the is they don’t like the taste, all they want time spent on bar manager training was too is the effect and that’s what they get with short and the standard required to obtain the alcopops. certificate inadequate. focus group h They are trendy, they are designed for young people and women. focus group i focus group h Beef up enforcement, it’s not working. The packaging is to make them look like V It works in some areas but not others. and other drinks teens like. Police need to be more active where the pubs and liquor stores are. 5.5 LICENSING AND ENFORCEMENT Stricter license conditions are needed. Most focus group participants were of the Fines should be more stringent. opinion that stricter conditions on obtaining a liquor license and stricter enforcement of focus group k regulations, coupled with higher penalties Get the outlets to be more vigilant. for offending premises are needed. Most There should be much stricter fines for contravention of liquor licenses, thought that, generally, bars were well like instant fines. regulated and abided by the law, although Patrol public places, there’s really big some differences were observed between problems on the beaches and parks. city centre bars and neighbourhood taverns, If there are liquor bans, they are not which were considered to be less concerned being enforced, and patrolling them about compliance. Liquor stores and dairies can push the problem into other areas. were regarded as the worst offenders of selling to underage drinkers, to intoxicated people focus group h and to adults whom they know are supplying Yes, there are places that will serve minors. Some who had worked in the industry intoxicated people said that underage sales are an ongoing problem, with young people devising tricks to obtain liquor. A few would like to see the law relating to Some considered that the processes to obtain adults supplying liquor to a minor tightened; a liquor license and bar manager’s certificate they saw this as no different to a licensed 157 are too lenient and need to be more rigorous. premises supplying to a minor. However, One person considered that it was easier to others, particularly women, justified their

UNDER THE INFLUENCE | 47 purchase of alcohol for their underage teens Several participants commented on the cheap to drink at home as responsible behaviour. price of alcohol in New Zealand compared to They knew their teens would find other ways Australia. A minimum price was supported by to drink and they would rather the teens be in some. They considered that it would provide a safe supervised surroundings. disincentive to young people’s consumption as Other changes that focus group participants well as reducing adult consumption. would like to see included: Participants considered young people to be • a ban on carrying liquor in the car; it must particularly price driven and responsive to be confined to the boot as in some other price increases. While all agreed that those countries who are alcohol dependent will not cease drinking simply in response to price rises, • a wider use of liquor bans in public places there was a widespread view that people will and enforcement of existing bans more drink a greater quantity of alcohol if it is cheap. rigorously Although a few participants disagreed, there • police more proactively enforcing liquor was a general view that increasing the price laws, including focusing on premises may slow the consumption of heavy drinkers. and areas where there are problems with However, it was also a widespread view that violence and disorder those dependent on alcohol would also switch to cheaper alternatives wherever possible. 5.6 PRICING There was strong support for a ban on allowing Thirteen focus groups commented on raising single units to be sold. One focus group the price of alcohol or establishing a minimum commented that the sale of single cigarettes price. Nine of those groups supported a and 10 packs has been banned and a similar minimum price or an increase in price, while regulation should be adopted for single units support for those changes was mixed or rejected in the other groups. The range of issues raised about price is reflected in this exchange in one focus group: focus group h focus group j Alcoholics will always buy it and Don’t muck around, put the price up. sacrifice the basics, food and warmth, Maybe it would have slowed me down. or downshift, get something cheaper. It would increase home brew, there’s focus group o already a market in home brew. Don’t raise the price, there’ll be less food on the table. Alcoholics will find It would penalise the couple celebrating the money anyway. their anniversary, they’d have to mortgage the house.

48 | UNDER THE INFLUENCE of beer and RTDs. A few would like to see a Thirteen focus groups supported taxing alcohol general ban on heavily discounted alcohol and and using those funds directly for treatment cut price promotions such as “happy hours”. and public education about alcohol. There Others suggested making non-alcoholic or was also a suggestion that funding go towards low-alcohol drinks cheaper. They would like to compensation for victims of drunk drivers. see low-alcohol beer and soft drinks promoted Several participants suggested using a similar as alternatives. It was also suggested that bars tax model to that employed in levying the should be encouraged to serve free soft drinks. gambling industry. Participants felt that using taxation for treatment and public education Those who were less convinced about the was justified as drinking alcohol is legal, and effectiveness of price in reducing consumption they have contributed through liquor taxation. said that those who are alcohol dependent will always buy alcohol, no matter what the price. They considered that an increase in focus group h price would increase the production and (black market) sale of home brew, as well as theft of [Alcohol] is legal, we get taxed, we are addicted, therefore they need to alcohol. Others considered that low-income provide the treatment for us and our earners will just spend more of their income on families. alcohol and make sacrifices on food, shelter focus group i and heating. They saw families suffering if the There’s a huge tax take from alcohol, price of alcohol rises. there’s a huge vested interest. Some also asked: is it fair to increase the focus group b price to attempt to control the excesses Get breweries to contribute money for of a few? They questioned why moderate programmes. drinkers’ freedom to drink should be limited or penalised.

5.7 ALCOHOL EXCISE TAX There was a strong view that funds derived from the liquor industry for mitigation of the Discussion around the taxation of alcohol damaging effects of alcohol should not be was spontaneously raised by focus group controlled in any way by industry interests, participants, rather than being specifically but that decisions about the use of such funds prompted. However, the discussions did not should be made by an independent body. In use terminology such as excise tax; rather general, it was considered that the alcohol participants used such terms as ‘liquor tax’, industry is a very strong lobby, which would be ‘industry tax’ and ‘tax take’. resistant to any tightening of legislation and increased taxation.

UNDER THE INFLUENCE | 49 One focus group would like to see alcohol tax would make the system much simpler and funding go towards the establishment of a clearer than currently. commission that has more power than ALAC. Although some participants agreed with a The role of such a commission would be to lowered blood alcohol limit, they did not agree oversee all alcohol legislation and policy, with reducing the blood alcohol limit to zero. monitor changes and conduct research. They They thought this would penalise the majority thought this commission could also take over who drank responsibly. Others wanted the all liquor licensing, thus giving it consistency blood alcohol limit reduced for those aged throughout the country. The commission would over 20 or even 25 years, but zero for younger also work closely with other sectors to raise people, and those on learners and restricted awareness and promote responsible alcohol licenses. practices. One focus group thought that companies would increase the price of alcohol to focus group h compensate for increased alcohol tax; Booze buses, we need a lot more and however, they regarded this as a good random. thing because that would serve as a further The worst offenders are over 40. disincentive to those driven by price. Country drivers are the worst. 5.8 DRINK DRIVING focus group t The focus groups included several people Laws are sensible now, but consequences are not hard enough. who had multiple drink-driving charges. All Lock up a repeat offender on the first except two focus groups wanted to see lowered repeat offence. (or zero) blood alcohol limits and harsher focus group k penalties for drink-driving offences. Drink driving is a big problem and I Blood alcohol levels feel that’s getting worse. There was a lot of support in the focus groups for a zero blood alcohol level.158 In part this was because participants considered that the Two focus groups did not agree with lowering current regime is confusing and misleading as blood alcohol limits because they considered everyone is different in the way they react to that it would not make any difference to heavy alcohol; a person can be incapacitated on less drinkers who would still drive regardless. than the legal alcohol limit. There was also a focus group h view that zero blood alcohol would be easier to Waste of time tinkering around with that. enforce. Adopting a zero blood alcohol regime [lowering blood alcohol] won’t make any different to problem drinkers.

50 | UNDER THE INFLUENCE One of those focus groups considered that was a general call for more use of penalties the only things that might have an effect was such as confiscation of car and community to confiscate cars, and to have devices in cars service. Some would like to see a person that would immobilise the car if the driver getting an alcohol and drug assessment the was over the limit. Several other focus groups first time they appear on a drink-driving charge would also like to see the widespread use of and more use of court directed treatment such devices in cars. programmes.

The other focus group that did not agree 5.9 INSTITUTIONAL RESPONSES with lowering blood alcohol limits suggested The focus groups made several suggestions increasing the frequency of random testing for increasing awareness of alcohol issues and on the roads and targeting anti drink driving improving alcohol-related practices in a range messages particularly to those over 40 and of sectors. They considered that institutional country dwellers, whom they thought were the responses could be improved in the following worst offenders. areas: the liquor industry, justice sector, Penalties general practitioners, financial assistance There was general support for increasing (covering income support, taxation and penalties for drunk drivers, particularly repeat accommodation assistance), employers and offenders. Many were scathing about a system sports clubs. that they considered allows recidivist drink- Liquor industry drivers to offend again, and cited examples of Several focus group participants had worked acquaintances with numerous drink-driving in the liquor industry. There was some support convictions (up to 22 in one case). for more training to be given to bar managers Several participants were critical of public on the impacts of alcohol and information figures who are perceived to abuse alcohol and about help available. There was a view that to “get away” with alcohol-related offences those at the point of sale could be much more that the average person would not get away informed about alcohol issues and given with. They called for politicians and sports training on how to give information about help people to be better role models. One person available to customers who clearly have an said, “Why should we change our behaviour alcohol problem. when they don’t change theirs?” Three focus groups commented on the host Many considered that it was too easy to get responsibility of bars. They applauded pubs off having the license revoked. One person and clubs that offer free soft drinks and make thought that prison sentences would be much courtesy vehicles available. However, they more of a deterrent than loss of license. There also commented on encountering negative

UNDER THE INFLUENCE | 51 attitudes from bar staff when ordering soft Financial assistance drinks and, in some establishments, a practice The focus groups identified several issues in of charging for water. They would like to see dealing with agencies that provide income licensed premises with a more inclusive support, tax assistance and accommodation approach to non drinkers. It was also pointed assistance. Lack of earning is a huge issue out that one deterrent to people wishing to use as the debts mount up when individuals are a courtesy vehicle or taxi is a fear of leaving in treatment. Participants called for agencies their car vulnerable to being vandalised in pub such as Work and Income, Inland Revenue and car parks. They commented that increased Housing New Zealand Corporation to work security in car parks could improve people’s together to support people during treatment willingness to use alternative transport, rather and while they are in recovery. than drink-drive. Lack of agency coordination and lack of Justice sector understanding of alcohol dependence and There was a call for judges, lawyers, police the processes of recovery were identified as prosecutors, probation officers and duty ongoing issues facing people coming out of solicitors to be better informed about addiction treatment. treatment programmes available. Some Employers participants favourably commented that some There was a call for employers to be made judges and lawyers in their areas are aware more aware of the impacts of alcohol, and of treatment programmes and will direct to control drinking at work as well as after offenders to them. work in the workplace by establishing alcohol General practitioners policies. This approach reflects the fact that Three focus groups thought that general many problem drinkers are employed, and that practitioners need more training on workplaces are important sites for drinking. understanding alcohol, alcohol dependency Focus group participants made suggestions and the help available. Some also said for employers to provide advice about help that doctors are too quick to expect people available, offer counselling to employees, who are undergoing treatment for alcohol and hold jobs open while people are in dependency to get off the sickness benefit in a treatment. In the participants’ experience, few months. They suggested that there is little large employers are generally understanding, understanding of the recovery process, which however it is difficult for small employers as may take an extended period of time and will many would not be able to afford to hold jobs 159 vary according to the individual’s situation. open. They suggested that there should be a scheme to help small employers support their

52 | UNDER THE INFLUENCE staff in treatment and hold the job so that they have a job to return to.

Sports Several participants would like to see sports taking a lead in raising awareness about the harmful effects of alcohol. They would like to see sports organisations providing information to children and young people about responsible drinking, promoting sports mentors with responsible drinking behaviour, and controlling alcohol consumption on sporting club premises. In particular, participants commented that some clubs appear to ignore minors drinking. It was suggested that some clubs rely heavily on income from the sale of alcohol and perhaps that contributes to lax controls on alcohol.

UNDER THE INFLUENCE | 53 54 | UNDER THE INFLUENCE 6. TREATMENT

All focus groups commented extensively on focus group c what they considered to be shortcomings in It takes a lot to walk into a place and the current system of provision for treatment. say you’ve got a problem. Often participants drew on their experiences of different types of programmes run by different agencies in forming their views. Key issues Given the composition of focus groups, it is not discussed were: surprising that participants discussed options • gaps in the types of programmes currently for treatment in detail, as most focus group available participants had experience of at least one • pre-programme support type of treatment or support services. Some had extensive experience spanning years. • post-programme support There was a widespread view among • involvement of families in programmes participants that investment in treatment is • provision of assessment and programmes money well spent, compared to the costs of in the justice system alcohol-related harm to the health and justice • the interface between mental health and systems, as well as to individuals, families and addictions programmes employers. These views are well supported by evidence of the costs of alcohol to death, • the need for information about help to be disease and injury in New Zealand.160 more widely available. The following exchange in one focus group These issues are discussed below. expressed points that were common to several 6.1 TYPES OF PROGRAMMES focus groups: Discussion about the types of treatment focus group e programmes needed covered what participants For hard core alcoholics, the main thing is believed to be currently available and the gaps treatment. they perceived in services, the location of A small proportion of people are creating services and the duration of programmes. most of the damage, they need to be A wider range of programmes treated. They don’t look at their drinking until it becomes serious. The strong message from all focus groups was that there are not enough programmes Education won’t work for them. to meet demand across the range of services Save money by building more treatment that are needed in the community, including centres, get people well so they can assessment, counselling, detoxification contribute to society again. treatment and rehabilitation.

UNDER THE INFLUENCE | 55 This perception concurs with Salvation Army people cannot get support to detox, or believe data. The Salvation Army reports that for the that no other options are available, then they year-ending 30 June 2009 it experienced detox themselves. This can be life-threatening an increase in demand with a 21 percent and it is preferable to detox in supervised increase in uptake of its addictions services. situations.162 A further increase in uptake of 33.5 percent With regard to rehabilitation programmes, was experienced for the first two quarters of there was strong support for both day and the 2009/10 financial year. More people have residential programmes. used the service through an increase in all Residential programmes are particularly types of referrals, including self-referral and important for individuals whose living referrals from other addictions services, as well situations are not safe and/or detrimental to as social services. There has been no increase recovery. They are also suitable for people in funded bed numbers to meet the increase in with extensive rehabilitation needs. In some demand. situations intensive day programmes are With regard to assessment, several linked to supervised accommodation.163 In participants commented that there were New Zealand, over the past twenty years there 161 waits to get assessment in their areas. has been a shift from residential programmes Long waits was also one of the main concerns as the only option, to a wider range of expressed about accessing counselling. community-based treatment models. Some were also concerned about the costs of In several of the focus groups there was counselling. strong condemnation of the past closure of some residential programmes. In part this

focus group s People detox themselves, it’s dangerous. focus group e focus group l You need live in treatment, you need Some think they can handle it. to pull yourself right out, disconnect. focus group a Residential is 24/7 and so is the With regard to the availability of “detox” addiction. programmes (detoxification treatment), focus group s participants perceived that it was hard to get [residential] it’s more intensive, it’s support to detox, either as an in-patient, or harder than being an outpatient. The in the community with appropriate medical peer pressure keeps you straight. support. Participants commented that if

56 | UNDER THE INFLUENCE was because those participants considered with loneliness.166 One focus group, which the residential aspect to be valuable for included former programme participants now rehabilitation and recovery. There was also working in addictions services, suggested that a view that there are insufficient community- both mental health and addictions services based programmes to meet demand. Many of are under pressure because of young people in the focus group participants would like to see their 20s with drinking problems.167 more places in residential programmes.164 Programme location Although there was support for more Among focus group participants, there was a residential programmes, some participants widely-held view that even large metropolitan have found that day programmes suit them centres are not well served for programmes, better than residential programmes as they while many small towns and rural areas have can stay with their family. They have also no services at all. A number of focus group responded well to the challenge of “dealing participants had travelled from provincial or with the real world” while receiving treatment. rural areas to take part in a Salvation Army There was also a call for flexibility and “second Bridge Programme. chances” so that people who “fall off the wagon” can re-enter programmes. Participants said it is common for people to need more than focus group l one programme of treatment.165 Country people, what do they have? Needs of different groups As well as commenting on the types of programmes needed, the support and Local programmes are seen to be more treatment needs of different groups were accessible and personal. Several participants identified. These included programmes would like to see more community-based tailored for young people, women-only treatment options so that people do not have programmes, and programmes for women to travel long distances for treatment. where they can have their children with them. Programme duration In the course of discussion, participants Several focus groups commented that suggested some trends that may see programmes must be of sufficient duration current services under even more pressure. and intensity. They said that one day a week These include more young people in their courses, or once a week counselling, are not 20s developing alcohol dependency and enough to challenge people, or to give them increasing alcohol problems among older the tools they need for recovery. Some talked people, especially older women coping about short programmes that were limited

UNDER THE INFLUENCE | 57 in what they provided. These were regarded 6.2 PRE-TREATMENT SUPPORT as dangerous as people who go through In all the areas where focus groups were held, such programmes receive some tools and most participants were strongly of the view then “think they are cured”. Others said that that no, or very little, pre-treatment support is short, less intensive options do not provide a available. Few participants commented that supportive and challenging community that they had received any pre-treatment support. gets them out of their daily routine and away Those who did identify pre-treatment support from harmful influences. Many participants received, said it had been counselling, or a said that longer programmes are needed. In support person dropping in to visit them at their view, an eight week residential course is home. too short for people who have been battling an A dearth of pre-treatment support becomes addiction for 30 years. a particular problem if there are long waits to enter treatment. In all areas participants talked about their own and others’ experiences of focus group j long waits extending to weeks and months One day a week courses aren’t to get into a programme after detox. They enough, you’ve got to go every day. It needs to be intensive, like residential reported waiting times to enter a programme or all week. ranging from 10 days to seven months, with focus group p most waiting two to three months. Several participants reiterated that when people make Programmes are great, but after 12 weeks you only start to scratch the contact with services they are in crisis and surface. need help immediately. They have observed focus group m that the consequences of long waiting times include individuals resuming drinking, going to Eight weeks is nowhere near long enough, the fog is just starting to lift. jail, or death. You’re dealing with a lifetime issue Many focus group participants considered and you can’t deal with that in eight that the ideal is to go straight from detox into weeks. rehab. If this cannot be done, then a proper Some programmes are very limited support programme is needed. One person in in what they provide, they only partly the pre-treatment stage said it is very difficult help and are inadequate. They’re condensed, rushed, chuck you some to fill in the day and sleeping is difficult. tools and you are left to do the rest. Participants suggested that support workers People think that once they’ve done and programmes should be available to help the residential they are cured. individuals stay off alcohol until they enter a programme.

58 | UNDER THE INFLUENCE 6.3 POST TREATMENT SUPPORT focus group h Participants called for more post-treatment [four months wait to get into a support to be available, as this is the time programme] I nearly gave up after when people are at high risk and vulnerable. three months … received counselling but even talking about it was a trigger, Many participants would like to see more long went out and had a drink afterwards. term support available. As one person said, focus group n “Recovery doesn’t finish when you walk out the door; it only starts.” I was waiting for a year to get into a CADS programme (Focus Group N). Some participants noted various forms of post- focus group l programme support such as counselling and support groups are available, but they are not You’re in crisis, then you have to wait. There’s three options, death, jail, or offered in all areas. Several participants who hang in there and wait. It’s Russian were working commented that most support Roulette. is available only during working hours, which focus group g makes it difficult for employed people to Go to detox and then you have to wait access those programmes. weeks, you just fall off the wagon Across the focus groups, there was a again. Community support is needed if you’ve got to wait. Someone to visit, perception that there are few supported make sure you are eating … keep an housing options for those leaving treatment, eye on you. and the options available cannot meet I did everything myself, finding out demand.168 Several participants said that and doing the phoning up myself. finding suitable housing is a huge problem for It took me two years to get it all most coming out of rehab, as they need a place together. I was in detox several times. where they are safe and can recover. Often they have lost their former accommodation and do not have a job. Some have no family or suitable support. Some participants considered that those most at risk of not finding suitable housing were young people and single people. Several participants were of the view that the relapse rate is very high and a big factor is the dearth of after care and suitable housing.

UNDER THE INFLUENCE | 59 Allowing people to see their families, that’s a good thing and a change from 10 years focus group p ago. Coming out, you don’t know how to access support or you go to a town Your whanau’s going to be your support where there is nothing available. when you get out. focus group l They’re affected too; our drinking has People literally come out of residential scarred our families. programmes with no place to sleep that night. focus group h focus group l [After programme support] it’s a major There’s very little support for families, thing, you fall over, it’s the most and what there is doesn’t address vulnerable time. what people have been through in A lot of people just got nowhere to go. programmes. Some need somewhere to live for six months. Rushing around trying to find a house Suggestions for involving families included: brings on stress. a family information night; weekend barbeques; involvement in sessions with 6.4 INVOLVEMENT OF FAMILIES IN the client at the end of the programme; and PROGRAMMES a pre-exit meeting with the family. In one area where The Salvation Army provides Several participants commented that they visitor accommodation for some families of would like to see opportunities for families programme participants from out of town, to be involved in some way in programmes. this was noted by one participant and much This would help families understand what the appreciated. programmes are about, and the treatment their family member needs, as well as 6.5 PROGRAMMES IN THE JUSTICE getting support themselves. One focus group SYSTEM discussed the supports needed for families A number of focus group participants had been and whanau: ordered by the court to attend a treatment focus group o programme. While there was debate about Families need support too, a support court orders, participants generally supported worker for them … and making families court direction to programmes. There was aware of how hard it really is [to go through also considerable support for alcohol and a programme].

60 | UNDER THE INFLUENCE drug assessment as a routine part of the court turned around their thinking. It was widely process, so that people get an opportunity to agreed among participants that entering a be considered for a programme early on. The rehabilitation programme is not a soft option following comments from two focus groups or an easy way to avoid a sentence. The point show different aspects of the discussion: was made that “they [court ordered people] focus group e have a right to be here too”. We need more counselling in prisons. In several focus groups, there was an Courts are referring a lot more people to unprompted call for more assessment and rehab, it’s increasing the demand. treatment programmes in prison. Several participants expressed a view that time spent But it’s easier than going to prison. in remand could be used to offer people Yeah, they are disrupting the courses. alcohol and drug assessment, counselling and focus group f education. One focus group identified a lack It’s not just about getting out of jail, it of follow up support for those who have been takes balls, it’s a lifestyle change. through prison-based treatment programmes.

There should be assessment in the court 6.6 INTERFACE BETWEEN MENTAL process. HEALTH AND ADDICTIONS The initial attitude is, avoid jail, but it [the PROGRAMMES programme] changes your whole way of Four focus groups commented on the need for thinking. better integration and cooperation between In several focus groups, one participant mental health and addictions services. They questioned whether some people would like to see people who need both mental attend programmes as a way of avoiding health and addictions treatment able to access imprisonment. This generated considerable both types of services from either sector. A few discussion. Some participants observed participants referred to their own experiences that court direction puts more pressure on of needing help with mental health issues as the few programme places that are available well as treatment for alcohol dependence. “at the expense of someone else”, as often Four participants who had graduated from court orders are given preference. There was a programme and were now assisting with a feeling of: Why should those who commit a running a programme talked about the crime get preference when those who haven’t need for coordination of mental health and committed a crime need help too? addictions services. Some participants, both court ordered and voluntary, said that initially they had come reluctantly to a programme but it had

UNDER THE INFLUENCE | 61 Three focus groups argued that there has One New Zealand estimate is that 40 percent of been a progressive loss of expertise from the those experiencing a substance use disorder have addictions sector. They called for an increase also experienced an anxiety disorder, and 29 percent have experienced a mood disorder.170 in the numbers working in addictions, as Other research on a representative sample from well as specialised training for workers Community Alcohol and Drug Service found who can cover both addictions and mental 74 percent had a current psychiatric disorder health issues. Others considered that there diagnosis.171 Furthermore, up to 60 percent of all are very few counsellors who are competent mental health service users experience drug and 172 in both addictions and in sexual abuse alcohol problems. counselling. Several participants perceived 6.7 INFORMATION ABOUT HELP a need for better access to counselling for There was strong support across the focus people undertaking treatment for alcohol groups for widespread dissemination of dependence.169 information about where people can seek Those who experience addictions problems are help. Most participants agreed that getting also likely to experience mental health problems. information about treatment is very difficult. Many participants said that they did not know about the help that was available before they focus group p were referred (or were court ordered) to a There is not enough information about Bridge programme. Several people said that counselling and where you can get there is a general perception that only fee help for the underlying emotional and mental health problems that drive paying programmes are available, which is a people to drink. deterrent to seeking help. There’s too much throwing pills at One focus group considered that the dearth you. of information on help shows that alcohol Deal with root causes. Alcohol is the problems are not seen as worthy of attention in symptom not the cause. our society. One person in the group summed focus group r it up: “There is more information on how Depression and emotional issues are to get help for erectile dysfunction than for triggers for drinking … it’s hard to find alcoholism.” the right support, and to know it’s OK to ask for help. Several participants suggested that information about help needs to be more Subsuming A&D under mental health was a retrograde step. There was loss visible and widely available. They believe that of funding, closing of places and loss lack of easily available information on help of expertise. deters people from seeking help. Participants in some areas said that the existing alcohol

62 | UNDER THE INFLUENCE and drug helpline is poorly advertised. Participants would like to see 0800 help numbers prominently displayed at point of sale. Others suggested that information about help should be available in shopping centres, on billboards, in doctors’ waiting rooms and in newspapers. Some thought that The Salvation Army should raise the profile of the Bridge programmes so they are better known in the community. The 2007/08 New Zealand alcohol and drug survey found that, among those people who wanted help to reduce their level of alcohol use but had not received help, the second most common reason was ‘not knowing where to go for help’. Over 28 percent said they did not know where to go for help; this equates to around 18,000 of the total population aged 16-64 years.173

focus group t I thought treatment programmes were just on TV, a story line. focus group j I only found out about this [programme] when I was in prison. Heaps of people don’t know they can get help. focus group f I thought rehab was just for rich folk. I thought that too. I’m really happy my lawyer recommended I come here [to the programme]. I couldn’t see any way out, I didn’t know what to do. Put the help number on the bottle.

UNDER THE INFLUENCE | 63 64 | UNDER THE INFLUENCE 7. THE MOST EFFECTIVE RESPONSES

The large majority of focus group participants agreed that changes in community norms and were of the view that changes are needed to practices around drinking are desperately the way our society deals with alcohol. Only needed. a very small number of participants believed The two main policy responses that the focus that nothing at all could be done to change groups considered to be potentially the most New Zealanders’ drinking behaviour. Most effective in changing New Zealanders’ drinking participants considered that there are some practices and addressing alcohol-related harm responses that will work. However, they are: public education campaigns, particularly emphasised that there is no one, simple targeted to children and young people, and solution. treatment. Instead, the focus groups considered that The large majority of focus group participants multiple responses are needed that will engage considered public education to raise different people. In particular, they made clear awareness about alcohol-related harm is distinctions between moderate drinkers and necessary. However, there was also a widely- those for whom alcohol is a big problem in held view that the attitudes of adults and their lives. They also distinguished between parents would be the hardest to change. young drinkers and those who have been Some considered it is too late to change adult established in their drinking habits for years. behaviour because they are set in their ways. In their view, those who are alcohol dependent There was a certain pessimism that parents are will not significantly alter their behaviour in not interested in or not able to stop drinking, response to regulations, penalties, reducing and are not interested in teaching their the number of outlets, pricing signals, social children about the dangers of alcohol. marketing, or many other interventions Most of those who were sceptical about the because of their uncontrollable urge to drink. effectiveness of social marketing campaigns They will drink regardless and accommodate for adults considered that they have a very changes; as one person commented, “You limited effect on heavy drinkers and no effect make sure you organise everything around at all on those who are alcohol dependent. your drinking.” Another said, “You’d walk They considered that it is more effective to across glass to get alcohol.” focus on educating children, and that schools Most focus group participants had thought and sports/recreation organisations catering carefully about the most effective policy to children and young people need to be responses. There was a strong view that New targeted. Zealand’s drinking culture will be very hard Those who commented on the difficulties of to change because it is so embedded in our changing public norms through education social fabric. However, despite that, most also nevertheless pointed out that there has

UNDER THE INFLUENCE | 65 been a huge shift in attitudes and behaviour The widest divergence of opinion in the focus around smoking over one generation, and groups was around changing the purchase age. similar results could be achieved with drinking While there was strong support, there was also behaviour. They thought that the answer was a view that raising the age would have little or for successive governments to make a “real no effect on drinking behaviour among youth. commitment” to address the issue. There was more support for raising prices or While there was some debate about the introducing a minimum price as a means of effectiveness of campaigns to change adult reducing consumption, particularly amongst drinking behaviour, there was almost universal young people. However, some saw negative support for public education being used to: consequences for families if income was used for alcohol instead of essentials. • Reduce stigma through raising public understanding about alcohol dependency. • Encourage people to seek help for their alcohol problems. Alongside the call for public education was a clear message that the only response that will affect those who are alcohol dependent is treatment. Other interventions will not deter them from drinking. Consequently, there was strong support across all focus groups for increasing the range and opportunities for assessment, counselling, treatment programmes, pre- and post- treatment support, and also support for families. There was some support for other changes. Most focus groups considered that the number of alcohol outlets should be reduced and that controls on the availability of RTDs should be introduced. There was also some support for reducing hours of sale. There was general agreement that legislation and enforcement need to be strengthened around licensing and drink driving. There was also general support for controlling liquor advertising.

66 | UNDER THE INFLUENCE UNDER THE INFLUENCE | 67 68 | UNDER THE INFLUENCE 8. SUGGESTIONS FOR CHANGE

This concluding section reflects on the options growing evidence that alcohol advertising that focus group participants suggested for does influence drinking behaviour, changing the way New Zealand manages including the amount of alcohol consumed, access to alcohol and addresses alcohol- and the age at which young people start related harm. It also puts those suggestions in drinking. the context of the findings from the literature • There was strong support for increasing review on the environmental influences on controls on or banning of RTDs. A growing drinking behaviours. body of research argues that RTDs are Generally, the focus groups were of the view a major contributor to youth initiation that New Zealand’s current liquor laws and into drinking, increases in amount and policy framework have enabled the pendulum frequency of youth drinking, youth binge to ‘swing too far’ towards easy access to drinking and higher levels of youth alcohol. They would like to see more controls intoxication. introduced to better manage the availability • There was strong support for limiting the of alcohol in our society, and more responses availability of alcohol, including reduction that effectively deal with alcohol-related harm. in the number of outlets and controls on Many suggestions from the focus group the hours of sale. Research shows that discussions have strong resonance with consumption of alcohol increases when the findings of studies concerned with the number and density of liquor outlets the environmental influences on drinking increase; that a higher density of licensed behaviours. For example, in the focus groups: premises is associated with alcohol-related • There was support for raising prices harm; and that longer trading hours are or introducing a minimum price as associated with higher levels of drinking, a means of reducing consumption, intoxication and alcohol-related harm. particularly amongst young people. The • There was general agreement that literature shows that higher prices lower legislation and enforcement need to be consumption and price reductions increase strengthened, especially around licensing consumption. Price increases have also and drink driving. The literature shows been found to reduce alcohol-related harm. that enforcement is a critical influence Young people’s drinking behaviour appears on drinking behaviours. Inadequate to be especially influenced by price. enforcement of purchase age laws has been • There was support for controlling liquor found to contribute to early exposure of advertising. While evidence about the link minors to alcohol and underage drinking, between exposure to alcohol advertising as well as increases in intoxicated drinkers. and alcohol consumption is mixed, there is Effective enforcement has been found

UNDER THE INFLUENCE | 69 to reduce risky drinking behaviours and • Treatment is a crucial part of the mix of alcohol-related harm. responses if the drinking behaviours of • The widest divergence of opinion in the both current and future generations are focus groups was around changing the to be changed. Many responses do not purchase age, although there was some work for those who are alcohol dependent, support for raising it. Research shows because of the compulsion for alcohol, that purchase age does influence young increased tolerance and difficulty in people’s drinking patterns, and there is a controlling drinking. Most who are alcohol “trickle down” effect with those close to the dependent cannot easily quit drinking legal purchase age also gaining access to by themselves. They are likely to be alcohol. relatively unaffected by price rises, tougher penalties, social marketing campaigns The main policy implications from the focus or by a reduction in the number of liquor group findings are: outlets or trading hours. The most effective • An effective and strategic response to policy responses for them are the provision New Zealand’s drinking problems must be of support and treatment. This report multi-faceted, with consideration given to confirms issues that have been raised by tailoring responses to the needs of different other research concerning the need to drinking behaviours, different groups and increase the range of addictions services to local communities. Those engaging to meet growing and diverse needs, in risky drinking who are not alcohol address barriers to services, and to support dependent need different approaches than the ongoing development of a skilled those who are alcohol dependent. Women addictions treatment workforce.174 and men need different approaches, • The range of responses cannot be confined while responses also need to be tailored to central government agencies. Better use to youth, older people, Maori, Pacific could be made of existing services and and those from cultural backgrounds resources by providers working together where alcohol is not commonly used. New better. Focus groups commented that often migrants from such backgrounds are often addictions services are piecemeal and unsure how to cope with the New Zealand do not coordinate well together, possibly drinking culture. Those in the focus groups because of competition for funding. reiterated what New Zealand research has Furthermore, inter-sectoral responses are shown; that low-income neighbourhoods likely to be most effective, with central experience greater exposure to alcohol. government and local government working This situation suggests that responses also together. For example, local government need to be developed for local conditions. has a key role in managing the availability of alcohol and keeping public areas safe.

70 | UNDER THE INFLUENCE • The co-existence of mental health issues »» increasing sponsorship of alcohol-free and alcohol dependence is common. events to reduce reliance on alcohol Programmes need to address both issues sponsorship or revenue from sale of to assist people’s recovery. alcohol

• Participants pointed to a widespread »» information and awareness campaigns lack of public awareness about, and about responsible alcohol use and stigma attached to, alcohol dependence. alcohol-related harm for children and Consideration should be given to young people

developing a campaign aimed at raising »» support, skills development and awareness of alcohol dependence, treatment aimed at managing youth showing that recovery is achievable and problem drinking behaviour providing information about the availability • Several participants made suggestions of treatment and support for those with for the establishment of voluntary codes alcohol dependence and their families. of conduct around the provision and • Regardless of the legal purchase age, there promotion of alcohol. Such voluntary will continue to be underage drinkers. initiatives may engage the community Specific policy responses need to be more widely than a narrow focus on law targeted to underage drinkers. Those enforcement. Participants raised the responses identified in the focus groups following areas for consideration: include: • guides for employers concerning the use of »» control of alcohol promotions and alcohol at work and assistance to staff with advertising likely to be influential with alcohol problems or attractive to minors • guides for licensed premises and liquor »» more effective enforcement of liquor outlets on legal requirements and sale regulations responsible host ideas »» mandatory training for liquor sellers • guides for supermarkets on the responsible on legal requirements and responsible display and promotion of alcohol practice • guides for sports clubs in the provision »» targeting adult buyers of alcohol for of alcohol, managing drinking behaviour, minors to increase responsible practice managing underage drinking and host »» restricting or banning alcohol use at responsibility outdoor venues and community events • voluntary codes of practice for the that involve young people manufacture and responsible promotion of RTDs

UNDER THE INFLUENCE | 71 POLICY RECOMMENDATIONS

Based on the outcomes and conclusions from public understanding of alcohol dependency this research the following recommendations (which deters people from admitting that are offered as suggestions for policy or they have a problem), and many people do programme responses. not know where to go for help, either for themselves or family members. 1. EXCISE TAX There is New Zealand evidence that a common Increase excise tax and use the tax to secure reason for not seeking help is that people do funding for an increased number and range not know where to go to get help (2007/08 NZ of treatment options and alcohol education alcohol and drug survey). programmes. 3. TREATMENT AND SUPPORT Rationale • Increase the range of alcohol assessment, The focus groups supported an increase in treatment and support services to meet excise tax, but only if taxes were directly growing and diverse needs. used to improve alcohol treatment and public education on alcohol. • Improve accessibility to alcohol assessment, treatment and support Research shows that liquor tax increases lower services, including increasing the provision alcohol consumption (because tax increases of free services. lead to a rise in the price of alcohol) while lowering of taxes increase consumption. • Improve access to alcohol assessment, Research also shows that young people’s treatment and support services for those drinking behaviour appears to be especially in the justice system and mental health influenced by price. services.

2. PUBLIC EDUCATION CAMPAIGNS • Increase resources to support the ongoing development of a skilled addictions Run public education campaigns to: workforce. • raise awareness and reduce stigma about • Improve services coordination, both within alcohol dependence the addictions sector and between the • encourage people to seek help for their addictions and other sectors. alcohol problems • Increase support available to families of Rationale those who are alcohol dependent.

The focus groups were supportive of Rationale campaigns to reduce stigma and to provide All these actions were supported by the focus information about where people could go to groups, which identified gaps in current get help. They felt that currently, there is little services. Focus groups also said that there

72 | UNDER THE INFLUENCE is a general perception that only fee paying programmes are available, which is a deterrent to seeking help. Evidence from research shows that those who are alcohol dependent are likely to be relatively unaffected by price rises, tougher penalties, social marketing campaigns or by a reduction in the number of liquor outlets or trading hours. The most effective policy responses for them are the provision of support and treatment

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UNDER THE INFLUENCE | 79 ENDNOTES

1 11 See Appendix 1 for a description of The Salvation Army Bridge p.5 National Addiction Centre and Matua Raki, Orientation to Programme the Addiction Treatment Field Aotearoa New Zealand. National 2 The comment on ethnicity and cultural background is largely Addiction Centre, University of Otago, Christchurch and Matua based on observation and is indicative only. Participants were Raki, Wellington. 12 not asked about their ethnic background, although some p.4 World Health Organisation 2007 WHO Expert Committee commented on their own cultural or ethnic background in the on Problems Related to Alcohol Consumption Second course of the focus group discussions. Report. WHO Technical Series No. 944 Geneva, World Health 3 Almost all who completed the survey indicated they were Organisation. 13 not drinking at present, and reported on their past drinking p.16, 28 Ministry of Health 2009 Alcohol Use in New Zealand: behaviour. Key results of the 2007/08 New Zealand Alcohol and Drug Use 4 ALAC defines binge drinking for those aged 18 and over as Survey. Wellington, Ministry of Health www.moh.govt.nz 14 consuming seven or more standard drinks on one occasion. National Institute of Health 2009 International Comparisons of See p.20 Research New Zealand 2009 ALAC Alcohol Monitor Adult Alcohol Consumption. www.enotalone.com 15 – Adults and Youth 2007–08 Drinking Behaviours Report. Phillips, J. 1987 A Man’s Country? The Image of the Pakeha Prepared for ALAC. Male – A History. Auckland, Penguin Books. 5 16 p.55 Brown, M., Wells, J., Scott, K. (eds) 2006 Te Rau p.16, 23 Ministry of Health 2009 Alcohol Use in New Zealand: Hinengaro The New Zealand Mental Health. Wellington, Key results of the 2007/08 New Zealand Alcohol and Drug Use Ministry of Health. Survey. Wellington, Ministry of Health www.moh.govt.nz 6 17 Babor, T., Caetano, R., Casswell, S., Edwards, S., Giesbrecht, p.109, University of Auckland 2008 Youth ’07: The Health N., Graham, K., Grube, J., Gruenewald, P., Hill, L., Holder, H., and Wellbeing of Secondary School Students in New Zealand Homel, R., Osterberg, E., Rehm, J., Room, R., Rossow, R. 2003 Technical Report. Auckland, Faculty of Medical and Health Alcohol: No Ordinary Commodity Research and Public Policy. Sciences, University of Auckland. Oxford University Press. 18 Adolescent Health Research Group 2004 Alcohol and New 7 p.6 National Addiction Centre and Matua Raki, Orientation to Zealand Youth: a Snapshot of Young People’s Experiences with the Addiction Treatment Field Aotearoa New Zealand. National Alcohol. University of Auckland. Addiction Centre, University of Otago, Christchurch and Matua 19 Alcohol Advisory Council of New Zealand 2006 The Way We Raki, Wellington. Drink 2005 – Executive Summary. ALAC Occasional Publication 8 Safe limits are generally defined as: for men, no more than 21 No. 27 Wellington, Alcohol Advisory Council of New Zealand. alcohol units per week and no more than 4 alcohol units per 20 p.34, 39 Ministry of Health 2009 Alcohol Use in New Zealand: day. For women, safe limits are no more than 14 alcohol units Key results of the 2007/08 New Zealand Alcohol and Drug Use per week and no more than 3 alcohol units per day. Pregnant Survey. Wellington, Ministry of Health www.moh.govt.nz women should drink no alcohol. See http://www.drinking- 21 problem.sab.org.nz/ ALAC has a different definition of binge drinking for young 9 people (under 18 years), compared to older age groups. p.4 National Addiction Centre and Matua Raki, Orientation to ALAC defines binge drinking for young people as five or more the Addiction Treatment Field Aotearoa New Zealand. National standard drinks on the last occasion they drank alcohol, or Addiction Centre, University of Otago, Christchurch and Matua on any occasion in the last two weeks. For those aged 18 Raki, Wellington. and over, the number of drinks defined as binge drinking is 10 p.5 National Addiction Centre and Matua Raki, Orientation to seven standard drinks. See p.20 Research New Zealand 2009 the Addiction Treatment Field Aotearoa New Zealand. National ALAC Alcohol Monitor – Adults and Youth 2007–08 Drinking Addiction Centre, University of Otago, Christchurch and Matua Behaviours Report. Prepared for ALAC. Raki, Wellington. 22 p.20, 25 Research New Zealand 2009 ALAC Alcohol Monitor – Adults and Youth 2007–08 Drinking Behaviours Report. Prepared for ALAC.

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84 | UNDER THE INFLUENCE 93 105 Anon, 2004/2005 “Environmental and Contextual p.130-132 Casswell, S., and Maxwell, A. 2005 “What Considerations” Alcohol Research and Health, 28(3):155–162. Works to reduce Alcohol-Related Harm and Why Aren’t the 94 p.132 Gallet, C. 2007 “The demand for alcohol: a meta- Policies more Popular?” Social Policy Journal of New Zealand, analysis of elasticities” The Australian Journal of Agricultural 25:118–141. 106 and Resource Economics, 51:121–135. p.135 Copeland, J., Gates, P., Stevenson, D. and Dillon, P. 95 p.272 Anderson, P. and Baumberg, B. 2006 Alcohol in Europe. 2006 Young People and Alcohol: Taste Perceptions, Attitudes London: Institute of Alcohol Studies. and Experiences. NDARC Technical Report No. 241 National 96 Drug and Alcohol Research Centre, University of New South p.133 Roche, A., Bywood, P., Borlagden, J., Lunnay, B., Wales, Sydney. Freeman, T., Lawton, L., Tovell. A and Nicholas, R. 2007 107 Young People and Alcohol The Role of Cultural Influences. p.271 Anderson, P. and Baumberg, B. 2006 Alcohol in National Centre for Education and Training on Addiction, Europe. London: Institute of Alcohol Studies. 108 Flinders University of South Australia, Adelaide. p.32 World Health Organisation 2004 Global Status Report 97 Settertobulte, W., Jensen, B., and Hurrelmann, K. 2001 on Alcohol 2004. Geneva Department of Mental Health and Drinking Among Young Europeans. Copenhagen, WHO Substance Abuse, World Health Organisation. 109 Regional Office for Europe; Roche, A., Bywood, P., Borlagden, p.92 Cagney, P. and Palmer, S. 2007 The Sale and Supply of J., Lunnay, B., Freeman, T., Lawton, L., Tovell. A and Nicholas, Alcohol to Under 18 Year Olds in New Zealand: a Systematic R. 2007 Young People and Alcohol The Role of Cultural Overview of International and New Zealand Literature (Final Influences. National Centre for Education and Training on Report). Report prepared for Alcohol Advisory Council of New Addiction, Flinders University of South Australia, Adelaide. Zealand by Research New Zealand, Wellington. 98 110 Casswell, S., and Maxwell, A. 2005 “Regulation of Alcohol Copeland, J., Gates, P., Stevenson, D. and Dillon, P. 2006 Marketing: A Global View” Journal of Public Health Policy, Young People and Alcohol: Taste Perceptions, Attitudes and 26:343–358. Experiences. NDARC Technical Report No. 241 National Drug 99 Jernigan, D. 2008 “Intoxicating Brands. Alcohol Advertising and Alcohol Research Centre, University of New South Wales, and Youth” Multinational Monitor July/Aug 2008:23–27 Sydney. 100 111 Jernigan, D., Ostroff, J. and Ross, C. 2005 “Alcohol p.132 Casswell, S., and Maxwell, A. 2005 “What Works to Advertising and Youth: A Measured Approach” Journal of reduce Alcohol-Related Harm and Why Aren’t the Policies more Public Health Policy, 26:132-325. Popular?” Social Policy Journal of New Zealand, 25:118–141; 101 Anon 2009 Ready-to-drink Beverages – Policy Paper. Chen, M-J., Grube, J., Bersamin, M., Waiters, E. and Keefe, www.ndp.govt.nz D. 2005 “Alcohol Advertising: What Makes it Attractive to 112 Youth?” Journal of Health Communication, 10:553–565. Jernigan, D. 2008 “Intoxicating Brands. Alcohol Advertising 102 and Youth” Multinational Monitor, July/Aug 2008:23–27. Collins, R., Ellickson, P., McCaffrey, D., Hambarsoomians, K. 113 2007 “Early Adolescent Exposure to Alcohol Advertising and Copeland, J., Gates, P., Stevenson, D. and Dillon, P. 2006 its Relationship to Underage Drinking” Journal of Adolescent Young People and Alcohol: Taste Perceptions, Attitudes and Health, 40(6):527–34. Experiences. NDARC Technical Report No. 241 National Drug 103 and Alcohol Research Centre, University of New South Wales, Ellickson, P., Collins, R., Hambarsoomians, K., McCaffrey, Sydney. D. 2005 “Does Alcohol Advertising Promote Adolescent 114 Drinking? Results from a Longitudinal Assessment” Addiction, p.112, University of Auckland 2008 Youth ’07: The Health 100(2):235–246. and Wellbeing of Secondary School Students in New Zealand 104 Technical Report. Auckland, Faculty of Medical and Health p.29–30 World Health Organisation 2007 WHO Expert Sciences, University of Auckland.; Research New Zealand Committee on Problems Related to Alcohol Consumption 2009 ALAC Alcohol Monitor – Adults and Youth 2007–08 Second Report. WHO Technical Series No. 944 Geneva, World Drinking Behaviours Report. Prepared for ALAC. Health Organisation.

UNDER THE INFLUENCE | 85 115 125 p.155 Ministry of Health 2009 Alcohol Use in New Zealand: p.232 Wagenaar, A., Toomey, T., and Lenk, K. 2004/2005 Key results of the 2007/08 New Zealand Alcohol and Drug Use “Environmental Influences on Young Adult Drinking”Alcohol Survey. Wellington, Ministry of Health www.moh.govt.nz Research and Health, 28(4):230-235; Roche, A., Bywood, 116 Wagenaar, A., Toomey, T., and Lenk, K. 2004/2005 P., Borlagden, J., Lunnay, B., Freeman, T., Lawton, L., Tovell. “Environmental Influences on Young Adult Drinking”Alcohol A and Nicholas, R. 2007 Young People and Alcohol The Role Research and Health, 28(4):230–235. of Cultural Influences. National Centre for Education and 117 Training on Addiction, Flinders University of South Australia, p.160 Roche, A., Bywood, P., Borlagden, J., Lunnay, B., Adelaide; Huckle, T., Huakau, J., Sweetsur, P., Huisman, O. Freeman, T., Lawton, L., Tovell. A and Nicholas, R. 2007 and Casswell, S. 2008 “Density of alcohol outlets and teenage Young People and Alcohol The Role of Cultural Influences. drinking: living in an alcogenic environment is associated National Centre for Education and Training on Addiction, with higher consumption in a metropolitan setting” Addiction, Flinders University of South Australia, Adelaide. 103:1614–1621; Donnelly, N., Poynton, S., Weatherburn, D., 118 p.160 Anon, 2004/2005 “Environmental and Contextual Bamford, E and Nottage, J. 2006 “Liquor outlet concentrations Considerations” Alcohol Research and Health, 28(3):155–162. and alcohol-related neighbourhood problems” Alcohol Studies 119 Kypri, K., Langley, J. Whigham, P., and Wiggers, J. 2005 Bulletin, No. 8; Popova, S., Giesbrecht, N., Bekmuradov, Geospatial Aspects of Alcohol-related Harm in New Zealand. D. and Patra, J. 2009 “Hours and Days of Sale and Density Paper presented at SIRC 2005 – the 17th Annual Colloquium of Alcohol Outlets: Impacts on Alcohol Consumption and of the Spatial Information Research Centre, University of Damage: A Systematic Review.” Alcohol and Alcoholism, Otago, Dunedin, New Zealand. 44(5):500–516; Rabinovich, L., Tiessen, J., Janta, B., Conklin, 120 Hay, G., Whigham, P., Kypri, K. and Langley, J. 2009 A., Krapels, J., van Stolk, C., 2008 Reducing Alcohol Harm “Neighbourhood deprivation and access to alcohol outlets: a International Benchmark. RAND Corporation, Santa Monica. 126 national study”. Health Place, 15(4):1086–93. p.124 Casswell, S., and Maxwell, A. 2005 “What Works to 121 p. 92, Nelson, J. 2008 “How Similar are Youth and Adult reduce Alcohol-Related Harm and Why Aren’t the Policies more Alcohol Behaviors? Panel Results for Excise Taxes and Outlet Popular?” Social Policy Journal of New Zealand, 25:118–141. 127 Density” Atlantic Economic Journal, 36:89–104. Casswell, S., and Maxwell, A. 2005 “What Works to reduce 122 World Health Organisation 2007 WHO Expert Committee Alcohol-Related Harm and Why Aren’t the Policies more on Problems Related to Alcohol Consumption Second Popular?” Social Policy Journal of New Zealand, 25:118–141. 128 Report. WHO Technical Series No. 944 Geneva, World Health Nelson, J. 2008 “How Similar are Youth and Adult Alcohol Organisation. Behaviors? Panel Results for Excise Taxes and Outlet Density” 123 p.169 Roche, A., Bywood, P., Borlagden, J., Lunnay, B., Atlantic Economic Journal, 36:89–104. 129 Freeman, T., Lawton, L., Tovell. A and Nicholas, R. 2007 Casswell, S., and Maxwell, A. 2005 “What Works to reduce Young People and Alcohol The Role of Cultural Influences. Alcohol-Related Harm and Why Aren’t the Policies more National Centre for Education and Training on Addiction, Popular?” Social Policy Journal of New Zealand, 25:118–14; Flinders University of South Australia, Adelaide. Popova, S., Giesbrecht, N., Bekmuradov, D. and Patra, J. 124 Huckle, T., Huakau, J., Sweetsur, P., Huisman, O. and 2009 “Hours and Days of Sale and Density of Alcohol Outlets: Casswell, S. 2008 “Density of alcohol outlets and teenage Impacts on Alcohol Consumption and Damage: A Systematic drinking: living in an alcogenic environment is associated Review.” Alcohol and Alcoholism, 44(5):500–516. 130 with higher consumption in a metropolitan setting” Addiction, Stockwell, T. and Chikritzhs 2009 “Do relaxed trading hours 103:1614–1621. This research defined density by the number for bars and clubs mean more relaxed drinking? A review of of outlets reached within 10 minutes’ drive. international research on the impacts of changes to permitted hours of drinking” Crime Prevention and Community Safety, 11(3):153–170.

86 | UNDER THE INFLUENCE 131 140 Popova, S., Giesbrecht, N., Bekmuradov, D. and Patra, J. Wagenaar, A., Toomey, T., and Lenk, K. 2004/2005 2009 “Hours and Days of Sale and Density of Alcohol Outlets: “Environmental Influences on Young Adult Drinking”Alcohol Impacts on Alcohol Consumption and Damage: A Systematic Research and Health, 28(4):230-235; Kypri, K., Voas, R., Review.” Alcohol and Alcoholism, 44(5):500–516. Langley, J., Stephenson, S., Begg, D., Tippetts, S., Davie, G. 132 Casswell, S., and Maxwell, A. 2005 “What Works to reduce 2006 “Minimum Purchasing Age for Alcohol and Traffic Crash Alcohol-Related Harm and Why Aren’t the Policies more Injuries Among 15- to 19-Year-Olds in New Zealand” American Popular?” Social Policy Journal of New Zealand, 25:118-141; Journal of Public Health, 96(1):126–131. 141 World Health Organisation 2007 WHO Expert Committee on Toumbourou, J., Godfrey, C., Rowland, B. and Duff, C. 2004 Problems Related to Alcohol Consumption Second Report. Law, Regulation, Policing and Enforcement in the Prevention of WHO Technical Series No. 944 Geneva, World Health Alcohol-related Harm. Prevention research evaluation report Organisation. No. 9 Drug Info Clearinghouse, Australian Drug Foundation, 133 Nelson, J. 2008 “How Similar are Youth and Adult Alcohol Melbourne. 142 Behaviors? Panel Results for Excise Taxes and Outlet Density” Kypri, K., Voas, R., Langley, J., Stephenson, S., Begg, D., Atlantic Economic Journal, 36:89-104. Tippetts, S., Davie, G. 2006 “Minimum Purchasing Age for 134 p.11 Adolescent Health Research Group 2004 Alcohol and Alcohol and Traffic Crash Injuries Among 15- to 19-Year-Olds New Zealand Youth: a Snapshot of Young People’s Experiences in New Zealand” American Journal of Public Health with Alcohol. University of Auckland. 96(1):126–131. 135 143 Casswell, S., and Maxwell, A. 2005 “What Works to reduce Huckle, T., Pledger, M., and Casswell, S. 2006 “Trends in Alcohol-Related Harm and Why Aren’t the Policies more alcohol-related harms and offences in a liberalised alcohol Popular?” Social Policy Journal of New Zealand, 25:118–141. environment”. Addiction, 101(2), 232–240. 136 144 p.113-114 University of Auckland 2008 Youth ’07: The Toumbourou, J., Godfrey, C., Rowland, B. and Duff, C. 2004 Health and Wellbeing of Secondary School Students in New Law, Regulation, Policing and Enforcement in the Prevention of Zealand Technical Report. Auckland, Faculty of Medical and Alcohol-related Harm. Prevention research evaluation report Health Sciences, University of Auckland. No. 9 Drug Info Clearinghouse, Australian Drug Foundation, 137 Melbourne. World Health Organisation 2007 WHO Expert Committee 145 on Problems Related to Alcohol Consumption Second p.177 Roche, A., Bywood, P., Borlagden, J., Lunnay, B., Report. WHO Technical Series No. 944 Geneva, World Health Freeman, T., Lawton, L., Tovell. A and Nicholas, R. 2007 Organisation. Young People and Alcohol The Role of Cultural Influences. 138 National Centre for Education and Training on Addiction, Casswell, S., and Maxwell, A. 2005 “What Works to reduce Flinders University of South Australia, Adelaide. Alcohol-Related Harm and Why Aren’t the Policies more 146 Popular?” Social Policy Journal of New Zealand, 25:118– See for example, Gosselt, J., van Hoof, J., de Jong, M., and 141. Wagenaar, A., Toomey, T., and Lenk, K. 2004/2005 Prinsen, S. 2007 “Mystery shopping and alcohol sales: Do “Environmental Influences on Young Adult Drinking”Alcohol supermarkets and liquor stores sell alcohol to underage Research and Health, 28(4):230–235. customers?” Journal of Adolescent Health, 41(3), 302–308; 139 Drugs and Crime Prevention Committee 2004 Inquiry into Toumbourou, J., Godfrey, C., Rowland, B. and Duff, C. 2004 Strategies to Reduce Harmful Alcohol Consumption Discussion Law, Regulation, Policing and Enforcement in the Prevention of Paper. Parliament of Victoria, Australia; Imm, P., Chinman, Alcohol-related Harm. Prevention research evaluation report M., Wandersman, A., Rosenbloom, D., Guckenburg, S. and No. 9 Drug Info Clearinghouse, Australian Drug Foundation, Leis, R. 2007 Preventing Underage Drinking Using Getting to Melbourne. Outcomes with the SAMHSA Strategic Prevention Framework to Achieve Results. RAND Corporation Santa Monica.

UNDER THE INFLUENCE | 87 147 156 p.10 Toumbourou, J., Godfrey, C., Rowland, B. and Duff, Cox, W., Brown, M., and Rowlands, L. 2003 “The Effects of C. 2004 Law, Regulation, Policing and Enforcement in the Alcohol Cue Exposure on Non-dependent Drinkers’ Attentional Prevention of Alcohol-related Harm. Prevention research Bias for Alcohol-related Stimuli” Alcohol & Alcoholism, evaluation report No. 9 Drug Info Clearinghouse, Australian 38(1):45–49. 157 Drug Foundation, Melbourne. Under current law a parent or guardian is allowed to supply 148 Wagenaar, A., Toomey, T., and Lenk, K. 2004/2005 liquor to a minor in a supervised situation, however other “Environmental Influences on Young Adult Drinking” Alcohol persons are not. 158 Research and Health, 28(4):230–235; Huckle, T., Casswell, S., Currently the legal blood alcohol limits for driving are and Pledger, M. 2005. “Evaluation of a regional community age-related. For those under 20 the legal alcohol limit is action intervention in New Zealand to improve age checks 150 micrograms per litre of breath or 30 milligrams per 100 for young people purchasing alcohol”. Health Promotion millitres of blood. For those aged 20 or over, the limit is International, 20(2), 147–155. 400 micrograms per litre of breath or 80 milligrams per 100 149 Mansdotter, A., Rydberg, M., Wallin, E., Lindholm, L., and millitres of blood. 159 Andreasson, S. 2007 “A costeffectiveness analysis of alcohol One New Zealand study of general practitioners concluded prevention targeting licensed premises”. European Journal of that many doctors miss opportunities or inadequately use Public Health, 17(6), 618–623. opportunities to talk about alcohol and other drug use 150 Grube, J., and Stewart, K. 2004 “Preventing impaired driving with their patients. This study also pointed out the barriers using alcohol policy” Prevention, 5(3), 199–207; Kypri, K., to doctors taking up opportunities, including wanting to Voas, R., Langley, J., Stephenson, S., Begg, D., Tippetts, S., maintain a relationship of trust with patients, and awareness Davie, G. 2006 “Minimum Purchasing Age for Alcohol and that the patient is a paying customer who may wish to use Traffic Crash Injuries Among 15- to 19-Year-Olds in New the consultation time for other matters. The study suggests Zealand” American Journal of Public Health, 96(1):126–131; that what is currently happening in primary care does not Casswell, S., and Maxwell, A. 2005 “What Works to reduce follow best practice guidelines for dealing with alcohol Alcohol-Related Harm and Why Aren’t the Policies more and other drug use in primary care. See Moriarty, H. “AOD Popular?” Social Policy Journal of New Zealand, 25:118–141. doctor-patient talk – how conversation analysis helps us 151 p.164-169 Drugs and Crime Prevention Committee 2004 understand” in Schroder, R. and Sheridan, J. (eds) 2009 New Inquiry into Strategies to Reduce Harmful Alcohol Consumption Zealand Addiction Treatment Research Monograph Research Discussion Paper. Parliament of Victoria, Australia. Proceedings for the Cutting Edge Conference September 2008 152 ISSN 1179-0040 Drugs and Crime Prevention Committee 2006 Inquiry into 160 Strategies to Reduce Harmful Alcohol Consumption—Final Alcohol is a leading factor contributing to home injury and Report. Parliament of Victoria, Australia. death, as well as to road injury and death in New Zealand 153 (p.29 Accident Compensation Corporation 2008 Annual Report Stockwell, T. 2003 “Just say no sir”. Drug and Alcohol 2008. Wellington, Accident Compensation Corporation). Findings, 9:4–7. The BERL study has estimated that harmful alcohol use cost 154 p.153 Huckle, T., Casswell, S., and Pledger, M. 2005. an estimated $4,437 million in diverted resources and lost “Evaluation of a regional community action intervention welfare in 2005/06 (Slack, A., Nana, G., Webster, M., Stokes, in New Zealand to improve age checks for young people F., and Wu, J. 2009 Costs of Harmful Alcohol and Other Drug purchasing alcohol”. Health Promotion International, 20(2), Use. Report to Ministry of Health and ACC. Wellington, BERL 147-155. Economics). For 2007/08, Police estimated that at least 31 155 Kambouropoulos, N. and Rock, N. 2007 “Towards a percent of recorded offences and one third of violent offences Phenomenology of Urge to Drink: A Future Prospect for involved an offender that had consumed alcohol prior to the Cue-reactivity Paradigm” North American Journal of committing the offence (p.106 Ministry of Health 2009 Alcohol Psychology, June 2007. Use in New Zealand: Key results of the 2007/08 New Zealand Alcohol and Drug Use Survey. Wellington, Ministry of Health

88 | UNDER THE INFLUENCE 167 www.moh.govt.nz). The Ministry of Transport has estimated Overall, 62 percent of those who could be classified as the total social cost of crashes involving driver alcohol/ binge drinkers are in the 18–39 age group. See Research New drugs was about $838 million in 2007 (Ministry of Transport Zealand 2009 ALAC Alcohol Monitor – Adult & Youth 2007–08 2008 Alcohol/drugs Crash Factsheet. Wellington, Ministry Drinking Behaviours Report. Wellington, Alcohol Advisory of Transport www.transport.govt.nz/research/Alcohol-and- Council of New Zealand. 168 drugs/ ). Another study estimated a net loss of almost 12,000 The Salvation Army is one of the few organisations providing years of life due to alcohol in one year in New Zealand (Connor, supported housing that can be used by individuals waiting to J., Broad, J., Jackson, R., vander Hoorn, S., Rehm, J., 2004 enter treatment, or after leaving treatment. See Appendix 1. The Burden of Death, Disease and Disability Due to Alcohol in 169 The focus group views are supported by a study on New Zealand Research Summary. Report to ALAC. Auckland, workforce capability on the treatment of people with co- University of Auckland and Alcohol Advisory Council of New existing disorders, which concluded that “alcohol and drug Zealand). key service workers are not good at identifying psychiatric 161 The Ministry of Health advises that managing waiting times problems and community mental health key team workers are for assessment has been a challenge in the addictions sector not good at identifying alcohol problems”. This report also for a number of years. observed that mental health workers and alcohol and drug 162 p.11 . National Committee for Addiction Treatment 2008 workers tend to “work in parallel rather than collaboratively, Investing in Addiction Treatment. a Resource for Funders, and more thinking about wrap around services would be Planners, Purchasers and Policy Makers. Christchurch, helpful in bridging unmet need”. See p.24 MacEwan, I. 2007 National Committee for Addiction Treatment www.ncat.org.nz Mental Health and Alcohol and Drug Co-existing Disorders: 163 p.11 Matua Raki 2009 Stocktake of Alcohol and Other Drug An Integrated Experience for Whaiora? Matua Raki National Treatment Services in New Zealand 2008. Wellington, Matua Addiction Treatment Workforce Development Programme, Raki www.matuaraki.org.nz Wellington. www.matuaraki.org.nz 164 170 The Ministry of Health advises that in 2009 there were p.76 Brown, M., Wells, J., Scott, K. (eds) 2006 Te Rau 23 providers of residential alcohol and drug programmes Hinengaro The New Zealand Mental Health Strategy. funded from Vote Health, which constitutes the majority of Wellington, Ministry of Health. 171 residential contracts. They are located in Whangarei, Auckland p.15 National Addiction Centre and Matua Raki, Orientation region, Hamilton, Rotorua, Waipukurau, Palmerston North, to the Addiction Treatment Field Aotearoa New Zealand. Wellington, Blenheim, Christchurch, Timaru, Dunedin. National Addiction Centre, University of Otago, Chrishchurch 165 The rate of relapse among those with moderate-severe and Matua Raki, Wellington. 172 dependence who have withdrawn from alcohol is high; p.53 Mental Health Commission 2006 Te Haerenga mo te one finding is 95 percent relapse within two years of Whakaoranga 1996–2006 The Journey of Recovery for the New detoxification. See p.7 National Addiction Centre and Matua Zealand Mental Health Sector. Mental Health Commission, Raki, Orientation to the Addiction Treatment Field Aotearoa Wellington. 173 New Zealand. National Addiction Centre, University of Otago, p.100–102 Ministry of Health 2009 Alcohol Use in New Chrishchurch and Matua Raki, Wellington. Zealand: Key results of the 20007/08 New Zealand Alcohol and 166 The Alcohol Advisory Council of New Zealand (ALAC) reports Drug Use Survey. Wellington, Ministry of Health. 174 that there is some evidence of an increasing trend of excessive p.13, 16. National Committee for Addiction Treatment 2008 drinking among women, especially young women (see www. Investing in addiction treatment. A Resource for Funders, alcohol.org.nz/NZStatistic_170103.aspx). Other analysis of Planners, Purchasers and Policy Makers. Christchurch, trends concludes that there is a rise in both the use of alcohol National Committee for Addiction Treatment www.ncat.org.nz over the lifetime and a higher proportion of drinkers reporting drinking more alcohol (see Wilkins, C. and Sweetsur, P. 2008 “Trends in population drug use in New Zealand: findings from national household surveying of drug use in 1998, 2001, 2003, and 2006” The New Zealand Medical Journal, 121(1274).

UNDER THE INFLUENCE | 89 APPENDIX 1: SUPPORT PROGRAMMES

SALVATION ARMY BRIDGE AND three quarters of programme participants OTHER ALCOHOL-RELATED SUPPORT are aged between 30 and 59 years old (73 PROGRAMMES percent).

Bridge Programme • Considerably more men than women The Salvation Army Bridge Programme is participate in the programme—64 percent aimed at people moderately to severely are men while 36 percent are women. affected by their harmful use of or dependency • Over two-thirds of programme participants on alcohol and/or drugs. identify as NZ European (69 percent), while The programmes involve support from initial 23 percent identify as Maori, four percent contact through to detoxification, treatment identify as Pacific people and five percent and for a support period afterwards. The identify with another ethnic group. length of programmes varies, with the average Individuals are referred to the Bridge period of engagement with an individual being Programme through a wide range of six months. A few programmes run for up to government and non-government agencies, one year. including other addictions services such Bridge Programmes are in 15 locations as CADs and social services including CAB throughout New Zealand from Kaitaia to and budget advisory services. Self referral Invercargill. Those locations include wider is common. Often this reflects the actions of catchment areas from where programme family and friends, as well as employers and participants are drawn. Some locations run a in some cases lawyers in encouraging the range of programmes that are tailored to the individual to seek treatment. needs of individuals and the community. In all Pre-programme support areas, typically, a treatment plan is developed The Salvation Army recognises that the with the individual. Where practical, family and time before treatment is very difficult for friends can become involved in the individual’s individuals. Bottlenecks into detoxification treatment plan. and from there into treatment mean that Over the 2009 calendar year, a total of 744 the process has to be carefully managed, people from all backgrounds went through the with coordination of times to reduce waiting Bridge Programme. The following provides a and to keep individuals motivated in their picture of programme participants: commitment to treatment. • They range from under 20 years to over Pre-programme support includes assessment, 60 years of age. The largest proportions counselling and preparing individuals to enter are in the 40–49 (27 percent) age group treatment programme. The latter includes help and 35–39 (16 percent) age group. Almost with making arrangements regarding their family and household matters.

90 | UNDER THE INFLUENCE Contact is maintained with individuals prior Supported accommodation is provided to to entering detoxification and treatment in a some, such as those released from prison variety of ways through meetings, phone calls who are waiting to enter a Bridge Programme. and text messages. The accommodation is also available for those graduating from a Bridge Programme Post-programme support who need help with accommodation. The Salvation Army operates on the key However, most are able to arrange their own principles that critical to recovery is safe accommodation before leaving a Bridge accommodation and meaningful activity, such Programme. as employment, education or training that can build self-worth. Working with other agencies In working to those principles, The Salvation Salvation Army personnel work in courts and Army runs a two-year after care programme prisons proving addictions assessments and for Bridge Programme graduates. After care support. involves a range of activities tailored to the The Salvation Army also refers individuals individual. These include group work, one-on- to other addictions providers, mental health one counselling, Recovery Church, spiritual providers and other specialised supports focus groups, and assistance with finding safe where needed. accommodation and meaningful activity. Evaluation These supports are available where Bridge The Salvation Amy has recently implemented Programmes are run. Those who live at a an evaluation process to gather data on post distance from programme locations may find treatment outcomes. This process will include it difficult to access support. The Salvation following up both those who complete a Army acknowledges that there are significant programme and those who do not. challenges in making support arrangements happen as this usually involves coordination of different services run by a number of agencies.

Supported Accommodation The Salvation Army provides supported accommodation for a wide range of people. The main supported accommodation properties are in Epsom Auckland (91 beds), Addington Christchurch (75 beds), Invercargill (around 33 beds) and Palmerston North (around 15 beds).

UNDER THE INFLUENCE | 91 APPENDIX 2: FOCUS GROUP QUESTIONS

1. What influences your drinking habits and 5. What aspects of your environment could behaviours? be changed to help reduce the impacts of a. Family? alcohol on you? b. Friends? a. Your environment could be your family, c. Community? (e.g. availability, promotion, your community, the neighbourhood, the sports) workplace, who you have contact with. d. Other influences? (e.g workmates, church) 6. Are there aspects of your environment 2. Is there something specific that triggers that would be very difficult to change to your drinking? (explore what that is) help reduce the impacts of alcohol on you? 3. Out of all those influences and triggers, a. What sort of things are those? what do you think has the biggest b. Why do you think they would be difficult to influence on your drinking habits and change? behaviours? a. And why is that? 7. In general, what aspects of our society need to be changed in order to reduce the 4. How do these influences and triggers impacts of alcohol on people’s lives? work? a. Do they cause your behaviours? How? 8. How do you think those changes could b. Do they support or reinforce your happen? behaviours? How? a. What should happen? c. Do they challenge your behaviours? How? b. Who should be involved in making these d. Do they change your behaviours? How? changes?

92 | UNDER THE INFLUENCE ABOUT THE AUTHOR

Bev James, DPhil. Bev James is the principal of Public Policy & Research Ltd. Bev has wide-ranging experience in policy analysis and management, social research and evaluation. Her particular interests are in housing, community development and resource management. She has worked on a range of policy and research projects for central and local government agencies, as well as for community organisations. Bev has an academic background in sociology and has lectured at Massey University. Currently she is involved in a five-year research programme: ‘Ageing in Place, repairs and maintenance of older people’s housing’. Bev lives in Marlborough where she is active in the promotion of affordable housing through a local housing trust.

UNDER THE INFLUENCE | 93 The Salvation Army Social Policy and Parliamentary Unit New Zealand, Fiji & Tonga Territory

PO Box 76-075, Manukau City 2104, New Zealand Phone (09) 261 0883 | Fax (09) 262 4103 | salvationarmy.org.nz/socialpolicy