AFRICAN J O U R N A L

N A C I R F A Volume 12 ISSN 1531-4065 of DRUG and ALCOHOL STUDIES Number 1 2013

VOLUME 6 N U M B E R 2 2 0 0 7

L A N R U O J AFRICAN J O U R N A L Contents ofof Composition of surrogate alcohol from South-Eastern Nigeria...... 65 Obiora S. Ejim, Bruna Brands, Ju¨rgen Rehm, & Dirk W. Lachenmeier OF DRUGDRUG DRUG Relationships of drinking behaviour, gender, and age with self-reported alcohol-related andand problems in Namibia...... 75

Heli Mustonen AND ALCOHOLALCOHOL STUDIESSTUDIES

Field tales of hazardous home brewed alcoholic beverages: the case of Selebi Phikwe, ALCOHOL Botswana...... 89 Joseph M. N. Pitso In this issue:

A conversation with Alan Haworth ...... 104 STUDIES

List of published articles, 2000–2007...... 113 In this Issue EVIDENCE-BASED WORKPLACE PREVENTION Announcements...... 118 ALCOHOL AND ROAD SAFETY IN ALGERIA

In Memory of Olabisi Odejide...... 119 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS

Acknowledgements ...... 120 TRAMADOL AU NIGER

E M U L O V ALCOHOL MARKETING IN AFRICA 6

R E B M U N 2

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ISSN 1531-4065

A S I R C

P U B L I S H E D B Y Centre for Research and Information on Substance Abuse

Job #113977

AFRICAN J O U R N A L N A C I R F A of DRUG and ALCOHOL STUDIES VOLUME 6 NUMBER 2 2 0 0 7 VOLUME 6 N U M B E R 2 2 0 0 7

L A N R U O J AFRICAN J O U R N A L Contents of Composition of surrogate alcohol from South-Eastern Nigeria...... 65 Obiora S. Ejim, Bruna Brands, Ju¨rgen Rehm, & Dirk W. Lachenmeier OF DRUG DRUG Relationships of drinking behaviour, gender, and age with self-reported alcohol-related and problems in Namibia...... 75

Heli Mustonen AND ALCOHOL STUDIES

Field tales of hazardous home brewed alcoholic beverages: the case of Selebi Phikwe, ALCOHOL Botswana...... 89 Joseph M. N. Pitso In this issue:

A conversation with Alan Haworth ...... 104 STUDIES Surrogate alcohol from Nigeria List of published articles, 2000–2007...... 113 Gender, age and drinking problems in Namibia Announcements...... 118 Hazardous home brewed alcohol in Botswana In Memory of Olabisi Odejide...... 119 A conversation with Alan Haworth Acknowledgements ...... 120 E M U L O V 6

R E B M U N 2

7 0 0 2

ISSN 1531-4065

A S I R C

P U B L I S H E D B Y Centre for Research and Information on Substance Abuse

Job #113977 African Journal of Drug and Alcohol Studies

Purpose and Scope

The African Journal of Drug & Alcohol Studies is an international scientific peer-reviewed journal published by the African Centre for Research and Information on Substance Abuse (CRISA). The Journal publishes original research, evaluation studies, case reports, review articles and book reviews of high scholarly standards. Papers submitted for publication may address any aspect of alcohol and drug use and dependence in Africa and among people of African descent living anywhere in the world.

The term “drug” in the title of the journal refers to all psychoactive substances other than alcohol. These include tobacco, cannabis, inhalants, cocaine, heroin, prescription medicines, and traditional substances used in different parts of Africa (e.g., kola nuts and khat).

EDITORIAL AND MANAGEMENT TEAM

EDITOR-IN-CHIEF ASSOCIATE EDITORS Prof. Isidore Silas Obot Dr Neo Morojele Centre for Research and Information Medical Research Council on Substance Abuse (CRISA) Pretoria, South Africa E-mail: [email protected]; E-mail: [email protected] [email protected] Dr Nazarius Mbona Tumwesigye DEPUTY EDITORS Makerere University West Africa Kampala, Uganda Professor Hope Obianwu E-mail: [email protected] Niger Delta University Wilberforce Island, Nigeria Dr Andrew Zamani Psychiatric Hospital Southern & Central Africa Gwagwalada, Abuja, Nigeria Professor Charles J. Parry E-mail: [email protected] Medical Research Council Cape Town, South Africa MANAGING EDITOR E-mail: [email protected] Akanidomo J. Ibanga, CRISA E-mail: [email protected] Eastern Africa Prof. David M. Ndetei EDITORIAL ASSISTANTS University of Nairobi Pam Cerff, Cape Town, South Africa Nairobi, Kenya Danjuma Ojei, Jos, Nigeria E-mail: [email protected] EDITORIAL ADVISORY BOARD Francophone countries Dr Reychad Abdool, Nairobi, Kenya Prof. Baba Koumare Dr O.A. Ayo-Yusuf, Pretoria, South Africa Hopital Point G Prof. Moruf Adelekan, Blackburn, UK Bamako, Mali Dr Yahyah Affinih, New York, USA E-mail: [email protected] Prof. E. E. O. Alemika, Jos, Nigeria Dr Pascal Bovet, Seychelles Rest of the world Prof. Layi Erinosho, Abuja, Nigeria Prof. James T. Gire Prof. A.J. Flisher, Cape Town, South Africa Virginia Military Institute Dr Axel Klein, London, UK Lexington, VA, USA Prof. Hope Obianwu, Benin, Nigeria E-mail: [email protected] D. A. Pritchard, Swaziland African Journal of Drug and Alcohol Studies

Volume 12, Number 1, 2013

CONTENTS

A systematic review of evidence-based workplace prevention programmes that address substance abuse and hiv risk behaviours...... 1 Nadine Harker Burnhams, Alfred Musekiwa, Charles Parry, Leslie London

Taboo of alcohol and road safety policies in Algeria...... 23 Houria Bencherif & Farès Boubakour

Patterns and determinants of alcohol use among Nigerian university students: an overview of recent developments...... 29 Emeka W. Dumbili

Representations sociales de la consommation de tramadol au Niger, perceptions et connaissances des communautes : enjeux pour les actions de lutte...... 53 Djibo Douma Maiga, Houdou Seyni, & Amadou Sidikou

Alcohol marketing in Africa: not an ordinary business...... 63 Isidore S. Obot

Abstracting/Indexing services: The journal is indexed/abstracted by the following services: Addiction Abstracts, African Journals Online (AJOL), DrugScope, Applied Social Sciences Index, Social Services Abstracts, Sociological Abstracts, Scopus, Embasse, and PsycINFO.

African Journal of Drug & Alcohol Studies, 12(1), 2013 Copyright © 2013, CRISA Publications A SYSTEMATIC REVIEW OF EVIDENCE-BASED WORKPLACE PREVENTION PROGRAMMES THAT ADDRESS SUBSTANCE ABUSE AND HIV RISK BEHAVIOURS

Nadine Harker Burnhams¹, Alfred Musekiwa²’5, Charles Parry¹’4, Leslie London³

1Alcohol and Drug Abuse Research Unit, South African Medical Research Council 2Biostatistics Unit, South African Medical Research Council 3School of Public Health and Family Medicine, University of Cape Town 4Department of Psychiatry, Stellenbosch University 5Witwatersrand Reproductive Health & HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

ABSTRACT

The purpose of the systematic review was to determine the effectiveness of workplace substance abuse prevention programmes that also address substance-related HIV risks. A search of major electronic databases was conducted. Two authors independently applied eligibility criteria, assessed study quality, and extracted data using a standardised data extraction form. Due to the heterogeneity of study results, a qualitative approach was applied in assessing the effectiveness of the programmes. The search yielded 14 studies. All studies presented mixed results, with the majority reporting improvements in self- reported substance abuse measures. The review highlighted paucity in the availability of good quality workplace prevention programmes and none that addressed substance abuse and HIV risk behaviours in such settings.

Keywords: Substance abuse, evidence-based, prevention programmes, workplace, industry

INTRODUCTION ley, 2006; Webb et al., 2009; World Health Organisation (WHO), 2010). Surveys es- Substance abuse1 in the workplace has timate that 1 in 10 American employees generated considerable interest globally report experiencing problems related to (Broome & Bennett, 2011; Elliott & Shel- substance abuse, while one in three em-

1 Substance abuse refers to a maladaptive pattern of use of a substance which is not considered dependent. Substances associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, methaqualone, and opioids (American Psychiatric Association, 2000).

Corresponding Author: Nadine Harker Burnhams, Alcohol and Drug Abuse Research Unit, South African Medical Research Council, P.O Box 19070, Parow Valley, Cape Town, 7505. Email: [email protected] BURNHAMS ET AL. ployees report experiencing the effects 22.9 million the number of people living of co-worker substance abuse (Bennett et with HIV (United Nations Programme on al., 2004; Merrick et al., 2007). Similarly, a HIV/AIDS (UNAIDS), 2011). South Africa survey of 39 companies (n=2566) in Bra- has an estimated 5.6 million people living zil found that 12.4 per cent of employees with HIV, an amount more than any other drank at risky levels (United Nations Office country in the world (United Nations Pro- on Drugs and Crime (UNODC), 2005) and gramme on HIV/AIDS (UNAIDS), 2011). 1% reported current use of illicit drugs. This is particularly worrisome given the Although literature on substance abuse in body of research on the link between sub- the South African workforce is limited, the stance abuse and HIV globally (Parry et country has seen a surge in reported use of al., 2010). In Southern Africa the majority substances such as alcohol, heroin, cocaine of HIV/AIDS transmissions occur through and particularly crystal methamphetamine heterosexual contact and numerous stud- which has become increasingly wide- ies have demonstrated evidence of an spread in Cape Town over the past eight association between substance abuse years (Pithey & Parry, 2009; Pluddemann and sexual HIV risk behaviours among et al., 2008). In 1996, Ronelle (1996) esti- men, women and adolescents (Morojele, mated that 20% of the average workforce Pithey, Pule & Joubert, 2006; Parry & in South Africa is likely to have ever experi- Pithey, 2006; Pithey & Parry, 2009). Re- enced a substance-related problem. cent studies found that two adult com- Although South Africa has a high per- munity populations studied in Cape Town centage of persons abstaining from drink- were more likely to engage in risky sex ing alcohol, when compared to other practices, characterised as sex with mul- countries, the annual per capita consump- tiple partners and unprotected sex (OR tion of pure alcohol per drinker is esti- = 6.2, 95% CI = 3.1–12.3), if they were mated to be at 19.5 litres (Roerecke et al., methamphetamine or alcohol users (Car- 2008). Many drinkers drink at problematic ney & Parry, 2008; Parry & Pithey, 2006; levels, particularly over weekends (Parry Simbayi et al., 2004). et al., 2005). A recent review of harmful Substance abuse by employees, on or drinking patterns and level of consump- off-site, impacts on work performance tion in 20 African countries, ranked South resulting in decreased productivity, work Africa fourth highest in terms of the pro- errors, wasted materials, tardiness and portion of heavy drinkers as a percentage absenteeism, all translating to substan- of current drinkers (Clausen et al., 2009). tial productivity losses each year (Garcia, The prevalence of risky drinking among 1996; Kew, 1992; Merrick et al., 2007; Ro- sectors such as the mining industry in man & Blum, 2002). Attempts to address South Africa has been estimated to be at these huge economic losses incurred by 25% (Pick et al., 2003; Wilson, 1999). industry have seen a growth in research This reported growth in the abuse of on substance abuse prevention strategies substances has been paralleled over the designed for use in the workplace (Cook same period of time by an increase in & Schlenger, 2002; Webb et al., 2009). HIV prevalence. An estimated 1.9 million Although there is widespread agree- people were newly infected with HIV in ment on the need for substance abuse sub-Saharan Africa in 2010, bringing to workplace prevention programmes glob-

2 EVIDENCE-BASED WORKPLACE PREVENTION ally (Broome & Bennett, 2011; Cook & METHOD Schlenger, 2002; Webb et al., 2009) and in Africa (World Health Organisation (WHO), We conducted a search of electronic 2010), there has been no critical review of databases in October 2009 to identify published literature on substance abuse literature on evidence-based workplace workplace programmes that also address substance abuse prevention programmes HIV risk behaviours. Webb et al., (2009) that also address substance-related HIV however conducted a systematic review risk behaviours. The following key words of alcohol abuse prevention programmes were used: ‘substance abuse’; ‘substance for the workplace which did not include a misuse’; ‘drug abuse’; ‘alcohol abuse’; focus on other substances of abuse such ‘alcohol misuse’; ‘dependency’; ‘inter- as illicit drug use. The review however ventions’; ‘programmes’; ‘workplace’; highlighted the existence of few method- ‘work-related’; ‘workers’; ‘employees’; ologically adequate studies of workplace ‘industry’; ‘HIV/AIDS’; ‘HIV’ and ‘HIV-re- alcohol interventions. Weaknesses in the lated’. This first search yielded no results ten studies included in the Webb et al., and a second search was executed drop- (2009) review related to representative- ping HIV/AIDS and HIV-related keywords. ness of samples, consent and participa- We searched the following databases: tion rates, blinding, post-test time-frames, PubMed, MEDLINE, Science Direct, EB- contamination and reliability, and validity SCO, Ovid, Cochrane and SABINET. Our of measures used. Despite the limitations search for unpublished data involved reported the review concludes that brief making email contact with key informants interventions, interventions contained such as the UNODC, and other local ex- within health and life-style checks, psycho- perts in the field of substance abuse in social skills training and peer referral have the workplace. We provided experts the potential to be replicated and to pro- with a brief description of the overall aim duce beneficial results Webbet al., (2009). of the review and asked if they knew of Given the dual burden of substance any workplace prevention programmes abuse and HIV in South Africa and the that fit our descriptions. All applicable need for information on how best to ad- information was emailed to the corre- dress this burden, the objectives of the sponding author. We also searched the study were to assess the effectiveness WHO, SAMHSA and ILO websites for un- of evidence-based workplace substance published articles and documents. The abuse prevention programmes from relevant keywords were entered into the around the world that also address sub- websites search engine and any docu- stance-related HIV risk behaviour and to mentation relating to the workplace and select an intervention suitable for imple- prevention was downloaded. mentation in a South African workplace Eligibility criteria included the follow- setting. This review forms part of a larger ing: articles had to be in English; the as- study aimed at testing the effectiveness sociations between substance abuse and/ of a substance abuse and substance-re- or substance-related HIV risks prevention lated HIV risks prevention programme at programmes and the workplace needed workplaces in the Western Cape province to be stated clearly and concisely (for ex- of South Africa. ample, the mean difference in number of

3 BURNHAMS ET AL. Figure 1: Flow chart indicating search strategy and process

Search strategy used for searches: (January 1995 – October 2009)

Substance abuse or substance misuse or drug abuse or alcohol abuse/misuse or dependency AND intervention/programme AND workplace or work-related or workers

1544 potentially relevant articles indentified in:

Pubmed: 65 Science Direct: 776 Ovid: 406

Ebscohost: 175 Cochrane database: 117 Reference search 2

Networking with colleagues 3 Scan of relevant databases

1459 Excluded based on review of titles and abstracts

85 identified for further review

71 excluded based on full review Exclusion Criteria Non English: 3 Non-experimental: 4 Same sample as another study: 1 Not workplace based: 3 Primary focus not AOD: 16 Review Papers: 5 Methods Papers: 16 Duplicates: 23

14 included in sample

Randomised Non-randomised Retrospective Control Trials experimental ecologic 10 Studies analyses

3 1

Figure 1: Flow chart indicating search strategy and process

4 EVIDENCE-BASED WORKPLACE PREVENTION days using alcohol or drugs, effect sizes); ing the effectiveness of the programmes verifiable quantitative measures appro- was firstly, due to the variability of studies priate for inferring relationships between and secondly to facilitate the choice of an the intervention and outcomes were intervention for implementation. Any dif- used; published in the 15 year period ferences in assessment of eligibility were 1995 – 2009 (inclusive). resolved through interactive discussion. Two review authors (NB and AM) inde- The selected studies (14 studies) were pendently i) screened the results of the rated (by NB and AM) on the following sev- searches to select potentially relevant en criteria: standards of evidence, breadth studies, ii) applied eligibility criteria, iii) of research support, cross-cultural appli- extracted data on the methods, par- cability, target group representation, cost ticipants, interventions, and outcomes to implement, methodological strength of from each eligible study into a specially study, and other practical influences (Ba- designed extraction form, iv) compared bor et al., 2003; Leff et al., 2009). The au- data in respect of intervention effective- thors added target group representation ness, quality and key findings using Babor to the list of criteria since it was deemed et al., (2003) Objective Decision Model important to identify the target population approach. This approach uses a system- in the identified studies. A programme atic procedure to evaluate the evidence, targeting the general workforce would be compare alternate interventions and as- more suited to the purposes of the study. sess the societal/community or popula- Based on these ratings, the 3 studies with tion benefits of an intervention (Babor et the best scores were chosen for further al.,, 2003). Babor and colleagues propose review and possible implementation in a that interventions be rated according to South African setting. four major criteria: evidence of effective- To further facilitate the task of choosing ness, breadth of research support, extent a quality study for replication in South Af- of testing across diverse countries and rica, a group of 6 experts were identified cultures, and relative cost of the inter- to further rate the selected interventions vention in terms of time, resources and on the seven criteria (Babor, et al., 2003; money (Babor et al.,, 2003). Evidence of Leff et al., 2009). The experts were se- effectiveness refers to the quality of the lected on the basis of their experience in scientific evidence and intervention effec- the substance abuse field and/or Employ- tiveness. Breath of research support goes ee Assistance Programmes. The experts beyond considering the quality of science comprised of 3 academics, 2 EAP consul- and looks at the consistency of the avail- tants (1 a specialist in substance abuse) able evidence. Cross-cultural testing sug- and a medical doctor knowledgeable on gests that an intervention applies well alcohol and the workplace. to different cultural settings and further Each member of the expert panel was considers possibility for intervention rep- mailed a rating sheet which contained lication. Cost to implement and sustain the categories described by Babor et refers to the monetary costs associated al., (2003). Using the categories, experts with the intervention. The rationale for were asked to rate the studies as being using the objective decision model ap- least suited, moderately suited or most proaches by Babor et al, (2003) for assess- suited for implementation in South Africa.

5 BURNHAMS ET AL.

Studies rated as being least suited were als (RCTs), three were non-randomised given a rating of ‘1’ and studies most suit- experimental studies and one study was ed were afforded a rating of ‘3’, with ‘2’ a retrospective ecologic analysis. The 14 given to those that were categorized as studies selected are described in Table 1. moderately suited. The ratings provided were summed and the intervention with Participants and location the highest result was chosen for imple- Twelve of the identified studies were mentation (see Table 3). conducted in the USA. One study was conducted in Australia and one study in Iran. The target populations were all RESULTS adults (>18 years), and the majority of Description of studies studies had both male and female par- Study selection ticipants whilst three studies did not re- The systematic review identified 1544 port a gender breakdown. Seven studies potentially eligible studies that met in- provided a description of participant race clusion criteria. For the published studies classifications. The worksites included where abstracts matched the study inclu- were all medium to large enterprises, sion criteria, 85 corresponding full articles with eight workplaces in the services in- were retrieved and further reviewed to dustry (Anderson & Larimer, 2002; Ben- determine eligibility. Of the 85 articles, 71 nettet al., 2004; Billings et al., 2008; Cook were further excluded through a second et al., 1996; Deitz et al., 2005; Doumas review. Following this process of review- & Hannah, 2008; Richmond et al., 2000; ing the titles and abstracts, removing du- Snow et al., 2002), four in the manufac- plicates and articles not meeting inclusion turing industry (Cook et al., 2004; Heirich criteria (see Figure 1), 14 potentially eli- & Sieck, 2000; Moradi et al., 2009; Wal- gible intervention studies were subject to ters & Woodall, 2003), one in the trans- further analysis. One ecological study was port industry (Spicer & Miller, 2005) and included in the review. The decision to one industry chose to remain anonymous include the retrospective ecologic analy- (Matano et al., 2007). The mean age of sis was based on the type of intervention employees was reported in only six stud- tested. Despite the lack of a control, the ies (see Table 1). author (Spicer & Miller, 2005) used cross- sectional time-series data to examine the Interventions association between PeerCare implemen- Interventions differed in respect of the tation and occupational injury over a 13 type of strategies used to deliver preven- year period. tion messages. In five of the included stud- The initial aim of the study was to ies, alcohol and drug messages were em- search for substance abuse and substance bedded in a health promotion framework related HIV workplace interventions. The which focused on topics such as healthy search yielded no results, which led to the eating, weight management, smoking, de- adaptation of the search and a search for pression and anxiety and other wellness only substance abuse workplace preven- aspects (Anderson & Larimer, 2002; Bill- tion programmes. Of the 14 identified ings et al., 2008; Cook et al., 1996; Cook studies, 10 were randomized control tri- et al., 2004; Deitz et al., 2005; Heirich &

6 EVIDENCE-BASED WORKPLACE PREVENTION

Sieck, 2000). Five of the studies (Bennett to the website which ranged between 30 et al., 2004; Cook et al., 2004; Moradi and 90 days. et al., 2009; Snow et al., 2002; Spicer & Miller, 2005) provided psychosocial skills Outcomes training paying particular attention to The substance abuse outcome mea- peer referrals, team building, self-effica- sures chosen varied between studies, al- cy, coping mechanisms, resistance skills though the most frequently chosen out- and stress management, whilst Doumas comes were changes in alcohol or drug & Hannah, (2008), Matano et al., (2007) use behaviours and attitudes, changes and Walters & Woodall, (2003) provided in drinking patterns, reductions in binge alcohol and drug information. The major- drinking and quantity and frequency of ity of interventions were provided in a consumption of either alcohol or drugs. group setting (Bennettet al, 2004; Billings The majority of studies assessed alcohol et al., 2008; Cook et al., 1996; Cook et use patterns with only two studies (Cook al., 2004; Deitz et al., 2005; Moradi et al., et al., 2004; Moradi et al., 2009) assess- 2009; Snow et al., 2002; Spicer & Miller, ing frequency of use of drugs. All studies 2005), but one study used both a group used self-report measures and two studies setting and provided individual feedback (Cook et al., 2004; Spicer & Miller, 2005) (Heirich & Sieck, 2000). Three studies pre- confirmed self-reports biochemically. sented alcohol and drug prevention infor- Many of these outcomes were measured mation via an internet website (Billings at different time points which ranged from et al., 2008; Doumas & Hannah, 2008; immediately following pre–testing to two Matano et al., 2007) and one offered a weeks after pre-testing; on completion of free confidential check-up by mail (Wal- the intervention and after a four week to ters & Woodall, 2003). Two interventions six month follow-up period. Some studies took place in a brief intervention format also assessed other outcomes such as car- (Anderson & Larimer, 2002; Richmond et diovascular disease and alcohol risk pres- al., 2000). In their comparisons all studies ence (Heirich & Sieck, 2000) and associa- included a control group; however, some tion between the intervention and risk of studies had a no-treatment control group, occupational injury (Spicer & Miller, 2005). while others compared two different ex- Ratings of Interventions perimental treatments to each other as While the primary outcome was reduc- well as comparisons with a control group tion in substance abuse (alcohol and drug) (Bennett et al., 2004; Doumas & Hannah, consumption measures, we could not per- 2008; Heirich & Sieck, 2000; Matano et form a meta-analysis because of the het- al., 2007; Walters & Woodall, 2003). erogeneity in studies with respect to study The programme presenters comprised design and a wide variation of outcomes researchers, peer educators, EAP staff reported. Instead the 14 studies have been and three studies used the internet as rated on different dimensions using criteria the intervention agent. The duration of used by Babor et al., (2003) (see Table 3). the interventions ranged from two ses- sions in total to 15 sessions in total over Evidence of effectiveness a four week to one year time period. The The included studies yielded mixed re- web-based interventions provided access sults with the majority of studies report-

7 S M E S U E D and OUTCO TRU M ENT IN S Alcohol Dependence Scale; Inventory of drug taking situations; situations; of drug taking Inventory Dependence Scale; Alcohol questionnaire. of alcohol effects Comprehensive consumed per BAL; # of drinks and peak of consumption Frequency consumed # of drinks (typical BAL Typical 3 months; in previous day which drinking occurred over and period of time per occasion 3 months). during past Company Injury Records Company Questionnaire Health Behaviour in past drinks 5 or more having days drinking ( 5 or more - Heavy 30 days) 30 days) in past drinks with 5 or more drinking (1 day - Binge The Audit questionnaire The Audit questionnaire questionnaire The Cage Own measures developed developed Own measures 5 questions; and drunkenness) (frequency consumption Four problems to relating 6 questions to hangovers; relating questions and work drinking climate to related of use; 7 questions as a result use. co-worker (HFQ). Health and Fitness Questionnaire drinking excessive regular per week; drinks Mean # of standard 3 months drinking in previous binge index); (quantity/frequency Daily Drinking Questionnaire. peak (drinking quantity, consumption of alcohol 3 measures drinking Binge to intoxication); of drinking freq consumption, drinking). of binge (frequency measures

Sex 73% male Male: 83% 38% female 27% female Male: 22.1% & 26 women 51 men & 31 Not indicated Not indicated 62% male and Female: 77.9% Female: women 47 men women 86% 61% 77% 73% 63% R ate 2.7% 46% - 47% Participation Participation Not 155 587 124 8567 1167 1206 Size (n) Size Sample indicated RCT RCT RCT RCT RCT Quasi- design Design design. Time series experimental experimental Retail Safety Safety workers Industry Industry company Food and Food Transport Transport Insurance Insurance Anonymous arget I ndustry arget Not indicated Postal service Postal Sensitive Jobs Sensitive T USA USA USA USA USA USA C ountry Australia Study characteristics of the 14 studies identified of the 14 Study characteristics et al., et Miller, Miller, (2005) (2005) (2007) (2002) (2000) Author Spicer & Hannah, Anderson Anderson able 1. Doumas& al., (2007) al., (2004) Richmond & Larimer, & Larimer, Matano et et Matano Bennett et Bennett Deitz et al., Deitz et T

8 S M E S U E D and OUTCO TRU M ENT IN S Health Behaviour Questionnaire Questionnaire Health Behaviour 30 in past drinks 5 or more having days drinking ( 5 or more Heavy 30 days) in past drinks with 5 or more drinking (1 day Binge days); Questionnaire composed of items in National Household Survey Household Survey in National composed of items Questionnaire measured: also used. Outcomes was data on Drug Abuse. Bioassay Illicit of change; stages Drinking use quantity/frequency; Alcohol drug use use 30 day Past of Change; Stage Trans -Theoretical Model based on Prochaska’s processes of processes Model based on Prochaska’s -Theoretical Trans on drug abuse; Attitudes Knowledge measured: Outcomes change. skills drug abuse; Resistance towards Self-report drinking levels drinking levels Self-report and Frequency ; Quantity of CVD risks measures Biometric Questionnaires. Stress and Family Work was which alcohol to and; the extent per month drank # of drinks tension reduce used to Measures Used: Measures of Short Index Measure; of Consumption Quantity/Frequency Perceived Indicators; Importance-Confidence - Recent; Problems Risk of Alcohol Sex females 98% male All females 56% female 70% females Not indicated Not indicated 60 males and 47 29.4% males and -

- - R ate 7.4% Participation Participation 48 374 108 239 309 181 2000 Size (n) Size Sample

RCT RCT RCT RCT RCT Quasi Quasi Design experimental experimental experimental experimental Printing Printing workers workers workers workers workers workers company company company Industrial Industrial Secretarial Technology Technology Construction Construction arget I ndustry arget Petrochemical Petrochemical Manufacturing Manufacturing T Iran USA USA USA USA USA USA C ountry (2003) (2004) (2000) (1996) Heirich Author & Sieck, Snow et et Snow Woodall, Woodall, Billings et Billings et Moradi et et Moradi Walters & Walters al., (2008) al., (2009) al., (2002) Cook et al., Cook et Cook et al., Cook et

9

Overall Overall Assessment Web-based Not Web-based Suited Time frame Not Time frame suited Mailed self-report self-report Mailed results good – survey Not suited (Average (Average Not suited and Brief results Intervention) Not suited and results (Average Intervention) Brief Not suited Not suited (see practicalities) Not suited (see practicalities) Not suited (see practicalities) Considered but Considered because rejected only focus women 7 Practicalities Web-based Low Low Web-based participation Indirect measure of measure Indirect alcohol Mailed surveys Web-based; target group group target Web-based; people young Would require medical medical require Would Weak personnel. method Mailed feedback, may may Mailed feedback, BC not work Women only Women 6 Target Target Group GW GW GW GW Low Low -moderate risk users GW Young Adults GW HR Light to to Light moderate drinkers Women Women only 5 Cost to to Cost Implement Low High High High moderate Low Moderate High Moderate Low Moderate 4 + Cross Cultural Cultural Cross Applicability + + + + + + + + ? 0 Author 3 + Breadth of Breadth Research Support and Year + +++ +++ 0 + + ++ ++ + ++ and (Trinidad Tobago) 2 0 Intervention Intervention Integrity 0 0 0 0 ++ + 0 0 0 0 RCT Methodological Methodological of Study Strength Time Series Design Non-randomized Non-randomized experimental RCT RCT RCT RCT RCT Non-randomized Non-randomized experimental RCT RCT 1 Study Ratings of Interventions Study Ratings ++ dards of dards Stan Evidence ++ ++ ++ + + ++ ++ ++ ++ ++

Matano, Matano, al., 2007 et Table 2. Table Author and Year Spicer al., 2005 et Deitz, D al., 2005 et Bennett Bennett al., 2004 et Richmond Anderson Doumas al., 2007 et et al., 2000 et al., 2002 et Heirich al., 2000 et Cook al., 1996 et Walters Walters al., 2003 et Snow Snow al., 2002 et (Book Chapter)

10

Overall Overall Assessment Not suited (see practicalities) Not Suited Not Suited (see practicalities) Not suited Web-based 7 Practicalities Alcohol not the primary Alcohol Males only outcome Poor results Poor Web-based 6 Target Target Group GW but GW males only HR GW 5 Cost to to Cost Implement Moderate Moderate Low 4 + Cross Cultural Cultural Cross Applicability + + Author 3 + Breadth of Breadth Research Support and Year ++ + 2 0 Intervention Intervention Integrity 0 0 RCT Methodological Methodological of Study Strength Non-randomized Non-randomized experimental RCT 1 + dards of dards Stan Evidence + ++

0 Not tested adequately across cultures; ? Not reported on; + Studied in only one country; ++ Studied in two or more countries; +++ Studied in five or more countries +++ or more Studied in five countries; ++or more Studied in two on; + Studied in only one country; ? Not reported cultures; across adequately 0 Not tested and sustain implement to High: High cost and sustain; implement to cost Moderate Moderate: and sustain; implement to cost Low Low: Risk Users LR Low Risk Users; MR Moderate HR High Risk Users; Workforce; General GW context SA in the programme of the and implementability the practicalities considers This column 0 Evidence indicates a lack of effectiveness; + Evidence for limited effectiveness; ++ Evidence for moderate effectiveness; +++ Evidence of a high degree of effectiveness of degree +++ Evidence of a high effectiveness; for moderate ++ Evidence effectiveness; for limited Evidence + a lack of effectiveness; indicates 0 Evidence or more of fidelity Five with a high degree of fidelity; degree +++ Implemented with a low on; + Implemented +++ reported not of intervention completed; 0 Consistency effectiveness of studies to four Two ++ completed; effectiveness of study designed well one + Only undertaken; been have effectiveness of studies No 0 completed of effectiveness studies

Moradi Moradi et al., 2009 et Author and Year of Interventions Ratings Key: 1 2 3 4 5 6 7 Cook al., 2004 et Billing et al., 08 et

11 BURNHAMS ET AL.

Table 3. Expert Reviewer Ratings for three selected interventions (number of raters indicating that the intervention rates adequately for a particular category) Cook et al, Deitz et al, Bennett et al, 1996 2005 2004 Categories and Ratings A B C Ratings

Interventions Descriptions 9 13 15 Focus (Alcohol only or AOD) 7 16 17 Length 14 11 11 Material 11 13 15 Topics Addressed 9 18 13 Effectiveness 9 13 16 Methodological Strength of Study 9 17 12 Intervention Integrity 9 9 9 Breath of research support 11 17 13 Cross Cultural Applicability 11 11 12 Cost of implement 15 8 12 Target group 10 7 16 Practicalities 16 7 15 TOTAL 140 160 178 ing significant effects. Cook et al., (2004) to 4.1, as compared to the off-site con- reported no significant differences be- trol group which showed a slight increase tween the experimental group and the from 7.4 to 8.1 drinks (t=3.17, p=0.002). control group on any of the two alcohol The programme group also significantly consumption and one illicit drug use mea- reduced the average number of days on sure. In contrast, Bennett et al., (2004) which the employee drank five or more found that employees receiving the Team drinks as compared to the off-site control Awareness intervention significantly re- group (t=2.15, p=0.035). duced problem drinking from 20% to Matano, et al., (2007) found that the 11% as compared to control subjects mean number of beer binges by moder- who showed no significant change at pre- ate-risk participants dropped significantly and post-test (13% respectively): F=6.78, among participants receiving the Coping p=0.01). Bennettet al., (2004) also report- Matters intervention, an internet delivered ed significant reductions in working with alcohol education programme, from 1.36 a hangover or missing work because of a (SD 0.84) to 0.71 (0.91), per week, com- hangover from 16% to 6% as compared to pared to an increase of 1.00 (0.00) to 1.13 control subjects who showed no change (0.64) binges per week for the controls at pre and post-test (9% respectively) (Mann Whitney U test = 25.00, p =0.01). (F=7.34, p=0.007). Similar results were re- Similarly, low-risk participants showed a corded by Cook et al., (1996), where the significantly greater reduction in mean programme group significantly reduced number of beer binges (1.00 (0.00) to 0.59 the average number of days in the past 30 (0.50) (Mann Whitney U test = 95.50, p= days on which they had a drink from 7.9 0.02), as well as hard liquor binges 1.00

12 EVIDENCE-BASED WORKPLACE PREVENTION

(0.00) – 0.57 (0.51) (Mann Whitney U test al., (2000) found a significant decline in = 133.50, p=0.05) compared to the con- the number of drinks per week amongst trols. Participants in Billings et al., (2008) women in the experimental group as study adopted a more healthy approach to compared to controls (F = 39.98, p=0.01). drinking as compared to controls by show- Although men also showed a decline in ing a positive movement on the binge the number of drinks over time, the result drinking stage of change measure (from was not statistically significant. 4.54 (1.91) at baseline to 4.89 (1.72) after intervention; F=7.57, p=0.006). Although Methodological strength of the studies Deitz et al., (2005) reported a decrease The studies also varied on methodologi- in heavy drinking among participants in cal adequacy. Ten studies were RCTs, three the intervention group in comparison to were non-randomised experimental stud- those in the control (p=0.020), differenc- ies and one study employed an ecologi- es for binge drinking were not significant cal time series analysis. All ten RCTs were (p=0.070). Significant decreases in alcohol reported as randomised, yet none of the consumption were also reported by Wal- RCTs elaborated on sequence generation. ters & Woodall (2003) and Doumas & Han- Allocation concealment was clearly de- nah (2008). scribed in only three of the 10 RCTs (Ander- Spicer & Miller (2005) used an indi- son & Larimer, 2002; Doumas & Hannah, rect measure of alcohol use and found 2008; Walters & Woodall, 2003). Blinding a significant association between the was generally not reported on in any of the percentage of employees covered un- included studies except for the study by der the PeerCare contract, a programme Deitz et al., (2005). Three studies reported that promotes peer referral systems, and on possible contamination of the interven- injury rates (RR=0.9984, 95% CI: 0.9975- tion due to major policy changes at the 0.9994). These findings imply that a 1% time of the study (Bennettet al., 2004; De- increase in the workforce covered; re- itz et al., 2005; Heirich & Sieck, 2000). In sulted in a 0.16% decrease in monthly the latter study the control group gained injury rates (Spicer & Miller, 2005). Mo- access to the intervention which resulted radi et al., (2009) found a significant in changes to the study design, whilst the improvement in most of the resistance other studies were single-site interven- skills against peer pressure to use drugs tions and therefore failed to obtain an off- among those exposed to the intervention site comparison group. group (p=0.0006), improved attitude to- The main measures used were self- wards drug abuse (t= 5.55; p=0.000) and report measures, although two studies improved knowledge about drug abuse used specific biomarkers (Spicer & Miller, (t= 0.42, p= 0.000) when compared to 2005; Cook et al., 2004). Five studies re- the control group. Anderson & Larimer ported on the reliability and validity of (2002) evaluated differential treatment measurement tools used (Anderson & effects across time, condition and gen- Larimer, 2002; Bennett et al., 2004; Cook der and found that female drinkers were et al., 1996; Matano et al., 2007; Wal- more likely to benefit from the interven- ters & Woodall, 2003). Studies also rated tion when compared to male drinkers (F poorly on withdrawals and dropouts, = 4.01, p=< 0.055). Similarly, Richmond et with the exception of Walters & Woodall

13 BURNHAMS ET AL.

(2003) and Spicer & Miller (2005), where radi et al., (2009). Studies were represen- 80% of participants completed the study. tative of various population groups. Spicer & Miller (2005) ecological time se- ries analysis also included a long follow- Target Group up time period which strengthened the Of the 14 studies included in the review, study and facilitated monitoring change eight studies targeted the general work- over time. force. Two studies targeted light to moder- ate risk users (Richmond et al., 2000; Wal- Intervention integrity ters & Woodall, 2003) and a further two Thirteen studies did not describe meth- studies focused on high risk users (Cook et ods used to ensure intervention integrity al., 1996; Cook et al., 2004). Bennettet al., and fidelity monitoring and were judged (2004) and Richmond et al., (2000) incor- as weak in relation to meeting this crite- porated both white and blue collar workers ria. Although Anderson & Larimer (2002) whereas Deitz et al., (2005) focused solely indicated the use of checklists and feed- on white collar workers while Cook et al., back protocols to promote consistency in (1996), Moradi et al., (2009) and Cook et programme delivery, no formal evalua- al., (2004) targeted only blue collar work- tion method was reported. ers. The remaining 8 studies did not clas- sify workers into these categories. Breadth of research support Bennett et al., (2004), Deitz et al., Cost to implement (2005), Heirich & Sieck (2000), Cook et The costs associated with implement- al., (1996), Cook et al., (2004) and Snow ing the 14 included studies varied. Studies et al., (2002) have continued conducting by Billings et al., (2008); Doumas & Han- field tests of the studies covered in the nah (2008) and Matano et al., (2007) used review which have shown repeated effec- e-learning methods as a preventative tool tiveness. as the internet offers a cheaper method of delivering prevention messages. Simi- Cross-Cultural, Gender and Population larly, Walters & Woodall (2003) and Deitz Applicability et al., (2005) used mailed self-report sur- The studies included in the review did veys as their data collection tool, which not speak to cross-cultural applicability of are also cost effective. The study by Hei- the interventions, although there is anec- rich & Sieck (2000) focused mainly on dotal evidence (the corresponding author cardiovascular disease and alcohol and contacted the programme developers to required the use of medical personnel for establish cross-cultural applicability of data collection purposes, while Anderson the interventions) that the intervention & Larimer (2002) and Richmond et al., reported on by Snow et al., (2002) and (2000) mostly used individualised feed- Bennett et al., (2004) were respectively back sessions, both requiring the exper- replicated in Trinidad and Tobago, and tise and service of highly skilled person- Guan. All studies gave details on gender nel. The study by Spicer & Miller (2005) profiling of participants. Twelve studies employed the use of a fairly unique lon- were heterogeneous for gender with the gitudinal design which may be difficult to exception of Snow et al., (2002) and Mo- replicate. The studies by Bennett et al.,

14 EVIDENCE-BASED WORKPLACE PREVENTION

(2004); Cook et al., (1996) and Deitz et scarcity of evidence, with only 14 studies al., (2005) are not costly to sustain in the evaluating the effectiveness of substance long term, but require consultant input abuse workplace prevention programmes. for programme development, which may In addition, the review highlighted the require high initial financial outlay. dearth of substance abuse prevention pro- grammes in developing countries and also Findings of the ratings provided by key the variability in study design, methodol- experts ogy and programme content. The review Following the rating of the 14 studies also highlights the lack of intervention in- on the different dimensions supplied, two tegrity monitoring in prevention research, authors (NHB and AM) studied the 14 in- and further brings to light factors that terventions. They selected the interven- might hinder replication of programmes in tions which rated strongly on all or most developing countries. of the dimensions discussed previously. The fact that no substance abuse work- Additional comments and an overall as- place prevention programmes were found sessment of the feasibility of using the in- that address substance and HIV in one terventions by the two authors are given single programme is worthy of note con- in the last column of Table 2. The interven- sidering the growing understanding of the tions by Bennettet al., (2004); Cook et al., nexus between substance abuse and HIV, (1996) and Deitz et al., (2005) were con- and academic consensus on the intersec- sidered for further review. A copy of the tion between substance abuse and risky ratings sheet was sent to each member sexual behaviour (Morojele et al., 2006; on the expert panel and they were asked Parry & Pithey, 2006; Parry et al., 2005; to further provide their ratings on each of Wechsberg et al., 2008). This finding is the studies and related categories. Table not surprising given that similar findings 3 provides a breakdown of the ratings were also reported in a study examining supplied by the 6 experts. The study by the extent to which South African sub- Cook et al., (1996) was rated most suited stance abuse treatment services provide in respect of programme length, cost to HIV risk reduction services to patients. implement. Deitz et al., (2005) rated most Limited availability of such services was suited on the diversity of topics covered, reported (Myers, 2010). This is most con- methodological strength and breath of re- cerning for developing countries where search support. Bennettet al., (2004) was HIV prevalence rates are highest. rated strongly on target group, cross cul- Most of the 14 studies originate from tural applicability, intervention integrity, the USA. This may partly explain the ab- effectiveness, focus on alcohol and drugs sence of a substance-related HIV risks and material availability. Once the results component found in this review. Devel- were tallied, the intervention by Bennett oped countries like the USA are more et al., (2004) rated the strongest overall. likely to integrate substance abuse pre- vention into stress and coping-based in- DISCUSSION terventions, peer-to-peer approaches, and other wide-ranging health promo- Despite the large number of stud- tion programmes that aim to reduce the ies identified, the review highlighted the health risks such as cardiovascular diseas-

15 BURNHAMS ET AL. es which are more germane to first world when considering prevention literature societies (Bray et al., 2011). Although (Leffet al., 2009). Intervention integrity is potential biases of this nature can be ad- defined as the degree to which the inter- dressed by customising or adapting the ventions were implemented as they were intervention for replication in a different prescribed. In a literature review on the setting, there is still a need for local pro- degree to which intervention studies re- grammes that are not only cost effective, port on intervention integrity conducted easy to implement in differing contexts Leff et al., (2009) found that intervention and sustainable (Veniegas, 2009), but also integrity is only recorded in a handful of address the reality of substance related – studies ranging from 3.5% to 28% of stud- HIV risks which are more marked in many ies they reviewed. This contributes to developing countries. the need for the development of a set of From the review it is also evident that guidelines for reporting on implementa- various direct and indirect approaches are tion integrity of interventions in general used for delivering substance abuse pre- (Foxcroft et al., 2005; Webb et al., 2009). vention messages. Scholars in the field of Furthermore, the relative monetary workplace substance abuse prevention costs to implement and sustain an inter- have found programmes embedded in vention as well as intervention feasibility less stigmatized topics such as employee issues are all important facts to consider health and wellness to be less of a threat to when evaluating an intervention (Babor corporate sectors, and often receive more et al., 2003). Consequently, the criteria attention in a relation to a programme that for selection of an intervention for imple- focus solely on substance related issues mentation should not only include stud- (Bennett et al., 2000; Cook & Schlenger, ies reporting significant results with good 2002; Heirich & Sieck, 2000). Similarly the methodological and other strengths, but use of a study design that ascribes to evi- also evidence of cost-effectiveness, prac- dence-based practices and shows the me- tical implementable and representative- dium to long term effects of any interven- ness of the target audience. For example, tion should be encouraged. Programmes although recent literature (Billings et al., ensuring sustained effects over a period of 2008; Matano et al., 2007) report on the time remain valuable to the prevention sci- effectiveness of e-learning methods as a ence field (Rossiet al., 2004). preventative tool, it raises a concern which Although the review produced a wide is related to accessibility considering that range of studies, variability in study de- computers are possibly only accessible to sign and methodology was significant. skilled employees (Richmond et al., 2000). Webb et al., (2009), in a review of alco- In addition, a further barrier to utilising hol abuse prevention programmes cites web services, specifically in developing this variability as a challenge calling for countries, may be literacy levels. This could the standardization of methods used for be a barrier in South Africa for instance, evaluating substance abuse interventions where the mean reading level is the sixth in the workplace. grade (Centres for Disease Control and It is also important to discuss interven- Prevention, 2008). Additional factors that tion integrity which remains a fundamen- should be considered include the use of tal construct to understand and evaluate mailed self-report surveys as a data col-

16 EVIDENCE-BASED WORKPLACE PREVENTION lection tool. This may also pose difficulties A final limitation is that all the included considering the realities of informal hous- studies are from developed country set- ing and lack of formal postal addresses in tings and therefore it is unclear whether certain areas of South Africa and other de- these findings can be generalised to low- veloping countries (Wilkinson, 2000). and middle-income countries. Findings from this study should howev- er be considered in the light of some limi- CONCLUSIONS tations. Firstly, there was substantial het- erogeneity between the studies which did Despite the systematic search for not allow for meta-analyses. In addition, methodologically sound workplace pre- the studies reviewed are weighed down vention programmes, the search yielded, by methodological inadequacies high- for inclusion in the review, no interven- lighting the need for more rigorous study tion studies aimed at addressing both designs. Although RCTs remain costly to substance abuse and substance related implement, they are the gold standard HIV in the workplace and only 14 stud- and their implementation should be en- ies involving interventions to address couraged. In instances where RCTs are substance abuse in the workplace. Wide- not practical to implement, Foxcroft et al., ranging variability in study design, study (2005) suggests the use of longitudinal or results and outcome measures resulted in time series study designs with sufficient an inability to compare the 14 studies but measure points. The majority of studies three promising interventions were iden- were small scale, once-off studies which tified for implementation in South Africa. compromise the generalisability of results and do not add to the breath of research support which is valuable in motivating ACKNOWLEDGEMENTS for study replication. Ideally future inter- ventions should be larger scale and rep- We acknowledge the U.S. President’s licated in multiple settings to ascertain Emergency Fund for AIDS Relief (PEPFAR) whether adapted versions of the study through the US Centers of Disease Con- will have similar effects. Similarly, studies trol and Prevention (CDC) (PO S-SF750- failed to report on intervention integrity 06-M-0781), and the South African Medical considering that evaluating the degree Research Council for funding some of the to which study processes were followed activities that informed this manuscript. Its is an important indicator to determining contents, however, are solely the responsi- success or failure of a study. In addition bility of the authors and do not necessarily future research should consider the use represent the official views of the CDC, PEP- of outcome measures other than only us- FAR or other organizations referred to above. ing self-report measures. Consideration should also be given to developing single REFERENCES outcome measures that can be used to predict substance abuse.The develop- American Psychiatric Association. (2000). ment of cost effectiveness assessment Diagnostic and statistical manual of tools will also be advantageous for study mental disorders (Revised 4th ed.). replication in resource poor settings. Washington, DC: APA.

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African Journal of Drug & Alcohol Studies, 12(1), 2013 Copyright © 2013, CRISA Publications TABOO OF ALCOHOL AND ROAD SAFETY POLICIES IN ALGERIA

Houria Bencherifa & Farès Boubakourb

Management-Transport-Logistics Laboratory aInstitute of Health and Safety, University of Batna (UHL), Batna, Algeria bFaculties of Economic and Management Sciences, University of Batna (UHL), Batna, Algeria

ABSTRACT

The objective of this work is to show the real dimension of drunk driving in Algeria through the statistics of road accidents, the evolution of the legislative framework concerning driving while drunk and road preventive actions undertaken to fight against this risk factor. We first analyzed the statistics published by the National Centre for Road Safety (NCRS) in recent years to present the part of driving while drunk in the national data of road accidents. Then we retraced the evolution of the legislative framework for road safety particularly the laws governing driving while drunk. Finally, an overview of how the mass media process and disseminate information related to road traffic accidents, especially one devoted to driving while drunk and that has been achieved to show the part of the means of information in road safety. The results show that driving under the influence of alcohol is behind a significant number of road traffic accidents in Algeria. The results also show that the legislative framework concerning this risk is limited to the fixing of rates of blood alcohol concentrations authorized for driving. These same results reveal the absence of sensitization actions, information and research for this risk factor particular by the mass media. Driving while drunk is a real problem for road safety in Algeria which preserves an unclear representation in the society and constitutes a taboo subject which slows down road safety policies.

Key words: Alcohol, driving while drunk, driving under influence of alcohol, road safety, Algeria

Corresponding Author: Houria Bencherif, Institute of Health and Safety, University of Batna (UHL), BP 355 RP, Batna, Algeria. E-mail : [email protected] Phone: 213 7 72 70 32 53 ; Fax: 213 (0) 86 43 67 BENCHERIF & BOUBAKOUR

INTRODUCTION region. First, data published by the Na- tional Centre for Road Safety (NCRS) from It is well known that driving requires 2005 to 2010 were analyzed in order to concentration, attention, appropriate present the part concerning driving while skills, common sense and a concern for drunk. Then the evolution of the legisla- the safety of all road users, especially tive framework concerning the road safety those who are vulnerable (ECE, 2010). especially the laws regulating the driving Furthermore the consumption of sub- while intoxicated was assessed. This is the stances that influence the behavior has Law No. 1-14 of 19 August 2001 complet- measurable negative effects on road safe- ed and modified by the law N ° 04-16 of ty, alcohol is the main problem (Siegrist, 10 November 2004 and by Ordinance No. 2006). Indeed, consumption of alcohol 09-03, 22 July 2009. Finally, the results of can seriously affect the perception of the a study on the ways that the mass media driver, reduce his ability to react and deal treat and disseminate the information re- safely with unexpected or unforeseen lated to the road traffic accidents in Algeria events, and may be fatal for both the during 2008 were presented. The corpus driver and other road users. According consists of 276 articles published in four to the World Health Organization (WHO), newspapers (the most read in 2008), radio driving while intoxicated increases both records (programs + radio spots) and tele- the risk of accidents and the probability vision documents (programs + TV spots) of death or serious trauma (WHO, 2009). that tackled the problem of road accidents. In Algeria, there is not enough knowledge about the real dimension of the phenom- enon of driving under the influence of RESULTS alcohol, there is also a lack of important elements for determining the categories Alcohol and road safety of users the most affected. Large deficien- According to statistics published by the cies also exist regarding the preventive NCRS the number of accidents that oc- measures to be taken. This work attempts curred during 2010 in Algeria were 32,873 to tackle the problem of driving under the with 52,435 casualties and 3,660 deaths. influence of alcohol in Algeria in terms of Human factor was behind more than statistical data published by the authori- 80% of the accidents recorded. All of the ties concerned, laws that regulate driving causes related to the human factor are under the influence of alcohol and the presented in Table 1. road preventive actions undertaken to It appears that drunk driving represents fight against this risk factor. one of the causes of road traffic accidents in Algeria with 1.37% of accidents caused by human factors in 2010. It is clear that METHOD these numbers are probably lower than the actual, due to the lack systematic This study was carried out in Algeria, a analysis of control in traffic and the lack country of more than 35 million inhabit- of autopsies of deaths. Furthermore, the ants and where the rate of motorisation risk of drunk driving is the cause of ac- is the fastest in the whole of the Maghreb cidents not only of the driver but also of

24 ALCOHOL AND ROAD SAFETY IN ALGERIA

Table 1. Human factors related to road traffic accidents in Algeria (NCRS, 2010)

Human factors Number of accidents (%)

Non respect of the regulatory speed 8382 25.50 Loss of control 5177 15.75 Non compliance of pedestrian 3996 12.16 Non respect for the signals 2807 8.54 Dangerous overtaking 2527 7.69 Non respect of the safety distance 1933 5.88 Non respect of the priority 1595 4.85 Dangerous maneuvers 1054 3.21 Driving without a driving license 491 1.49 Driving while drunk 451 1.37 Parking or dangerous stopping 226 0.69 Non respect of the charge 188 0.57 Hit and run crime 178 0.54 Use of mobile phone 79 0.24 Blinded by the light 67 0.24

Total 29,151 8868 pedestrians for which we have no data. Alcohol and road safety policy Moreover, the percentage change of driv- The first actions on road safety go back ing while drunk in road traffic accidents to the 80s with the appearance of the Law from 2005 to 2010 is presented in Table 2. No. 87-09 of 10 February 1987. This law According to this table drunk driving came to provide public authorities with is responsible for an annual average of tools to improve road safety. In this sense, 2.16% of the recorded accidents between the law determines the speed limit in ur- 2005 and 2010 (NCRS, 2010). Although ban areas and in open country. Also, the the proportions may seem relatively low use of seat belt for road safety becoame- in terms of frequency, what is worrying is compulsory. The permitted blood alcohol the absence of reliable data on the cate- concentration for driving the vehicle is set gories of users involved and the recorded at 0.80 g/l of blood. These preventive mea- and exceeded rates of alcohol. sures were then reinforced by the Law No. 01-14 of 19 August 2001 which abrogated Table 2. Percentage of drunk driving in the Law 87-09. Among the most important road traffic accidents (NCRS, 2010) innovations introduced by this new law include the drastic reduction of the level Year Number of accidents Alcohol related (%) of alcohol permitted in the blood of road 2005 39233 2.99 vehicle drivers to 0.10 g/l of blood. The 2006 40885 2.51 effects of these prevention efforts were 2007 39010 1.86 ephemeral as the number of accidents has 2008 40481 2.63 continued to increase. The statistics show 2009 41224 1.60 that the human factor is the main cause of 2010 32873 1.37 the accidents with an average annual rate

25 BENCHERIF & BOUBAKOUR of 80%. In this regard the government has press which deal with the road traffic acci- decided to revise the legislative frame- dents are few compared to the high num- work concerning the road safety which ber of accidents. Driving while drunk was led to the promulgation of the Law 04-16 treated in a general way and consequent- of 10 November 2004, which modified ly little information was provided about and completed the law of 19 August 2001 this risk factor. For sound recordings (ra- concerning the organization, security and dio) and audiovisual (television) we noted police road traffic. This law aims mainly to the total absence of programmes, spot improve the system of controls to improve advertising and sensitization campaigns road safety. In this sense, the law envis- that deal with drunk driving compared to ages, as administrative penalties, 34 cases the other factors such as speeding, dan- of immediate retrieve of the driving license gerous parking and use of cell phone. The with suspension of the ability to drive in- latter two factors were not as important cluding driving while drunk and under the a risk as driving while drunk, according to influence of substances or plants classified statistics of NCRS. as narcotics. Concerning violations with It seems that the regulatory disposi- writing minutes in addition to the pos- tions and the actions of information and sibility of suspension or cancellation of sensitization initiatives planned to fight driver’s license with the agreement of the against driving while drunk in Algeria is wali (head of province), twelve (12) other still insufficient. These insufficiencies are cases were set for the new holders of a related to the absence of reliable data temporary driving certificate among which on the extent of the problem (user cat- are the drunk driving, and the driving un- egories, quantities consumed, etc.), on its der the influence of substances or plants causes (personal, social, economic) and classified as narcotics. The Ordinance No. its consequences (costs on healthcare, 09-03, July 22, 2009, which modified and social costs, economic costs). completed the Law No. 16-04, and espe- cially in its article 2 has helped to define Driving while drunk is primarily a social the drunken state as a state which is char- problem acterized by the presence of alcohol in In many Western societies, the con- the blood at a rate equal to or higher than sumption of alcoholic drinks is strictly 0.20 g/l of blood. It appears that the per- controlled and considerable means are mitted blood alcohol levels have recorded used to sensitize the public to the harm- variations from 1987 to 2009. There is no ful effects of alcohol on health and ac- information on the manner used for fix- cident risks (Bay, 2010; Hamelin et al., ing these rates but this already marks the 2011). Moreover, in most Arab and Mus- presence of risk associated with driving lim countries that prohibit the presence while drunk in Algeria. of alcohol, its consumption is increasingly Concerning information and sensitiza- widespread in the societies and especially tion activities, the results of a study on among youth and constitutes a real prob- how the mass media treat and dissemi- lem for road safety in these countries in nate the information related to the road the lack and deficiencies in the strategies traffic accidents in Algeria (Bencherif et to control this problem. In Algeria, the al., 2012) show that the articles of the social use of alcohol preserves a fuzzy

26 ALCOHOL AND ROAD SAFETY IN ALGERIA representation and constitutes a taboo traffic enforcement by mobilizing the nec- subject in a society that forbids the con- essary human and financial resources. sumption while setting limits for excess consumption for driving. Indeed, driving Acknowledgements under the influence of alcohol is a sign of a vast social problem regarding the so- We thank all who have kindly given their ciocultural situation of Algeria. Moreover, time and their knowledge to carry out this the perception of the actors in our society work. We would also like to thank the edi- concerning alcohol did not change much tor and reviewers for their suggestions for and alcohol was not recognized until now improving the content of this article. as a real danger in the lack of information and especially of research which is an es- sential element for the knowledge of the REFERENCES risk and which helps in shaping public ac- tion on road safety (Hamelin et al., 2011). Bay, F. (2010). Does our society impulse a change in the behavior of adolescents as regards to alcohol? Part 4: Alcohol, Conclusion do we regulate individuals or adver- tising? Analysis of United Federation In recent years, road safety matters of Associations of Parents of Catholic have received greater attention of - gov Education, N°5 10. Archived by Web ernments in Algeria. However, the results Cite® at http://www.ufapec.be/nos- show that much remains to be done. This analyses. work shows the importance of the issue Bencherif, H., Boubakour, F. and Belkacem, of alcohol on the road in Algeria and the N. (2012). Canadian Journal of Com- limits of current policies to fight this prob- munication, 30(1). http://communi- lem. It particularly emphasizes the fact cation.revues.org/index2967.html. that alcohol is a serious social problem for Economic Commission for Europe of Unit- the road users particularly drivers. It also ed Nations (2010). Resolution on road emphasizes the fact that alcohol is a ta- traffic, Working Group on Road Safe- boo subject for which you must open the ty, ECE/Trans/211, Geneva. debate and start the search on the extent Hamelin, F. Chatzis, K., Kletzlen, A., of driving while drunk and how to imple- Lannoy,P., Moguen-Toursel, M., Pet- ment for the fight against this problem. ica, S., Pérez-Diaz, F., Pottast, J., Ra- Finally, the results of this study showed mos, M. (2011). Final report: Project that three factors determine the strategy ANR-07-TSFA-002-01. IFSTTAR. against driving while drunk in Algeria: (1) General Secretariat of Government. the recognition of the risk of drunk driv- (2001). Law N°01-14. Official Journal ing by the different actors in society; (2) of People’s Democratic Republic of Al- knowledge of this risk in terms of experi- geria, 46, 4-14. mentation, exposure and development General Secretariat of Government. of regulations; and (3) the establishment (2004). Law N°04-16. Official Journal and monitoring of functioning of the edu- of People’s Democratic Republic of Al- cation system, training, sensitization and geria, 72, 3-6.

27 BENCHERIF & BOUBAKOUR

General Secretariat of Government. 16, 2013 from http://www.rue89. (2009). Ordinance N°09-03. Official com/2012/12/30/lalgerie-vers-la- Journal of People’s Democratic Re- prohibition-de-lalcool-entre-tabou- public of Algeria, 45, 2-12. et-hypocrisie-238214/30/12/12. National Centre for Road Safety. (2010). Programme for research and innovation Analytical study on road accidents in in land transport, (2006). Road Safe- Algeria. Algiers: NCRS. ty, G03 Research, France. Grenoble: National Institute of Health. (2007). Proj- MSH-ALPES. ect TAHINA: Epidemiological Transi- Siegrist, S. (1996). Alcohol and illegal drugs tion and Health Impact in North- Af in road traffic: size, risk measures, Swit- rica, N°ICA3-CT-2002-10011. Algeria. zerland. Berne: Swiss Prevention Office. Nouvel Observateur, (2012). Algeria to World Health Organization (2009). It is probation due to alcohol: between time to act: status report on road taboo and hypocrisy , Retrieved July safety. Geneva: WHO Press.

28 African Journal of Drug & Alcohol Studies, 12(1), 2013 Copyright © 2013, CRISA Publications PATTERNS AND DETERMINANTS OF ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS: AN OVERVIEW OF RECENT DEVELOPMENTS

Emeka W. Dumbili

School of Social Sciences Brunel University, Middlesex, UK

ABSTRACT

Use of licit and illicit drugs among students is a growing global phenomenon. Studies from different western countries reveal that students use and misuse substances such as alcohol and tobacco more than non-students. In Nigeria, cultural restraints prevented young people from consuming alcohol in the traditional era. However, recent studies show that many now consume alcohol and other substances in harmful ways. Findings from this recent literature indicate that while some Nigerian university students use alcohol to enhance sexual performance, boost confidence and reduce stress, others use heavy episodic drinking as means of constructing social identity. Other findings reveal that a majority combine alcohol with other drugs and that anxiety, depression, injury to self and others and failing examinations are some of the alcohol-related problems among users. It can be argued that factors such as lack of policy, aggressive advertisements, brewer-sponsored promotions and sponsorship of youth-oriented programmes are some of the facilitators of students’ alcohol use. The paper discusses the implications of these developments for contemporary Nigerian society and recommends that alcohol policies should be formulated and implemented.

Keywords: alcohol misuse, alcohol-related problems, determinants of alcohol use, Nigerian university students, patterns of alcohol use

INTRODUCTION alcoholic beverages date back over many centuries (Obot, 2007). Though alcohol has Alcohol has been used for various pur- been used for many purposes in the com- poses in many human societies for over ten munities that make up the place presently thousand years (Smart, 2007). In Nigeria called Nigeria, drinking patterns and pur- and other parts of Africa, locally produced poses were culturally controlled (Umunna,

Corresponding Author: Emeka W. Dumbili, Department of Sociology and Communications, School of Social Sciences, Brunel University, Kingston Lane, Uxbridge, Middlesex, UB8 3PH London, UK. Email: [email protected] DUMBILI

1967). A consistent characteristic of the Perry, Stigler, & Komro, 2009; Wechsler, patterns was that alcohol consumption Lee, Hall, Wagenaar, & Lee, 2002; among women and youths was not popu- Wechsler & Nelson, 2008; Wemm et al., lar (Odejide, Ohaeri, & Ikuesan, 1989). In 2013; Young, Morales, McCabe, Boyd, & contemporary Nigerian society, this group d’Arcy, 2005) because of this is leading is said to be drinking alcohol as well as us- to many problems amongst this group. ing other psychoactive substances harm- This has been attributed to many predic- fully (Klein, 2001). This shift has been at- tors; one such is the growing culture of tributed to many factors, but to date, there intoxication in western countries (Piacen- has been little agreement. While some say tini & Banister, 2009). Additionally, schol- it was ignited by the oil boom of the 1970s ars from these western countries have that led to the proliferation of breweries argued that not only do students drink (Hathaway, 1997), some argue it was due more alcohol than non-student popula- to the effects of modernisation or global- tions (Kypri, Langley, & Stephenson, 2005; ization (Ikuesan, 1994) while a few others Kypri et al., 2009; Kypri, Cronin, & Wright, (especially recent studies) blame all the 2005), but that they also use other drugs. foregoing, in addition to the influence of For example, Dawson, Grant, Stinson, & the media, advertising, sophisticated mar- Chou’s (2004) comparative study in the keting and lack of alcohol policy (Dumbili, USA revealed that students drank heavi- 2013a; Jernigan & Obot, 2006; Obot, 2007; er than their non-students counterparts Odejide et al., 1989). while Caldeira, Arria, O’Grady, Vincent, & Though there is a 61.7% abstention Wish (2008) reported other drug-related from alcohol consumption among Nigeri- disorders among this group. ans due to socio-religious factors (World Though substance research generally is Health Organization, 2011), studies have undeniably in its infancy in Nigeria (Dimah revealed that high episodic consumption & Gire, 2004), a considerable number of exists among those that drink alcohol. For research has been conducted focusing on instance, Umoh, Obot, & Obot (2012) re- Nigerian students. These studies (past and ported that while the average per capita present) have produced evidence to show consumption for adults in Africa stands that Nigerian students use different psy- at 6.2 litres, Nigerian’s adult per capita chosocial substance for diverse reasons consumption is 12.3 litres which ranks it (Adelekan, Abiodun, Obayan, Oni, & Ogun- among the highest in Africa. This lends remi, 1992; Adelekan, 1989; Fatoye & Mor- credence to an earlier study (Room & Se- akinyo, 2002; Ihezue, 1988a; Makanjuola, lin, 2005) which ranked Nigeria second in Daramola, & Obembe, 2007; Olley & Ajiteru, Africa behind Uganda, but also reported 2001). In spite of the growing number of re- equal alcohol-related problems among search among students in the country, to male and female drinkers. date, there has been little agreement on Currently, one of the most serious dis- the pattern of substance use, factors that cussions in substance use literature glob- engender substance consumption among ally is hazardous alcohol consumption Nigerian students, the category of students among young people, (Foxcroft, Ireland, that use substances, and to my knowledge, Lister-Sharp, Lowe, & Breen, 2003), espe- no review article among the student popu- cially students (Kaynak et al., 2013; Pasch, lation exist in Nigeria.

30 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS

It is against this background that this orders among Nigerian university under- paper fills this gap by reviewing studies graduates’’. Other search terms were ‘‘per- conducted among Nigerian university stu- ceived benefits of alcohol among Nigerian dents between January 2000 and May, students’’, ‘‘motives for consuming alcohol 2013. Though the focus is on alcohol, it is by Nigerian undergraduates’’ ‘‘alcohol ad- difficult to ignore the fact that substance verts in Nigeria university’’, ‘‘alcohol mar- literature in Nigeria is replete with find- keting in Nigeria university’’ and ‘‘alcohol ings to show that the majority that use al- promotion in the Nigerian universities’’. It cohol (a licit drug), also use one or more is noteworthy that the search was based illicit substances together (Makanjuola et on only English language databases. Fol- al., 2007 p.113). The review, therefore, will lowing the multiple check and cross ex- highlight the findings of these studies, dis- amination of the literature, 19 articles cuss their implications and suggest reme- were identified. Though the scope of this dial measures for contemporary Nigerian paper was to include papers published be- society. The article is divided into four sec- tween 2000 and 2013, no study published tions. The ensuing section highlights the in 2000 was identified. Thus, ten titles met methods adopted in the review. This is fol- the inclusion criteria because they were lowed by the section that synthesized the published between January 2001 and May findings of identified studies and discussed 2013 in peer reviewed journals. their implications. This last section high- lighted the factors that engender alcohol use among students and concluded by rec- RESULTS ommending some remedial measures and areas that require further research. As noted, the searches yielded 19 titles, but after a further sifting, nine studies were eliminated. While four of these studies METHOD (Enekwechi, 1996; Ihezue, 1988a; Ihezue, 1988b; Ohaeri et al., 1996) were published The literature for this review was ob- before 2000, three studies (Adewuya, Ola, tained fromsearches of the African Jour- & Aloba, 2006; Adewuya, 2006; Odenigbo, nal Archive, PubMed, MEDLINE, PsychAr- Agbo, & Atinmo, 2013) did not sample only ticles, Cochrane Library, EBSCOhost and university students. Similarly, two stud- Sociological Abstracts. Further searches of ies (Gire, 2002; Welcome, Razvodovsky, Google Scholar and the African Journal of & Pereverzev, 2010) examined Nigerian Drug and Alcohol Studies (that publishes and non-Nigerian students due to the fact peer reviewed scholarly work in Nigeria) that they were not conducted in Nigeria. In were conducted to identify recent litera- all, ten studies (see Table 1) (all employed ture. A combination of search terms was quantitative methods) that met the inclu- used such as: ‘‘patterns of alcohol use/ sion criteria were included in the review. consumption among Nigerian university students’’, ‘‘determinant of alcohol use Patterns of alcohol use among Nigerian among Nigerian university students’’, “al- university students cohol misuse in Nigerian universities/ As noted, all the studies included em- tertiary institution” and ‘‘alcohol use -dis ployed quantitative approaches. Abikoye

31 DUMBILI

Table 1. Studies included in the literature review

Author Year Aims Demographic Results Predictors Characteristics alcohol use

Olley & 2001 To document the 525 Female A prevalence of 54.2% of Severe family Ajiteru prevalence and students from all alcohol use was found; while relationships pattern of alcohol levels of study; 87.3% from this number were and social consumption mean age: 22.06. drinking normally, 7.7% used anxiety alcohol hazardously and 5% harmfully abused alcohol Adewuya 2005 To validate the 248 students 141 had no alcohol- NA instrument for (mean age: related problems; 107 had the detection of 22.5years) alcohol-related problems; alcohol-related completed the two 76- hazardous alcohol use; problems instruments; 225 25-harmful alcohol use; undergraduates, 6-alcohol dependence 23 postgraduate; 229 were single Adewuya 2007 To estimate the 2658 (males: 1913; The 12-month prevalence for Parental et al. prevalence and females: 745) alcohol abuse is 3.5% (Male: drinking; being explore the socio- students 4.4%; Female: 1.1%) and a male; non- demographic alcohol dependence is 0.8% religious; higher correlates of (Male: 1.1%; female: 0.13%) economic status alcohol use disorders Makanjuola 2007 To determine 961 medical 43.2% noted they have been Having study et al. the prevalence, students (males: offered alcohol; with 122 difficulty; living pattern and 625; females: 336); (13.6%) current users and alone; male factors associated aged between 16 341(38.0%) had lifetime use gender; being a with substance and 43 participated clinical student use (who mostly live off campus) Olley 2008 To examine the 841 (16-25 years) 180 were sexually active; NA prevalence and year one students; 53 (male), 20 (female) used associated factors 538 males; alcohol normally; 10males of sexual risk 303 females; and 11 females use alcohol behaviour 819 (single), hazardously; one female use 22 (married) alcohol harmfully Abikoye & 2010 To examine 325 undergraduate 204(62.8%) had ridden in Inability to delay Adekoya substance students (183 a car driven by someone gratification; abuse in a males; 142 who was high on alcohol/ being of non-residential females); mean age: drug; 193(59.4%) had used younger university 22.5. 148 are in 1st alcohol/drug to relax; 159 age; social and 2nd years; 120 have received warning to stop pressure; freer in 3rd and 4th years; alcohol/drug use; males use environment; 57 in year 4 and more drugs off campus above Chikere & 2011 To examine 482 Males students While 78.4% prevalence To feel good; Mayowa the prevalence with mean age of of alcohol use was for all because all and perceived 24.7 years; 79% respondents, 92.2% was for my friends health effect of single; 1st year those aged 26 and above. Being drink alcohol; alcohol use of 53(11%); 2nd year unmarried predicted higher to feel high; undergraduates 90(18.7%); 3rd year alcohol(p-value <0.001) to be famous 152(31.3%); 4th year on campus; to 188(39.0%) enhance sexual performance

32 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS

Abikoye & 2011 To examine 1705 (965males 44.5% are low-risk drinkers; Parental Osinowo alcohol use and 740 females) 43.3% are high-risk drinkers alcohol use; pattern and students from (recommended for simple high parental perception of 3universities; mean advice); 10.4% high-risk socio-economic student-patrons age is 21.52 years; drinkers (need advice, status; living off of bar low economic counseling and continued campus status 30.7%; monitoring); 3.7% fell under middle 42.7%; high alcohol dependence (need 26.6% referral to specialist); 72.6% noted that alcohol is good for socializing; 57.7% noted that it reduces stress; 36% (alcohol enhances sexual performance) Umoh et al. 2012 To examine 492 (265male 84% believe alcohol harm NA perception of and 227 female) exceeds its benefits; above alcohol promotion students with 88% want the government to and policy mean age of 24.84 intervene in order to protect years. 127 males the populace; 85% noted use alcohol, 138 do that alcohol can be bought not use alcohol. 98 anywhere females drink while 129 are abstainers. Abayomi 2013 To examine the 443 (291 male and 12 months prevalence of Older age, et al. relationship 152 female) second alcohol was 40.6%; 14.9% had higher parental between alcohol year students alcohol-related problem, 31.1% education and consumption and from the 32 reported heavy episodic alcohol male gender psychological departments. Age is use. 8.9% had alcohol-related predicted more well-being between 14 and 28 injuries. alcohol use

Figure 1: A flow diagram for literature review on patterns and determinants of alcohol usw among Nigerian University students, 2000-2013

33 DUMBILI

& Osinowo’s (2011) study of alcohol use consumption among respondents to in- patterns and alcohol-related perceptions clude: parental drinking, socio-economic of students who patronised drinking bars status of parents and place of residence in within the host communities revealed the university (Abikoye & Osinowo, 2011). that 44.5% had scores within Zone 1 in Their findings lend support to an earlier the AUDIT scale, and this means that they study conducted in one of the universities were low risk alcohol users, recommend- they studied (Abikoye & Adekoya, 2010). ed for just alcohol education; 43.3% had In this 2010 study, 59.4% respondents re- scores within Zone 2 and were ‘‘high-risk ported using alcohol/drug for relaxation drinkers recommended for simple advice’’ and to ‘‘feel better; 48.9%, had received (Abikoye & Osinowo, 2011 p.261). The au- warning to cut down substance use while thors reported that 10.4% of the respon- 32.6% had gotten into trouble using alco- dents were high-risk alcohol consumers hol or drugs’’ (Abikoye & Adekoya, 2010 that did not just require advice but also p.303). The authors revealed that males ‘‘counselling and continued monitoring’’ and younger students used and misused (Abikoye & Osinowo, 2011 p.261). This substances than females and older stu- is because their scores were within the dents because of the inability to delay third Zone; about 3.7% could be catego- gratification (Abikoye & Adekoya, 2010). rised under alcohol dependence because In fact, these two studies have produced their scores fell within the fourth Zone some interesting findings that corrobo- and this group needed to be referred to rated another related study (Chikere & specialists for further diagnosis and possi- Mayowa, 2011). In that study Chikere and bly treatment (Abikoye & Osinowo, 2011). his colleague note that 24.4% of the re- The results of perception, revealed that spondents use alcohol because ‘‘it makes 72.6% participants believe that alcohol fa- them feel high or on top of the world’’, cilitates a group’s socialisation, 67.9% re- 6.6% use alcohol because ‘‘it makes them ported that it helps to reduce stress, and belong to the group of happening guys’’ 57.7% use it because drinking is a mark in their various campuses (Chikere & of maturity (Abikoye & Osinowo, 2011). Mayowa, 2011 p.118). The scholars ar- Findings also revealed that 39.2% use al- gued that 52% of the respondents use cohol because it provides them with alert- alcohol for relaxation and stress reduc- ness or concentration, 36.2% believes it tion, 16% drink because of having friends enhances sexual performance, 25% use that use alcohol, and 51.1% use alcohol to it to have fun while 21.7% and 10.4% re- enhance sexual performance or pleasure spectively, reportedly use alcohol to en- (Chikere & Mayowa, 2011). That these hance boldness/confidence and to avoid students use alcohol to enhance sexual being bored (Abikoye & Osinowo, 2011). pleasure may not be unconnected to the These scholars argued that these themes way some alcoholic beverages are por- of perception were central in all the dif- trayed by producers in Nigerian as Obot ferent study sites. The respondents were & Ibanga (2002) reported: ‘‘even before also knowledgeable of alcohol-related Power added his charm to marketing of problems such as injuries, accidents, vio- the stout, Guinness was associated with lence, etc. The findings further revealed strength and sexual virility. It is not sur- other independent predictors of alcohol prising, therefore, among many lovers

34 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS of the beverage that Guinness is called contemporary Nigeria, drinking motives ‘black power’ and Viagra’’ (p.6). include inter alia: for sexual pleasure and The fact that a majority of respondent for the construction of social identity. Abikoye & Osinowo (2011) sampled are in Another finding of Abikoye & Osinowo’s the category of risky drinkers show that (2011) study that is worth noting shows alcohol use among students in Nigeria that the non-residential university’s status may be high as it is in western society has an influence on students’ drinking, and among the age group studied. This can be this is because of the increasing drinking argued to be a paradigm shift from what bars and ‘Joints’ in these communities. This obtained in the traditional Nigerian soci- finding has serious implications because it ety because young people hardly drank predicted risky sexual behaviours among alcohol and if they must drink on festive undergraduate students in Enugu (Okafor days, they must not drink independently: & Obi, 2005). One main reason is because, in Nigeria, universities prohibit sales of al- Even though, Nigerians drink a cohol on campuses, especially in the hos- great deal of alcohol, it is generally tels. Thus, host communities often take believed that it is bad to drink too advantage of this to sell alcohol and food much…. The youngest person pres- around campuses. One undeniable fact is ent, pours drinks from a container or that in Nigeria, hotels, nightclubs and bars bottle, handing the first cup to the are increasing built around universities. oldest person and then to others, in Because most universities provide partial descending order of age (Oshodin, or no accommodation for their students, 1995, p. 215). many live off campuses and due to lack of monitoring, a majority that drink attend Though the foregoing may not depict nightclubs and visit bars regularly (Abikoye the entirety of how alcohol was used in all & Osinowo, 2011). the ethnic groups that make up Nigeria, it In the same vein of alcohol and risky buttresses, the point that elders were the behaviours, a study conducted among group that drank alcohol being served by year one students at the University of the youths. Based on data from Abikoye Ibadan revealed that 33% of the respon- and colleagues’ study, it can be argued dents had used alcohol before that study that young people are not just beginning was conducted (Olley, 2008). Out of the to drink, but some are misusing alco- 30.8% participants that were active sexu- hol. In the same vein, these three stud- ally, 53% reported consuming alcohol ies (Abikoye & Adekoya, 2010; Abikoye while 8.5% males and 18% females haz- & Osinowo, 2011; Chikere & Mayowa, ardously use alcohol (Olley, 2008). Again, 2011) have revealed findings on motives Benjamin Olley revealed that, among for drinking in the contemporary Nigeri- males, alcohol abuse has a significant re- an society that are also inversely related lationship with risky sexual behaviours. to the motives for drinking in the -tradi Similarly, he argued that 3% of sexually tional Nigerian society. This is because in active participants had sex in exchange the latter, alcohol was used for religious for drugs, 7.2% for alcohol and 11% use worship, entertainment of guests, and alcohol heavily before intercourse (Olley, for pleasure (Odejide et al., 1989), but in 2008). That some students exchanged sex

35 DUMBILI for alcohol is recent evidence in Nigeria, currently use alcohol (17.6% and 4.7%, but has been reported in South Africa x2 =26, p<0.001), and the lifetime use where alcohol serves as currencies for [42.8% and 27.0%, x2 = 19.84, p<0.001] exchange of sex (Townsend et al., 2011). (Makanjuola et al., 2007) while factors Also, that 18% of females drink hazard- that predicted alcohol use include: ‘‘liv- ously corroborates an earlier study among ing alone during school period’’, having females in that same university (Olley & difficulties in ones’ academics and ‘‘being Ajiteru, 2001) which revealed that there a clinical student’’ (p.113).The data fur- was a 54.2% prevalence of harmful use ther revealed significant relationships be- of alcohol among female students. Stud- tween lifetime alcohol use, tobacco and ies concerning western countries have cannabis showing that those who were reported that young people, especially mentally healthy according to self-report males see drinking and getting drunk as were those likely to be non-current users part of growing up or becoming a man of alcohol (Makanjuola et al., 2007). This (Iwamoto, Cheng, Lee, Takamatsu, & Gor- finding corroborates the fact that alcohol don, 2011; Nayak, 2006; Roberts, 2004). misuse is harmful to health and supports This is rapidly becoming part of females’ Chikere and colleague’s study that report- life-style, especially in cultures where fe- ed that 45.5% of the participants who use male drinking is normative (MacNeela & alcohol agreed that it makes them feel Bredin, 2011), but scholars have reported bad, 63.8% reported that it makes them that rape, sexual assaults and other risky feel drowsy, encourages drunk-driving, behaviours among females are higher hangovers and causes weakness (Chikere when they are drunk (Parks & Fals-Stew- & Mayowa, 2011). Further, Makanjuola et art, 2004; Roberts, 2004). This culture of al. (2007) argued that those who claimed intoxication has arguably encroached into to be very religious were less likely to use Nigerian universities. alcohol which lends support to a previous In another study conducted among study conducted in the same university medical students of the University of Ilo- where Adelekan, Abiodun, Imouokhome- rin, Makanjuola et al. (2007) reported that Obayan, Oni, & Ogunremi (1993) report- 32% of the respondents either lived with ed that being ‘‘very religious’’, reduced their friends or were living alone. Further, use of alcohol and other substances than the data revealed that 74.1% claimed being ‘‘just religious’’ (p.250). What we to be ‘‘very religious’’, and among them know about substance use and religiosity were 68% and 32% Christians and Mus- is largely based upon empirical findings lims respectively (p.113). Additionally, from western countries. For example, 40.4% currently use at least one of these Pedersen & Kolstad (2000) argued that substances, and the findings revealed those who attached much importance to a 78% lifetime prevalence of substance religion were likely to be non-drinkers in consumption (Makanjuola et al., 2007). Norway while Gryczynski & Ward (2012) Further, 13.6% were currently consum- reported that religiosity has associations ing alcohol, and this makes it the second with abstention, less drinking, as well as most used drug among the substances less binge drinking in the USA. These Ni- examined. There were significant differ- gerian studies were conducted in western ences between males and females who Nigeria cohabited by Christians and Mus-

36 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS lims. Therefore, such empirical studies categories. Adewuya and colleagues also are required in other parts of the country argued that not being religious, paren- where 98% and 2% of the population re- tal alcohol use, being a male and having spectively are likely to be Christians and higher socioeconomic status predicted al- traditional worshipers. cohol use disorder (Adewuya et al., 2007). Makanjuola and colleagues’ finding That higher parental socioeconomic status that students who lived off-campus are predicted alcohol is in consonance with likely to be using substances than on- Abikoye & Osinowo’s (2011) study, and this campus students, lends support to two has been attributed to parental permis- other studies conducted in that same re- siveness. There is a popular maxim among gion (Abikoye & Adekoya, 2010; Abikoye, parents who might have passed through 2012). The study produced surprising re- economic difficulties growing up that sults that are relevant to the debate on ‘‘their children should not undergo hard- students’ use and misuse of substances, ship because they (parents) had it tough in especially because it was conducted life’’ (Abikoye & Adekoya, 2010 p.305), and among medical students who supposedly, this arguably encourages young people to would have known the consequences of consume substances. Though there is a substance misuse. It arguably shows that dearth of empirically result in this debate the motive for using a substance super- in Nigeria, scholars outside Nigeria have sedes the perception of a likelihood of argued that parental leniency, less moni- substance-related problems, and this is in toring and permissiveness predict young agreement with the study that reported people’s substance misuse (Ledoux, Miller, that students rode on a car under inhibi- Choquet, & Plant, 2002; Pokhrel, Unger, tion with their driver-friends who were Wagner, Ritt-Olson, & Sussman, 2008). also drunk (Abikoye & Osinowo, 2011). Similarly, Abayomi et al’s (2013) study Similarly, it supports Chikere & Mayowa’s of year one students, revealed a 14.9% (2011) finding that 52.1% current alcohol hazardous alcohol drinking prevalence. users had no intention of quitting harmful They also reported that 24.3% and 49.1% alcohol use. This finding that though peo- female and male students respectively ple may know the consequences of harm- used alcohol in the past one year. Further, ful alcohol use, they may not be willing 67.8% use alcohol monthly while alcohol- to stop drinking may not be unconnected related injury to self or others occurred with the fact that drunkenness among among 7.3% of the participants (Abayomi young people is used for constructing et al., 2013). Factors that predicted more social identity. This is in agreement with harmful alcohol consumption include: Demant & Järvinen’s (2010) findings that male gender, having a father with high drunkenness serves as social capital or re- educational status or having a severe re- source among young Danish. lationship with one’s father. The scholars In another study conducted in Osun also noted that those who reported haz- State, Adewuya et al. (2007) reported a ardous alcohol use were ‘‘four times likely 4.4% alcohol abuse for males and 1.1% for to have psychological distress’’ (p.3). The their female counterparts. The scholars ar- ensuing section will examine probable gued that 1.1% males and 0.13% females reasons for using this drug among Nige- can be rated under alcohol dependence rian students.

37 DUMBILI

Determinants of alcohol use among Presently, Nigeria has no specification/ students and consequences definition of standard drinks, no standard One factor that arguably popularised measurement for selling alcoholic bev- alcohol use on Nigerian campuses is the erages in bars as it is found in western founding of the palm wine drinkers’ club, countries, and alcoholic beverages do not called Kegite at the University of Ife in carry ABV on their labels. Unsurprisingly, 1962 (Ohaeri et al., 1996). Though the what exist in Nigeria are the self-imposed intention of this club was to reinforce Af- brewers’ self-regulations (Dumbili, 2013a). rican culture, the glamour at which mem- One of these self-imposed regulations is bers dance and drink palm wine on cam- either the drink responsibly warning mes- pus, the fact that it is a legally registered sage that often hurriedly ends electronic confraternity in Nigerian universities, the media adverts, or the International Centre popularity of Nigerians who founded the for Alcohol Policies’ (ICAP) drink responsi- club and the spread of the club to many bly campaign (Dumbili, 2013b). Scholars university campuses contributed to the (e.g. Barry & Goodson, 2010; Dowling, normalization of drunkenness among Clark, & Corney, 2006) have argued that Nigeria undergraduates. Nonetheless, the brewer-sponsored responsible drink- other plausible explanations that can be ing message is not effective mainly - be grouped under community, structural cause it is often designed with ambiguity and individual factors are hereunder ex- to promote brewers’ image (Smith, Atkin, amined. & Roznowski, 2006). In the Nigerian con- text, it has been argued to be ineffective Community and Structural Factors due to various reasons. Firstly, how can ir- Lack of policy responsible drinking be determined where Suffice it to say that Nigeria to date, is responsible consumption has not been one of the countries with high alcohol and defined? This is why Dumbili (2013a p.25) other substance-related problems (World described the drink responsibly warning Health Organization, 2009) but without message as ‘‘a paradox of semantic decep- a corresponding measure in the form of tion’’ because for one’s alcohol consump- policy (Obot, 2007; Umoh et al., 2012). tion to be defined as irresponsible, what Scholars in the 1970s (Anumonye, Omoni- constitutes responsible consumption must wa, & Adaranijo, 1977) and 1980s (Ode- have been defined. For instance, the UK jide et al., 1989) identified this problem has stipulated that male and the female’s and called on the various governments to responsible drinks per week are 21 and formulate policy to regulate alcohol but 14 units respectively (Farke, 2011); thus, to date, no policy has been formulated. In there is a basis for judging irresponsible 2010, Nigeria had a delegate at the World consumption. Health Assembly’s meeting that adopt- In the same vein, Nigerian brewers have ed the 10-point resolution for countries been collaborating with ICAP in the ‘drink without an alcohol policy to adopt and responsibly’ campaign (Vanguard, 2011), formulation policies (Chick, 2011), yet has but this has been described as an attempt eschewed any initiative towards formulat- to silence policy formulation because ICAP ing policies that will regulate alcohol sales is a brewer-funded pro-drinking organi- and consumption. zation (Jernigan, 2012; McCreanor, Cass-

38 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS well, & Hill, 2002) that cannot support ee, & Petticrew’s (2012) systematic review anti-alcohol policies. In terms of tobacco concluded that ‘‘higher outlet density in a policy, a Bill was presented to the National community may be associated with high Legislative House, but to date, it has not levels of alcohol use’’ (p. 355). In a study of been passed into law (Tafawa, Viswanath, 1050 American adolescents, for example, Kawachi, & Williams, 2012). This lack of Resko et al. (2010) noted that alcohol out- regulation has been attributed to several let density engendered violence among reasons, one such being ‘‘the immense these adolescents. Similarly, McKinney, benefit that the government derives in the Caetano, Harris, & Ebama (2009) found a form of tax from alcohol industries’’ (Iban- strong association between alcohol outlet ga et al., 2005 p.150). The non-regulation density and partner violence among Amer- of alcohol is having serious impacts on the ican couples while Spoerri, Zwahlen, Pan- normalization of alcohol misuse among czak, Egger, & Huss (2013) observed that, Nigerian students, and this contributes to in Switzerland, alcohol-related deaths had the increasing alcohol-related problems an association with the closeness of sale in Nigeria. This is in keeping with a recent outlet in the neighbourhood. Additionally, study in a Nigerian university which re- Ahern, Margerison-Zilko, Hubbard, & Ga- ported that 88% of the students agreed lea (2013) note that it was associated with that lack of policy is the main cause of the binge drinking among adults in the USA, increasing alcohol-related problems in Ni- and Schofield & Denson (2013) observed geria (Umoh et al., 2012). that the longer the hour of alcohol outlet Additionally, Umoh and colleagues re- sale, the higher violent crime is witnessed ported that more than 85% of the partici- in New York State. pants noted that this makes it easy for any- That alcohol can be purchased any- body to purchase ‘‘alcohol anywhere in Ni- where lends support to the fact that, in geria’’ (Umoh et al., 2012 p. 110-111). This Nigeria, there is no restriction on alco- unrestricted availability has a long history hol sale (Umoh et al., 2012) (except in according to Oshodin (1995) because ‘‘it some northern states where Sharia laws is possible to see a five-year-old child pur- exist) due to lack of policy on on/off li- chasing alcohol’’ in Nigeria (p.219), and this cence sales. One serious consequence of corroborates Chikere & Mayowa’s (2011) this lack of policy is that minors can buy finding that alcohol can be purchased any- and consume alcohol in Nigeria, and this where. Internationally, scholars (e.g., Cam- leads to early alcohol initiation. For- ex eron et al., 2012; Cameron, Cochrane, Gor- ample, Chikere and colleague reported don, & Livingston, 2013; Pridemore & Gru- that 11.6% of their respondents started besic, 2012; Young, Macdonald, & Ellaway, drinking between 11-15 years, and this 2012) have argued that alcohol-problems corroborates Odejide, Ohaeri, Adelekan, increase with the increase in availability & Ikuesan’s (1987) report that 40% of of sale outlets and its density. Thus, it is the participants had their first drink at argued that regulating alcohol availability 11 years. Though this has a long history via policy reduces access to alcohol, deters in Nigeria (Oshodin, 1995), it arguably has misuse, and reduces alcohol-related prob- increased in contemporary Nigeria where lems among young people (Gruenewald, alcohol industries are sponsoring differ- 2011). For example, Bryden, Roberts, McK- ent night youth-oriented events, admit-

39 DUMBILI ting youths free of charge and nurturing drink more regularly’’ (Van Den Bersselaar, and arguably future patrons (Dumbili, 2011 p.401). This persuasion of light drink- 2013b). Another implication of this lack ers to consume more has persisted as Obot of regulation is that many faculty events & Ibanga (2002) argued: ‘‘the introduction are now sponsored by alcohol producers, of the new bottle brought a sudden revival and many sales outlets are increasingly in consumer interest for Star and at the located in Nigerian university campuses. moment, Star is Nigeria’s favourite beer… Undeniably, this contributes to high and Star is now the beer of pleasure, fun, lei- alcohol misuse among students, which of- sure and shared drinking’’ (p.7). One rea- ten results in clashes that are rampant in son these marketing activities may predict Nigerian higher education (Rotimi, 2005). students’ alcohol use is that:

Advertising, Marketing, Promotion and Advertising and other marketing Availability techniques are one potential source Presently, alcohol adverts, marketing of information for young people and promotions are becoming increas- about the cost and benefits of al- ingly aggressive, and brewer-sponsored cohol. Advertising creates the im- promotion are rife with offers including pression that, for a relatively small ‘drink and win free drinks’, cash, cars and expenditure, young people can psy- other gifts. As noted, brewers now spon- chologically connect to the positive sor different youth-oriented programmes fantasy places, lifestyle and person- such as fashion shows, faculty night ality characteristics that it portrays events, etc. on and off campuses that (Saffer, 2002 p.173). may encourage students to drink alco- hol (Dumbili, 2013b; Nigerian Breweries, Though this ‘‘buy five and get one free 2012). Additionally, different other youth- promotion’’ has been since the early targeted events are sponsored by brew- 2000s (Obot & Ibanga, 2002 p.7), it is be- ers and tobacco producers either on the coming increasingly sophisticated. This is media, hotels or stadia such as Star Trek, because brewers and tobacco producers Star Quest, Legend Real Nite Deal, Benson use popular Nigerian musicians or actors/ and Hedges Music Time (Dumbili, 2013b; actresses as models to advertise and pro- Tafawa et al., 2012). mote these events, admit attendees free This aggressive advertising may have as well as offer them free drinks. Simi- accounted for the reason ‘Star beer’ was larly, as tradition media are promoting the most used beverage among Chikere & these events/promos, brewers upload Mayowa’s (2011) respondents. It is note- them in their websites and social media worthy that in the 1960s Nigerian Brewer- such as Facebook and YouTube and en- ies Limited [NBL] (Star producer), conduct- courage Nigerian youths to visit and view ed a research and discovered that Star was them (Nigerian Breweries, 2013), but this not selling as the brewer intended. Fol- has serious implications. Scholars have lowing this, ‘‘NBL wrote a new advertising argued that young people who are ex- brief for their agency, specifying the need posed to constant media messages and to build up a stronger brand image, and texts are likely to behave in tandem with the aim of persuading ‘light’ drinkers to ‘media fact’, because many receive media

40 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS messages at face value (Atkinson, Bellis, see advertising 2 or 3 or 4 times a week’’ & Sumnall, 2012; Hanewinkel & Sargent, and further explained why she prefers 2009; Hanewinkel et al., 2012), especially Star commercials: ‘‘because you can win in relation to alcohol and drugs (Minnebo so many things, for example, free drinks’’ & Eggermont, 2007; Thomson, 2012). (p.37). This lends support to what schol- Thus, Atkinson et al. (2012) reported that ars from other countries noted that the ‘‘social norms theories of alcohol con- sponsorship of events encourages people sumption suggest that individuals draw to drink (O’Brien, Miller, Kolt, Martens, & on the behaviour of significant others Webber, 2011), promotional parapherna- (e.g. peers, parents, and television char- lia directly induces those who received the acters) as a guide to what are ‘normal’ items to use the product (O’Brien & Kypri, drinking practices, which then reinforces 2008) while ‘‘bar-sponsored drink special socially acceptable behaviour’’ (p.91-92). increased patrons’ level of intoxication’’ Because ‘‘mass media depictions are (Thombs et al., 2009 p.206). This arguably not true, at best, they are partial truths; contributes to the growing culture of in- sometimes we may even feel they are col- toxication in Nigerian universities and may lections of lies’’ (Seale, 2003 p.514), they continue because of lack of regulations. often portray commercials and adverts that create ‘‘product hyper-reality’’ (Mc- Individual factors Creanor, Greenaway, Barnes, Borell, & Scholars have argued that no amount of Gregory, 2005 p.255). This creation of ex- alcohol is risk free, therefore, ‘‘abstinence aggerated messages and texts has been is a socially acceptable choice’’ (DeJong, argued (Connolly, Casswell, Zhang, & Silva, Atkin, & Wallack, 1992 p.675). In contem- 2006; Ellickson, Collins, Hambarsoom- porary Nigeria, many young people due to ians, & McCaffrey, 2005; Gordon, Moodie, the inability to delay gratification (Abikoye Eadie, & Hastings, 2009; Gunter, Hansen, & Adekoya, 2010) often take the freedom & Touri, 2008; Nicholls, 2012; Saffer, 2002) from their parents as an opportunity to to enhance young people’s alcohol misuse drink alcohol and involve in other social not just because they are often targeted vices. This is because some parents still at young people (Jones & Donovan, 2009), prohibit young people from using alcohol but because they ‘‘entail an interactive as- at home. That Nigerian undergraduate stu- pect in the sense that the content engages dents now use alcohol and drunkenness the audience, evoking their cultural capital for constructing social identity (Chikere & in a way that rely on some of the methods Mayowa, 2011) as has been reported in of conversation’’ of the media characters other countries (Ridout, Campbell, & Ellis, (McCreanor et al., 2005 p.256). 2012), shows that many young people use In Nigeria, the implications of this media this drug with predetermined motives and pervasiveness have been reported among arguably careless about the consequenc- adolescents. De Bruijn (2011) reported es. Many students, especially males often that a boy of 14 revealed that he admires want to be seen as part of the elites on the advertisement of ‘Stout’ due to ‘‘the campus, and this makes them attend par- free drinks they promote’’ and added that ties, nightclubs (Chikere & Mayowa, 2011) ‘‘if I don’t see the Stout ad on television, I and other places where it may be difficult feel bad’’ (p.37). Another girl said that ‘‘I to resist peer pressure to drink alcohol.

41 DUMBILI

This theme was consistent in all the stud- severe relationship with one’s parents, ies that examined factors that can predict having academic difficulties and being a alcohol use. Again, parental factors such clinical student encouraged alcohol con- as having severe relationship problems sumption among Nigerian students. with one’s parents, having parents that drink and having parents with high socio- Strengths and limitations of the studies economic status predicted alcohol use. Studies reviewed varied in quality, but This reveals that many parents contribute the overall strength is that many used rela- to this social problem. That parental drink- tively large samples, appropriate designs ing predicted more alcohol among these and validated instruments (AUDIT) as well students corroborates Cranford, Zucker, as an explicit language of expression in Jester, Puttler, & Fitzgerald’s (2010) study their data presentation and discussion. De- in the USA. spite these strengths, many were flawed In Nigeria, Oshodin (1984) had earlier because of the choice of self-reporting in- noted that secondary school students in struments. Again, some did not use a rep- Benin City use and misuse alcohol be- resentative sample while some chose to cause while some of their parents use the sample only male or female without giving drug, others apply alcohol herbal medi- any reason for making such choices. Addi- cine to their sick wards which leads to tionally, all the ten titles were quantitative the early onset of alcohol use. He equally studies, and this is a major flaw. That no added that many parents often send their qualitative or mixed methods study has children (mostly minors) to buy alcohol- been conducted in Nigeria among universi- ic beverages for them or for their guest ty students arguably, means that address- (Oshodin, 1995), and this contributes to ing the rising alcohol-related problems exposing these minors to alcohol which may be difficult because quantitative data arguably continues when they leave their may not be enough to proffer solutions to homes for higher education. In the same alcohol-related problems because they do vein, lack of parental discipline has been not capture people’s lived experience. recently found to predict substance use in Nigeria (Abasiubong, Idung, Udoh, & Strengths and limitations of the review Ekanem, 2012), and as Abikoye & Ad- The review as noted is the first to syn- ekoya (2010) noted, many Nigeria parents thesis studies of this kind in Nigeria, thus who might have encountered economic has added to the literature. Secondly, constraints while growing up often boost the review points out clearly the find- that their wards will not suffer the same ings of different studies based on the re- fate. Thus, they give large sums of money gion these studies were conducted. This to these youths while returning to school. will arguably make intervention easier Because some of these students are un- for specific regions and populations. This derage (as this reflected in this review notwithstanding, the review is limited that younger age predicted more alcohol by the fact that a number of studies may use), they tend to use the money on fri- have been missed, especially those that volities, one such being alcohol misuse. were not published in journals (grew liter- It is also noteworthy that factors such as ature) such as thesis and dissertation or in living off campus, being a male, having some Nigerian journals that do not have

42 ALCOHOL USE AMONG NIGERIAN UNIVERSITY STUDENTS online databases. Secondly, as the review purchasing age laws, promotion of al- covered only papers published in English, cohol free activities on campuses and articles published in other languages may community mobilisation approach’’ have strengthened the review if they were (Umoh et al., 2012, p.113). included. It is also worthy of note that the papers reviewed were not selected based Brewers should be banned from spon- on their qualities. Therefore, this varia- soring faculty activities and the giveaway tion in the quality of these studies may of branded paraphernalia should be re- have affected the quality of the review. considered. There is also an urgent need to address the sale of alcohol to minors. Recommendations and conclusion In order to achieve this objective, the Moderate alcohol consumption may government has to issue the citizens na- not harm the body but misuse engen- tional identity cards as this has been -ef ders severe consequences which might fective for identifying minors in devel- not just affect the drinker but also others oped countries. Similarly, there is a need (Wechsler et al., 2002). That some Nige- to designate on and off licence sale points rian youths use alcohol for sexual pleasure and strictly enforce it because many of (Chikere & Mayowa, 2011; Klein, 2001; the studies reviewed reported that alco- Sunmola, Olley, & Oso, 2007) may lead to hol can be purchased anywhere. In the none or inconsistent use of contraception meantime, the parents, religious organi- such as condoms due to lack of inhibition zations and nongovernmental organiza- (Sunmola et al., 2007) and may engender tions should assist in reorienting Nigerian the contraction of sexually transmitted ill- youths. This is because as the government ness. In the same vein, Nigeria’s higher ed- has eschewed every attempt to formulate ucation (due to drug misuse among some and implement alcohol policies, orienta- students) has witnessed several clashes tion and social marketing should bead- due to secret cult activities, and many -in opted for value reorientation. nocent students have been killed by stray In addition, every university should bullets (Rotimi, 2005). Other substance-re- establish different spheres of interven- lated problems reported among Nigerian tion ranging from counselling centres to students include: depression, anxiety (Ad- treatment of alcoholics. This will help in ewuya et al., 2006), alcohol dependence informing students about the health and (Abikoye & Osinowo, 2011), and poor aca- social consequences of using alcohol as demic performance (Ihezue, 1988a). a means of reducing stress, managing Therefore, to proffer solutions to the academic difficulties and harmful alco- increasing substance misuse among Nige- hol use. It is also vital that the screen- rian students, policies should be formu- ing of individuals/students for hazardous lated and implemented to regulate the: and harmful alcohol consumption, brief intervention and referral to treatment physical availability of alcohol and (SBRIT) should as a matter of urgency other drugs by partial or total ban, be periodically performed by trained ex- regulating retail outlet, hour and days perts with instruments such as AUDIT and of retail sale, restriction on eligibility CAGE questionnaire in various campuses. to purchase and sell alcohol, minimum As it was reported that living off cam-

43 DUMBILI pus predicted more alcohol use, hostels Abikoye, G. E., & Adekoya, J. A. (2010). Pre- should be constructed by many universi- dicting substance abuse in a sample ties where such is lacking, and students of Nigerian undergraduate students: should be encouraged to live on campus The role of core self-evaluations and because alcohol sale is prohibited in most delay of gratification. Psychological Nigerian universities’ hostels. It is equally Studies, 55(4), 299-307. recommended that parents should desist Abikoye, G. E., & Osinowo, H. O. (2011). from sending minors to buy alcoholic bev- In the eye of the beholder: Alcohol erages for them and should not give their use and perceptions among student- wards too much money that can lead to patrons of ‘Joints’ in three Nigerian spending such in frivolities. Until these university communities. Psychologi- are implemented, the growing culture of cal Studies, 56(3), 258-265. intoxication may continue, and other mo- Adelekan, M. L., Abiodun, O. A., Imouok- tives for consuming alcohol will emerge. home-Obayan, A. O., Oni, G. A., & Ogunremi, O. O. (1993). Psychosocial correlates of alcohol, tobacco and REFERENCES cannabis use: Findings from a nige- rian university. Drug and Alcohol De- Abasiubong, F., Idung, A., Udoh, S., & pendence, 33(3), 247-256. Ekanem, U. (2012). Parental influence Adelekan, M. L., Abiodun, O. A., Obayan, on substance use among young peo- A. O., Oni, G., & Ogunremi, O. O. ple in the Niger delta region, Nigeria. (1992). Prevalence and pattern of African Journal of Drug and Alcohol substance use among undergradu- Studies, 11(1), 9-16. ates in a Nigerian university. Drug and Abayomi, O., Onifade, P. O., Adelufosi, A. Alcohol Dependence, 29(3), 255-261. O., & Akinhanmi, A. O. (2013). Psy- Adelekan, M. (1989). Self-reported drug chosocial correlates of hazardous al- use among secondary school stu- cohol use among undergraduates in dents in the Nigerian state of Ogun. south-western Nigeria. General Hos- Bulletin on Narcotics, (1),41 109-116. pital Psychiatry, 35(3), 320-324. Adewuya, A. O. (2005). Validation of the Abdulmalik, J., Omigbodun, O., Beida, O., alcohol use disorders identification & Adedokun, B. (2009). Psychoactive test (audit) as a screening tool for al- substance use among children in in- cohol-related problems among Nige- formal religious schools (Almajiris) in rian university students. Alcohol and northern Nigeria. Mental Health, Reli- Alcoholism, 40(6), 575-577. gion and Culture, 12(6), 527-542. Adewuya, A. O., Ola, B. A., & Aloba, O. O. Abikoye, G. E. (2012). Psycho-spatial pre- (2006). Gender differences in the re- dictors of alcohol use among motor lationship between alcohol use and drivers in Ibadan, Nigeria: Implica- anxiety symptoms among Nigerian tions for preventing vehicular acci- college students. Drug and Alcohol dents. The International Journal of Al- Dependence, 85(3), 255-257. cohol and Drug Research, 1(1), http:// Adewuya, A. O. (2006). Prevalence of ma- ijadr.org/index.php/ijadr/article/ jor depressive disorder in Nigerian view/32/19. college students with alcohol-related

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African Journal of Drug & Alcohol Studies, 12(1), 2013 Copyright © 2013, CRISA Publications REPRESENTATIONS SOCIALES DE LA CONSOMMATION DE TRAMADOL AU NIGER, PERCEPTIONS ET CONNAISSANCES DES COMMUNAUTES : ENJEUX POUR LES ACTIONS DE LUTTE

Djibo Douma Maiga1,2, Houdou Seyni2, & Amadou Sidikou2

1Faculté des Sciences de la Santé de Niamey, Niamey, Niger 2Service de Psychiatrie, Département de médecine et spécialités médicales de l’Hôpital National de Niamey, Niamey, Niger

RESUME

Le chlorhydrate de Tramadol est un antalgique de palier II sur la classification de l’OMS des médicaments anti douleurs. Son trafic illicite et utilisation détournée et abusive sont devenus un problème social au Niger. L’objectif de cette étude était de décrire les représentations sociales du tramadol évaluées à travers les connaissances et les attitudes des communautés - représentées par les élus locaux, les vendeurs ambulants de produits pharmaceutiques et les administrateurs - et de mettre ces représentations en lien avec les pratiques de sa consommation. L’étude était qualitative, transversale et descriptive. Il ressort une dualité dans la dynamique représentationnelle du Tramadol passant du «Tramadol-médicament» au «Tramadol-drogue» responsable respectivement d’une consommation naïve et d’une consommation abusive et dépendante. Toute mesure de lutte contre ce phénomène doit promouvoir des connaissances et attitudes communautaires en lien avec les conséquences sociales et sanitaires de la consommation de cette substance.

Mots clés: Représentations sociales, Tramadol, drogue, médicament, prévention

ABSTRACT

SOCIAL REPRESENTATIONS OF CONSUMPTION OF TRAMADOL IN NIGER, PERCEPTIONS AND KNOWLEDGE OF COMMUNITIES: ISSUES FOR ACTION Tramadol hydrochloride is a Level II analgesic on the WHO classification of anti-pain medications. Its smuggling, diversion and abuse have become a social problem in Niger. The objective of this study was to describe the social representations of tramadol evaluated through the knowledge and attitudes of communities -- represented by the local officials, vendors of pharmaceuticals and administrators -- and to these representations in connection with practices of consumption. The study was qualitative, cross-sectional and descriptive. It follows a duality in the representational dynamics of Tramadol from the “Tramadol-

Corresponding Author: D. Douma Maiga : Psychiatre, Maitre assistant. Faculté des Sciences de la Santé de Niamey, Université Abdou Moumouni, BP : 10896, Niamey Niger. Email: [email protected] MAIGA, SEYNI & SIDIKOU medication” to “Tramadol-drug” responsible for respectively naive consumption and abuse/ dependent consumption. Any control measures against this phenomenon must promote community knowledge and attitudes in relation to the social and health consequences of the use of this substance.

Key words: Social representations, Tramadol, drug, prevention

INTRODUCTION de santé (Maiga et al., 2013b), l’objectif était, premièrement d’appréhender les Plusieurs études, font état d’une pro- univers représentationnels du Tramadol gression de l’utilisation des médicaments à travers les connaissances et perceptions à des fins non médicales par les adoles- des communautés, puis secondairement cents et les jeunes adultes dans le monde. de mettre en relation ces représentations En Afrique, ce phénomène a concerné avec les pratiques de sa consommation certains médicaments (coritico-stéroïdes, dans les communautés. dihydroergocryptine, trinitrine percu- tanée, testostérone, dapsone, rétinol, METHODOLOGIE hydroquinone, benzodiazépines et autres sédatifs etc.) pour des motifs divers (Lévy Type d’étude & Thoër, 2008). A cette liste non exhaus- Il s’est agi d’une étude qualita- tive, s’est ajouté le Tramadol (UN Office tive, transversale et descriptive sur les Contre la Drogue & le Crime, 2013a ; UN représentations du Tramadol à travers les Office Contre la Drogue & le Crime [UNO- connaissances et perceptions en milieu DC], 2013b). communautaire. Elle a été réalisée du 1er Au Niger, le Tramadol est devenu avril au 10 mai 2013. aujourd’hui la substance psychoactive la plus consommée, en raison de son agré- Cadre, Populations cibles et méthodes ment populaire (Sani, 2009 ; Maiga et al., Cadre 2013a ; Maiga et al., 2013b). L’étude a été réalisée au Niger. Elle Parce que le rapport aux substances s’était intéressée aux communes ur- psychoactives s’inscrit dans un contexte baines (dont les conseils sont localisés social et culturel porteur de sens, un dé- au niveau des chefs lieux des départe- bat s’est déclenché au tour de la nature ments). Selon le découpage adminis- et de la dangerosité de cette substance tratif, le pays compte 45 communes d’une part et des moyens de lutte à mettre urbaines. en œuvre face à l’ampleur grandissant du Le choix des communes urbaines ayant phénomène d’autre part. servi de sites pour l’étude a été effectué Au regard, des données dont on dispose selon une commodité motivée par les sur le Tramadol au Niger : Trafic illicite moyens financiers destinés à l’étude. (UNODC, 2013b); usage détourné et abusif Étaient retenues, les communes si- par les communautés (Sani, 2009 ; Maiga tuées aux alentours et sur les principaux et al., 2013a) ; conséquences sanitaires axes divisant le pays de l’Ouest à l’Est et du mésusage observées dans les centres du Sud au Nord.

54 TRAMADOL AU NIGER

Populations cibles La collecte des données Les populations cibles étaient les com- Elle a été réalisée par une équipe munautés1 des communes urbaines, re- d’enquêteurs composée de trois per- tenues pour participer à l’étude. sonnes : un spécialiste en santé mentale Chaque communauté de commune re- (Technicien supérieur en santé mentale tenue, a été représentée par des élus lo- ou psychiatre), modérateur qui a animé caux, des vendeurs ambulants de produits l’entretien ; un magistrat et un psycho- pharmaceutiques et des responsables ad- logue, observateurs, ont noté les en- ministratifs sur le postulat que ces profils tretiens et ont intervenu au cours des de représentants détiennent l’information entretiens. qui aiderait à atteindre les buts de l’étude. Avant le début de chaque entretien Les groupes de discussion (un par com- de groupe, les participants ont été infor- mune) ont été constitués par les directions més que leur inscription sur la liste de des conseils communaux et les enquêteurs présence correspondait à leur consente- à dessein d’un dialogue serein et construc- ment pour participer à l’étude. Ils ont été tif. Pour atteindre ce but, chaque groupe également informés de la possibilité de de discussion a été constitué par au moins retirer leur consentement à tout moment un élu local, au moins un vendeur ambu- du déroulement de l’étude. lant de produits pharmaceutiques et au Les entretiens de groupe se sont moins un responsable administratif. Toute déroulés dans les hôtels des villes des fois le nombre de participants par groupe communes selon le schéma suivant : de discussion a été prévu pour ne pas dé- passer 14, pour satisfaire aux exigences 1 présentation de l’équipe d’enquêteurs numériques de participants à un groupe et des objectifs de la rencontre ; discussion d’étude qualitative (4 à 12 par- 2 animation de la discussion de groupe par ticipants) avec une moyenne fixé à 10 (Ba- introduction progressive des thèmes ; ribeau et al., 2010). Les participants aux 3 au cours des discussions, les partici- groupes de discussion étaient, sans distinc- pants ont été invités à s’exprimer pen- tion de sexe, d’ethnie et de langue, mais ils dant environ une heure sur les thèmes étaient d’âge excluant les mineurs. suivants contenus dans le guide d’entretien : Déroulement de l’enquête a. connaissances sur le Tramadol et sa Les responsables administratifs ont été consommation dans les communau- informés du passage des enquêteurs par la tés ; voie administrative deux semaines avant b. perception de l’ampleur (fréquence l’arrivée de l’équipe. Ils ont été chargés à et gravité) de la consommation de leur tour d’informer les informateurs clés, Tramadol dans les communautés ; potentiels participants aux groupes de c. propositions de stratégies pour la discussion (élus locaux et vendeurs ambu- lutte contre le phénomène si néces- lants de produits pharmaceutiques). saire.

1 Dans cette étude le terme de communauté fait référence à des habitants d’une entité administrative (Ici communes urbaines). Il s’agit de communauté hétérogène composées de plusieurs groupes ethniques (donc de pratique culturelle différente) qui selon les régions parlent tous une des deux langues impérialistes (une des deux langues dominantes du Niger) : Haoussa ou Djerma. Ils partagent toute fois la même religion.

55 MAIGA, SEYNI & SIDIKOU

Un résumé immédiat de chaque en- RESULTATS tretien de groupe a été fait et présenté aux participants, le rapport final de l’enquête L’enquête a été menée dans 34 com- leur a été communiqué par courrier. munes urbaines (sur les 45 du pays soit 75,55%), avec la participation de 442 per- Analyse des données sonnes réparties dans 34 focus groupes Les noms des participants ont été chan- composés de 5 à 14 sujets. gés ainsi que ceux de leur communauté d’origine afin d’assurer l’anonymat. L’analyse a été thématique, elle a utilisé CONNAISSANCES DU TRAMADOL la technique déductive. Les données tex- tuelles ont été saisies par le logiciel Word. Les noms d’appellation du Tramadol Puis, les différentes parties du texte ont Le Tramadol est connu généralement été regroupées selon les catégories thé- sous le nom de « tramol », mais 14 au- matiques suivantes : tres noms ont été répertoriés princi- palement donnés par les vendeurs am- 1 nom d’appellation du Tramadol; bulants de produits pharmaceutiques. 2 fréquence de consommation ; Selon ces derniers, ces appellations 3 gravité (conséquences sociales et sani- sont en rapport avec non seulement la taires); présentation et l’intensité de ses effets 4 raisons et modes de consommation; mais également avec la dissimulation 5 consommateurs; du produit. Le tableau I donne les dif- 6 drogue ou médicament; férentes appellations répertoriées, leur 7 structures de soins de santé; traduction en français et leurs référenc- 8 prestations de soins de santé. es symboliques

Tableau 1. Appellations du Tramadol, traduction en français et références symboliques

Appellations Traduction en Français Références symboliques

“Salou Djibo” Salou Djibo Nom d’une personne considérée comme un héro au Niger “Maiguiwa” «A éléphant» L’emballage comporte la photo d’un éléphant symbole de force “Tra” Tra Diminutif de tramol = Nom de code “Moltra” Moltra Verlan : prononciation des mots en syllabes inversées “Goudou” Courir Augmentation de la vitesse d’exécution des activités “120” Dosage 120 mg Conditionnement forte à 120 mg “Bari Ban Bari” « Arrête ! je n’arrête pas » Persévérant dans les activités physiques “Gabi” Force Force physique “General” Général Apte à tout faire “Kioum” Sec Relatif aux crises convulsives “Sodja” Militaire Symbole du combat, de la force du feu “Wouta” Feu Qui ravage tout sur son passage “Chaud” Chaud Très actif “Tramol-Monsieur” Tramol-monsieur Relatif à l’usage aphrodisiaque

56 TRAMADOL AU NIGER

Fréquence Une analyse plus approfondie permet Les participants ont estimé que la con- de regrouper les raisons abordées en sommation de Tramadol est fréquente deux thèmes plus larges, une première voire très fréquente, que les consomma- consommation de Tramadol comme un teurs sont souvent jeunes (intervalle d’âge traitement médicamenteux et une sec- 10 à 30 ans) et de genre masculin. Ils ont onde comme une drogue. noté toute fois que cette consommation n’épargne aucun âge ni aucun sexe. Modes de consommation Quelque soit la raison évoquée, deux Gravité modes de consommation ont été mis en En termes de gravité de la consom- évidence : Une consommation collective mation, les participants ont associé la au cours des regroupements d’hommes consommation du Tramadol à certaines et/ou de femmes et surtout des jeunes et complications sanitaires et sociales une consommation individuelle souvent comme : les crises convulsives, troubles indépendante de l’âge et du sexe. psychiatriques, décès, bagarres ran- Le tableau II résume les deux modes gées, vols en association, enlèvements de consommations de consommation du et viols, meurtres, accidents de la circu- Tramadol et leurs circonstances lation. L’administration se fait par voie orale Les effets dévastateurs du Tramadol sur sous la forme de comprimé. Le Tramad- la santé des consommateurs et la société ol est consommé seul ou dilué dans des ont été comparés par certains partici- boissons (sucreries, café, thé etc.). pants à ceux du Vih/Sida.

Raisons de la consommation PERCEPTIONS ET REPESENTATIONS Les raisons de la consommation de DU TRAMADOL Tramadol abordées par les participants se focalisent sur l’amélioration de la per- Une analyse thématique plus détail- formance au travail physique, la préven- lée du discours des participants met en tion et le traitement de la fatigue liée au évidence une perception différenciée de travail, le traitement de certaines dou- cette substance influencée par les mo- leurs physiques, la recherche de sensa- dalités de consommation. Le «Tramadol- tion et de plaisir, la délinquance et la drogue» était évoqué par certains par- dépendance. ticipants, dans ce cadre, il est associé à

Tableau 2. Modes et circonstances de consommation du Tramadol

Modes de consommations Circonstances de la consommation

Consommation collective Regroupement de réjouissance (Baptêmes, mariages etc.) Travaux physiques collectifs (travaux communautaires, etc.) Toxicomaniaque (délinquance, recherche de sensation etc.) Consommation individuelle Prévention de la fatigue Traitement de la fatigue Recherche de performance physique ou sexuelle (sport, compétition, plaisir etc.) Traitement de toutes formes de douleurs

57 MAIGA, SEYNI & SIDIKOU la détente, au plaisir, à l’abus et ses con- physique, une de mes amis m’avait séquences sur la santé et la société. Cette donné une plaquette de tramol en me analyse est soutenue par le témoignage ventant ses mérites sur l’amélioration de cet administrateur : des performances physiques. Arrivée à la maison, lors du colisage des mes « Ce que je vais raconter est honteux. bagages, les enfants ont vus le mé- C’était, à la fermeture des bureaux dicament et s’étaient écriés tout en de vote d’une des élections passées, me demandant ce que je voulais faire les jeunes animateurs des bureaux de avec cette drogue » (Z, 48 ans). vote nous avaient demandé de l’agent du tramol. Sans aucune hésitation, nous potentiels élus avions accéder à LES MESURES DE LUTTE CONTRE leur demande. Hum ! Quelques heu- LA CONSOMMATION ABUSIVE res, plus tard les jeunes étaient dans une situation d’agitation collective, ils En termes de stratégies de lutte contre n’étaient pas accessibles à nos tenta- l’abus du Tramadol, toutes les proposi- tives de raisonnement. Alors pour les tions ont indiqué l’implication des poli- dissuader, nous avions fait appel à tiques, responsables coutumiers, admi- la police, qui n’avait pas réussi à les nistratifs et religieux, agents de santé, calmer, c’est alors que nous avions forces de sécurité et des douanes. Elles eu l’idée de faire intervenir l’armée. étaient les suivantes : A l’arrivée, l’armée avait fait des tirs − campagnes générales de communication en l’air dans le but d’intimider et de sous diverses formes (sketches, publi- disperser les jeunes. Qu’elle fut ma reportages, débats radiophoniques et té- surprise, notre surprise ! A chaque lévisés, caravanes de sensibilisation etc.) salve de tirs, les jeunes demandaient pour le changement de comportement encore des tirs en l’air. En fait les tirs à l’endroit de toutes les couches sociales ne faisaient que les exciter davantage, surtout les jeunes et les vendeurs ambu- finalement les altercations que nous lants de produits pharmaceutiques etc. ; voulions éviter surmenèrent. C’était − mesures législatives telle que la pénali- terrible » ! (M, 38 ans) sation du trafic et de l’usage ; − interdiction de l’importation et du tran- Le «Tramadol-médicament» évoqué sit au Niger ; par d’autres était associé au traitement − amélioration de l’accessibilité aux pres- ou à la prévention de certains états jugés tations de soins de santé et de la dis- à tort ou à raison comme troubles ou mal- ponibilité des médicaments (Réorgan- adies. Le témoignage de cette élue locale iser, encadrer, accompagner et multi- est illustratif : plier les dépôts légaux de vente des médicaments pharmaceutiques) ; « Je devais aller à la Mecque pour le − prise en charge médicale des per- pèlerinage, et il est d’usage de pren- sonnes souffrant des complications de dre des conseils et même des cours l’usage du Tramadol ; auprès des avertis. Savez-vous que, le − création de centres d’insertion des pèlerinage est également une épreuve jeunes oisifs.

58 TRAMADOL AU NIGER

DISCUSSION sommation abusive et dépendante. Les raisons de la consommation pourraient L’intérêt de cette recherche réside dans être expliquées par un processus fondé l’identification de la dynamique représen- sur les psychologies naïves et les théories tationnelle du Tramadol dans nos commu- de sens commun (Heider, 1958). Ce type nautés. Cela peut être porteur d’enjeux de processus a déjà été mis en évidence publics (santé publique, cadre légal) et de au sujet de l’alcool, quant à ses effets privés (mode de vie), en raison des infor- thérapeutiques curatifs et/ou préventifs mations qui font état de son trafic et de de certaines affections (Dubet, 1992 ; son mésusage au Niger (UNODC, 2013a ; Dany, & Apostolidis, 2002). UNODC, 2013b ; Sani, 2009 ; Maiga et al., Le mode de consommation qui a ori- 2013a ; Maiga et al., 2013b). enté la catégorisation, les préoccupations La qualité des informations de cette et centres d’intérêts des participants à étude peut être garantie et reprodu- travers la valorisation de certaines théma- ite par des entretiens de groupe bien tiques a permis d’identifier une dualité des conduits, un échantillonnage par com- perceptions du Tramadol. Premièrement, modité d’abord (ayant permis de pren- le Tramadol est perçu comme une drogue dre en compte la quasi totalité des com- par certains participants. Cette percep- munes du Niger) et à dessein des enquê- tion est argumentée par le mode abusif tés basé sur des statuts sociaux qui font de la consommation (dose et fréquence) d’eux des informateurs clés. Les apports et ses conséquences sanitaires et légales. d’informations de ces derniers dans les Cette perception est également argumen- études qualitatives ont été prouvés (Ci- tée par certains noms de code attribués cero et al., 2011). à cette subtance qui font penser à une Ces caractéristiques de l’étude nous reconnaissance tacite de l’illégalité de la ont permis d’approcher la relation que consommation. Deuxièment, le Tramadol les communautés entretiennent avec est perçu comme un médicament. Cette le Tramadol, c’est à dire les connais- perception est argumentée par une con- sances, croyances et attitudes partagées. sommation pour suppléer à une insuffi- L’ampleur, tant en termes de fréquence sance des prestations de soins de santé de consommation, que de gravité va dans et une non disponibilité des médica- le même sens que les écrits précédents ment dans les structures de soins. Elle est sur le sujet au Niger (Sani, 2009 ; Maiga également argumentée par l’idée selon et al., 2013a ; Maiga et al., 2013b). En ef- laquelle l’amélioration de l’accessibilité fet, tous les participants s’accordent sur financière et géographique des médica- l’ampleur grandissant du phénomène. Il ments dans les structures de santé est ressort également que, les participants un moyen de lutte contre l’abus. Ce point s’accordent sur les effets nocifs de son de vue est partagé par HAMEL (http:// mésusage pour la santé des consomma- www.remed.org/THESE_V_Hamel.pdf teurs. Toute fois, ils appréhendent beau- cité 8 juillet 2013) dans sa thèse intitulé : coup moins les capacités addictogènes in- La vente illicite de médicaments dans trinsèques du Tramadol qui semble jouer les pays en développement : analyse de un rôle majeur dans la transformation l’émergence d’un itinéraire thérapeu- d’une consommation naïve en une con- tique à part entière, situé en parallèle du

59 MAIGA, SEYNI & SIDIKOU recours classique aux structures officielles des connaissances et attitudes commu- de santé. nautaires en lien avec les conséquences Les connaissances des participants in- sociales et sanitaires de la consomma- fluencent donc les représentations que tion, dans un environnement doté de pr- ces derniers développent vis-à-vis du estations de soins de santé accessibles Tramadol, mettant à jour des enjeux dif- férents en termes d’actions de lutte. Les actions de lutte proposées par les partici- REFERENCES pants prennent en compte une réduction de l’offre et de la demande. Retenues, Baribeau, C., & Germain, M. (2010). L’en- ces propositions doivent s’opérer dans tretien de groupe : considérations une réalité communautaire comportant théoriques et méthodologiques. Re- des déterminants sociaux et sanitaires cherches qualitatives, 29(1), 28–49. négatifs (chômage, inaccessibilité aux pr- Cicero, T. J., Ellis, M. S., Paradis, A., & Ort- estations de soins de santé primaires, le bal, Z. (2011). Role of key informants relâchement des normes sociales, etc.). and direct patient interviews in epi- En ce qui concerne la réduction de la demiological studies of substance demande, les résultats invitent à réfléchir abuse. Pharmacoepidemiology and quant à l’opportunité d’une prévention drug safety, 20(3), 308–312. spécifique visant la réduction des ris- Dany, L., & Apostolidis, T. (2002). L’étude ques encourus dans toutes les formes des représentations sociales de la de relation à cette substance, au regard drogue et du cannabis: un enjeu pour de l’ampleur (fréquence et gravité) de la prévention. Santé publique, 14(4), son usage par les jeunes adultes. Un des 335–344. principes préventifs pourrait être le re- Dubet, F. (1992). Les deux drogues. In trait du Tramadol, de la liste officielle de : Ehrenberg A, Mignon P. Drogues, produits pharmaceutiques, un second politique et société. (369p). Paris: Le principe pourrait être l’amélioration de monde. la disponibilité des médicaments dans les Heider, F. (1958). The psychology of inter- structures sanitaires. personal relations. New York: John En ce qui concerne la réduction de Wiley & Sons. l’offre, toutes les actions proposées vont Lévy, J. J., & Thoër, C. (2008). Usages des dans le sens de mettre le Tramadol sous médicaments à des fins non mé- contrôle national comme l’ont déjà fait dicales chez les adolescents et les certains pays (UNODC, 2013a). jeunes adultes : perspectives -em piriques. Drogues, santé et société, 7(1), 153–189. CONCLUSION François, M. L., Jacky, M. M., & Martine, M. A. (s. d.). La vente illicite de médi- Les résultats de cette étude montrent caments dans les pays en développe- bien, comment une consommation naïve ment : analyse de l’émergence d’un iti- du Tramadol se transforme en une con- néraire thérapeutique à part entière, sommation abusive, voire dépendante. situé en parallèle du recours classique Une action préventive doit promouvoir aux structures officielles de santé.

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Consulté à l’adresse http://www.re- U N Office Contre la Drogue et le Crime med.org/THESE_V_Hamel.pdf. (2013). La criminalité transnationale Maiga, D. D., Seyni, H., Moussa, A. O., & organisée dans la région de l’Afrique Sidikou, A. (2013). Mesusage du tra- de l’Ouest. Vienna: UNODC. madol par les adolescents et jeunes UN Office Contre la Drogue et le Crime adultes en situation de rue. Pan Afri- (2013). World drug report 2013. Vi- can Medical Journal, 13(1), 55. enna: UNODC. Maiga, D. D., Seyni, H., Sidikou, A., & Sani, B. (2009). L’air du temps, Ça carbure Azouma, A. (2013). Crise convulsive au Tramadol. Sahel dimanche. (13p). chez les abuseurs de Tramadol et ca- Niamey: Office National d’édition et féine : à propos de 8 cas et revue de la de Presse. littérature. Pan African Medical Jour- nal, 13(1), 24.

61

African Journal of Drug & Alcohol Studies, 12(1), 2013 Copyright © 2013, CRISA Publications COMMENTARY

ALCOHOL MARKETING IN AFRICA: NOT AN ORDINARY BUSINESS

Isidore S. Obot

Department of Psychology, University of Uyo, Uyo, Nigeria & Centre for Research and Information on Substance Abuse (CRISA), Uyo, Nigeria

ABSTRACT

Alcohol was the cause of nearly five million deaths globally in 2010, an increase of over one million deaths recorded ten years earlier. It was the leading risk factor for disease in southern sub-Saharan Africa (SSA), fifth in the East and West, and sixth in the Central African region. Several factors account for the increasing harm associated with alcohol in Africa among which are the availability of a wide variety of alcoholic beverages, rising urban populations, more disposable income to purchase alcohol, and unrestrained marketing and promotion of alcohol. Using a variety of strategies, producers of alcohol target young people and women with aspirational messages and other exhortations in an unprecedented onslaught of marketing and promotion which is increasingly being recognized as detrimental to public health and social welfare. Missing in the discussion on alcohol in most African countries is a clear understanding that alcohol marketing is not an ordinary economic activity and that the business of alcohol (an addictive substance with high potential for harm) can subvert the rights of individuals and the principles of democracy which many African societies are struggling to enthrone. This paper discusses these issues with particular attention to the harms caused by alcohol (to drinkers and non-drinkers alike), the potential for far-reaching harms to individuals and the society at large if the present scenario continues, and how these harms can be averted or minimized with the implementation of evidence-based policies.

Key words: Alcohol marketing, alcohol promotion, Africa, alcohol advertising

Corresponding Author: Professor Isidore Obot, Department of Psychology, University of Uyo, P. O. Box 4230, Uyo, Nigeria. Email: [email protected]; Phone: +234 703 940 8945 OBOT

INTRODUCTION due to the existence of pools of abstainers and their increasing levels of disposable Alcohol has featured in both positive income (even as poverty remains a major and negative lights in the social history affliction in the most countries). It is also a of sub-Saharan Africa where different region with little or no restrictions on the types of fermented beverages manufac- behaviours of producers and marketers tured from fruits and grains have been because alcohol control policies are lack- consumed for millennia as part of normal ing or not enforced where they exist. The cultural and social interactions. While result, as recent findings have shown, is problematic drinking has always featured that alcoholic beverages have become one in the drinking habits of people in the Af- of the most accessible and affordable com- rican continent (Adomakoh, 1976), wide- mercial products in many countries of the spread recognition of drunkenness as a region (de Brujin, 2011), and unfortunately social problem began with the arrival of also a product associated with a growing distilled drinks beginning with pre-colo- burden of health problems due mostly to nial contact with European traders and unintentional injuries and chronic health explorers. It is on record that gin, rum, conditions (Lim et al., 2012) often caused whiskey and other beverages were used by road traffic accidents. as items of exchange in commercial trans- actions during the colonial penetration of the continent (Pan, 1975). What might DRINKING IN AFRICA have been the first recorded evidence of serious concern about the negative role In every country in the African continent of alcohol in Africa was expressed in con- more people abstain from drinking than nection with rum-induced drunkenness. drink, with the proportion of abstainers In 1844 a chief in what is today central Ni- as high as 90 percent in Muslim countries geria complained to the colonial adminis- (WHO, 2011). Total adult per capita con- trators that “Rum has ruined my country; sumption (APC) is 6.15 litres of pure alco- it has ruined my people. It has made them hol, which is about the global average of become mad” (Pan, 1975, p. 11). Thus 6.13 litres and less than the consumption through the exchange of “African raw ma- in Europe (12 litres) and the Americas (8.7 terials and slaves with whiskey and gin in litres). However, the low overall per capita an infamous barter system the stage was consumption in Africa hides a couple of set for the large scale commercialization ugly secrets. First is that while some of of alcohol which is being witnessed today the lowest per capita consumption in the in the continent” (Obot, 1993, p. 75). world can be found in Africa, two countries Western commercial beverages have in the region – Nigeria and Uganda -- are not only penetrated every nook and cran- consistently among those with the high- ny of sub-Saharan African societies, the est level of APC. Second is that when the region is experiencing an onslaught of al- amount consumed per drinker is consid- cohol marketing and promotion activities ered, South Africa and Nigeria are in the by industrial giants and less endowed lo- top league of countries recording the high- cal players. Africa is a sought-after market est levels of consumption (WHO, 2011). because there is a large room for growth What this means is that the typical drinker

64 ALCOHOL MARKETING IN AFRICA in these countries simply drinks too much young people (Roerecke, Rehm & Obot, at a sitting, a pattern of consumption- de 2006; Rehm et al., 2010). This emerg- scribed as heavy episodic or all-or-nothing ing profile of increased consumption drinking (Partanen, 1991). and problems among women and young What is being consumed? Up to 50% of adults is related to a number of economic alcohol consumed in Africa is not captured and social factors one of which, as stated in official government records; this catego- earlier, is that the large base of abstainers ry of unrecorded alcohol is made up mostly has become a prime target of advertisers. of homemade fermented and distilled bev- erages. The consumption of these bever- ages today is generally out of necessity not AVAILABILITY OF ALCOHOL: NOT choice because the most preferred bev- BUSINESS AS USUAL IN AFRICA erage is western commercial beer (Obot, 2006); in other words differential cost is The influence of economic operators what limits the consumption of commer- on the availability of alcohol is well estab- cial beverages and somehow helps to sus- lished and not surprising. Whether avail- tain the market for home brews. However, ability is viewed as making sure that alco- this is a fast-changing situation because as holic beverages can be bought at afford- national income increases, consumption able prices, in terms of acceptability, or its of unrecorded alcohol will decrease while accessibility as and when needed, the in- overall consumption will increase (WHO, dustry has interest and has been involved 2011). Yet homemade drinks will remain in many types of activities to achieve the an important aspect of the drinking hab- overall goal of increased availability and its of many African consumers, especially consumption. This industry role in- driv among the poor and people living in rural ing supply of and demand for a danger- areas, even as increasing availability and ous substance is not limited to alcohol but affordability of western commercial drinks has been studied in the context of tobac- will likely diminish their acceptability. co and other products (guns, cars, food) Even in societies where alcohol is con- that are also associated with disability, sumed by a majority of the population, disease and other negative outcomes (Ja- most of the abstainers can be found hiel, 2010). The concept of “corporation- among women and young people. In induced diseases” as proposed by Jahiel traditional African societies drinking by (2008) refers to morbidity and mortality women was regulated and children and from diseases caused by the consump- adolescents were largely expected not to tion of or exposure to industrial products. drink on their own and sanctioned by par- How this applies to alcohol has received ents if caught consuming alcohol (Obot, some attention (Jahiel & Babor, 2007), 1993). Again, this situation has changed and this attention is bound to increase in recent years as drinking among women with renewed focus on the contribution seems to have increased (Ibanga et al., of alcohol to the global burden of dis- 2005; Tumwesigye et al., 2005; WHO, ease, especially in low and middle income 2011), and as there is growing evidence countries (Lim et al., 2012). In line with that alcohol is associated with high in- this conceptualization, this paper asserts cidence of death and disability among that the alcohol industry is a vector for

65 OBOT health and social problems in Africa be- 2017 (Smith, 2013). Across the continent cause it exists to propagate consumption beer remains the most preferred bever- of an addictive substance through unfair age but spirits are making a noticeable ways and means that subvert the rights of entry and wine consumption is not negli- young people and vulnerable groups. gible. In particular Diageo has been mar- keting Johnnie Walker whiskey in Africa and in its 2012 annual report promises to MARKETING OF ALCOHOL grow the spirits business in the continent. Since it was launched in 2006 Smirnoff The African market has been described ice, a mixed drink, has remained very as a “jewel” and the alcohol industry popular among young drinkers. spends large and increasing amounts of There seems to be no doubt that be- money to market and promote different cause of growing populations and increas- types of beverage (Jernigan, 2012a, b). In ing prosperity in some sections of fast de- some of the traditionally high consump- veloping countries, Africa will become a tion countries in the continent (Kenya, centre of high level marketing and promo- Nigeria, South Africa, Uganda) alcohol tion of alcohol in the coming years. This is producers are among the top advertisers. not a surprising view, however what makes Large producers like Heineken, Diageo and alcohol marketing and promotion in much SABMiller are focused on expanding the of Africa different is the near-total lack of market in these and other countries by in- controls which allows the industry room to vesting heavily in new breweries and ad- employ a wide variety of techniques and vertising their brands, and these activities strategies to grow the market. seem to be producing the desired results. Marketing and promotion strategies: In Nigeria, a country long known for its Alcohol marketing and promotion activi- love for Guinness stout (the first Guinness ties are ubiquitous in most African coun- brewery outside Ireland and the UK was tries and highly unregulated. These ac- built in Lagos in 1962), net sales of Guin- tivities have been highlighted in various ness products rose in the year ending in reviews and studies (Obot, 2002; Jernigan June 2012 and profits increased over the & Obot, 2006; de Brujin, 2011) and tend previous year even as sales declined a bit. to include sponsorship of events and pro- Nigeria has indeed for many years been grammes. These events are the ones that the second largest global market for Guin- attract young people, e.g., fashion shows, ness extra stout and number one in Africa. beauty contests, sports events, music seg- In a new strategy in Nigeria, alcohol is ments on radio, performances by foreign being promoted by the country’s movie musical stars, and end-of-year or seasonal industry and the hip-hop music industry carnivals where alcohol is the centre of seems to have played a major role in what attraction (Obot, 2002). In a systematic is a growing interest in expensive liquor effort to study the marketing and promo- and wine. According to Euromonitor In- tional strategies used by alcohol producers ternational Nigeria is one of the fastest- in four African countries (Gambia, Ghana, growing champagne markets, with sales Nigeria and Uganda) a massive amount of of $49 million in 2011, $59 million in 2012 alcohol advertising was reported in these and estimated to reach $105 million in countries except The Gambia, a predomi-

66 ALCOHOL MARKETING IN AFRICA nantly Muslim country (de Brujin, 2011). products from the industry perspective is Most of the advertising was on radio but that they products make beer seem more also in magazines targeting special groups like a local and natural beverage and allows like women and young people. Product the industry to easily penetrate sectors of placement was common in urban areas the economy and governance structures and indeed the main message coming out with an appealing message hinged on con- of this study is that a walk through urban tributions to the economy. It is an old strat- and semi-urban areas of these countries egy reminiscent of the tobacco industry is to experience an elaborate display of which for many years held up its purported beer advertising on billboards, sides of contributions to the development of the buildings, moving vehicles and store fronts agricultural sector through its young farm- where the products are often exhibited ers programme (Obot, 1993) and continue and ready for consumption. to defend their opposition to Nigeria’s to- An analysis of the common themes in bacco control bill because of what they see the advertisements confirm what has been as a potential loss to the economy. the predominant messages for many years Targeting women and young people: (Obot, 2002). Alcohol (beer and spirits) is Guinness (a member of the Diageo fam- presented as a cultural item and the act of ily) is known for its innovative and the- drinking a particular beverage is encour- matic campaigns (Michael Power, The aged as behaviour in keeping with the ways Ticket) which emphasize “action” or carry of life of a people. The theme of success (in aspirational messages. In 2012 the com- business, sports and the professions) and pany launched a special fruit-flavoured participation in a western way of life is a alcoholic drink for women called SNAPP direct call to non-drinkers not to miss out across four venues in the country. Accord- and drinkers to continue to imbibe. And, of ing to an industry spokesperson: course, the producers tout their contribu- SNAPP has been introduced into the tion to society in terms of jobs created and ready to drink category in response to the tax paid to government coffers. increasing demand for an alcoholic drink Other strategies include product design that appeals to women who want to show where, for example, spirits are sold in small their individuality and unique style when packages or bottles rendering them afford- out socializing with friends. This is very able to young people. A recent develop- much in line with Guinness Nigeria’s vision ment is the local sourcing of agricultural of celebrating life, everyday, everywhere. inputs (sorghum, maize, barley, cassava) as SNAPP is a drink that is made with the raw materials for the production of beer. choicest ingredients giving it a crispy and New products from these have emerged naturally refreshing taste. It is a first of its in Uganda, Kenya and Mozambique with kind for women in the alcoholic Ready-To- encouragement from governments in the Drink category and is the perfect choice form of tax waivers. Because the products for the modern, classy woman looking for of these “home grown” raw materials are a feminine and stylish alcoholic beverage” cheaper and therefore more affordable (Okorie, 2012). beer consumption may increase as the We are also informed that SNAPP was economic constraint mentioned earlier created because “We know that women is removed. Another advantage of these are rapidly gaining economic power and

67 OBOT becoming more independent. Women ev- policy development with potential for erywhere are increasingly celebrating their long-lasting impact. As documented in successes in their various fields of endeav- an influential paper by Bakke and Endal or, be it family or at work” (Okorie, 2012). (2006), the alcohol industry has sought In a similar vein a brand from the to take over the role of government in Heineken stable advertises its television the design of alcohol policies in several reality show in which young people go on African countries. Employing the ser- a search and “the last man standing” goes vices of an industry-funded centre and home with very attractive prizes. The Gul- international consultants, and with the der Ultimate Search programme was cre- collaboration of often unsuspecting local ated to “promote the brand’s values of organizations, such efforts were in high confidence, discernment, focus, courage, gear at a time when the World Health determination and [not to be forgotten] Organization was developing its global al- success” (Odusote, 2010). In Africa target- cohol strategy. What the industry wanted ing young people and women for the pro- and continues to seek was to influence motion of alcoholic beverages has become the policy process in these countries by a bare-faced and growing phenomenon. foisting on them a one-size-fits-all policy Table 1 shows examples of the mes- which promotes strategies not supported sages the alcohol industry tries to convey by scientific evidence but which protects to the public not only in advertisements the interests of the industry. The policies but in other forms of communication. proposed by the industry agents (like the The second column of the table are refu- focus on education and responsible drink- tations of the messages on the basis of ing) ignore the public health impact of al- available scientific evidence. cohol and the process of designing them is a subversion of the rights of countries to direct their affairs in ways that are not A PERNICIOUS ROLE IN THE POLICY detrimental to the welfare of its citizens. PROCESS

The alcohol industry exists for the pur- NOT AN ORDINARY BUSINESS pose of making money for its investors. It is not a secret that in trying to maximize The publication of the bookAlcohol: no profit and make shareholders happy the ordinary commodity (Babor et al., 2003) products are presented in ways that make ten years ago served as a wake-up call to them appealing to potential consumers. the public health community and policy This often involves use of unethical ap- makers to the role of alcohol in society. proaches to marketing and promotion of Alcohol is not a commodity like bread and products which were highlighted earlier. vegetables; it is a toxic, intoxicating and It has become clear in recent years that dependence producing substance with the alcohol industry goes beyond push- well-established causal links to acute and ing their products to trying to exert con- chronic health and social problems. And trol over the environment in which they unlike the consumption of ordinary prod- operate. This pernicious type of control ucts, drinking leads to more drinking and involves direct involvement in national more drinking means more trouble espe-

68 ALCOHOL MARKETING IN AFRICA

Table 1. Alcohol industry views versus scientific evidence

Industry views The scientific evidence

Drinking is a normal activity; No, everybody does not do it. In fact most people do not drink (WHO, 2011) everybody does it. and there are good reasons for them not to drink. For example, adolescents, pregnant women, people engaged in some risky activities like operating machinery, and those with some medical conditions are advised not to drink. Moreover, in some religious traditions the consumption of alcohol is prohibited.

Drinking and success This is a powerful message especially among the young so it is not surprising go together. that success has remained a common theme in advertisements. Of course, available evidence does not support the touted association. On the contrary, failure is more likely to follow heavy drinking than success. Alcohol is a risk factor for non-communicable diseases, HIV/AIDS and drinking is associated with problems that impede personal and socio-economic development (Room, Rehm & Parry, 2011).

Alcohol is part of The beverages that are advertised as cultural items tend to be spirits – gin your cultural heritage. is a favorite. It is a drink often used in transactions between two parties, in libations to appease the gods, and favoured by elders and leaders of the clan. But as distilled spirits play quite a disruptive role in the African culture, a role that led a traditional ruler in colonial times to call for help because of the effects (Pan, 1975).

Alcohol is good for you. There is evidence from some western countries that moderate drinking is associated with cardio-protective effects. However, because of the pattern of consumption that is characterized by heavy episodic drinking the net effect of alcohol consumption in Africa in terms of death and disability is negative (Lim et al., 2012).

Alcohol advertising may be important in brand loyalty but it does much more Alcohol advertising is only for than that. There is good evidence that exposure to advertising influences the brand loyalty; it is not meant to initiation of drinking among young people (Anderson et al., 2009; Henrikson encourage drinking initiation. et al., 2008).

The alcohol industry is an Alcohol producers pay taxes to government but unlike other products alcohol important contributor to the is a major contributor to burden of disease across the world (Lim et al., 2012). economy. Alcohol is associated with chronic diseases, accidents, health care costs, etc. In countries where the social and economic costs of alcohol have been conducted as in Canada, US, Australia, the costs to society outweigh whatever tax benefit there might be.

If only everyone drank “Responsible drinking” is a deceptive term. The deception lies in the responsibly there would not be assumption that the problem with alcohol lies with people who habitually any alcohol-related problem. drink too much. In real life people who “drink responsibly” sometimes drink too much and there is evidence that occasional heavy drinking is associated with elevated mortality in males (Rehm et al., 2001).

The alcohol industry should be We have seen what being at the table means in the actions of economic at the table as a partner in the operators in several African countries (Bakke & Endal, 2006). It means policy development process. behaviours which aim to protect the interests of investors and against the principles of public health. As the Director-General of the World Health Organization recently observed “The development of alcohol policy is the sole prerogative of national authorities. In the view of WHO, the alcohol industry has no role in the formulation of alcohol policy, which must be protected from distortion by commercial interests” (Chan, 2013).

69 OBOT cially in African societies where the pat- governmental bodies but in Africa little of tern of drinking often involves heavy epi- that is going on. Worse still, only a few coun- sodic consumption. tries have policies which seek to control the Just as alcohol is not an ordinary com- production, distribution and consumption modity, alcohol marketing is not an ordi- of alcohol. For example, only a handful of nary business. It is a business that carries countries have alcohol policy in the form with it a high potential for harm and this a government document with debated harm increases with use. For example, and adopted principles and actions to at- the high level of harm associated with al- tain the goal of reducing consumption and cohol in some parts of the African conti- alcohol-related harm. In other words while nent (Lim et al., 2012) seems to be most- it is clear from available data that alcohol is ly a direct result of increasing availability a growing menace in the African region the of alcoholic beverages in these countries response by governments has been tepid at (WHO, 2011). Alcohol marketing is not best and in some cases whatever response an ordinary business because advertising exists is influenced by the industry through influences consumption. Products are ad- their role in the development of the policy vertised to increase their exposure to the document. This case of asking the goat to public or some sections of it, make them watch over the yams has been documented appealing to potential buyers, and ulti- by Bakke and Endal (2011) and serves as a mately increase sales of the product. This warning to governments that the self inter- business consideration is not any differ- est of the alcohol industry is incompatible ent when it is beer, wine and spirits that with public health which should serve as are advertised and it is doubtful that so the bedrock of alcohol policy. much would have been invested in adver- The influence of the alcohol industry is tising them if there was no overall busi- manifested not only in its meddlesomeness ness benefit derived from it. Beer com- in the policy process but also in wanting to panies are among the largest advertisers foist strategies that are not supported by ev- in several African countries targeted by idence of effectiveness. There is consensus the industry and the evidence is there to today that alcohol problems can be reduced show that indeed advertising influences with the application of evidence-based poli- the behaviour of young people in such cies which include restrictions of availability a way that those exposed to advertis- and control of marketing and promotion ing messages are more likely to initiate (WHO, 2011; Babor et al., 2010 ). However, drinking and drink more than those not in what can only be regarded as attempts so exposed (Anderson, de Bruijn, Angus, to mislead, the industry continues to push Gordon, & Hastings, 2009; Henriksen, those policy options that are less likely to af- Feighery, Schleicher, & Fortmann, 2008). fect the bottom line. The focus on strategies that do not work to reduce consumption and problems is guided by economic con- THE RESPONSE siderations and not social welfare.

In much of the western world the behav- Vigorous national responses are needed iour of the alcohol industry is increasingly In the face of industry onslaught on the being monitored by government and non- rights of young and vulnerable people

70 ALCOHOL MARKETING IN AFRICA through direct targeting, the response to informal and illegal alcohol especially as this alcohol problems in Africa and other parts impinges on the successful implementation of the world has benefitted from work of effective policies. carried out by the World Health Organiza- tion. A Global strategy to reduce harmful use of alcohol was adopted by the World CONCLUSION Health Assembly in 2010 in recognition of the link between alcohol, health and That alcohol is a major contributor to development (WHO, 2010). The strategy the burden of health and social problems document lists ten policy options and in a growing number of African countries interventions and calls for global efforts is hardly debatable. This burden has been to assist member states in implement- highlighted recently for some countries ing evidence-based measures to address in southern and East Africa. There is no consumption and related harm. Among reason to believe that many countries the ten areas of work are: response from in West and Central Africa are not in the the health sector to minimize the effects same boat and only lack of data prevent of harmful use of alcohol, drink-driving similar findings. countermeasures, pricing policies, avail- The good news about alcohol problems ability of alcohol and marketing of alco- across the world is the availability of the holic beverages. Following the lead of technology to control alcohol problems the global body, the African Office of the via the implementation of tested policy World Health Organization has also iden- options. Though the success of these tified ten policy options or priority areas strategies have been predominantly in similar to the global policy options. western countries, there is some evi- Since the developments of these guides dence that the three “best buys” com- to action a consensus has emerged among bined with other measures mentioned public health practitioners that that some above (including providing services in the actions are more important than others and health care sector) can offer the protec- that to achieve reductions in harmful con- tion needed. As presented in the WHO sumption and problems three areas are par- strategy (WHO, 2010), an awareness of ticularly poignant. Sometimes known as the the danger caused by unrestricted mar- “three best-buys” these areas are reduced keting and its consequence is a first step availability, pricing and taxation policies, in action against alcohol by nations across and control of marketing and promotion. the world. More needs to be done by civil National alcohol control policies should be society and public health experts in Af- developed with a special attention to these rican countries to advocate for effective three options based on extensive literature alcohol policies while keeping at bay the which support their association with use and meddlesomeness of economic operators harm. Unfortunately these are the policy op- whose interest is in selling more and more tions often ignored by the alcohol industry of their products but who masquerade as while they focus attention on policies that defenders of public health. Ultimately it is have limited effectiveness. Of course in -Af the responsibility of countries to protect rica it is also necessary to address availability the right to health of young people and all in the context of widespread consumption of their citizens by reducing their exposure

71 OBOT to targeted marketing and promotion of commodity – research and public pol- what is essentially an addictive and dan- icy. Oxford: Oxford University Press. gerous psychoactive substance. Bakke, O., & Endal, D. (2010). Alcohol It is also important to keep in mind policies out of context: drinks indus- that the major alcohol producers in Africa try supplanting government role in (Heineken, Diageo, SABMiller) are large alcohol policies in sub-Saharan Africa. global organizations with heavy financial Addiction, 105,(1), 22-28. involvement of Western-based investors, de Brujin, A. (2011). Alcohol marketing and that the unethical behaviours of the practices in Africa: Findings from the industry in Africa are largely not tolerated Gambia, Ghana, Nigeria and Uganda. in their home countries. The road to suc- Dutch Institute for Alcohol Policy cess, therefore, needs to include concert- (STAP): Utrecht, The Netherlands. ed global action to check the excesses of Chan, M. (2013). Letter in reply to BMJ economic operators through monitoring feature on the alcohol industry. and reporting of unethical activities of the http://www.bmj.com/content/346/ industry by interest groups in their home bmj.f1889/rr/640534. Accessed 23 turfs and in what the industry sees as the May 2013. emerging alcohol markets of Africa. Henriksen L, Feighery EC, Schleicher NC, Fortmann S. P. (2008). Receptivity to alcohol marketing predicts initiation ACKNOWLEDGEMENTS of alcohol use. Journal of Adolescent Health, 42(1), 28-35. Research for this paper was supported Ibanga, A., Adetula, V., Dagona, Z., Ka- by a small grant from Blue Cross Norway, rick, H., & Ojiji, O. (2005). The con- Oslo, Norway. texts of alcohol consumption by men and women in Nigeria. In I. Obot & R. Room (eds.), Alcohol, gender and REFERENCES drinking problems: perspectives from low and middle income countries (pp. Adomakoh, C. C. (1976). Alcoholism: the 143-166). Geneva: WHO. African scene. Annals of New York Jahiel, R. I. (2008). Corporation-induced Academy of Sciences, 273, 39-46. diseases, upstream epidemiologic sur- Anderson P, De Bruijn A, Angus K, Gordon veillance, and urban health. Journal of R, Hastings G. (2009). Impact of alco- Urban Health: Bulletin of the New York hol advertising and media exposure Academy of Medicine, 85(4), 517-531. on adolescent alcohol use: a system- Jahiel, R. I. & Babor, T. F. (2007). Industrial atic review of longitudinal studies.Al - epidemic, public health advocacy, and cohol and Alcoholism, 44(3), 229-243. the alcohol industry: lessons from oth- Babor, T., Caetano, R., Casswell, Edwards, er fields. Addiction, 102, 1335-1339. G. et al. (2003). Alcohol: no ordinary Jernigan, D., & Obot, I.S. (2006). Thirsting for commodity – research and public pol- the African market. African Journal of icy. Oxford: Oxford University Press. Drug and Alcohol Studies, 5(1), 57-70. Babor, T., Caetano, R., Casswell, Edwards, Jernigan, D. (2012a). The Size of the Glob- G. et al. (2010). Alcohol: no ordinary al Alcohol Market and its Penetration

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73 AFRICAN J O U R N A L N A C I R F A of DRUG and ALCOHOL STUDIES VOLUME 6 NUMBER 2 2 0 0 7 VOLUMEV o l u m e 16 2 NN Uu M m B b E e R r 2 1 2 2 0 0 0 1 7 3

L A N R U O J AFRICAN J O U R N A L CONTENTContentsS of AComposition systematic reviewof surrogate of evidence-basedalcohol from South-Easternworkplace preventionNigeria...... programmes that 65 address substance abuse and hiv risk behaviours...... 1 Obiora S. Ejim, Bruna Brands, Ju¨rgen Rehm, & Dirk W. Lachenmeier OF Nadine Harker Burnhams, Alfred Musekiwa, Charles Parry, Leslie London DRUG DRUG and TabooRelationships of alcoholof anddrinking road behaviour,safety policiesgender, in Algeriaand .age...... with self-reported alcohol-related23 Houriaproblems Bencherifin Namibia ...... & Farès Boubakour 75 Heli Mustonen AND ALCOHOL STUDIES Patterns and determinants of alcohol use among Nigerian university students: anField overviewtales of ofhazardous recent developmentshome brewed...... alcoholic beverages: the case of Selebi Phikwe,29 ALCOHOL EmekaBotswana W...... Dumbili 89 Joseph M. N. Pitso Representations sociales de la consommation de tramadol au Niger, perceptions et connaissances des communautes : enjeux pour les actions de lutte...... 53 In this issue: DjiboA conversation Douma Maiga,with AlanHoudouHaworth Seyni, ...... & Amadou Sidikou 104 STUDIES Surrogate alcohol from Nigeria AlcoholList of published marketingarticles, in Africa:2000–2007 not an ordinary...... business...... 11363 Isidore S. Obot Gender, age and drinking problems in Namibia Announcements...... 118 Hazardous home brewed alcohol in Botswana In Memory of Olabisi Odejide...... 119 A conversation with Alan Haworth Acknowledgements ...... 120 E M U L O V 6

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L A N R U O J AFRICAN J O U R N A L Contents of Composition of surrogate alcohol from South-Eastern Nigeria...... 65 Obiora S. Ejim, Bruna Brands, Ju¨rgen Rehm, & Dirk W. Lachenmeier OF DRUG DRUG Relationships of drinking behaviour, gender, and age with self-reported alcohol-related and problems in Namibia...... 75

Heli Mustonen AND ALCOHOL STUDIES

Field tales of hazardous home brewed alcoholic beverages: the case of Selebi Phikwe, ALCOHOL Botswana...... 89 Joseph M. N. Pitso In this issue:

A conversation with Alan Haworth ...... 104 STUDIES Surrogate alcohol from Nigeria List of published articles, 2000–2007...... 113 Gender, age and drinking problems in Namibia Announcements...... 118 Hazardous home brewed alcohol in Botswana In Memory of Olabisi Odejide...... 119 A conversation with Alan Haworth Acknowledgements ...... 120 E M U L O V 6

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