Lecture 7 Health 112(1).pdf

The Drinking Age Should be 20 Lecture 7 Associate Professor Damian Scarf  Alcohol & Health Alcohol Use in Aotearoa Quantifying the Harm Adolescent Alcohol Use Addressing Adol. Alcohol Use  Alcohol Use by Age 15 (%) New Zealand...

The Drinking Age Should be 20 Lecture 7 Associate Professor Damian Scarf  Alcohol & Health Alcohol Use in Aotearoa Quantifying the Harm Adolescent Alcohol Use Addressing Adol. Alcohol Use  Alcohol Use by Age 15 (%) New Zealand 74.1 China 31.7 Japan 30.4 South Africa 9.4 Nigeria 31.4 Lebanon 24.3 Israel 15.2 Ukraine 39.3 Spain 52.8 Netherlands 59.6 Italy 44.9 Germany 82.1 France 68.2 Belgium 67 USA 50.1 Mexico 29 Colombia 57.4 0 10 20 30 40 50 60 70 80 90 % Drinking in NZ Alcohol Abuse & Dependence in NZ  Alcohol Use @ UoO (1 st year) 45 40 Pre-University Number of Standard Drinks Orientation Week 35 Academic Year 30 Consumed 25 20 15 10 5 0 Males Females  Alcohol & Health Alcohol Use in Aotearoa Quantifying the Harm Adolescent Alcohol Use Addressing Adol. Alcohol Use Alcohol-Attributable Deaths in NZ An Overview of Harm Intrinsic lethality of the drug Extent to which life is shortened by the use of the drug e.g., cirrhosis e.g., damage from cutting agents Extent of urge to continue use despite consequences e.g., amfetamine-induced psychosis e.g., mood disorders secondary to actual drug-use e.g., income, housing e.g., family, friends e.g., violence, fetal harm crime (beyond use-of drug act) at the population level e.g., toxic waste from amfetamine factories e.g., family breakdown, child neglect e.g., destabilisation of countries Direct (e.g., health care) & Indirect (e.g., absenteeism) Decline in social cohesion and decline in the reputation of the community Ranking Different Drugs Brief Young Adult Alcohol Consequences Questionnaire B-YAACQ 1. While drinking, I have said or done embarrassing things. 2. I have had a hangover the morning after I had been drinking. 3. I have felt very sick to my stomach or thrown up after drinking. 4. I often have ended up drinking on nights when I had planned not to drink. 5. I have taken foolish risks when I have been drinking. 6. I have passed out from drinking. 7. I have found that I needed larger amounts of alcohol to feel any effect. To the right is a list of things that 8. When drinking, I have done impulsive things that I regretted later. sometimes happen to people either 9. I’ve not been able to remember large stretches of time while drinking heavily. during, or after they have been 10. I have driven a car when I knew I had too much to drink to drive safely. drinking alcohol. Next to each item 11. I have not gone to work or missed classes at school because of drinking 12. My drinking has gotten me into sexual situations I later regretted. below, please mark an “X” in either 13. I have often found it difficult to limit how much I drink. the YES or NO column to indicate 14. I have become very rude, obnoxious or insulting after drinking. whether that item describes 15. I have woken up in an unexpected place after heavy drinking. 16. I have felt badly about myself because of my drinking. something that has happened to you 17. I have had less energy or felt tired because of my drinking. IN THE PAST WEEK. 18. The quality of my work or schoolwork has suffered because of my drinking. 19. I have spent too much time drinking. 20. I have neglected my obligations to family, work, or school because of drinking. 21. My drinking has created problems between myself and my spouse, family, etc. 22. I have been overweight because of drinking. 23. My physical appearance has been harmed by my drinking. 24. I have felt like I needed a drink after I’d gotten up (that is, before breakfast). Brief Young Adult Alcohol Consequences Questionnaire B-YAACQ @ UoO Hangover symptoms (66%) Saying embarrassing things they later regretted (50%) Average: 5 negative Throwing up (38%) consequences during O’Week vs. 1 over a Memory loss (28%) typical week. Doing impulsive things (21%) Passing out (10%) Experiencing regrettable sexual experiences (9%).  Alcohol & Health Alcohol Use in Aotearoa Quantifying the Harm Aotearoa MPA Addressing Adol. Alcohol Use Minimum Purchase Age (MPA) Before After VS. ≤1999 >1999  Annual Frequency (18-19 year olds) 140 120 100 80 60 118.2 126.7 40 80.4 68.8 20 0 Male Female Before After  Typical Quantity* (18-19 year olds) 7 6 5 4 3 6.1 5.2 2 4.4 3.1 1 0 Male Female Before After Weekend Assaults* (18-19 year olds) 250 200 150 100 211 166 50 26 37.3 0 Male Female Before After  Traffic Crashes (18-19 year olds) 300 250 200 150 247 232 100 50 46 48 0 Male Female Before After  Alcohol & Health Alcohol Use in Aotearoa Quantifying the Harm Aotearoa MPA Addressing Adol. Alcohol Use Addressing Adol. Alcohol Use Parent Approaches Psychological Approaches Policy Approaches  Parental Supply NZ 34% with 72% of those children 15-17 were present years old every time  Impact of Parental Supply Western Australia New South Wales Tas. n = 1927  Impact of Parental Supply W 1: 12·9yrs W 2: 13·9yrs W 3: 14·8yrs W 4: 15·8yrs W 5: 16·9yrs W 6: 17·8yrs  Alcohol-Related Harms 1. Have you been unable to remember what had happened while you had been drinking? 2. Did you get in a physical fight with someone because you were affected by alcohol? 3. When affected by alcohol, did you have sex that you later regretted? 4. Has your school performance been affected by your use of alcohol?  Alcohol Use Disorder (AUD) 1. Ended up drinking more, or longer than you intended? 2. Wanted to cut down or stop drinking, or tried to, but couldn’t? 3. Experienced craving — a strong need, or urge, to drink? 4. Continued to drink even though it was causing you trouble? 5. Cut back on activities that were important in order to drink?  Who is Supplying Alcohol? 60 Parent Other Both 50 40 % 30 20 10 0 ~12yrs ~13yrs ~14yrs ~15yrs ~16yrs ~17yrs  Binge Drinking and Harm 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs 70 Binge 60 Harm 50 40 % 30 20 10 0  Risk Based on Supply Binge Harms AUD 7 No Supply Adjusted Odds Ratio Parent Supply Only 6 Other Supply Only Both Sources 5 4 3 2 1 0  Protective Family Factors 1. Cohesive & Supportive Family Environment 2. Clear Rules for Expected Behaviour 3. Parental Monitoring 4. Parents’ Knowledge of the Predictors of AAU 5. Parents’ Knowledge of the Consequences of AAU 6. Authoritative but not Authoritarian Addressing Adol. Alcohol Use Parent Approaches Psychological Approaches Policy Approaches  Days Drinking in Past Year 1-5 6-11 12-23 24-51 >52 ≤11 12-15 High Risk Age 16 17 Mod. Risk 18 Low Risk  Low Risk Brief advice: “I recommend that you stop drinking, and now is the best time. Your brain is still developing, and alcohol can affect that. Alcohol can also keep you from making good decisions and make you do things you’ll regret later. I would hate to see alcohol interfere with your future.” Notice the good: Reinforce any strengths and healthy decisions.  Mod. Risk Do they have alcohol-related problems? If no, provide beefed-up brief advice: Start with the Low Risk advice and add your concern about the frequency of drinking. If yes, conduct brief motivational interviewing to elicit a decision and commitment to change. Ask if parents know  High Risk Low Risk High Risk Conduct brief motivational interview to elicit a decision and commitment to change. Consider further evaluation or treatment Ask if parents know: If so, ask permission to share recommendations with them. If not, take into account age, the degree of acute risk posed, and other circumstances, and consider contacting parents.  Brief Motivational Interview Express Empathy Develop Discrepancy How goals could be hindered or compromised Take a warm, non-judgmental stance. by drinking. Roll with Resistance Support Self-Efficacy Point to patient’s strengths and other Avoid lecturing or debating, affirm autonomy. successes as examples.  Follow Up Goals Achieved 1. Reinforce and support continued adherence 2. Praise progress and reinforce strengths and healthy decisions 3. Elicit future goal(s) to build on prior ones Goals NOT Achieved 1. Reassess the risk level 2. Acknowledge that change is difficult 3. Praise honesty and reinforce strengths 4. Relate drinking to consequences to enhance motivation 5. Identify and address challenges  FRAMES Feedback about current level of harm. Responsibility for change sits with them. Advice that supports positive change. Menu of options, strategies, goals and plans Empathy in communication style Self-Efficacy building to strengthen self belief Addressing Adol. Alcohol Use Parent Approaches Psychological Approaches Policy Approaches  Alcohol in Our Lives: Curbing the Harm Part 1: The Case for Reducing Alcohol-Related Harm Chapter 1 What New Zealanders Told Us Chapter 2 Context for Reform Chapter 3 Alcohol and Harm Chapter 4 Case for Change Part 2: Controlling the Supply of Alcohol Chapter 5 Regulating the Sale and Supply of Alcohol Chapter 6 Why the Availability of Alcohol Matters Chapter 7 Licence Criteria Chapter 8 New Criteria for Selling Takeaway Alcohol Chapter 9 Conditions on Licences Chapter 10 Licensing Bodies Chapter 11 Licence Fees, Renewals, & Managers Chapter 12 Club Licences Chapter 13 Special Licences Chapter 14 Exemptions Chapter 15 Licensing Trusts Chapter 16 Age Restrictions Part 3: Reducing the Demand for Alcohol Chapter 17 The Role of Price Chapter 18 Alcohol Pricing Policies Chapter 19 Advertising, Sponsorship, & Promotion of Alcohol Chapter 20 Offences, Monitoring, & Enforcement Chapter 21 Alcohol in Public Places Chapter 22 Regulating Alcohol Products Chapter 23 Education Chapter 24 Treatment 587 page document…  CHAPTER 1 : What New Zealanders told us 1.60 …licensees …believe the lack of consequences is one of the root causes of problem youth drinking. E.g., Hospitality Association of New Zealand: Changing the age of purchase of liquor does nothing to address New Zealand’s drinking culture, making it illegal for those under the age of 18 to consume, except when supervised by their parent or guardian, could however send a strong signal against a youth drinking culture and promote better individual responsibility. 1.62 …a more nuanced approach to youth drinking, reflecting the changing levels of risk associated with the maturing adolescent and providing some sort of progression towards responsible independent drinking similar to the graduated drivers’ licence. E.g., New Zealand Winegrowers: “…at least for a certain probationary period, say two years, the ability for young persons to purchase alcohol should be conditional on appropriate behaviours, and not a right.” 1.63 Our tentative proposal to introduce a split purchase age, permitting 18 year olds to drink in licensed premises, but not to purchase takeaway alcohol until aged 20, was seen to have merit as an example of a graduated approach.  Voting Options The options Aged 18: for drinking at on-license premises and buying liquor from off-license premises. Aged 20: for drinking at on-license premises and buying liquor from off-license premises. Split age: 18 for drinking at on-license premises and 20 for buying alcohol at off-license premises.  Voting Outcomes 60 50 40 Votes 30 20 10 0 Aged 18 Aged 20 Split Age  Alcohol Action NZ 5+ Solution 1.▲prices 2.▲purchase age 3.▼accessibility 4.▼advertising and sponsorship 5.▲drink‐drive countermeasures  Alcohol & Health Alcohol Use in Aotearoa Quantifying the Harm Adolescent Alcohol Use Addressing Adol. Alcohol Use