1. Preamble
In Australian society, excess alcohol consumption is an issue of public health significance, leading to an unacceptably high level of sickness and social disruption. It is associated with diseases of the nervous system, heart, liver and other organs and contributes to many common medical problems, accidents of all types, family breakdowns, unemployment, violence in our society and other alcohol-related offences.
For particular diseases, consumption of any alcohol increases the risk. However, evidence suggests that not all patterns of alcohol use are harmful. Low levels of consumption reduce the risk of death from cardiovascular disease in older individuals.
While the cost to the Australian community of the harmful effects of alcohol has long been underestimated and poorly understood, it was estimated as being $4.5 billion in 1992. Most ill effects are due to the consumption of hazardous, but socially acceptable, amounts of alcohol. This pattern of consumption is often considered normal and has become part of Australian culture. However, the effects are just as damaging to the individual, and far more damaging to society. There is widespread ignorance of the damaging effects of these socially acceptable levels of alcohol consumption.
Researchers variously estimate that from 5-25% of all medical consultations involve dealing with individuals who are affected by an alcohol-related problem or are using alcohol in a hazardous or harmful way.
Because of the time lag between the onset of alcohol use and abuse and the development of clinical disease, substantial opportunities exist for intervention to modify behaviour.
2. Position Statement
2.1 The AMA is committed to achieving a reduction in the incidence of hazardous and harmful levels of alcohol consumption.
2.2 To achieve its objectives the AMA:
2.2.1 endorses the National Health and Medical Research Council's recommendation that it is potentially hazardous and harmful to exceed a daily intake of four standard drinks for men and two for women, (unless pregnant, when abstinence is desirable)1;
2.2.2 will work in cooperation with the liquor industry to create a climate of popular opinion which makes hazardous alcohol consumption socially unacceptable and to promote the concept of host/licensee responsibility; and
2.2.3 will actively support appropriate public health programs which inform the public of the harmful effects of excess alcohol consumption.
2.3 The AMA believes that the producers and retailers of alcoholic beverages have a responsibility to ensure that consumers of alcohol are fully aware of the alcoholic content of beverages and the potential harmful effects, both health and social, of excess alcohol consumption.
2.4 Individuals should be aware of the health and social effects of alcohol consumption on themselves and the community.
2.5 The AMA believes that consumers of alcohol can be assisted in understanding the health and social effects of alcohol consumption by familiarising themselves with the information portrayed by standard drink labelling.
2.6 The AMA believes that there should be a requirement that standard drink labelling be displayed in a prominent position on all containers of alcohol in a manner that is easily understood by the consumer.
2.7 The AMA, in recognising that advertising of alcoholic beverages could encourage hazardous levels of consumption, recommends that all such advertising be clearly aimed at encouraging no more than the NHMRC-recommended levels of consumption. All advertisements should draw attention to the NHMRC recommendations about hazardous and harmful consumption.
2.8 The AMA believes that both producers and retailers have a responsibility to reduce the incidence and consequences of 'binge' drinking, particularly in relation to unlawful supply and consumption of alcohol among teenagers and young adults. The association encourages responsible service of alcohol programs that facilitate the training of licensees, managers, and industry staff in appropriate serving practices and refusal of services to intoxicated or underage customers. Liquor licensing legislation should ensure that adequate powers exist for the inspection of licensed premises to assess whether such practices are observed.
2.9 The AMA discourages the consumption of alcohol during work activity and encourages all employers to participate in appropriate workplace-based programs directed towards increasing the awareness of the potential hazards of alcohol use at work and the prevention of alcohol-related problems in the workplace.
2.10 The AMA supports uniform enforcement of drink-driving laws in all states, including random breath testing. For most motor vehicle drivers, blood alcohol levels at or below 0.05 grams per 100ml at present are appropriate. For learners, provisional licensees, public, commercial and dangerous goods drivers, this level should be zero. Those found guilty of a driving whilst under the influence of alcohol should be assessed and referred to a diversionary educational program.
2.11 The AMA believes that the enormous social and financial costs borne by the Australian community as a consequence of the hazardous consumption of alcohol demands that consumers receive a clear price signal when purchasing alcohol in any form. The AMA therefore, calls for state and federal government taxes to directly reflect the total volume of alcohol in the product. Such measures should encourage a shift to the consumption of products containing less alcohol per unit volume. The AMA would oppose any tax system that does not directly reflect the volume of alcohol in the product as this creates a 'window' through which alcohol may be purchased cheaply, potentially encouraging excessive consumption.
2.12 The AMA strongly recommends that a component of existing taxation on alcohol be allocated to support research into the health effects of alcohol consumption; the evaluation and establishment of prevention and treatment programs for alcohol-related problems; and training for community and health care workers in this area.
2.13 The AMA supports the involvement of medical practitioners at all levels, as well as the involvement of industry and community-based groups, in the early detection and treatment of alcohol-related problems.
2.14 The AMA is committed to raising the level of professional awareness to achieve early detection and treatment of hazardous and harmful levels of alcohol consumption. It encourages all medical practitioners to participate in appropriate educational activities, both independently and in association with approved organisations. Medical practitioners should look for patterns of hazardous and harmful alcohol consumption in their patients and should provide, for those patients, appropriate information and advice on low-risk alcohol consumption or an alcohol-free lifestyle. For those patients suffering from alcohol use disorder and/or alcohol dependence, early detection, and full diagnosis are essential if treatment is to be effective.
2.15 The AMA believes that there is an urgent need for the review of existing training and accreditation programs for medical practitioners who choose to specialise in the area of drug and alcohol medicine to ensure an empirically-based, consistent and effective approach.
2.16 The AMA views with serious concern the curtailment of in-patient services for severely alcohol-dependent people. The AMA calls for this process to be halted until it is demonstrated that these individuals can be adequately cared for outside of hospital.
2.17 The AMA recognises that there are certain occupational and social groups where the incidence of the hazardous and harmful effects of alcohol consumption have a particularly damaging effect. In particular, in some Aboriginal and disadvantaged communities, appropriate mainstream services together with community-controlled and community-based programs are required to address excessive alcohol consumption.
2.18 Given the incidence of death in police custody among individuals who are intoxicated, the AMA believes that greater levels of assessment, supervision and care are needed in situations where an intoxicated individual is detained.
References:
1. NHMRC (1992), Is there a safe level of daily consumption of alcohol for men and women?, AGPS, Canberra, Australia