alcohol, violence, policy and politics: can we make … · 2017-06-06 · alcohol-related violence...

Deakin University CRICOS Provider Code: 00113B

ALCOHOL, VIOLENCE, POLICY AND POLITICS: CAN WE MAKE PROGRESS?A PUBLIC HEALTH PERSPECTIVE

Peter MillerDirector, Violence Prevention Group, Deakin University

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Acknowledgements: Firstly, traditional owners of this land, their elders past and present. Secondly, This is a great honour for me having


WHAT IS PUBLIC HEALTH?

“Public health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.”

“A large part of public health is promoting healthcare equity, quality and accessibility.”

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Discussions filled with ideology. Typically, the statement “alcohol is neither a necessary nor sufficient cause of interpersonal violence” (Taft & Toomey, 2005: 4) Supplying alcohol to an individual in an enclosed room will not result in them becoming violent (except violence to the self). But we do have better information about how alcohol affects our mental state – and how this might relate to increased likelihood of violence or aggression


VIOLENCE/ALCOHOL OR BOTH?• Alcohol-related harm and violence are inextricably interwoven• Not always

• Alcohol -> Violence

• Violence -> alcohol use

• Intergenerational transfer of both


VIOLENCE

• More than 1 billion children – half the children in the world –are victims of violence every year

• 45% (45.3% F/43.5% M) report lifetime violence experience• 13.5% in the past 12 months • approximately 11.2% of the Australian population aged over 15

years (1.93 million persons) have experienced physical or sexual violence perpetrated by a current or former partner.


IMPACT OF VIOLENCE• Developmental

–young men who were physical beaten by their father were 2 time more like to be Perpetrators of bar-room aggression (Miller et al 2012)

–Corporal punishment (smacking)

–Banned in 43 countries, predicts large array of harm• A leading cause of disability/death in young people

• Especially if we include suicide

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**list harm of spanking**


LONGITUDINAL PREDICTORS OF VIOLENCE

1.Having been abused or neglected as children2.poor behaviour management practices, such as poor

supervision of children; 3.high levels of family conflict; and 4.family history of antisocial behaviour.

THE FIRST 1,000 and 5,000 DAYS OF LIFE

Costa, BM, Kaestle, CE, Walker, A, Curtis, A, Day, A, Toumbourou, JW & Miller, P 2015, 'Longitudinal predictors of domestic violence perpetration and victimization: A systematic review', Aggression and Violent Behavior, vol. 24, pp. 261-72.

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Need to be informed by what drives violence In 2013, we conducted a review into the predictors of anti-social behaviour, especially youth violence. Key risk factors include: Having been abused or neglected as children poor behaviour management practices, such as poor supervision of children; high levels of family conflict; and family history of antisocial behaviour. Then, 2014, long pred of FDV CHILD ABUSE, NEGLECT AND MALTREATMENT Early Adversity Child and adolescent behaviour problems Substance Use in Adolescence


GENETICSPlay a role in both• ‘Addiction’

– complex

• 50-80% prediction for alcohol

• MAOA gene• Short expression


ALCOHOL• Acute and chronic impacts

• Acute gets attention

• Chronic important


Percentage of disability-adjusted life years (DALYs)attributed to 19 leading risk factors, by country income level, 2004 – cf. WHO Global Health Risks 2009


Prevalence of abstention in World 2005

0.00 - 0.20

0.20 - 0.40

0.40 - 0.60

0.60 - 0.80

0.80 - 1.00

PREVALENCE OF ABSTENTION 2005


MORE THAN HALF THE WORLD DOES NOT DRINK!


ALCOHOL-RELATED HARMHealth problemsPancreatic cancer Liver cancerHeart attack and strokeOral cancer, Esophageal cancer, Head and neck cancer, Laryngeal cancerbreast cancerbowel cancer liver cirrhosis DiabetesAcute and chronic pancreatitisaddictionAnd even HIV/AIDS

Social order problems 45% of homicides in Aus 2001-7 47% assaults in Australia 66% of perpetrator for sexual assault incidents in 53.3 of sexual assault victims 6,800 serious or fatal road injuries per year - Vic 4,800 ambulance attendances in Melbourne 2006/7

24,714 inpatient hospitalisations in Victoria 2006/7 39% of all people seeking help for addiction


ALCOHOL-RELATED VIOLENCE• 367 deaths and 13,669 hospitalisations because of the drinking

of others (2005).• 69,433 Australians were victims of alcohol-related assaults

(2008)• 24,581 were victims of alcohol-related domestic violence.• 19,443 cases of child abuse involved alcohol (2006-07)

• costs Australians more than $20.6 billion.


DOES ALCOHOL CAUSE VIOLENCE?

The evidence of direct relationships:–Street violence (60%)–Family violence (30%)–Domestic violence (30-40%)–Child abuse (24,000 cases)

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Discussions filled with ideology. Typically, the statement “alcohol is neither a necessary nor sufficient cause of interpersonal violence” (Taft & Toomey, 2005: 4) Supplying alcohol to an individual in an enclosed room will not result in them becoming violent (except violence to the self). But we do have better information about how alcohol affects our mental state – and how this might relate to increased likelihood of violence or aggression


Three kraters do I mix for the temperate: one to health, which they empty first, the second to love and pleasure, the third to sleep. When this bowl is drunk up wise guests go home. The fourth bowl is ours no longer but belongs to arrogance, the fifth to uproar, the sixth to prancing about, the seventh to black eyes, the eighthbrings the police, the ninth belongs to vomiting, and thetenth to insanity and the hurling of furniture.

Dionysus 4th Century BC

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I’m not the first person to talk about this. The bible says, in proverbs, that violence comes from drinking. Most ancient civilisations and religions have descriptions like this of the relationship between alcohol and violence and I’m not sure all of our sophistication with standard drinks and definitions of anti-social behaviour actually gives us any greater insight into the relationship, or a more accurate description of the process. But, we have learnt more about the relationship from many studies, and certainly more about whom this archetype applies to, and who it doesn’t.


HOW DOES ALCOHOL CAUSE VIOLENCE?

1. Reduced cognitive ability after 2 drinks2. Disinhibition3. Temporality (focussing on the moment) –No thought of consequences

4. Obsessional thinking5. Poor interpretation of social cues

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But remember, most people want these effects to some degree, through history they have served a purpose. Dutch courage, was coined from the practice of the Dutch military feeding soldiers alcohol so they would be more likely to enter battle; I haven’t been able to find out if they fought any better.


THE BRAIN

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Our mood is a transient frame of mind that influences how we think and view the world. It is influenced by events in our lives, the amount of sleep we get, hormones, even the weather. But what role does the brain play in shaping our mood? The limbic system Many regions fundamental to mood are buried deep in the most primordial parts of the brain; that is, they are thought to have been among the first to develop in the human species. This is probably because mood is evolutionarily important. Being glum can be advantageous and has been shown to sharpen our eye for detail, for instance. But, overall, the brain seems geared towards maintaining a mildly positive frame of mind. Being in a good mood makes us more likely to seek new experiences, be creative, plan ahead, procreate and adapt to changing conditions. When we add drugs (especially alcohol), many functions are affected. The cognitive control network links up regions that co-ordinate our attention and concentration so that we can complete tasks. It recruits a circuit of the front part of the cingulate cortex and dorsolateral prefrontal cortex, which are specialised for cold, unemotional, rational thought.


• Alcohol ↑ aggression for persons with higher levels of : dispositional aggressiveness (Barnwell, Borders, & Earley- wine, 2006),

trait anger (Parrott & Zeichner, 2002),

rumination (Borders, Barnwell, & Earleywine, 2007),

sensation seeking (Cheong & Nagoshi, 1999)

Low emotional control (Miller, Hobbs et al, 2013)

WHO IS ALCOHOL MORE LIKELY TO AFFECT?


PRE-CURSERS, MEDIATORS AND MODERATORS

•Impulsivity•Desensitization•Patriarchy•‘Masculinity’


WHAT DOES MASCULINITY MEAN?

• Aggression (couched in terms of either violence or desire to win)• Impulsivity• Narcissism• Dislike or fear of homosexuals, especially being seen as one• Risk-taking (or sensation seeking), • Playboy (or desire to procreate as widely as possible), and • Power over women

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All of these elements are actually the psychological traits we discussed before, and women who show the same traits – are also more likely to engage in barroom aggression!! How many men subscribe to these norms? The vast majority rely on university student samples! Psychology and Sociology students to be exact. Masculinity not significant when trait aggression and family history of violence is included in the study It fails to address they key underlying issue of gender equality, patriarchy and violence; all of which I believe are extremely important.


VICTIMS (STREET)Similar psych profiles (in tradies) • Less trait anger, though still high• Heavy drinking played much more significant role in predicting physical aggression (up to 8x)• Not significant difference to perps for verbal aggression

• But also, remember effects of alcohol on other victim psychological profiles

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The other key flaw in the literature is the lack of investigation of the profiles of victims. while alcohol plays a role in perpetration of violence, and engagement in mutual violence, alcohol plays a major role in turning people into victims, for all or the same reasons outlined above. This is key part of understanding why the policies that have been found to reduce violence do so. So do things like masculinity actually matter? many resources can expended working on factors that don’t have real impact, while the measures that work are not implemented. a key reason why the alcohol industry is so keen to advance the ‘masculinity as a cause’ agenda; it avoids the discussion about reduced alcohol sold.


ALCOHOL USE AND FDVAssociations

• Any drinking day:– 8 times higher odds of male-to-female violence– 11 times higher odds of SEVERE male-to-female violence.

• Heavy drinking days: – 19 times higher odds of SEVERE male-to-female violence


FINDINGS


PUBLIC HEALTH RESPONSESMost effective (Babor et al, 2010)

•Availability (trading hours, density)•Access (price)•Advertising


MAJOR EVENTS IN TOBACCO CONTROL, PRICE, AUSTRALIA, 1906 TO 2010, (GMS PER PERSON 15+)

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This is how we change culture


ALCOHOL AVAILABILITY

• Increases in the number of alcohol outlets per capita has been linked with higher rates of:–Assault (Yu et al., 2008; Livingston, 2008)

–Domestic violence (McKinney et al., 2009)

–Crime in general (Ingemann-Hansen & Brink, 2004)


ALCOHOL AVAILABILITY

• Restrictions on alcohol availability in terms of shorter licensee opening hours has been associated with decreases in such factors as:–Overall alcohol consumption (Norström & Skog, 2005)

–Homicide (Dualibi, et al., 2007)

–Drink-driving (Norström, 2003)


WHAT WORKS?Reduced trading hours-Newcastle

Miller PG, Curtis A, et al. Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities. Drug & Alcohol Review.

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Alcohol-related intoxication and harm increases by between 15 and 20% every hour of trading after midnight (Chikritzhs & Stockwell, 2002, 2006; Chikritzhs & Stockwell, 2007; Pennay et al., 2014). The most evidence-based approach to reducing intoxication levels is through closing all venues earlier (Kypri et al., 2011; Kypri et al., 2014; Miller et al., 2012). Research has also shown that when trading hours restrictions are applied widely, they can lead to positive changes in drinking culture (Miller et al., 2012).


Closing venues earlier (but not precinct lockouts)


IMPACT ON DRINKING CULTURE?• Interviews commenced in Newcastle at 9pm, • Could not start in Geelong until 11:30pm

Geelong Newcastle Total

Money spent tonight ($):• 0–20• 21–50• 51–100• 101–200

44.8%27.7%16.7%7.5%

35.2%30.1%21.8%8.4%

39.6%29.0%19.4%8.0%

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**note that the industry, recently taken up by others, mantra of changing culture takes generations, even when we have excellent evidence from other fields on how to change culture. Pub owners in Newcastle reinvesting over $5m per year 50% more licenses than in 2008


BENEFIT?

March 2008

March 2013 July 2015 % increase 2008

Hotels 13 17 23* 77%

Registered Clubs 5 5 5 stable

On Premises 41 66 98 140%

Packaged Liquor 5 6 8 ns

Total 64 94 134 110%

Number of licensed premises in Newcastle CBD 2008 – 2015


WHAT WORKS?Pricing measures• 10% increase on average MINIMUM PRICE (Canada):–19.5% ⇓ in alc-related traffic offences–18.5% ⇓ in property crimes –10.4% ⇓ violent crimes (incl DV)


EXCISE AND SALES ALCOHOL TAX

• Wagenaar, et al., 2009:- 1003 associations in 112 independent studies. Benefits include:• Excise and sales taxes on alcohol affect the entire population.• Higher alcohol prices have also been associated with lower rates of

alcohol-related harm, including:• Traffic accidents. • Assault. • Domestic violence. • Rape. • Homicide.

– Also extremely cost-efficient in terms of :

• low short-term cost of amending alcohol policy.

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Excise and sales taxes on alcoholic beverages signify the most prevalent public policy affecting the general availability of alcohol.


WHAT WORKS?Pricing measures - Alcopops tax

Source: Chikritzhs et al, 2009, MJA


ALCOHOL ADVERTISING

• Exposure to alcohol promotion has been linked with:–Increased under-aged drinking (Hastings et al., 2005).

–Increased consumption in any session (Engels et al., 2009)

–Alcohol-related violence (Casswell & Zhang, 1998).

• Earlier initiation of drinking and greater levels of alcohol consumption is associated with possession of alcohol brand merchandise (e.g. Bundy bear/Jim Beam cap) (McClure et al 2009).


WHAT WORKSEnforcement/surveillance data sharingViolent venues register

Source: BOCSAR

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a rapid decline in GBH assaults from July 2008 onward The first major change occurred on the 1st of July, 2008, with the commencement of the new Liquor Act (2007). The second major change, on the 30th of October, 2008, involved the imposition of a freeze on the issuance of new 24 hour liquor licence trading permits. The third major change, introduced on the 1st of December, 2008, was the commencement of the ‘declared premises’ scheme. ACCOUNTABILITY


WHAT DEFINITELY DOESN’T WORKPsycho-educational campaigns

- ‘Boomerang effect’

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Making people aware of danger without giving them skills, just makes the scared. 4.5 fold increase in assaults What happens when you make people scared, but don’t give them practical skills.


A RESPONSE FRAMEWORKA national strategic approach

• ALL forms of violence• Across the life-course• Across levels of prevention


A RESPONSE FRAMEWORKAnte-natal Childhood Adolescence Adulthood

Primary

Reduce maternal substance use Reduce alcohol/drug supply

Enforcement

Education regarding the

impacts of substance use

Comprehensive education and labelling campaigns

Education should be a curriculum item

Reduce alcohol advertising

Parenting interventions aimed at whole-of-family

Secondary

Pre-natal support for

vulnerable parents

Community nursing

visits

Strengthening Families Therapeutic interventions

Community nursing

visits Peer Mentoring

Social and Emotional

Competence

Tertiary

Family Drug Court /Mandated Treatment Psychological interventions Situational interventions

-restricting trading hours

Child protection

(including abstinence

conditions)

Child protection

(including abstinence

conditions)

Social and Emotional

Competence TrainingSwift and Certain Justice

Offender rehabilitation

-SADV

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Discuss framework.


POLITICSWe know what works, but how do we get it implemented?• Sydney/NSW: 3am close, 10pm packaged liquor• QLD: 2am/3am close

• VIC: changes to late night licence ‘freeze’• Extension of PTV to 24 hour service (>$100m)

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Describe the differences between NSW, QLD and Vic Talk about changes to ‘freeze’ The extension of PTV to 24 hour service. $87million In addition to the safe streets taskforce – 250 police every Fri and Saturday night COST!! Compare this to Newcastle or Sydney 50% of police shift going home at 4am


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Among those who had postcode data recorded, 11.8% (n=192) lived inside MCC municipality. Melbourne numbers continue to be very high – despite 250 police!


CAN WE MAKE PROGRESS? We have never had more or better evidence

• “Public health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.”

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On the other hand, there is momentum. We have never had more, or better, evidence than we have today. And we are continuing to build the evidence base, both in terms of what works, but also now on how the alcohol industry and their partners, the tobacco and gambling industries, corrupt the political process and promote their profits over community interest to our bureaucrats and politicians. Our governments are such as NSW and QLD are beginning to make decisions which are in the interests of the community, and evidence-based. But they need more and better evidence to counter the spin and rhetoric of the industry. And, they need to be held accountable. They need to understand that even though the alcohol industry are some of the biggest funders of their political campaigns and careers, their job is to represent those that cannot afford offices across from parliament house or throw banquets for the entire federal parliament.


THANK [email protected]

Our team:Nic Droste, Ashlee Curtis, Lucy Zinkiewicz, Florentine Martino, Arlene Walker, Nicholas Taylor, Kerri Coomber, Beth Costa, Shannon Hyder, Steven Litherland, Alexa Hayley, Kate McLachlan, Richelle Mayshak, Eric Koukounas, Belinda Guadagno, Gennady Baksheev, Lauren Moulds, Lorraine Tonner, Darren Palmer

alcohol, violence, policy and politics: can we make … · 2017-06-06 · alcohol-related violence...

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