Tim StockwellTim Stockwell
Centre for Addictions Research of BC, Centre for Addictions Research of BC, University of VictoriaUniversity of Victoria
Preventing violence in and around late-night drinking venues:
A review of the international evidence
CARBC and BC Mental Health and Addictions Research Network public seminar, SFU Harbour Centre, Vancouver, 23 February, 2009.
‘Three bowls 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 violence; the fifth to uproar, the sixth to drunken revel, the seventh to black eyes, the eighth is the policeman’s, the ninth belongs to biliousness, and the tenth to madness and hurling the furniture.’
Eubulus 375 B.C.
Bars, booze and violence in BC: Bars, booze and violence in BC: A time to take stock?A time to take stock?
BC Provincial health officers report on alcohol
and public health, December 2008
Evidence of increasing alcohol-related harm
and violence
Proposals before Vancouver city council to
extend hours of liquor service: the right way
forward?
Number of Liquor Authority and Agency/Private Liquor Stores, BC, 1992-2008
Age 15+ per capita alcohol consumption in BC and Canada, 1997/8-2007/8
Canada (StatCan)
British Columbia (StatCan)
British Columbia (BC AOD Monitoring)
6.5
7
7.5
8
8.5
9
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Litre
s of
eth
enol
per
per
son
Figure 17: % Serious Injury Crashes that Involve Alcohol, BC and Canada, 1995-2005
Figure 20: Provincial Net Income from the Control and Sale of Alcoholic Beverages, BC
Physical availability Affordability Consumption +8% Hazardous drinking Hospital visits +3.4% Alcohol-related crashes +11%
In BC since 2002….
In Vancouver CBDIn Vancouver CBD
In late 2003 hours of service for bars
increased from 2 AM to 4 AM
Number of liquor “seats” in
entertainment district increased from
1000 to 6700
Marked increase in calls for assistance,
fights, assaults and stabbings reported
by police
Apparent impact on late-night calls to VPD
Apparent impact on fights recorded by VPD
Apparent impact on assaults recorded by VPD
Two recent CARBC reviews on Two recent CARBC reviews on violence and licensed premisesviolence and licensed premises
1. For Alberta Gaming and Liquor Commission:
28 literature reviews and special reports (5 Canadian;
24 international)
39 descriptive and analytic studies (12 Canadian; 27
international)
30 intervention studies (3 Canadian; 27 international)
2. Crime Prevention and Community Safety (In press)
Review of public health and safety impact of changes
to opening hours of bars and restaurants (48 studies)
Ratings of EvidenceRatings of Evidence
O Limited investigation, inconclusive data
Evidence is contra-indicative
Warrants further research
Evidence for implementation.
Evidence for outcome effectiveness
Evidence for effective dissemination
Five guiding principlesFive guiding principles
Ensure retail prices are not too low
Reduce intoxication levels
Create stress-free drinking
environments
Set clear house rules
Establish credible deterrence against
irresponsible practices
16
Dose-response relationships Dose-response relationships between alcohol consumptionbetween alcohol consumption
and harms and harms
At the individual and population levelsAt the individual and population levels For harms caused by both short and long-For harms caused by both short and long-term effects of alcoholterm effects of alcohol
0
1
2
3
4
5
6
BAC Level %
Od
ds R
ati
o Risk of Violent versus Accidental Injury Risk of Violent versus Accidental Injury
for Different BAC Levelsfor Different BAC Levels
Chi square for linear association p<.0001Source: Macdonald et al, 2005
Operator Best PracticesOperator Best Practices
Responsible Beverage Service Responsible Beverage Service ‘‘Safer Bars’ – violence preventionSafer Bars’ – violence prevention
Plastic/shatterproof glasses Plastic/shatterproof glasses
Food service with alcoholFood service with alcoholManage the flow of late-night customersManage the flow of late-night customers
Screen for underage drinkersScreen for underage drinkers
Self breath testing machinesSelf breath testing machines
19
Freo Respects YouFreo Respects You RBS Project RBS ProjectLang et al, Australian J Public Health, 1998Lang et al, Australian J Public Health, 1998
8 ‘high risk’ intervention sites, 7 control8 ‘high risk’ intervention sites, 7 control Feedback from police, risk assessment, RBS Feedback from police, risk assessment, RBS training, mystery shopperstraining, mystery shoppers Patron exit BAC’s reduced, no change in house Patron exit BAC’s reduced, no change in house policies, age ID checking or service refusalpolicies, age ID checking or service refusal One premise changed house policies, refused One premise changed house policies, refused service and # patrons with high BACsservice and # patrons with high BACs Can work with strong management supportCan work with strong management support Collaboration: 23 changes to WA Liquor ActCollaboration: 23 changes to WA Liquor Act
20
The Safer BarsThe Safer Bars Project ProjectGraham et al, Graham et al, Drug and Alcohol ReviewDrug and Alcohol Review, 2004, 2004
Based on detailed studies of violent barsBased on detailed studies of violent bars Risk assessment: patron flows, atmosphere, Risk assessment: patron flows, atmosphere, screening, supervision, closing time screening, supervision, closing time 3 hour training program: early intervention, 3 hour training program: early intervention, clear house rules, team work, controlling clear house rules, team work, controlling anger, conflict resolution skills anger, conflict resolution skills 18 intervention sites – large Toronto clubs18 intervention sites – large Toronto clubs 12 month reductions in violence vs. 15 12 month reductions in violence vs. 15 control sites, best if low staff turnover.control sites, best if low staff turnover.
Regulatory Best PracticesRegulatory Best Practices
Raise or maintain pricesRaise or maintain prices[& Tax on alcohol content] [& Tax on alcohol content]
Raise the minimum legal drinking ageRaise the minimum legal drinking age
Restrict happy hours/discounting Restrict happy hours/discounting Restrict days and hours of serviceRestrict days and hours of serviceMandatory third-party insuranceMandatory third-party insurance
Enforcement of liquor lawsEnforcement of liquor laws
Restrict density of liquor outletsRestrict density of liquor outlets
Set taxes and prices according to ethanol content
Principle of using price to control Principle of using price to control alcohol use is well-establishedalcohol use is well-established
Meta-analysis by Gallet (2007):Meta-analysis by Gallet (2007):Identified 132 studies, 1945-2003 and concludes: Identified 132 studies, 1945-2003 and concludes:
A 10% increase in price leads to an average of a 5% A 10% increase in price leads to an average of a 5% decrease in consumptiondecrease in consumption
Meta-analysis by Wagenaar et al (in press):Meta-analysis by Wagenaar et al (in press):Identified 112 studies worldwide (1823-2007) with Identified 112 studies worldwide (1823-2007) with 1007 estimates and conclude: 1007 estimates and conclude:
A 10% increase in price leads to a 4.4% decrease in A 10% increase in price leads to a 4.4% decrease in consumption and 2.8% for heavy drinkersconsumption and 2.8% for heavy drinkers
Low alcohol beerThere are 38 varietiesof beer in Australiacontaining between 2.5% and 3.5% alcohol. We have found 3 inBC liquor stores.
Increasing Market Share of Low Increasing Market Share of Low Alcohol Beer (<3.8%) in AustraliaAlcohol Beer (<3.8%) in Australia
0
20
40
60
% S
har
e o
f B
eer
Mar
ket
NSW VIC SA TAS QLD WA NT
State
'89 '99
Source: Australian Associated Brewers
Tax per Drink for Canadian Beer
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
0.50% 2.50% 3.50% 4% 5% 8.00%
% Alcohol by Volume
$ p
er S
D $GST/SD$PST/SD$Excise Tax/SDTotal Taxes/SD
Price incentives for drinking different strength coolers in BC, 2005/6
Strength N of brands
Mean alcohol content
% Cooler market -5+ % alc
Mean $’s
per SD
Mean $ per
L of drink
5.0-5.9% 35 5.06 12.90 2.74 8.07
6.0-6.9% 14 6.10 9.38 1.94 6.87
7.0% 91 7.00 77.73 1.33 5.41
Total 140 6.43 100.00 1.74 6.22
Set effective minimum drink prices and index to cost of
living
Cheapest alcohol in BC Liquor Stores Cheapest alcohol in BC Liquor Stores per standard drink, August 2008per standard drink, August 2008
>6% beer @ 75 cents
7% coolers @ 71 cents
40% spirits @ 86 cents
11.5% wine @ 91 cents
>20% fortified wine @ 62 centsMinimum mark-ups in BC not increased since 1994 for
beer, 1995 for wine and 1998 for spirits, recommendation to update not accepted
Recent moves to apply minimum Recent moves to apply minimum pricing to alcohol in Canadapricing to alcohol in Canada
Minimum prices of $2.50 per drink set in both
Alberta and Nova Scotia in 2008
6.5% increase for packaged beer in Ontario,
November 2008
Recommendation from BC provincial health
officer in December 2008
Longer hours, more civilised drinking?
32
Impact of changes to Impact of changes to trading hours of bars and restaurantstrading hours of bars and restaurants
Stockwell and Chikritzhs (in press), Crime Prevention and Stockwell and Chikritzhs (in press), Crime Prevention and Community SafetyCommunity Safety
48 studies over four decades, mostly from 48 studies over four decades, mostly from the UK, USA, Australia and Canadathe UK, USA, Australia and Canada Only 14 included both baseline and control Only 14 included both baseline and control measures, all peer-reviewedmeasures, all peer-reviewed Of these 11 reported significant impacts on Of these 11 reported significant impacts on at least one outcome in predicted directionat least one outcome in predicted direction 4 of these high-quality studies focused on 4 of these high-quality studies focused on violence – all found significant impactsviolence – all found significant impacts
0
1
2
3
4
5
Before After Before After
Impact of extended trading hours on rates of Impact of extended trading hours on rates of assaults in Perth Hotels, 1991-1995assaults in Perth Hotels, 1991-1995
Extended TradingPremises
Other Premises
Assaults/M
onth
Source: Chikritzhs and Stockwell (2002), Journal of Studies on Alcohol
Targeted regulation of high risk licensed premises
Kalgoorlie, Western Australia
Assaults and drink-driving offences linked toAssaults and drink-driving offences linked toKalgoorlie licensed premisesKalgoorlie licensed premises
37
NSW Alcohol LinkingNSW Alcohol Linking ProgramProgramWiggers et al, Drug and Alcohol Review, 2004Wiggers et al, Drug and Alcohol Review, 2004
All 400 licensed bars in 2 police districtsAll 400 licensed bars in 2 police districts For 6m all officers recorded if alcohol For 6m all officers recorded if alcohol involved and location of last drink involved and location of last drink Safety audit of high risk bars and feedback Safety audit of high risk bars and feedback by police by police 15% reduction in violent incidents 3 months 15% reduction in violent incidents 3 months post intervention compared with control post intervention compared with control districtsdistricts
Enforcement of liquor laws regarding intoxication: need
for credible deterrence
Classic US Study: Law enforcement versus server training
% Service refusal for ‘pseudo patrons’ (McKnight and Streff, 1992)
1012
3
16
54.3
47.7
41
4.3 5.6
12
16.7 17.5
0
10
20
30
40
50
60
Pre Post Pre Warning Cite-1 Cite-2
Partial InterventionFULL Intervention
Server Training 1986 Enforcement 1990-1991
Avoid high concentrations of late-night liquor outlets in one
district
Relationship between alcohol-related assaults Relationship between alcohol-related assaults and number of bars and restaurants in and number of bars and restaurants in Melbourne, Australia (Livingston, 2007)Melbourne, Australia (Livingston, 2007)
0
5
10
15
20
25
30
0 20 40 60 80 100
# of on-premise liquor licences
# of
alc
ohol
-rel
ated
ass
aults
per
yea
r
Predicted assaults (non-linear)
Predicted assaults (linear)
Community mobilisationCommunity mobilisation0 to0 to
Early intervention with children and Early intervention with children and adolescentsadolescents
Public education campaigns Public education campaigns Alcohol education in schoolsAlcohol education in schools
Collaboration between police, licensees and Collaboration between police, licensees and
civic authorities (e.g. Accords)civic authorities (e.g. Accords)
43
Police-Licensee AccordsPolice-Licensee Accords Signed agreements usually covering RBS, Signed agreements usually covering RBS, happy hours, door charge and police supporthappy hours, door charge and police support May involve staff trainingMay involve staff training Self-regulation and, to a degree, targeted Self-regulation and, to a degree, targeted law enforcement law enforcement Some short term tangible benefits in Some short term tangible benefits in violence reduction violence reduction Benefits not consistent and maybe short-Benefits not consistent and maybe short-termterm Accords can be fragileAccords can be fragile
A sustainable and effective regulatory A sustainable and effective regulatory system to prevent alcohol-related harmsystem to prevent alcohol-related harm
Accurate and well-publicised monitoring
Credible deterrence and graded penalties
Incentives for violence prevention
Opportunities for local community input
Effective controls on physical availability
Pricing policies to promote health and safety
Clear legislation to support effective enforcement