Drug and Alcohol Review (I992) i i , 51-58

Lying down with the lion: co-operating with the alcohol industry? The I99i Leonard Ball Oration

DAVID HAWKS

National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology, Perth, tFestern Australia Abstract

The author examines the extent to which the alcohol industry, while purport ing to be a responsible industry sensitive to the potential harm associated with alcohol, has a t tempted to subvert the efforts of those seeking to reduce that harm. Reference is made to recent attempts to circumvent the advertising code, exaggerate the beneficial health effects of alcohol, co-opt the N H & MRC guidelines regarding responsible drinking and minimize community support for control measures. Notwithstanding these manifestations of the industry's duplicity, it will be argued that the lion and the sheep will need at some stage to lie down together i f the alcohol industry is not to suffer the same fate as the tobacco industry. I t will be suggested that among the issues on which both sides might co-operate are the advertising and promotion of alcohol, the responsible serving o f alcohol and the design of the licensed dr inking environment. It will, moreover, be argued that such co- operation is in the long-term interest of the alcohol industry, which like any other must be responsive to community concerns. [Hawks D. Lying down with the lion: co-operating with the alcohol industry? The i99i Leonard Ball Oration. Drug Alcohol Rev I992; Ix: 51-58.]

Key words: alcohol advertising; alcohol industry; prevention.

Some of my more urbane colleagues have warned me that one can no longer assume that biblical references are commonly understood or part of normal discourse. I should perhaps then explain my choice of title before proceeding to the heart of my talk.

The prophet Isaiah in the eleventh chapter of his testimony offered this hopeful view of the future:

The wolf shall dwell with the lamb, and the leopard shall lie down with the kid, and the calf and the lion and the fading together,

and a little child shall lead them. The cow and the bear shall feed; their young shall lie down together; and the lion shall eat straw like an ox.

Now I shall leave you to speculate as to who in the alcohol industry might best be described as a wolf, a leopard, a bear or a lion and whether I might best be described as a lamb, a kid, a calf or even a fading.

What I am wanting to draw attention to, however, are the prospects of greater co-operation between those of us who express a concern for the health and other harmful consequences of alcohol

David Hawks, PhD, Director, National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology, GPO Box UI987, Perth, Western Australia 6OOl, Australia. Correspondence to Prof. Hawks.

51

5 2 D a v i d Hawks

and those whose primary concern is to market alcohol. In particular, I am wanting to identify those specific areas in which there does seem even now to be a greater willingness to co-operate, while at the same time pointing to the 'duplicity' of some components of the alcohol industry. To borrow another biblical image, the lamb, if it is to lie down with the lion, will even so need to maintain some of the cunning of the fox.

Let me start on a hopeful note. While the alcohol industry has for some time blamed the advertising agencies for the excesses of some advertisements (which has always seemed to me to be a somewhat ingenuous stance, since presumably he who pays the piper is able to call the tune even if he does not choose to do so), there are encouraging signs that the industry itself does wish to become more responsible in its advertising [x]. The suggestion, for example, that the wine industry may establish its own code, while hardly likely to be popular with other components of the alcohol industry, does at least indicate that one branch of the industry acknowledges the excesses of the others.

Similarly, the moves evidenced by the hoteliers to establish their own code of practice, while not yet available for public comment, suggests that they recognize that not all of their commercial practices in the past have been in the public interest.

The willingness of the various components of the alcohol industry to co-operate with the Commonwealth Department of Community Ser- vices and Health in the production and dissemina- tion of a set of guidelines for responsible serving suggests an openness to change in this area, even if compliance with these guidelines can only be volunteered and their distribution at least in some quarters has been haphazard. I know from my own discussions with representatives of the alcohol industry that not all of the practices of their colleagues are considered defensible and that even they acknowledge that there are some delinquents in their industry, as in most.

There can be little doubt that the deregulation of the alcohol industry which has occurred in most Australian states, resulting in many in a prolifera- tion of licenses, has resulted in a greater variation in the circumstances under which alcohol is sold. This move to deregulation, which while resulting in greater availability (itself a matter of concern for those of us preoccupied with the harm associated

with alcohol), has also resulted in alcohol being sold in more benign environments. Now, obviously the matter of availability is much more complex than reflected in the number of outlets--one beer barn does not equate to one restaurant, nor does the establishment of even four wine bars necessa- rily result in more harm than say the establishment of one tavern. At least some licensees have come to acknowledge that not everyone wanting to drink wants to get drunk and that at least some do not wish to drink alcohol at all, or if they do, wish to drink low alcohol beverages. They have, moreover, realized that to provide real food, as distinct from merely enhancing the thirst of their customers, not only makes premises more convivial it may actually reduce the possibility that drinking on their premises will result in harm elsewhere.

However, the recent national survey commis- sioned by the Ministerial Council on Drug Strategy, carried out by Reark Research, of the community's perception of alcohol advertising has provided confirmation, if confirmation was needed, of the extent to which the advertising code for alcohol is perceived to be frequently breached [2].

In his media release reporting this survey Mr Staples, the Minister for Aged, Family and Health Services, observed that:

Two thirds of the Australian community believed that more regulation of alcohol advertising is needed. A majority of those surveyed saw alcohol advertisements as en- couraging young people to drink and as leading them to view drinking as glamorous and exci t ing--a perception at variance with the requirements of the voluntary advertising code. Of the 19 alcohol beverage advertisements (which comprised 13 television and 6 print advertisements) used in the survey, 15 were perceived by a significant majority of the public to depict or contain at least one element proscribed in the alcoholic beverages advertising code. The average number of proscribed code elements perceived by re- spondents was 3-4 per commercial. Included among these were some advertisements about which a complaint had not been upheld by the Advertising Standards Council. [3]

Moreover, it was shown that such breaches were not usually complained of precisely because the

Co-operatino~ with the alcohol industry 53

public was unaware of the complaints procedures. (The Advertising Standards Council has previously claimed that the absence of complaints provided prima facie evidence of the public's satisfaction with the operation of the code.) Those of us who have been aware of the complaints procedure and have used it have, by contrast, become disillu- sioned with its partiality and its tardiness.

This research, which its critics can hardly claim to have been undertaken by people already prejudiced against the operation of the code, merely confirms research earlier carried out by Saunders and his colleagues [4,5J, research which has been dismissed by the Advertising Standards Council as methodologically flawed and biased and which they have stated should not have been carried out at all, representing as it does, the misuse of public funds [6].

What both surveys showed is that advertise- ments for alcohol frequently make allusions and create associations which are expressly precluded by the code and that the public, the intended audience, perceive such allusions. (It has to be assumed precisely because the market research which preceded the launch of the advertisements demonstrated such allusions.) This has occurred despite the industry's claim that it was committed to adhering not only to the letter of the code but its spirit, and the Advertising Standard Council's proud claim that the system of co-regulation practised in Australia operated in the public interest and was second to none. One can only wonder at the competition. Anyone familiar with the contents of the alcohol industry's various house journals will know that, far from seeking to comply with the spirit of the code, industry representatives have exercised considerable inge- nuity and expressed considerable cynicism about subverting the intention of the code [7].

If as a result of the recent, admittedly more representative, survey of public opinion, a survey which demonstrated a wilful and repeated failure to comply with the code of advertising, we move to a more impartial, public-health-based set of rules about the advertising of alcohol this can only be a good if somewhat belated development~ after all the industry has already had sufficient notice of the public's dissatisfaction with the present code [8,9]. The industry does not require, nor does it deserve, more notice of this dissatisfacton.

Similarly with responsible serving practices.

While the industry's active co-operation with the Commonwealth Department of Community Ser- vices and Health in the publication of responsible serving guidelines is to be welcomed, a survey carried out before their dissemination suggested that industry employees were woefully ignorant of their responsibilities, even those which were legally defined. A more recent survey confirms this ignorance [io]. Nor has there been any systematic attempt to determine whether the guidelines have in fact influenced practice since their publication despite the intervening one year. While endorsing the guidelines, the industry did not contribute financially to their publication or distribution and so by this test alone could be said to be less than committed to them.

What is of particular concern is the fact that the guidelines paid such little attention to the licen- see's obligation not to serve customers to the point of their becoming intoxicated, despite such a requirement being part of licensing law. While the guidelines address such concerns as identifying under-age drinkers, and even mention practices like discounting and serving in jugs, serving to intoxication, a frequent practice in some Austra- lian hotels, is not given sufficient emphasis, presumably because such a practice underwrites the profitability of some outlets. Recent research carried out by Rydon and colleagues has demon- strated that of people breathalysed leaving Perth hotels, 55 % had blood-alcohol levels (BALs) in excess of o.o5% , and 37 % had BALs in excess of o.o8%. Moreover, of those with BALs in excess of 0.080/0, 250/0 were seen to drive away [II].

While there is no commonly accepted definition of intoxication--itself a deficiency in the existing law and widely appealed to in explanation of the fact that the law is rarely prosecuted--o.o5% is accepted in most states as evidence of one's impairment to drive. Even if this is not accepted as a fair definition of intoxication, especially if one is not intending to drive, o.08% and certainly o.i2% would be accepted by most as reflecting a level of intoxication likely to be observable by a discerning bartender. Even so, 2i% of patrons leaving Perth hotels exceeded this level and indeed anyone with any familiarity with Australia's drinking establish- ments would have to concede that patrons are regularly served alcohol to the point of their intoxication. While there have been some at- tempts, for example the patron care scheme in

54 David Hawks

Queensland, to educate licensees in 'caring' for the excessive drinkers among their patrons, such schemes too often lend themselves to excluding drinkers on discriminatory grounds or else evicting noisy drinkers (having contributed to their drunk- enness) while tolerating the intoxicated patron who is doing no harm to anyone but himself.

What is clearly needed is a willingness on the part of the industry to train staff to identify signs of increasing inebriety and to intervene before a patron is manifestly intoxicated as the law pre- sen@ requires. Such training has become manda- tory in Ontario, Canada [i2], where it is a precondition of employment in the hospitality industry, and is provided voluntarily in many states of America where the training of staff is seen by the industry to be the best defence against any server liability prosecution. Of particular interest to the alcohol industry will be that research which suggests that server training, if supported by a house policy, does not reduce the profitability of an outlet [i3]. Indeed it might increase it by attracting a different clientele. The Health and Welfare Department in Canada markets its server training materials under the logo "It 's Good Business: a guide to responsible beverage service".

The alcohol industry in Australia should accept the need for appropriate training, independently delivered, without the successful prosecution of a case of vicarious liability being brought against it. Failing that, there is legal support in Australia, and precedent elsewhere, for bringing such a prosecution under existing Australian law. It can only be a matter of time before such a prosecution is brought.

Another area of industry calumny is in the interpretation placed on the NH & MRC endorsed 'Safe levels of drinking' [i4]. While the incredulity which greeted these guidelines when they were first published has largely abated and their recommen- dations adopted not only by a variety of safe drinking campaigns but by the alcohol industry itself, there is nonetheless a worrying aspect to the industry's ready acceptance of these levels.

As the authors of the original report acknow- ledge, there has been some reluctance in the scientific literature to recommend 'safe' levels of consumption, in part because no level of drinking is inherently safe, in part because of the many caveats that have to be entertained in recommend- ing any level of consumption and in part because

of the implied invitation in appearing to recom- mend certain levels of drinking, to drink up to those levels. Even so the authors concluded that to leave people uninformed about the risks associated with certain levels of consumption was an even larger omission despite the fact, as I have pointed out elsewhere, that if all existing drinkers were to approximate the levels recommended it would result in an increase in total consumption of between 26 and 48% without assuming that any previously abstinent person started to drink as a result of these recommendations [i5].

There can be little doubt that the alacrity with which the industry has adopted these recommen- dations owes something to their recognition that, if interpreted as 'safe' levels of drinking, the recommended levels represent a significant in- crease in consumption. Most drinkers in Australia, if male, do not regularly drink four standard drinks a day and, if female, do not drink two standard drinks a day. For them to do so, acting on the advice of the NH & MRG, would represent a considerable increase in the profitability of the alcohol industry. While the NH & MRC docu- ment is properly circumspect, and a recently added addendum specifically deals with some of the misunderstandings resulting from the original document [x6], industry publications reporting these levels have been decidedly less circumspect; indeed there is a suggestion in some of them [i7] that these levels of consumption are in fact beneficial to health--which brings me to another area of industry duplicity.

The literature regarding the so-called 'protec- tive effect' of alcohol is complex to put it mildly, and is in any case equivocal and I do not intend to deal with it here in any detail [i8]. Suffice it to say that there is some evidence (which is itself contested) that the incidence of some manifesta- tions of cardiovascular disease may be lowered in people who regularly drink small quantities of alcohol. Without entering into the argument as to whether the control groups employed are appro- priate or, as is true in some studies, include people whose present abstinence from alcohol is as a result of an earlier alcohol-related disease, it is important to note that it is only for some, and a very limited number of manifestations of cardio- vascular disease, that alcohol is claimed to be protective. Alcohol is generally found to exacer- bate most medical conditions and to contribute to

Go-operating with the alcohol industry 55

the aetiology of others. No one claims, for example, that alcohol is protective for cancer, for liver disease, brain disease, peripheral neuritis, pancreatitis or hypertension [r9].

Secondly, and most importantly, the quantities alleged to be protective are very small--less than the four standard drinks for men and two standard drinks for women identified as 'safe' by the NH & MRC. In other words, people wanting to be protected from some manifestations of heart disease by drinking alcohol would be confined to drinking less alcohol on a regular basis than that accepted as 'safe' by the NH & MRC. Such evidence can hardly, therefore, despite the indus- try's claim, be taken as an invitation to drink up, or 'drink to your health' [r7,2o ]. Indeed, if the levels of drinking interpreted as 'safe' rec- ommended by different authoritative bodies over recent years are reviewed, these levels have gone down, not up, as the deleterious effects of alcohol are found to be associated with levels of consump- tion which were previously considered moderate. Even since the NH & MRC guidelines were published the Royal College of Physicians has come out with lower limits for men [2i].

While elements of the alcohol industry are increasingly adopting the slogan "Enjoy alcohol in moderation", and this is to be welcomed, they are notably non-specific in defining what they mean by 'moderation' and when appealing to the NH & MRC guidelines are inclined too often to depict them as levels which might be safely drunk up to rather than depict them as the upper limits of what can be considered safe. They are, moreover, inclined to identify all moderate consumption as beneficial to health when in fact the benefits, if any, are highly specific and associated with very modest levels of consumption (less than two standard drinks).

Industry sources are similarly inclined to exag- gerate the harmlessness of the new 'light' beers. An advertisement appearing in the tVest Austra- lian in December i988 depicted a prominent footballer drinking seven middies of Emu 2.2 beer over a i-hour period under the heading "How many middies of Emu 2.2 can a person drink and still be under o.o8 in a breath test?" [22]. The answer, if the footballer could be considered representative, was that one could drink seven middies and record a BAL of o.ox2 15 min after drinking the last of these middies. As McLaughlin

and Smith [23] demonstrated, the footballer could not be considered representative and to the extent that he could not the message given was mislead- ing. The five men and five women tested by McLaughlin and Smith, while varying consider- ably in their BALs, all greatly exceeded the very low BAL obtained by the football player. More- over, all io exceeded the o,02% probationary limit in Western Australia having consumed seven middies of Emu 2.2 in i hour, while two exceeded the o.o5% limit for driving adopted in most Australian states. A1/, despite their recorded BALs, reported that they felt their ability to drive was considerably impaired.

While the introduction of low alcohol beverages is a welcome, if belated, development the tendency to imply that such products are safe in the sense that they can be consumed in any quantity with impunity is to be deplored.

Perhaps the most insidious development to be observed of late is the proposal by the Australian Wine Federation that the Government and the wine industry collaborate in a program of alcohol education which at least in part is to be pursued in schools [24]. Quite aside from whether the alcohol industry can be expected to be impartial in presenting information about alcohol, there is the question as to whether any industry, whether it be the timber industry talking about pulp mills or the nuclear industry talking about uranium mining, should be permitted entr& to our schools. Judging from the misrepresentations contained in their publication Taking a Lead in Alcohol Education [24] the answer should be 'not'.

While quoting a survey released by the Federal Minister for Health in June i99o to the effect that 90% of parents considered an increase in alcohol education to be an effective way of minimizing under-age drinking, the document notably fails to mention that the same summary reports that 80% of parents endorsed structural changes in the sale of alcohol. Eighty per cent also wanted non- alcohol entertainment to be available to teenagers, while 80% wanted retailers who sold alcohol to under-age drinkers fined [25]. Seventy-six per cent of teenagers identified the lack of enforcement of the drinking laws as an occasion for drinking (compared to 78% who identified peer pressure as a factor), while 72% of parents perceived the advertising of alcohol as an important influence on under-age drinking.

5 6 D a v i d H a w k s

Judged by their willingness to selectively quote the results of research, and their declared intention to make wine a part of day-to-day life in Australia, the Australian Wine Federation does not recom- mend itself, at least to this commentator, as a responsible educator.

The Australian Wine Federation is not the only body to misrepresent the public's view on matters related to alcohol. Despite the moves to deregulate the alcohol industry, and in doing so to make alcohol more available, surveys of Australian public opinion do not lend support to such changes. Flaherty et al. [26], in a survey carried out in New South Wales before changes were made in that state's licensing law, found little support for increasing the availability of alcohol either by increasing the hours of availability or the number of outlets. In a recent survey of xo2o households representative of the Perth metropoli- tan area population aged i6 years and above, Lang et al. [27] found that 56% were in favour of raising the drinking age to 2I, 78% were in favour of stricter enforcement of the law against serving customers who are drunk, 80% were in favour of a more visible police presence in and around pubs and clubs, while 75 % were in favour of allowing the police to breath-test customers of licensed premises before they entered their cars--hardly a mandate for further deregulation.

Such results do not suggest that the public believes that the only, or most effective way, of reducing the problems associated with alcohol is through public education. Majority public support for the introduction of random breath testing in Western Australia preceded the legislation intro- ducing this measure by some 2 years (to its credit the Australian Hotels' Association of Western Australia did not oppose this legislation) and even now, when Western Australia is one of the few states not to have introduced o.o 5 legislation, public support for this position in both the city and country districts is high [28].

The point to be made here is that while the aleohol industry would pretend that moves to limit the availability of alcohol are the ploy of a small anti-alcohol conspiracy determined to render Australia teetotal, the fact is that numerous surveys of public opinion do not lend support to the industry's wish to make alcohol more available and in some important regards provides support for further restricting its availability.

The one measure advocated by the so-called 'anti-alcohol lobby', strongly resisted by the alcohol industry precisely because they know it would have the desired effect of reducing con- sumption, which does not yet enjoy public acceptance, is an increase in the price of alcohol. Explaining the basis for this recommendation and in particular its efficacy in reducing those prob- lems associated with alcohol is perhaps the greatest challenge facing those of us who advocate the adoption of public health principles in relation to alcohol. Despite the industry's claim to the contrary, there is now ample expert testimony to the effect that increasing the tax on alcohol wou ld have the effect of reducing the costs associated with its use [29-3x ]. The need is not for more research but rather more effort on the part of those concerned with the problems associated with alcohol to persuade the public, and therefore politicians, of this fact.

While it is of trifling importance compared to the other instances of misrepresentation quoted above, the alcohol industry's repeated and wilful depiction of those of us who advocate public health principles in the area of alcohol as anti- alcohol is illustrative of their preparedness to mislead and denigrate if it suits their purpose.

In a speech given at a forum in Melbourne arranged by the alcohol industry under the title 'Alcohol, Freedom and Responsibility', Mr P. C. O. Stone made repeated denigrating references to the anti-alcohol lobby [32]. Now I would suppose that Mr Stone would count me among that lobby--I know I am widely believed to be among it. Can I say, therefore, that I am not anti-alcohol nor have I ever been so, nor to the best of my knowledge are any of my colleagues who are similarly depicted. I enjoy the occasional glass of alcohol, believe I use it responsibly and do not object to its accurate depiction in advertising. Contrary to the alcohol industry's claims, I do not believe it can be regarded like any other com- modity. It has a large potential for harm, very conservatively estimated by Collins and Lapsley [33] in a recent report as over six billion dollars in i989 . This is not to be sneezed at, or dismissed as the result of the excessive drinking of an atypical few. It is the result of the acceptance of alcohol as an everyday part of life, indeed a natural part of life in Australia, that we can no longer afford nor, I would suggest, tolerate.

Co-operating with the alcohol industry 57

The alcohol industry has at times acted as if it believed it had some inviolate right to produce and market its goods in a totally unfettered way. Clearly it does not have that right given the enormous and costly harm associated with the product. At a time when it is accepted that other industries, some of them larger employers and bigger export earners even than the alcohol industry, must demonstrate a public responsibility, whether it is to the environment or to their customers, it should not be too much to expect the alcohol industry to demonstrate a similar responsi- bility. The alcohol industry is not alone in having .to adapt itself to public pressures, even to lower profit margins. There are numerous other indus- tries such as the automotive, mining and now the wool industry which had to curtail their activities at least in part due to the public's changing perception of their accountability.

For too long we in Australia have acted as if alcohol was 'a natural part of life', a necessary component for commercial and social discourse and a product whose promotion could safely be left in the hands of its producers and advertisers. Clearly this is not the case and there are thankfully, even among the producers themselves, some who recognize this to be the case.

The tenor of my remarks notwithstanding, I sincerely hope that a t least in some pastures the lion and the lamb will be able to lie down together while in others there may inevitably be an inherent conflict of interest. Except, however, that the alcohol industry accepts a new level of responsi- bility for the distribution and promotion of its product, there can be little doubt that the harm associated with its use will result in calls for harsher legislative measures. While alcohol is not to be equated with tobacco, the persistence for so long of the tobacco industry in denying the harmfulness of its product has in the end rebounded on it to its ultimate detriment. It is to be hoped that the alcohol industry will be more responsive to public opinion and professional advice and having changed its spots indeed lie down with the kid.

References

[I 1 Federation of Australian Winemakers Associa- dons Inc.

[2] Reark Research. A study of attitudes towards

alcohol consumption, labelling and advertising. A report prepared for the Department of Commu- nity Services and Health. Canberra, i99i.

[3] Staples P. Survey finds community wants more restrictions on alcohol advertising. Media release. Canberra: Parliament House, ix March I99L

[4] Saunders W, Yap E. Do our guardians need guarding? An examination of the Australian system of self-regulations of alcohol advertising. Drug Alcohol Rev i99x;io:xs-27.

[5] Saunders W, Phillips M, Levinthal T, Corti B. Women's perceptions of alcohol and other televi- sion advertising. A preliminary i report. Perth: Addiction Studies Unit, Curtin University of Technology, June i99o.

[6] Harcourt CJ. Letter from Executive Director Advertising Standards Council. Sydney, 13 Febru- ary i989.

[7] Foley J. A fine example of S.P.O.F. (Society for the Prevention of Fun) in action. Ad News, 28 July i989:io.

[8~ Northern Territory Department of Health. The advertising of alcohol and tobacco products: the views and experience of the Northern Territory Drug and Alcohol Advisory Service. Darwin: Northern Territory Department of Health, x984.

[9] Australian Consumers' Association. Proposed new standards for advertising of alcoholic liquor on television: submission to the Australian Broad- casting Tribunal. Sydney: Australian Consumers' Association, i985.

[io] Lang E, Hawks DV. Serving pub patrons to intoxication: community perceptions of server responsibility and liability. Paper prepared for the Workshop on the Licensed Drinking Environ- ment, Melbourne, May i99i.

[ii] Rydon P, Stockwell T. Levels of drunkenness of people leaving Perth pubs--a comparison of high risk and low risk premises. Preliminary Report. Perth: National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology, I99L

[I2] Single E. Paths ahead for server intervention i n Canada. In: Research action and the community: experiences in the prevention of alcohol and other drug problems. OSAP Prevention Monograph Series No. 4. Maryland: OSAP, i99o.

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5 8 David Hawks

[i5] Hawks DV. Is it possible to recommend safe drinking levels without increasing per capita consumption? Another aspect of the prevention paradox. Br J Addict i989184:37i- 5.

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[221 Emu 2.2 advertisement. The West Australian, 2i and 23 December 1988.

[23] McLaughlin KL, Smith DI. A study of an alcohol advertisement for low alcohol beer. Drug Alcohol Rev 199o~9:233-48.

[24] Australian Wine Foundation Inc. Taking the lead in alcohol education: a proposal to the South Australian Government. Adelaide: Australian Wine Foundation, x99o.

[25] Department of Community Services and Health. The quantification of drug caused mo/tality in

Australia i989 . Canberra: Department of Com- munity Services and Health, i99o.

[26] Flaherty B, Homel P, Wall W. Community attitudes toward public health policies on alcohol. Aust J Public Health, in press.

[27] Lang E, Stockwell T, Rydon P, Gamble C. Community survey of patterns and places of drinking. Technical Report. Perth: National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology, i99 I.

[28] McLaughlin KL, Smith DI, Maisey G. Survey of driver preferences for the legal blood alcohol limit in Western Australia. Paper prepared for the 'Blood alcohol levels and accident prevention:o.o 5 or o.o8' Seminar. Perth: Road Accident Preven- tion Unit, February 199o.

[29] Richardson J. Alcohol taxation to reduce the social costs of alcohol. Perth: National Centre for Research into the Prevention of Drug Abuse. Curtin University of Technology, i989.

[3 o] Cowley S, Richardson J. Alcohol taxation to reduce the cost of alcohol induced ill-health. Working Paper No. ¢. Melbourne: National Centre for Health Program Evaluation, i99i.

[3 I] Baker P, McKay S. The structure of alcohol taxes: a hangover from the past? Commentary no. 2L London: Institute of Fiscal Studies, i99o.

[32] Stone PCQ. Alcohol, freedom and responsibility. Speech made at a Forum on Alcohol Freedom and Responsibility, Melbourne, 29 November 199 ° .

[33] Collins DJ, Lapsley HM. Estimating the eco- nomic costs of drug abuse in Australia. Report prepared for the Department of Community Services and Health, Canberra, I99i.