Christian Bölckow Rolf Hüllinghorst Jan Jacobs Dr. Thomas Redecker Jürgen Schlieckau Hans-Günter Schmidt Günter Schumann Roswitha Siedelberg Dr.

Transcription

1 The DHS Alcohol Action Plan 2008 Authors: Gabriele Bartsch Christian Bölckow Rolf Hüllinghorst Jan Jacobs Dr. Thomas Redecker Jürgen Schlieckau Hans-Günter Schmidt Günter Schumann Roswitha Siedelberg Dr. Theo Wessel Hamm, September 2008

2 DHS-Aktionsplan Alcohol Seite 2 Contents Page Introduction 3 1 Reducing per capita alcohol consumption by 25 per cent 5 2 Raising the age of onset of alcohol consumption 8 3 Reducing binge drinking by young people and adults 10 4 Changing the status of alcohol 12 5 Treating alcohol related ill health 14 6 Reducing alcohol related traffic fatalities and injuries 15 7 Preventing alcohol related harm for third-parties 17 7A Protecting road users from harm caused by someone else s drinking 17 7B Supporting families adversely affected by alcohol 17 7C Lowering the incidence of alcohol-related violence 18 7D Lowering the incidence of FASD, supporting those affected and their families 19 8 Reducing alcohol-related health inequalites 21 9 Reducing the negative impact of alcohol at the workplace 22 2

3 DHS-Aktionsplan Alcohol Seite 3 Introduction Over ten years ago (in 1997) the German Centre for Addiction Issues (DHS) published its first Alcohol Action Plan, which gave a detailed picture of the consequences of alcohol consumption in Germany and outlined the health-oriented objective of a comprehensive policy on alcohol. The measures called for were based on the assumption that a reduction of alcohol consumption would require a change in society s attitudes toward alcohol, as well as the involvement of all those politically responsible. This still remains the case. Alcohol is a toxic and addictive substance, a drug; its consumption represents the third highest avoidable risk of disease and premature death. Despite these considerable risks the dangers of alcohol are underestimated and made light of, since the effect of alcohol is considered agreeable by a large proportion of consumers. Current legislation in Germany does not require any warning notices or consumer information for alcoholic products, either on labels or on packaging. Only the percentage by volume a term which means very little to most people must be declared on alcoholic drinks. This shortcoming reinforces the mistaken impression that alcohol is a harmless product. The ubiquity of alcohol is so extensive, be it through advertising in the streets or on television, be it at parties or sport, that people tend to feel it is abstinence that needs justification rather then alcohol consumption. Although alcohol consumption in Germany has been falling slightly for years, the Germans still drink too much. The per capita consumption of pure alcohol is around 10 litres a year, which is higher than the limits specified by the World Health Organization (WHO) for low-risk consumption. If all Germans, man and women, young and old, would restrict their daily intake of alcohol to these lowrisk levels, the average annual consumption of pure alcohol would be about 8 litres. (The limits for low-risk consumption are 24 g. of pure alcohol a day for men and 12 g. for women. This is the equivalent of one or two glasses of beer or wine.) Sensible though it is for individuals to reduce their intake, there is no level of alcohol consumption that is completely risk-free. A public health approach does not only consider health and disease as something affecting individuals but also encompasses social perspectives. Apart from the possibilities open to the individual for making pro-health decisions, there are also legislative controls which influence health, such as youth protection laws, per mille limits for drivers or public house regulations forbidding alcoholic drinks from being served to people who are recognisably drunk. Even though individual alcohol policy measures have been scientifically proved to be particularly effective, no single measure can be regarded as providing the answer to alcohol-related problems and impairments. This is why it is necessary to incorporate the cumulative effects of various measures in an Alcohol Action Plan involving all those who bear social and political responsibilities. 3

4 DHS-Aktionsplan Alcohol Seite 4 Alcohol Action Plan 2008 Objectives and Instruments The primary objectives of the new Alcohol Action Plan is to reduce the harm done by alcohol in Germany, together with a change in public attitudes towards alcohol. This can only be brought about by a lasting reduction in average per capita consumption. An important means of achieving these objectives is the application of a concept that has long been called for: that of targeted abstinence in various contexts: during pregnancy and breastfeeding, on the roads, at work, at sport and while taking medicaments. This concept is taken up at various points in the new Action Plan. In addition, the longstanding call for the use of tax revenues - for instance from of a unified duty levied on alcohol to finance effective alcohol policy measures, must be restated. Specific Objectives To make the primary goals more tangible and to differentiate more clearly between the various spheres of activity, the following overview details specific objectives and names the instruments in each case which have proved effective in achieving these goals. The regulation of alcohol advertising, marketing and sponsoring (commercial communication) has a special status in alcohol policies. Alcohol advertising aims to make the product attractive to potential customers, to position it in specific areas of life and to endow the brand with a certain lifestyle feeling, the better to sell the product. Alcohol advertising in particular encourages to a special degree the stylisation of alcoholic beverages as lifestyle products with a youthful, dynamic and positive image. The regulation of alcohol advertising, marketing and sponsoring sets out to limit the attractiveness of the product alcohol and to reduce its social status and its omnipresence, thereby assuming an important role in lowering the per capita consumption of alcohol. The special orientation of advertising, marketing and sponsoring towards young people and towards securing new target groups such as women clearly indicates how important it is to introduce effective regulation in this sphere. 4

5 DHS-Aktionsplan Alcohol Seite 5 Objective 1: Reducing per capita alcohol consumption by 25 per cent to 7.5 litr itres The per capita consumption of alcoholic beverages is one of the most important indicators for alcohol-related problems that can be expected in the population, especially for health problems. After high blood pressure and tobacco consumption, alcohol consumption is the third biggest risk factor for avoidable disease and premature death. In Germany there are over 70,000 fatalities a year in which alcohol plays a causal role. Throughout Europe, 25% of deaths among young men aged between 15 and 29 years are ascribed to alcohol consumption and 20% in the 30 to 44 age group. The per capita consumption of pure alcohol in Germany continually fell slightly from 1970 on, but in 2006 it increased again for the first time, by 1 per cent. At around 10 litres, it is high in comparison with other European countries (e.g. Norway 5.5 l., Italy 8.02 l., Poland 8.09 l., Greece 9.01 l.). The alcohol consumption of around 13 million Germans puts their health at risk. If alcohol consumption for everybody above the age of 16 in Germany were to keep to the relatively low-risk daily level of 24 g. for men and 12 g. for women, the annual per capita consumption of pure alcohol would amount to approx. 7.1 litres. This figure serves as the orientation point for lowering per capita consumption. The evidence shows that increasing prices via tax on alcohol and reducing the availability of alcohol have the greatest effects on the reduction of alcohol consumption and are therefore the most important instruments of government control. These prevention measures are not only effective but also particularly cost-efficient. Alcohol-related disorders result from the consumption of all drinks containing alcohol. There is no justification for depicting individual drinks as more or less dangerous. The German Centre for Addiction Issues (DHS) is therefore calling for a uniform rate of taxation for a litre of pure alcohol (currently at approx euros). This means levying duty on wine and raising the duty on beer. Advertising and marketing influence in particular the shaping of needs and of lifestyle among young people and adults. They promote the idea that alcohol is something positive and normal, a manageable risk. The control of alcohol advertising, marketing and sponsorship, therefore, cannot be left to those who have an economic interest in the sale of alcohol. Media campaigns are essential for promoting a critical public debate on alcohol consumption and counteracting the trivialisation of risky alcohol consumption. Behaviour prevention must also be carried forward. Germany s well established counselling and treatment system for alcohol addicts must be expanded into early diagnosis and early intervention, in order to reach those who could not so far be motivated by existing provision to change their behaviour. 5

6 DHS-Aktionsplan Alcohol Seite 6 Instrument: Price increase 1.1 Uniform alcohol duty of euros per litre Federal government / governments of the federal Länder 1.2 Adjustment of tax level in keeping with changes in the cost of living. Alcohol must not become cheaper in comparison with other consumer goods or with incomes rising. Federal government / governments of the federal Länder Instrument: Reducing availability 1.3 The existing regulations governing the minimum age for buying and consuming alcohol are to be uniformly set at age 18. Clarification: this is protective rather than prohibitive legislation. 1.4 The monitoring of regulations governing the protection of children and young people is to be lastingly and continuously guaranteed. 1.5 Test purchases by young people are to be made possible and implemented. 1.6 Selling hours for alcohol retail are to be fixed at between 8 a.m. and 8 p.m. from Monday to Saturday. 1.7 The sale and dispensing of alcohol are to be governed by licensing. 1.8 The density of retail outlets must be adjusted to suit the location. 1.9 The sale of alcoholic drinks at petrol stations will not be permitted Those selling and dispensing alcohol must observe the regulations in force. This is to be checked on a regular and long-term basis The provisions of the existing Licensing Law [for example: Section 20, the ban on serving alcohol to people who are drunk, or Section 4, refusing to grant or renew a liquor licence if the applicant is guilty of, for example, abetting alcohol abuse] are to be enforced. In the light of flat-rate parties and drinking competitions, central importance is attached to the enforcement of the licensing laws Section 19 of the Licensing Law, governing the temporary dispensing of alcoholic beverages for a limited period of time and a limited location, is to be extended to include the sale of alcohol as well, when this is required for preserving public safety and order. Federal government Municipalities Legislation Regional authorities Legislation, local authorities, municipal offices, trading regulations Local authorities, municipal offices Trade regulations Retail outlets, catering trades, municipal offices Catering trades, general public Legislation, local government, municipal offices 6

7 DHS-Aktionsplan Alcohol Seite 7 Instrument: Legal regulation of alcohol advertising, marketing and sponsoring 1.13 See measures 4.1 Introduction of a general ban on alcohol advertising 4.2 Legal regulation of alcohol marketing and sponsoring. This also includes buzz or viral marketing. Instrument: Behaviour-prevention interventions 1.14 See measures Age and target-group specific prevention All instrument nstruments and measures from Objective 5 Treat Treating alcohol related ill health 7

8 DHS-Aktionsplan Alcohol Seite 8 Objective 2: Raising the age of onset of alcohol consumption Childhood and adolescence represent a key phase with regard to substance consumption. This is when attitudes and behavioural patterns are adopted, which become established in adulthood. Most young people already have their first experiences of alcohol by the age of around 14. Of the year age group nearly all (97%) have consumed alcohol at least once. In recent years, there has been a marked increase in the early and high-risk consumption of alcohol among children and young people. Alcohol is especially injurious to health for young people. The developing organism suffers short-term and long-term damage from the cytotoxin alcohol. Currently 10% of fatalities among young females and 25% of fatalities among young males are caused by alcohol consumption. An effective policy on alcohol, therefore, must take child and youth protection seriously and implement it effectively. Young people react particularly sensitively to the price of alcoholic drinks, as has been clearly shown by the drop in the consumption of pre-mixed spirits following the introduction of tax on alcopops. This is why price increases through raising the level of taxation on all alcoholic beverages is an important instrument for influencing the alcohol consumption of young people. Reducing the availability of alcohol is another important instrument for raising the age of onsset of consumption. Restricting the opening hours of shops which sell alcohol is crucial because young people seldom have stocks of alcohol available. Alongside structural prevention behaviour prevention with target-group specific measures should not be neglected. They help young people to develop a critical attitude towards alcohol. It should be borne in mind that the consumption and abuse of alcoholic beverages by children and young adults is only possible if adults sell or give them these beverages. Alcohol that s drunk by children and young people has always passed through the hands of adults. Instrument: Price increase 2.1 See measures Tax increases Federal government / governments of the federal Länder Instrument: Regulating availability 2.2 The existing legislative provision governing the minimum age for buying and consuming alcohol is to be uniformly set at 18 years. Clarification: this is protective rather than prohibitive legislation. 2.3 Scanner-compatible labelling of alcoholic beverages is to be introduced, to remind check-out staff to check age identification. 2.4 Test purchases by young people are to be made possible and implemented. 2.5 Adults may not pass on alcoholic beverages to underage young Legislation Retail outlets Legislation 8

9 DHS-Aktionsplan Alcohol Seite 9 persons Instrument: Age and target-group group specific prevention 2.6 Prevention must begin as early as possible, e.g. through skill strengthening programmes at kindergarten. 2.7 Evidence-based interactive prevention programmes for young adults are to be implemented in schools and out-of-school venues 2.8 Gender-specific programmes should be developed and implemented. Young male adults are at particular risk. 2.9 There should be no alcohol consumption in kindergartens or schools, not even on festive occasions; (adults have a role model function) The use of age-appropriate media in prevention work (e.g. Internet provision, cinema, TV) The issues of alcohol and drug prevention should be introduced into teacher training and the training of related professionals (technical trainers, sports trainers etc.) 2.12 Parents and adults must be sensitised to the issue of early alcohol consumption: in kindergartens and schools, through campaigns and special information materials. The role model function must be clearly articulated. Regional authorities, local authorities, child day-care organisers Regional authorities, local authorities, youth and addiction services Federal government, regional authorities, local authorities, youth and addiction services School authorities BZgA prevention centres, local authorities School authorities, sport associations BZgA, DHS, Regional centres for addiction issues, prevention agencies All instrument and measures from Objective 4 Changing the status of alcohol a lcohol 9

10 DHS-Aktionsplan Alcohol Seite 10 Objective 3: Reducing binge drinking by young people and adults Excessive alcohol consumption is responsible for a range of negative consequences. It is not only in terms of health that alcohol plays a dangerous role, but also with regard to violence and intentional and unintentional injuries and accidents (see Objectives 6 and 7). Special attention must be paid in this respect to alcohol intoxication (binge drinking) among young people. Most people in Germany (approx. 75 per cent of year-olds) consume alcohol in a relatively low-risk manner, i.e. women no more than 12 g. of pure alcohol per day and men no more than 24 g. of pure alcohol per day. This should not however blind us to the fact that binge drinking is widespread, even among people whose average alcohol consumption is normally at a low-risk level. A third of people who have consumed alcohol in the last 30 days have drunk excessively at least once, i.e. five or more glasses on one occasion. While 33 per cent of young people aged between 18 and 24 in the year 1995 had drunk excessively more than once within the previous month, in 2006 the figure had already reached 45.6 per cent. When it comes to buying alcoholic beverages, people react in the same way as when buying other consumer goods. The more affordable alcohol is in comparison with other products, the more alcohol is consumed. If the price of alcohol rises, the amount consumed falls. Particularly sensitive in their reaction to price increases are young people, people who drink a lot of alcohol and people with little money. That is why increasing tax in order to raise prices is one of the most effective instruments for combating binge drinking. Of comparable importance for reducing the quantities consumed is the availability of alcohol, i.e. the density of the sales network and shop opening and closing hours. The greater the number of places where alcohol is dispensed or sold and the shorter the closing hours (or the longer the shops are open), the higher the sales and consumption of alcohol. A range of studies conducted by various regional authorities in Europe has shown that changes in the conditions of access to alcohol have an influence on consumption. The reduction of availability is therefore a tried and tested instrument for reducing excessive drinking. Instrument: Price increase 3.1 See measures Increasing tax Federal government / governments of the federal Länder Instrument: Reducing availability 3.2 See measures 1.6 Hours for selling alcohol are to be fixed at between 8 a.m. and 8 p.m. from Monday to Saturday. 1.8 The density of retail outlets must be adjusted to suit the location. 1.9 The sale of alcoholic drinks at filling stations will not be permitted. Agen gents Regional authorities 10

11 DHS-Aktionsplan Alcohol Seite Permission should not be granted for the sale of alcohol on certain occasions and at certain locations, such as sporting events, sports stadiums. Alcohol-free zones (public areas) should be permitted. (It should be made clear in such cases that this measure is intended for the purpose of preventing violence and protecting residents in the respective built-up areas and not for the purpose of creating a legal basis for excluding homeless people.) 3.4 The provisions of the licensing laws should be exploited to the full in order to prohibit flat-rate parties, cut-price rates ( happy hours ) and the staging of drinking competitions etc. Special offers and price discounts on alcoholic drinks should not be permitted in retail outlets. Regional authorities, local authorities, DFB and sports associations Regional authorities, local authorities, catering trades, retail outlets 3.5 The sale of alcoholic beverages in vending machines is to be banned. 3.6 Employees in the catering trades must not receive commission or bonuses dependent on alcohol sales. Legislation Legislation. catering trades Instrument: Prevention 3.7 Sales and catering staff are to receive specific training prior to fetes and club celebrations such as fire brigade fairs, shooting matches, carnival events, funfairs, beer festivals, wine festivals, barn dances etc. and those in charge will be specified. 3.8 Target-group specific provision will be offered for groups at special risk (selective prevention, e.g. for migrants, those on military service etc.) Agen gents Local authorities, catering trades, clubs, associations, prevention centres Regional authorities, local authorities, addiction prevention centres 3.9 Nationwide introduction and implementation of local project initiatives such as the HALT programme for young people 3.10 In addition: All measures from Age and target-group specific prevention Federal government, regional authorities, local authorities, hospitals All instrument nstruments and measures from Objective 4 Changing the status of alcohol 11

12 DHS-Aktionsplan Alcohol Seite 12 Objective 4: 4 Changing the status of alcohola Alcohol is a toxic and addictive substance. Despite these known facts this dangerous substance has positive associations for most people in Germany: for young people, it has lifestyle associations: feeling good and having fun; for older people, it is associated with conviviality, often in clubs or associations, with celebrations or with after-work leisure time. Largely by means of sponsoring in sport, the alcohol and marketing industries have succeeded in creating a positive and almost inseparable link in people s minds between alcohol and sport (football and beer). Through investing nearly a billion euros a year in advertising and sponsoring in Germany alone, the alcohol industry achieves a lasting presence in almost every area of life. For fear of statutory controls, the alcohol and marketing industries in Germany have themselves introduced voluntary restrictions on advertising content. But the rules of behaviour laid down are neither realistic nor adequate. They lag behind current trends, for example, in what appeals to young people. One of the most effective elements of advertising, especially among young people, is humour; this element is not taken into account at all by the Advertising Council s voluntary code of conduct. Violations against the code of practice go unpunished. For this reason alone the restrictions have hardly any effect. What s more, the voluntary restrictions on advertising content do not cover the equally important factor of advertising volume and frequency. An effective self-regulation of advertising by the alcohol and advertising industries themselves is not possible because it runs counter to the economic interests of these industries. The latest findings of the European project known as ELSA (Enforcement of National Laws and Self-regulation on Advertising and Marketing of Alcohol) make clear the ineffectiveness of regulation of alcohol advertising, marketing and sponsoring which is in the hands of the alcohol and advertising industries and show the superiority of statutory regulation. For restrictions to be effective it is essential for possible evasive strategies such as sponsoring or buzz marketing to be equally subject to regulation. Apart from its intoxicating effect, alcohol has a number of more dangerous sideeffects. Around 60 different diseases and disorders have been proved to be associated with alcohol. Advertising for a dangerous product is unacceptable. Under current legislation alcoholic beverages are treated like foodstuffs, or even more laxly than normal foodstuffs. The packaging for foodstuffs must display information for the consumer, such as ingredients, or necessary health information for diabetics, whereas with alcohol all that has to be displayed is the percentage by volume. While other dangerous products, such as cleaning agents, have as a matter of course to carry a warning on the label, which also indicates that the product should be stored out of the reach of children, there are no such warnings in the case of alcoholic drinks. Even small amounts of alcohol can prove fatal for children. In the interests of consumer protection, therefore, the introduction of warnings on alcoholic beverages is sensible and necessary. 12

13 DHS-Aktionsplan Alcohol Seite 13 Instrument: Statutory regulation of alcohol advertising, marketing and sponsoring soring Agen gents 4.1 Introduction of a general ban on alcohol advertising. Federal government, EU 4.2 Statutory regulation of alcohol marketing and sponsoring. This also includes so-called buzz or viral marketing. Federal government, EU Instrument: Consumer information 4.3 Introduction of health warnings on the packaging and labelling of alcoholic beverages Federal government, EU, consumer protection organisations Instrument: Inform nformation 4.4 Counter-advertising in cinemas and on TV BZgA, local authorities 4.5 Ban on product placement in cinemas and on TV Legislation, TV stations Instrument: German Civil Code 4.6 Alcohol consumption will no longer be recognised by courts as grounds for penalty reduction Legislation 13

14 DHS-Aktionsplan Alcohol Seite 14 Objective 5: Treating alcohol related ill health Apart from the prevention aspects, an overall policy on alcohol must also include the fields of counselling, early intervention, treatment, after-care and self-help. to reduce damage to health caused by alcohol are of benefit not only to the individual but to society as a whole. The various counselling and treatment provisions on the one hand sensitise the public at large to the problems that can result from alcohol and on the other hand help to reduce alcohol-related costs for society. The earlier that interventions take place, the greater the chances of bringing about changes in drinking behaviour and the lower the resulting costs. It must be assumed that demand for treatment for alcohol dependency will continue to rise. So cutbacks in the budget for the costs of treatment must be abolished. Savings should be made not in rehabilitation but by means of it. Self-help groups are a distinct support provision. They provide help without preconditions, are low-threshold and suitable for helping people to get out of dependency at an early date. Instrument: Promoting early and a brief interventions 5.1 The nationwide introduction and implementation of local project initiatives, such as the HALT programme for young people. 5.2 In-service training for doctors in techniques of early and brief interventions and in conducting motivational conversations. 5.3 Establishing the structural preconditions for early and brief interventions in doctors practices and hospitals. This includes an appropriate payment structure. Federal government, regional and local authorities, hospitals Medical council Health insurance bodies, doctors, hospitals Instrument: Counselling and treatment 5.4 The expansion of the existing support system is necessary, especially in the direction of regionalisation and flexible provision in the field of medical rehabilitation. 5.5 New treatment initiatives are to be promoted, such as Community Reinforcement and Family Training (CRAFT). Associations, churches, local authorities, health insurance bodies, pension schemes Provider associations Instrument: Self-help 5.6 Creating a climate favourable to self-help in society in general, in order to make joining a self-help group a matter of course. Churches, associations, doctors, DRV, GKV, independent providers 14

15 DHS-Aktionsplan Alcohol Seite 15 Objective 6: Reducing alcohol a related traffic fatalities and injuries Drinking and driving continues to be one of the principal causes of road accidents. In Germany, there are over 50,000 traffic accidents a year in which alcohol is involved. In 2006, over 22,000 of them resulted in injuries. In the ten years between 1995 and 2005 alcohol-related accidents, i.e. accidents in which at least one person involved was under the influence of alcohol, resulted in over 400,000 people being injured and 11,850 people being killed. Whereas the number of alcohol-related accidents has more or less continuously fallen in the last 30 years, approx. 11% of road deaths in Germany are still the result of drinking and driving. Most of the people killed by alcohol-related accidents have not themselves been drinking. The material damage caused by drinking and driving in Germany amounted to over half-abillion euros in In recent years, Germany has tightened up its laws governing drinking and driving. The top limit for blood-alcohol concentration (BAC) for drivers of vehicles has been adjusted in line with the European standard. In 1998 the upper limit was lowered from 0.8 per mille to 0.5 per mille. In addition, the results of breathalyser tests can be called on to establish excessive alcohol consumption. The ban on alcohol for new drivers, which has been in force since 2007, will contribute to increased road safety. One important means of enforcing existing legislation, which is still missing in Germany, is random breath controls. These have proved an effective method of reducing the incidence of drinking and driving in all the regions of Europe where these have been introduced. A zero blood-alcohol level should be introduced on the roads, and in all other areas of transport, such as rail, waterways and the air. The already existing laws must be enforced. Implementing the following measures and restrictions at national, regional and local levels will reinforce the concept of targeted contextual abstinence in Germany. Instruments: : StVG, StGB, StVO, VwV-StVO, FlugVG, LuftVG, LuftPersV PersV,SeeSchStrO, BinSchStrO, Versicherungsrecht (AKB), Lebensmittelgesetz (Regulatory legislation and codes governing road traffic, air traffic and shipping,, as well as laws governing insurance and foodstuffs) 6.1 An across-the-board zero blood-alcohol limit (0.0 BAC) to be introduced for all vehicle drivers. Federal government, legislation 6.2 Sentencing to be revised: immediate loss of licence for drinking and driving. Federal government, legislation 6.3 Random breath controls to enforce compliance with contextual abstinence on the roads. Federal government, legislation 6.4 No alcohol to be sold at filling stations. Legislation, German Filling Station Association, regional associations, oil companies 6.5 Introduction of compulsory labelling of alcoholic beverages including warnings notices. Federal government, legislation, consumer protection organisations 15

16 DHS-Aktionsplan Alcohol Seite An Alcohol on the Roads module, or an Intoxicant Skills Course, is to be incorporated into driving lessons. 6.7 Roadside breath tests are to be stepped up at weekends and in areas around discotheques and clubs. 6.8 Interdisciplinary campaigns on Contextual Abstinence on the Roads are to be conducted at local authority level. 6.9 The BAC limit for inland and sea-going shipping will be reduced to 0.0 g/l. Federal League of Driving School Associations Police Local authorities, police, prevention centres Federal government, legislation 16

17 DHS-Aktionsplan Alcohol Seite 17 Objective 7: 7 Preventing alcohol related harm for third-parties Many negative consequences caused by alcohol affect people others than the drinker. These are principally: road-users, children and relatives of families adversely affected by alcohol people exposed to alcohol-induced violence, and children whose mothers consumed alcohol during pregnancy. That s why, as early as 1995 in its European Charter on Alcohol, the World Health Organization (WHO) called on all member states to formulate comprehensive policies on alcohol and to implement corresponding programmes. The underlying ethical principles of the Charter include the following: All people have the right to a family, community and working life protected from accidents, violence and other negative consequences of alcohol consumption. Objective 7A: Protecting road-users from harm caused by someone else s drinking ing Based on UK and US data, it is estimated that every year nearly 10,000 pedestrians, passengers or non-drinking drivers are killed in Europe in alcohol-associated road accidents due to other people who drink and drive. Compared with the measurable economic losses caused by alcoholrelated accidents, the human suffering resulting from injury and death cannot be quantified by the official statistics. It is all the more important, therefore, to assert the right of all people to a life protected from accidents. This can best be achieved by implementing the call by the WHO to its member states to enact and apply effective laws against alcohol on the roads. 7.1 See: all instruments and measures from Objective 6 Objective 7B: Supporting families adversely affected by alcohol In Germany, the number of children of alcohol-dependent parents is estimated to be around 2.65 million. This means that one in seven minors lives periodically - and one in twelve permanently in a family burdened with alcohol. Between 5 and 6 million adult children of addicted parents have to battle with the consequences of their parents addiction. Above and beyond this, between 5 and 7 million relatives are affected by the alcohol dependence of a family member. One in three children in addiction-burdened families regularly experiences physical violence, either as a witness or a victim. The children of addicted parents represent the group at highest risk of developing substance dependency. Around per cent of them will themselves become addicts. The risk of serious consumption, misuse of and dependency on illegal drugs is also higher among these children, as is the risk of other mental disorders such as anxiety, depression and ADHD (Attention-Deficit Hyperactivity Disorder). Alcohol-burdened families, therefore, are one of the most vital target groups for supportive and preventive measures. 17

18 DHS-Aktionsplan Alcohol Seite 18 Instrument: The qualification of addiction professionals, youth and self-help workers / Further training ing for f paediatricians 7.2 Promoting family and community based initiatives such as the Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT). 7.3 Improving co-operation between youth support and addiction support services. 7.4 Counselling and treatment provision for relatives and partners of people suffering from addiction is to be made available and further developed. 7.5 Provision for children of addicted parents is to be made available and further developed. 7.6 Paediatricians should be sensitised to this problem area and offered further training. Preventive medical examinations are to be used to identify what action is necessary. Local authorities, addiction support services Regional authorities, local authorities, associations Local authorities, addiction services, GKV health insurers Local authorities, addiction services Medical associations, health insurers Objective 7C: Lowering the incidence of alcohol-related violence Alcohol is a highly significant factor in the field of inter-personal violence. There is a strong link between the consumption of alcohol and an individual s risk of becoming a perpetrator or victim of violence. The World Health Organization (WHO) drew attention to this link back in 2002 in its world report on violence and health. Nearly one in three acts of violence in Germany is committed under the influence of alcohol. Alcohol consumption directly affects the physical and mental functions of human beings. As a result of reduced self-control, inebriated people are more likely to respond violently in confrontational situations than people who have not drunk any alcohol. The diminished capacity for processing information leads inebriated people to fail to recognise warning signals of potentially violent situations and makes them an easier target for those intent on violence. This is true of violence in general but particularly for sexual violence. Most people become aware of the link between alcohol consumption and violence through drunken hooligans, whether at night following parties, public festivals or visits to clubs or during the day in connection with sporting events, especially football matches. The fact that courts usually view alcohol consumption as a reason for reducing sentences does not adequately reflect the link between alcohol consumption and violence. Less well known is the violence people inflict on themselves. There is a close connection between alcohol consumption and suicide or attempted suicide. The risk of suicidal behaviour is increased above all by heavy drinking and for young alcohol consumers, especially if they suffer additionally from psychological disorders such as depression. Nearly 7% of people with alcohol dependence die through suicide. The suicide rate mounts with increased per capita consumption and tends to be higher wherever the drinking culture is characterised by high-risk drinking pat- 18

19 DHS-Aktionsplan Alcohol Seite 19 terns in combination with inter-personal violence. An effective means of reducing alcoholassociated violence has been shown internationally to be the restriction of alcohol availability by limiting the number of retail outlets and their opening hours. Instrument: Reducing availability 7.7 The density of retail outlets is to be reduced by limiting the number of licences issued. Local authorities, municipal offices, trading regulations 7.8 No round-the-clock selling of alcohol in shops and kiosks. Regional authorities 7.9 Alcohol consumption should no longer be recognised as grounds Legislation for penalty reduction See also: 1.9 No sale of alcohol at filling stations 1.11 No dispensing to inebriated people 1.12/3.3 Ban on dispensing and sales on certain occasions and for specified areas 3.4 Ban on flat-rate parties, cut-price rates and drinking competitions 3.5 The sale of alcoholic beverages in vending machines is to be prohibited. 3.6 Targeted training of sales and catering staff prior to public festivals and club events Objective 7D: Lowering the incidence of FASD, supporting those affected and their families The number of babies born suffering from the health consequences of their mothers alcohol consumption during pregnancy is around 10,000 a year in Germany. These include both underweight babies and those suffering from mental impairment. Alcohol is now the biggest cause of mental impairment, even ahead of chromosomedependent Down Syndrome. Around 2,200 alcohol-damaged children are born in Germany every year, which means one in 300 births. (The incidence of Down Syndrome is around 650 in Germany.) The consequences of consuming even small amounts of alcohol during pregnancy are still not fully known. Most pregnant women reduce their alcohol intake or drink no alcohol at all, but too many continue to drink alcohol. There have so far been no definitive scientific conclusions as to when and how alcohol during pregnancy, and in what quantities, produces what damage. There can therefore be no definition of the amounts of alcohol which can be considered completely harmless or of when it might be safely consumed, which would make alcohol consumption during pregnancy less dangerous. So pregnancy is another instance in which contextual abstinence should be practised, i.e. an instance in which the context (pregnancy) prohibits any alcoholic consumption at all. 19

20 DHS-Aktionsplan Alcohol Seite 20 Labels on alcoholic beverages and packaging should include a clear and conspicuous message warning of the potential damage to the unborn child caused by alcohol consumption. Instrument: Information and prevention 7.11 Information for the general public BZgA, DHS, regional centres for addiction issues, associations, youth and addiction services, prevention centres 7.12 Target-group oriented information, e.g. in biology lessons and pregnancy counselling 7.13 Improving information and counselling for pregnant women and breast-feeding mothers in medical provision; inclusion of midwives. Motivational conversations aimed at contextual abstinence. Regional authorities, schools, Pro Familia etc. Gynaecologists umbrella organisation, midwives, Pro Familia etc. Instrument: Treatment and counselling 7.14 Provision to be made available for those directly affected and their families Health services, associations, self-help groups Instrument: Consumer information 7.15 Warning notices on alcoholic drinks to be made statutory and implemented Federal government, industry 20

21 DHS-Aktionsplan Alcohol Seite 21 Objective 8: Reducing alcohol-related health inequalities* Population groups of differing social status in terms of education, income and employment levels are also differentiated with regard to their alcohol consumption. Poorer people, for instance, more often live abstinent lives than richer people. Men of a higher level of education are rarely heavy drinkers, whereas with women a higher education level expresses itself in higher alcohol consumption. Generally, the alcohol-associated health inequality between poor and rich reveals itself as follows: poorer people generally suffer more harm from a given amount of alcohol than richer people; poorer people are at greater risk of developing alcohol dependence than richer people; poorer people have an increased risk of alcohol abuse. This is true in Europe both within individual countries and between poorer and richer countries. In addition, a considerable stigma is generally attached to heavy drinking, irrespective of the attitude a particular society has to alcohol consumption. However, the stigmatisation of heavy drinkers who are poor is normally substantially greater. Raising the price of alcoholic beverages has proved to be a particularly effective instrument for reducing alcohol-related health inequality between poor and rich. High prices result especially in health benefits for poor alcohol consumers, young alcohol consumers and heavy drinkers. * The term health inequality is replacing the more cumbersome term socially dependent inequality of health opportunities. It also encompasses the socially determined element of inequality. Instrument: Price increase 8.1 Raising tax on beer, wine, sparkling wine, spirits and alcopops at least in keeping with the cost of living. See 1.1 and 1.2 Federal government / governments of the federal Länder Instrument: Setting and target-group group specific initiatives 8.2 Promoting family oriented prevention initiatives. Local authorities, youth and health promotion organisations, addiction services 8.3 Promoting support provision in socially disadvantaged districts and areas: for example, health-promotion at child day-care centres and at schools etc.. 21

22 DHS-Aktionsplan Alcohol Seite 22 Objective 9: Reducing the negative impact t of alcohol at the workplace Addiction prevention in private firms and in public administration is an important constituent of a comprehensive policy on alcohol. It has helped to remove taboos surrounding the issue of addiction at all hierarchical levels. Nevertheless, between 5 and 7 per cent of the working population in Germany have an alcohol problem. Alcohol at the workplace represents a safety risk: % of accidents at work occur under the influence of alcohol; alcohol addicts are 3.5 times more frequently involved in accidents at work. Apart from the personal detriments to those affected, alcohol also causes economically relevant costs as a result of: reduced work performance or quality; this encompasses: - reduced output, often over a period of years; - those affected achieve a maximum performance at work of 75 % right from the beginning of the disease; - work performance continues to decline as the illness progresses; - the number of mistakes grows; absence from work: alcohol addicted people are 2.5 times more often absent from work than other employees; they stay away from work 16 times longer than other employees; detriment to the working atmosphere. For these reasons the principle of targeted contextual abstinence at the workplace is of enormous importance and should be instituted in all places of work. Since alcohol at the workplace affects all professional groups and status levels, this fact must also be taken into account in works and company agreements. Specific prevention approaches must be developed for groups at particular risk. Instrument: Further development of addiction prevention and support measures at work / Changing the corporate culture 9.1 Concepts for prevention and support for employees must be introduced and further developed. Quality standards must be introduced. Workplace addiction support, health insurers 9.2 Service and company agreements must be introduced. Management, workplace addiction support, trade unions, staff 9.3 The stipulations of accident prevention bodies and occupational accident insurance funds must be observed. Health and safety officers, supervisors 9.4 Specific approaches should be developed (for young people, security staff, management etc.) 9.5 No sale or dispensing of alcohol in works canteens and restaurants Workplace addiction support, hospitals, rehabilitation clinics Management 22

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