CONTENTS The Australian context What did we do? What definitely works What probably works What probably doesn't work What definitely doesn't work

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1 WHAT WORKS TO REDUCE ALCOHOL RELATED SUPPLY, DEMAND, AND HARM A/Prof Peter Miller Director, Violence Prevention Group, Deakin University ACKNOWLEDGEMENTS funded by the National Drug Law Enforcement Research Fund (NDLERF) Co authors Ashlee Curtis Tanya Chikritzhs John Toumbourou Inspector Bill Mathers Supt Tony Cooke Debra Salter Pat Ward Supt Jim Migro Barry Newell Pat Doyle Steve Allsop CONTENTS The Australian context What did we do? What definitely works What probably works What probably doesn't work What definitely doesn't work Trends in per capita alcohol consumption LITRES OF PURE ALCOHOL CONSUMED PER ADULT, 2005/ /11 Sources: WA, NT & QLD trend: Loxley, Gilmore et al. (2014) Australian trend: ABS (2014) METHOD Systematic Literature Review A systematic review any interventions which were reported in the literature for reducing alcohol supply, demand, and harm all EBSCO databases, ProQuest, EMBASE and Sociological Abstracts METHOD DELPHI STUDY Round One Environmental Scan Invitation sent to over 500 people around the world List any interventions they were aware of for reducing alcohol supply, demand, and harm 83 respondents with NEW interventions 1

2 METHOD DELPHI STUDY Round Two 20 people from the field (police, researchers, other officials) rated interventions for ability to reduce : alcohol related assaults, intoxication, alcohol related harm, crime and alcohol consumption. solve crime Supply Reduction Demand Reduction Harm Reduction Round Three re rate interventions in round two with very low agreement rate new interventions suggested from round two. Supply Reduction Minimum legal purchase age Reducing trading hours Minimum legal purchase age (MLPA) NZ reduction in MLPA from 21 to 18 years was associated with a 20 33% increase in alcohol consumption 10% increase in fatal traffic accidents for adult males (Kaestner & Yarnoff, 2011). 12% increase in alcohol involved crash for 18 to 19 year olds 14% larger for 15 to 17 year olds A similar pattern was observed for hospitalized injuries Reduced trading hours Reduced trading hours Newcastle Newcastle Perth Kypri K, McElduff P, Miller PG. Restrictions in pub closing times and lockouts in Newcastle Australia 5 years on. Drug and Alcohol Review. 2

3 Reduced trading hours Newcastle IMPACT ON DRINKING CULTURE? Interviews commenced in Newcastle at 9pm, Could not start in Geelong until 11:30pm Newcastle now has 25% MORE licenses than before 2008 (small bars) Miller PG, Curtis A, et al. Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities. Drug & Alcohol Review. Geelong: 12 venues closed since 2009, 1 by court order Increased trading hours Perth For every hour of trading after midnight, there was a 15 to 20% increase in: violence in and around Perth hotels (Chikritzhs & Stockwell, 2002) levels of alcohol consumption (Chikritzhs & Stockwell, 2002) levels of impaired driver road crashes (Chikritzhs & Stockwell, 2006). Demand Reduction Pricing measures Developmental prevention initiatives Pricing measures 10% increase on average MINIMUM PRICE: 19.5% in alc related traffic offences 18.5% in property crimes 10.4% violent crimes 1% PRICE INCREASE % reduction in wife abuse. Pricing measures Alcopops tax Source: Chikritzhs et al, 2009, MJA 3

4 Developmental prevention initiatives In USA, savings and returns to government $5 for every $1 spent Communities that Care reduced adolescent alcohol, tobacco, other drug use, and delinquent behaviour (Hawkins et al., 2009) Australian trial of CTC found reductions in alcohol use and misuse after 2 years (McBride et al. 2004). Developmental prevention initiatives alcohol misuse prevention for young people is effective universal and family based (Foxcroft & Tsertsvadze, 2011) supporting the development of parenting skills parental support, nurturing behaviours, establishing clear boundaries or rules, and parental monitoring Eg targeted support for under 5s in poor and workless households From birth, every child has access to a named person to promote, support and safeguard their wellbeing. Strengthening Families Harm reduction Safer Bars Police interventions targeted Consequence policing Mandatory plastic glassware Community interventions with enforcement Electronic monitoring/immediate sanctions Violent venues register Safer Bars Reduced aggression and violence Moderate/severe physical aggression by patrons decreased from 11.5% pre intervention to 8.3% post intervention, compared to a 5.1% increase in control bars (Graham et al., 2004). But, it s expensive and staff turnover is high CONSEQUENCE POLICING Police interventions targeted The Alcohol Linking Program 36% in alcohol related crime incidents over 3 month period Assault rates by 32% over 3 month period The TASC project (hospital data) 8% in the rate of violent incidents 4

5 Mandatory plastic glassware WHAT WORKS Violent venues register The evidence relating glassware to alcohol violence severity is relatively strong and clear. pragmatic easily adopted strategy shown to prevent a number of serious injuries in licensed venues. Source: BOCSAR WHAT WORKS Monitoring/immediate sanctions 24/7 Sobriety (alcohol) Breath tests 7am, 7pm daily Immediate incarceration 8 24hrs 99% tests passed 66% never failed one, 9% failed twice OUTCOMES Drunk driving down 78% Assaults decline by 12% Domestic assaults decline by 16%. Statewide reports of FDV declined 10% Supply reduction Restriction of sale on specific beverage types Reducing outlet density Restriction of sale on specific beverage types 1. Halls Creek: 46% in assaults 19% in the proportion of alcohol related assaults 47% in domestic violence assaults 16% in the proportion of alcohol related domestic violence offences 39% in alcohol related emergency department visits 2. Fitzroy Crossing: in assaults & Emergency Dept visits 3. Gunnedah after midnight 35% in assaults (media reports) 5

6 Reducing outlet density in alcohol outlet density and consumption = related harms, particularly interpersonal violence in on site outlets = assaults reported. restaurants = higher assault risk alcohol sales predicted greater risk of: assaults occurring at hotels, assaults in the street, serious assaults and assaults on females. Harm reduction Risk based licensing In ACT, all offences declined by 21% Alcohol related offences relevant to RBL declined 25%. Small / negligible effect sizes 1. Alcohol free or dry zones a) or in specific locations 2. ID Scanners mandatory 3. Random Police interventions 4. Supervised taxi ranks 5. Night time buses and trains 6. Patron banning notices 7. Good Sports 8. Advertising and promotion restrictions 9. Test purchasing Supply reduction? Social Norms campaigns Cochrane review: no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students Tasmanian trial: Changes (drinking, peer drinking, drunkeness) were short lived and returned to baseline levels at 12 months. Harm reduction RSA training Liquor Accords CCTV Lock outs (precinct wide) Drink safe precincts 6

7 RSA training (on it s own) 8.9% in patrons rated as extremely drunk, and a small improvement in staff scores on an RSA questionnaire (Lang et al., 1997). Other studies have found that training has had no effect on service to intoxicated patrons or intoxication levels of patrons (Krass & Flaherty, 1994). Young staff, high turnover, management demands etc Online training Liquor accords Few have been formally evaluated unable to demonstrate effectiveness reliance on voluntary commitments individuals who operate in a highly competitive profit orientated industry reductions in alcohol related harm only sustained for a few months Risk of capture Excuse to do nothing Lock outs Precinct wide lockouts appear ineffective, and are associated with some negative consequences. Specific venue lockouts can be useful* However, a more general need remains to evaluate the use of lockouts for specific venues Kypri K, McElduff P, Miller PG. Restrictions in pub closing times and lockouts in Newcastle Australia 5 years on Drug and Alcohol Review 7

8 Drink Safe precincts The Queensland trial was evaluated after 14 months and again at 18 months. No change in community safety or alcohol related violence WHAT DEFINITELY DOESN T WORK 1. Psycho educational campaigns e.g. Just Think or Step Back Think 2. Drinkwise get the facts the trial was poorly planned, implemented and evaluated, rendering the efficacy of this intervention unknown. Just Think since June 2008 Separate from Accord/Community Safety Awareness campaign featuring battered heads beside footy players no practical strategies Geelong Advertiser/ Geelong Footballers + Drinkwise funding Intervention β t 1. Night Watch Radio Program ID scanners Just Think Campaign * 4. Operation Nightlife WHAT DEFINITELY DOESN T WORK Drinkwise get the facts 6.41% of respondents had visited the DrinkWise website recognition (24.44%) of the Get the facts logo was significantly worse than previous findings on US warning labels (43%). (Coomber et al, in press) Strategic thinking A response framework Mandatory vs Voluntary Enforcement Cost effectiveness Involvement of industry A RESPONSE FRAMEWORK A national strategic approach Supply, demand, and harm strategies Across the life course Across levels of prevention 8

9 Mandatory vs voluntary (Only one study) DANTE: patrons in Newcastle were more likely to be refused service when intoxicated RSA practice was significantly better in Newcastle Many venues observed in Geelong were not even signatories to the liquor accord ID scanners in Geelong provides a perfect example: two of the venues operating past 1 am did not have ID scanners working 50% of observers were not scanned Mandatory vs voluntary Key informants identified the following benefits of mandatory systems: it created a level playing field for all venue operators; venue operators were clear about the rules; regulatory authorities were able to act immediately on infringements; and a clear message was sent to patrons that the government and community were serious about responsible alcohol consumption. Enforcement Abundant evidence that enforcement is a crucial element (Babor et al., 2010; Chikritzhs et al., 2007b). Restrictions often fall short of their full potential, simply because there are too few police. It is not enough, however, to simply enforce. penalties imposed must be substantial enough Cost effectiveness Almost no information Prevention efforts save $5 for every $1 spent Hospital record linking save $58 for every $1 spent only 20% of income generated in night time economy comes from midnight 6am (UK) Involvement of industry the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests (Margaret Chan, Director of the WHO BMJ, 2013). Substantial confusion exists about the appropriate level of industry engagement Alcohol industry strategies now well documented Industry cannot be objective mandated to make profit CONCLUSIONS A wide range of effective interventions exist A holistic approach Enforcement of existing laws: effective, but expensive! Limiting alcohol supply reduces all forms of violence at NO cost to the wider community Appropriate guidelines should be developed to regulate the industry influence on alcohol policy. 9

10 THANK YOU Our team: Nic Droste, Darren Palmer, Ashlee Curtis, Kerri Coomber, Florentine Martino, Arlene Walker, Elise Cox, Lucy Zinkiewicz, Beth Costa, Shannon Hyder, Steven Litherland, John Toumbourou, Eric Koukounas, Emma McFarlane, Andrew Day. 10