story

by Cassandra Wright, Menzies School of Health Research; Beau Jayde Cubillo, Menzies School of Health Research; John Holmes, University of Sheffield; Mark Mayo, Menzies School of Health Research; Mark Robinson, The University of Queensland; Michael Livingston, Curtin University; Nicholas Taylor, Curtin University; Sarah Clifford, Menzies School of Health Research, and Tim Stockwell, University of Victoria*

The new Northern Territory government is planning a swathe of changes to alcohol policy.

If implemented, these changes fly in the face of what evidence shows works to reduce alcohol-related harms. Some are also out of step with the rest of Australia.

Among our concerns are plans that would lead to harmful alcohol products becoming cheaper, alcohol becoming more easily available, criminalising public drunkenness, and a particularly worrying type of mandatory alcohol treatment – all of which evidence suggests will cause more harms.

No one is downplaying the magnitude and complexities of alcohol-related issues in the NT. But we hope the territory government will pay more heed to the evidence and voices of those most impacted.

Alcohol-related harm in the NT is complex
Alcohol-related harms in the NT are significantly higher (for both Aboriginal and non-Aboriginal people) than elsewhere in Australia.

In the territory, these harms contribute to health and social outcomes costing at least A$1.4bn [US$1bn]  a year. Alcohol harms result in costs related to health care, deaths, crime, policing and child protection.

Aboriginal communities in the NT have for decades cried out for solutions and services that effectively respond to alcohol-related harm. Instead, they found their lives made part of a political football match on law and order. Policies have been reactive and mostly ineffective. They’ve been overturned at each election.

Now, the new NT government is discussing changes that promise to exacerbate the very issues it aims to address.

1. Cheap alcohol that contributes most harm would be on the market
The World Health Organisation recognises that raising the price of alcohol is one of the most effective ways for governments to reduce alcohol-related harm.

So some governments around the world, including in the NT, have set a price below which alcohol cannot be sold, known as the minimum or “floor price”. This targets cheap, high-strength alcohol associated with patterns of drinking that cause the most harm.

The new NT government plans to repeal this, despite evidence showing this works to reduce harms.

Since the NT alcohol floor price was set at A$1.30 per standard drink in 2018, there has been a:

• 14% reduction in alcohol-related assaults in Darwin and Palmerston

• 11% reduction in domestic and family violence assaults

• 21% reduction in domestic and family violence assaults involving alcohol

• 19% reduction in alcohol-related emergency department attendances.

Originally, experts recommended a A$1.50 floor price but this was reduced to A$1.30 after a backlash from alcohol industry lobbyists. Had the policy not been watered down, evidence suggests the impacts above would likely have been greater.

The floor price has likely also lost some of its initial impact as it has never been indexed for inflation.

The best available research shows the floor price has reduced alcohol-related harms with no evidence of unintended consequences or negative impacts on the alcohol industry, despite claims otherwise.

Researchers and experts from around the world have been writing to NT ministers urging them to reconsider repealing this effective policy.

This includes researchers from the United Kingdom and Canada, who have coauthored this article. In these countries, evidence on the effectiveness of minimum pricing has been used to increase the floor price by 30%, not abolish it.

2. Bottle shops could be open longer
There are also proposals to repeal current restrictions on bottle shop trading hours. Such restrictions are highly effective in reducing alcohol harms, including violence.

Our paper from earlier this year found that in the town of Tennant Creek, restrictions to reduce trading hours and introduce purchase limits at bottle shops resulted in a 92% reduction in alcohol-involved domestic and family violence assaults.

Preliminary analyses of the reduced trading hours introduced in Alice Springs following Prime Minister Anthony Albanese’s visit in early 2023 also suggest a clear reduction on violence rates.

3. New public drunkenness offence
Ministers were also set to pass laws to create a new offence for “nuisance” public intoxication (also known as public drunkenness). This would allow police officers to arrest people and fine them up to A$925, in addition to current powers to seize and tip out alcohol from people drinking in prohibited areas.

This is at the time when nearly every other jurisdiction in Australia is in the process of decriminalising public drunkenness, making the NT out of step with the rest of the nation.

The NT’s proposed new laws on public drunkenness would criminalise more people who are already locked out from our society, placing them at risk of the negative, intergenerational and preventable impacts that often arise from contact with the justice system.

4. Mandatory rehab
Mandatory alcohol treatment was also an election commitment.

In its previous term of government, mandatory alcohol treatment was focused on people with a public intoxication offence rather than providing quality care to people with alcohol dependence in life-saving circumstances. If the same model is reintroduced, this is potentially harmful and at best ineffective.

In the NT, this model of mandatory alcohol treatment had no better outcomes than for those who may not have received any treatment at all. But it cost the taxpayer three times as much.

Where to from here?
Researchers, health professionals and partner organisations have urged the NT government to reconsider these decisions, as we have well-founded concerns these may worsen the very issues the government aims to address.

There’s no need to guess the outcomes of changing, repealing or introducing alcohol policies. We can draw on robust evidence, including extensive research from the NT, on what works in our communities.

*This piece is republished from The Conversation under a Creative Commons license. Read the original piece. ■

[Read more…] about Guest post: Why Northern Territory alcohol reforms would be a disaster, according nine experts

Just one in five Brits know how many calories are in wine or beer or know the official low-risk drinking guidelines, according to a Yougov survey from campaigners calling for labelling to inform them.

“It is absolutely unacceptable that the alcohol industry is able to get away with not providing full information on its packaging,” said Holly Gabriel from Action on Sugar, a view echoed by campaign partners Alcohol Health Alliance.

Alcohol is a carcinogenic drug of dependence with a calorie density comparable to cooking oil, causing a wide range of common physical and mental health problems and mistakes ranging from the deadly to the embarrassing.

But a legal loophole means alcoholic drinks labels need to contain less nutritional information than orange juice. Alcohol suppliers compound the problem by omitting low-risk drinking advice to protect shareholder profits. 

Labels provide crucial information to consumers, but alcoholic drinks labels need only show alcohol content, allergens and container size. Campaigners see an upcoming consultation as a way to put this right.

Our individual decision making has major limitations in curbing harm from an addictive drug, but denying us basic pieces information is not a solution. ■

by Nicole Lee, Curtin University

With everything going on over the past couple of years, many people have changed their drinking habits.

We’ve seen an increased demand for support, suggesting more people are trying to cut back or quit.

There are so many options for cutting back or quitting alcohol it’s hard to know what will be most effective.

What works depends on how much you drink
Most people successfully quit or cut back their alcohol consumption on their own.

People who drink more frequently are much more likely to have symptoms of dependence and might find it more difficult.

You might be dependent if:

• you can’t easily go a day without drinking alcohol, or find it hard to cut back
• a lot of your social activities include or are based around drinking
• you find yourself thinking about or wanting alcohol a lot
• you find it difficult to control the amount you drink once you start
• you need to drink a lot to feel the effects
• you experience withdrawal symptoms, even mild ones, such as feeling unwell or a slight shaking in your hands when you go a day or two without alcohol.

The more of these signs you have and the more severe they are, the more dependent you’re likely to be. You can check your risk of dependence here.

If you have a mild dependence on alcohol, you may be able to cut back on your own. But if you are moderately dependent, you may need to get some kind of support.

If you are severely dependent, you should seek medical advice before you make any change to your drinking because stopping suddenly can cause severe health problems, including seizures and even death in some people.

For people who are severely dependent, the usual recommendation is to take a permanent or temporary break from alcohol. It may take six months to a year or more before you are able to start drinking again. Some people find it’s better for them not to drink again at all. With severe dependence, there’s a high risk of quickly going back to heavy drinking if you just try to cut back.

If you experience any symptoms of dependence, once you stop or cut back your drinking, you might need specialist treatment or ongoing support to prevent going back to heavy drinking.

‘Cold turkey’ or reduction?
If you’re not dependent, you should be able to either reduce the quantity or frequency of drinking or quit altogether. You may do this on your own or choose to get some support. If one method doesn’t work, try a different way.

If you experience mild to moderate dependence, every time you have a drink it can become a trigger to drink more. So it’s sometimes easier to increase drink-free days, rather than reducing the quantity on drinking days, or to quit altogether for a period of time.

People who are severely dependent usually require some kind of withdrawal support to stop drinking. It is usually better to stop altogether (“cold turkey”) as long as you have medical support. You can undertake withdrawal treatment in a hospital, at home with the help of a GP or nurse, or via telehealth. Alcohol withdrawal typically lasts about five to seven days.

Zero-alcohol drinks
Zero-alcohol drinks are alcoholic drinks with the alcohol removed but which retain a taste similar to the alcoholic version. There is now a huge variety of options for spirits, beer and wine.

If you are not dependent but are trying to reduce your alcohol intake for health or other reasons, these can be a good option. By replacing some or all of your usual alcoholic drinks with zero-alcohol drinks, you can still enjoy the social aspects of drinking without the health risks of alcohol.

If you are dependent on alcohol, the smell and taste of zero-alcohol drinks can act as a trigger for drinking alcohol. They might make it more difficult to make permanent changes to your drinking.

Treatment apps and online support
A range of computerised, web-based, and mobile apps have been developed to support people cutting back or quitting alcohol. They have shown promising results in early trials. The benefit of these apps is accessibility, but the outcomes are modest and they seem to work best in conjunction with professional support.

Hello Sunday Morning’s Daybreak program is a large online alcohol support community, accessed through a mobile and desktop app. It’s designed for moderate drinkers who want to cut back or quit. Early research suggests it’s effective in reducing drinking, as well as improving psychological well-being and quality of life.

Some previously face-to-face support groups like SMART Recovery and Alcoholics Anonymous have moved online, which has increased accessibility. These are typically more suited to people who are dependent on alcohol.

Psychological interventions

Brief interventions: As little as five minutes of advice from a GP can reduce alcohol consumption by 30%, especially for people who are in the mild to moderate dependence category. So it’s worth chatting to your doctor if you need a little help getting started.

Counselling and psychological therapy: The main treatment type to help with alcohol issues is counselling. Sessions are usually once a week with a qualified professional, such as a psychologist. Sometimes they are delivered in group settings. Counselling is suitable for any level of drinker who is trying to make changes.

Some of the main evidence-based counselling treatments in Australia are behavioural and cognitive therapies, such as cognitive behavioural therapy and mindfulness-based relapse prevention. These types of treatments have been shown to be at least as effective as medication

Intensive group programs
A number of more intensive group programs are suited to people who are dependent on alcohol or who are having significant problems, including:

• residential rehabilitation, which is usually for people who have tried other treatments unsuccessfully or who may be unsuitable for non-residential treatment because their home life is not supportive of making changes. It has been shown to be effective in increasing abstinence in dependent drinkers
• day programs, which are similar to residential rehabilitation programs but participants live at home and go in each day. These are a relatively new treatment type and there is limited good quality research on their outcomes.

Medication
A number of medications can help people who are moderately to severely dependent on alcohol. They tend to work best in conjunction with counselling.

• disulfiram is an older medication that works on the alcohol metabolism system and induces nausea and vomiting if alcohol is taken at the same time
• acamprosate can help prevent relapse in people who have already been through withdrawal
• naltrexone reduces cravings in heavy drinkers.

Self-help groups
Alcoholics Anonymous’s 12-step movement has a long history dating back to the 1930s, when there was very little available in the way of real alcohol treatment. There is relatively little research on AA and much of that has been conducted from within the organisation. The known outcomes are modest – the success rate is estimated to be around 10% and the dropout rate appears high.

AA can be helpful for some people and also provides a very well-established peer support network if you need support. It seems to be more effective in conjunction with professional treatment.

There are many options if you are trying to reduce your drinking and no single strategy works for everyone. The best approach is to start with something that looks appealing and feasible to get the outcomes you are looking for. If that’s not effective, try something else or seek professional help. ■

Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.