Alcohol: preventing the harm: towards a national policy: anational conference held by the Irish National Council on

Alcoholism at the Royal Marine Hotel, Dun Laoghaire, CoDublin on November 27th 1986

Item type Conference Presentation

Authors Irish National Council on Alcoholism

Publisher Irish National Council on Alcoholism

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IRISH NATIONAL COUNCIL ON ALCOHOUSM - 19 - 20 FLEET ST .. DUBUN 2 . PHONE 774832

ALCOHOL

Preve~ting the Har~

TOWARDS A NATIONAL POLIC Y

ALCOHOL, Preventing the Harm

Towards a National Po licy

A n~tion~l conference held by tbe Irish N~tional Council On Alcoholism at tbe Royal Marine Hotel, Dun Laogb~ire, Co, Dublin, on Nov. 2G 1986.

TABLE OF COliTENTS

Introduction • • • • • • • • • •

Opening Address . • • • • • • • • Dr. Patrick Hillery, An tUachtaran

Preventing the Harm. . . . • • • • Mr. Justice Costello, Chairman, INCA

Intervention and Education. • • • • •

Kr. Donal o 'Shea , Chairman. Health Education Bureau , CEO North Western Health Board

A View From the Drinks Industry . • • •

Xr. Harry Hannon , Director, Irish Brewers Association

The Place of Alcohol in SOCiety Today. . Dr . Max IL Glatt. Medical Director, Dependence Unit.

• •

• •

• •

• •

• •

• •

Charter Clinic, London; Honorary Physician of Psychological Kedicine. University College Hospital, London

In Trouble With the Law. • • • • • • • • Kr. Martin Tansey, Principal Probation and Welfare Officer, Probation and Welfare Service

Why a National Policy? . . . . . . • Dr .Norman Krei tman, Professor of Psychiatry. Edinburgh University; Director of Unit for Epidemiological Studies in Psychiatry, Royal Edinburgh Hospital

For the Future. • • • • • Planning Mr . Liam Flanagan, Secretary, Department of Health

Conclusion . • • • • • • • • •

• •

• •

•

•

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• • • • 1

• • • · 2

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• • • .15

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ALC OHOL, Pr e v e nti ng t h e Har m

Towards a Na t i on a l Policy

/;. XUJtiODld conference beld by tbe Irish liatioIlal Coullcil on AlcobolislI! at the Royal RariDe Hotel, Dun Laogbaire, Co. Dublin, OD N07. 27, 1986.

TABLE OF COIITEIITS

Introduction • • • • • •

Openins Address . • • • •

Dr. Patrick Hillery, An tUachtaran

the Harm • • • • Prevent.ing Kr. Justice Costello, Chairman, INCA

Intervention and Educatiou. •

• • • •

• • • •

• • • •

• • • •

Hr. Donal C'Shea. Chairman, Health Education Bureau , CEO North Wes~ern Health ~card

A View From the ~inks Industrv o • • • • V" l:l D' .. r . tta:"ry .. snnan, lrec'to:-. I:-ish B:-ewe~ Association

The Place of Alcohol in Society Today • •

T\- .., .. ,. ¥ G, . ..... "e~l' -a' D~-~~~""- Tle-''''''''';;e--< .v~. I·...... .'. . .u.< ~ " . r. <... .....:. ..... ~ .... ~'-''- , w !c'-""'" L.~"" Unit •

• •

• •

• •

• •

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Cha:-'te:- Clinic, Lanao;:; nonora:-y !"hysi:::::ian 0: Psycholosical ]iiedicine, University College

In Trouble With the Law. • • • • • • • • Er. Xa:-;:in Tansey, Princ:pa.: ?ro':1ation ~nd. \lielf~re O:fioer , Proba~io~ anQ W~~i~re Ser vice

i:ny ~_ Rz;.:tional Policy? • • • • • • • • T,_ ~- ___ ..,_ ti _,:,._-. . _ -o...., "<es50- 0- -;'5"--" ~" --- -;;-",~",-o"-"";" }.,I .... "" • .., ..... > •• ___ ~_ ..... , ~_ ... .:. ""_ ' . ~ •• _~ ....... ~ • .>. _ ......... u-e"'" H~ , • • __ <:; ~_j .. D- - e--OT 0' Un~- -"-- -:'_i"':", _ _ ~-, __ ~~.- S~.:;~l· es " _. " "'-_ • • , • • .... ..... - ... .. --"- ---.!"' ... '"'--...... ~ .. ""~ . .... - ._-'j - ~5··--., .;.-~·· ::'oy· ' -- < 1'--'" ~.), n .....

:.::- . - -.. - ",'" ..... -.­~ -._,::, -, 5o- - e-a- " ""''' 'J'

" . . -- .. _. -,=- ~ .... ~- -~- ... =- ......... • • • •

.. . . ........ = .... --<.'-J=" .. ""'- .

• • •

• • •

• • • •

0: Heal-tb

• • • •

•

•

•

• • • • 1

• • • • 2

• • • • 5

• • • .10

• • • .15

• • • · 17

• • • .22

• • • .2'7

• • • .31

• • •

1

INTRODUCTION

The Irish National Coullcil OD AlcoholiSJl1 <INCA) is the

primary adviso~ body iD the field of alcohol-related

problems in this country aDd this organisation should be

involved iD the f01BUlati01J of a national alcohol policy.

(Psychiatric Services - "Planning tor the

Future" , Stationery Off ice. Dublin, 1984)

I n response to the concern voiced in the directive "Planning -for the Fut ur e" I INCA took the decision to hold a national

conierence, the theme being : "Alcohol. Preventing the Harm -

Towards a National Policy,"

With our choiCE of speakers from various diSCipl ines, and

thei r wide practical experience a nd knowlege, we hoped to -bring tG attention the areas that needed to be emphasised in

order to formulate a comnrehensive and e:::fect~ve na~innal -po!icy on al cohol.

Followi ng are addresses given at the Conference by t he em:'nent

speake:-s. p:-esen.:ed he:-e :'n ~b·:;.reviated fo:-:m h:'ghl igh;:;::' ng t he

-o ; --~ I-' _ .... ~= - sign:'f:'can~ to the the~ of ?:-even;:;:'ng ;:;oe na:-~.

I ~houl d ! ike to ava~l of this oppo::-~ur.~ty t o ex;:;end sincere

":.:..:l.an.!':s to s-::; a:::f , ro€.nosrs 0: the Counc::'l. speake:-s , anc. all

- - ... o-~ '-' ".;.J. _ _ <:> W!lO gave so gene:-o~ 5 1 y ef thei:- ~ :"me a nc. e::=o::-~

Sally Ed",-ards, ~..-pP T T ~ .. ~ -~

~a~~c~~1 D'-e c-or .lli _L ........ _ .... _ " •

INCL

2

OPENING ADDRESS

~. Pa~rick Hillery, An tUacbraran

It gives me very great pleasure ~o we lcome • here all ""ho are

par~1c1pat1ng in this conference. I extend a special ly warm

we lcome to those who nave come from abroad to share with us

their understanding and experience •

and eXDer"tise in

deal ing with, the very serious problem with which the

conference i s concerned .

IJo praise for t;he I r ish 1:iational ro"nr; 1 '-' u '"'_ on Alcoholism anc

work o ver the past twenty years could De too great. It has

brought a ;:ru ' y admirabl e dedication. de"te:-mi na;:ion , ba l ance

and enligh~ened unders~and1ng anc sens~~ivity to its effort;s

~o grapple with a grea~ human problem. Te all t;hose qualit;ies

rou s 't b e a't;::-i b t: -::ec. t h e g :-eat success .... hieb. i't has a chi eved in

suc~ a short t~me, and on which I cong~a~ulate it mos~

sincerel y .

has to, s q uarely and ra .. tionall y. ana tu:-nec. a

u":)on a deep-roo~ed nat i onal problem which, "0-" - all

~ - - "--~-6 ~ ~ v d ..L ,,= ............... o:::u ......... an · :.~S all 'too obv ious awesome :'~0 i ica~ions and

conse qu ences, >,'a,::: for. ~OO lon--~ - .. ,~ .. ,_'"_ no-. - ignore~,

_e5= ~han tb.~ fu: l seriousness wnich it d eservec. There can

L.a -..re been any ~ i me wno were unawar-e ~ne preva l ence

G: ~ lle m~su se O~ a lcohol in their co~munit i es . ':'here c an have

-----,

- -~­_. - .

"'Cl. , ';"'0 _ _ n ..

.... ~ .. ,.... -~- ~,

......... .1 '-'- .!.." Y

unha.ppy results such :5. s:' ~u a~ ion were

yet h~cause of the readiness •

:.gnore anc. a -:;o le:-a~ior_

, ' eo . - ;:,---n- =--; =-~C'" 1 , Y ';"''''"'''-=0.' " .. _'- .... _'"'-_=_'" ..... __ .... __ -"' _ Co>. weakness" ::..n people , a

· ... ·as De rn::;.:" ~-::;6c.. •

to gat~er -~'"" ..... --u~ ...... ....:~ .......... .

3

•

It is true that at d iffe r ent times most praiseworthy campaigns

were launche d agains t the excessive consumption of alcohol.

It , . .... 6 "tru e , too, that such efforts bore good results, f or a

period, i f n ot permanently. Nevertheless , t he basi c problem

of the abuse of alcohol remained entrenc hed in o u r socie ty and

has continued to grow ane wreak navoc on men and women, old

ana young. on the ir families a t home, and on their colleagues

in the workplace.

Thanks to the incomparable endeavours of INCA there is now a

fulle r unde rstanding . a deeper appreciation ana a more

r ealisti c recognition of the rea l ity of the posit ion in which

we find ou rse lves in re lation to the abuse o f alcohol a nd "to

the impact of alcoho l - re l ated problems in our midst . is no •

s~ll achi evement to be able to c lai m t hat no~ at least , a~

las~, we a dmit that the~e is a probl em. -

But much more tha~ admission o f the tru th has been forced upon

U6. At~itu des t o excessive d~inking hav~ changed, Se~vices

fo~ ~~Gbl e m d~i nkers nave increased. mo~e Eode~n anc ef~ective

t!"eatmen~s have been in~roduced . the knowleage and skil ls of

thOSE wh o work ..... 1 th D!"oble m drinke!"s have been deepened and • • ex't:enaec..

}:u c h indeed has been achievec.. But ""hile we have r eason ~ o

:ee: encou~aged, we have no cause at al l to feel comnlacen't: .

.l. need hC!~dly to b~ing to the attention of anybody in "this

eno~ni ty 0:: ~he task which sti ll challengES us.

~. nO':e i:u. the broch;.;re fa!" 't:his Confe r ence conce:-ning the

a =.""~ .e.nces ""·:'ich have been n:ade over the past 't: wen't:y yea:-s enaG

"Howeve ::-. alcoho l consumpt ion in

(and consequent2y alcohol-related problems) . " as

Neec 1 say more?

4

If I may draw upon the Conference brochure again, I would l ike

to draw attention to two further sentences, The firs t is:

"Public education helps people understand the impor tance of

:measures to control alcohol consumpt ion." The second is:

"The first task in preventing the harm is to convince peopl e

in genera l that th~s is an issue of public importance." For -us, I think, the import of those two sentences has special

significance.

I have already mentioned the detrimental effect of our too

tolerant attitude to excessive drinking and its consequences.

We need a very much altered attitude, we need much more

besides, of course, if we are to make an impression upon the

problem which is the source 0= so much illness, misery and

unhappiness in our socie~y,

I am ve~y much impressed by the progra~~e of your Conference.

I am confiden~ that very fruitful resul~s will flow from it,

among them. I hope. a less toleran ~ accep~ance of the abuse of

somsthing that was meant to be enjoyed. I wi sh you~

Conference eve~y success. It gives me great pleasu~e to

declare it open.

5

ALCOHOL. PREVENTING THE IIARX

YJ. Justice CostellD, Chairman, INCA

The I r ish National Council on Alcoholism i s , like many other

organisations a nd individuals, deepl y concerned a t the high

level of a lcohol abuse in our SOCiety and believes that a

national policy to prevent the har m which resul ts from it is

urgently required. Tbe Council has conv ened this Conference

to discuss and. hopefully. to support this view and to

exchange ideas on what a national preventative pol i cy s hould

a im to a chieve and how best it could be implemented.

Pe::--haps the fir-s~ ana key- issue ",-hi ch ...,i 11 reCH';:!. re -resolution is whether can be established that the overall

nationa l increase in the consuID?tion and the inc~ease in ~he

number 0:: a l cohol - :-e la-::ed p=--oD~ ems a:-e re lated. - INCA accepts

as valid for this country conclusions reached in o ther

countries as exemplif i ed recently in the repo~t of the Dept,

of Heal th and Social Secu~ity i n England which linked a shalp

increase in alcohol misuse in the UK with the r ise in overall

consumption of alcohol ,

The accentancE of this concl~sion carries wi~h it an imnortan~ •

c8ra; lz:..~y faT' a national policy, For it woulc. .folIo,..' t hat

E=~ec~ive~y to reduce the harm associate~ ~~th alcohol abuse

,"'ou!':" involve a conscious e.nd cielibe:-a-:;.e e~fort to red.uce the

1 ' ~ ..... _eve~ o. consu~ ~~ on. •• ~ .. ...0.1.5 •

ac-:;.icns ~hic~ a na-:;.ional

should.

pol icy shou::"ci

•

6

A second broad aim of a national policy, bu~ of probably

greater importance, should be to bring about changes in public

attitudes towards drinking , and in particular to reduce the

level o£ tolerance to alcohol abuse which exists throughout

Irish society.

If it is accepted that overall consumption should be reduced,

a national p o licy ~ll have to take a position On whether

there exists a l ink between the o~ice of alcohol and the level •

of c onsumpt i on. Recent evidence here ariSing f r om a reduc~ion

in the price of - spiri~s strongly sugges~s ~hat in this coun~ry

now (as in other coun~ries ) there is a close rela~ionshlp

be't.'l-:een p:-ice aue consu~tion. -

I n IN~A' s view !. t would be un ... ·:..se a na;;ional policy be

basee on the assumption that a fiscal policy is not one of ~he

means available for reducing cons umption. The cons~raints on

such a policy must of cou~se be recognisee. The obvious one

is the Droblem -A .. ' " ........ nO ,, !le~ 1.5 ~;.J.a ...

e.ssociatec..

as long as

i llegal cross-bo~der trade .

d.rink D~ices - a r e heavily weigh~ed

in the consumer price i::l.de::, governmen"'t;s may be unwilling to

~ncrease the m because 0= "'the economic consequences which mi ght

follow -- a fac-:. which ..... ould suggest that. =0:- the Du~pose 0: - -assisting the ~~ms of such a na~ion~l policy. alcohc~ should

" he 0"1-' .. ' .... -- ..... ~- ccnSUI!!er

C - .... ---.. ., 6 - - as-"-e - "-"' ­....... ~,,_ "u, ",.... :0,,". " ..... ~ .. so::-:. c..~inks

- .-.... : -ula-I v ~ .... - ¥~- -- .. ar::;ons "'the Y:Hlng" •

7

A national policy designed

itself with the problem of

to reduce consu~tion must concern

teenag e drinking. Existing

legislation designed to restrict t e enage drinking is defective

and requires amendnent. INCA has suggested what changes are

required:

-- It should be an offence to allow a person under 18 on

licensed prendses and not,

under.

as at n r esent, •

just those 15 and

-- Ignorance of the age of a young person should afford no

excuse.

-- Sale of alcohol to a person under 18 should be an

absolute offence.

-- A younS person who violates the code should, along with

the license holder. be guilty of an o ffence.

The law relating to off-license sa.lea also needs reform.

Sales to all -;::>80'01e unae:- 18 should be n ::-ohi b ited, with strict • • •

liab~1 1ty for the oifence on the licence holde~. The~e ghoul:::'

b€ a requ ~~eme~~ that alcohol must be sole =~OW a se?a~a~e,

de:::inec. and enclosed. a:-ea a:: "the premises vd th access to it by , e h" · .. . persons unae ~ age _ pro ~o~~ec .

11':CA has also recommende:::' that Denal ties fo::- breach 0:

licensing l aws should pro .... ide an e=fec~ive deter-ren"!:.. A

national po~icy should de~nd that all aSDects of the •

licensing code be e£~ectively en£o~ce~, those

cea~ins ~th teenage drinking .

co"s~~e-- - ~ o" '0 '--n~~n -.... ,-,- ~ ..... .. ... ...... ..... . -' -"'-~,:;, "n spo:-~s clubs w~ l l have •

- . 1· • ~aw ~n re at~on ~G

. . . , -:- _ :;;:)z ..... :. __ :r-ecu~ =-e ~o be e:.;:~.rr:i nee..

to

8

In adeition to conce~n with restrictive laws and their

enforcement, a national policy must involve a national effort

involving the medical profession, nurses, social workers,

teachers. lawyers, gardai. trade unionists, employwers

organisations, voluntary organisations and statutory agencies.

The responsibility of the ordinar y citizen will need to be

particularly emohasised.

A strategy aimed at establishing informed and responsible

a ttitudes to alcohol should be most particularly directed

towards young children who have not yet developed potentially

harm£ul attitudes and habi ts . Expert advice should be sought

on ho""o best to -i mpa:-t s uch info:-mation in pri:ma:-y and

secondary school s_

Parental example in es~ablishing responsible d~inking habits

may well

od' alIne a.,.

be crucial in

young people ,

'n° 0 , - success of an info:-rw.tion programme

and the involvement of parents groups

at national and local level wo~ld form part of the na~ioual

policy .

The na~ional pol icy should encourage ~~~r-p!ace preventa'tive -programmes, devisee. ir~ c..:'s:::ussion between t:-ade unions anc.

employe:-s , the e=fect iveness 0= which has alread .... ~ been >

ciemo:1.s~::a ~ec.. How bes~ ~o devel op the counsel l ing <! :ld

~,.. ' '-)­..., ..... _- "" .

se:-vices wil l also :'!:lDo~tant aspec;:;.s -

7~e policy should dete~~ne whe~he~ co::n.su:c:ro-:'ion - levels ere

:'::;:: "I ~e:1.ced ~y advertising, and wne"ther such advertising ehoule.

bsnned or con~rolled . ,,"";·.:re -- ~ ~" n- sty ' e -..... ...... ~ -=-·e - '='

n oe'" ro='" s" ...,':') _ ..... _ ' .... .1.'-' 1 ••

9

The policy must decide whether the benefits of random breath

testing outweigh the objection the sober driver will

experience at being subj e cted to it.

The organisational structure for formu l ating and implementing

a national policy needs to be considered and decisions taken

at how, at national level, the responsibilities of the

Depart~ents of Health, Education, Ju s tice anc Finance can best

be coordinated, and whether an advisa~y council of

representat ives from non-statutory bodies should be

constituted.

10

IHTERVERTIOH AND EDUCATION

Mr. Danal O ' ~ea. Chairman, Health Education Bureau,

Chief Executive Officer, Nortb Western Health Board

There are t ..... ·o main types of intervention, one on a g l Obal

co:mrnuni ty basis , the other on a personal basis.

The areas of global intervention in the case of alcohol

include Fiscal or pricing policy, control of access o r

availability, regulation of permitted consumption levels and

controls on advertising or promotion .

On the Dersonal interve~tional basis. there a re three levels -

Primary. befO!'"8 abuse: education, information,

lifeskills;Secondary, early stages of aDuae: crisis

intervent'on, early diagnosis, mon:.torins, referral; anc.

Tertia:-y. s~ages of aouse: " . . "rea"troen-:: , hosp~talisa-::ion ,

maintenance .

are pa::-t • 0= < o_o-ra""'""',::o ..... - - ~- ........ - is sensi:"<ve te the

att:.tudes , as'O:'::-ations. DrOC.i ems and susceiJtab:'lities of the

va--u­• ~ 0

neonl e. • •

grou p s and su bgroups that o u r

3.PD::-oacn ~o alcohol

have

~o""".o:.. .- -,,- e f

a::-e:

education " mUB ~ include

.; - . vO" n g _.. ..l .... people . - so

In "the Nocc:1:; "es-""~"'" .. '- - _ "

i n all

·hrou -' '- - 6--

and BE;l :-es c;eer::;. ;

11

hov,' to be assertive; decision making ski lls; dealing with

negative emotions; relationship building The ski ll s

are put into context for the students by SDecific •

reference

toalcohol use and abuse. Thus students can explore the

complex interactions which go into the decision to take a

drink and to make drinking part of their lifestyle.

Entry into the world of work is one of the crucial pe~iods of

any young people, during which they will affirm their

independence in part t hrough d rinking alcohol. Alcohol and

the "pub cu l ture," including the tradition of "round buying"

assume an important place at this stage. Early recognition

and counselling . ~, , s nOU1-Q p ... ay a major part in any

" comprehensive

s t rategy,

The increase i n the number of women ref erred to alcohol

treatment centres is significant. b~ought on by the increas~ng

economic inde~encience of women, changes in their role in

society,

-\ mpor"tB.nt

G' gene:--al

s houl d bE- • mace.

The -oroble:m . . . d:--~nKer

and ~ncreasing stress . It is

perspective • •

hea~tn messages that a l cohol

is eas-; :!.. v • :-eachec.

and . +h :...n ~ e

in;:.erven"tions

than through any other area.

th::ough his

I :-ish indus~;y has

been slow to recognise that its oro=its and productivity are

adversely af=ected by problem d ~inking a~n5 its empl oyees.

;-;o~e ve:--, the American eXDe:--:::.enCE; and the e:-:pe:-ience of I::isL

s uch as ES3 an::' he!:' L~r..gus

bene:::its

12

The major intervention open to the state is to control alcohol

consumption through legislative initiatives, There are a

number of areas where ~his can be done:

Raising the purchasing age to 21 . There would be severe

practical di£iiculties in imposing a ban and the opposite of

what is hoped for might result. In aur society moderate

consumption of alcohol is SOCially acceptable. Such handling

Of alcohol requires skills acqUired, in par~ , through

experience. By delaying t.he moment when decisions h~_ve to be

taken. we may be delaying ~he l earning process.

Enforcing t he presen~ age li~t. The minim~m l egal purchasing

age of 18 years is ra~ely strictly adhered to. U ,. 1 'h n ... :l. "ere

a vdll ingne ss on the part of the garda. i to reall y enforc e

these prOVisions, publicans will not feel under any real

pressure ~o u~dertake a responsibl e approach. Public

is

a~titudes here seem to play a :rr.~Uor :-ole, and. en the oasis 0::

everyday experience there seems to be li~~ le demanc fo:- th~s

. - ' - , .La .... • ,,0 De en:!orcea.. 0:- is it the general view that since

young people can dr~nk at home under adult supervision, s~ould

t hey ·oe a l lOWEd. similar o':)pon:uni "t ies - - in ?ublic houses?

There is evidence t~t links

bI'OSS ~lcohol sales directly wl~h pricing policy . Ho wever ,

:~~~le resea rch has been done to es~ablish how the various

movemen"ts.

:i~iJres for ~lcohol - "trea~ment incica~e t ha t is the

:'ov..'o:::::-- paid \.o,:o:--kers who mostly n eed ~rea"Cment, and the higher

-.~ . -_. ~ .... - ... '-" • co--.', ,,,,·- rp.~··'-s ..... .... _ _ h. ~= .... _ ". It - is

13

essential that more research is done on its effect s on both

attitudes and l ong term c onsumption patterns .

Drink-dri v e laws. One of the most dangerous forms of alcohol

abuse relates to drinking and dri v i ng . Irish peop le have

to be convinced that they will b e adequately punished for

engaging in this a buse and until a f orceful initiative is

undertaken allied with approp~iate judicial practice,

attitudes will not change .

Y~· --

Controlling advertising . There are fair ly strict guidelines

laid do~~ by the government. It ~s trUE, never the less , that

many advertisements about alcohol are Quite at~rac~~ve to •

people under 18 years of age. Attemots should be :maQe to •

bring advertisers to consider more carefully the aangers to

young oeoDle. • •

than ev.a:- before 'to the majo:- hel:.ltb. he.ze.:rc. which l:.lcohol

~oses ana to ~he :- isks ant! ha:-~ wh'ch are associa~ ed wi~h

.!:.nc. t o t.he of t he . , proc ... e:uls.

, ... -- must be seen '" ": t:>.a- 'l or "' ... _ _ .J.. ) as z;;, mY l~i-face t.ed o:-cc~e~ involving

a~ Governmen~ l eve l:

The Government as a whol e -- ove:-all policy

7he Depa~me~t of He~l~h -- healt.h and health service policy

•

0'::: Pi ne.D.ce and revenue policy

Indust:-y I Cor;;merce, Tou:-isID and Labour --

Educat.ion -- education policy

legisll:'.tio:J. ot: sales. age

acive:- ;'isinS.

14

Outside the Government, continuing action is clearly necessary

from the Health Boards, both directly and with local community

groups and organisations, the Health Education Bureau in

creating the environment for progress, and INCA in

initiatives such as this conference.

There is need at national level for the Government and its

agencies to:

-- Commission or carry out research into Irish attitudes on

alcohol. consumption patterns among specific sub-groups of the

population. and on the effectiveness of various controls and

interventions.

-- To take appropriate action to ensure that effective

controls and programmes of intervention are iEpleme~ted.

There is a need for the introduc~ion or expansion of

educational progamrnes in our SGhools, to be suppo~ted by the

relevant snecialist agencies. ~

There is a need for community action tD~ough the approp~iate

sec~ions c= the liealth Boards.

".:"here is a need for specific pra5r~mmes aimed young

vo~kers. at WDtteD, at the unelli~loved . ~ -

•

15

J,. VIEW' FROJ( THE DRINKS INDUSTRY

Xr. Harry HanD.on, Director. Irisb Brewers Associa'tioD.

The drinks indust:-y in Ireland employs some 44.000 peo~le - -directly at the retail l eve l and 7,500 in manufacturing.

making a real contribution to Ireland's economic and social

1 · , ~ ... e .

There has been much research done on the effects of alcohol on

the health throughout the world and findings sho~ tha~ alcohol

in moderat~on is no~ harm=ul to health. The vast majority of

drinkers in I~eland use alcohol sensibly. In a ~ree SOCiety.

all adults exercise free choices, including whether to drink

or not to drink, or whether to drink sensibly or not . Mature •

a dul ts who choose to drink take responsibi lity for the ir own

actions ane their own health. In fact, rese~rch shows that

alcohol h as ben e= icial e=fec~E promoting longer l~=e, ~educing

the risk 0= coronary c:sease,

elde:-ly.

There are a ~narity of people, however, who abuse alcohol,

and who cause serious d~mage to themselves, tneir fami~ies ~ad

to society in general, In ~he a rea of alcohol use, the need

~he:-efore is ~G ~ro~ec~ t~e weak and the vulneraole from

caus:. ns c.a:rna.R"e ~o ~hems.:: 2. ves ::z-o:r. abuse, v,.':" tho1.!~ penal isi ng

li balance

="JS-': be st:::-UCl:: ~tween the rish~s of tae ma.j ori ty and the need.

--o .... o~-~on oJ. ,,_~~ ... •

- . e·.·--e_- < en~e .-:~ =e!". :--:-r:: a:lc . .., ... _ ... ·"'-ou .... ·n ~ · · ........ n· e "0- ; "" -es- ; ..:=~, .... ba-v..... '"' __ '-'''' .... ... '" __ '-- '- '- __ , .... ... - . the

r :,.~< .;;: :.:· ::e~-=i V~ ,,"-ay to oeal wi th alcohol abuse is trough

15

preventi on, through educational programmes at a young age,

through peer group influence and parental example.

The prohibi tionist approach has been t r ied and has failed,

Banning alcohol. prohibitive taxes to act as a price

de~errent. banning advertising have been tried with l i ttle

success because these measures take no account of the root

causes of the problem of alcohol a buse.

The causes are complex and deep-rooted and have more to do

with factors w; t hin the person than in the alcohol they drink.

The problem of abuse is a people problem. not a product

problem. To counteract abuse, you aim your progra~mes

therefore at people.

The Irish Bre wers Association has embarked on a se~ of

measures to he lp in the fight against abuse, i nclucing

progr ammes in the workplace , policing a st~1ct code of

adve r~isins for the industry anc th~owing our support beh~nd

campaigns ~im=d a~ r educing drunken driving.

There are no s~mple o r e xnedient solutions to the problem and

enlightened approaches aimed at prevention , which a re

posi~ive, well researched, workable a nd worthwhil e ao no~

always h ave the same pu~lic or poli~ical apoeal as the

a pnroacnes. - -

L na"tioD.al 001iGV ~Jst therefore be realistic. . , must take

E'.cco:..:.n~ 0::: tne real pos::'"'.::i ve role alcohol plv.ys in socie"ty and

the probl e::::. az abuse in a const~uc~~ve and •

Coooera>::ion and pos~tive preventat ive measures

---· e-·~ -~-e "n-ar. ~~-"~en- ~a l_ l~ -_:0-. ac~;nn= ' ·'h;~n- sac.-~~_<c~ <:0 _____ v = ..... w. .... • ~ ,- .... u. • '- _ __ .... __ ... .t.. _ _ ... =

i ~,..:;~ _.; "':;u· " e ,... i e-;"-s '-" ..... _ v .t..u. Q.J.. ~ _ -0 ........ ,

17

THE PLACE OF ALCOHOL IN SOCIETY TODAY

Dr. ~x X. Glatt. Xedical Director, Dependence Unit, Charter

Clinic, London ; Honorary Pbysician of Psychological Xedicine,

University Collese HDspit~l. LondoD.

In the past, INCA and national councils elsewhere were

concerned only with alcoholism, not with drink itself . Such

attitudes have largely c hanged. This meeting. for exampl e. is

concerned ft~th alcohol and its use and misuse. We are

nowadays c ODcerned alsa with alcohol-induced problems falling

short of a lcoholism and in many ouarters - emphasis has shifted

f rom treatment to prevention.

But is Utonian t o th~nk tha t even t he most s uccessful

(educa~io~al and cont~al ) p~evention policies wil~ ever

completely eradicate alcoholism. With all the f ully justified

and necessary emphasi s on ?reven~ion we mus~ not forge t t hose

who are al~eacy ~oday's cas ualties or the many who are bound

to become casualties tomo~row. There wil l always be a neec

rehabili~ation as well as for orevention. , ' ".no.. , l ikewise, in the "task of Dreven~i on i t is n ot a aues"tior. . -of ei t he r educat ion or control but of education aDd co~"trol ,

as we l l a s research.

:"he is sa ::" c. , co~cerns peopie, n~~ ~n' e ~ ......... " product.

Tll.ere is an old. slogan. " L.lcoholism comes i n individuals.

"oe- ---'-..... <:> .............

. . - - -- 1=­_ ...... ~-=- .

-- 0 ..... - - .

coma in bo .... ..I..'e- " ... "' ... .:>.

:'ne i ndi vi dual .

But surely it

~-c'e-" oOW ... ""). and. the

is in both. It is

-- ~ -. '"- . -:::>e... .... __ . ... nE • .. ~ -, ---

18

The problems of alcohol abuse are rising internationally .

There are different approaches in differ ent countr ies, But

throughout , when there has been a rise in consumpt ion ~here

has been an at~endant rise in c r ime, mortality and the like.

Whil e s ome of us are probably more pr edisposed than others,

all of us are potential alcohol ics. Anyo ne who drinks long

enough and hard enough can become alcohol dependent or

sufferother alcohol-induced harm. Factors such a s ~he greater

availability or cheapness of drink or ignorance of dangers

a~tached to heavy drinking may increase alcohol consumption.

In general, throughout history and ~n our time, wnere there

has been a rise af per capita alcohol consumption there has

been an a~tendant rise in health neteri oration, mGrtal~ty,

crime and the like. The higher t he per capita consumption.

the higher the prev~lence of alcohol-related pro~lems and the

greater the nu~ber of casualties.

Can we 1 ea-.... .-~...., ;... ~ s· C- ) ' ... "-" _ ...... = .......... v " , way previous genera~1ons

fell \~iC1:i!:l to, and lea:-ued to overcome the p :-oble:ms of

excessive drink~ng7

England witnessed two previous ~~ves of ~~despreac alcohol

abuse. and is no\<" ensu1fec. in the third "'-'1lve , .'".hen aODl iec. to , ,

t.he d:"i.n1::: probleJI';.. the law :frequently contrib:...:tes towar<is

causing or eudins alcohol epidemics, • • • .... l.cens:.ns; .

-',,- -" ,-,-""c. .... "a" ........ , ~-,",< • • • ..; .,.,', .... w.::o--- " 1' - .• _- ' -~"'~ ... = . • '=' <-- -. at one time :Jr

S . • oc:. a .... ,

outle~s,

g:-oups, -. o".o.er. e ' -ho -- " _ .

.,:a ves.

cer-ta~n

19

Often it seemed that alcohol consumption increased after

relaxation of the law; rising consumption led to problems

arousing public disquiet; initially the government took

little notice; but complaints or action by pressure groups •

finally forced the government to take active steps. followed

by gradual reduction of consumption and problems.

The first wave, at its height between 1720 and 1750 , had its

origin in English agricultural interests in the partiality of

King William of Orange (originally Dutch) to gin. He favoured

the production of gin and banned import of foreign alcoholic

drink. The epidemic of gin-induced public drunkenness, wi t h

gin being plentiful and cheap. and its disastrous consequences

caused public concern which pushed the government into action:

the uns uccessful 1736 Act amounting to prohibition, which had

to be abandoned in the face of public protest, and finally the

Acts in 1751 and 1752 restricting the sale of gin and coming

down on "disorder ly houses".

improvement. -These led to a quick

The second wave came one hundred years later between 1820 and

1825 when beer as we l l as gin was involved in the epidemic,

triggered by the reducti o n of duty on spirits in 1825 and the

introduction in 1830 of Wellington's Beerhouse Act. allowing

anyone to open a "beershop" on paying a nominal fee.

Once again , public drunkenness and its disastrous consequences

caused public concern, leading to the setting up of four

committees and eventually to the emer gence of the powerful

Temperance movement. Finally the government's 1869 Act ended

the free trade in beer and brought control back into the hands

of licensing justices. Conditions began to improve and the

Liberal Party came down on the side of Temperance, intruducing

licensing la~Q in 1871 / 2 and in fol lowing decades.

20

An emergency situation, the First World War, gave Lloyd George

the chance to use the sledgehammer approach and impose drastic

regu l ations by reduction of opening hours of pubs. production

of beer and spirits, and reducing the number of licensed

premises. Between 1814/18 beer and spirit consumption had

fallen by 63 and 52 per cent respectively, followed b y a

marked reduction of p ublic drunkenness and liver cirrhosis

mortality,

After the war and partial withdrawal of controls, alcoho l

consumption began to increase again but on the whole, because

of the 19305 recession and the Second Great War, remained at a

relatively low l evel unt;l the 19505 when controls were

repealed or forgotten , new outlets increased availabi lity, and

at a time of affluence the real price of drink continued to

fall steadily. Thus the present, third wave, which started in

the ' 50s , continues to roll along.

The view has recently been expressed repeatedly that

alcoholism is a pol it i cal rather than a medical problem. But

no government is li ke l y to introduce drastic control and

fiscal measures in such a sensitive area without feeling

supported by public opinion . This presupposes education of

the publiC, and it is the medical profession which could

exercise a vital function by setting an example. In this way

the alcohol problem is clearly a medical as well as political

and social problem, and education and control are both vital

in this field.

Like the alcoholic beverage trade, the British Government has

come out in favou r of educational measures , in its publication

"Drinking Sensibl y" whil e not publishing the "Think Tank"

report commissioned by the previous government which favo ured

control.

21

Nearly 3. 000 years ago, the philosopher Eccliastes said that

there is "nothing new under the sun." The two previous

periods of alcoholism in the British I sles subsided aIter

about 30 and 5 0 years respectively; we are now 25 years into

t he present one . As in the case of the previous waves, the

present one is only likely to susbside when concerned bodies,

social pressure groups. d octors. the churches, etc.. educate

the publiC and thus lead the government to take adequate

control measures, in particular, preventing the real price of

alcoholic drink from falling. and maintaining efficient

licenSing laws.

Alcohol is everyone's business, Vie cannot just l e ave it all

to the Government or to the doctors. There has to be c lose

collaboration between all the interested bodies and. in

particular, a partnership between INCA and the Government to

produce the urgently needed comprehensive national policy. as

your President . Justice Costello. so excellently outlined at

this conIerence.

22

IN TROUBLE WITH THE LAW

Mr. ~rtin Tansey. Principal ProbBtioD and Welfare Officer.

Probation and Velfare service

Kost adults would claim the y can restrict their drinking to

what 1s appropriate for r easonable relaxation. However. for

some the enjoyment is marred by the consequences of 111-

advised or excessive indulgence -- the personal. familial and

social harm that society tries to prevent or reduce.

wnen the dri nker's reaction to alcohol transg resses the limits

of what is s ocia lly accEptabl e , then the cri minal l aw steps in

to c urtail this behaviour by penalising the perpetrator 1f

needs be.

One of the objectives of the Probation Service is to prevent

and remedy social breakdown. therefore it is vital ly concerned

to minimise the aamage done to the basic unit of society, the

nuc lear family. If we are really to prevent the harm being

done, t hen the part played by other social institutions may

need reassessment.

How does the law seek to regulate alcoho l abuse? What is t h e

statutory framework and what kind o f penalties does it

prescribe? How effective is custody as a means o f managing

r epet itive alcohol offenders? Is it the case that Ireland's -traditional ambivalence towards or tolerance of excessive

drinking extends to t he cri mdnal justice system and those

acting within it?

There is a belief that persons accused of offences wi ll be

dealt with lenient ly by p leading that they were drunk at the

23

time. In fact, this 1s untrue and contrary to the experience

of those who freq uent the c riminal courts. All p ersons

arepresumed to intend the natural and probable consequences of

t hei r acts. Therefore a person who drimks too much and

diminishes his or her self control i s responsible for

anydelinquent or criminal act which may be done during the

period of intoxicati on. -

The Gar da Commissioners Report on Crime gives figures for the

volume of offe nces dealt with by the Gardai. Over the period

af 1977 to 1984 inclUSive . the annual level of convictions of

people whose drinking has led them into conflict with the law

has increased by more than 45'%.. All of this rise is

attributable to both d r inking and driving and being present

illegally on licensed premises. while convictions f o r both

s i mpl e and aggravated drunkenness have fa llen by 27% and 9%

respective ly.

In tandem with other agencies in the c riminal justice system,

the Probabion and welfare Service has found in recent years

that whi l e the vol ume of referra l s made by cou r ts to the

service is increasing. the number of cases referred for

drinking offences a lone is not.

Examini n g the statistiCS. one i s struck by two factors - - the

sharp rise in numbers committed and the contemporaneous but

even sha rper decline in t he volu me of committals for d rinking

offences alone. This is not to s uggest that c onsumption of

a lcoho lic liquor is a diminishing phenomenon among offenders.

Ra ther it indicates that habitual drinkers t end increasingly

to come into confl i ct with the law by way of eithe r larcenies.

etc . . to financing the alcohol intake. or a ssaults and other

offences perpetrated while "under the influencce ."

24

Regarding young offenders, researchers have arrived at three

general conclusions:

-- alcohol plays a prominent part in the lives of young

offenders.

-- for many of them, consumption is of such an extent as to

create serious problems, and

-- in general, such prisoners represent a portion of our

SOCiety which is socially disadvantaged from birth.

Prisons are primarily containment, not curative. Prison

stigmatises alcoholics and accelerates the vicious circle of

crime leading to heavy drinking on release and further

offences as a consequence,

The National Youth Policy Committee advocated giving the

courts power to commit to a residential facility, similar to

drug t reatment centres, in lieu of prison sentence. The

Committee on the Penal System recommended that the courts

explore the possibility of treatment for offenders who are

serious abusers of alcohol or drugs. affording an accused

person outpatient or community care. Greater use could be made

of probation generally. and probation supervision in the

community could be linked to mandatory attendance at courses

designed specifically for alcohol abusing

offenders.

An element of compul sion is inescapable. Any form of

intervention outside custody that has education prevention and

diVersion as its basic aims requires some element of

compu lsion to stiffen motivation to see it through. The

initial decision to attend must indeed be a genuine option.

but once a contract has been agreed conditions of attendance

are needed to encourage commitment.

25

Again and again. the prevalence of delinquency, crime and

a l cohol or drug abuse, especially among disadvantaged yout h,

comes aut as high DU the list of priorities to be tackled.

Habi tual drinking originates at local comllluni ty level, be it

in the home, the street or the neighbourhood, so it is at this

level that the primary counter-measures must be taken. Hence

the importance of court s having available a range of non­

custodial disposals with which to deal with causes where

alcohol abuse i s a factor.

Assessment and diagnosis should be able to identify the "at

risk" drinker who may be referred to appropriate cOIll1lluni ty-

based therapeutic programmes. These later then aim to

intervene early and effectively in the person ' s drinking and

offending career.

The Court Alcohol Education Programme. in operation since

1972. adapted for Irish conditions from an American

initiative. has a rational e which can be stated thus:

-- committing an alcohol-related offence is an indicator or

symptom of a drink problem.

-- the person's underlying need far continued alcohol intake

is unaffectived by the normal legal procedures open to the

court.

high rates of recidivism tend to result. and

there is therefore an at-risk group in the community.

whose menbers are frequently before the courts. that could

benefit from il!!!!8diate intervention.

Fear of imprisonment may act as a strong motivating force for

the heavy drinker. Courts therefore can be instrumental in

compelling some offenders seriously to consider their drinking

and their need for help. The Probation and Welfare Service

will continue to provide, to the best of its ability and

26

within its limited resources. back- up support and liaison with

concerned agencies in the community.

Youth leaders, teachers. gardai. probation officers, social

workers and many others have a supportive role to play but not

the primary role that is ours as parents. Instead of foc us ing

exclusively o n t he need for legi s lation and the defects that

may be in present - day facilities, a positive attitude to our

responsibil it ies would go a long way towards preventing our

young people from getting into trouble with the law.

21

"WHy A NATIONAL POLICY?"

Dr. Norman Krei t.ma:n. Professor of Psychiatry, Edinburgh

University, Director of Unit for Epidemdological ~udies

~n Psychiatry, Royal Edinburgh HDSpit~l

The proportion of drinkers in trouble is well documented,

Al cohol dependency is an international experience and we must

take a wide view of the problem.

There are five principal strategies for containing the extent

of alcahol~related damage in Western societies: The public

health approach, which is concerned with the overall

relationship between consumption and harm, and which is

probably t he most important; education, which is so f ar of

uncertain efficacy; . early detection and screening; early

intervention, by all treatment agencies;

problem drinkers.

and treatment of

In attacking the problem throu gh the concept of public health.

we can note that average overall consumption is shown to be

directly related to alcohol-related deaths and alcoholism.

Any fall in consumption is reflected as wel l as rises. For

example. i n France during World Wars One and Two. there were

dramatic falls in deaths from cirrhosis when the s uppl y of

wine diminished. In studies from 1970 to 1982 on consumption,

the i ncide nce of cirrhosis, first admissions for alcoholism,

and alcohol-related mortality were a ll in line with levels of

consumption.

In a study in England and Wales in 1980 it was shown that in

the small minority of problem drinkers some 30% experienced -

25

health probl ems , while in the majority of average drinkers

only 3% e xperienced such problems. But the 3% of the

majority. in total numbers, was many times the 30% of the

problem drinkers; thus, most individua ls with alcohol -related

problems are drawn from the moderate consumption group.

There is a clear link between average consumption levels and

the price of a lcohol and availability ; alcohol advertising may

also be relevant.

The Danish experience showed that when the Government trebled

the pr ice of drink there was a dramatic drop in consumption.

Canadian studies linked the price of alcohol to consumption

leve ls over a 40-year period. A 1978-79 World Health

Organisation s tudy in the Lothian area of Scotland showed that

when both tax and trade price r ose, giving a perceptable

increase in pr ice of alcoholi c drink, a re- survey of people

interviewe d before the price rise showed that the same people

were drinking less. There was an across the board effect, but

in the heaviest drinkers the reduction was even more marked.

There is a direct link in consumption levels W±th the n u mber

of places where alcohol is available for purchase.

Some £250 million is spent annua lly in the UK on advertis ing

alcoholic drinks. There is a need for improved advertising

standards. In present alcohol advert isements, it is a

practice never to use any actor o ver the age of 25, but many

of them look like l6-year-olds. Advertisers are al s o allowed

t o use sex to sell their product (the Smirnoff vodka ads, as

an exampl e ). There is a link in t he public mind between the

excitement and g lamour depict~d in advertising, and alcohol.

On soap opera programmes the characte rs drink constantly.

29

In the strategy of education, there are two streams -- schools

and adults.

Ordinary education progammes increase outward knowlege of

alcohol problems but do not gUide attitudes. Each schoo l

programme has to be critically evaluated. Some have beenshawn

to be counter-productive. In a two-part survey of education

effect in Scotland, comparing those given informat ion on

a lcohol and those given none, there was found to be no

difference in attitudes towards drinking.

In screening at early stages, the involvement of general

practitioners is of vital importance. ¥~ny other programmes

for early detection can be mounted, through probation

officers, c h ild welfare officers, treatment centres,

industrial programmes and primary care agencies.

For early invervention we must call on voluntary agencies and

councils for counselling and befriending of those tending to

alcoholic proble ms. There is also punitive intervention

through the law, for drink-driving offenders. The risk of

being caught, however, is too low. Steps might be taken to

increase the risk, such as random breath testing.

more work to be done in this area.

There is

For treatment of alcohol-related problems, there has to be a

move away from in-patient services and a move towards major

services for outpatients, through GPs, counselling, etc.

All these s t rands have to be taken into account. This

conference by INCA is a landmark. and a commission should be

set up to draw up integrated recommendations. There are hard

decisions to be made -- there will be competing claims from

government departments such as those concerned with tou rism

and the brewing trade, versus those

etc.

concerned with health

In an outline policy, there must be clear statements ox the

objective. Government intervention is essential xor a

coherent policy to be implemented.

31

PLANNING FOR THE FUTURE

Mr. LiBm Flanagan. secretary, Department of Health

The report "Psychiatric Services - Planning for the Future"

was published last year. The Minister, Barry Desmond. has

directed that in the Department we should concentrate

specifically on implementing with the health boards the

recommendations of that report.

Our policy for alcohol services must be seen in the context of

a major re- organisation of our present psychiatric services.

"Planning for the Future" recQl!!!fcnds the development of a

comprehensive psychiatric service which is community based and

is an integral part of the general health services.

Rather than the present large "catchment areas" , services will

be organised on the basis of smaller "sectors" of 25,000-

30,000 people with a multi-disciplinary psychiatric team

having responsibility for the psychiatric needs of the people

in each sector. It will be led by a consultant psychiatrist

and wi ll inc lude psychiatric nurses and should have access to

other professionals -- a psychologist, a social worker and an

occupational therapist. -

Sectorisation involves expanding community faci li t ies s uch as

day hospitals o r day centres, outpatient clinics ,

workshops/rehabilitation fac ili ties, high support hostels, and

fami l y support.

Our policy now is that all admissions should be to psychiatric

units In, or associated with. general hospitals. PsychiatriC

32

units in generz:. l hospit<3_1s will provide short and medium stay

beds for patients needing stays of up to one year in hospital.

In regard to a lcoholism treatment. there should be a local

alcoholism service in each sector with the major emphasis on

outpatient treatment with therapy programmes and effective

follow-up services. We will need to train moTe alcoholism

counsellors to provide the personnel to run these services.

Al ready most psychiatric hospital s have deve loped specialised

alcoholism services. However, these services usually cater

for catchment areas of 100,000 people or more. We see the

of local alcoholism services as having many

advantages. It will allow people to receive help in their own

environment so they can learn to cope with their problem in

their everyday life. It means, too, that treatment can

uroceed with the minimum disruption to work, and help and

support can be given by families of people with alcohol

problems.

The establishment of loca l services should enable admissions

for alcoholism to psychiatric hospitals to be large ly

discontinued. As alcoholism now accounts for one auarter of -all admissions to psychiatric hospitals this will have a major

impact on scaling down activities at psychiatric hospitals.

Research now suggests that there lS no evidence that

intensive, in-Datient treatment is in any way superior to good

community-based intervention. Since intensive in- patient

treatment appears to be less cost - effective than more simple

methods, less emphasis is now being given to providing

specialist in-patient units.

Where someone needs in- patient care with a severe al c oho l -problem he o r s h e will go to a psychiatric unit in a general

hospital. We recognise that some people may need to be

a dmitted for sho r t periods -- perhaps for a few weeks

the main focus wi ll be on out-patient programmes.

- - but

Priority must be on strengthening the role of primary health

care services in the treatment and alleviation of alcohol-

related problems. Communication and cooperation between

general practitioners and the specialised psychiatric services

needs to be strengthened. The importance of the GP's role in

preventing alcohol-related problems cannot be over-emphasised.

Ila matter h ow sophisticated we are in our treatment methods

and facili t ies, the ultimate cure for our alcohol problem must

lie in prevention. Research shows that Government policies on

licensing and taxing al cohol have a ma jor infl uence on the

prevalence o f alcohol-re lated problems. It can , therefore, be

seen that a l coholism is not simply a medical problem;

also a social and political one.

it is

F i rstly , a lcohol poses somet hing of an economic paradox in

that its manufacture and sale provides significant employment

and public r evenue while also impos i ng significant costs o n

the economy, not just in t e rms of health expenditure but a l so

throu gh lost p r od uction and intangible costs in terms of human

misery and suffer ~ng.

Secondly, t here is a degree of ambi· .... alence in at.titu des to

alcohol in Ireland . While, on the one hand, we recognise t hat

we have an alcohol problem, our drinking habits in practice

suggest a fairly wide tolerance of excessive drinking. These

34

two characteristics -- the economic and the cultural dimension

-- militate against any simplistic solution. Any serious

attempt at a preventive solution could have implications well

beyond the health sector, spilling over into the industrial

policy area, fiscal policy, trade policy and the whole area of

licensing.

This conference has brought together people from all the

various sectors concerned with alcohol in this country. This

exchange of ideas and information is very useful and will. I

hope , help to prevent at least some of the harm caused in our

society from alcohol abuse.

35

CONCLUSION

In a short conference it was not possible to cover all the opt i ons. The

conference was, however, very s uccessful in highlighting a number of areas

which will form the basis of a national policy.

In his address, Preventing the Harm, ¥u. Justice Castello, Chairman of

INCA, pointed out the following exigencies, which were echoed by the

succeeding speakers:

A conscious and deliberate effort to reduce the national

level of consumption through fiscal policy

- Improved legislation on teenage drinking and effective

enforcement of the licensing code

Education to bring about changes in social attitudes in

the use of alcohol

- Encouragement af work-place preventative progra IIIUPS

Additional points raised by the speakers included:

- The need for research into Irish attitudes and

consumption patterns

A positive role for general practitioners lD early

intervention

The development of local alcoholism services with the

major emphasis on outpatient treatment, and the training

of more alcoholism counsel lors to run these services

36

The cancensus of this conference calls for a programme of preventative

action by the Government UDaer the following headings:

1 - Support of educational prograumE's to bring about

responsible attitudes to the use of alcohol

2 - Improvement and effective enforcement of legislation.

particularly in the area of teen-age drinking

3 - A fiscal policy aimed at reducing the level of

alcohol consumption in the commlnity

4 - Development and support of local alcoholism services

This policy, if itt?lemented with vigour and determination, should bring us

Ever closer to the reali ty of preventing the harm caused by the abuse of

alcohol in our society today.

• •