Collateral damage from alcohol abuse: the enormous costs to Australia

Alcohol abuse is a problem that could affect any member of society, including the majority who are abstinent or use alcohol in moderation. Although much has been written about alcohol abuse and its effects on the drinker, there has been less emphasis on the deleterious effects on innocent bystanders, such as the physical, emotional and/or financial loss or damage. The spectrum of this "collateral damage" includes alcohol-related violence, road accidents, family problems, adverse pregnancy outcomes, consequences of alcohol abuse by doctors, and the resultant financial burdens incurred by society.

Past studies have found that alcohol abuse plays a significant role in violent crime.¹ It is estimated that about 13% of Australians aged 14 years and over (well over one million people) have been physically abused at least once by someone affected by alcohol, while 16% have had their property damaged at least once.² Alcohol has also been implicated in about one-third of sexual assault cases.³ In 1992, 294 people died from alcohol-related assaults in Australia.¹

Drunk drivers put not only their own lives in peril, but also pose a significant risk to other road users. In NSW in 1995, of the 620 people killed in road accidents, 141 (including 37 passengers and pedestrians) died in alcohol-related accidents. In addition, 298 non-drivers were seriously injured.⁴ Even more dramatic examples of alcohol-related transport accidents have been recorded internationally, such as the tragic Exxon Valdez oil spill in Alaska in 1989.

At least 1% of the population (about 180 000 people) have a close family member with a serious alcohol problem. Isolation, neglect, aggression and disruption within the family, particularly spouse abuse, are frequent.⁵ Sexual and financial problems, stress, verbal and physical abuse, separations and divorce are also common between couples where at least one partner abuses alcohol.⁶ A Victorian report in 1988 found that alcohol was definitely or possibly involved in 53% of several thousand reported incidents of family violence.⁷ Children are particularly affected by having an alcoholic parent and they are more likely to become depressed,⁵ have lower IQ,⁸ and be alcohol dependent themselves in the future.⁹ In 1992, there were 226 hospital episodes resulting from alcohol-related child abuse in Australia.¹ However, the extent of family problems is probably underestimated because there is underreporting of alcohol-related domestic violence.

Maternal alcohol abuse is associated with adverse perinatal outcomes. These include the fetal alcohol syndrome, pseudo-Cushing's syndrome, alcohol withdrawal in the newborn, and increased risk of perinatal mortality.¹⁰ The incidence of fetal alcohol syndrome has been estimated to be between one and two per thousand live births, or 250 to 500 new cases per year in Australia.¹¹

Alcohol abuse among doctors may lead to impaired clinical judgement and skills. While it is widely believed that alcohol abuse may be common among medical professionals, it is very difficult to identify doctors with alcohol-related problems. In the 12 months to March 1996, the NSW Medical Board heard 31 matters related to "impaired registrants", of which five were related to alcohol abuse.¹² Similar problems may also occur in other health care workers. The costs of this to society include the costs of litigation, as well as the costs of patients' excess morbidity and mortality.

The financial burden of alcohol abuse to the Australian community is substantial. In 1992, the costs of alcohol abuse were estimated to be $4.5 billion, or $250 for every man, woman and child in Australia.¹³ About three-quarters of these costs were tangible, including lower productivity because of lost work days, health care costs, road accident costs and legal and court costs. About 93% of the total tangible costs were borne by business and government. The intangible costs of about $1 billion include the value of loss of life, and pain and suffering of road accident victims.¹³

The extent of the problems and costs of alcohol abuse is enormous, but they can be reduced or prevented. About 84% of the costs ($3.8 billion) have been deemed avoidable and potentially amenable to public policy initiatives and behaviour changes.¹³

While health interventions may play a role, by detection and treatment of alcohol misuse, tougher measures need to be taken in other areas to prevent hazardous drinkers from doing harm to themselves and also to others. Such measures might include:

• alcohol taxation to reflect alcohol content of beverages rather than the cost of manufacture;

• major aim of liquor law reforms to be reduction of alcohol-related harm;

• strict enforcement of liquor laws by both police and state licensing authorities;

• mandatory training in liquor laws of bar staff, managers and licensees; and a

• truly independent alcohol advertising regulation authority.

The NSW Parliament has enacted legislation which requires hotels, clubs and restaurants not to serve alcohol to patrons with certain defined behaviour suggesting intoxication (Liquor and Registered Clubs (Harm Minimisation) Act (NSW) 1997). The fines for drunken patrons who refuse to leave entertainment premises, if requested to do so, have been increased from $2000 to $5000.

These measures are a necessary, but only preliminary, step to place the onus of responsibility on alcohol abusers for their actions, to encourage retailers to adopt a strict code of conduct and to protect the public from the consequences of irresponsible drinking.

Yen F Tai
Medical Student, University of Sydney, NSW

John B Saunders
Head, Department of Alcohol and Drug Studies
University of Queensland, Brisbane, QLD

David S Celermajer
Associate Professor of Medicine, University of Sydney, NSW

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