Reducing alcohol-related violence and other harm in Australia

We need to increase alcohol taxation and reduce hours of sale to reduce alcohol-related harms

Alcohol can harm drinkers and non-drinkers as a result of the acute effects of alcohol intoxication (eg, injuries, car crash deaths, assaults and suicides) and the effects of sustained heavy drinking (alcohol dependence, liver disease, heart disease, strokes and cancers). In the most recent study of the behavioural risk factors that contribute to the Australian burden of disease, alcohol was the third most important (5.1%) after tobacco smoking (9%) and high body mass (5.5%). It accounted for 28% of road traffic crash burden of disease, 24% of chronic liver disease and 23% of self-inflicted injury.1

Community concern about alcohol in recent years in Australia has focused on violence and injury in the wake of several high profile deaths of young men killed by the punches of intoxicated assailants. The efforts of parents, public health advocates and medical professionals who have to deal with alcohol-related violence have led several state governments to introduce a suite of policies to reduce alcohol-related violence. These have included legislating for shorter trading hours and the timing of last drinks in hotels and nightclubs in city entertainment precincts.2,3 There is good evidence to support some of these approaches. They ideally should be part of a package of public health-oriented policies that could substantially reduce all forms of alcohol-related harm. Critically, this includes reforming Australia’s incoherent alcohol taxation system and setting a minimum price per unit of alcohol sold.4

Earlier closing times and lockout laws have been strenuously opposed by the alcohol industry and its partners.5 Their main claim has been that these measures have restricted the personal enjoyment of the well-behaved majority, while negatively affecting responsible drinkers and small businesses in entertainment districts.6 The industry opposes any policy that reduces their profits, although there is disagreement on the extent to which early closing laws have done so.5

The hotel and nightlife industry minimises the causal role of licensed alcohol sales in producing violence.7 Its representatives have argued that alcohol-related injury and assaults are attributable to illicit drug use7 and pre-loading.6 Illicit drug users are participants in the night time economy and they are more likely to engage in violence than peers who do not use these drugs, but illicit drug use is nowhere near as prevalent as drinking to intoxication as a causal factor in violence.8,9 Illicit drug use is also much less amenable to regulation than alcohol use.

Pre-loading is undoubtedly a factor in violence around licensed premises. Many patrons of licensed premises drink to intoxication before entering an entertainment precinct, usually by purchasing cheap alcohol from bottle shops and consuming this in their homes and elsewhere before venturing out.6 Australian research has shown that pre-loading is the norm among drinkers entering entertainment precincts in New South Wales, Victoria, south-east Queensland and Western Australia.9,10

The motives for pre-loading are primarily economic; namely, drinkers aim to reduce the cost of an evening’s drinking because of the high price of drinks in licensed venues.10 Research on blood alcohol concentration in patrons of these precincts finds higher concentrations among patrons later in the evening.11 This suggests that alcohol-related harm is elevated in entertainment precincts as a result of both pre-loading and continued drinking in licensed venues.

The high prevalence of pre-loading does not mean that we should abolish laws requiring earlier venue closing. Patrons report that licensed venues contribute to pre-loading by the high prices they charge for drinks.10 These venues also contribute to alcohol-related assaults by continuing to serve intoxicated customers into the early hours. This is most clearly shown by research evidence on the public health benefits of earlier closing of licensed venues.5,12

Experience in the central area of Newcastle and in Sydney’s Darlinghurst and Kings Cross clearly shows that reducing trading hours substantially reduced violence and assaults in these areas. This was achieved without evident displacement of violence into other areas.5 The policy has also improved community amenity and as such now enjoys majority support in community surveys, including in the age group most likely to visit entertainment precincts (18–24-year-olds).13

Pre-loading, and risky drinking more generally, needs to be addressed in another way. There is considerable evidence in favour of a low cost and very efficient policy approach12 that uses taxation to increase the average price of alcohol and the lowest price of the cheapest types of alcohol sold at discounts to heavy drinkers.

This goal can be achieved by raising alcohol taxes on beverages in proportion to their alcohol content (a volumetric tax) and setting a minimum price per standard unit of alcohol. The benefits of this policy will extend beyond reducing violence in entertainment precincts; it is likely to reduce all types of alcohol-related harm in Australia.4

Contrary to a common alcohol industry argument, a volumetric alcohol tax does not punish the majority of drinkers in order to deter the minority who drink hazardously. It is a user-pays tax that has the greatest effect on heavy drinkers because they drink the most and spend the largest amount of their income on alcohol. A volumetric tax thereby extracts compensation for taxpayers for the social costs of alcohol from drinkers directly in proportion to the amount of alcohol that they consume.4

Setting a minimum unit price on alcohol prevents the alcohol industry from undermining the benefits of a volumetric tax by discounting cheap forms of alcohol that are most attractive to heavy drinkers. Alcohol taxes provide funds to offset the adverse effects that heavy drinkers have on non-drinkers via alcohol-related accidents, assaults, neglect of children, and the costs of policing drunken behaviour in public places.

It is politically unrealistic to expect that the alcohol industry will change its priorities and practices to reduce the damage caused by easy access to and heavy promotion of alcohol. The alcohol industry’s approach to public education about alcohol emphasises individual responsibility and choices. This is exemplified in the work of the industry-funded organisation — DrinkWise (https://www.drinkwise.org.au). This approach allows the industry to take credit for seemingly positive health messages while continuing to maximise their profits by promoting their product to heavy drinkers using price discounts.14

Both state and federal governments have a responsibility to reduce alcohol-related harms in Australia. The Commonwealth can and should use its taxation powers to increase the costs of alcohol and thereby reduce all types of alcohol-related harm in Australia.15 Raising alcohol prices is the most cost-effective strategy. Sadly, it remains politically unpalatable because of powerful alcohol industry opposition, especially from the South Australian wine industry, which benefits from a de facto tax subsidy in the form of an ad valorem tax on Australian wine. The export success of the Australian wine industry indicates that this form of subsidy should be phased out in the same way — over 5–10 years — that tariffs were reduced on imported motor vehicles.

The Commonwealth also has the power to more effectively regulate the advertising and promotion of alcohol via sports sponsorship and alcohol advertising during popular sporting events. The current system of so-called self-regulation of alcohol advertisements is pervaded by conflict of interest because the alcohol and advertising industries control the process of adjudicating on complaints made about advertisements. The current Alcohol Beverage Advertising Code Scheme (http://www.abac.org.au) specifically excludes sports sponsorships, and remains resistant to external criticism or complaint about alcohol sponsorship during televised sporting matches.

State governments should also make more effective use of their powers to regulate the trading hours of retail liquor outlets. The latter are now much more important than licensed premises because they sell 80% of all alcohol that is consumed,4 often at a considerable discount to the heaviest drinkers.

Australia needs a nationally coherent alcohol policy if we are to substantially reduce alcohol-related harm. This should combine cost-effective policies at both state and federal levels. State governments should use their regulatory powers to reduce bottle shop trading hours to substantially reduce all types of alcohol-related harm, including that of most public concern — alcohol-related violence in licensed venues and entertainment precincts. The federal government should discourage heavy alcohol consumption by using its taxation powers to enact a combination of a volumetric alcohol tax and a minimum unit price for alcohol.