Without binging

The horrible accident which took the life of 19-year-old Jeanette Mifsud after having attended an open bar party on New Year's Eve is bound to re-ignite the debate on what Time magazine recently called the British disease. New Year's Eve is the party night par excellence but the pattern is not confined to such occasions. Mark Micallef reports.

The debate on alcohol abuse, especially by young people, is very much alive overseas, especially in the UK where new, controversial laws were introduced to curb the trend among British youth. The controversy in Britain rested mostly on the plan to extend pub hours.

Locally, the sector's experts lamented to The Times, that the debate often faces sudden "binges" of interest fuelled by public outcries which then die down. Unfortunately, in the words of the head of the National Drugs Commission Richard Muscat, there does not seem to be a "magic bullet". "What is needed is a concerted effort which requires level headed decision-making," he says.

The UK Labour government's reason behind removing the curfew from British pubs is to do away with the deadline which is thought to translate into revellers, drinking fast before the pubs close.

Whether or not the so-called disease was ever confined exclusively to the Anglo-Saxon world is debatable but what is evident is that it is a behavioural pattern that is true of young and not-so-young revellers across the continent.

An analysis of the 2003 European School Survey Project on Alcohol and other Drugs (Espad) by the World Health Organisation shows that while Maltese youngsters (under 16) say they do not get as drunk as their European counterparts, they are starting to top the charts when it comes to binge drinking.

Besides being unhealthy, Prof. Muscat explained, those who indulge in binge drinking are exposed to risky behaviour. "It's one thing having five drinks over a span of hours and completely another when you take it all in an hour."

Binge drinking; has been defined by the study as drinking five or more drinks in a row. One fifth to one third of students who took part in the survey in about half of the Espad countries admitted to binge drinking over the previous 30 days. Malta (25 per cent), features with the top Nordic countries Denmark, Ireland, Isle of Man, the Netherlands, Norway, Poland and the UK (24 -32 per cent).

But the Espad also shows that Maltese teenagers are more accustomed to the hard stuff. The Maltese respondents were more likely to drink wine and spirits, as opposed to beer and what are known as alcopops - flavoured alcoholic beverages mostly marketed among the younger generations.

The proportion of students that reported drinking wine more than three times in the previous 30 days in the case of most European countries is lower than 20 per cent with Malta's exception of 35 per cent. With regard to spirits, the cohort of Maltese students that said they had consumed spirits three times or more was the highest with 43 per cent.

Most countries report very high rates of teenagers having drank at least once in their lifetime. Malta's figure stands at (93.7 per cent); not much of a change over previous surveys: 94 per cent in 1999 and 91.9 per cent in 1995. But Maltese youngsters (under 16) are also found to be among the most frequent drinkers. Some 42 per cent of the Espad's respondents said they had consumed alcohol at least 40 times in their lifetime, comparable to the figures of Denmark, Austria, the Czech Republic, Isle of Man, the Netherlands and the UK.

Prevention is better than cure

Fundamentally, the survey belies another issue, which is that people under 16 should not be drinking in the first place. Most of the respondents (32 per cent) said they had their last drink at a disco, although the next largest group of respondents (21 per cent) said it was at home, highlighting the cultural acceptance of alcohol.

Commenting on this point, Remona Cuschieri, Sedqa's secondary prevention unit leader, who has been involved in prevention services for the past six years, said the figures just show the local attitude towards alcohol. "I'll never forget it... I was shocked one day to see a child, not more than two-and-a-half years old, being given some beer in his bottle at a beer festival."

From a health perspective, in fact, alcohol abuse, although not as sensational, turns out to be a bigger problem than drugs. In its bi-annual report, Sedqa recognises this, saying that alcohol remains the country's number one problem with the most "far reaching health problem". In that report, Joe Gerada, CEO of the Foundation for Welfare Services, under which Sedqa and other agencies fall, does not beat about the bush: "From a public health perspective, the negative effects of alcohol abuse on the health of the population far outweighs that of illicit drugs".

That does not mean that the problems with drugs, especially heroin use, can be underestimated, especially because of their far-reaching social consequences, Prof. Muscat pointed out when asked about this issue. Most of the agency's - limited - budget is dedicated towards drug abuse.

In the last government budget, the allocation to Sedqa was increased from Lm850,000 to Lm870,000.

Nonetheless, according to the report's own estimates, 70 per cent of Sedqa's budget goes on salaries, and the reality is that the agency is left with an operating budget of some Lm261,000.

Most of the money goes into care, Ms Cuschieri said, when issues such as binge drinking are really matters that can only be tackled through preventative measures. People who binge drink on a regular basis, even youngsters, are often able to limit that behaviour to the weekends and continue with their lives normally.

"Binge drinkers do not have the social problems of alcoholics or drug addicts. Nowhere near. They do not need treatment in the way that is understood traditionally. To tackle the issue we need to be able to have outreach programmes, for example, but it's impossible as things stand.

"We had an outreach programme but our team has been reduced from six people to two. I cannot possibly afford to go on outreach if I want to deal with the waiting lists of people we treat here. And, naturally, we have to take care of the people who request treatment."

Sedqa's CEO Jean Claude Cardona was more diplomatic, but he did confirm, when asked, that when all the costs are seen to Sedqa is left with a meagre Lm30,000 for marketing and educational campaigns.

"I am positive about the developments which took place over the years," Ms Cuschieri said. "Some years ago we just had care treatments and hardly any educational campaigns. Now we've made that step, I just hope we can sustain it."

Eighteen and over

Besides the educational front, which Ms Cuschieri herself admitted, is a long-term solution, the government is also considering short-term measures such as raising the legal age for consumption of alcohol to 18.

The industry, represented by the Sense Group - a lobby made up of alcohol producers, importers and wholesalers campaigning for responsible drinking - is against this move, saying it would create rather than solve problems.

Secretary Joe Farrugia said the group is against under-aged drinking and believes that existing laws should be enforced but raising the legal age for consumption of alcohol will push teenagers who drink underground.

However, European countries are moving in this direction and even tighter regulations across the board, Marylin Clark, a researcher and lecturer at the university, explained.

"Alcohol cannot be treated like any other commodity and research shows that cutting availability works," she says.

The United Nations, EU institutions and the World Health Organisation are all pushing in a similar direction, Dr Clark explained. The latter, in fact, is even calling for hefty taxes to be imposed on alcohol.

Mr Farrugia says that the research used to justify such argument usually deals with Scandinavian countries. The local cultural element cannot be ignored. Mr Cardona, however, begs to differ. In line with Dr Clark, he pointed out that similar action was being taken across Europe.

Going the extra mile

But there is still disagreement among those who would like to raise the drinking age. Currently, the law prohibits the sale of alcohol to young people. Sedqa is suggesting that the age be raised to 18 but also that the consumption of alcohol by those under 18 be made illegal.

This, Dr Clark explained, would criminalise young people caught drinking rather than those selling them the alcohol. "We'll be filling our juvenile courts with youngsters. We should attribute responsibility to the real source, those who ultimately benefit significantly from young people's drinking. We need a shift in focus. The alcohol industry and entrepreneurs need to take more responsibility as should adults generally."

Mr Cardona, however, maintains that leaving the law with regard to consumption as it is will mean a loophole is left unplugged. "I think it is a good thing that some responsibility is passed on to young people.

Moreover, with the law as it is there is no way in which action can be taken if a youngster is spotted drunk in the street, unless he or she says where the drinks were bought from."

On this point, Ms Cuschieri said young people in such cases should not be handled by the police. "I agree with regulating consumption as well as its sale but we should be careful how to deal with young people.

"I think we can deal with young people socially and not legally. We have a negative experience in this sense with youngsters who were caught with small amounts of cannabis and taken to court. Research shows such action makes youngsters adopt deviant behaviour instead of rehabilitating them."

Here there is consensus. Echoing Prof. Muscat's comments, all those in the field who spoke to The Times said there is need for a concerted effort on a number of fronts.

"The problem is fundamentally social," Prof. Muscat explained. "We have to ask ourselves the question: why do young people think they have to get sloshed to have fun?"

"Why do youngsters, as young as 13 years old, who do not fit in the alternatives provided by the Church or are not inclined towards a particular sport don't see an alternative to the commercial alcohol-based entertainment facilities?" Ms Cuschieri asked.

Part of the solution lies in understanding what young people want, Dr Clark explained, by engaging them in policy making, among other things.

The other short-term solution, the experts say, should be directed at regulating the industry.

Besides reducing availability as suggested by WHO, Ms Cuschieri thinks there should be further regulation of the retail aspect.

"We just cannot say one thing and do another... say we don't want binge drinking but then issue permits for open bars and other similar events that encourage it."

But regarding more restrictions on advertising, also a suggestion by WHO, Joe Farrugia, of the Sense Group, says the sector is already regulated by broadcasting laws. When prompted about the print media, Mr Farrugia said industry, like all other stakeholders, expect to be consulted.

"We promote responsible drinking and have been doing so in a number of ways since the group was set up in 1997. We expect to be consulted before something is finalised."