The Law Commission is currently undertaking a first principles review of this country’s alcohol policy.1 A feature of the public discourse on alcohol use in New Zealand is the recurrent theme that hazardous drinking is a minority issue, in that only a minority of people drink too much.

An extension of this view is that legislative change that impinges on the drinking habits of most New Zealanders represents a blunt and unjust response to the problem, and instead we should be implementing legal and treatment interventions targeted at the small group of problem drinkers.

This perspective was well encapsulated by the Associate Minister of Health, the Hon Peter Dunne, when he opened Cutting Edge, a national alcohol and drug treatment conference, in Wellington in September of this year. The minister stated: “For the majority of people, alcohol will never be an issue in their lives, so our focus must be on enabling the majority to continue to enjoy alcohol responsibly while at the same time mitigating the adverse impacts on the minority and our communities generally.”2

We believe this widely expressed view to be incorrect, underestimating the prevalence of hazardous drinking in New Zealand society. In particular, it mis-identifies cross-sectional prevalence as being indicative of lifetime prevalence.

Te Rau Hinengaro: The New Zealand Mental Health Survey reveals that 25% of those who drank alcohol in the past year were drinking in a hazardous fashion over that period, with 49% doing so among those aged 16–24.3 A finer age breakdown shows a peak of 56% among those drinkers aged 18–21: males 64%, females 49% (Wells, personal communication, 2009). Similar results have been found in another recent large national household survey.4

Hazardous drinking has therefore been found to characterise the drinking pattern for the majority of drinkers during the peak years 18–21. Do these results represent the likely past drinking profile of older drinkers and the likely future drinking profile of younger New Zealanders, or might they pertain only to the narrow cohort aged 18–21 at the time of Te Rau Hinengaro (2003/04)?

We do not believe there is justification to dismiss this high prevalence of hazardous drinking as merely a cohort effect, as there is evidence that heavy and problematic drinking has characterised youth drinking patterns for a sustained period in New Zealand. For example, in the Christchurch Psychiatric Epidemiology Study, carried out in 1986, around 70% of young males and 25% of young females reported having experienced at least one DSM-III symptom of alcohol disorder by 25 years of age.5

We have identified a peak hazardous drinking rate of 56% for ages 18–21. Does this represent the maximum rate of lifetime hazardous drinking? This would be the case if none of the 44% of 18–21 year old drinkers who are not identified as drinking hazardously were drinking hazardously prior to the 12 months captured by Te Rau Hinengaro or would go on to do so subsequently. We believe this scenario is highly improbable, although the magnitude of increase in hazardous drinking across the adult lifespan is difficult to estimate.

There is good evidence, however, from a New Zealand longitudinal cohort study showing that drinkers move in and out of problem drinking, even over a relatively narrow period of time6 and that lifetime rates of alcohol problems are substantially higher than 12-month prevalence rates.7

Hazardous drinking by most youth means that most New Zealand drinkers will have a problem with their drinking at some time in their life. Nonetheless it is important not to focus only on youth; a substantial proportion of older drinkers currently drink hazardously. This proportion sits between 30% and 33% for men aged in their 40s and 50s—and even at 70–74 years, 22% of males are drinking hazardously as revealed by Te Rau Hinengaro data. The proportions are smaller for women but still not trivial: 19% for 40–45 year olds, 8% for 55–59 year olds and 4% for 70–74 year olds (Wells, personal communication, 2009).

Hazardous drinking as identified in Te Rau Hinengaro does not simply refer to one or a small number of occasions of drinking more than might be healthy, although this in itself would not be a trivial point. Rather hazardous drinking is defined using the international standard of an AUDIT score greater than eight,8 representing a sustained pattern of drinking in a heavy or problematic way during the year preceding interview.

Problems arising from alcohol are not limited to a small minority drinking most heavily. The risk of alcohol-related problems rises steadily as alcohol consumption increases. Physical health complications, negative impact on mental health, work absenteeism or underperformance, interpersonal conflict, assault and motor vehicle accidents all become more likely with increasing consumption.9

There is increased risk for most health problems even at a low level of alcohol consumption and certainly at the levels associated with AUDIT-defined hazardous drinking.

Concerted actions are needed to reduce the harms caused by alcohol consumption. Targeting of strategies is important but it needs to be acknowledged that broader strategies that affect most drinkers, such as taxation, are also an important element, both because they disproportionately affect priority populations, heavy drinkers and youth, and because alcohol-related harms are so widely distributed across the population of New Zealand drinkers that population levels of reduction are a legitimate public health aim. Such measures have been clearly identified in Alcohol: No Ordinary Commodity10, a distillation of the international evidence base.

The Law Commission, in its preliminary consultation document, has outlined many policy options compatible with the recommendations contained within Alcohol: No Ordinary Commodity. We call upon the Law Commission to be bold in its recommendations to government and urge health professionals and the public to support these measures, given the high impact of alcohol-related problems and the fact that hazardous drinking is not just an issue for the minority of drinkers in New Zealand.

Author information: Simon Adamson, Acting Director, National Addiction Centre, and Senior Lecturer, Department of Psychological Medicine, University of Otago, Christchurch; Elisabeth Wells, Research Associate Professor, Department of Public Health and General Practice, University of Otago, Christchurch

Correspondence: Simon Adamson, National Addiction Centre, Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand. Fax” +64 (0)3 3641225, email: simon.adamson@otago.ac.nz