Understanding dangerous consumptions: moving forward with a national strategy for research on tobacco, alcohol, other drugs and gambling.

• Author: Adams, Peter

Abstract

Tobacco, alcohol, other drug use and gambling impact significantly on the well-being of New Zealanders, and research plays a critical role in formulating appropriate responses. The project reported on in this paper aimed to identify ways in which the general infrastructure and supports for applied research in this sector could be improved to enable increases in both the quantity and quality of outputs. An advisory group made up of key researchers, end users and other stakeholders contributed to the preparation of a discussion document reviewing the current scene and outlining issues and opportunities for the future. The document identified strong needs for development in the areas of overall coordination, funding processes, research workforce and communication/dissemination. Feedback on the document was then sought via submissions and key informant interviews. Responses informed the preparation of a strategy advisory document, which recommended a two-step process for improving the research infrastructure: (1) fostering greater interaction and integration across the sector by bringing together researchers and other stakeholders from each of the four sub-sectors to explore the viability of developing a common identity and collective purpose; (2) building on the relationships formed in the first step, including implementing of a range of infrastructure development projects targeting funding mechanisms, research workforce development and communication/dissemination. The document also signals the eventual need to form a national coordinating committee to provide ongoing support for infrastructural development, to advance sub-sector strategies and to advise and liaise with government agencies on sector development.

INTRODUCTION

Aotearoa New Zealand has significant health and social problems arising out of, and linked to, the widespread availability and use of tobacco, alcohol, other drugs and gambling. In a World Health Organisation (WHO)-sponsored project that aimed to identify the main contributors to the global burden of disease, of the 10 selected risk factors examined in developed countries, tobacco was identified as the highest risk factor, followed by high blood pressure, alcohol and, further down at eighth, illicit drug use (World Health Organisation 2002). The New Zealand Health Strategy (Ministry of Health 2000) clearly identifies minimising "harm caused by alcohol, illicit and other drug use to both individuals and the community" as one of its 13 key objectives, with another seven of these objectives having a strong relationship with alcohol and other drug use. Achieving a better understanding of the complex origins of these problems, and identifying and evaluating interventions to counter them that are appropriate to New Zealand conditions, requires a robust infrastructure for planning, undertaking and disseminating relevant, good-quality research in these areas.

Tobacco Consumption

In New Zealand, as in many other countries, a prime impetus for undertaking harm-reduction research on tobacco (otherwise known as tobacco control research) is the scale of the human costs attributable to cigarette smoking. About one in four New Zealanders regularly smoke tobacco, and tobacco is the nation's leading cause of preventable death (Ministry of Health 1999). Every year in New Zealand smoking results in an estimated 4,700 premature deaths (Ministry of Health 2002) and an estimated 347 deaths from exposure to second-hand tobacco smoke (Woodward and Laugesen 2001). The annual cost of smoking to New Zealand society was estimated in 1997 as $22.5 billion (Easton 1997). The scale of death and disability attributable to tobacco has major implications for the quality of life for families and communities forced to deal with its consequences. A major concern is that despite large investments in change, rates of Maori smoking have remained twice those of non-Maori rates, with a worrying increase in younger smoking (Laugesen and Scragg 1999).

Alcohol Consumption

Although fewer deaths are directly attributable to alcohol, it has broader impacts in terms of the mental, family and social wellbeing of the population. Approximately 90% of adult New Zealanders drink alcohol, and about one in five are likely to experience an alcohol use disorder at some time in their life. While heavier drinking by men has been a long-standing feature of New Zealand society, there are also indications that women's rates of alcohol consumption are rising. The average annual volume consumed by a woman has increased markedly from 5.4 litres in 1995 to 7.3 litres by the year 2000, an increase from seven to nine glasses per week (Habgood et al. 2001).

Alcohol is an acknowledged risk factor for some types of cancer, stroke and heart disease, and its use contributes significantly to death and injury on the roads (Ministry of Health 2001). International research on hospital admissions in developed countries indicates that 15-30% of male general hospital admissions and 8-15% of women admissions are for problems associated with alcohol misuse (Umbricht-Schneiter et al. 1991). Heavy alcohol use correlates strongly with the frequency of violence, including violence in public places, male-to-male violence and violence towards women. For instance, when surveyed, 10% of men and 5% of women indicated they had been physically assaulted in the past year by someone who had been drinking (Wylie et al. 1996). Heavy drinking also interacts significantly with mental health disorders. In a national survey of populations in the United States, 37% of those with a current alcohol abuse disorder also had a mental health disorder at some stage in their life (Bourbon et al. 1992). Alcohol and other drugs have also been identified as main contributors to current high rates of youth suicide in New Zealand (Beautrais 2000). An estimate of the social costs associated with alcohol use in 1991 ranged from NZ$1 billion to NZ$4 billion (Devlin et al. 1997).

Finally, alcohol (together with other drug use and gambling) forms a strong but undoubtedly complex interrelationship with criminal behaviour. For example, a study of 1,287 prison inmates in New Zealand prisons identified 83.4% had a substance abuse or dependence diagnosis (Simpson et al. 1999).

Illicit Drug Consumption

The illicit nature of most other drug use poses difficulties for research into the precise nature of consumption patterns and its contribution to health and wellbeing, and as a consequence local research is scant. As with alcohol, the heavy consumption of illicit drugs tends to be associated with a range of health and mental health issues, and is heavily associated with criminal offending (Adamson and Sellman 1998). A 1998 random survey of alcohol and drug treatment services indicated that, aside from alcohol, the main substances for which clients were in treatment were cannabis (27% of clients), followed by opioids (17%), benzodiazepines (5.5%) and a range of other substances (5.2%) (Adamson et al. 2000). With regard to cannabis use, those between the ages of 15 and 45 who acknowledged using cannabis over the last year increased from 18% in 1990 to 21% in 1998 (Field and Casswell 1999). International research has connected regular cannabis use to increased risk of respiratory disease, reductions in energy, drive and motivation, and some contributions to learning disabilities (Ministry of Health 1996).

With regard to opioid use, an estimated 13,000 to 26,600 New Zealanders experience opioid dependence, and this contributes to rates of infection, overdose and crime (Sellman et al. 1996), and an estimated $11 million is spent annually on providing 2,500 people with access to methadone. The current rise in the use of stimulants, particularly amphetamines, is posing new challenges to social, treatment and law enforcement agencies. In a telephone survey, 5% of a sample of 15-45-year-olds had used stimulants (uppers, speed, amphetamine, methamphetamine) in the last year. About one in five of those using amphetamines used quantities in a single session that have been identified in previous research as being hazardous (Wilkins et al. 2004). In addition, the inappropriate use of prescription sedatives (particularly benzodiazepines) continues to contribute to drug dependency for the "accidental addict" and to supplement the illicit consumption of multi-drug users (Porritt and Russell 1994).

Gambling Consumption

The impact of gambling on health and wellbeing has only recently registered, mainly as a result of the increasingly visible rises in overall consumption. Over 90% of the population gamble (Department of Internal Affairs 1996), and in 2003 total gambling turnover (including winnings) in New Zealand exceeded $13 billion, with gambling expenditure (money lost (2)) rising from around $0.1 billion in 1979 to $1.9 billion by 2003 (Department of Internal Affairs 2003b). This translates to a rise in adult population per capita spend from about $43 in 1979 to about $500 in 2003. In New Zealand, as overseas, the expansion is associated with the increased availability of higher-intensity forms of gambling, most importantly the introduction of new "continuous" forms, particularly the spread of electronic gambling machines (EGMs). Over half of current expenditure is now on EGMs (Department of Internal Affairs 2003b) and over 85% of the 6,410 people seeking help for the first time gamble primarily on EGMs (Problem Gambling Committee 2003).

This increase is having important effects on the economic and social ecology of New Zealand communities. Because the study of the impacts of gambling is relatively new, only limited information is available regarding New Zealand contexts. However, international research is pointing to strong links with poverty, mental health concerns, family disruption, crime and other determinants of health and wellbeing (Australian Productivity Commission 2000, Lesieur 2000). For example...