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Transcript of “If Alcohol (Ethanol) Was Discovered Today, It Would be Subject to Controls Under The Misuse of...
The University of Auckland
“If Alcohol (Ethanol) Was Discovered Today, It
Would be Subject to Controls Under The Misuse of
Drugs Act.”
Lisa Zollo
ID #629635486
Supervisor: Matthew Russell, ESR Ltd.
5th October 2015
Word Count: 14,001
1
Contents
1.0 Introduction…………………………………………………….………..…………2
2.0 History of Alcohol Consumption………………………….…………………….....4
3.0 Pharmacology of Alcohol……………………………………………………...…..5
4.0 Effects of Alcohol to the Human Body……………………………………..…......9
5.0 Alcohol – A Psychoactive Drug………………………………………………..…13
6.0 The Misuse of Drugs Act…………………………………………………….…...15
7.0 Current Legislation on Alcohol………………………………………………..….17
8.0 Comparison of Alcohol to Controlled Psychoactive Drugs…………………..…..18
9.0 Statistics on Alcohol Consumption in New Zealand……………………………...27
10.0 Involvement of Alcohol in Crime…………………………………………………29
10.1 Example 1………………………………………………………………....30
10.2 Example 2………………………………………………………….……...31
10.3 Example 3 ……………………………………………………………..….32
10.4 Example 4………………………………………………………..……..…32
10.5 Example 5………………………………………………………………....34
10.6 Example 6……………………………………………………………..…..36
10.7 Example 7……………………………………………………………..…..37
10.8 Example 8………………………………………………………..………..38
11.0 Medicinal Benefits of Alcohol – Do These Outweigh its Harmful Effects………39
12.0 Does Alcohol Fit the Description of a Class Controlled Drug?..............................41
13.0 Ways to Address the Issue of Alcohol Misuse……………………………………44
14.0 Conclusion………………………………………………………………………...47
15.0 References…………………………………………………………………………49
2
1.0 Introduction
A legal psychoactive drug is widely available, one that caused the death of 3.3 million people
worldwide in 2010, including underage consumers and young teenagers who may have been
oblivious to the harmful risks (WHO, 2015). According to the World Health Organization,
this clear liquid is rapidly metabolised by the human body, then is distributed throughout the
body to affect every organ along the way. Responsible for potentially causing over 200
diseases such as cirrhosis of the liver and cancer, when misused it is believed by some that
this drug is more harmful to users and to others than certain illicit drugs such as ecstasy and
cannabis. People can become addicted from consuming it just once, and those who are
addicted will do anything, including crime and violence, to get their next fix. This drug has
great potential to cause harm to users, and to those around them. Although this drug has been
around for centuries, if it were discovered today, it would most likely be considered a class
controlled drug under the New Zealand Misuse of Drugs Act.
Alcohol is the most commonly used recreational drug worldwide. It is a highly addictive and
dangerous drug when consumed too often. Drug abuse, including alcohol abuse, refers to
“non-medical administration of a drug for its psychoactive effect, intoxication or altered body
image (despite knowing the risks involved)” (M. Russell, 2015, pers. comm., 30 April). For
centuries, alcohol has been used and abused by humans. Since alcohol has been around for so
long, it is well understood in terms of its effects and toxicity. Upon first consuming alcohol, it
delivers a euphoric effect to the individual, activating the reward pathway in the human brain.
A moderate amount of alcohol decreases motor coordination, impairs judgement and alters
the mood of the individual consuming it. In high concentrations and with continuous
consumption, alcohol can cause severe health effects to individuals, such as, cirrhosis of the
liver, heart disease and an increased risk of developing various forms of cancer (Wallner &
3
Olsen, 2008). Alcohol is involved in a large volume of crime and violence not only in New
Zealand, but across the world. According to the New Zealand Police, at least one third of all
offences recorded by police officers in 2010 were committed by an offender, or multiple
offenders, who had consumed alcohol before committing an offence (New Zealand Police,
2010).
Ethyl alcohol (ethanol) is the psychoactive substance found in alcoholic beverages such as
beer, wine and liquor. In today’s society, its main use is for human consumption, however, it
is also has a number of valuable uses. It can be used as a renewable fuel source (as it can be
mixed with petrol), used in household cleaning products and for medicinal purposes such as
antiseptics and treatment for methanol poisoning (What is Ethanol? 2013). Although it has
some beneficial uses, in large amounts its toxic effects to the human body make it arguably
one of the most dangerous legal drugs widely available to the population. According to The
World Health Organization (2014), despite the known harmful effects of alcohol and its
ability to alter ones perception and emotional state, it still remains a low priority in public
policy. Having more controls put in place regarding alcohol consumption should start to
become a priority. Other psychoactive drugs, which have similar harmful effects on
individual health as alcohol, such as cannabis, are more tightly regulated under the Misuse of
Drugs Act. This essay will compare alcohol which is legal, to other psychoactive drugs,
which are illegal and tightly regulated, and therefore will discuss the following hypothesis,
“If alcohol (ethanol) were discovered today, it would be subject to controls under the
Misuse of Drugs Act”.
4
2.0 History of Alcohol Consumption
Alcoholic beverages have existed for centuries, with evidence suggesting it has been used in
China since around 7,000 B.C (Foundation for a Drug Free World, 2015). Alcohol was
widely used for medicinal purposes in the sixteenth century. Peak distribution began in the
eighteenth century when Britain passed a law that encouraged the use of grains for making
spirits. It wasn’t until the nineteenth century that attitudinal changes began, (once the harmful
effects of alcohol became well known). It was during this time that promotion for moderate
use of alcohol instead of frequent consumption began. Eventually this lead to alcohol being
known as a potentially harmful beverage, and greater restrictions developed as a result.
In New Zealand, the European settlers introduced drinking, as the Maori traditionally did not
drink alcohol. As there were few restrictions placed on alcohol, intoxication became high in
the 1870s and in fact was twice as high as Britain. Many New Zealanders in the early
twentieth century wanted alcohol banned completely, as people could begin to see the health
effects of heavy drinking and social outcomes, such as violence (especially) towards women.
Restrictive laws were put in place which decreased the number of pubs and introduced
closing times. However, bans were never put in place as Central government earned revenue
from alcohol. Supermarkets could sell wine from 1989, and bars could continue to stay open
all night. The legal age to purchase alcohol in New Zealand was lowered in 1999 to 18 years.
In the 21st century, binge drinking became common in New Zealand, particularly among
young people, Pacific Islanders and Maori. With approximately $85 million spent each week,
alcohol is currently New Zealand’s most widespread drug (Phillips, 2015). According to the
Encyclopaedia of New Zealand, the most noticeable consequence was the availability of
alcohol to individuals, as the number of licensed premises available to purchase alcohol
increased from 1,000 premises in 1969 to 14,000 premises in 2010.
5
Alcohol has become normalised into everyday behaviour. It can be consumed for cultural
reasons, entertainment, celebrations and social events and is not considered a harmful drug by
many people. According to the Health Promotion Agency, the English verb “to drink”
generally applies to alcohol rather than any other beverage (2014). This is a clear indication
of how alcohol has become a normal part of everyday life for many people. Alcohol legality
and restrictions on alcohol has become widely debated between health experts, researchers
and the general public, with mixed reviews on whether it is really as harmful as health
experts warn.
3.0 Pharmacology of Alcohol
The structure of ethanol (C2H5OH) is shown in Figure 1. It is an organic compound
containing a methyl group, methylene group and the hydroxyl group, which indicates it
belongs to the alcohol group. In its pure state, ethanol is a flammable, colourless liquid which
is made from the fermentation of sugars from various agricultural crops such as grapes,
barley and potatoes.
Figure 1: Structural formula of ethanol
6
Figure 1: The structural formula of ethanol (C2H5OH), containing the various groups which make up
the molecule (What is Ethanol? 2013).
Once alcohol is consumed orally, it is absorbed almost completely from the duodenum, the
first section of the small intestine. This process mainly occurs through diffusion, as ethanol is
a small, lipophilic molecule which can easily cross the lipid membranes of cells (Guenther,
n.d.). There are many factors that affect absorption of alcohol, such as, the rate at which the
individual is drinking, whether any food was consumed with it, as well as the type and
quantity of alcohol consumed. Gender, age and body composition of the individual who is
consuming the alcohol, are also factors that affect the absorption rate. Following absorption,
alcohol is then distributed into the total body’s water, where it rapidly enters the central
nervous system before being carried out to every organ in the body. Effects from alcohol can
be felt within five to ten minutes after consumption, indicating how quickly it can exert its
effects on the body. Metabolism of the alcohol occurs next, primarily in the liver through a
two-step process, as shown in Figure 2.
The metabolism of alcohol follows zero order kinetics, where it is eliminated from the body
at a constant rate. Firstly, alcohol is oxidised to acetaldehyde by the enzyme alcohol
dehydrogenase with NAD+ as a co-factor. Secondly, acetaldehyde is converted to acetate
(acetic acid), by the enzyme aldehyde dehydrogenase. This step ensures that there is no build-
up of toxic acetaldehyde by converting it to acetic acid. As the acetaldehyde levels increase
and slightly build-up, the effects to the individual may include headaches, vasodilation and
flushing. Over 90% of alcohol consumed is metabolized, the rest is excreted.
7
Figure 2: Alcohol Metabolism Pathway
Figure 2: The two-step process of alcohol metabolism in the human body. Step one converts ethanol
to acetaldehyde and step two converts this product to acetic acid (Guenther, TM, n.d.).
Rapid communication between cells in the brain occur through specialised cells called
neurons. Neurons communicate information to other cells through axons and receive
chemical messages from other neurons by dendrites. There are many proteins on the surface
of neuron membranes that allow small atoms that are charged to pass from one side of the
membrane to the other. These can be voltage-gated channels which allow neurons to send
rapid electrical signals, called action potentials (Lovinger, 1999). Another form of
transmission can be through chemical communication, which occurs at the synapse of the
neuron. The pre-synaptic neuron is where the chemical (neurotransmitter) is released from
vesicles at the axon terminal. It then binds to receptors on the post-synaptic neuron to exert
its effects, depending on the type of neurotransmitter it is.
Alcohol affects the central nervous system by causing a release of inhibition by activating
inhibitory pathways and interacting and modifying the function of some membrane-bound
1)
2)
8
proteins. Neurotransmitters are chemicals that allow for signal transduction to occur along
neurons. Under normal conditions, the brain balances the neurotransmitters to allow the body
to function efficiently. Alcohol can cause an imbalance in neurotransmitters, affecting brain
function as it interacts with serotonin transmission in the brain. Serotonin is a
neurotransmitter that acts on the 5-hydroxytryptamine (5-HT) receptors in the brain and is
involved with controlling emotions, as well as motivation to perform certain activities and
behaviours, such as drug and alcohol abuse (Lovinger, 1999). Alcohol also increases GABA,
an inhibitory neurotransmitter which decreases neuronal excitability by activating protein
kinase C, causing sedation. This then inhibits neurotransmitters such as glutamate to be
released (which is the main excitatory neuron), as well as acetylcholine (which converts short
term memory to long term memory). This process is the main reason behind the blackouts
people can experience during intoxication, and the memory loss that may occur after.
Euphoria (a state of intense happiness and increase in self-confidence) occurs as dopamine
(D2) receptors are activated, causing a release of endorphins (Davies, 2003).
Figure 3: GABAA ligand-gated ion channel
9
Figure 3: Diagram of the GABAA ligand-gated ion channel. This receptor is made up of five subunits.
Ethanol affects the alpha subunit, causing an increase in inhibitory neurotransmitters (Lovinger,
1999).
Alcohol interferes with the communication pathway in the brain, affecting the cognitive and
physical functions of the person consuming it. This may include affecting their mood,
behaviour, coordination and ability to think clearly and logically. Due to this action, alcohol
is known as a central nervous system depressant. When a person consumes alcohol, they
experience a psychoactive effect. The mesolimbic dopamine system, also known as the
‘reward pathway’, produces a euphoric response to alcohol, increasing dopamine levels
(Enoch, 2003). This process is a positive reinforcement for the individual consuming the
alcohol as they feel that alcohol is rewarding. The development of drug and alcohol addiction
occurs when the drug affects specific areas of the brain that increases the motivation of the
individual to continual use of the drug (Guenther, n.d.). When the brain is continually
exposed to alcohol, it begins to become tolerant or insensitive to its effects. Therefore, the
individual can consume more alcohol than someone who drinks moderately to become
intoxicated, as they have developed a tolerance to it.
4.0 Effects of Alcohol to the Human Body
Alcohol can have a number of effects on the body depending on the concentration of alcohol,
how much of it was consumed, type of alcohol consumed, gender and the body composition
of each individual. All these affect the individual’s blood alcohol concentration, a measure of
the concentration of ethanol in the blood over time. When consumed in low concentrations,
alcohol acts as a stimulant, causing an initial feeling of euphoria, which is rewarding to the
individual. It also causes disinhibition, affecting cognitive and emotional behaviours causing
10
impaired judgement as a result of poor risk assessment (Health Promotion Agency, 2014). As
the dosage of alcohol increases, it can start to alter the mood of the individual by increasing
anger and unhappiness as well as impairing their motor function and causing their speech to
slur. In large doses, alcohol is described as being a depressant of the central nervous system,
as it slows down breathing rates dramatically. Higher concentrations (500 mg/dL or greater of
ethanol in the blood) can lead to vomiting and in extreme situations result in a coma,
respiratory failure or even death (Davies, 2003).
Figure 4: Levels of blood alcohol concentrations and corresponding symptoms
Figure 4: This table shows the blood alcohol concentration and the effects alcohol can have on the
body with increasing concentrations (Health Promotion Agency, 2014).
11
Researcher Floyd Bloom conducted an in vivo study to analyse the effects of ethanol as a
central nervous system depressant on specific regions of the brain in rodents. He examined
the cerebellum, inferior olive, locus coeruleus and the hippocampus to determine the
intoxicating effects of alcohol within these four regions. In all four regions of the rodent’s
brain, alcohol intoxication caused sensitivity to various neurons. Based on the data from this
study, the sequence of events that occurs to each part of the brain is critical when studying
intoxication. Ethanol in low doses increased responsiveness to neurons in the locus coeruleus,
leading to inattention. Higher doses of ethanol to rodents activated the neurons of the inferior
olive, causing the increase formation of endogenous serotonin and also the increase of
acetylcholine from the hippocampus. Each region of the brain showed a varied response to
ethanol, indicating that there is a cellular basis for the effects and behavioural changes that
occur during intoxication, which occurs in humans also. Recognising the cellular changes and
the mechanisms of intoxication would assist in our understanding of alcohol dependence and
possibly allow for preventative measures for chronic alcohol consumption (Bloom, 1988).
Excessive and frequent drinking, also known as binge drinking, can cause a number of
serious health problems. Alcohol affects every organ in the human body, and can have long-
term effects to the liver, blood and immune system, bones, muscles, heart, the brain and
mental health, the lungs, the pancreas, the stomach and the reproductive organs (Health
Promotion Agency, 2014). According to the World Health Organization (2014), alcohol can
cause over 200 various diseases or injury to individuals. Liver cirrhosis, or damage to liver
cells, is a common diagnosis with long-term alcohol consumption and is often fatal. Fatty
liver is also an effect from alcohol abuse, as large lipid droplets can accumulate in liver cells
causing an enlarged liver. Various cancers are associated with continuous alcohol
consumption, as ethanol is a known carcinogen and has been found to increase the risk of
12
developing a number of different cancers. These can include cancer to the liver, mouth, throat
and oesophagus. Heavy alcohol intake can also damage nerve cells in the brain, potentially
leading to memory problems, eye problems and difficulty in walking as it can effect balance
and motor coordination of an individual. With such severe possible health effects associated
with drinking, and a population which is now more educated than ever before on its
damaging effects, there is still a large proportion of the population who continue to consume
alcohol regularly. A 2013 survey from the Ministry of Health found that 80% of people
fifteen years and over consume alcohol in New Zealand (Health Promotion Agency, 2015).
Although this figure has dropped from 84% in 2006/2007, this figure is still alarmingly high
for an educated population, and may increase.
Consuming alcohol whilst pregnant can affect unborn babies and can cause miscarriages or
birth defects that may impair the growth and development of their brain as well as their
central nervous system (World Health Organization, 2014). When the child further develops,
this could lead to mental retardation, learning disabilities and behavioural problems as they
grow older. To avoid these risks The Ministry of Health (2010) advises women not to drink
alcohol in the lead up to, as well as during pregnancy.
Not only does alcohol abuse affect the individual drinking alcohol, it also affects the people
around them. Drink-driving is a serious crime that can cause motor vehicle accidents, which
in turn can affect a number of people. Violence, such as domestic violence, sexual assault,
child abuse and homicide is another effect of alcohol abuse. Studies have shown that alcohol
is a major factor contributing to a number of crimes across New Zealand and internationally,
all of which will be discussed further in this essay (World Health Organization, 2014).
13
5.0 Alcohol – A Psychoactive Drug
As previously mentioned, ethanol is the psychoactive substance in alcohol. Psychoactive
drugs alter the consciousness, mood and the thoughts of the individual taking them. This
affects the normal perceptual, emotional and motivational mechanisms in the brain. Examples
of psychoactive substances include legal substances such as alcohol and tobacco, as well as
illegal drugs such as heroin, ecstasy and amphetamines. Communication in the brain is
altered by psychoactive substances such as alcohol. Brain cells (called neurons) normally
communicate with each other through neurotransmitters, which are messengers that are
released from the neuron. They send a chemical message by binding to receptors on the
neuron which is receiving the message. Psychoactive drugs work by mimicking the effects of
these endogenous neurotransmitters naturally occurring in the body, or they can interfere with
the normal brain function by obstructing its normal function or varying the way it releases or
stores particular neurotransmitters (World Health Organization, 2004). Psychoactive
substances have a number of different ways that they act in the brain, in order to cause an
effect. They can increase or decrease neuronal activity by binding to different types of
receptors in the brain, causing behavioural effects and eventually the development of
tolerance and dependence. They also affect regions in the brain which are associated with
motivation. This also has been found to cause substance dependence as the reward pathway
in the brain is activated (World Health Organization, 2004).
Common psychoactive drugs can be distributed into four main groups; depressants,
stimulants, opioids and hallucinogens. Depressants include alcohol, sedatives and hypnotics
which decrease the central nervous system activity and can reduce awareness and produce a
short-term feeling of relaxation. Stimulants have the opposite effect, in that they increase
activity in the central nervous system. Nicotine in tobacco products, cocaine, ecstasy and
14
amphetamines are all examples of stimulant psychoactive drugs. These drugs produce
euphoria and increase alertness and energy. Morphine and heroin are examples of opioids and
are known to relieve pain as well as induce sleep. Hallucinogens cause delusions or
hallucinations which affect an individual’s perception. These psychoactive substances include
the naturally occurring substances such as mescaline and cannabis as well as the synthetic
substances such as LSD (New Zealand Law Commission, 2011). These drugs are all unique
in the way they act on receptors in the brain, however, they are similar in the way they
activate the reward pathway resulting in motivation and drug addiction.
According to The New Zealand Law Commission Report (2011) people have been using and
abusing psychoactive substances for thousands of years. Attitudes towards drug use are
continually changing over the years and the legality and controls of certain drugs have also
changed over time, depending on the type of drug and how it is used. Over a century ago,
people in New Zealand were legally able to purchase large amounts of opium without a
prescription, and opium and morphine were commonly prescribed to people for a range of
illnesses and even for the common cold. The drug started being regulated in the 1920s when
the known dangers and addictive properties of opium became better understood. New
Zealand’s drug laws were reviewed in the early 1970s, and The Misuse of Drugs Act was
developed in 1975. This Act prohibited, among other substances, the recreational use of
psychoactive drugs. However, the country continues to allow for recreational purposes, the
sale and promotion of two dangerous and toxic drugs (in high concentrations); ethanol and
nicotine.
15
6.0 The Misuse of Drugs Act
The Misuse of Drugs Act (1975) is New Zealand’s drug regulation law which classifies
certain drugs into different classes based on their likelihood to cause harm to humans or to
society by its misuse. It does this by regulating the sale, importation and manufacture of
psychoactive drugs in New Zealand, and, restricting its use to medical and scientific purposes
only. According to the Ministry of Health, a controlled drug is one that is tightly regulated to
restrict the access and decrease the misuse of these drugs. Under section 3A of the Act, Class
A drugs refer to those that pose a very high risk of harm and include drugs such as cocaine,
heroin and methamphetamines to name a few. Class B drugs pose a high risk of harm and
include amphetamines, MDMA, cannabis preparations and opium. Class C controlled drugs
pose a moderate risk of harm, such as the cannabis plant or seed (New Zealand Legislation,
2014). In 2006, the New Zealand government introduced a new class, Class D, to include
‘party pills’ Benzylpiperazine (BZP). The classes of drugs represent a hierarchy of potential
to cause harm, with penalties increasing for any offence involving Class A and decreasing
when offences occur in Class B and Class C. The classes have two main purposes; firstly,
there is a primary classification to establish the penalty involved with dealing, possession or
use of the drug under the act. Secondly, Class B and Class C drugs are divided into sub-
classifications to control storage, prescribing and keeping records of those who deal with
controlled drugs (New Zealand Law Commission, 2011).
Like other psychoactive drugs that are classified under the Act, alcohol has some similarly
damaging effects. When the harm of alcohol abuse is well known questions are raised as to
why alcohol is not classified as a risk, and why it is not more tightly regulated. Health
professionals who specialise in drug addiction research have stated that if alcohol was a drug
that was discovered today and applied to the criteria that makes up The Misuse of Drugs Act,
16
it would be categorised as a high risk Class B drug, and subject to controls under the act
(Sellman, 2010). According to The New Zealand Law Commission Report (2011) the
explanation for such variation in regulatory approaches of the Act is that the use of ethanol
can be both harmful, yet also beneficial for some purposes, depending on the context it is
used. The Misuse of Drugs Act tends to treat drugs as a criminal matter, rather than basing it
on its health effects when the concern should be about both (New Zealand Law Commission,
2011).
The Government asked for a review by the Law Commission of New Zealand’s drug law in
2007. A reform of the law was required as new psychoactive drugs were continually
emerging, and many felt that the current classification required adjustment. The fact is that in
none of the reforms and proposed reviews, has ethanol even been mentioned as requiring to
be under the control of Misuse of Drugs Act. The Law Commission reviews the Misuse of
Drugs Act and considers issues such as the harm of the drug to society, the best model for
controlling drug use, how new psychoactive substances should be treated and the appropriate
penalties for offences of the Misuse of Drugs Act (New Zealand Law Commission, 2011).
The Misuse of Drugs Act classifies psychoactive substances as class controlled drugs based
on their potential to cause harm to the individual and to others around them. Psychoactive
drugs work by acting on the central nervous system affecting how an individual behaves and
perceives situations, impairing their judgement and ability to make decisions. The New
Zealand Law Commission believes that the Misuse of Drugs Act should be modified and
aligned with the National Drug Policy. The current Act focuses more on the criminal aspect
of illegal drugs classified as class controlled drugs, rather than focusing on minimising harm
to individuals who take these drugs and those around them. It also fails to assist those with
17
drug dependence and addiction issues who need support and help. There have been a number
of experts who are suggesting a reform of the current Act to further control psychoactive
substances that have a potential for misuse and abuse. Excluded in this suggestion, however,
are alcohol and tobacco, two highly addictive drugs that have the potential to cause harm.
Under this Act, substances must be assessed by the Expert Advisory Committee on Drugs
(EACD) and must fit certain criteria to be considered a class controlled drug. These criteria
range from how the drug affects the user and society, any risks to public health, whether the
therapeutic or medicinal (if any) benefits outweigh its risks, potential for the drug to cause
death by overdose and physical dependence or addiction of the drug to name a few (New
Zealand Parliamentary Library, 2003).
7.0 Current Legislation on Alcohol
The current legislation on alcohol consumption in New Zealand falls under the Sale and
Supply of Alcohol Act 2012. The purpose of the Act is to benefit communities by putting a
new system in place “to control the sale and supply of alcohol and to reform the law in regard
to sale, supply and consumption of alcohol” (New Zealand Legislation, 2015). Under this
Act, the minimum legal age for an individual to purchase alcohol is 18 years of age. There is
no minimum legal drinking age in New Zealand, so although those under 18 cannot purchase
alcohol themselves, they are allowed to consume it legally under supervision.
The Sale and Supply of Alcohol Act also regulates the promotion of alcohol in order to avoid
encouraging excessive alcohol consumption. This is achieved through limiting the display of
alcohol in supermarkets, banning the promotion of alcohol discounts of greater than 25% and
prohibiting the advertising of free alcohol to people. Alcohol can be sold at various venues,
18
off-licenced venues including dairies and convenience stores and licenced venues such as
alcohol stores, bars and restaurants.
With these regulations in place, the aim is to overall decrease New Zealand’s alcohol
consumption and to reduce the harm that is caused from excessive drinking. This Act also
allows communities to express their opinions on matters regarding alcohol licensing in their
areas as well as establishing stricter rules on the types of places that can sell alcohol. Certain
local councils have banned alcohol in particular areas in the hope of reducing alcohol
consumption in that area. Breaches of any of the above restrictions and regulations under the
Sale and Supply of Alcohol Act could result in fines.
8.0 Comparison of Alcohol to Controlled Psychoactive Drugs
There are a number of arguments that suggest alcohol (a legal psychoactive drug), is more
harmful in terms of health and social effects to users and to others compared with cannabis, a
Class C controlled drug under New Zealand’s Misuse of Drugs Act. Cannabis has been
labelled as the most frequently used illicit, recreational drug in New Zealand whilst alcohol
still remains the most commonly used legal, recreational drug in New Zealand. The main
psychoactive component of cannabis is THC, which is hallucinogenic in high doses. A vast
amount of experimental studies have suggested that since cannabis has a relatively low
toxicity, there are much lower risks of developing short-term or long-term health effects
compared with alcohol’s risks (New Zealand Law Commission, 2011). Cannabis intoxication
can affect judgement, motor skills, reaction time and concentration, similar to alcohol
intoxication. Like alcohol, cannabis has a sedative effect on the body.
19
Cannabis affects the circulatory system and although may not be harmful to healthy
individuals, it can be for those with pre-existing cardiovascular disorders. As it can affect the
respiratory tract, chronic bronchitis and lung cancer are potentially long-term effects
associated with smoking cannabis. Cannabis has also been found to increase short-term
mental health with effects such as psychosis and impaired motor function but these effects
can generally be reversed. According to a study by Van Ours and Williams (2012), although
there are certain risks involved with cannabis use, these are generally associated with long-
term use. The majority of individuals who have taken cannabis are not addicted or long-term
users. In addition, Van Ours and Williams argue that the risks of cannabis are far lower than
that of other illicit drugs in Class B such as amphetamines, with lower risks compared to
long-term alcohol consumption and tobacco smoking (Van Ours & Williams, 2012).
MDMA (Methylenedioxymethamphetamine), also known as ecstasy, is similar in structure to
the psychoactive drug amphetamine. Ecstasy is another psychoactive drug and is considered a
Class B controlled drug under the Misuse of Drugs Act. MDMA is a stimulant, its effects can
occur within thirty minutes of taking the drug and lasts for up to eight hours (Queensland
Government Australia, 2013). Like alcohol, ecstasy can cause euphoria, excess energy, and
an increased pulse. It can also cause hallucinations and altered perception. Since ecstasy
tablets are generally not ‘pure’, the effects can often be unpredictable depending on what
other substances are mixed with it (Patient, 2015). Post euphoria, the user may experience
depression and anxiety and could potentially develop serious health complications such as
liver, heart and kidney problems. In a worst case scenario, taking ecstasy could result in
death.
20
Professor David Nutt, a well-known British psychiatrist and pharmacologist specialises in the
research of drugs and their effects on the brain, including addiction. He has written a number
of literature - some of the literature involves research from other scientists containing
scientific facts on the issue, his own research, and, experimental studies as well as his
professional opinions, RE: “if alcohol were discovered today, would it be illegal?” (Nutt,
2012). Professor Nutt believes that people consider alcohol to be an ‘acceptable’ drug
because of its legality, however, he argues if it were not legal this would probably not be the
case. As alcohol can be toxic to humans when misused, Professor Nutt suggests that if it was
discovered today, alcohol would possibly be illegal. Based on one of his experimental studies
(described below) Professor Nutt describes how he believes alcohol is more harmful than the
drug ecstasy. This comment has sparked debate and caused controversy between experts.
Executor of the National Drug Prevention Alliance, David Raynes, has criticised Professor
Nutt’s view that alcohol is more harmful than ecstasy, stating that his comments are unwise
and could potentially promote greater use of the illicit drug (The Telegraph, 2009). Although
Professor Nutt is not suggesting that ecstasy is not harmful and it should be legal, he is
suggesting that the government take more action to regulate alcohol as it should be
considered just as harmful.
In 2010 in the United Kingdom, a group of specialised experts in the pharmacology,
physiology, legal aspects and the social harm of drugs came together to rate 20 of the most
commonly used psychoactive drugs in the United Kingdom on basis of harm. This
classification system was created by British scientists David Nutt, Leslie King and Lawrence
Phillips on behalf of the Independent Scientific Committee on Drugs (ISCD), an independent
organisation of drug experts. Some of these drugs included heroin, ecstasy, cannabis, tobacco
and alcohol to name a few. For the purpose of this essay, we will be comparing alcohol to
21
cannabis and ecstasy only, two controlled drugs under the Misuse of Drugs Act. The study
used a Multi-Criteria Decision Analysis (MCDA) based approach to create sixteen criteria
based on harm, nine of these relating to the harm of the drug to the user itself and seven to the
harms the drug causes to others, not only in the United Kingdom, but worldwide. The harm
criteria is further categorised into groups of physical, social and psychological harm, three
categories considered to be most important in terms of harm. The group of experts took into
account subjective judgements as well as objective facts about the harm of the drugs. As new
psychoactive substances are constantly being developed, the rating scale was able to evolve
over time. This included factors such as dependencies, injury, wealth, mental impairment and
social factors such as relationship loss. The study also looked at the number of deaths each
drug caused per annum in the United Kingdom, as well as hospitalisations from these drugs.
Figure 5 below is a diagram describing the harm criteria that was created to analyse the 20
drugs in this experiment.
The MCDA approach involves a series of intensive meetings (known as decision
conferences) between a selected group of experts. MCDA models are valuable in that they
can analyse costs, benefits and risks in certain situations. The experts must all be in
agreement with their final subjective scores. According to Leslie King, MCDA has proven to
be quite effective in that it is a process that allows a group of experts to come to a rapid
agreement on each aspect (L. King, 2015, pers. comm., 25 September).
22
Figure 5: MCDA approach to formulating harm criteria of psychoactive drugs.
Figure 5: This image shows the harm criteria formulated by the MCDA approach from scientists in
the UK to numerically rate 20 psychoactive substances on basis of harm (Nutt, King, Phillips, 2010)
All 20 psychoactive drugs were scored out of 100 points, 100 being the most damaging drug
based on the harm criteria, and 0 having no harmful effects. Weighting of the scores was
important as some criteria are more harmful than others, such as overdose and death cause by
the drug. Weighting ensures that the criteria are all equivalent in terms of harm, by
comparing all the drugs that were given a score of 100 across all the criteria in figure 5. To
score each drug, the experts had to work in two stages. Firstly, they had to assess the
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difference of harm directly, and secondly, they had to consider how much the difference in
harm really matters in a particular context (for example in crime or drug-related mortality).
The experts assessed the weight of harm within each cluster of criteria shown in figure 5, to
make sure that the units of harm were equivalent throughout all the criteria.
According to Leslie King (one of the authors from this paper), the team of experts took each
of the 16 harm criteria (as shown on the far right side of figure 5) and assessed the score of
each drug. The most harmful drug in respect to each criterion scored 100. The weighting
process involved looking at all of the 16 criteria where a drug scored 100, and were compared
pair-wise whilst considering the following question; “Does the score of 100 on this criterion
represent a higher level of harm than the score of 100 on the next criterion? If so then what
fractional weight is given to the second example?” (L. King, 2015, pers. comm., 25
September). For example, in the physical cluster group containing four harm criteria to users,
the weighting for drug-related mortality was found to be the biggest difference of the four,
and was therefore given a weight of 100. The second largest harm in the group was found to
be drug-specific mortality, which was given a weight of 80, as it was found to be 80% as
great as for drug-related mortality. Therefore, the score for all of the drugs on the drug-
related mortality scale was multiplied by 0.8. This resulted in a weighted score of 80 for
heroin, as opposed to its original score of drug-specific mortality, which was 100. The scores
that weighted 100 in each cluster were then compared between each other, “with the most
harmful drug on the most harmful criterion to users compared with the most harmful drug on
the most harmful criterion to others” (Nutt, King, Phillips, 2010). This was to ensure that the
units of harm on all scales were equated. The weighting process allowed “the harm scores to
be combined within any grouping, by adding their weighted scores” (Nutt, King, Phillips,
2010).
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According to King, this is of course partly subjective but states that experience has shown
that is a process that allows a large group of experts to come to an agreement on each aspect.
The results from the study are shown in figure 6 below, where the total harm score assigned
to each drug is shown above the bar. It is important to look at the graph in a two-dimensional
way, looking separately at harm to user versus harm to others, as these greatly affect the
score. Based on the results from this study, alcohol has been rated as being the most
damaging drug to others, whereas cocaine has been rated as being most harmful to the user.
Cannabis and ecstasy have a much lower harm scores to the user and to others compared with
alcohol. Based on its ability to cause great harm to others and evidenced through crime,
violence and other ways it has been shown to affect society, alcohol was given the overall
highest harm score (72) compared to all other psychoactive substances shown. Cannabis was
given a score of 20, and ecstasy a score of 9, relatively low considering its known harmful
effects.
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Figure 6: Graph displaying the numerical rating of 20 psychoactive substances based on the
MCDA approach.
Figure 6: Psychoactive drugs and their total harm score developed by the ISCD. The score
incorporates harm to the user (shown in blue) as well as harm to others (shown in red) (Nutt, King,
Phillips, 2010).
The team of experts in this study argue that alcohol is more harmful than ecstasy as it causes
tens of thousands of deaths annually from not only alcohol poisoning, but also from road
accidents and diseases associated with it such as liver cirrhosis and cancer. Ecstasy, causes
the death of approximately ten people each year, out of the half a million people who use it
weekly (Highfield, 2007). According to Professor Nutt, because alcohol has been used for so
long and has become socially acceptable in society, it will unlikely ever be criminalised. If it
were discovered today and we had all the knowledge of its harmful effects as we do now, this
would be a different story.
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There are limitations to this study by Nutt, King and Phillips which are important to consider.
Although many adults consume alcohol, far fewer have had any experience with
MDMA/ecstasy. This is a key reason as to why alcohol ranks much higher on the scale as a
more dangerous drug than ecstasy - it is consumed a lot more often. Many disagree with this
study, as the ISCD base this scale on their professional judgement and do not consider the
beneficial properties of certain drugs, or that some of these drugs are prescribed for medical
reasons. These rankings are also highly variable. Even though some drugs may have a similar
score, the mortality risk may be greater in some, whereas the potential to cause psychological
impairment or crime and violence may be higher than the mortality rate in others. The
experiment also does not take into account the legality of the drug or its availability. If some
of these psychoactive drugs were legal and more easily accessible, then they would have a
much higher ranking than alcohol. Although there are these limitations, the experiment
provided a way in which drugs could be compared between each other on basis of their harm.
However, it did come with large amounts of controversy, and has sparked debate between
other experts and health professionals.
As cannabis continues to be tightly regulated as a Class B controlled drug, alcohol use has
been tolerated for centuries without proper consideration of the evidence of its harmful
pharmacological and social effects to individuals. According to the New Zealand Law
Commission (2011), many argue for the reassessment of cannabis under the Misuse of Drugs
Act as evidence suggests that moderate cannabis use has few risks compared with legal drugs
such as alcohol. While many experts believe that alcohol is more dangerous when misused
than cannabis, this study has become quite controversial, as the experts present the harmful
effects of these drugs from a one-sided point of view only. Many critique the imperfections of
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this study, as determining the risks of drugs is much more complicated than numerically
rating them (Lopez, 2015). Since alcohol is the most consumed recreational drug worldwide,
the higher rates of death, injury and other effects from it would seem higher compared with
other psychoactive drugs, as it is consumed more often and in greater doses. Therefore it does
not seem appropriate to place alcohol at a higher rating for harm than some of the other
harmful drugs.
9.0 Statistics on Alcohol Consumption in New Zealand
The New Zealand Health survey was conducted over 2012 and 2013 to determine the amount
of alcohol New Zealanders consume. It provides valuable data regarding alcohol use and
misuse by individuals aged over fifteen years, across different populations including gender
and cultural background, all which may have an influence on alcohol consumption. The
intention of this survey was to analyse the data to assist government agencies, organisations,
researchers, education departments and the general public to determine the best possible way
to reduce alcohol misuse and harm to individuals in New Zealand (Ministry of Health, 2015).
Figure 7: Alcohol Consumption in 2012/2013 of People Aged 15+ in New Zealand.
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Figure 7: This graph depicts the alcohol consumption over one year of individuals in New Zealand
aged over 15. The graph shows the age group and the percentage of adults who drank. It also
tabulated gender differences and cultural differences.
The outcome of the survey indicated that 79% of individuals drank alcohol in this year, which
equates to approximately 2.8 million adults in New Zealand, out of a total population of
4.471 million in 2013 (Statistics New Zealand, 2013). According to this survey, males were
more likely to have consumed alcohol during 2012/2013, as opposed to females who
consumed less. European / other and Maori also consumed more alcohol during this period
compared with people of other cultural backgrounds.
Individuals who lived in more disadvantaged areas of New Zealand consumed less alcohol
(71% of people) compared to those who lived in more established areas of New Zealand
(84% of people). It was also alarming to find that over half of the teenagers in this survey
aged 15-17 had consumed alcohol during this year. The survey indicated that the most
frequent place to drink alcohol was at home, which could explain this large number.
According to the Ministry of Health, drinking alcohol from a young age such as those aged
15-17 increases the risk of alcohol induced harm in teenagers. It also increases the risk of
alcohol dependency and alcohol abuse when they become adults. From these statistics, it is
clear that drastic measures need to be taken in order to lower these statistics.
As mentioned previously Professor David Nutt, a well-known British psychiatrist and
pharmacologist specialises in the research of drugs and their effects on the brain, including
addiction. He believes society has classified alcohol as acceptable and something that is
completely different to other psychoactive drugs that get you ‘high’, even though it has a
similar mind altering effect. People happily drink to get ‘drunk’ as it they believe this is
29
socially accepted and is even encouraged in certain cultures, although many believe that it is
wrong to take other drugs to get ‘high’. Nutt argues that this is not true, and society needs to
start changing the way they look at alcohol.
There have been 40,000 alcohol related deaths, 1.2 million violent incidents and 500,000
crimes that have been alcohol related. These alarming statistics have emerged from recent
annual statistics from the United Kingdom (Nutt, 2012). The statistics also revealed that over
40% of domestic violence and 50% of child protection cases have involved alcohol. Professor
Nutt also suggests that if it were discovered today, alcohol would not be legal as it is far too
toxic for human consumption. Many people ignore the research and data that has become
available regarding the effects of alcohol, others don’t consider it to be a drug given its
legality.
10.0 Involvement of Alcohol in Crime
Causing the death of millions of people worldwide each year, alcohol has been termed one of
the most dangerous recreational drugs. With its known hazardous health effects and potential
to cause harm and injury, approximately 80% of New Zealanders between the ages of 16-24
consumed alcohol at least once in 2013, (Health Promotion Agency, 2015). An alarming 600
– 800 people in New Zealand have died from alcohol related reasons each year. Disease isn’t
the only negative outcome for individuals who consume alcohol, as there is a strong link
between violent crime and alcohol. As discussed, alcohol affects the central nervous system
and can begin to affect a person’s mood by increasing anger and irritation. When alcohol
concentrations in the blood reach levels that cause this behaviour, the odds of committing a
crime and becoming violent increases. In 2010, The New Zealand Police estimated that at
least one third of all crimes that were reported to the police involved alcohol. Every single
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day, more than three hundred alcohol-related offences are committed in New Zealand (New
Zealand Police, 2010). These crimes may include drink driving, assault (including sexual
assault), child abuse, homicide and domestic violence. Alcohol abuse is an important, yet
adjustable factor in reducing violence and crime in society.
A large number of researchers agree that there is a connection between alcohol and violence
but many do not agree on why it is such a factor. Most theories that have been suggested can
be organised into models based on their assumptions. These models are; the disinhibition
model, the indirect casual model and the expectancy model. Parker and Rebhun suggested a
model in 1995 which is based around the “selective disinhibition theory”. This theory
suggests that alcohol effects an individual’s ability to interpret other people’s intentions and
actions, affecting their perception. Depending on the situation, this can allow aggression to
occur, causing negative social situations and psychological effects that can lead to violence to
make their point (Kuhns et. al, 2014). The indirect casual model is commonly used to explain
aggression associated with intoxication. This model assumes that any cognitive, emotional or
physiological changes that occur from drinking can result in alcohol related aggression
depending on the social situation. Kuhns et al describe the expectancy model’s difference
revolving around the individuals beliefs that they have learnt about alcohol from their
previous experiences which cause aggressiveness (as opposed to the pharmacology of
alcohol). There a number of different crimes where alcohol has been identified as playing a
major role. This is further discussed below.
10.1 Example 1
There have been a number of literature studies that have looked into the involvement of
alcohol in different crimes across New Zealand. A study by Boden J.M. et al examined
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alcohol misuse and criminal behaviour over a thirty year study in a New Zealand birth cohort
(2012). The study looked at whether alcohol dependency symptoms in individuals influenced
the likelihood of them committing an offence such as theft, use of a weapon, assault and
property damage. It also looked at whether age was a factor. This study was conducted as it
was suggested that there are three major issues that require further experimentation. One of
the issues raised was that crime and alcohol abuse is a reflection on an individual’s personal
and social behaviour if they are excessive alcohol drinkers. Secondly, they wanted to
determine whether age had an effect on the misuse of alcohol and crime. It is believed that
rates of alcohol misuse and crime is more likely to occur during adolescence and as a young
adult, however, there is little evidence to support this. Research needed to take into account
that alcohol misuse and crime may vary the type of offence that is committed as it would
more likely involve short term impulse actions such as assault, rather than offences that
require planning or pre-meditation. The results from the study by Boden et al indicated that
there were statistically significant associations between alcohol dependency and committing
an offence. Individuals in the cohort that showed higher levels of alcohol dependency
symptoms were more likely to have committed an offence. It also found that as age increased,
the chances of committing an offence decreased, suggesting that age is also a factor.
10.2 Example 2
Fergusson and Horwood (2000) studied alcohol abuse and crime and also found that alcohol
abuse or dependence was clearly related to a significant rise in rates of property crime as well
as violent crime. They studied a cohort of individuals between the ages of 14 and 21,
measuring the number of symptoms of alcohol abuse and their type of offence. They
achieved this by using a fixed-effects regression model which estimated the association
between rates of crime and the frequency of alcohol abuse symptoms. From the model, they
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estimated that every increase in alcohol abuse symptom to an individual, the rate of crime
increased by 1.10 and 1.15 times. Results from this study found that an increase in alcohol
abuse in young individuals evidently increased the rate of violent crimes and property crimes,
as demonstrated by the statistical value, P<0.0001 (Fergusson & Horwood 2000).
10.3 Example 3
One of the most commonly reported crime in New Zealand is sexual assault. It is thought that
when males drink, they feel power, strength and control which is highly associated with an
impaired perception about how to handle situations that can quickly get out of control.
Researcher Linda Hill has studied the connection between alcohol and violence in New
Zealand. A national survey of alcohol consumption was undertaken in 1988 and the results
found that 82% of women who reported to have been sexually assaulted in the previous 12
months said their offender had been consuming alcohol. Although this is an alarmingly high
figure, this source is over 20 years old and the statistics would therefore no longer be valid. A
literature review report was prepared for the Ministry of Justice New Zealand in 2008 by
Nina Russell. This review provided more recent statistics that incorporated a study from
2001, which found that approximately half of all sexual assault cases involve the
consumption of alcohol by the offender prior to the assault. This is an underestimate
however, as there are many cases that are often not reported to police (Russell, 2008).
10.4 Example 4
The number of homicide offenders who were under the effects of alcohol has been under
debate in a variety of studies as the estimates varied greatly from 83% in a study by Shupe in
1954 to 15% in a study by Varano and Cancino in 2001 (Kuhns et. al, 2012). This variability
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could be due to a number of differences across the studies, including sample size, as well as
random differences that were unobserved, making it difficult to review literature. Studies on
alcohol involvement in crimes such as homicide is difficult for researchers. While they can
obtain toxicology information on homicide victims, this evidence is generally not available
for the offenders - by the time they are convicted, the alcohol in their body has been
metabolised. This makes it impossible for researchers to accurately record blood alcohol
levels at the time of the offence, and therefore they rely on reports or observations from the
offender’s case notes.
A study by Kuhns et al in 2014 analysed 20 three different studies over the past 60 years,
which included information from a total of 28,265 homicide offences from 9 different
countries. They analysed literature by using ‘meta-analytical’ techniques which is a more
precise way of calculating the mean across studies and contains a database which can be
updated as new experimental studies arise. This study found that on average approximately
half of these homicide offences (48%) were committed by offenders who had consumed
alcohol at the time and 37% of offenders were intoxicated. These values were obtained by
focusing on two factors, firstly the proportion of offenders of homicides who tested positive
for alcohol in their system at the time of their offence and secondly the proportion of
offenders who were intoxicated. The proportions were converted to logit values (the inverse
of log), and were converted to the percentages as shown above. Converting to the inverse of
log allowed for different sample sizes across the studies to be taken into account. The table
shown in Figure 8 below is the results of the study which display alcohol involvement (if
any) in homicide offenders.
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Figure 8: Involvement of alcohol in homicide cases in various countries over the years.
Figure 8: Various studies have been undertaken to illustrate the involvement of alcohol in a number
of crimes, in this case homicide. From this table it is clear that alcohol is involved in majority of
homicide cases that have been analysed by these studies (Kuhns et. al, 2014).
This study outlines the difficulties in using information provided on alcohol consumption
prior to the offence based on reports, rather than from biological tests. Although over half of
homicides involve the offender consuming alcohol prior to committing the offence, it is
evident that alcohol is a major factor that is involved in crime. This study demonstrates that
alcohol is one of many possible factors that can contribute to homicide.
10.5 Example 5
Alcohol affects driving as it can slow down reaction time, affect problem solving, memory
and attention. Since legislation changed in December 2014, the legal drink driving limit in
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New Zealand must be less than 250 micrograms of alcohol per litre of breath and 50
milligrams of alcohol per 100 millilitres of blood for drivers over the age of 20. For drivers
under the age of 20, the blood alcohol concentration must be 0. Drink driving is a crime
causing approximately 30% of New Zealand’s fatal road accidents (Ministry of Transport,
2015). On an average day for New Zealand Police, approximately 100 offences out of the 340
people arrested each day are for drink-driving. In a 2012/2013 health survey by The Ministry
of Health, a cohort of regular drinkers in New Zealand were asked if they had driven a car in
the past twelve months whilst under the influence of alcohol. The survey found alarming
results, indicating that 17% of drinkers drove at least once in the past twelve months whilst
under the influence of alcohol. This is approximately 416,000 individuals in New Zealand
(Ministry of health, 2013). Figure 9 below shows a graph of the percentage of drinkers who
drove in the twelve months of 2012/2013 across a range of age groups and both genders. It
also took into consideration cultural background, to see if there were any obvious patterns.
The graph shows a peak in driving under the influence for the 20-24 aged group, then the
pattern decreased with age.
The survey found that male drinkers were more likely to drive after consuming alcohol.
Approximately 21% of males over 15 years of age drove under the influence of alcohol,
compared with approximately 12% of females over the age of 15.
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Figure 9: Graph depicting the percentage of people who consumed alcohol and drove over
2012/2013.
Figure 9: The graph illustrates the number of people who drove whilst under the influence of alcohol
in 2012/2013. Males and females were compared, as well as age groups and cultural backgrounds
(Ministry of Health, 2013).
10.6 Example 6
Simonsen et al conducted a study in 2012 which assessed the number of psychoactive
substances found in blood samples of 840 critically injured drivers that were admitted to
hospitals across Denmark. Psychoactive substances included alcohol, medicines and illicit
drugs. Statistics revealed that in 2005, over 41,000 people were killed in the European Union
from road accidents, and approximately 1.7 million were injured. It was believed that many
of these road accidents were associated with drivers having taken a psychoactive substance of
some sort. A method known as solid-phase extraction was carried out on the blood samples,
target drugs were then quantified. The results from this study indicated that a total of 284
drivers out of the 840 tested (34%) were positive for alcohol and / or other psychoactive
37
substances in their blood. Approximately 172 drivers (20.5%) tested positive for
psychoactive substances (methamphetamine for example) or medicinal drugs (such as
diazepam and tramadol) in their blood. The average age of those who tested positive was 36
years, and the majority were male drivers. Alcohol was the most common substance found in
the blood samples, and at levels higher than the legal driving limit for Denmark. Overall, this
study confirmed results from other studies which looked at psychoactive drugs and alcohol
associated with traffic accidents. Simonsen et al have suggested that police need to stop
drivers more frequently to test for alcohol and illicit drugs. This could be a valuable method
used to prevent driving under the influence and potentially lower the rate of traffic accidents
caused by those who have taken a psychoactive substance.
10.7 Example 7
A massive 71% of New Zealand secondary school students have consumed alcohol (Ministry
of Health, 2013). Stacey and Elvy from the University of Canterbury analysed data obtained
from a national survey from The New Zealand Alcoholic Liquor Advisory Council. They
obtained a sample of 1278 New Zealand teenagers, aged 14-17 to determine the relationship
(if any) between alcohol consumption, gender, age and their attitudes in regards to alcohol
and its role in society. Alcohol consumption has been persistently rising over the past 25
years, and people are beginning to drink at a younger age and more frequently. Binge
drinking among teenagers has become an issue in New Zealand. It is believed they are
increasingly consuming more alcohol, subsequently resulting in increased intoxication,
alcohol related offences and alcohol-related illnesses and complications within the body. The
contribution of alcohol in crime and violence among teenagers, including serious traffic
accidents, sexual assaults and other assaults, has become a major concern for police, health
38
professionals and researchers. This review found that most New Zealand teenagers are first
introduced to alcohol in their home, expanding to illegally drinking in public locations. The
legal age to purchase alcohol in New Zealand is 18. However, these restrictions have little
control over teenagers, as they increasingly find ways of obtaining alcohol.
The analysis involved a sample of 1278 teenagers aged 14-17, 651 male and 627 female.
Subjects were interviewed regarding their attitudes to alcohol and drinking, their personal
involvement in such situations, their medical history (if any) and other characteristics
including age, gender, race, religion and cultural beliefs. To analyse data, the authors used a
linear combination between two sets of variables (variables being age, gender and alcohol
consumption) and did a regression analysis. The results showed that 917 teenagers out of the
1278 sample have had a small quantity or more to drink of alcohol, slightly more being male.
Approximately 1 in 3 of the teenagers that drank were reported to consume alcohol on more
than three occasions per week. From the study, it was concluded that alcohol consumption is
certainly related to gender, age and attitudes in the 14-17 year old sample.
10.8 Example 8
There is evidently a strong association between alcohol and violent crime, including family
violence and child abuse. Alcohol abuse in parents can lead to child abuse, neglect and injury,
as well as the child developing problems with violence and substance abuse from the
psychological damage. The child may grow up not knowing any better and not learning from
their parents mistakes (Alcohol Healthwatch, 2006). According to the New Zealand Police,
alcohol is involved in approximately 34% of family violence, however, this figure is reported
to be higher as family violence tends to be under-reported to authorities (New Zealand Police,
2010).
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Family violence does not only include child abuse, it also correlates to domestic violence.
Alcohol fuels aggression causing people to feel powerful and in control, which is the main
cause of domestic violence. According to The Encyclopaedia of New Zealand (2015),
domestic violence is probably the most common form of crime in New Zealand, with many
cases remaining unreported. In 2008 it was estimated that police attended 72,482 domestic
dispute incidents in New Zealand.
Since alcohol is a major factor in a large amount of various crimes across New Zealand, it is
time for the government to restrict alcohol consumption in order to reduce crime and violent
behaviour associated with drinking alcohol. Regulating alcohol as a class controlled drug
under the Misuse of Drugs Act would most likely decrease crime rates in New Zealand, as
there would be greater penalties for breaching the Act. Other restrictions, such as reduction in
alcohol availability and greater monitoring of alcohol consumption could also be put in place.
11.0 Medicinal Benefits of Alcohol – Do These Outweigh its Harmful
Effects?
Although alcohol is known for its potentially harmful effects to human health, and, has been
shown to be involved in crime and violence, it is important to consider the valuable uses of
alcohol. According to the New Zealand Commission Report (2011), the explanation as to
why ethanol is not a class controlled drug under the Misuse of Drugs Act is because of its
ability to be used for beneficial purposes. Many believe that the benefits and the numerous
modern day uses of alcohol outweigh its risks, and would therefore not fit the description of a
class controlled drug.
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Ethanol is a renewable biofuel for cars, as it can be made from biomass material collected
from various plants. It is used to oxygenate the fuel, as well as to reduce greenhouse gas
emissions which contribute to air pollution. According to the U.S. Department of Energy,
over 95% of gasoline fuel in the U.S. contains ethanol (2015). It is also commonly used in
domestic burners which are used for heating as well as cooking.
Ethanol is a good solvent, and is miscible with both water and organic solvents. This property
enables it to be used in perfumes, deodorants, paints, methylated spirits and markers. We use
ethanol in our everyday lives, probably without even realising it. This is why we tend not to
consider is as fitting the description of a class controlled drug.
Although health experts warn against the harmful effects of ethanol when consumed in
alcoholic beverages, it has a number of medicinal benefits which some believe may outweigh
its overall risks. Ethanol is used in antiseptic and disinfectants as it has strong anti-bacterial
properties, killing organisms such as viruses and bacteria by dissolving their lipids and
denaturing proteins. As described, ethanol is a good solvent and used in a number of
medicines such as cough syrups. According to Guenther, ethanol is used in certain
therapeutic drugs for elderly patients, particularly in nursing homes. This drug improves
appetite, improves psychological wellbeing and aids in socialisation (Guenther, n.d.).
A standard treatment of severe methanol poisoning in individuals is ethanol. Methanol
poisoning results in metabolic acidosis, optic nerve generation and respiratory depression
(Ekins et al, 1985). A solution of ethanol is administered intravenously to patients suffering
methanol poisoning, and is a safe and effective treatment. The excess methanol is then
removed via kidney dialysis. Ethanol works by blocking the metabolism of methanol from
41
formaldehyde to formic acid, which is toxic to humans. A clinical study by Ekins et al treated
seven patients with methanol poisoning by intravenously giving them a 10% ethanol solution
then filtering their blood for excess methanol. All patients in the study survived, displaying
the effectiveness of this treatment if it is delivered quickly.
Research has suggested that drinking wine in moderation is beneficial for the circulatory
system and the heart. Moderation is the key word. Alcohol in moderation has been found to
lower the risk of cardiovascular disease as it raises levels of high-density lipoprotein (HDL)
levels in the blood, which protects against heart disease (Harvard School of Public Health,
2015). Further studies in this area are required, as many are still not convinced that there are
cardiovascular benefits from alcohol. It is also fair to say that many people do not know what
a moderate amount to drink is, therefore consuming more than the moderate amount which is
potentially harmful to an individual’s health.
Although there are some health benefits associated with alcohol, many argue that the risks
associated with alcohol misuse most certainly outweigh any benefits it may have. Even if
alcohol was a class controlled drug in the Misuse of Drugs Act, if necessary it would still be
able to be prescribed by doctors but greater controls and restrictions would be in place.
12.0 Does Alcohol Fit the Description of a Class Controlled Drug?
As stated in the Misuse of Drugs Act (1975), classification of a class controlled drug is based
on its risk to cause harm to the individual or to society by its misuse. Drug control is assessed
by the Expert Advisory Committee on Drugs (EACD) on the basis of the health and social
welfare of society as well as in terms of criminal justice. There is a more broad and detailed
42
set of criteria that is considered when evaluating the risk of harm and classifying a drug under
the Act. According to the New Zealand Parliamentary Library (2003), these include;
1. The chance of drug abuse and misuse and its effects on society
2. The overall effects of the drug (including pharmacological and toxicological effects
as well as if it is a psychoactive substance)
3. Any risks associated to public health
4. If there is any therapeutic benefits of the drug that outweigh its risks
5. Whether or not the drug can cause death (i.e. any potential for overdose)
6. The ability of the drug to cause psychological or physical addiction and dependence
7. International classification of the drug
8. Any other matters relevant to the Minister of Health
When determining whether alcohol fits the description of a class controlled drug, the above
criteria needs to be addressed. Firstly, we know that alcohol is a drug that when abused
affects society - it is involved in alcohol induced crime and violence, such as theft, sexual
assault, child abuse and neglect. This is evidenced by the many case examples described, and
the statistics from the New Zealand police department.
Secondly, alcohol has harmful effects to human health, especially when abused. It is a
psychoactive drug that is a known carcinogen, which increases the chance of developing a
number of cancers and it affects the liver in large, continuous doses, causing liver damage. It
is also a risk to public health as it can affect children and unborn babies of pregnant women
that drink. As previously discussed alcohol is involved in a number of crime and violent
situations.
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Although there are some medicinal benefits and other valuable uses of alcohol, its risks
outweigh its benefits. The drug can cause death from various diseases associated with alcohol
consumption and also from blood alcohol concentrations greater than 400 mg/dL. Suicide is a
possible outcome and crimes such as homicide can cause the death of others, as perception
and judgement are greatly affected when intoxicated.
Individuals can become physically and psychologically dependent on alcohol. Alcohol is the
second most commonly abused drug in the world, following the other legal drug nicotine and
tobacco. This means that alcohol misuse is more common than the abuse of any other illegal
substance found on the Misuse of Drugs Act. Although alcohol is only banned in certain
countries, such as in some Islamic States, these effects should not be ignored, a reform of the
current Act should be considered to incorporate alcohol.
Many experts and researchers such as Professor David Nutt believe that if alcohol were
discovered today it would be classified as a Class B controlled drug. Class B drugs are those
that pose a high risk of harm and generally have both therapeutic benefits as well as potential
to cause abuse, which fits the description of alcohol well. Professor Nutt claims that a good
way to measure a drugs ability to cause harm when determining whether it should be
classified as a controlled drug or not is by comparing the costs of hospital admissions
associated with substance taken. For example, in the United kingdom cannabis leads to
approximately 1000 hospitalisations each year, whereas alcohol led to over 1 million
hospitalisations in 2011 (Nutt, 2011).
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Based on all the information described so far, would alcohol be classified as a class
controlled drug, and would it be subject to controls under the Misuse of Drugs Act if it were
discovered today? The answer to this would be yes.
The Misuse of Drugs Act 1975 was created to regulate illegal psychoactive substances in
New Zealand, a time where experts, politicians and the public were all debating drug laws,
and the need for greater restrictions. It was created following the ‘hippie’ culture in the 1960s
and 1970s where there was a spike in the use of illegal substances, mainly cannabis, opiates,
cocaine and psychedelics such as LSD. Since then, a lot has changed. These days, alcohol is
considered the most widely used recreational drug worldwide. Changes have been made in
other countries to legalise certain drugs originally restricted and new drugs and psychoactive
substances that should be restricted keep emerging. Research has been key to changing our
thinking towards certain drugs, as we have learnt more about addiction and the harmful
effects of alcohol compared to over forty years ago when the Act was created. Many find it
hypocritical that there are controls on the use of cannabis. Some believe the medical benefits
of cannabis outweigh its minimal harmful effects, whereas alcohol, the most abused drug in
New Zealand with greater health and social problems associated with it, is legal.
13.0 Ways to Address the Issues of Alcohol Misuse
In 2010, The World Health Organization sponsored the Global Strategy to Reduce the
Harmful Use of Alcohol, a guide to support a number of countries to implement legislation
that is effective in controlling alcohol consumption (WHO, 2010). The guide describes a
number of potential legislative ideas which could aid in the reduction and affordability of
alcohol, by increasing tax, reducing the availability of alcohol by regulating its sale, reduce
the marketing of alcohol to the public, stop drink driving and reduce consumption of alcohol
45
by children and teenagers through setting a minimum age for purchase and consumption. The
guide does not discuss whether alcohol should be listed as a class controlled drug under The
Misuse of Drugs Act, which is a potential thing to consider when discussing ways of reducing
alcohol consumption. The National Drug Policy of New Zealand encourages the need for a
drug reform of the 35 year old Misuse of Drugs Act, stating that it is outdated and fails to
“prevent and reduce the health, social, and economic harms that are linked to tobacco,
alcohol, illegal and other drug use” (Law Commission Report, 2011). Below are some
suggested ways experts believe will decrease excessive alcohol consumption and
consequently decrease alcohol related harm, in conjunction with the Global Strategy to
Reduce the Harmful Use of Alcohol and the New Zealand National Drug Policy.
1) Reducing the affordability of alcohol:
According to The World Health Organization, the lower the cost of alcohol is for purchase,
the higher the consumption by heavy drinkers and underage drinkers in particular, which in
turn could lead to a rise in alcohol related violence and harm. Increasing the tax on alcohol
would increase its sale price and decrease its affordability to many individuals. It is believed
that this would assist in decreasing alcohol consumption, particularly among heavy drinkers
and underage drinkers. There are a number of issues to consider if the government decides to
increase alcohol tax, such as, the potential for an increase in illegal production of alcohol and
importation.
2) Regulate the availability of alcohol:
A way which may potentially decrease the amount of individuals with alcohol dependence
and alcohol abuse may be to decrease the number of alcohol outlets and liquor stores. For
most New Zealanders, alcohol can be purchased within a short driving or walking distance.
46
According to a survey by The New Zealand Ministry of Health, 78% of New Zealand people
aged over fifteen years, live within a two minute drive (approximately 1.5 kilometres) of an
alcohol outlet. A study by Campbell et al, found that having a lower density of alcohol outlets
in neighbourhoods and communities could in fact reduce excessive alcohol consumption, and
consequently reduce alcohol related harm, crime, injury and violence in these areas. Alcohol
outlet density refers to the total number of areas / locations where alcohol can be purchased in
a given area or per population (Campbell, 2009). The World Health Organization believes
that controlling alcohol outlet densities in areas will effectively reduce alcohol related harm.
3) Regulate the marketing and advertisement of alcohol:
Advertisements are a common method alcohol companies use to promote this message, by
associating alcohol with parties, having friends and other leisure activities. In fact you rarely
see advertisements from alcohol companies displaying the accurate side of drinking too much
alcohol including health effects, car accidents, violence, child abuse and even suicide (World
Health Organization, 2015). Binge drinking, particularly among teenagers has become very
common, and therefore it should not be promoted as a part of everyday life. The marketing of
alcohol should be more tightly regulated, unless trying to display its harmful effects.
4) Greater penalties and effective monitoring:
Greater penalties for alcohol related crime and violence, as well as drink-driving should be
put in place to discourage it, and effective monitoring of this should accompany it. Banning
alcohol consumption in certain public areas may also help to decrease alcohol related crime
and violence in particular areas.
47
5) Increase education of its harmful effects:
Education is important to spread awareness to those who may not be aware of the potentially
harmful effects to not only human health, but to social life and those around you. This would
be particularly useful in schools, to educate the youth about the dangers of binge drinking and
how it could lead to alcohol abuse in the future.
6) Potentially make alcohol a class controlled drug under the Misuse of Drugs Act:
Although it was discussed that if alcohol were discovered today, it would be subject to
controls under the Misuse of Drugs Act, there would be a large amount involved in changing
current legislation to include alcohol in the Act now. This could create public outrage, as
many would not agree on changing the legislation now, since alcohol has been consumed for
thousands of years and is considered part of many people’s daily lives. Since the government
makes a large sum of money from alcohol tax, and it is used in a number of other products
discussed, it could pose many issues. Even if not classified under the Act, experts such as
Professor David Nutt believe that alcohol should be regulated more effectively than it
currently is (Nutt, 2012).
14.0 Conclusion
Alcohol, the most commonly used recreational psychoactive drug worldwide, is harmful
when misused. According to the World Health Organization it has the potential to cause over
200 diseases such as cancer and liver cirrhosis. It increases crime rates, as the New Zealand
Police estimate that over 1/3 of their daily work involves attending a crime where alcohol has
been consumed by the victim or suspect. These crimes include violence, sexual assault, theft,
child-abuse, homicide and drink-driving. Alcohol is a legal drug, and when compared to other
psychoactive drugs which are class controlled drugs such as cannabis and ecstasy, it is clear
48
that alcohol can be just as harmful if not more, in some cases when misused. Although it has
certain medicinal benefits and other valuable uses, its harmful effects outweigh its useful
purposes.
Alcohol has been labelled as a socially ‘acceptable’ drug by society because of its legality
and widespread use. Experts such as Professor David Nutt believes if it was discovered today,
alcohol would be a class controlled drug, potentially Class B. This conclusion is based on not
only its harmful effects to human health, but to those around them who are also affected by
an individual’s drinking behaviour, such as innocent children and victims of crime. Based on
analysing studies from various scientists and drug experts, as well as looking into alcohols
association with crime and violence and addressing the criteria for a class controlled drug
under the Misuse of Drugs Act; if alcohol (ethanol) were discovered today, it would be
subject to controls under the Misuse of Drugs Act.
49
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