Perspectives on ATOD Prevention

Robert I. Reynolds, DirectorCenter for Policy Analysis and Training

Pacific Institute for Research and Evaluation

Drug “Capture” Rate

Percent of Users Who Become Clinically Dependent

Tobacco 31.9%Heroin 23.1%Cocaine 16.7%Alcohol 15.4%Stimulants 11.2%Marijuana 9.1%

Source: National Comorbidity SurveyAnthony, Warner, and Kessler

U.S. Economic Costs of ATOD Use, 1995

Total Costs = $415 Billion

40%

33%

27% Alcohol-$167 Billion

Tobacco-$138 Billion

Illicit Drugs-$110 Billion

Sources: Harwood, Fountain, & Livermore, NIDA & NIAAA, 1998Rice (unpublished) Institute for Health and Aging, UCSF, 1995

Question:

ATOD Problems in the United States are:

A. At epidemic proportions

B. Steadily declining

C. Both of the above

ATOD consumption in the U.S has declined over the past 20

years.Alcohol consumption is down.

Tobacco consumption is down.

Other Drug use is down.

Tobacco use has declined. Percent reductions in monthly tobacco use by age group (1985 to 2000)

Age 1985 2000 Percent Reduction

12-17 29.4% 15.6% 47%

18-25 47.4% 42.9% 9%

26-34 54.7% 35.6% 35%

35-up 35.5% 27.3% 23%

Illicit drug use has decreased. Percent reductions in monthly illicit drug use

by age group (1979 to 2000)

Age 1979 2000 Percent Reduction

12-17 16.5% 9.7% 41%

18-25 38.0% 15.9% 58%

26-34 20.8% 7.8% 63%

35-up 2.8% 3.4% (21)%

Alcohol consumption has decreased in the past 20 years... Reduction in per capita consumption

1980-1999 (gallons of pure ethanol)

1980 1999 Percent Reduction

Beer 1.38 1.25 9%

Wine 0.34 0.32 6%

Spirit 1.04 0.64 38%

All Beverages

2.76 2.21 20%

Percent Reduction: Monthly Alcohol Use, 1979-2000

…and fewer youth are drinking now versus twenty

years ago.

Age 1979 2000 Percent Reduction

12-17 49.6% 16.4% 67%

18-25 75.1% 56.8% 24%

26-34 71.6% 58.3% 19%

35-up 59.7% 46.8% 22%

In particular, fewer fatalities

are alcohol-related.

25

30

35

40

45

50

55

60

Percent alcohol-related

Percentage traffic fatalities related to alcohol(1982-2000)

What these successes have in common:

• changes in Social Norms

• policy interventions

• deterrence and enforcement

Changes in Social Norms

Media Advocacy:

• “If you’re not in the news, you don’t exist”

• Media Advocacy is the strategic use of media to advance a social or public policy goal

• Media Advocacy is “Earned Media”

Policy Interventions

• To prevent ATOD problems, policy interventions must focus on the Availability of alcohol, tobacco, and other drugs.

• Effective policies address the–Price–Place–Product–Promotion…

…of ATOD products

Deterrence and Enforcement

• Effective Deterrence requires the Perception of

• Certainty• Swiftness• Severity

• Active Enforcement is a Requirement for Effective Deterrence.

Essential Elements of Effective Prevention of ATOD Problems

Public Support

EnforcementPolicies and Laws

Preven-tion

Alcohol Markets and Problems: 2003

Global Market – Alcohol SpiritsSales Exceed 2 Billion Cases Annually

Country Case Volume

China 725 million casesRussia 350India 249Brazil 195Japan 176United States 135Korea 79Thailand 76Germany 60France 37

Source: Mark Brown, President

Sazerac Company, Inc.

March 4, 2003

Product Categories – Alcohol Spirits

Product Category Case Volume

Baijiu 725 million casesVodka 400Whisky 205Cachaca 200Rum 115Brandy 82Shochu 70Soju 70Liqueurs 51

Source: Mark Brown, President

Sazerac Company, Inc.

March 4, 2003

Global Burden of Disease(Disability-Adjusted Life Years)

Attribution

Tobacco Alcohol Illicit Drugs

Worldwide 4.1% 4.0% 0.8%

North America 8 - 15.9% 4 - 7.9% 2 - 3.9%

South America 2 - 3.9% 8 - 15.9% 1 - 1.9%

Source: World Health Report 2002

World Health Organization

Myths about alcohol suggest alcohol is an “integral part of American life”.

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“…the vast majority of consumers drink responsibly and in

moderation…”

From an industry website:

The real picture of “Drinking in America” is much different.

Adults: Most adults do not drink or drink infrequently.

Youth: Most young people do not drink.

Prevention Policy: There is widespread support for policies to reduce alcohol-related harm.

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Most adults do not drink or drink infrequently.

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50%

26%

12%7% 5%

0%

20%

40%

60%

0 1 to 4 5 to 10 11 to 21 21+

Frequency of Drinking Among U.S. Adults 21 and Older, 2000 (past 30 days)

Most adults do not drink at a hazardous level.

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51%

29%

15%

5%Nondrinker

Nonbingers

Infrequent Bingers

Frequent Bingers

Drinking Patterns among U.S. Adults 21 and Older, 2000(past 30 days)

Alcohol sales depend on the heaviest drinkers.

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4%

15%

29%

44%36%

20%

0%

20%

40%

60%

80%

FrequentBingers

InfrequentBingers

Non-bingers

Population

Alcohol

Alcohol Consumed by Drinking Pattern Among Adult Drinkers, 2000

(past 30 days)

Binge drinkers are 20% of the population, but consume 80% of the alcohol.

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20%

80%

0%

20%

40%

60%

80%

100%

Population Alcohol

Binge Drinkers, 2000

Most young people do not drink.

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15- to 17-year-olds 18- to 20-year-olds

Drinking occasions

0 1 to 4 5 or more

Drinking Among Youth, 2000(past 30 days)

94%

12- to 14-year-olds

17%

75%

8%

52%

25%

23%

Young drinkers tend to drink more heavily than adult drinkers.

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Comparison of drinking patterns for adult and underage drinkers, 2000 (past 30 days)

Nonbingers Bingers

51%68% 71%

41%

49%32% 29%

59%

0%

20%

40%

60%

80%

100%

12- to 14-year-olds

15- to 17-year-olds

18- to 20-year-olds

Adults

Young bingers consume the majority of the alcohol for their age group.

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15- to 17-year-olds 18- to 20-year-olds

Nonbingers Infrequent Bingers

Frequent Bingers

Percentage of Drinks Consumed by Drinking Pattern Among Underage Drinkers, 2000

94%

12- to 14-year-olds

34%

62%

4%

26%

70%

4%

45%

12- to 14-year-olds

8%

47%

What is the REAL message in “Designated Driver” programs?

Binge Drinking: Adverse Health Effects

SuicideAlcohol Poisoning

HypertensionAcute Myocardial Infarction

GastritisPancreatitis

Sexually Transmitted DiseasesMeningitis

Poor Control of DiabetesInterpersonal Violence (homicide, assault, domestic

violence, rape, & child abuse

Binge Drinking is Increasing1995 - 2001

Age 1995 2001 % Increase

18-20 8.8 15.3 74

21-25 11.6 18.0 55

26-34 7.6 9.2 21

35-54 5.1 6.7 31

55 + 1.9 2.7 42

All Ages 35

Source: Timothy Naimi, et.alJAMA, 1/1/03

Rate of Binge-Drinking Episodes(Episodes/Person/Year among US Adults)

Binge Drinking is Increasing…

• Binge drinking episodes increased by 35%

• Binge drinkers reported impaired-driving 14 times more frequently than non-bingers.

• The majority of binge-drinking episodes (70%) occurred among those 26 or older.

• Moderate drinkers (average 1-2 drinks/day) accounted for almost as many binge drinking occasions as did heavy drinkers.

• Underage drinkers had the largest increase (74%) in the rate of binge-drinking.

Source: Timothy Naimi, et.al

JAMA, 1/1/03

Prevention Policy: There is widespread support for policies

to reduce alcohol-related harm.

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In Order to Continue Our Progress and to Confront Our Challenges

We Must:

Change Social Norms.

Adopt Policies impacting the Price, Place, Product and Promotion of ATOD availability.

Increase Deterrence and Enforcement.