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Health Promotionand Protection
Alcohol Indicators Report 2011
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Health Promotionand Protection
Alcohol Indicators Report 2011
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Peer ReviewersNorman Giesbrecht, PhDSenior Scientist, Public Health and Regulatory Policy SectionSocial, Prevention, and Health Policy Research DepartmentCentre for Addiction and Mental Health
Tim Stockwell, PhD Director, Centre for Addictions Research of British Columbia
To obtain additional copies, please contact:Nova Scotia Department of Health and Wellness Mental Health, Children’s Services & Addictions BranchPO Box 488Halifax, Nova Scotia, Canada B3J 2R8
Telephone (902) 424-4807Toll free 1-866-231-3883Fax (902) 424-4716
Email: [email protected]
This document is available in PDF at www.gov.ns.ca/DHW
© Crown copyright, Province of Nova Scotia, 2011
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Contents
Executive Summary 1
Introduction 3
Alcohol Consumption 4Per capita Consumption 4Outlet Density 5Patterns of Use 7Alcohol Use Among University Students in Nova Scotia 12Alcohol Use by Underage Youth 14Alcohol Use Age of Onset 15Summary 16
Alcohol-Related Harms 18Alcohol-Related Morbidity and Mortality 18Incidents of Alcohol-Related Offences 24Self-reported Harms 28Summary 31
Treatment 32Summary 34
Benefits and Costs of Alcohol 35Economic Benefits of Alcohol Consumption 35Health Benefits of Moderate Alcohol Consumption 35Benefit/Cost Analysis 37Summary 39
Glossary of Terms 40
Appendix 41ICD–9 and ICD–10 codes for disease conditions related to alcohol 41
References 44
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Alcohol Indicators Report 2011 1
Executive Summary
This report follows the 2005 Alcohol Indicators Report. It includes information to
describe trends in per capita consumption, outlet density, alcohol-related morbidity
and mortality, and incidents of alcohol-related offences. Data regarding patterns of use,
alcohol-related harms, and treatment rates among adults and underage youth have been
updated. Alcohol use and harms in undergraduate students and a benefit/cost analysis of
alcohol use in Nova Scotia were added.
The major findings of the report are:
• PercapitaconsumptionbyNovaScotiansincreased6.6percentovera20-yearperiod,
goingfrom7.6litresofpurealcoholin1991to8.1litresin2010.
• IncreasedaccesstoalcoholinNovaScotiahasbeenledbya65.0percentincrease
inretailoutletsfrom2000to2009,anda20.0percentincreaseinlicensedeating
establishmentsandloungesfrom2004to2008.
• Heavy-drinkingratesintheprovincearehigh.In2007–2008,38.9percentofmales
and17.5percentoffemalesengagedinheavymonthlydrinking.Duringthesame
timeframe,17.9percentofmalesand7.0percentoffemalesengagedinheavy
weeklydrinking.
• Heavy-drinkingratesareparticularlyhighamongyoungadults.In2004,theusual
consumptionpatternfor51.7percentofNovaScotiauniversityundergraduate
studentswasfiveormoredrinksonthedaystheydrank,with27.2percentofall
universitystudentsdrinkingheavilyatleastonceaweek.
• Heavydrinkingbyunderageyouthhasremainedstableovertheyears,butheavy
drinkingbyunderagefemaleyouthisnowonparwithunderagemaleyouth.
• TheaverageageoffirstalcoholuseamongNovaScotiastudentsingrades7,9,10,and
12was12.9years.
• Youngadults(19–24years)accountforonly12.0to13.0percentofclientstreatedat
Addiction Services.
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2 Nova Scotia Department of Health and Wellness
• Thealcohol-relatedmortalityrateincreasedby27.0percentbetween2002and2008.
In the latest reporting years, 252 Nova Scotians died from alcohol-related causes in
2007and231in2008.Ifthecurrentheavy-drinkingratescontinueinNovaScotia,itis
expected that these numbers and rates will increase over time.
• Althoughratesofimpaireddrivinghavedecreasedovertheyears,drinkingand
drivingisstillasignificantprobleminNovaScotia.From2003to2007,23.1percent
to26.2percentofdriversinvolvedincrashesthatcausedseriousinjuryhad
consumedalcohol.TheCanadianratesforthesameperiodrangedfrom18.0percent
to19.5percent.
• Thenumberofalcohol-attributedcrimesinNovaScotiawas23,310in2002,
accountingfor31.2percentofallcrimescommitted.Thetotalpolicing,court,and
correctionscostsforthesecrimeswere$78.09milliondollars.Withtheincreaseseen
inheavyorhigh-riskalcoholuseintheprovincesince2002,thesenumbersarelikely
much higher now.
• AlthoughtheeconomicbenefitsofalcoholinNovaScotiaarehigh,thecostsareeven
higher.In2006,thefiscalrevenuetotheprovincialgovernmentwas$224.2million.
The costs to Nova Scotia were more than twice as much. Direct social costs were
estimatedat$242.9millionandindirectsocialcostsat$249.6million.
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Alcohol Indicators Report 2011 3
Introduction
The recreational use of small quantities of alcohol generally poses few problems. For older
menandwomen,moderatedrinking(twotosevendrinksperweek)mayhaveaprotective
effect for all-cause mortality.1 Conversely, for the majority of the general population who
consume, the relationship between low alcohol consumption and health benefits may
be confounded by other factors that influence health such as gender, age, socioeconomic
status, diet, and physical fitness.2Moreover,risksoffsetbyalcoholforonetypeofdisease
couldfurtherincreasetheriskforothers.Hazardousalcoholuseisasignificantcauseof
chronicdisease,injury,FetalAlcoholSpectrumDisorder(FASD),riskysexualbehaviour,
crime, and social problems. In addition, alcohol has a negative effect on the Nova Scotia
economy causing increased spending on health care and the justice system, and lost
productivity that surpasses the amount collected through alcohol-related revenue and
taxation, as will be discussed in the section titled “Benefits and Costs of Alcohol.”
In 2004, harmful alcohol use was identified by the Government of Nova Scotia as an
importantpublichealthissue.NovaScotiaHealthPromotionandProtection(NSHPP)
was instructed to develop an alcohol strategy that would prevent and reduce alcohol-
related harm in the province. The 2007 Alcohol Strategy, Changing the Culture of Alcohol
Use in Nova Scotia, provides the direction for priority planning and implementation of
initiatives to prevent and reduce alcohol-related acute and chronic health, social, and
economic harms, and related costs in the province.3
Usingtheframeworkestablishedforprovincialmonitoringinthe2005AlcoholIndicators
Report,the2010AlcoholIndicatorsReportbuildsupontheWorldHealthOrganization’s
recommendations for alcohol indicators best practices by incorporating a benefit/cost
of alcohol use in Nova Scotia.4, 5Withresearchandevaluationbeingcriticalcomponents
oftheDepartmentofHealthandWellness’strategytoreducealcohol-relatedharms,
afewnewindicatorswereaddedtotrackthesuccessofcurrentandfutureinitiatives
implemented to reach the intermediate and long-term goals of the 2007 Alcohol Strategy.
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4 Nova Scotia Department of Health and Wellness
Alcohol Consumption
Per capita Consumption
PercapitaconsumptionforNovaScotiaandCanadaincreasedoverthe20-yearperiod
endingin2010(Figure1).ForNovaScotiansaged15yearsandolder,percapita
consumptionrangedfromalowof7.6litresin1991toahighof8.1litresofpurealcohol
in2010.
6
7
8
9
20102009200820072006200520042003200220012000199919981997199619951994199319921991
Nova Scotia
Litr
es p
er C
apit
a
Canada
Figure 1 Per Capita Consumption of Pure Alcohol, Nova Scotia and Canada, 1991–2010
Source: Statistics Canada, CANSIM Table 183–0019. Per capita consumption estimates determined using population aged 15 years and over.
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Alcohol Indicators Report 2011 5
The per capita consumption data used by Statistics Canada to determine these rates are
based on sales of alcoholic beverages by volume by liquor authorities and their agents.
True per capita consumption in Nova Scotia is probably slightly higher than the data
presentedinFigure1.Consumptionfromhomemadewineandbeer,salesinduty-
free shops and private wine stores, and “unrecorded transactions” are missing from
these calculations.6In addition, Statistics Canada uses typical alcohol strengths in its
calculations which may not accurately reflect the alcohol purchased in Nova Scotia. For
example,a4.3percentincreaseinpercapitaconsumptionwasnotedfor2006inBC
when U-Vin and U-Brew sales were included and more accurate estimates of alcohol
strength in wine and coolers sold in BC were used in calculations.7 The revised per capita
estimateforBCwas8.76litresofpurealcoholcomparedtotheStatisticsCanadaestimate
of8.4litres.
Outlet Density
The introduction of privately-owned agency stores and private wine and specialty stores,
andanincreaseinpermanentliquorlicensesarelikelystrongfactorsinthisobserved
increase in per capita consumption in Nova Scotia. The Centre for Addictions Research
of British Columbia recently conducted a study to determine the impact of an increase
in outlet density and private versus government ownership of liquor stores on per capita
consumption.8 The investigators showed a positive relationship between number of
outletsper10,000populationandpercapitasales.Inparticular,apositiverelationship
was observed for restaurants, bars, and private stores but not for government stores.
Fromfiscalyear2000–2001to2008–2009,thenumberofretailoutletssellingliquor
inNovaScotiaincreasedby65.0percent(Figure2).In2000,8agencystoreswere
introducedinconvenientlocations(e.g.,grocerystoresandgasstations)aroundNova
Scotia.By2006,therewere55agencystoresintheprovinceand4privatewineand
specialty stores. Accessibility to alcohol in Nova Scotia was further increased through the
issuanceof290additionalactivepermanentliquorlicensesbetween2004and2008.9 As
showninFigure3,therewasa19.0percentincreaseinlicensedeatingestablishmentsand
a 22.0 per cent increase in lounges.
Overthe10-yearspanbetween2001and2010,percapitaconsumptionincreased
9.5percentinNovaScotia,from7.4litresin2001to8.1litresin2010(Figure1).Based
onresearchconductedinotherjurisdictions,itislikelythatgreateraccessinNovaScotia
is associated with higher rates of alcohol sales and consumption in the province.10 Further
analyses would be required to confirm this observation.
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6 Nova Scotia Department of Health and Wellness
0
20
40
60
80
100
120
2008–20092007–20082006–20072005–20062004–20052003–20042002–20032001–20022000–20011999–20001998–1999
Agency Stores
Specialty Stores
NSLC Stores
Figure 2 Number of Retail Liquor Stores, Nova Scotia, 1998–1999/2008–2009
400
600
800
1,000
1,200
20082007200620052004
Lounges
Liq
uo
r Lic
ense
s Eating Establishments
Figure 3 Number of Liquor Licenses at Eating Establishments and Lounges, Nova Scotia,
2004–2008
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Alcohol Indicators Report 2011 7
Patterns of Use
Whenexaminingconsumption,itisimportanttoconsiderpatternsofdrinking.Aperson
whohasonedrinkperdaywillconsumethesameamountofpurealcoholassomeone
whodrinkssevenatoneweeklysitting,buttheeffectofconsumptionislikelytobe
much different.5 Theriskofinjuryordeathfromacutealcohol-relatedharmincreases
exponentially with the amount of alcohol consumed at a sitting.10 Furthermore, there is a
linear relationship between chronic harms and quantity of alcohol consumed over time.10
Thissectionlooksatdifferentpatternsofdrinking:thenumberofNovaScotians
whoconsumedalcoholinthepastyear,thenumberwhoexceededlow-riskdrinking
guidelines,thenumberofheavydrinkers,andthenumberofhazardousdrinkers.The
datawaslargelydrawnfromthreesources:theCanadianCommunityHealthSurvey
(CCHS);CanadianAlcoholandDrugUseMonitoringSurvey(CADUMS);andthe
CanadianAddictionSurvey(CAS)2004.11 In addition to using previously published
results, further analyses were performed using these data sources to adequately assess the
impact of alcohol use in Nova Scotia. The CADUMS is an on-going general population
surveyofalcoholandillicitdruguseamongCanadiansaged15andolder.Itisderived
from the 2004 CAS.
Samplesizeandrepresentativenessareimportantissueswheninterpretingpopulation-
based survey results.5 TheCCHSsurveyshavehadexcellentresponseratesinNovaScotia
ofover80percentwithsamplesizes(ages12yearsandolder)ofover4,500.Thesample
sizesforCASof1,002(ages15yearsandolder)andCADUMSof1,008for2009and1,328
for2010(ages15yearsandolder)areabout20.0percentofthoseusedbyCCHS.The
response rates for CAS and CADUMS are also much lower. The 2004 CAS response rate
inNovaScotiawas49.9percentandthe2009CADUMSresponseratewas47.3percent.
Hence,CCHSfindingscanbeviewedwithmuchmoreconfidencethanthosefromCAS
or CADUMS.
Survey data have been shown in the past to severely underestimate true consumption
rates.Percapitaconsumptionusingthe2004CASwaslessthanone-thirdofthatfound
when calculated using Nova Scotia alcohol sales data.4 Survey data are still useful when
determiningpatternsandharmsofalcoholuse.However,inviewofthesmallsample
sizeandlowresponseratesforCASandCADUMS,thepatterns-of-usefindingsforthese
surveys may also be underestimated. In addition, since survey data are self-reported and
because some alcohol behaviours are socially unacceptable, they may be under-reported.
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8 Nova Scotia Department of Health and Wellness
Past-year UseIn2010,72.3percentofNovaScotiansage15yearsandolderreportedthatthey
had consumed alcohol in the past year. This rate was lower than the Canadian rate
(77.0percent)andtheNovaScotiaratein2004(Figure4).
Basedon2009data,males(79.3percent)reportedpastyearusemorethanfemales
(71.2percent).Pastyeardrinkingratesfortheyoungest(15–17years)andoldest
(65+years)agegroupswerethelowestamongNovaScotiansat60.9percentand
61.0percentrespectively.The35–44yearoldagegrouphadthehighestpastyeardrinking
rates(84.9percent).
0%
20%
40%
60%
80%
100%
20102004
Nova Scotia Rest of Canada Nova Scotia Rest of Canada
75.8 79.3 72.3 77.0
Figure 4 Past-Year Drinking in Nova Scotia and Canada for those aged 15+ Years,
2004 and 2010
Source: CADUMS 2010 and CAS 2004.
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Alcohol Indicators Report 2011 9
Exceeding Low-risk Drinking GuidelinesLow-riskdrinkingguidelines(currentlyunderreviewinCanada)recommendthathealthy
individualsshouldnotexceedtwostandarddrinksperdayandweeklylimitsshouldbeno
higherthanfourteenstandarddrinksformenandnineforwomen.40
Standard Drinks (13.6 grams of pure alcohol)
Type of drink millilitres ounces
Beer and coolers (bottle or draft) 341 12
Wine 147.64 5
Spirits 44.3 1.5
In2009,17.8percentofadultNovaScotians(15+years)exceededthelow-riskdrinking
guidelinesduringthepastsevendaysatthetimeofsurvey.The2009CADUMSrate
forNovaScotiawassimilartothatobservedforotherCanadiansat17.7percent.The
CASratein2004forexceedingthelow-riskdrinkingguidelinesinNovaScotiawas
17.7percent.
Ratesofexceedingthelow-riskdrinkingguidelinesvariedsignificantlybygenderandage
group.Maleswerestillmuchmorelikelytoexceedthelow-riskdrinkingguidelinesthan
femaledrinkers(23.0percentversus13.2percent,respectively).Youngadultsaged18to
24yearshadthehighestrateforexceedingtheguidelines(31.6percent).
In view of the steady increase in per capita sales previously noted, as well as the decrease
in the proportion of Nova Scotians who consumed alcohol in the past year, these results
arelikelylowerestimatesoftruealcoholpatternsinNovaScotiaandCanada.Incontrast,
theoverallheavy-drinkingratesreportedbyCCHShavesteadilyincreasedovertheyears,
muchinkeepingwiththeincreaseseeninpercapitaconsumption.Asstatedpreviously,
CCHSfindingsshouldbeviewedwithgreaterconfidenceduetothemorerigorous
methodology.
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Heavy DrinkingHeavydrinkingisdefinedasconsumingfiveormoredrinksononeoccasionformen
andfourormoredrinksononeoccasionforwomen.Forthepurposesofthisreport
itisdefinedasfiveormoredrinksforbothmenandwomen.Thisisthedefinition
more consistently used in survey data for all age groups: adults, university students, and
underage youth.
AccordingtoCCHSdata,NovaScotiansweremorelikelythanallCanadianstoengage
inheavymonthlyand/orweeklydrinking.Basedon2008data,28.1percentofNova
Scotianswhohadadrinkinthepast12monthswereheavydrinkers,anincreasefrom
26.3percentin2001.Theheavyweeklydrinkingrate(fiveormoredrinksonone
occasionatleastonceaweek)inNovaScotiaincreasedfairlysteadilyoverthesame
period,goingfrom9.0percentin2001to12.4percentin2007-2008.
NovaScotianmenandwomenconsistentlydrinkmoreheavilythantheirCanadian
counterparts(seeFigure5).In2007–2008,38.9percentofmalesand17.5percentof
femalesengagedinheavymonthlydrinking,and17.9percentofmalesand7.0percent
offemalesengagedinheavyweeklydrinking.The20–34yearagegrouphadthehighest
rateofheavymonthlydrinking(41.1percent)followedbythe12-19yearagegroup
(35.8percent).
10%
20%
30%
40%
50%
2007–2008200520032001
CA Females
NS Females
CA Males
NS Males
Figure 5 Trend in Heavy Monthly Drinking by Gender in Nova Scotia and Canada, 2001–2008
Source: CCHS 2001, 2003, 2005, 2007–2008.
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Alcohol Indicators Report 2011 11
Aone-timeNovaScotiastudy(2008)usedagendereddefinitionofheavydrinking(five
ormoredrinksformenandfourormoredrinksforwomenononeoccasion)andfound
thatamongthosewhoconsumealcohol,37.7percentofmalesand17.9percentof
females,15yearsofageandolder,reportedheavydrinkingatleastonceamonth.12
In2009,StatisticsCanadachangedthewayitreportsheavydrinkingintheCCHSsurvey.
Previously,theheavydrinkingdatareportstherateofheavydrinkersfromamongthe
populationthatreportedhavingatleastonedrinkinthepast12months.Thesamplenow
includesthepopulationthatdoesnotdrink.Thishashadtheeffectofreducingtherates
overall.
Basedonthenewreportingmethod,in2010,20.2percentofNovaScotiansreported
heavymonthlydrinking(includingnon-drinkers).Maleshaveaheavydrinkingrateof
25.9percentandfemaleshavearateof15.0percent.Therateofheavydrinkingfor
malesdroppedfourpercentbetween2009and2010andbetween2003and2009males
consistentlyhadaheavydrinkingratehoveringaround30percent.Females,onthe
otherhand,haveincreasingratesofheavydrinking,goingfrom9.9percentin2003to
15.0percentin2010.The20–34yearagegroupcontinuestobetheheaviestmonthly
drinkers:41.2percentofmalesand26.6percentoffemalesage20–34reportedheavy
monthlydrinking.Again,ifthissurveyincludedonlythosewhoconsumedalcohol,the
ratesofheavydrinkingwouldbehigher.
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12 Nova Scotia Department of Health and Wellness
Hazardous DrinkingHeavydrinkingisoftensynonymouswithhazardousdrinking–apatternofdrinking
thatincreasestheriskofharmfulconsequencesfortheuser.Hazardousdrinkingis
measuredbytheAlcoholUseDisordersIdentificationTest(AUDIT)–avalidandreliable
assessmentscreeningtooldevelopedbytheWorldHealthOrganization.13 The AUDIT
isusedtoidentifyhazardousconsumption,harmfulalcoholusepatterns,andalcohol
dependence.AnAUDITscoreof8istypicallyusedasthecut-offpointforharmfuland
hazardousdrinking.14Inthe2009CADUMS,12.6percentofNovaScotiansreportedthat
theyengagedinhazardousalcoholuseintheprioryear,adecreasefromthe15.7percent
reportedin2004.However,thesmallsamplesizeandlowresponseratefortheCADUMS
mayresultinsomeuncertaintyintheseestimates.Onewouldexpecttoseeanincreasein
ratesconsideringtheriseinheavymonthlyandweeklydrinkingovertheyears.According
tothedata,theproportionofNovaScotiansengaginginhazardousalcoholusewasnot
significantlydifferentfromthatfoundforotherCanadians(12.0percent)in2009.Thisis
alsosurprisingconsideringtheheavy-drinkingratesforbothmenandwomenarefairly
consistently higher than those observed for all Canada.
Genderandagewerestrongpredictorsofhazardousalcoholusein2009inNovaScotia.
Men(20.8percent)weretwiceaslikelytoengageinhazardousalcoholuseaswomen
(5.1percent).YoungNovaScotiansaged18to24years(31.6percent)weremostlikelyto
putthemselvesatriskforharmasaresultoftheiralcoholuseintheprior12months.
Alcohol Use Among University Students in Nova Scotia
The2004CanadianCampusSurveyresultswereusedtoassessthedrinkingpatternsof
Nova Scotia university students and compare them to other university students across
Canada.15 The proportion of undergraduate university students in Nova Scotia who
consumed alcohol in the year prior to the survey was similar to other universities across
Canada(95.1percentversus95.2percent,respectively),althoughagreaterproportion
of Nova Scotia university students consumed alcohol in the month prior to the survey
comparedtostudentsatotheruniversities(92.5percentversus89.8percent,respectively,
Figure6).Inaddition,agreaterproportionofuniversitystudentsinNovaScotiaengaged
inheavy-drinkinguseoverthepastyear(usualconsumptionoffiveormoredrinkson
thedaystheydrank)andengagedinhazardousalcoholuse(AUDITscoregreaterthan8)
compared to other university students across Canada.
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Alcohol Indicators Report 2011 13
0%
20%
40%
60%
80%
100%
*Hazardous/Harmful Drinking (AUDIT 8+)
*Heavy DrinkingPattern
*Past Month UsePast Year Use
Nova Scotia University Students (n=267)
Other Canadian University Students (n=6,015)95.1 95.2 92.5 89.8
51.7 31.5 49.7 34.8
Figure 6 Alcohol Use Among Undergraduate Students at Nova Scotia and Other Canadian
Universities, 2004
* Statistically significant difference at 95% CI, p
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14 Nova Scotia Department of Health and Wellness
Figure 7 Trend in Prevalence of Alcohol Use among Underage Youth in Nova Scotia, 1991–2007
Alcohol Use by Underage Youth
TheStudentDrugUseSurveys(SDUS)areavaluableresourceinassessingunderage
drinkingbyyouthinNovaScotia.TheSDUShavebeenadministeredtostudentsingrades7,
9,10,and12inrandomlyselectedclassesacrosstheprovincesince1991.16,17,18,19 Figure 7
shows the trend in prevalence of alcohol use among underage youth in Nova Scotia. In 2007,
51.7percentofstudentsconsumedsomealcoholintheprioryear.Alcoholconsumption
peakedamongunderageyouthin1998andsincethattimehassteadilydeclined.Ineachof
the study years, alcohol use increased significantly with age. The proportion of males and
females reporting alcohol use in the prior year were about the same.
Exceptfor1998,thepercentageofstudentsreportingbingeorheavydrinking(fiveor
moredrinksatasitting)intheprevious30dayshasbeenrelativelystableovertheyears
(Figure8).However,heavydrinkingamongfemalestudentshasincreasedincomparison
to male students. In 2002 and 2007, no gender differences were noted among heavy
drinkerscomparedtotheearliersurveyyearsinwhichmalestudentsweremorelikelyto
reportheavydrinkingthanfemalestudents.In2002and2007,youngmaleshadheavy
drinkingratesof31.1and28.3percent,respectively.Youngfemaleshadheavydrinking
ratesof27.1and27.2percent,respectively.Overallyears,heavydrinkingincreased
with age.
Note: Vertical bars denote the 95% confidence interval on the prevalence rate.
40%
45%
50%
55%
60%
20072002199819961991
50.654.1
56.7
51.7 51.7
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Alcohol Indicators Report 2011 15
25%
27%
29%
31%
33%
35%
2007200219981996
Heavy Drinking in Past 30 Days
28.2
33
29
27.7
Figure 8 Per Cent Reporting Heavy Drinking Among Students in Grade 7, 9, 10, and 12,
1996–2007
Alcohol Use Age of Onset
TheaverageageoffirstalcoholuseamongNovaScotiastudentsingrades7,9,10,and12
was12.9yearsin2007.20Inthe2008CADUMS,theaverageageoffirstalcoholusewas
19.5yearscomparedtothe18.5yearsinthe2004CAS.TheStudentDrugUseSurvey
ageoffirstonsetislikelyamoreaccurateassessmentofthecurrentageoffirstalcohol
consumption in Nova Scotia, as student results would not be influenced by the recall bias
ofolderrespondentsinCASandCADUMS.Asaresult,datafromtheSDUSarelikely
more reliable in assessing the effect of future initiatives aimed at increasing the age of first
alcohol consumption in the province.
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16 Nova Scotia Department of Health and Wellness
Summary
• PercapitaconsumptionincreasedinNovaScotiaoverthe20-yearperiodendingin
2010,goingfrom7.6litresofpurealcoholin1991to8.1litresin2010.
• A65.0percentincreaseinretailoutletssellingliquorfrom2000to2009acrossthe
provinceandtheadditionof290activepermanentliquorlicensesbetween2004and
2008likelycontributedtothisincreaseinpercapitaconsumption.
• The2009CADUMSNovaScotiaprevalenceratesforpast-yearuse,exceedingthelow-
riskdrinkingguidelines,andhazardousalcoholusewerealllowerthanthosereported
in2004foradults15yearsofageandolder.Inviewofthereliabilityofthedataused
inthesecalculations,cautionshouldbeexercisedinviewingtheseresults.In2009
• 72.3percentofNovaScotiansaged15yearsandolderconsumedalcoholinthe
prior year
• 17.8percentofNovaScotiansaged15yearsandolderexceededthelow-risk
drinkingguidelines
• 12.6percentofNovaScotiansaged15yearsandolderwereidentifiedasengaging
inhazardousorharmfulalcoholusethroughtheAUDITscreeningtool
• HeavymonthlyandweeklydrinkingratesarerisingamongNovaScotiansaged
12yearsandolder.
• In2007–2008,38.9percentofmalesand17.5percentoffemalesengagedin
heavymonthlydrinking.Duringthesametimeframe,17.9percentofmalesand
7.0percentoffemalesengagedinheavyweeklydrinking.
• SimilartootherundergraduateuniversitystudentsacrossCanada,nearlyallNova
Scotiauniversitystudentsconsumedalcoholinthepastyear(95.1percent).However,
NovaScotiastudentshadmuchhigherratesofheavyandhazardousalcoholuse
compared to university students in the rest of Canada.
• Theusualconsumptionpatternfor51.7percentofNovaScotiauniversity
studentswasfiveormoredrinksonthedaystheydrankoverthepastyear,with
27.2percentofalluniversitystudentssurveyedintheprovincedrinkingheavily
onceaweekormoreoften.
• 49.7percentofNovaScotiauniversitystudentswereidentifiedasbeingathigh
riskforharmsasaresultoftheiralcoholusecomparedto34.8percentofother
Canadian students.
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Alcohol Indicators Report 2011 17
• Since1995,alcoholusebyunderageyouthinNovaScotiacontinuestodecline.In
2007,51.7percentofstudentsingrades7,9,10,and12consumedsomealcoholin
theprioryear.Bingeorheavydrinkingbystudentshasremainedstableovertheyears;
however,heavydrinkingbyunderagefemalestudentsisnowonparwithunderage
male students.
• TheaverageageoffirstalcoholuseamongNovaScotiastudentsingrades7,9,10,and
12was12.9yearsin2007.
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18 Nova Scotia Department of Health and Wellness
Alcohol-Related Harms
Alcohol-Related Morbidity and Mortality
Alcoholisanintoxicantdirectlylinkedtoavoidableillness,injury,anddeath.Excessive
patternsofconsumptionincreasethelikelihoodofhealth-relatedharmsandsocial
problems;bothcanresultfromacuteorchronicmisuse.Theformerisconnectedwith
higher levels of morbidity and mortality than the latter.8 Acute misuse is associated with
alcohol poisoning, acute pancreatitis, acute cardiac arrhythmia, Fetal Alcohol Syndrome
(FAS),falls,drowning,assaults,homicide,suicide,andmotorvehicledeathsandinjuries
causedfromdrunkdriving.21Chronicusehasbeenlinkedtovariousformsofcancer,
liver damage, neuropathy, stomach problems, alcohol dependency, and some infectious
diseases.21,22
The morbidity data used in this report were obtained from the Canadian Institute for
HealthInformation(CIHI)DischargeAbstractDatabase(DAD).Themortalitydatafor
this report were obtained from Statistics Canada Vital Statistics Database. The calculations
in this report were made by applying the 2002 Nova Scotia-specific attributable fractions
todiseaseconditionsknowntoberelatedtoalcohol(seeAppendix).23
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Alcohol Indicators Report 2011 19
HospitalizationAlcohol-relatedhospitalizationrateshavevariedoverthepastsevenyearsinNovaScotia
(Table1).Theratioofalcohol-relatedhospitalizationstoallhospitalizationsranged
from2.33to2.48percentovertheseven-yearperiod.Thehighestalcohol-related
hospitalizationrateswereobservedin2002andthelowestin2007,beforerisingagain
slightlyin2008.Incontrast,hospitalizationratesforallcauseshavedecreasedsteadilyin
Nova Scotia since 2002. In view of the increase in per capita consumption in the province
overtheyears,itissurprisingtoseethedownwardtrendinalcohol-relatedhospitalization
rates.Hospitalizationratesareperhapsnotasgoodanindicatorofalcohol-relatedhealth
effectsasmortality.Hospitalizationratesareinfluencedbythereorientationofhealth
resources resulting in some reductions in the availability of hospital services and visits
(e.g.bedclosures).
Table 1 Number and Rate of Hospitalizations from All Causes
and Alcohol-Related Hospitalization in Nova Scotia, 2002–2008
Year Total Nova
Scotia
Population
Hospitalizations from
All Causes
Alcohol-Related Hospitalizations
Number Rate/10,000 Number Rate/10,000 % of Total
2002 934,520 99,517 1,064.9 2,409.25 25.78 2.42
2003 936,527 99,002 1,057.1 2,309.78 24.66 2.33
2004 937,970 98,005 1,044.9 2,383.28 25.41 2.43
2005 936,000 96,118 1,026.9 2,332.01 24.91 2.43
2006 935,060 93,303 997.8 2,256.31 24.13 2.42
2007 934,312 91,898 983.6 2,162.56 23.14 2.35
2008 933,149 92,568 992.0 2,298.49 24.63 2.48
-
20 Nova Scotia Department of Health and Wellness
AsshowninFigures9and10,theratesofalcohol-relatedhospitalizationsformenare
muchhigherthanthoseforwomen.Themalehospitalizationrateforalcohol-related
conditionswas58.0to91.0percenthigherthanforwomenbetween2002and2008.
Forbothgenders,theratesforalcohol-relatedhospitalizationsincreasedwithage.The
femaleratesforallagegroupsfluctuatedslightlyovertheyears,butmostratesin2008
weresimilartothosein2002.Hospitalizationsforfemalesaged15to29yearsshowedthe
mostvariabilityending16.0percenthigherin2008than2002.Allmalehospitalization
ratesper10,000byagegroupdecreasedfrom2002to2008exceptthe0to14-year-oldage
group.Thebiggestdecreasesinhospitalizationrateswereseeninthe60to74-year-oldage
group and the 75 and older age group.
-
Alcohol Indicators Report 2011 21
0
10
20
30
40
50
60
2008200720062005200420032002
Rat
e p
er 1
0,00
0
0–14 yr15–29 yr
30–44 yr
45–59 yr
60–74 yr
75+ yr
Figure 9 Trends in Female Rates of Age-Specific Alcohol-Related Hospitalizations
in Nova Scotia, 2002–2008
0
20
40
60
80
100
120
2008200720062005200420032002
Rat
e p
er 1
0,00
0
0–14 yr15–29 yr
30–44 yr
45–59 yr
60–74 yr
75+ yr
Figure 10 Trends in Male Rates of Age-Specific Alcohol-Related Hospitalizations
in Nova Scotia, 2002–2008
-
22 Nova Scotia Department of Health and Wellness
Mortality Table2showstherateofdeathsfromallcausesandalcohol-relateddeathsper10,000
from2002to2008.Therateper10,000fordeathfromallcausesfluctuatedwithina
narrowmarginfrom2002to2008.However,whiletherateforalcohol-relateddeathsper
10,000didfluctuate,italsoincreasedslightlyovertheseven-yeartimeframe.Thealcohol-
relateddeathratein2008was27percenthigherthanthe2002rate.Thealcohol-related
percentage of total deaths has increased over the years.
Table 2 Number and Rate of Deaths from All Causes and Alcohol-Related Deaths
in Nova Scotia, 2002–2008
Year Total Nova
Scotia
Population
Death from All Causes Alcohol-Related Deaths
Number Rate/10,000 Number Rate/10,000 % of Total
2002 934,520 8,012 85.73 182 1.95 2.27
2003 936,527 8,099 86.48 172 1.84 2.12
2004 937,970 8,295 88.44 197 2.10 2.37
2005 936,000 8,307 88.75 221 2.36 2.66
2006 935,060 8,117 86.81 207 2.21 2.55
2007 934,312 8,395 89.85 252 2.70 3.00
2008 933,149 8,269 86.61 231 2.48 2.79
Thetrendsinage-specificalcohol-relatedmortalityaredisplayedinFigures11and12.
The rates of alcohol-related deaths for males were three to four times higher than those
forfemalesbetween2002and2008.Althoughtherateofalcohol-relatedmortality
increases with age for both genders, it is not as pronounced for women as it is for men.
Thealcohol-relatedmortalityrateforfemalesaged0to29yearsvariedlittleoverthe
years.Forwomenaged30to44years,thealcohol-relatedmortalityratepeakedin2008
at0.86per10,000fromalowof0.32per10,000in2002.Themortalityrateforwomen
aged45to59yearsalsoincreasedovertheyearsfromalowof0.72per10,000in2000to
1.16per10,000in2008.Theratesforwomeninthe60to74yearagegroupdecreased
overtheyearsfromahighof2.73per10,000in2002.Theratesforwomenaged75years
andoldervariedthemostovertheyearspeakingat6.27per10,000in2007.
Thealcohol-relatedmortalityratesformalesaged0to59yearsfluctuatedwithinanarrow
marginovertheyears.Themortalityratesformalesaged60to74yearsincreasedfrom
2002 to 2005 before decreasing again. A steady increase in alcohol-related mortality rates
for men aged 75 years and older was observed between 2002 and 2007 before decreasing
slightlyin2008.
-
Alcohol Indicators Report 2011 23
0
1
2
3
4
5
6
7
2008200720062005200420032002
Rat
e p
er 1
0,00
0
0–14 yr15–29 yr30–44 yr45–59 yr
60–74 yr
75+ yr
Figure 11 Trends in Female Rates of Age-Specific Alcohol-Related Mortality in Nova Scotia,
2002–2008
0
5
10
15
20
2008200720062005200420032002
Rat
e p
er 1
0,00
0
0–14 yr15–29 yr30–44 yr45–59 yr
60–74 yr
75+ yr
Figure 12 Trends in Male Rates of Age-Specific Alcohol-Related Mortality in Nova Scotia,
2002–2008
It will be important to monitor these trends, particularly with the increase in heavy and
high-riskalcoholuseamongyouthandyoungadultsinNovaScotia.Ifthecurrentheavy-
drinkingratescontinueintheprovince,theproportionoftotaldeathsfromalcoholwill
continue to rise.
-
24 Nova Scotia Department of Health and Wellness
200
250
300
350
20082007200620052004200320022001200019991998
Nova Scotia
Rat
e p
er 1
00,0
00
Canada
Figure 13 Rates of Impaired-driving Charges* and Refusal to Provide Breath Sample,
Nova Scotia and Canada, 1998–2008
* Rates/100,000 population of impaired operation of a motor vehicle over 0.08 blood-alcohol concentration.
Source: Statistics Canada, CANSIM Table 252-0013.
Incidents of Alcohol-Related Offences
Alcohol-impaired DrivingDrinkinganddrivinghasamajorimpactonthelivesofCanadians,theeconomy,andthe
healthcaresystem.Impaireddriving(wherebloodalcoholcontent(BAC)is.08percent
orhigher)iscurrentlytheleadingcriminalcauseofdeathinCanada.24 This section draws
on data from several different sources: Nova Scotia Department of Transportation and
Infrastructure Renewal, Statistics Canada, and the Traffic Injury Research Foundation of
Canada.
In2010therewere21alcohol-relatedfatalitiesonprovincially-maintainedroadways.
Thiswas30.4percentofallmotorvehiclefatalitiesandincludesfatalitiesinvolving
motorcycles, bicycles, farm tractors, and all-terrain vehicles.25 Alcohol was also a factor
in8.1percentofallmotorvehiclesseriousinjuriesin2010.Whileoverallratesofmotor
vehicle collisions have been declining for more than ten years, fatalities and serious
injuries associated with alcohol impaired driving in Nova Scotia have remained relatively
consistent.
-
Alcohol Indicators Report 2011 25
10%
20%
30%
40%
50%
60%
200720062005200420032002200120001999199819971996199519941993199219911990198919881987
Nova Scotia
Canada
Figure 14 Percentage of Fatally Injured Drivers with a Blood-alcohol Concentration of
0.08 or Higher, Nova Scotia and Canada, 1987–2007
Note: Percentage is among those fatally injured drivers who were tested for BAC and died within six hours. Excluded are operators of bicycles, snowmobiles, farm tractors, and other non-highway vehicles.
Source: Traffic Injury Research Foundation of Canada, 2007.
The Nova Scotia rates of impaired driving and refusal to provide a breath sample between
1998and2008aredisplayedinFigure13.WhileboththeCanadaandNovaScotia
chargerateshavedeclinedoverthe10-yearperiod,theratesinNovaScotiashowmore
fluctuation and, with one exception, are consistently higher than the national rates.
Figure14showsthepercentageoffatallyinjureddriverstesting0.08BACorhigher
in Nova Scotia and Canada. The average percentage of fatally injured drivers who
hadminimum0.08BACwas4.4percenthigherinNovaScotiathantheall-Canada
percentagebetween1987and2007.Althoughthepercentageofimpairedfatallyinjured
driversinNovaScotiacontinuestoriseandfall,thepeakshavebeenlowersincethelast
largespikein2000.The2006and2007percentageswerefairlyconsistentat27.0percent
and27.9percent,respectively.
-
26 Nova Scotia Department of Health and Wellness
15%
20%
25%
30%
2007200620052004200320022001200019991998199719961995
Nova Scotia
Canada
Figure 15 Percentage of All Drivers in Serious-Injury Crashes Involving Alcohol,
Nova Scotia and Canada, 1995–2007
Note: Excluded are operators of bicycles, snowmobiles, farm tractors, and other non-highway vehicles.Source: Traffic Injury Research Foundation of Canada, 2007.
Although the incidence of fatally injured drivers in Nova Scotia seems to have declined
recently,thepercentageofdriversinseriouscrashes(definedasacrashthatresultedin
apersonbeingadmittedtohospital)involvingalcoholhasrisen.AsseeninFigure15,
the percentage of drivers in serious-injury crashes involving alcohol in Nova Scotia has
increasedsince1995,whiletheCanadianpercentagehasdecreased.(BritishColumbia
andtheYukonareexcludedfromtheCanadatotalsbecauserelevantinformationon
seriousinjurywasnotavailableforthesejurisdictionsinalloftheyearsexamined.)From
2003to2007,23.1percentto26.2percentofdriversinvolvedincrashesinNovaScotia
that caused serious injury had consumed alcohol. The average Nova Scotia percentage
ofdriversinserious-injurycrashesinvolvingalcoholwas3.3percenthigherthanthe
Canadianratefrom1995to2007.
Impaireddriverskilledinalcohol-relatedmotor-vehiclecollisionsaremostoftenmale
(92.9percent),withimpaireddriversaged26to45yearsaccountingforhalfofall
impaireddriverskilledinNovaScotia.26Youngdriversaged16to19yearsaccountedfor
thehighestpercentage(24.2percent)ofdriversinvolvedinalcohol-relatedserious-injury
crashes.26Again, the majority of drivers in this age group involved in alcohol-related
serious-injurycrashesweremales(81.1percent).26
-
Alcohol Indicators Report 2011 27
Alcohol-Related Crime Researchers estimate that 25.0 to 40.0 per cent of crimes committed by federal and
provincial inmates in Canada is attributable to the use of alcohol alone or alcohol in
combination with illicit drugs.27Policebelievethatmuchoftheirworkloadrevolves
aroundsubstanceabuse.PoliceinNovaScotiaestimatethat90.0percentoftheirworkis
related to drugs or alcohol.28 Vancouver police are currently collecting data to determine
the exact effect alcohol and drugs have on police-related incidents.29
In 2002, the percentage of alcohol-attributed crimes and charges in Nova Scotia
(67.6percent)wasslightlyhigherthanitwasforCanada(66.2percent)(Table3).The
costs to Nova Scotia for these alcohol-related crimes are very high. In 2002, the total
provincialcostforpolicing,courts,andcorrectionsamountedto$78.09milliondollars
for alcohol-related crimes.
Table 3 Alcohol-Attributed Crimes, Charges, and Prison Sentences, Nova Scotia and Canada,
2002
Nova Scotia Canada
Number Percentage
of All
Cost
(millions)
Number Percentage
of All
Cost
(millions)
Alcohol-
Attributed
Crimes
23,310* 31.2% $41.53 761,638** 30.4% $1,898.76
Alcohol-
Attributed
Charges
5,916 36.4% $21.36 206,594 35.8% $513.07
Alcohol-
Attributed
Prison
Sentences
(Provincial
and Federal)
486 n/a $15.2 28,162 n/a $660.4
Note: *This includes an estimated 4,360 alcohol-attributed violent crimes for Nova Scotia.Note: **This includes an estimated 127,383 alcohol-attributed violent crimes for Canada.Source: Rehm et al., 2006.
-
28 Nova Scotia Department of Health and Wellness
Self-reported Harms
Alcohol use can lead to a number of personal and social harms that include health,
relationship, occupational, legal, and housing problems.21 Calculations were made using
the2009CADUMSdataandcomparedtothe2004CASresults.Inviewoftheweakness
of both datasets, caution should be exercised in interpreting these results.
In2009,theproportionofNovaScotiansaged15yearsandolderwhoreportedoneor
more of eight harms from their own alcohol use in the past year was roughly equivalent
tothenationalaverage(6.8percentversus6.5percent).(Alcohol-relatedharmsinclude
harms to physical health, friendships and social life, financial position, home life or
marriage,work,studiesoremploymentopportunities,legalproblems,difficultylearning,
andhousingproblems.)Thisisvirtuallyunchangedfromthe2004CASdataanalysisof
6.8percentofNovaScotiansreportingatleastonealcohol-relatedharmfromtheirown
use in the prior year.
Womenwerelesslikelythanmentoreportharmfulalcoholuse(4.3percentversus
9.5percent).However,youngadultsaged18to24yearsweremuchmorelikelytoreport
oneormoreharmsfromtheirdrinkingthanotheradultswith20.2percentofyoung
adults reporting at least one alcohol-related harm in the prior year. This is not surprising
giventhehighproportionofyoungadultsengagedinheavyand/orhazardousalcoholuse
foundinthe2009CADUMS.
-
Alcohol Indicators Report 2011 29
15%
20%
25%
30%
2007200620052004200320022001200019991998199719961995
Nova Scotia
Canada
Figure 16 Proportion of Students Experiencing Alcohol-Related Harms in 2004, Nova Scotia and
Other Canadian Universities
* Statistically significant difference at 95% CI (p< 0.000). Source: Adlaf, Demers, & Gliksman, 2004.
The proportion of university students in Nova Scotia reporting alcohol-related harms,
eitherduetotheirowndrinkingorthatofothers,wassignificantlyhigherthanforother
Canadianuniversitystudents(Figure16).15Atsomepointduringthe2003–2004academic
year, almost four in ten university students in Nova Scotia reported having a serious
argument, being pushed, hit or assaulted, experiencing sexual harassment, or being a
victimofsexualassaultordaterapeasaresultofanotherstudent’sdrinking.Inaddition,
almostthreeintenstudentshadunplannedsexorunsafesexduetotheirowndrinking.
-
30 Nova Scotia Department of Health and Wellness
0%
5%
10%
15%
20%
25%
30%
35%
2007*(Grade 7
at least 1 of 12problems;
Grade 9-12 at least 1 of 13
problems)
2002(Grade 7-12
at least1 of 10 problems)
1998(Grade 7-12
at least1 of 8 problems)
1996(Grade 7-12
at least1 of 8 problems)
28.2 29.4 30.5 28.4
Figure 17 Alcohol-Related Problems* Reported Among Underage Youth in Nova Scotia,
1996–2007
* Students in 1996 and 1998 were asked about eight alcohol-related problems: damaged things when drinking, drinking caused one to injure oneself, cost of alcohol has prevented buying other things, drinking has caused tensions or disagreement with family or friends, consumed alcohol before or instead of breakfast, trouble with police as a result of drinking, school work or exams affected by drinking, and had a motor vehicle accident as a driver after drinking in the previous two hours. In 2002, driving under the influence of alcohol and unplanned sex under the influence of drugs were included. Additional indicators added in 2007 were using a fake ID or lying about age to get alcohol, drinking in a licensed venue, and riding with a drunk-driver.
Note: 2007 alcohol problem rate calculated using unweighted data and thus are slightly lower than the weighted findings
Alcoholuseamongunderageyouthcanalsoleadtoharms(Figure17).In1996and1998,
28.2percentto29.4percentofstudentsingrades7,9,10,and12reportedhavingat
least one of eight alcohol-related problems in the prior year.17,18In2002,30.5percent
of students in the same grades reported experiencing at least one of ten alcohol-related
problems.19In2007,8.0percentofstudentsingrade7reportedexperiencingatleastone
oftwelvealcohol-relatedproblems(studentsingrade7werenotaskedquestionsabout
sexualbehaviour).Over40.0percentofstudentsingrades9,10,and12experiencedone
or more of thirteen alcohol-related problems.20
-
Alcohol Indicators Report 2011 31
Summary
• Alcohol-relatedhospitalizationratesinNovaScotiafluctuatedbetween2002and
2008.Thehighestratewasobservedin2002at25.8per10,000andthelowestin
2007at23.2per10,000.Thisobservationcouldresultfromamixingofeffectswhen
combiningacuteandchronicalcohol-relatedoutcomes(seeAppendix).Overall,
hospitalizationratesdecreasedovertheyearsduetocost-savingmeasuressuchasbed
closures.
• Alcohol-relatedmortalityrateshaverisenfairlysteadilysince2002,withthe2008rate
27.0 per cent higher than the 2002 rate.
• In2010therewere21alcohol-relatedfatalitiesonprovincially-maintainedroadways.
Thiswas30.4percentofallmotorvehiclefatalities.Alcohol-relatedrateshavebeen
relativelyconsistentforthepast10years,despiteadeclineinoverallratesofmotor
vehicle fatalities.
• In2002,thepercentageofalcohol-attributedcrimesandchargesinNovaScotiawas
slightlyhigherthanforCanada.ThecosttoNovaScotianswas$78.09milliondollars
for policing, courts, and corrections.
• In2009,6.8percentofNovaScotiansreportedoneormoreofeightharmsfromtheir
ownalcoholuseintheprioryear.Youngadultsaged18to24years(20.2percent)
weremostlikelytoreportoneormoreharms.
• Inthe2003–2004academicyear,almostfourintenuniversitystudentsexperienced
harmasaresultofanotherstudent’sdrinkingandthreeintenstudentshad
unplanned or unsafe sex due to their own alcohol use.
• In2007,morethan40.0percentofstudentsingrades9,10,and12experiencedone
ormoreofthirteenalcohol-relatedproblemsand8.0percentofstudentsingrade7
had at least one of twelve alcohol-related problems.
-
32 Nova Scotia Department of Health and Wellness
Treatment
AddictionServicesintheDistrictHealthAuthoritiesandIWKHealthCentreare
responsible for the delivery of addiction prevention and treatment services in Nova
Scotia. Addiction Services uses a comprehensive approach that involves providing
programs, services, and supports to individuals based on current, evidence-informed
literature. Services range from prevention and health promotion, to early identification,
early intervention, brief intervention, and treatment for individuals and families who
experience problems associated with alcohol use. Treatment programs, services, and
supports specific to alcohol include: withdrawal management, community-based services
(withenhancedservicesforruralwomenandyouth),drivingwhileimpairedandalcohol
ignitioninterlockprograms,andstructuredtreatment(21–day).
Alcohol-treatmentratesfor2007to2009havebeenrelativelystableat57.8to58.6per
10,000population(Figure18).Althoughtheseratesseemlowerthanthosecalculated
usingthe2000to2004datareportedinthe2005AlcoholIndicatorsReportat62.5to
72.0per10,000,theseearlierratescannotbedirectlycomparedtothecurrentrates.4
Intheinterveningyears,anewinformationsystem(ASsist)wasintroduced.ASsistis
more efficient at capturing unique clients in the province. In the 2005 report, clients
were unique in regional tallies but not necessarily in the provincial count. Clients may
have been treated in more than one region resulting in duplication in provincial counts.
Comparedtotheoldinformationsystem(StatIS),ASsistusesdifferentdata-collection
processes, definitions, and reporting requirements. For example, in StatIS if a client was
admittedforsmokingcessationandreportedusingalcoholduringtheirclientassessment,
they were also counted as an alcohol-treatment client even if they did not receive alcohol-
specific treatment services. In addition to the change in information systems, several sites
and programs experienced closures and/or restructuring resulting in a decrease in the
numbersofclientsreceivingtreatmentfrom2006to2008.
From2000to2009,themaletofemaletreatmentratioremainedfairlyconsistent,with
malescomprising68.0to75.0percentofallalcoholtreatmentclients.However,the
proportionofclients18yearsofageandyoungerseekingalcoholtreatmenthasdecreased.
From2000to2004,11.3percentofclientsseekingtreatmentforalcoholissueswere
18yearsofageandyounger.From2005to2009,theproportiondecreasedto9.2percent.
-
Alcohol Indicators Report 2011 33
55
56
57
58
59
60
200920082007
Rat
e p
er 1
0,00
0
Figure 18 Alcohol Treatment Rates in Nova Scotia (all ages), 2007–2009
As reported earlier in the alcohol consumption and harms sections of this report, young
adultshavethehighestratesintheprovinceforpastyeardrinking,exceedinglow-risk
drinkingguidelines,andforheavymonthlydrinking.Youngadultswerealsothemost
likelytoengageinhazardousalcoholuseandcauseharmtothemselvesandothersasa
resultoftheirdrinking.Yet,from2007to2009,19to24-year-oldsaccountedforonly
12.0to13.0percentofallclientstreatedatAddictionServices.Perhapssomeofthese
youngadultsareseekingtreatmentfromtheirfamilypractitionersoratcampushealth
servicesfortheiralcoholissues.Itisalsoaslikelythattheyarenotrecognizingthatthey
have a potential problem with their alcohol use. The 2007 Alcohol Strategy identified the
need to increase outreach and engage individuals experiencing alcohol problems so that
they access the appropriate services. It seems that this goal is more important than ever
for this age group and appropriate interventions need to be created to decrease harmful
alcohol use in young adults.
-
34 Nova Scotia Department of Health and Wellness
Summary
• Alcoholtreatmentrateswerestablefrom2007to2009at53.6to55.6per10,000
population.
• Malescomprised68.0to75.0percentofallalcoholtreatmentclientsfrom2000
to2009.
• Youngadults(19-24years)havethehighestratesintheprovinceforpast-year
drinking,exceedinglow-riskdrinkingguidelines,heavydrinking,engagingin
hazardousalcoholuse,andcausingharmtothemselvesandothersasaresultoftheir
drinking.However,theyaccountforonly12.0to13.0percentofalltheclientstreated
atAddictionServicesfrom2007to2009.
• Theproportionofclients18yearsofageandyoungerengagedintreatmentthrough
AddictionServicesdecreasedoverthepastfiveyearsfrom11.3in2004to9.2percent
in2009.
-
Alcohol Indicators Report 2011 35
Benefits and Costs of Alcohol
Economic Benefits of Alcohol Consumption
Alcoholicbeveragesareimportanteconomiccommodities.Productionofalcohol,
wholesale and retail alcohol sales, in combination with the tourism and service industries,
generates economic and fiscal benefits to Nova Scotians through employment, revenues,
andtaxation.Betweentheyears1995and2009,NovaScotiapostedtotalrevenuesof
$2.28billionandtheCanadiantotalwas$50.31billion(Figure19).30 Alcohol is also
important to the tourism and service industry. Not including restaurants, liquor-licensed
establishmentsposted$68.1millioninreceiptsin2008.31
Health Benefits of Moderate Alcohol Consumption
Some studies suggest that low levels of alcohol consumption may have specific health
benefitsforsomegroupsincludingloweringtheriskofcoronaryheartdisease,ischemic
stroke,andpossiblybloodpressure.32,33,34,35 Individuals might also benefit from infrequent
consumption of low levels of alcohol through lowered stress, increased sociability, and
relaxation.36,37However,therelationshipbetweenlowalcoholconsumptionandhealth
benefits may be confounded by factors such as gender, age, socioeconomic status, diet,
and physical fitness. Moreover,risksoffsetbyalcoholforonetypeofdiseasecould
furtherincreasetherisksforothers.Nopatternofdrinkingiswithouthealthrisksand
possibleharmtoselforothers,andforyoungadults,inparticular,therisksoutweighthe
benefits.32
-
36 Nova Scotia Department of Health and Wellness
100
Mill
ions
150
200
250
200920082007200620052004200320022001200019991998199719961995
Nova Scotia
2,000
3,000
4,000
5,000
200920082007200620052004200320022001200019991998199719961995
Canada
Mill
ion
sFigure 19 Annual Alcohol Liquor Profits, Nova Scotia and Canada, 1995–2009
Source Statistics Canada, CANSIM Table 385-0002.
-
Alcohol Indicators Report 2011 37
$ 150,000,000
$ 175,000,000
$ 200,000,000
$ 225,000,000
$ 250,000,000
2008200720062005200420032002200120001999
Figure 20 Total Fiscal Alcohol Revenues Nova Scotia, 1999–2008
Source: Foster 2010. Note: The total revenue is the sum of net income from NSLC and revenue from licenses, permits, fines,
and confiscations plus 8% provincial HST.
Benefit/Cost Analysis
Alcohol is a legal commodity that provides economic, fiscal, and possible health
benefitsforcitizensoftheprovinceofNovaScotia.Provincialalcoholprofitsrose
from$163.4millionto$243.4millionbetweentheyears1999and2008(Figure20).38
Nevertheless, alcohol-related harms to self and others produce costs for Nova Scotians.
Thesecostscanbedirect(health,lawenforcement,preventionandresearch,andother
costs),orindirectcosts,thelatterofwhichareprimarilyconcernedwithproductivity
losses associated with alcohol consumption.
Thedirectsocialcostsofalcoholusein2006exceededthegovernment’sfiscalbenefits
($242.9millionincostsversus$224.2millioninrevenues)withabenefit/costratioof
0.92(Table4).38Directsocialcostsofalcoholrose$37.6millionfrom2002to2006.
Indirectsocialcoststhroughlostproductivitywereevenhigherat$249.6millionin
2006(Table5).38From2002to2006,theindirectsocialcostsofalcoholinNovaScotia
increasedby$37.6million.AsshowninFigure21,whenthesocialcostsofalcoholare
combined($492,537,753)theresultismorethandoublethefiscalrevenueresultingina
benefit/costratioof0.46for2006.38
-
38 Nova Scotia Department of Health and Wellness
Table 4 Social Costs of Alcohol Consumption – Direct Costs, Nova Scotia, 2002 and 2006
Direct Costs 2002 2006
Direct Health Care
Morbidity – Acute-Care Hospitalization $50,870,211 $54,596,634
Morbidity – Psychiatric Hospitalization $311,395 $622,204
Inpatient Specialized Treatment $12,785,802 $13,808,666
Outpatient Specialized Treatment $798,036 $861,879
Ambulatory Care: Physician Fees $3,918,288 $4,392,291
Family Physician Visit $4,888,386 $6,174,793
Prescription Drugs $23,686,634 $35,209,114
Total Health Costs $97,258,752 $115,665,581
Direct Law Enforcement
Police $41,530,000 $51,111,514
Courts $21,360,000 $23,585,532
Corrections (Including probation) $15,200,000 $16,891,200
Total Law Costs $78,090,000 $91,588,246
Other $30,000,000 $35,677,688
Total Direct Social Cost $205,348,752 $242,931,515
Source: Foster 2010. Note: Other costs include fire damage, traffic accident damage, losses in workplace such as employee
assistance programs, health promotion, drug testing, administrative costs for transfer payments such as social welfare and other programs, and worker’s compensation. The data was updated using the total health costs as the escalator.
Table 5 Social Costs of Alcohol Consumption – Indirect Costs, Nova Scotia, 2002 and 2006
Indirect Cost 2002 2006
Productivity Loss due to Short- and Long-Term Disability $182,500,000 $214,873,294
Productivity Loss due to Premature Mortality $29,500,000 $34,732,943
Total $212,000,000 $249,606,237
Source: Foster 2010.
-
Alcohol Indicators Report 2011 39
$ 0
$ 50,000,000
$ 100,000,000
$ 150,000,000
$ 200,000,000
$ 250,000,000
Indirect Social CostsDirect Social CostsFiscal Revenues
$1
82
,72
0,1
60
$2
24
,19
9,8
80
$2
05
,35
8,7
52
$2
42
,93
1,5
16
$2
12
,00
0,0
00
$2
49
,60
6,2
37
2002
2006
Figure 21 Alcohol-Related Revenues and Costs in Nova Scotia, 2002 and 2006
Summary
ThebenefitsandcostsofalcoholuseinNovaScotiaareconsiderable.In2006
• fiscalrevenuetotheprovincialgovernmentwas$224.2million
• directsocialcostsfromalcoholconsumptionwere$242.9million
• indirectsocialcostsfromalcoholwereestimatedat$249.6million
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40 Nova Scotia Department of Health and Wellness
Glossary of Terms
Agency stores are privately-owned local businesses licensed to sell alcohol on behalf of NSLCinadditiontotheirtypicalproducts.Anagencystoremustbeatleast14kilometres
from an existing NSLC outlet. Most are situated in small rural communities where the
NSLC has deemed it not financially feasible to open a retail store.
Direct costs due to alcohol are costs which the individual incurs directly. These costs are primarily financed by government. Examples are health-care or law-enforcement costs.
Hazardous drinking isapatternofdrinkingthatincreasestheriskofharmfulconsequences for the user. It is measured by the Alcohol Use Disorders Identification Test (AUDIT),astandardscreendevelopedbytheWorldHealthOrganization(WHO)toassesshazardousalcoholuse.Hazardous drinkersaredefinedasthosescoring8ormoreon the AUDIT scale.
Heavy drinkingisdefinedastheconsumptionoffiveormoredrinksatasitting.
Alcohol-related harms include harms to physical health, friendships and social life, financialposition,homelifeormarriage,work,studies,oremploymentopportunities,
legal problems, difficulty learning, and housing problems.
Indirect costs due to alcohol refer to costs that are less clear and that are borne by society. These are not expenses. eg., the productivity lost due to long-term disability. Definition
from.
Low-risk drinking guidelinesrecommendhealthyindividualsnotexceedtwodrinksperday,andweeklylimitsof14drinksformenorninedrinksforwomen.
A standard drinkreferstoone341mlor12ouncebottleofbeeroraglassofdraft;one142mlor5ounceglassofwine;oronestraightormixeddrinkwithoneounceandahalf
or43mlofliquor.
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Alcohol Indicators Report 2011 41
Appendix
ICD–9 and ICD–10 codes for disease conditions
related to alcohol
Malignant neoplasms Oropharyngealcancer:C00–C14
Oesophagealcancer:C15
Liver cancer: C22
Laryngealcancer:C32
Breast cancer: C50
Otherneoplasms:D00–D48
Diabetes Diabetesmellitus:E10–E14
Neuro-psychiatric conditions Alcoholicpsychoses:291F10.0,F10.3–F10.9
Alcoholdependencesyndrome:303F10.2
Alcoholabuse:305F10.1
Unipolarmajordepression:300.4F32–F33
Degenerationofnervoussystemduetoalcohol:G31.2
Epilepsy:G40–G41
Alcoholicpolyneuropathy:G62.1
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42 Nova Scotia Department of Health and Wellness
Cardiovascular diseases Hypertensivedisease:I10–I15
Ischaemicheartdisease:I20–I25
Alcoholiccardiomyopathy:I42.6
Cardiacarrhythmias:I47–I49
Heartfailureandill-definedcomplicationsofheartdisease:I50–I52,I23,I25.0,I97.0,
I97.1,I98.1
Cerebrovasculardisease:I60–I69
Ischaemicstroke:I60–I62
Haemorrhagicstroke:I63–I66
Oesophagealvarices:I85
Digestive diseasesAlcoholicgastritis:K29.2
Cirrhosisoftheliver:K70,K74
Cholelithiasis:K80
Acuteandchronicpancreatitis:K85,K86.1
Chronicpancreatitis(alcoholinduced):K86.0
Skin diseasesPsoriasis:L40
Conditions arising during the perinatal period (maternal use)Foetalalcoholsyndrome(dysmorphic):Q86.0
Excessalcoholbloodlevel:R78.0
Unintentional injuriesMotor vehicle accidents: §
Poisonings:X40–X49
Accidentalpoisoning&exposuretoalcohol:X45
Falls:W00–W19
Fires:X00–X09
Drowning:W65-W74
Otherunintentionalinjuries:†RestofV&W20–W64,W75–W99,X10–X39,
X50–X59,Y40-Y86,Y88,Y89
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Alcohol Indicators Report 2011 43
Intentional injuriesSelf-inflictedinjuries:X60–X84,Y87.0
Intentionalself-poisoningbyandexposureto:X65
Homicide:X85–Y09,Y87.1
Otherintentionalinjuries:Y35
Ethanol and methanol toxicity, undeterminedIntent:Y15
Lowbirthweight&shortgestation(asdefinedbytheglobalburdenofdiseasestudy):
*P05–P07
*Relativeriskreferstodrinkingofmothers
†RestofV=V-seriesMINUS§.
§V021–V029,V031–V039,V041–V049,V092,V093,V123–V129,V133–V139,
V143–V149,V194–V196,V203–V209,V213–V219,V223–V229,V233–V239,
V243–V249,V253–V259,V263–V269,V273–V279,V283–V289,V294–V299,V304–V309,
V314–V319,V324–V329,V334–V339,V344–V349,V354–V359,V364–V369,V374–V379,
V384–V389,V394–V399,V404–V409,V414–V419,V424–V429,V434–V439,V444–V449,
V454–V459,V464–V469,V474–V479,V484–V489,V494–V499,V504–V509,V514–V519,
V524–V529,V534–V539,V544–V549,V554–V559,V564–V569,V574–V579,V584–V589,
V594–V599,V604–V609,V614–V619,V624–V629,V634–V639,V644–V649,V654–V659,
V664–V669,V674–V679,V684–V689,V694–V699,V704–V709,V714–V719,V724–V729,
V734–V739,V744–V749,V754–V759,V764–V769,V774–V779,V784–V789,V794–V799,
V803–V805,V811,V821,V830–V833,V840–V843,V850–V853,V860–V863,V870–V878,
V892.
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44 Nova Scotia Department of Health and Wellness
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