Overview of national alcohol policies in the 15 countries of the … · Alfred Uhl,...

S o c i é t é F r a n ç a i s e d e S a n t é P u b l i q u e

Overview of national alcoholpolicies in the 15 countries ofthe European Union

European CommissionDirectorate General V

Employment, Industrial Relationsand Social Affairs

Public Health and Safety at workPromotion of health, health monitoring

and injuries prevention

Neither the European Commission, nor any other person acting in itsname, may be held responsible for any use to which information

contained in the following report may be put.

October 1998

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Daniel Oberléin association with

Michel Craplet, Hélène Therre

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Acknowledgements

AustriaMag. Ilse Lesniak, Bundesministerium für Arbeit, Gesundheit und SozialesJohanna Schopper, Bundesministerium für Arbeit, Gesundheit und SozialesRafr Schönberg, Ministerium für frauen, jugend, familie und gesundheit des landesnordrhein-westfalenAlfred Uhl, Ludwig-Boltzmann Institute for Addiction Research

BelgiumLuc Bils, CCADCathrine Preumont, CCADRodolphe de Looz-Corswarem, CBMC Confédération des Brasseurs du Marché Commun

DenmarkFinn Hardt, HS RigshospitaletErik Linde, Head of section, National Board of Health

FinlandKari Paaso, Ministry of social affairs and healthJussi Simpura, STAKES National Research and development center for welfare andhealth

FranceMichel Craplet, ANPAColette Ménard, Comité français d’Education pour la SantéJean-Dominique Faivre, Société française d’AlcoologieJean-Pierre Bridault, Data Shop Eurostat Paris

GermanyClaudia Maria Riempp, BZgA, Federal Centre for Health Education (FCHE)

IrelandAnn Hope, Department of health and children, Health promotion UnitMichaelis LoftusCornelius F. O’Donohue, Sergeant National juvenile office community relations section

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ItalyDaniel Rossi, Osservatorio permanente sui giovani e l’alcoolBastiana Pala, Dipartimento delle prevenzione, ufficio VIM.N. Condone, Dipartimento delle prevenzione, ufficio VI

LuxembourgYolande Wagener, Direction de la Santé, Division de la médecine préventive et socialePaul Hammelmann, La Sécurité Routière ASBL

NetherlandsAndré de Wit, STIVASandra Van Ginneken, Ministry of Health, Welfare and SportWim Van Dalen, NIGZR. Bijl, ALCON

PortugalAlvarao de Carvalho, Ministerio de saudeRita de Magalhaes Collaço, Ministerio de saudeJoao Breda, Ministerio da saudePaula Dias, Alcohology Regional centre

SpainTeresa Robledo de dios, Ministerio de sanidad y consumo

SwedenGreta Stridsman, Swedish Brewer’s AssociationPeter Allebeck, Göteborg UniversityUlf Wallin, The National Temperance Council of SwedenDaniel Svensson, Swedish National Institute of Public HealthOla Arvidsson, Folk Hälso Institutet

United KingdomAnnie Britton, London School of Hygiene and Tropical MedicineRob Jex, Alcohol policy team, Dept of Health

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Table of contents

INTRODUCTION 4

AUSTRIA 5

BELGIUM 11

DENMARK 18

FINLAND 24

FRANCE 29

GERMANY 39

GREECE 44

IRELAND 48

ITALY 54

LUXEMBOURG 61

NETHERLANDS 66

PORTUGAL 73

SPAIN 79

SWEDEN 87

UNITED KINGDOM 98

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INTRODUCTION

The public health professionals of the 15 countries of the EuropeanUnion have agreed that alcohol must be considered a major publichealth priority.

The measures implemented by the various governments to fight thisproblem are very different.

Thus, this document presents information gathered by the FrenchSociety of Public Health on the many aspects of actions initiated bygovernments, non-governmental organizations, and the industrialsector.

The report represents an initial presentation, which must becompleted and up-dated. We hope that readers will provideadditional data to help make this document increasingly useful for allprofessionals involved in prevention.

For your information, we have provided a directory on our web-site ofalcohol experts and organizations in the 15 countries of the EuropeanUnion working in the field of prevention of alcohol-related problems:(http://www.sfsp-publichealth.org/europe.html).

Daniel Oberlé

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PRODUCTION

* World Drink Trends 1996 (alcoweb) OSTAT

1980 1990 1995 1975 1990 1995Spirits (liters of purealcohol) 109 000 (1989)

notavailable

307 505 284 774(1994)

Wine (hectoliters)3 086 000 2 229 000 1 664 924 2 580 861 2 646 635

Beer (hectoliters)7 606 000 9 662 000 7 710 000 9 442 989 9 727 753

Production of beer1991 1995 1996 1997

In 1,000 hl 6,933 6,928 6,713 6,623Source: Les Brasseurs Européens

Production of wine1994 1995 1996

In 1,000 hl 2,647 2,229 2,110Source: L’Office International de la Vigne et du Vin

CONSUMPTION(in liters per capita)

WorldDrink

Trends 1997 OSTAT

1975 1990 1995 1996 1975 1990 1995 1997Wine (liters) 35.10 35.00 32.00 31.50 35.10 35.00 31.90 30.00Beer (liters) 103.80 121.03 115.60 116.00 103.80 121.30 114.40 111.70Spirits (pure alcohol) 1.65 1.51 1.51 1.50 1.65 1.51 1.20Total (pure alcohol) 11.10 10.40 9.80 9.80 9.80 10.50 9.60

Consumption of beer1991 1995 1996 1997

In 1.000 hl 9,661 9,300 9,185 9,132Per capita in liters 123.9 115.6 114.0 113.1Source: Les Brasseurs Européens

AUSTRIAPopulation : 8,1 million inhabitantsGeography : 9 Federal states (Bundesländer)Currency : Austrian Schilling (AST)Gross National Product in 1997 : 22.516 ECU per capitaLife expectancy 1996 : Men 73,9 years, Women 80,2 yearsMortality in 1997980,24 deaths per 100.000 inhabitantsMen : 37.000 deathsWomen : 42.400 deaths

Source: Eurostat

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Consumption of wine1994 1995 1996

In 1,000 hl 2,483 2,640 2,640Per capita in liters 31.0 32.0 32.0Source: L’Office International de la Vigne et du Vin

By age group

We are unable to evaluate consumption by age group in the absence ofany comparative studies of total consumption. An improvedmethodology should be developed in this respect1.

Developments over the past few years: Reduced consumption, which has not beenconfirmed.

Information on consumption, as based on production, exportation,importation and sales, was much more reliable prior to Austria’sadmission to the European Union (EU). Since admission, a largequantity of alcohol has been exported and imported illegally, and is notquantifiable. Although a systematic assessment in terms of quantifyingthis phenomenon is not possible, further studies should provide theseresults. Certain national boards are collecting such data, and the EUmay encourage other countries to undertake this task as well.

Alcohol consumption appears to have increased in a linear fashionbetween 1955 and 1975 and has remained stable ever since. Therehave been some indications of a reduction over the past few years, butit is difficult to confirm the reliability of this trend.

A significant reduction in 1994 has been linked to the decrease indistilled beverages and liqueurs. Production for these types ofbeverages has declined from 1.46 liters of alcohol per person in 1993to 1.08 liters in 1994. This decline persisted in 1995, as confirmed bymanufacturers.Beer consumption has also decreased (120 liters in 1993 comparedwith 114 liters in 1994). As for wine consumption, it has decreasedonly slightly (32.7 liters in 1993 to 31.0 liters in 1994).

As for the production of distilled beverages and liqueurs, the decreaseper capita is greater than the total decrease between 1990 and 1994.There are three factors that contribute to this result:- 1994 statistics include rum (80% vol.) (16,661 hl) while figures from1990 do not include this beverage.- the population has increased from 7,729,236 in 1990 to 8,029,700 in1994- the alcohol content of liqueurs has decreased significantly sinceEuropean regulations have come into effect.

1 See the study dated 1993-1994: Uhl A, Springer A (1996) and other studies carried out by the Member States.

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RISKS OF ALCOHOL ABUSE

Deaths associated with alcohol consumption

Number ofdeaths/year

1970 1990 1995 1997

Total 2741 2473 2470 2322with:

absoluterelative

absoluterelative

absoluterelative

Car accidents 36813.43%

1265.10%

1134.57%

964.13%

Cirrhosis (ICD9 571) 2,24781.98%

2,14486.70%

2,10185.06%

1,95884.32%

Alcoholic psychosis(ICD9 291)

351.28%

50.20%

60.24%

30.13%

Alcoholism (ICD9303)

913.32%

1988.01%

25010.12%

26511.41%

OSTAT

Note: The figures in this table are not completely reliable. The codification system forregistering deaths does not allow for reporting of more than one cause of death.However, there is another source of information in addition to death certificates. Since 1990,all hospitals must report ICD9 diagnoses (both primary and secondary) to a central agency forall treated patients on an anonymous basis. These statistics are available from the NationalInstitute of Statistics, but are not perhaps as reliable as other data given that many doctors donot take the time to fill out the additional forms that this system entails. Moreover, thediagnosis has no direct impact on the funds collected by hospitals for each patient.

Alcoholic psychoses from 1990 to 1992

population alcoholicpsychoses

per 100 000 inhabitants

1990 7 729 236 2,297 29.71991 7 812 971 2,030 26.01992 7 913 812 1,789 22.61993 7 991 485 1,938 24.31994 8 029 717 1,792 22.31995 8 046 535 1,826 22.71996 8 059 385 1,803 22.4

COSTS OF ALCOHOL ABUSE

There is no data available.This type of economic analysis is complex. If accompanied by anincrease in life expectancy and with the addition of the social andmedical costs of caring for the elderly, a real reduction in alcoholconsumption will not be productive from an economic point of view ifthe financial aspect is the only factor taken into account.

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LIMITING ACCESS TO CONSUMPTION

Gewebeordnung (code governing professional activity) (art 149 à151)Jugendschutzgesetze (regional laws for the protection of youngpeople)

No license is required for alcohol production. Sales and the import andexport of alcohol are subject to the same regulations as other foodproductsAlcoholic beverages may be sold only in the following places:

- cafes and restaurants- grocery stores, butcher shops and fast food outlets (only beer)- wine producers with an on-site production authorization.

Consumer laws regulate all aspects of food products and beverages.

The legal age for consumption in public venues, including restaurants:from age 15 to 18 depending on the state.Nine federal states authorize consumption of alcoholic beveragesstarting at age 18, 8 states authorize consumption of wine and beerstarting at age 16, and in one state the legal age limit for wine and beeris 15 years (Lower Austria). The limit for being served spirit is 18 years.

Legal hours of sale: opening hours of restaurants and stores (generalcode).

There is a national law requiring all restaurants to offer at least twotypes of non-alcoholic beverages at a price at least equal to the leastexpensive alcoholic beverage. But this legislation is not sufficient, andmay be easily circumvented by restaurants who choose to offerunpopular beverages in this category.

ALCOHOL TAXATION

There are three types of taxes:- fixed percentage- fixed rate per liter of beverage- fixed rate per liter of pure alcohol

There are three types of taxes vary according to the producer andquantity produced. The most frequent are as follows (in certain cases,taxes may be lower or higher):

- small farmers that sell their products themselves must pay valueadded tax (VAT) at a rate of 10%, while the others are taxed at 20%.In restaurants and bars, a tax of 5% is levied on non-alcoholicbeverages, and 10% for alcoholic beverages.- There is no additional tax for wine and cider.

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- sparkling wines or intermediate products similar to sparkling wines:1.54 ECU per liter,- sparkling wines (less than 8,5% degrees): 0.77 ECU per liter,- intermediate products: 0.54 ECU per liter,- beer: 0.02 ECU per liter and degree. Small independent breweries(less than 50,000 hl per year) are granted tax reductions (10 to 40%).

ALCOHOL AND DRIVING

Legal Blood Alcohol Concentration (BAC) limit: 0.5 g/l of blood.Exceptions: 0.1g/l for persons who have had a driving license for lessthan two years (probationary license), as well as for bus and truckdrivers of vehicles weighing over 7.5 tons and any person under theage of 20.

Penalties: a suspended license is a common penalty when the BAClevel exceeds legal limits. Prison is not specified except in the case ofserious or fatal accidents.License on probation: BAC between 0.1 and 0.8: required classes forthe driver.Between 0,05 and 0,08: from the second offence on within 1 year,suspended license from 3 weeks on increasing with number ofoffences.Between 0.08 and 0.12: suspended license for a maximum of 4 weeks.Between 0.12 and 0.16: suspended for a minimum of 3 months withmandatory classes for the driver.Over 0.16: suspension for a minimum of 4 months, with a psychologicaland medical examination and mandatory classes for the driver.

In Austria, the automobile is an indispensable tool for certainprofessions and in certain regions where public transportation is poorlydeveloped.The country intends to maintain regulations that become increasinglysevere in gradual stages, a process considered essential inencouraging decreased consumption. Frequent tests with lightpenalties are considered more effective than occasional tests andheavy penalties.

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ADVERTISING

Advertising of alcoholic beverages is regulated by:- The law for Austrian radio and television (Rundfunkgesetz 1974)- a voluntary code that specifies a number of general provisions.

Restrictions on the advertising of beer, wine and spirits for all mediaare specified in the voluntary code.Only television and radio advertising are subject to legal restrictions.No presentation of alcohol in connection with children, youth, driving,and sports is allowed. Explicit encouragement of consumption andabuse of alcohol is also illegal.

It is difficult to impose strict regulations in Austria due to the economicinterests involved. The government prefers to take indirect action ratherthan to impose strict measures. EU intervention may have an impact inthis area for a country such as Austria where economic interestsoutweigh public health considerations.

ALCOHOL ABUSE PREVENTION MEASURES

Government policy in the fight against alcoholismAustria has adopted the 1992 WHO recommendations, whose goal is a25% reduction in consumption by the year 2000. However, very fewmeasures have been implemented to attain this objective.

No national agency has been made specifically responsible forprevention of alcoholism. Several ministries, each of which handles agiven aspect of the question, are currently active:

! Ministry of Labor, Welfare and Health! Ministry of Education and Culture! Ministry of the Interior, which plays a role in circulating

information in schools. However, its actions tend to emphasizethe fight against drug abuse.

! Ministry of Youth and the Family Generally speaking, the results of prevention policies are insufficient.

Non-governmental organizations

There is a specialized alcohol research institute located in the AntonProksch Institute in the largest hospital for treatment of alcoholism: theLudwig Boltzmann Institute for addiction,

Manufacturers

Manufacturers play no part in alcohol prevention. On the contrary, theyactively lobby in favor of advertising alcoholic beverages.

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PRODUCTION World Drink Trends 1997 * ** 1980 1992 1995 1992 1995 Spirits (liters of purealcohol)

27 000 47 000

Wine (hectoliters) - - - 1000 Beer (hectoliters) 14 291 14 259 000 14 448 000 14 448 180 Sources: * Meeting of national counterparts for the European alcohol action plan, June 1995 ** Produktschap voor Dranken in Association with NTC, Publication LTD, 1995 The decline in alcohol-free or low-alcohol beer consumption is part of a general Europeantrend. A few years ago, efforts were directed towards prevention and the fight against alcoholabuse, and these types of beers became very popular. Since that time, various governmentshave opted for a preventive approach to the problem, thought to be more effective. Priorityhas thus been given to educating the citizen and increasing awareness among drivers of theimportance of responsible consumption. Production of beer 1991 1995 1996 1997 In 1,000 hl 13,799 15,046 14,180 14,168 Source: Les Brasseurs Européens Production of wine 1994 1995 1996 In 1,000 hl 1 1 2 Source: L’Office International de la Vigne et du Vin CONSUMPTION (in liters per person) 1975 1990 1995 1996 Wine (liters) 17.80 24.90 25.0 25.0 Beer (liters) 130.50 120.70 104.0 102.0 Spirits (pure alcohol) 1.99 1.20 1.1 1.1 Total (pure alcohol) 10.10 9.90 9.1 9.0 Source: World Drink Trends 1996.

Population : 10,2 million inhabitants Geography : 3 regions Currency : Belgian franc (BLF) Gross National Product in 1997 : 20.998 ECU per capita Life expectancy : Men 73,5 years – Women 80,2 years Mortality in 1997 964,81 deaths per 100.000 inhabitants Men: 52.200 deaths Women: 52.000 deaths

Source : Eurostat

BELGIUM

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Consumption of beer 1991 1995 1996 1997 In 1.000 hl 11,113 10,513 10,284 10,243 Per capita in liter 112.0 104.0 102.0 102.0 Source: Les Brasseurs Européens Consumption of wine 1994 1995 1996 In 1,000 hl 2,029 Source: L’Office International de la Vigne et du Vin By age group Among youth Percentage of regular drinkers (weekly consumption) in young French-speaking people 11 years 13 years 15 years 17 years boys 12% 20% 30% 43% girls 6% 12% 27% 27% (WHO survey: health-related behavior of young people in school in the French Community, ULB School of PublicHealth, 1990)

Among Flemish-speaking young people, 39.3% of 15-year-old boysand 21.6% of girls drink beer at least once a week. Among young French-speaking people, 33.4% of 15-year-old boys and14.8% of girls drink beer at least once a week. (Meeting of nationalcounterparts for the European alcohol action plan, June 1995). Developments over the past few years: Beer consumption, especially for table beers and "pils", is decreasingregularly. Only consumption of special beers is slightly on theincrease. Consumption of wine and cocktail drinks remains stable, whileconsumption of strong alcohol and spirits is decreasing.


The number of alcohol-dependent persons requiring treatment isestimated to be between 250 000 and 500 000. There is no national data available on the total number of annualdeaths linked to alcohol consumption.

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1970 1980 1990 1992 1994 Cirrhosis* (a) 1,141

cases 1,172 cases

1,194 cases

Traffic accidents **

111 cases or4.1% of deathsfrom road traffic

accidents

121 cases or 3.1% ofdeaths from traffic

accidents

94 cases or 3.0%of deaths fromtraffic accidents

105cases

Alcoholism *** 213 cases (1979) 200 cases 206 cases * WHO data on chronic disorders and cirrhosis of the liver (9th revision, provided by the National Statistical Institute) ** Traffic accidents with death or injury, Annual Report, Ministry of Economic Affairs, INS 1980-1990 *** WHO data on the alcoholic dependence syndrome (9th revision, provided by the National Statistical Institute) (a) According to IHE, Mortality due to cirrhosis of the liver in Belgium, 1987, cirrhosis accounts for 36% of deathslinked to alcohol. The total number of deaths due to cirrhosis in 1988: 12.76 per 100,000 inhabitants. COSTS OF ALCOHOL ABUSE

There is no direct data on the total cost of alcohol abuse. According to extrapolations from French and American studies of theComité de Concertation sur l’Alcool et les autres Drogues de laCommunauté française de Belgique (CCAD)2, as published in theJanuary 9, 1983 issue of Agora, the social cost can be evaluated at120 billion francs, or 12,000 francs/inhabitant. According to the WHO, European Alcohol Action, European RegionalOffice, 1995, the social costs represent 1 to 3% of GNP or 84.28 to 252billion francs (GNP in 1996 was 8.428 billion Belgian francs, INS).


Law dated December 28, 1983 on distribution of spirit beveragesand license taxation. The law includes a description of the different types of consumptionsites for beverages over 22° for which a license is mandatory. A license is mandatory only for on-site consumption of alcoholicbeverages over 22°. The license is delivered by the Ministry ofFinance. Legal age for consumption in public places: 16 years (law dated July9, 1973 modifying the law dated July 15 , 1960 on moral protectionof youth. Decree for the law dated November 14, 1939 (art. 5)relative to repression of drunkenness. Law dated December 28,1983 (art. 13) on distribution of spirit beverages and licensetaxation. Law for the protection of youth Legal age limit for purchasing alcohol: 16 years (law for the

2 Superior Committee for Research and Information on Alcoholism, « The cost of Alcoholism », Documentationfrançaise, Paris 1981. Fielding JE et Russo Ph « Smoking and Alcohol Abuse: a comparison of their economic consequences » NewEngland J of Medecine 569-571, 1978

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protection of youth). There are no time restrictions on the sale of alcohol. The CCAD has developed recommendations for draft modifications tothe law dated August 20, 1919, known as the « Vandervelde law »: - institution of a high-priced license for private clubs and luxury hotelsand restaurants and refuse licenses to other categories (cafe, cafeteria,etc.). - encourage the opening of sales points for non-alcoholic beverages.

ALCOHOL TAXATION

Royal decree dated December 29, 1992 concerning theorganization and level of excise taxes on alcohol and alcoholicbeverages, modified by royal decrees dated January 21 , 1994,September 27, 1996 and October 28, 1996. - Excise taxes (in the national currency): Wine: up to 1.2% vol.: 3 F/liter; from 1.2 to 8.5% vol.: 6 F/liter; over8.5% vol.: 19 F/liter Beer: % PlatoxHl taxed between 60 BLF (1,48 ECU) and 69 BLF (1.70ECU) Sparkling wine: 65 BLF (1.60 ECU) / liter when over 8.5% vol. Spirits: 22% vol. by hectoliter of pure alcohol at 20°: 9000 BLF (222.04ECU + 58 000 BLF (1430.93 ECU) - VAT of 21% on all alcoholic beverages Other taxes: - distribution of beer and fermented beverages in a location accessibleto the public is subject to an opening tax. - alcohol and spirits distribution in a location accessible to the public issubject to an annual license tax.

ALCOHOL AND DRIVING

Federal law dated July 18, 1990 relative to road safety Decree dated November 21, 1994 in force since December 1st,1994. Blood Alcohol Concentration (BAC) levels: - legal limit 0.5 g/l - secondary limit 0.8 g/l 1996 budget allocated to the fight against drunken driving: 150,000ECU Number of vehicles currently in circulation: 4 913 000 (1996), 5 230589 (1997) (Belgian Institute for Road Safety)

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The law specifies the following: - Punishable BAC limits have decreased from 0.8 to 0.5 per thousand.The balloon has been replaced by a device that tests the driver’sbreath. - Blood samples are replaced by analysis of exhaled air - The result of the analysis is given in milligrams of alcohol per liter ofexhaled air (0.22 mg/l exhaled air = 0.5 g/l of blood) - Drunken driving is punished more severely starting at 0.8 perthousand. - Driving with a BAC between 0.5 and 0.8 results in suspension ofdriving for 3 hours and a fine.

ADVERTISING

Royal decree dated April 17, 1980 concerning advertising for foodproducts (general principles on advertising content and form) Adoption of the provisions disposition included in the EEC directivedated October 3, 1989: - Decree dated 19 July 1991 for the French Community - Decree dated June 1991 for the Flemish Community Art 27 bis paragraph 3 of the law dated February 20, 1991, FrenchCommunity of Belgium Advertising is forbidden on television for beverages containing morethan 22% alcohol. Only advertising for alcoholic beverages over 22° ontelevision is currently regulated. For other media, there are no prohibitions. The CCAD has developed recommendations in the form of a draftaudiovisual decree regulating advertising, and especially alcoholadvertising, in the French Community.

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ALCOHOL ABUSE PREVENTION MEASURES Government policy in support of the fight against alcohol

There is no official policy on the fight against alcohol. However, several communication programs have been implemented,with the cooperation of non-governmental organizations: - the Belgian institute for road safety organizes various campaigns forprevention of drinking while driving. Note the campaign « Who has thekey to the party? », developed by the Arnoldus Group, proposing that aperson who promises to remain sober will accompany those who arenot during the evening and drive them home. - National campaign in 1990-1991 implemented by CCAD (FrenchCommunity) and VAD (Flemish Community): « Drink with moderation »carried out conjointly by the Ministries of the French and the FlemishCommunities, the Federal Ministry of Communication, and INBEL(posters, ads broadcasted on RTBF, and brochures distributed in postoffices).


The CCAD is a ASBL (Association sans but lucratif, or not-for-profitassociation) that was created in 1978 to implement government policy.It includes approximately 65 member associations, and plays animportant role in coordinating preventive actions for alcoholism, fundedby the French Community of Belgium. The CCAD objective is to ensure consensus in the coordination ofprevention programs and collection of epidemiological data within theFrench community through a combination of prevention, treatment andresearch organizations. Coordination of prevention specifically coversprimary prevention programs in a context of health care promotion. Practices: development of prevention tools centered on proper use ofalcohol and training for personnel in the field. In terms of research, the CCAD carries out: - data collection regarding registration of the first treatment demandand treatment demand indicators (drugs and alcohol) - Publication of reports analyzing statistical and epidemiological data - Population surveys.

Manufacturers

! Created in 1992, the Groupe Arnoldus, named after the patron saintof Belgian breweries, is an offshoot of the CBB (confederation ofBelgian Breweries). It has two primary objectives: to promote animage of beer in relation to responsible consumption, and to preventalcohol abuse. Three topics have been emphasized over the last fiveyears: alcohol and driving, alcohol and young people, and alcohol andhealth (campaign « Who has the key to the party », publication of

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conversation guides, videotapes, and support to health research). ! The FORUM for responsible consumption of alcoholic beverages isan ASBL created in 1991 by the Federation of wines and spirits.Priority is given to young people between the ages of 15 and 18.Communication programs: a pilot teaching project seeking toencourage responsible consumption of alcoholic beverages (« TasteDevelopment and Education » developed on an experimental basis bythe « Fondation pour l’étude des maladies de civilisations » -Prof.PELC I, ULD-).

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PRODUCTION World Drink Trends 1997 * ** 1980 1995 1996 1992 1996 Spirits (liters of pure alcohol) 41 000 142 000 65 000* Wine (hectoliters) - - - Beer (hectoliters) 8 169 000 9 508 000 6400 (pure

alcohol) * Meeting of national counterparts for the European alcohol action plan, June 1995 ** source questionnaire (illegible) Production of beer 1991 1995 1996 1997 In 1,000 hl 9,672 10,058 9,591 9,181 Source: Les Brasseurs Européens CONSUMPTION World Drink Trends 1997 GODA (in liters

alcohol) of pure

1975 1990 1995 1996 1975 1990 1995 Wines (liters/person) 11.48 21.31 27.60 28.33 1.55 2.53 3.26 Beer (liters/person) (a) 117.46 126.20 120.09 117.63 5.85 5.86 5.67 Spirits (liters pure alcohol/person) 1.74 1.30 1.07 1.11 1.75 1.34 1.07 Total (liters pure alcohol/person) 9.10 9.90 10.00 10.00 9.17 9.73 10.00 (a) Low-alcohol beers or beers without alcohol are included

A qualitative summary of the trends of alcohol consumption in the 90sshows the following. The registered alcohol consumption per capitahas risen by 0,4 liters of pure alcohol from 1990 to 1997. The increaseis related to repeated decreases in taxation rates on alcohol. However,the increase does not represent a true rise in consumption, but rathera shift in the Danish market. When estimating real consumption today,undeclared consumption is believed to be only of minor importance. Source: The 1997 report on alcohol and drugs; the National Board ofHealth,1998.

Population : 5,3 million inhabitants Geography : 14 counties (amter) Currency : Danish Crown (DKK) Gross National Product in 1997 : 26.537 ECU per capita Life expectancy : Men 72,8 years – Women 78,0 years Mortality in 1997 1130,18 deaths per 100.000 inhabitants Men: 29.600 deaths Women: 30.400 deaths

Source: Eurostat

DENMARK

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Consumption of beer 1991 1995 1996 1997 In 1,000 hl 6,490 6,505 6,363 6,165 Per capita in liters 125.9 124.4 120.9 116.7 Source: The Brewers of Europe for Consumption of wine 1994 1995 1996 In 1,000 hl 1,142 1,326 1,414 Per capita in liters 22.11 25.24 2.80 Source: L’Office International de la Vigne et du Vin

By age group There is very little data on consumption by age group. "When compared to the rest of Europe, Denmark is among thosecountries where early use of beer, wine or spirits is the most common.Denmark too, is among those countries with the highest prevalence ofdrinking among adolescents. The prevalence of alcohol consumptionamong 15-16 year olds in Denmark is 96%. The proportion of thosestudents who have consumed alcohol more than 40 times is 46%(most common among boys). The proportion that reports drinking 10times or more within the last 30 days is 15%. 80% of the studentsreported having been drunk at least once in their lifetime, and 45%reported have been drunk 10 times or more. 24% of the studentsreported being drunk 3 times or more within the last 30 days. Theinitial age for being drunk and the age that the first glass of alcoholwas consumed appears to have remained stable in Denmark from1990 to 1995. Source: The European School Survey Project on Alcohol and Drugs -the 1995 ESPAS Report." Young people Boys 15 to 17 years old:

! 25% consume less than one unit per week! 33% consume between 1 and 6 units per week! 16% consume between 7 and 13 units per week! 6% consume between 14 and 21 units per week! 20% consume over 21 units per week

Girls 15 to 17 years old:

! 33% consume less than one unit per week! 39% consume between 1 and 6 units per week! 13% consume between 7 and 13 units per week! 16% consume between 14 and 21 units per week! 4% consume over 21 units per week

« Among the 15-16 year old students 17%, drink hazardously,breaking down to 22% boys and 13% girls. A hazardous use of alcoholis defined as either consumption of more than 252 grams of pure

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alcohol per week, having been drunk six times or more within the lastmonth, or having consumed 60 grams or more in a row 5 times ormore within the last month ». The national 9th grade survey on alcohol and drugs; the University ofAarhus 1996 (survey data from 1995).


Deaths linked to alcohol consumption Source 1970 1990 1995 Total (number ofdeaths)

818 1256 1377

Deaths per year no data Available Cirrhosis 57% of

alcohol-relateddeaths

57% ofalcohol-relateddeaths


Traffic accidents 24% ofalcohol-related

deaths



The diagnostic system being use is ICD10 – since 1994. Source: The Danish Statistical Information, and The National Board of Health: cause of deathsregister COSTS OF ALCOHOL ABUSE

"In 1997, the Ministry of Health published a report on the cost ofalcohol abuse in 1994 (1994 fixed prices) for Denmark. Depending onthe method used in the calculations, the costs estimated in 1994 varyfrom 9,793,000.000 DKK (1,308,593,000 ECU) to 12,700,000,000DKK (1,697,042,000 ECU). Using the most conservative estimation (9.7 billion DKK – 1.3 billionECU), the cost distribution is as follows: health treatment costs: 8billion DKK or 1.07 billion ECU (29.1% of the total costs); cost ofalcohol-related road accidents: 1.3 billion DKK or 0.17 billion ECU(13.3% of the total costs); social costs due to abuse: 1.2 billion DKK or0.16 billion ECU (12.5% of the total cost); crime costs related to police,justice and ward enforcement: 3.6 billion DKK or 0.48 billion ECU(37.2% of the total costs); cost of loss of production: 0.7 billion DKK or0.09 billion ECU (7.3% of total costs); and cost of preventivemeasures: 0.06 billion DKK or 0.01 billion ECU (0.7% of total costs). Source: The cost to society of alcohol abuse, Ministry of Health,1997

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LIMITING ACCESS TO CONSUMPTION "Act number 256 regarding hotels and restaurants, May 6, 1993 Act number 97 regarding legal age to purchase alcohol, July 1, 1998. Act number 236 regarding opening hours in shops, June 1, 1995 According to the Act regarding hotels and restaurants, the license toserve alcohol in bars, restaurants and hotels is delivered by localauthorities. Alcohol (above 2.8% volume alcohol) must not be servedto adolescents below 18 years of age. According to the Act on thelegal age to purchase alcohol, alcohol must not be sold to (above 1.2%volume alcohol) children under 15 years of age. According to the Act regarding opening hours for shops, alcohol(above 2.8% volume alcohol) may be purchased from 6:00 to 20:00 onweekdays - and between 6:00 and 17:00 on Saturdays. No speciallicense is required to sell alcohol from shops. Shops in areas withholiday resorts can be given an exemption from the legal openinghours by local authorities to sell alcohol during weekends andholidays."

ALCOHOL TAXATION

Law n° 857 dated September 24, 1996 Laws voted in 1997 Taxation rates on beer, wine and spirits vary; the figures given belowrepresent an average rate: - Wine: approximately 20% - Beer (4-6% alcohol): approximately 18% - Spirits (over 35% alcohol): approximately 60% (Meeting of national counterparts for the European alcohol action plan,June 1995). Beverage under 2.8% alcohol: 0 DKK. Beer (varies with percentage): 4.8%: 2.59 DKK (0.35 ECU) per liter. Wine below 6% 4.36 DKK (0.58 ECU) per liter Wine between 6% and 15% 6.8 DKK (0.91 ECU) per liter Wine between 15% and 22%: 10.20 DKK (1.36 ECU) per liter Spirits above 22%: 275 DKK (39.42 ECU) per liter of pure alcohol.

22

ALCOHOL AND DRIVING

"Act number 468 on changing Traffic Act (BAC limits), July 10, 1997 (enforced March 1, 1998). The legal BAC limit is 0.5. the secondary limit is 0.8 and the tertiarylimit is 1.2. Depending on the severity of the offense, a BAC between0.5-0.8 will be fined. A BAC between 0.8-1.2 will also be fined, and fora second offense the driving license will be suspended. For a BACabove 1.2 , the driving license will be suspended in addition to a fine,with possible imprisonment. Undergoing treatment can to some extentreduce the penalty. The budget for information (national campaigns to fight drunk driving)in 1996 was 2,500,000 DKK (Approx. 334,063 ECU) Source: theCouncil of Traffic Safety"

ADVERTISING

"Legislation: Act number 489: Order on advertisement and sponsoringon radio and television, June 11, 1996. Order on restrictions foralcohol advertisement, the Forbruger-Ombudsmanden in a voluntaryagreement, July 27, 1990. According to the Act, advertising is forbidden on television and on theradio. The most important restrictions according to the order on thecode of practice for advertisement are: advertising must not targetyouth or adolescents, advertising must not take place by or in theneighborhood of public facilities, advertisement must not use idols orpeople below the age of 30, advertisement must not (with someexceptions) take place in conjunction with sports events,advertisement must not suggest that alcohol contributes to positiveeffects on health and success."

ALCOHOL ABUSE PREVENTION MEASURES Governmental policy in the fight against alcoholism

The abuse of alcohol is considered to have a serious impact on thehealth of the nation. Alcoholism, abuse and hazardous use of alcoholare among of the reasons that the Danish average life-span no longerrepresents a standard in the European community. Although taxation rates on alcohol have been lowered to the Europeanlevel, especially in 1991 and 1992, generally speaking it can be saidthat the fight against alcohol-related harm has been reinforced duringthe 1990s. Allocation of resources at a national level has been

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increased, primarily due to the Act on the fight against alcohol abusedated February 1, 1994. An annual total budget of approximately4,000,000 DKK (534,501 ECU) is spent to support research on analcohol program, health education, local projects, non-governmentalinitiatives, and national campaigns. Several of these initiatives arecarried out under the auspices of the National Board of Health, whichis also responsible for documenting abuse of alcohol and related harmand for advising authorities on prevention and harm reduction.Furthermore, local authorities, municipalities, and counties have beenobliged to pay greater heed to preventing abuse through requirementsto set targets for resource allocation in support of treatment andprevention measures as well as to increase efforts to secure a healthyenvironment for children.


The "non-governmental organizations" section is no longer relevant.The Danish Council of Alcohol completed its work in 1990, and itsresponsibilities have since been assumed by the National Board ofHealth.

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PRODUCTION STAKES 1980 1992 1995 1996 Spirits(liters of pure alcohol) 171 000 144 000 164 000 170 000 Wine* (hectoliters) 167 000 199 000 514 000 523 000 Beer hectoliters) 2 838 000 4 655 000 4 702 000 4 784 000 STAKES: National Research and Development. Center for Welfare and Health. Helsinki * includes fortified wine (107 200 hl) Production of beer 1991 1995 1996 1997 In 1,000hl 4,408 4,726 4,669 4,797 Source: Les Brasseurs Européens CONSUMPTION Alcohol Statistical Yearbooks

1975 1990 1995 1997 Wine* (liters/person) 5.13 6.49 11.53 13.01 Beer (liters/person) 54.40 83.49 82.70 83.90 Spirits** (liters purealcohol/person)

3.01 3.00 1.95 2.07

Total (liters purealcohol/person)***

6.30 7.70 6.80 7.00

* includes fortified wine ** includes ready-mixed cocktails (“long drinks”) of alcohol content around 5% *** Cider included in the total since 1995

Population in 1996: 5,1 million inhabitants Geography: 12 departments (Lääni) Currency: Finnish markka (FIM) Gross National Product in 1997: 20.368 ECU per capita Life expectancy: Men 73,0 years – Women 80,5 years Mortality in 1997 962,74 deaths per 100.000 inhabitants Men: 23.900 deaths Women: 25.200 deaths

Source: Eurostat

FINLAND

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Consumption of beer 1991 1995 1996 1997 In 1,000 hl 4,276 4,153 4,074 4,170 Per capita in liters 60.0 64.7 59.1 61.7 Source: Les Brasseurs Européens Consumption of wine 1994 1995 1996 In 1,000 hl 281 282 267 Per capita in liters 4.88 5.551 5.19 Source: L’Office International de la Vigne et du Vin

Developments over the past few years: In Finland, undeclared consumption (tourism, imports, etc.) hasincreased significantly during the 90s, and today amounts to 24-30% oftotal consumption compared with 10% for the preceding decade. If wetake this fact into account, current total consumption is between 8 and9 liters, equal to consumption in 1990. Consumption typology has changed since 1975, with beer as themajority beverage. 1996 data show beer at 52.7%, spirits at 26.4%,and wine at 20.9%. Source: Intoxicant Statistical Yearbook 1997,STAKES

RISKS OF ALCOHOL ABUSE Deaths linked to alcohol consumption: 1990 1993 Main cause of death alcoholrelated illness

1,417 1,372

Accidental and violent deathunder the influence of alcohol

1,036 1,059

Other violent deaths causedby perpetrators under theinfluence of alcohol

47 45

Total 2,500 2,476

1990: 2,500 deaths. 1995: 2,541 deaths. Mortality related to alcohol poisoning is higher in Finland than in otherNordic countries. This is due to a culturally-linked excessiveconsumption of alcohol (Nordics Alcohol Statistics, table 8, Deaths fromalcohol-related illnesses in 1991-1995). The number of persons hospitalized for a disorder linked to alcohol isestimated at 15 000, with between 60 000 and 80 000 personsundergoing detoxification cures. The number of excessive consumers of alcohol is estimated at250 000.

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COSTS OF ALCOHOL ABUSE Type of expense Amount

(million FIM) 1995 Amount

(million ECU) %

DIRECT COST 2740-3490 466-593 with: treatment 550-720 94-122 20% Morbidity / subsidies,pensions

220-450 37-77 10%

Accidents (traffic, crimes,other)

550-590 94-100 less than 20%

Social cost 150-210 26-36 less than 10% Criminal police, police, etc. 1180-1420 201-241 over 30% Research, prevention, control 90-100 15-17 less than 10% INDIRECT COST* Mortality

13 800-25 000

2347-4251

Source: Päihteiden kävton haittakustannukset vuosina 1994-1195. Ritva hein & Jukka Salonaa. Tilastoraporti4/1998 According to STAKES (1998), the total cost of alcohol abuse is 22 500 million FIM (3826 ECU) (mean of minimumand maximum estimations) * The value of life lost as a result of premature death and the value of work contributions lost. ALCOHOL TAXATION

VAT of 22% for all alcoholic beverages. Wine tax: table wine 14.0 FIM (2.38 ECU) per liter, fortified wine 42.0FIM (7.14 ECU) per liter Beer (4-6%): 1.7 FIM (0.29 ECU) per cl/pure alcohol Spirits (over 35%): 3.0 FIM (0.51 ECU) per cl/pure alcohol Source: Alcohol tax act (1471/1994) (1062/1997)

ALCOHOL AND DRIVING

The legal BAC limit: 0.5 g/l of blood (secondary limit is 1.2 g/l). Penalties for drunken driving are severe. The law specifies possible suspension of license and imprisonment. There are no specific budgets to fund the fight against drunken driving. Number of vehicles in the country: 2 300 000. Note: Breath tests are frequent: 1 550 000 in 1993.

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ADVERTISING The Alcohol Act 1143/1994 (section 3) dated December 8, 1994 Advertising for spirits (beverages containing over 22% alcohol) isforbidden for all media. Advertising for beverages containing less than 1.2% alcohol isauthorized for all media. Advertising for wine and beer is subject to restrictions Targeting young people or sports is forbidden. Sale of alcohol The Alcohol Act 1143 4/1994 dated December 8, 1994 Licensing: - sale of spirits: state monopoly - sale of wine and beer: state monopoly for beverages containing over4.7% alcohol. License mandatory for others. - for alcoholic beverages under 2.8%: no license required. Legal age for consumption in public places, according to the law: legalage for possession is the same as for purchasing (18 or 20 years) Legal age for purchasing alcohol: 20 years for beverages containingover 22% alcohol and 18 years under that amount. Legal hours of sale: - state monopoly from 9:00 to 20:00 or from 9:00 to 18:00. - licensed establishments: 7:00 to 21:00. Finland has been under considerable pressure from the EU to open itsretail sales system, but in the so-called Franzen Case (189/99) thecourt of justice stated that the Nordic retail system for alcoholicbeverages is in accordance with Community law. Note that Finland abolished state monopolies on importation,production and exportation of wines and spirits prior to its admission tothe European Community, but has maintained this system for retailsales.

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ALCOHOL ABUSE PREVENTION MEASURES Governmental policy in the fight against alcoholism

Prevention policies for alcohol abuse are the responsibility of theDepartment of Health and Social Welfare reporting to the Section ofPreventive Health and Social Policy. There is no policy common to both alcohol and other drugs, and lawsconcerning alcohol are distinct from those applicable to tobacco. General policy is prevention-oriented, and thus is based on regulationof total consumption. Actions include: • Administration of prevention programs.• Communication actions, research, treatment, screening and

rehabilitation are ongoing.• Changes in national legislation on alcohol to increase compliance

with EU recommendations.• One of the difficulties in implementing legislation is continued

pressure from producers and trade in favor of liberalizing controlpolicies.


Raittiusjärjestöjen ry was dissolved in 1997. The new organizationcarrying on its work is called the Finnish Center for Health Promotion.It is the focal point of health promotion in Finland. Through its nearly100 member organizations, it offers extensive links to research,campaigns and programs, both nationally and internationally. As acenter for non-governmental health organizations, it plays a dynamicrole in networking and initiating cooperation through sharing ofknowledge.

Manufacturers

The Alko Group and the Finnish Brewery Association sponsorcommunication programs.In addition, they exert pressure on a regulatory level to encouragemodifications in tax laws applicable to alcoholic beverages.

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PRODUCTION

World Drink Trends, 1997 French Spirits FederationYear 1980 1992 1995 1995 *** (pure alcohol equivalent)Spirits (liters of purealcohol)

2 880 000 ** 1 443 000 (sales) 1 239 000

Wine (in hectoliters) 69 598 000 65 401 000 55 610 000 4 030 000Beer (hectoliters) 21 648 000 21 297 000 20 634 000 1 170 000** Meeting of national counterparts for the European alcohol action plan, June 1995





CONSUMPTION

There are no direct statistics available on consumption. There isconsiderable variation depending on social and economic categories.

The IDA group has analyzed alcohol consumption in France usingtaxation data from the national market as well as a comparison withProduktschap data.

Population : 58,3 million inhabitantsGeography : 26 regionsCurrency : French franc (FRF)Gross National Product in 1997 : 20.869 ECU per capitaLife expectancy : Men 74,0 years – Women 81,9 yearsMortality in 1997915,95 deaths per 100.000 inhabitantsMen: 277.800 deathsWomen: 256.200 deaths

Source: Eurostat

FRANCE

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Wine Cider Otherproducts

Spirits Beer Total of litersof purealcohol

LAP % LAP % LAP % LAP % LAP %1970 11.75 75.1 0.30 1.9 0.22 1.4 1.64 10.5 1.73 11.1 15.671980 10.46 69.3 0.25 1.7 0.27 1.8 2.05 13.6 2.07 13.7 15.111990 8.09 63.7 0.20 1.6 0.23 1.8 2.17 17.0 2.02 15.9 12.711994 7.33 61.8 0.20 1.7 0.24 2.0 2.12 17.9 1.97 16.6 11.86

LAP: Liter of pure alcohol

General population

consumption inliters/year/inhabitant

1975 1990 1995 1996

Wine 103.70 72.70 63.5 60.0Beer (a) 44.90 41.5 39.10 39.60Spirits (pure alcohol) 2.42 2.49 2.52 2.43

(est)Total (pure alcohol) 16.10 12.6 11.50 11.10World Drink Trends, 1997(a) low-alcohol and non-alcoholic beers included

If we compare these consumption figures to the adult population,alcohol consumption in 1994 was at 15 liters of pure alcohol per adult.


In 1,000hl 22,880 2,690 23,133 21,655Per capita in liters 40.5 39.1 39.6 37.0Source: Les Brasseurs Européens


In 1,000 hl 36,663 36,515 34,795Per capita in liters 63.0 63.0 60.0Source: L’Office International de la Vigne et du Vin

By age group

Number of glasses of alcohol(average over the last 7 days)

Men Women18-24 years 10.0 3.225-34 years 10.6 4.135-44 years 12.7 5.345-54 years 17.1 6.155-64 years 13.6 5.765-75 years 15.0 4.9Source: “Baromètre santé 98/94, CFES

Among young people

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no consumption rare/occasionalconsumption

regularconsumption

12-13 years 61% 39% 014-15 years 36% 58% 6%16-17 years 22% 72% 6%18 years 17% 74% 9%Source: Survey CFES 1995

During 1994 - 1995, a distinct rise in consumption was noted amongyoung people. In 1995, 65% of young people between 12-18 years old(70% boys and 59% girls) consumed alcohol, compared with 47% in1994. We noted a considerable increase in consumption of beverageswith a high alcohol content for all age groups. In young peoplebetween 12 and 13 years old, 1 out of 5 admitted to occasionaldrinking. Among 17-year-olds, the percentage is 68%.The number of drunken episodes is also increasing significantly.Today, two-thirds of 12-25 years olds claim they have never beendrunk, compared with three-quarters in 1994. These drunken episodesare characterized by large amounts of beverages consumed,constantly increasing with age.

Estimation of drunken episodes over the three last months accordingage and sex.

1995 Total Sex AgeConsumer 12-18

yearsBoys Girls 12-13

years14-15years

16-17years

18 years

1 to 2 episodes 18 22 12 2 14 19 233 to 5 episodes 2 3 2 - 2 5 26 episodes and more 2 3 - - 1 2 5Had never beendrunk

78 72 86 98 83 70 70

Average 0.5 0.8 0.2 0.0 0.3 0.7 0.9Source: CFES, “La Santé de l’Homme” N° 320: p 19-20

Developments over the past few years:Consumption has decreased by 25% between 1970 and 1990. Wineconsumption, a traditional part of the culture, still predominates, whilebeer remains stable and consumption of spirits is slightly on theincrease.Generally speaking, the percentage of regular drinkers has decreasedcontinually since 1981, while the proportion of occasional drinkerscontinues to increase. The proportion of non-consumers appears tohave stabilized following a period of decrease.Over the last twenty years, alcohol consumption has beencharacterized by a definite decrease in wine consumption (especiallyordinary wines), stability in consumption of spirits, and a decrease inbeer consumption. In 1995, INRA researchers investigated thestabilization, and possibly slight increase, in wine consumption.

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Annual mortality linked to alcohol (directly and indirectly): 30 000

Deaths related to alcohol consumption in 1993

number ofINSERM cases

1993 data

% of deaths linked to

alcoholism ineach category

« L’alcool àchiffre ouvert »,

1997

Total linked to alcohol 24 189 (a) 100% 1991 1995withAlcoholism andalcoholic psychosis

2614 8% 5.6 deaths per100 000

inhabitantsCirrhosis 8788Cancers 787Unspecified 8%- road trafficaccidents (all types)- deaths alcoholrelated

- 8392

- around 2800

9% 15.67deaths per100,000

inhabitantsOther accidents 7%Suicides 8.5%Tuberculosis 1%(a) Total deaths 525 000 per year.

The number of deaths linked to alcohol intoxication is 4.6% of the totalnumber of deaths (figures from 1993).Frequency of pathologies linked to chronic alcohol intoxication: 52 per100 000 inhabitants (details in the table on Europe).

Over one-third of deaths from road traffic accidents (that is, 4,500),one-quarter of suicides and half of all homicides may be directly linkedto alcohol. (INSERM, 1993)According to the Road Safety department, in 1994, illegal BAC limitswere mentioned in 37% of fatal traffic accident reports.The number of alcohol-dependent persons is estimated atapproximately 2 million.There is no epidemiological survey on fetal alcohol syndrome. InFrance, the incidence of fetal alcohol syndrome has been estimated atas 3 cases per 1,000 to 1 per 10,000 viable newborns in 1991according to region, the type of calculation and the stage of thedisease. (“ Alcool et Communication ” CFES, 1997)

Cause/number ofdeaths

1980 1990 1994

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Traffic accidents 3 200VASD cancers 15 171 13 573 12 215alcoholism, alcoholicpsychosis, cirrhosis ofthe liver

18 301 12 462 11 184

(Inserm 1993 and INSEE 1996)

In 15 years, premature deaths related to chronic alcohol intoxicationhave decreased by 40%, essentially due to a decrease in mortality fromcirrhosis.There are significant regional variations for deaths linked to alcohol.


Type of expense AmountTOTAL 100 and 200 billion FRF

15.12 ECU and 30.25 ECUWithTreatment 6.3 billion FRF

0.95 ECU

Certain elements are difficult to evaluate quantitatively and are notincluded in these figures. In certain cases, such as for road trafficaccidents, other factors apart from alcohol may also contribute (speed,drugs, medicines, and so forth). Difficulties in assessing these factorsexplain considerable variations in the figures proposed for the cost ofalcoholism in France, which range from 100 to 200 billion FRF (15.12and 30.25 billion ECU in expenditures.


Beverage distribution code and the law dated July 13, 1992,(number 92-652) on alcohol and sports events.

Licensing: there are 4 different types of licenses depending on the typeof beverage:- first-category license for the sale of beverages in the first group: non-alcoholic beverages and those with an alcohol level under 1.2%.- second-category license for sale of beverages in the second group:fermented, non-distilled beverages (wine, beer, cider, perry), naturalsweet wines under the fiscal system for wines, black-currentconcentrate, and fermented fruit or vegetable juice containing 1.2 to 3%alcohol.- third-category license for the sale of beverages in the third group:natural sweet wines other than those in group 2, liqueur wines, wine-based cocktail drinks, and strawberry, raspberry, black current or

34

cherry liqueurs that titer under 18 degrees pure alcohol.- fourth-category license for the sale of beverages in the fourth and fifthgroups: all other alcoholic beverages.

Legal age limit for consumption in public places: 16 years (18 years foralcohol in the 3rd and 4th groups)Legal age limit to purchase alcohol: 16 years.Legal hours of sale:- in gas stations, it is forbidden to sell alcohol between 22:00 and 6:00.- no sale of alcoholic beverages in automatic distribution machines- limited consumption in facilities for physical and sports activities (art49-1-2).- no sale of alcohol in sports events (law dated July 13, 1992) (someexceptions are provided for in the texts)

Note: a maximum alcohol rate exists for each type of beverage: cocktailwines 18%, soda 0% and spirits 45%.

ALCOHOL TAXATION

General Taxation CodeBeverage Distribution Code

In addition to direct taxes of 20.6% (VAT) on alcoholic beverages, (non-alcoholic beverages at 5.5%), there are three types of indirect taxation(brought together under the term excise tax on a European level):- Transport taxes on wines and fermented beverages (except for beer)- Consumption taxes on spirits and intermediate products- Taxes specific to beerSince April 1, 1983: contribution via tax sticker at 1 franc per deciliter orfraction of a deciliter on beverages with an alcohol concentration ofover 25%. Directly paid to the social security department.(http://www.alcoweb.com)

Wine: 0.22 FRF (0.03 ECU) per liter, depending on the amount sold.Beer: 18.50 FRF (2.80 ECU) per liter of pure alcohol, depending on thedegree of alcohol.Cider: 0.076 FRF (0.01 ECU) per liter, depending on the amount sold.Spirits: 95.10 FRF (14.38 ECU) per liter of pure alcohol, depending onthe degree of alcohol.(French Federation of Spirits)

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ALCOHOL AND DRIVING

Driving code (Public Health Code law dated April 15, 1954)Law dated July 12, 1978: application of random breath or blood tests.

Law dated December 8, 1983: legal alcohol level in exhaled air at 0.40mg/l (0.8 g/l of blood). Exceeding this limit is considered amisdemeanor.Modified in 1995: reinstatement of a double threshold at 0.5 g/l and 0.8g/l.Law dated July 10, 1987: increased penalties with possible confiscationof vehicle for repeated offenses.BAC limit: 0.5g/l (or 0.25 mg/l in exhaled air)

Specified penalties:Between 0.5 and 0.8g/l: fine. 5000 FRF (756.13 ECU) maximum andloss of 3 points.0.8g/l or more: misdemeanor. Fine of 30,000 FRF (4536.79 ECU)maximum and imprisonment for 2 years maximum. Loss of 6 points.Suspension of driving license.

ADVERTISING

Beverage distribution code modified by law number 91-32 relativeto the law against smoking and alcoholism known as Evin’s Lawdated January 10, 1991 (art. 17 to 21), in effect since January 1,1993.

All direct or indirect advertising for alcoholic beverages is forbidden fortelevision, films, facilities for sports events, local associations for youngpeople or ongoing education centers.Sponsoring of sports events by alcohol is forbidden.Radio: advertising is allowed at certain times of the day.

Message limited to a simple description of beverages

No message inciting young people to consume alcohol is allowed.All advertising must include a health-related message (“alcohol abusemay have harmful effects on your health”).

ACTIONS ALCOHOL ABUSE OF PREVENTION

Governmental policy on alcohol

In December 1995, France adopted the principles andrecommendations of the WHO Alcohol Action Plan (1992).The Haut Comité de la Santé Publique -HCSP- (High Committee forPublic Health) has been assigned three priority objectives:

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- a decrease of 20% in average alcohol consumption per capita.- reduction of damaging alcoholic behavior with health and socialconsequences.- reduction of regional variations such that all regions achieve thelevel of regions with the lowest levels of consumption.

The Caisse nationale d’assurance maladie -CNAM- (National HealthInsurance Fund) is the institution that provides social and medicalcoverage. The CNAM finances health expenses, including costs relatedto treatment of problems linked to alcoholism. The National HealthPrevention, Education and Information Fund, created in 1988, reportsto the CNAM. With a budget of approximately 1 billion francs, the fundis dedicated to prevention of high-risk behavior in general. Its financingprogram, which must be approved by the government, stronglyemphasizes traditional methods of medical prevention programs(vaccination, cancer screening, etc.). The regional health insurancefunds are among the organizations that benefit from these funds.

The Comité français d’éducation pour la santé –CFES- (French HealthEducation Committee) is a national organization under the aegis of theMinistry of Health created by the Secretary of State to develop andimplement communication and education programs within theframework of health promotion policies. With nation-wideresponsibilities, the organization is developing a methodology tocoordinate nation-wide actions and more specific actions in the field.Partners: Ministries of Health, National Education, Youth and Sports,and the main organizations, associations and foundations dedicated topromoting health, including, for alcohol, Centers for Nutritional Hygieneand Alcohol Problems and Committees for the Prevention ofAlcoholism (see below).

National information campaigns:1984-1986: a message on moderate consumption, “Un verre ça va,trois verres, bonjour les dégats” (One glass is OK, but three is toomuch!) and “Un second verre pour l’eau (A second glass for water).1991-1995: campaign for young people. Derogatory message: “Tut’es vu quand tu as bu?” (How do you look when you’re drunk?)1997 -2000: "Et vous avec l’alcool, vous en êtes où?” (And where areyou with alcohol? )

Locations for actions: school, companies, health care facilities and allother public venues.Targets: young people, the family, the elderly, companies.

Partners:- Departmental Committees for Alcohol Prevention: information andprevention on the dangers of alcohol abuse for the entire population.Main targets: schools, centers for ongoing education, the professionalmilieu and military bases. Financed by the government.- Centers for Nutritional Hygiene and Alcohol Problems: anonymousand free assistance to problem drinkers. Treatment and support.- Various associations (see below).

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Non-governmental organizationsAssociations of former drinkers (Alcoholics Anonymous, Vie Libre, Joieet Santé, Croix Bleue, Croix d’Or, and so forth.)The Association Nationale de Prévention de l’Alcoolisme -ANPA-(National Association for the Prevention of Alcoholism) is a privateassociation founded in 1872 and currently recognized as a publicinterest organization.The association’s objective is to prevent risks encountered by anyindividual or group following consumption of alcoholic beverages. In aglobal perspective and in approaching the general population, theANPA seeks to limit production, accessibility and consumption ofalcohol.In addition to these century-old activities, the ANPA, which in the pasthas concentrated its efforts in primary prevention, has decided tobroaden its focus to include training and health care activities(management of half of the specialized consultations available inCenters for Nutritional Hygiene and Alcohol Problems, or CHAAs).The ANPA has branches located throughout France, includingdepartmental committees, a documentation center, an audiovisualservice, and a review (« Alcool and Santé »).

The Société Française d’Alcoologie or SFA (French Society ofAlcohology) takes part in information and training activities. It is a forumfor exchanges where the results of research and practical experienceswith alcohol use and abuse concerning prevention, therapy, andevaluation can be expressed. It participates in public health exchangeswith other national organizations in the field of alcohol research andprevention and with the other associations interested in various typesof substance abuse, such as tobacco addiction, use of illegalsubstances and abuse of psychoactive drugs.

Preventive action by beverage producers

Educ'Alcool France: created in 1994 following the example ofEduc'Alcool Quebec, this organization includes partners from thealcoholic beverages industry, governmental organizations and otherindividual members. It encourages actions in the educational milieuthrough programs designed for use by teachers. Its slogan: "Lamodération a bien meilleur goût” (Moderation tastes much better).

The Institut de Recherche sur les Boissons –IREB- (ResearchOrganization on Beverages): an excellent source of documentationand information on alcohol for scientific and medical professionals,governmental agencies and the media.

Entreprise & Prevention: created in 1990, this association includes 17companies with over half of their total turnover arising from sale ofbeer, wine and spirit.Its roles:- to contribute forcefully to proposals for prevention in a governmentalcontext• Field actions to increase awareness and provide information.• Implementation of the "Thirst for life" program.

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PRODUCTION World Drink Trends 1997 1980 * 1992 1995 Spirits (liters of pure alcohol)

1 829 000(1996)

Wine (hectoliters) 9 718 000 13 375 000 10 406 000 Beer (hectoliters) 115 975 120 158 000 117 403 000only FRG

Production of beer 1991 1995 1996 1997 In 1,000 hl 118,031 116,900 114,200 114,800 Source: Les Brasseurs Européens Production of wine 1994 1995 1996 In 1,000 hl 1018 11,050 8,300 Source: L’Office International de la Vigne et du Vin CONSUMPTION World Drink Trends 1997* Federal Office

of Statistics * 1975 1990 1995 1996 1995 Wine (liters/person) 23.20 26.10 22.2 22.8 Beer (liters/person) (a) 147.80 143.10 137.7 134.5 Spirits (liters pure alcohol /person) 3.04 2.23 2.2 2.1 Total (liters pure alcohol /person) 11.30 10.60 9.9 9.8 11.2 *Prior to 1991, only consumption in the FRG was taken into account (a) low-alcohol and non-alcoholic beers included * Figures given by Germany are calculated using different alcohol levels (beer 4%, wine 12%) from those used bythe World Drinks Trends report.

Generally speaking, there has been a slight reduction in the per capitaalcohol consumption in the last years –starting from a high level - dueto a trend to drink less spirits and beer. This trend is stronger in theyounger age groups, as confirmed by the last drug affinity study dated1997/1998 by the Federal Center for Health Education.

Population in 1996: 82 million inhabitants Geography : 16 federal states (Länder) Currency : mark (DEM) Gross National Product in 1997: 22.585 ECU per capita Life expectancy : Men 73,3 years – Women 79,8 years Mortality in 1997 1049,26 deaths per 100.000 inhabitants Men: 398.100 deaths Women: 462.300 deaths

Source: Eurostat

GERMANY

39

There is a significant difference between formerly West and EastGermany. In the former, 15% of the population consumes on a dailybasis, as opposed to 30% in the latter. 15.1% and 20.5% of menbetween the ages of 18 and 59 respectively consume over 40 g of purealcohol per day (European Forum on Alcohol and Smoking, December11-13, 1997, CFES )

Consumption of beer 1991 1995 1996 1997 In 1,000 hl 113,871 112,400 107,800 107,533 Per capita in liter 135.9 131.7 131.1 Source: Les Brasseurs Européens Consumption of wine 1994 1995 1996 In 1,000 hl 18,196 18,006 18,660 Source: L’Office International de la Vigne et du Vin

By age group

The Federal Center of Health Education has conducted arepresentative survey on risky health behavior (smoking, alcoholconsumption …) dated 1995/96. The study focused on the 14-25, 26-45, 46-60, and 61-95 age groups. The results show only a slight relation between age group and alcoholconsumption. As expected, only the younger age groups show a lowerdegree of alcohol consumption (47% of the respondents under 20years drink either very little or never). The smaller degree of alcohol consumption in the older age group isdue the fact that women (who drink less than men) are over-represented in this age group.

In young people

The number of young people between the ages of 14 and 25 thatconsume alcohol at least once a week has decreased significantly overthe last twenty years. This decrease has been observed since 1976. Developments over the past few years: Some minor changes have been observed over the past few years. Inspite of decreases in consumption, beer consumption stillpredominates.

40


Alcoholism is the most widespread chronic disorder in Germany: thenumber of excessive consumers of alcohol is estimated at 6.5 million,with 2.5 million alcohol-dependent individuals. Here too there are significant differences between the West and theEast. The German Association against Dangers of Addiction estimates40.000 deaths per year linked to alcohol abuse. Breakdown of death by type of pathology: no data.


The cost of alcohol consumption is estimated by the GermanAssociation against Dangers of Addiction at 40 billion DM per year. According to the German Association against Dangers of Addiction,costs to the German economy arising from alcohol abuse are between30 and 80 billion per year.


No license is required for the sale of alcoholic beverages. Law on protection of youth in public places (art. 4) Legal age limit for consumption in public places: age 16 for beer andwine and age 18 for spirits. Legal age limit to purchase alcohol: age 16 for beer and wine and age18 for spirits. Legal hours of sale: no legal restrictions Source: Meeting of national counterparts for the European alcoholaction plan, June 1995 There is no maximum limit on the amount of alcohol authorized.

ALCOHOL TAXATION

15% VAT. Wine: no additional taxes Beer:4-6% (The average beer tax in Germany is 8,57 ECU per hl) Spirits: more than 35% (Meeting of national counterparts for theEuropean alcohol action plan, June 1995).

ALCOHOL AND DRIVING

41

Legal BAC limit: 0.8g/l (criminal offence) 0.5 g/l (infringement of rule) Note: alcohol breath tests are frequent.

ADVERTISING

Advertisement is governed by series of regulatory provisions andprofessional ethics enforced on a voluntary basis, but is not forbiddenin any way. Law dated May 27, 1994 (art 2) ratifying the European CouncilConvention of May 5, 1989 and the community directive on October 3,1989, both broadcast on trans-national television. Rules laid down by the German Advertising Standards Authority. The amount of money spent for alcohol advertisement (cinema andprint media) is estimated by German Association against Dangers ofAddiction at 1.2 billion DEM (0,61 ECU) per year.

ACTIONS ALCOHOL ABUSE OF PREVENTION Governmental policy in the fight against alcoholism

On November 20, 1997, the German Länder health ministersconference (federal states) unanimously passed the “ Alcohol ActionPlan”. This action plan has incorporated the points defined by the EuropeanAlcohol Action Plan as well as the strategic approach set up in 1992. Itreinforces the principle specified in the “European Alcohol Charter”dated 1995. The health ministers conference has chosen the following prioritymeasures:� legal measures to reduce the alcohol supply as well asadvertisement for alcohol - eliminating consideration of alcohol as a mitigating circumstance - enforced legal protection for children and young persons and checksfor road safety� intensified research efforts in the field of habit formation In addition these structural measures, prevention and education mustalso be reinforced. Three German Länder have set up mass media campaigns which focuson remaining sober in specific situations and life-stages (driving,working, pregnancy, youth). A wide range of activities are still inpreparation. The FCHE has been asked to focus on the subject of alcohol in itscommunicative strategies for drug prevention by the German Ministry

42

of Health. Since 1992, The Federal Center for Health Education has sought toincrease awareness in the German public to the reasons for substanceabuse and to encourage people to become involved in primaryprevention, primarily via mass media (“Make children Strong”campaign). How and to what extent addictive substances are spoken aboutdepends on the target group. The subject of alcohol plays an importantrole in the media programs produced by the FCHE, as it one of the firstaddictive substances children or young people encounter. Theexemplary behavior of adults is important in terms of prevention. In addition to these primary prevention activities, the FCHE developsand provides special media programs on alcohol in cooperation withthe German Association Against the Dangers of Addiction. The mainissue of these measures is secondary prevention of alcohol abuse.Specific themes and target groups include: � alcohol in the work place� primary health care� women and alcohol� Journalists as multipliers� Counseling and therapy for alcohol abusers� Encouraging moderate drinking habits in the general public

On the federal, regional and local levels, a wide range of measures arein the planning stage, and some have already been implemented. TheFCHE recently initiated an overview of national alcohol abuseprevention activities


The German Association against Addiction includes many associationsinvolved in the fight against alcohol and drugs.Health insurance boards are also involved in prevention of alcoholism.

43

PRODUCTION(hectoliters)

World Drink Trends 19971980 1992 1995

Spirits(liters of pure alcohol)

150 000 * 215 000(1993)

Wine (hectoliters) 5 500 000 4 050 000 3 841 000Beer (hectoliters) 2 535 000

(a)4 010 000 4 085 000

* Meeting of national counterparts for the European alcohol action plan, June 1995(a) estimation from domestic sales





CONSUMPTION

In the general population

1975 1990 1995 1996Wine (liters/person) 38.0 32.8 34.5 34

(est.)Beer (liters/person) (a) 14.8 39.8 42.2

(40 in the 1996 edition)39

Spirits (liters pure alcohol/person) - 2.7 2.7 2.7 (est.)Total (liters pure alcohol/person) 5.3 8.6 9.0 8.7World Drink Trends, 1997(a) no data on low-alcohol or non-alcoholic beer

Consumption of beer

Population: 10,5 million inhabitantsGeography : 13 regionsCurrency : Grek drachma (GRD)Gross National Product in 1997: 10.051 ECU per capitaLife expectancy : Men 75,0 years – Women 80,3 yearsMortality in 1997961,90 deaths per 100.000 inhabitantsMen: 53.500 deathsWomen: 47.500 deaths

Source: Eurostat

GREECE

44

1991 1995 1996 1997In 1,000 hl 3,787 4,005 3,885 3,940Per capita in liter 36.7 40.0 39.0 39.0Source: Les Brasseurs Européens


In 1,000 hl 3,100 3,200 3,200Per capita in liter 30.30 30.93 30.93Source: L’Office International de la Vigne et du Vin

By age group

Prevalence 12-17yearsMen Women

18-24yearsMen Women

25-64yearsMen Women

Entire lifeLast 12 monthsLast 30 days

91.486.359.5

87.481.151.5

95.694.182.8

93.189.766.6

97.693.485.2

89.877.862.5

frequent consumption(more than 10 times overthe last 30 days)

15.0 8.4 42.2 16.8 53.7 18.5

Among young people

According to a study from 1984:11-17 years: 1.4% of men consume 201 g of alcohol weekly18-24 years: 5% of men (1.4% of women)24-44 years: 6% of men (1.7% of women)45-64 years: 7.7% of men (1.2% of women) (Meeting of nationalcounterparts for the European alcohol action plan, June 1995)

Developments over the past years:

Consumption has been on the increase since 1990, although it hasdecreased between 1983 and the end of the 90s overall.For many years alcohol consumption took place in the context ofreligious or social ceremonies, generally in a family or group context.This tradition is currently changing among adolescents, who tend todrink in cafes and nightclubs without family supervision.


Annual deaths from alcohol consumption: no data available.Deaths from road traffic accidents (all causes): approximately 2,000 peryear per 10 million inhabitants.


45

No data available.


No license is required for production and distribution of alcoholicbeverages.The legal age limit for purchase and consumption in public places 15-18 years old.No restrictions on hours of sale.(Meeting of national counterparts for the European alcohol action plan,June 1995 (Health for All, WHO)

ALCOHOL TAXATION

Table wine: 30%Beer (4-6%): 15%Spirits: 54% (over 4% for stamp)

ALCOHOL AND DRIVING

Legal BAC limit: 0.8 g/l of blood.

Frequent suspension of driving license.Frequent random testing.(Meeting of national counterparts for the European alcohol action plan,June 1995), (Health for All, WHO)

ADVERTISING

There are no specific restrictions other than limitations on the numberof advertisements per day for each TV and radio channel.Advertising of drinks containing more than 30% alcohol forbidden onradio and television. It is banned in the sporting press.

Source: Alcoweb.com

46


Governmental policy for the fight against alcohol

The Ministry of Health and its Primary Health Care Service isresponsible for defining and coordinating health prevention policies(especially the fight against smoking and alcohol).This action is relayed by « periphery » and « nomarchy » organizations(equivalent to regional committees).

No national agency has been specifically appointed to implement thefight against alcohol. This task is ensured by the Anti-drugOrganization, a national organization responsible for implementingprevention, treatment, rehabilitation and research programs for alcohol,tobacco, and other drugs.

- National programs- School programs- Company programs

Nine specialized therapeutic communities involved in treatingdependent subjects, including alcohol dependence, have been set upsince 1980. (Meeting of national counterparts for the European alcoholaction plan, June 1995), (Health for All, WHO)


No data available.

47

PRODUCTION

World Drink Trends 19971980 1990 1995

Spirits(liters of pure alcohol)

82 000 (sales)

Wine (hectoliters) - -Beer (hectoliters) 6 000 000 7 402 000



CONSUMPTION


1975 1990 1995 1996Wine (liters/person) 4.23 8.70 16.10 15.00

(est.)Beer (liters/person) (a) 128.60 122.40 141.30 142.50

(est.)Spirits (liters pure alcohol/person) 2.03 1.70 1.70 1.70

(est.)Total (liters pure alcohol/person) 7.70 7.60 9.20 9.10World Drink Trends 1997. (a) low-alcohol and non-alcoholic beers

Taken from the « National Alcohol Policy » Health Department,September 1996. Consumption in 1994: 11.23 liters of pure alcohol perinhabitant (15 years old and over), 9.03 in 1990 and 9.22 in 1975.Almost 20% of the population does not consume alcohol.

Since the late 1980’s there has been a steady increase in alcoholconsumption in Ireland. The consumption rate is not generally used inIreland, as 24% of the population is under 15 years of age.Consequently, the consumption rate per adult represents a more

Population in 1996: 3,6 million inhabitantsGeography : 26 countiesCurrency : Irish pound (IEP)Gross National Product in 1997: 18.169 ECU per capitaLife expectancy : Men 73,2 years – Women 78,5 yearsMortality in 1997877,77 deaths per 100.000 inhabitantsMen: 16.500 deathsWomen: 15.100 deaths

Source: Eurostat

IRELAND

48

meaningful figure.

Consumption per adult (15 years old and over)

1975 1990 1995 1996Total (liters pure alcohol/person) 9.22 9.03 11.70 12.40Source: CSO Statistical Abstract, Revenue Commissioners Annual Report


In 1,000 hl 4,335 4,932 5,193 5,406Per capita in liter 123.0 112.7 118.0 123.7Source: Les Brasseurs Européens


In 1,000 hl 205 188 263Per capita in liter 5.73 5.25 7.00Source: L’Office International de la Vigne et du Vin

By age group

The most recent National Survey that reported alcohol consumption byage group was in 1994. Three-quarters of those surveyed (74%) werecurrent drinkers, 8% were ex-drinkers and 18% had never drunkalcohol (Happy Heart National Survey, 1994).

Quantity consumed by regular drinkers

Number of alcohol unitsper week

30-49 yearsMen Women

50-69 yearsMen Women

Beer 13.5 2.2 12.7 1.0Wine 0.8 1.2 0.4 0.8Spirits 1.0 1.4 2.0 1.5Total 15.3 4.8 15.1 3.3(Source: Happy Heart National Survey, Irish Heart Foundation, 1994)

Among young people

Young people age 12 to 18 (data from 1993)From 12 to 13: 41% (45% of boys and 35% of girls) have alreadyconsumed an alcoholic beverageage 14: 51% (56% of boys and 45% of girls)age 15: 67% (68% of boys and 65% of girls)age 16: 77% (79% of boys and 76% of girls)age 17 and 18: 83% (94% of boys and 93% of girls)

Between age 12 and 13: 8% regular consumers (a), 8% occasionalconsumers (b)

49

age 14: 16% regular consumers, 11% occasional consumersage 15: 32% regular consumers, 13% occasional consumersage 16: 41% regular consumers, 16% occasional consumersage 17 and 18: 50% regular consumers, 19% occasional consumers

(Data from A National Survey, 1993)

(a) More than three times and more than one type of drink over the past month.(b) Only one type of drink and no more than 3 times over the past.(Smoking and Drinking among Young People in Ireland, Department of Health 1997)


Deaths related to alcohol consumption

Deaths per 100,000inhabitants

1970 1984 * 1990 1995

Cancers ICD 9 (140 to150, 155, 161)

15,89 14.90 16.05 18.26(1994)*

Cirrhosis ICD9 - 571 3.35 2.90 2.33 2.83Traffic accidents IDC9(E810-E819) (a)

16.30 14.10 13.50 10.86

Suicide ICD 9 (E950-E959)

1.76 6.50 9.50 10.86

Source: Department of Health, Vital Statistics, CSO

(a) Total number of road traffic accidents. According to the national police force , 40% of these are related to alcoholconsumption.


1995 Millions of pounds Millions of ECUTotal * 325.6 435.58with for example:Absenteeism, etc. 45 60.20Health 40 53.51Accidents 80 107.02Disability 55 73.58Police and others 28 37.46* estimated cost based on a calculated cost of 263 million IEP (351.83 ECU) in 1988.« National Alcohol Policy » Health Department, September 1996

50


Licensing Act, 1902Intoxicating Liquor Act 1988

! Licenses:! for sale of spirits: yes! for the sale of wine and beer: yes

3 types of license: on-licenses (pubs and hotels), off-licenses(supermarkets, shops), restaurant licenses. There are also wine-onlicenses for sale of wine. « National Alcohol Policy » HealthDepartment, September 1996 Legal age limit for consumption in public places: age 18. Legal age limit for purchasing alcohol: age 18 Legal limits on hours of sale: yes. Depends on the type of license andsales outlet. For most pubs, off licenses and supermarkets the hoursare as follows: Weekdays 10:30 to 23:30 (summer) and 10:30 to 23:00 (winter) Sunday: 0:30 to 14:00 and 16.00 to 23:00. Exceptions on St. Patrick’s day and Christmas. Restaurants, hotels and registered clubs can sell alcohol with mealsuntil 0:30. Note: drunkenness is forbidden in public places.

ALCOHOL TAXATION

1995 Data Beer: 15.65 IEP(20.94 ECU) / hl / % alcohol Spirits: 21.83 IEP (29.20 ECU) / liter of alcohol Wine: - between 5% and 15%: 215.01 IEP (287.63 ECU) per hectoliter - over 15%: 430.02 IEP (575.27 ECU) Wine: 48.1 % /bottle Beer (4-6%): 37.9% /pint Spirits (over 35%): 38.7% /glass and 65% /bottle. Source: Meeting of national counterparts for the European alcoholaction plan, June 1995. Taxes on alcohol are an important source of government revenue.

51

ALCOHOL AND DRIVING Road Traffic Act 1994 Legal BAC limit: 0.8 g/l since October 1, 1994. No random testing for alcohol while driving. Penalties: The Road Traffic Bill 1995 introduced graded penalties fordrunk driving offenses. Automatic disqualification applies to all drinkingand driving convictions but the minimum period varies, from 3 monthsto 4 years, depending on the BAC level in individual cases and the re-occurrence of offenses. Other penalties such as fines, the retaking ofdriving tests and possible terms of imprisonment are at the discretion ofthe court. In some cases the judge may impose attendance at analcohol education program.

ADVERTISING

Broadcasting Act, 1990, revised in 1995 (adaptation of the EECdirective number 69/552) Content: code governing advertising on the radio and television.Restrictions on content, form and broadcast times. For other media, advertising is subject to codes based on voluntarycompliance: Code for Advertising Standards revised in 1995: applies to all mediaand forbids inclusion in alcohol advertisements of young people underthe age of 25. Code of the Poster Advertising Association of Ireland: advertising isforbidden near schools, youth centers, churches, etc. « National Alcohol Policy » Health Department, September 1996 ! The words "forbids" or "forbidden" is used. However, these were never used, or

implied, in the policy document, as these codes are voluntary codes and can only atbest be interpreted as guidelines.

! Reform of licensing laws is currently under review by the Minister for Justice,Equality and Law Reform. The sub-committee on Legislation and Security of theOireachtas Joint Committee on Justice, Equality and Women’s Rights haverecommended changes including the extension of opening hours for the sale ofalcohol.


Governmental policy for the fight against alcohol

Government policyThe Irish National Alcohol Policy was launched in 1996. The mainpolicy objective is to promote moderation in alcohol consumption, forthose who wish to drink, and reduce the prevalence of alcohol-relatedproblems in Ireland. The plan of action in the policy sets out therequired actions by the different partners, such as GovernmentDepartments, Health Boards and the Drinks Industry, to bring abouteffective implementation.

52

Actions in communicationA National Alcohol Awareness Campaign in 1998, developed by theHealth Promotion Unit, Department of Health and Children, wastargeted at young adults and ‘binge drinkers’. The approach was to usehigh-quality visual aids such as posters to promote the centralmessage: control your drinking before it controls you.The National Safety Council promotes anti-drunk driving campaignseach year with high exposure during the summer and pre-Christmas toalert motorists to the dangers of drunk driving.

Alcohol educationA health education program for young people called ‘On Your Own TwoFeet’ was developed by the Departments of Health and Children andEducation. It is a broad-based approach which deals with substanceuse, including alcohol, and promotes the development of the skillsnecessary for making healthy decisions. Two other programs, namely"Drug Questions Local Answers" and "Family Communication and Self-esteem", are targeted at community groups and parents with the goalof helping in the long-term prevention of alcohol and drug misuse.

Practical ActionsThe Drinks Industry Group and the Health Promotion Unit, Departmentof Health and Children have developed a framework for examining theissues of Responsible Server Training.

The Health Promotion Unit has set up the National Alcohol SurveillanceProject (NASP) to collect and coordinate relevant information onalcohol-related issues.

TreatmentAlcohol-related treatment services are provided through the eightregional Health Board in the country. A community based servicemodel, as outlined in the ‘Planning for the Future’ document, providesthe framework. The delivery of treatment services occurs through thecommunity care program or the psychiatric service. A number of non-statutory organizations also provide treatment services for alcoholdependence.

53

PRODUCTION

World Drink Trends 1997 Osservatorio PermanenteSui Giovanni e l’Alcool,

1980 1992 1995 1996 1997Spirits(liters of pure alcohol)

1 000 000 (1994 sales)

890 000 689 000 *

Wine (hectoliters) 83 950 000 66 686 000 58 713 000 54 370 000 55 600 000 *Beer (hectoliters) 8 569 000 12 161 000 11 990 11 117 000 11 455 000* estimationsISTAT - Ministero del Bilancio, consuli delle famiglie





CONSUMPTION


World Drink Trends 1997 Osservatorio Permanente sui Giovannie l’Alcool

1975 1990 1995 1996 1975 1990 1995 1996 *Wine (liters/person) 103.9 62.5 60.4

(53.2 inthe 1996edition!!)

55(est.)

103.9 62.5 56.2 54.3

Beer (liters/person) (a) 12.8 25.1 25.4 (24in the1996

edition)

24.0 12.8 25.1 25.4 24.0

Spirits (liters purealcohol/person)

1.8 1.0 0.9 0.9(est.)

1.8 1.0 0.8 0.7

Total (liters purealcohol/person)

12.8 9.2 8.8 8.2 12.76* 9.2 8.5 8.1

* ISTAT - Ministero del Bilancio, consuli delle famiglie(a) low-alcohol and non-alcoholic beer included

Consumption of beer

Population in 1996: 57,4 million inhabitantsGeography: 20 regionsCurrency : Italian Lira (ITL)Gross National Product in 1997: 17.276 ECU per capitaLife expectancy: Men 74,9 years – Women 81,3 yearsMortality in 1997963,58 deaths per 100.000 inhabitantsMen: 281.800 deaths (1996)Women: 265.600 deaths (1996)

Source: Eurostat

ITALY

54

1991 1995 1996 1997In 1,000 hl 14,138 14,530 13,758 14,535Per capita in liter 24.9 25.4 24.0 25.4Source: Les Brasseurs Européens



By age group

(liters of purealcohol

1975 1990 1995 1996

11-15 years 0.13 0.09 0.08 0.0715-25 years 1.89 1.27 1.15 1.1025-65 years 8.84 5.96 5.39 5.1765 years and over 1.90 1.28 1.16 1.12Osservatorio Permanente sui Giovanni e l’Alcool, ISTAT - Ministero del Bilancio, consuli delle famiglie

Developments over the past few years:

Beer consumption has remained stable, while wine consumption andspirits consumption have dropped.


Deaths linked to alcohol consumption

1970 1990 1995 1996 1997number of deaths 27 200 17 100 14 800 14 330

(estimations)14 050(estimations)

Osservatorio Permanente sui Giovanni e l’Alcool, Societa Italiana di Alcologia (SIA)

55

Percent of deaths attributable to alcohol by category

Pathologies 1970 1990 1995cancers 25% 25% 17%cirrhosis 48% 36% 33%road traffic accidents 40% 33% 33%alcoholism 100% 100% 100%other accidents 20% 10% 10%suicides and criminal violence 30% 25% 20%other factors 15% 10% 5%fetal alcohol syndrome 100% 100% 100%unspecified 15% 10% 10%Osservatorio permanente Giovanni e alcool, Relazione sullo stato sanitario del Paese 1996, Ministero della Sanita

11 580 deaths from cirrhosis of the liver in 1987 (Alcool ou Santé February 1993)


Type of expenses in 1994 Amount (million ITL) Million ECU %TOTAL 11 476 310 5 948 100with:Treatment 2 343 476 1 215 20.4Morbidity 3 464 288 1 796 30.2Mortality 1 595 230 827 13.9Traffic accidents, legal costs(a)

3 357 145 1 740 29.3

Victim morbidity 217 507 113 1.9Victim mortality 498 664 258 4.3Osservatorio permanente Giovanni e alcool, Netherlands Economic Institute « Social Cost ... » NEI Press -Rotterdam 1996(a) Total cost of road traffic accidents including: treatment (140 066 million ITL or 72.6 million ECU), administrativecosts (1 171 799 million ITL or 607 million ECU) and costs linked to damage to private goods (2 045 300 million ITLor 1.060 ECU).


Royal decree dated October 19, 1930 number 1398 « CodeRocco » (legal age limit for consumption and purchase of alcohol)Law dated August 25, 1991 number 287 (revision of standards forestablishments and shops)

Mandatory licenses for production and distribution:- for the sale of alcoholic beverages: authorization granted bymunicipalities to any establishment serving beverages (alcoholic andnon-alcoholic) and food products. Regulations are strict: the number oflicenses granted is periodically limited.It is forbidden to serve beverages containing more than 21% alcohol(and exceptionally, any alcoholic beverages) in establishments where

56

young people gatherThe number of licenses granted is periodically fixed by each RegionalCouncil.

Legal age limit for consumption in public places: age 16Legal age limit to purchase alcohol: age 16

No restrictions on hours of sale.

ALCOHOL TAXATION

Decree-law dated October 26, 1995 number 504 (taxation,production and consumption with administrative and penal sanctions)

Spirits: 499 840 ITL (259 ECU) / hlWine: no taxationBeer: 32 720 ITL (16.96 ECU) / hlVAT at 20% for all alcoholic beverages since January 1, 1998

ALCOHOL AND DRIVING

The law for the definition of the legal level of alcohol in the blood, forthe regulation on the use of ethylometers and the process forunderlining the state of inebriation is governed by the decree of thePresident of the Republic n° 495 of December 12, 1992 « Regulationof execution and updating of the New Highway Code » (art. 379).

Ministerial Decree August 10, 1988 limiting blood alcohol content to0.8%Ministerial Decree September 6, 1988 specifying types of testingMinisterial decree dated May 22, 1990 number 196 definingethylometers as the instrument to be used to measure BAC limits byimmediately analyzing alcohol levels in exhaled air.

BAC limit: 0.8 g/l

Specified penalties: If found driving with BAC level at 0.8% or over,imprisonment for up to one month, and fine of 500,000 (259,16 ECU) to2 million ITL (103,65 ECU). Suspension of driving license for 15 daysto 3 months. Imprisonment over a longer period of time for repeatedoffenses. (alcoweb)Note: no BAC testing while driving (Alcohol Policy and The PublicGood, A guide for action (1995).

1996 budget for the fight against alcohol: 5 64 000 ECU.Number of vehicles: 31 000 000.

57

ADVERTISING

Italy is in compliance with European regulations for advertising on theradio and television.

Law October 5, 1991: Convention Strasbourg, May 5, 1989) ontransnational television.Advertising must not:- target minors- associate alcohol and physical performance, driving or sexualperformance- imply that alcohol has therapeutic or beneficial effects- encourage excessive consumption- associate good quality with a high level of alcohol

Ministerial decree dated November 30, 1991 number 425:adaptation to national law of articles 13, 15 et 16 of the Council ofEuropean Communities of October 3, 1989 (89/552/EEC) concerningtelevision advertising for tobacco and alcoholic beverages.Advertising must not:- target minors- associate alcohol and physical performance, driving or sexualperformance- imply that alcohol has therapeutic or beneficial effects- encourage excessive consumption- associate a high level of alcohol with good quality

Decree dated January 25, 1992 number 74: adaptation of the84/450/EEC directive on misleading advertising.Advertising of products that pose a health hazard is consideredmisleading if these hazards are not specified to.Decree dated December 9, 1993 on sponsoring of radio andtelevision programsContent: sponsorship by any legal entity involved in manufacturing ofalcoholic beverages is forbidden.

radio, films, dailies, magazines,billboards

Sports sponsoring

Spirits 2/3 3Wine 2 2Beer 2/3 2/32 voluntary; 3 legal restrictions

For other media, there is a voluntary advertising codeContent: do not encourage excessive consumption, target minors,associate alcohol with driving, etc. (National Assembly, July 1996)

58


Governmental policy

The fight against alcohol abuse is part of the institutional mission incharge of the Prevention Department of the Ministry of Health.Office VI of this department is now in charge of these missions, whichused to report to the Central Service for alcohol and illegal substancesdependence, established according to law n° 162/90, no longer inforce.It directs and coordinates all matters of prevention, treatment,rehabilitation, and epidemiological monitoring in the field of alcoholdependence, in cooperation with the regions managing the NationalHealth Service.

Law dated June 26, 1990 n°162: revision of the law dated December22, 1975 n° 685 on drugs and psychoactive substances, prevention,treatment, and rehabilitation.This law created a Central Service for addiction to alcohol and otherdrugs (Central Service for Alcohol and Drug Addiction) reporting to theMinister of Health, and made the Minister of Education responsible forcoordination of prevention and educational activities on a national level.

This service develops recommendations for prevention activities andsupervises circulation of data from the regions.Ministry of Education: educational programs on alcohol, tobacco, anddrugs in a school environmentIn relation to treatment, a decree by the Ministry of Health (DM August3, 1993) recommends that every municipal health care unit contributeto prevention and treatment of alcohol addiction and rehabilitation,using a global approach that takes into account medical, social andpsychological aspects.Alcoholism as a disorder was officially recognized only in 1978. Drugsare, and remain, the main concern.(Meeting of national counterparts for the European alcohol action plan,June 1995)


The Osservatorio Permanente sui Giovani e Alcool (The permanentobservatory for young people and alcohol) is a non-profit organizationcreated in 1991 as an agency independent of the Ministry. TheMinistry is however kept informed on the activities of the Observatoryas an institutional referee, including updates on all studies andresearch in the field of alcohol.

Funding is 50% private (industrial) and 50% public.Members: brewing industry, Ministries of Health, Industry, Welfare,Agriculture, National Council for the Economy and Labour (CNEL).

Objectives:

59

! update of information on young people’s behavior with respectto alcohol

! promotion of responsible alcohol consumption! prevention of excessive alcohol consumption, especially

among young people! improvements of alcohol-related policies.

Scientific activities include nation-wide qualitative and quantitativestudies, monographs (evolution of consumption behavior amongyoung people, social testing, national policy, role of advertising, cost ofalcoholism, etc.)

Prevention:An analysis has been completed on consumer behavior at theEuropean level, the meaning of alcohol and European alcohol-relatedpolicies, in addition to a proposal for the establishment of a EuropeanObservatory on Alcohol. (Published in the Quaderno n. 4 of theOsservatorio “Alcool Consumi e Politiche: Strumenti per unOsservatorio europeo”)

A national campaign on young people and alcohol, in cooperation withthe Ministry of Education and the European Commission has beenimplemented. In this context, a study carried out between 1996 and1997 based on an experimental model of a national campaigncentering on community action to increase young people's awarenessof risks linked to alcohol abuse (results published in the Quaderno n. 9of the Osservatorio “Young People and Alcohol Between School andWork”).

60

PRODUCTION

1980 (hectoliters) 1986-1990 1991-1994Spirits (pure alcohol) 2073.5 1364.4 (1986-1990) 887.5 (1991-1995)Wine (hectoliters) 146 000 (1980-1984) 156 000 (1985-1989) 166 000 (1990-1994)Beer (hectoliters) 756 424 649 286 (1986-1990) 549 769 (1991-1995)STATEC (Central Service of Statistics and economic studies), 1996


In 1,000 hl 572 518 484 481Source: Les Brasseurs Européens


In 1,000 hl 172 175 149Source: L’Office International de la Vigne et du Vin

CONSUMPTION


World Drink Trends 1997 Institut de statistiquesluxembourgeois

1975 1990 1995 1996 1993 *Wine (liters/person) 41.30 58.21 58.20 58.0

(est.)0.21 l/day

Beer (liters/person) (a) 127.31 121.40 99.40 109.0(est.)

0.40l/d

Spirits (pure alcohol) 1.74 1.57 1.60 1.6 24.49 ml pure alcohol/dayTotal (pure alcohol) (1) 10.50 12.20 11.60 11.8 73.69 ml pure alcohol/day

(a) no data on low-alcohol or non-alcoholic beerWDT data comes from STATEC, the national statistical organization. To take into account the large amounts ofalcohol consumed by tourists and neighboring countries – alcohol is much less expensive in Luxembourg than incountries along its borders – real consumption has been corrected.


In 1,000 hl 443 403 349 485Per capita in liter 116.0 99.4 95.0 80.0Source: Les Brasseurs Européens

Population in 1996: 418 300 inhabitantsGeography: 3 regions (districts)Currency: Luxemburg franc (BLF)Gross National Product in 1997: 33.035 ECU per capitaLife expectancy: Men 73,0 years or 80,0 yearsMortality in 1997932,34 deaths per 100.000 inhabitantsMen: 1.900 deathsWomen: 2.000 deaths

Source: Eurostat

LUXEMBOURG

61


In 1,000 hl 224 208Per capita in liter 51.00 55.20 50.40Source: L’Office International de la Vigne et du Vin

By age group

Luxembourg has no data source for a correct estimation ofconsumption by age group, especially for young people.

The only data available come from behavioral studies.According to a 1990 European study (Eurobaromètre):20% of adults over 15 years of age are frequent consumers (3 to 4days per week)45% are infrequent consumers (at least once a week)31% are moderate consumers.(Meeting of national counterparts for the European alcohol action plan,June 1995)

Developments over the past years:Luxembourg has the highest consumption level in Europe, withconsumption per day and per inhabitant at 73.69 ml pure alcohol in1993 (Wine 0.21 liters; Beer: 0.40 liters; Spirits: 24.49 ml pure alcohol).Consumption has remained stable since 1985, at approximately 12liters of pure alcohol per year per person.


Annual mortality related to alcohol consumption

1970 1990 19953.53 for 100 000inhabitants

1.82 for 100 000inhabitants

4.84 for 100 000inhabitants

Mortality statistics from the Ministry of Health

There is no reliable data on alcohol-related mortality in Luxembourg.Causes of death due to alcohol are not clearly defined and coding fordisorders (using 3 figures) does not allow for registration of more thanone cause, especially for alcoholism linked to cancer, cirrhosis, etc.

It is estimated that 2 to 3% of the adult population suffers from« medical problems » related to alcohol.The number of alcoholics in Luxembourg is estimated at between 8 000and 9 000.


62

No data available for the reasons mentioned above.


Law dated June 29, 1989 on the reform of cabaret regulations:

Cabaret privileges for establishments founded since 1912, or anauthorization delivered according to the number of establishments percapita (no more than 1 per 500 inhabitants).

Legal age limit for consumption (unsupervised) in cabarets is age 16(art. 20).Legal age limit for purchase of alcohol: recommendations exist, butthere is no legislation.Restrictions on hours of sale (art. 17): from 6:00 to 1:00, in certaincases until 03:00.

ALCOHOL TAXATION

Regulation RGD 30/12/92

Excise taxes on alcoholic beverages:

Type of beverage Luxembourg francsSpirits 90 000 +

33 000 /hl100%vol (tax on consumption, budgetlaw)

Wine 0Beer/cider 16 to 32 /hl/°Plato depending on annual production

(less than 50,000 HL to more than 200,000 HL)Intermediate products under 15% 1900 /hl

over 15% 2700 /hl

ALCOHOL AND DRIVING

Ministerial decree dated July 1, 1992 (modified in 1994) concerningmeans of implementation for testing as specified to determine the BAClimit in a driver or pedestrian.Legal BAC limit: 0.8 g/l of blood or 0.35 mg/liter of exhaled airContent:- imprisonment for 7 days and/or fine of 1,000 BLF (24.67 ECU) to5,000 BLF (123.36 ECU) for driving with a BAC limit greater than orequal to 0.35 mg/l exhaled air (0.8 g/l of blood).

63

- imprisonment for 8 days to 3 years and/or fine of 2,500 BLF (61.68ECU) to 50,000 BLF (1233.56 ECU) in case of an accident with lessthan 0.55 mg/l exhaled air (1.2 g/l of blood).- possible suspension of license.

Random breath tests for drivers.

ADVERTISING

Advertising is not subject to any specific restrictions.

The National Luxembourg Council for Alcohol Studies (CNLA) hasproposed a code governing advertising of alcoholic beverages(similar to the legislation passed tobacco), covering all beverages withan alcohol concentration above 1.2% and all advertising media.- Locations: No advertising near locations frequented by children orhealth care establishments, or in children’s or sports magazines.Restrictions on duration and size of billboard advertising.- Content: no representation of minors, sportsmen or drivers, noencouragement of excessive drinking. No links to social or sexualsuccess. Mandatory inclusion of health hazards in the event of abuse(to be approved by the Minister of Health).

Labeling: inclusion of alcohol content and general warning on theeffects of alcohol on health.


Governmental policy for the fight against alcoholism

In 1982, Luxembourg joined the WHO project, whose objective was toreduce alcohol consumption by 25% over the next 18 years. In order toimplement this perspective, the “Conseil National de Lutte contrel’Alcoolisme” was founded in 1985-1986 and is now known as “ConseilNational Luxembourgeois d’Alcoologie” Current data show that thisobjective is far from being met. Per capita consumption has remainedstationary.

The Center for Prevention of Drug Addiction, created in January 1995,is a national agency financed by Ministry of National Education. Itsadministrative council is inter-ministerial and multidisciplinary, with theobjective of increasing public awareness on primary prevention issues.The Preventive Medicine Division in prevention by developingawareness campaigns targeting young people still in school anddistributes some information.

For a long time, public interest and policies were focused on the fightagainst drug addiction, accompanied by a lack of awareness of theproblems posed by alcohol.

64

Alcohol occupies an important place in Luxembourg’s social andeconomic structure.


The National Council for the Fight against Alcoholism (CNLA), renamed The National Luxembourg Council for Alcohol Studies, wascreated in 1985. With its 190 members, it intervenes in many differentareas: information, prevention, research, first aid and treatment, andpost-cure follow-up.

Among others, the following organizations are active:Alcoholics AnonymousAl Anon: mutual-help group for family and friendsAlateen: mutual-help group (13-25 years).

65

PRODUCTION(hectoliters)

World Drink Trends1997 * and **1980 1992 1995 1996 1995

Spirits (pure alcohol) 487 000 495 500 *Wine (hectoliters) insignificant -Beer (hectoliters) 15 789 000 20 431 000 23 118 000 23 493 975 23 118 463 **

*Jaarverslag 1996, (Annual Report) Productschap voor Gedistilleerde Dranken et ** Jaarverslag 1995Productschap voor Bier.



CONSOMMATION


World Drink Trends 19971975 1990 1995 1996

Wine (liters/person) 10.26 14.54 16.57 17.10Beer (a) (liters/person) 79.00 87.70 85.80 83.70Spirits (pure alcohol) 3.44 1.98 1.74

(1.98 in the1996

edition)

1.76

Total (pure alcohol) (b) 8.90 8.10 8.00 8.00(a) low-alcohol and non-alcoholic beer included(b) fruit wines included



Population in 1996: 15,5 million inhabitantsGeography: 12 provincesCurrency: Dutch Guilder (NLG)Gross National Product in 1997: 20.392 ECU per capitaLife expectancy: Men 74,7 years – Women 80,3 yearsMortality in 1997877,41 deaths per 100.000 inhabitantsMen: 67.300 deathsWomen: 68.600 deaths

Source: Eurostat

NETHERLANDS

66



By age group

1975 1989 1995 1997*15-25 years 3.6 g 8.5 g 10.05 glasses/week

This is the only data available. The excessive drinkers group (>20) accounts for more than half of total alcoholconsumption*Jaarverslag 1996, (Annual Report) Productschap voor Gedistilleerde Dranken and NIGZ / NIPO-onderzoekFebruary, 1997.

As part of Alcohol Education Project, weekly alcohol consumption ofthe 15-25 age group has been surveyed 6 times since 1986 (date NSSand NIPO)

1977 1986 1989 1992 1994 1995All 15-25years

6.8 5.8 5.9 7.3 5.8 8.7

Drinkers 15-25 years

8.1 7.6 7.1 9.0 8.5 10.1

There are no time series of weekly consumption patterns in other agegroups.

Among young people

Consumption among 12-15-year old who consumed more than 5glasses on the latest occasion:1984: 12%1988: 19%1992: 28%1996: 30%(Kerngegevens Roken, drinken, drugs ... WM de Zwart. Trimbosinstituut, Utrecht 1997)

According to a study carried out in 1997 by the Trimbos instituut inyoung people between the ages of 10 and 18, the first glass isconsumed at an increasingly early age, and the quantity consumedeach time is rising.According to another 1997 study in (15-25 years-olds on vacation),boys consumed an average of 21 glasses per day, while girlsconsumed 11 (these figures hold for young people who vacation in theirown country; they are not true of all young people going on vacation).Consumption of « alcopops » is on the increase (European Forum onAlcohol and Tobacco, December 11-13, 1997, CFES )

67

Developments over the past few years

Consumption per inhabitant remains stable, and is even decreasingslightly.In young people, there is a significant increase in excessiveconsumption.


The number of persons treated for alcoholism is estimated at 100,000per year:Deaths related to alcohol consumption:

Deaths linked to alcohol

Pathologies 1994 *number of deaths

1994*% alcohol-related

deaths

1995**number

ofdeaths

Total 2710withcancers 1000 (/total

36,000 deathsfrom cancer (a)

36%

cirrhosis 385 (/total 1074deaths from

cirrhosis)

14% 1400

road traffic accidents 200 (/total 1160deaths from roadtraffic accidents)

10% +200 (a)

alcoholism 28% 740alcoholic psychosis 80other accidents 90 (/total 1520

accidents)3%

other factors 9%* Various sources (Sandra van Ginneken)** Jaarboek Verslaving 1996 Ed IP Spruit. Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction,Utrecht.

(a) Deaths from alcohol-related cancers represented 3% of deaths linked to alcohol in 1994.According to official figures, deaths from road traffic accidents involving illegal BAC limits totaled 7.8 per 100,000deaths in 1994. The latter figure is considerably under-estimated, as there is no systematic testing of BAC levels inaccident victims. According to the Stichting Wetenschappelijk Onderzoek Verkeersveiligheid, the reality is farsuperior, at 15% of alcohol-related deaths.

68


Type of expenditure Amount (million NLG) Million ECU % of total

TOTAL 4 840 2 189Treatment, morbidity,mortality

240 109 5%

Road traffic accidents 400 181 8%Social cost 4 200 1 900 87%Loss of productivity 2.5 1.13Cost of alcohol addiction 1 500 678

The social costs of dependence and the cost-effectiveness of addiction treatment, KPMG, 1996.

LIMITING ACCESS TO ALCOHOL ABUSE

Alcohol and Catering Licensing Act dated October, 1964 (licenses)Drank en Horecawet (law) (regulations on building)

Licensing:- for the sale of beverages containing over 15% alcohol:- on-license ( bars and restaurants) and off-license (liquor stores)- for sale of beverages under 15%: on-license (bars and restaurants).

Social hygiene qualification certificate.

Legal age limit for consumption in public places: age 16 for beveragesunder 15%, 18 years for beverages over 15%

Legal age limit for purchasing alcohol: age 16 for beverages with under15% alcohol content and age 18 for beverages with an alcohol contentof over 15%.Legal hours for sale: no national regulations. Most communities haveadopted ordinances to limit hours of sale for alcohol (for most towns:open until 1:00 to 3:00. In small communes: open until midnight to1:00).

Dutch Cabinet recently agreed on a change of Alcohol and CateringLicensing Act, presented to the Parliament in April 1998. The mostimportant proposal is a ban on alcohol sales in non-food stores, petrolstations, and in canteens in the work place.Furthermore, age limits will be enforced more effectively.

69

ALCOHOL TAXATION

Wine: approximately 16% (49 ECU/hl)Beer: approximately 34% (21 ECU/hl)Spirits: approximately 69% (604 ECU/hl) (with the exception of cherryliqueur: 41%)(CBMC, rates as of January 1, 1997)

An increase in excise taxes has encountered much opposition from theSTIVA and the Ministry of Economics. Temperance associations havefailed to obtain this increase.

ALCOHOL AND DRIVING

Road Traffic Act dated April, 1994

Legal BAC limit: 0.5 g/l of bloodContent and specified penalties:Driving forbidden with a BAC level equal or greater than 0.5 g/l or abreath alcohol test at 220 micrograms.Penalties specified for a first offense:From 0.5 to 1.3: ticketFrom 1.3 to 1.5: ticket and conditional suspension of driving licenseFrom 1.5 to 2.1: ticket and suspension of driving licenseFrom 2.1 to 2.5: ticket, suspension of driving license, and 2 weeks ofconditional imprisonment.Over 2.5: suspension of driving license and 2 weeks imprisonment.For second offenses, penalties are more severe. If deaths areinvolved, the prison term is 3 years maximum.Note: in certain cases (between 1.3 and 2.1 or in the case of a secondoffense with 0.8), the person may be required to attend a 3-dayinformation session.

BAC testing: testing is authorized even in the absence of anyinfringement of the road safety code or accident.

The annual budget for prevention of drunken driving is approximately100,000 ECU.This figure is difficult to evaluate, as testing for drunken driving hasbeen decentralized and is now a regional responsibility. The budget isinsufficient and does not allow for effective testing of drivers under theinfluence of alcohol.

Number of vehicles: 6 348 000

70

ADVERTISING

Alcohol advertising is regulated by a voluntary code, the Code forAlcoholic Beverages, dated September 1, 1990, as established on allparties involved with production, distribution and marketing of alcoholicbeverages.

This code applies to all advertising media and compliance is voluntary.There are no restrictions or prohibition on alcohol advertising.

The code is currently under assessment.


Governmental policy in the fight against alcoholism

The Department of Public Health of the Ministry of Health, Welfare andSport prepares and implements governmental policy in the field ofprevention.Its objective is to reduce alcohol-related problems by encouragingmoderate consumption.The five policy instruments of Dutch alcohol moderation policy are:• more education and prevention• better treatment of alcoholics• stricter Alcohol and Catering Licensing Act• responsible advertising for alcoholic beverages• higher taxes

The ministry implements the policy, and non-governmentalorganizations are responsible for its application.

In 1986, the ministry developed the Alcohol Education Project,responsible for implementing wide-range educational programs onalcohol for the entire population. The project has an annual budget of 3million florins. Between 1986 and 1996, the project contributed to theslight decrease in consumption recorded during this period. Since1996, the national board reports to a private organization, the NIGZ(Netherlands Institute for Health Promotion and Disease Prevention).

Its objectives:- information on alcohol-related risks- changes in attitudes towards alcohol- decrease in consumption

71

Means:- information campaigns for the general public (once or twice a

year)- campaigns targeted to a specific audience: schools, young

people, parents, physicians (occasional).- prevention programs on a local scale- research, qualitative and quantitative studies.

Results: In October 1990 the fifth media campaign was launched,primarily broadcast on television and targeting 15-25-year-olds. Acampaign targeting parents began in 1995. The 6th media campaign,targeting 15-25 years old, was launched in November 1997.

The governmental budget allocated to educational activities isconsidered too low.


Alcoholics AnonymousAl AnonAlateen and ACEALCON Foundation the NetherlandsDutch Traffic Safety AssociationFoundation for Responsible Alcohol UseNetherlands Foundation for Self-regulation of the Alcoholic BeverageIndustry – Foundation for Responsible Alcohol Use (STIVA)Netherlands Institute for Health Promotion and Disease PreventionNetherlands Institute for Mental Health and Addiction (TrimbosInstitute)The Netherlands Mental Health Care AssociationDutch Association for Alcohol Prevention (STAP)

72

PRODUCTION

1980 1990 1993 1995Spirits (pure alcohol) 80 000Wine (hectoliters) 10 172 6 607 000

(9 200 000*)

7 132 000

Beer (hectoliters ) 3 557 000 6 928 000World Drink Trends, 1997* Meeting of national counterparts for the European alcohol action plan, June 1995 (data from this encounter aremuch higher than those published in World Drink Trends).

Small-scale production of wine and spirits still exists on a broad scaleand has not been taken into account in assessment of total nationalproduction. Decrease in wine production between 1993 and 1994 isdue to poor climatic conditions.





Population in 1996: 9,2 million inhabitantsGeography: 18 continental districtsCurrency: Portuguese Escudo (PTE)Gross National Product in 1997: 8.919 ECU per capitaLife expectancy : Men 71,0 years – Women 78,5 yearsMortality in 1997:1143,47 deaths per 100.000 inhabitantsMen: 55.100 deathsWomen: 55.000 deaths

Source: Eurostat

PORTUGAL

73

CONSUMPTION


1975 1990 1995 1996Wine (liters/person) 89.8 50.0 58.4 60.6

(est)Beer (liters/person) (a) 32.7 65.1 64.7

(64.2 in the1996

edition)

61.9

Spirits (liters pure alcohol/person) 0.9 0.8 0.8 0.8Total (liters pure alcohol/person) 13.3 10.1 11.0 11.2World Drink Trends, 1997(a) no data on low-alcohol and non-alcoholic beer


In 1,000 of hl 6,635 6,416 6,136 6,218Per capita in liter 67.3 64.7 61.9 62.6Source: Les Brasseurs Européens



By age group

No data available on this subject.A database and new measurement tools are currently beingimplemented.

Among young people

Important studies showing the alcohol consumption among youngpeople.

74

Author Year Population Age group ConsumptionBarbosa et al 1993 Young students 13.8 +/- 2,4 years 77% consumption

during the last 12months

ESPAD 1995 Young students 16 years 76% consumptionduring the last 12months

Breda J. 1996 Young students 15-20 years 76% of the girls87.5% of the boys

Morais 1997 Young studentsand youngsterswho quit school

16 years 82.6% of thosewho quit school63.3% of thestudents

Consumption has been on the increase since 1990, although itdecreased between 1983 and the end of the 90s.Between 1990 and 1995, a definite increase was observed (17%) inwine consumption per person, which currently stands at 11 liters.Consumption of spirits has increased, while beer consumption hasdecreased slightly.During the same period, an increase in overall consumption (purealcohol) and later the appearance of a new type of beverage (alcopops)was noted.


There are no precise statistics available in Portugal on causes of deathrelated to alcohol, only a percentage of total number of deaths.The number of alcoholics is estimated at between 300,000 and500,000 persons, or 3 to 5% of the population

Annual deaths related to alcohol consumption:1995: 7 220 (Pinto A et al Boletin do CRAC Ano I, n°1, April 1997)This figure is an estimation based on the percentage of deathsattributable to alcohol (American criteria), and is probably under-estimated.

75

Percentage of deaths attributable to alcohol with respect to total deaths

Pathology/year 1970 1990 1995Cancerscirrhosis of the liver 2.6% 2.8% 2.6%road traffic accidents 1.3% 1.2%alcoholism 0.1% 0.06%other accidents 0.9% 0.8%(Institutos de Medecina Legal)


No data available.


Regulamento General de edificaçoes UrbanasPortaria 6065 dated March 30, 1990.Regulamentos Policiais dos Distritos

Sale of alcoholic beverages does not require a license. The onlyrestrictions concern proximity to schools and military bases.The legal age limit for consumption in public places is age 16 (PoliceRegulation of District and DR 20431 dated October 24, 1931).Legal age limit for purchase is age 16Hours of sale depend on the type of establishment.

Decreto-Lei 270/89 dated August 18, 1989 - Medidas s/Violenciano desporto - art15. (Indications on sale and consumption of alcoholicbeverages in a sports context)

ALCOHOL AND DRIVING

Decree-law 124/90 dated April 14, 1990 - Conduçao sob efeito doalcool (driving rules on the effects of alcohol).Decree-law 114/94 dated May 3, 1994 - Codigo da Estrada (RoadSafety Code).

Legal BAC limit: 0.5 g/l of blood (secondary limit 0.8 g/l).

Between 0.5 et 0.8 g/l of alcohol: fine and suspension of driving licenseBetween 0.8 and 1.2 g/l: more severe fine, considered as a secondoffense.Over 1.2 g/l: trial.

Budget for the promotion of the fight against drunken driving: no dataavailable.

76

Number of vehicles: 3 500 000.

Frequent random testing (Meeting of national counterparts for theEuropean alcohol action plan, June 1995) (Health for All, WHO)

ALCOHOL TAXATION

Taxation varies according to the type of beverage.

ADVERTISING

Decree-law number 270/89 dated August 18, 1989 Medidass/Violencia no desporto - art 15 - relative to sale and consumption ofalcoholic beverages during sports eventsArticle 17 from the Advertising Code (Decreto-Lei 330/90) datedOctober 23, 1990: broadcast of advertising for alcoholic beveragesprohibited on television and radio between 07:00 and 09:00, andrestrictions relative to targets and content (no associations with drivingor sports, no encouragement of excessive consumption).Decreto-Lei 6/95 dated January 17, 1995 - Advertising Code(revision of the 1990 decree) Legal restrictions are imposed onadvertising of alcoholic beverages, regardless of the media and type ofbeverage.


Governmental policy for the fight against alcoholism

Psychiatric and Mental Health Services Management – the DGS -whose role has been defined in article 28 of the decree-law n° 122/97dated March 20, 1997 regarding the General Health ExecutiveDepartment.

General policy: Technical orientation and evaluation of study on mentalhealth, with special emphasis on alcoholism and other drug use.

A national policy is almost non-existent.- Comisao Nacional de Combate ao Alcoolismo: national agency incharge of prevention of alcohol-related problems.- Three regional agencies (Coimbra - central region - (see detailsbelow), Lisbon - southern region -, Porto - northern region -), createdby Decree-law n° 269/95 dated October 19, 1995 (I series A), all playan important role in treatment and prevention of alcoholism. They arealso responsible for individual rehabilitation, coordination of anti-alcoholactivities as well as education and research in the field of alcohol.They each have a government-allocated budget as well as participation

77

by the patients in health care reimbursement. They employ a total ofabout 100 persons.

Information campaign developed by the centers, but with a very limiteddistribution.No national anti-alcohol campaign has been developed.A national program against drunken driving has been implemented bythe police.An information program for young people targeting teachers, studentsand civil servants in the national education system has beendeveloped.Targeted actions: campaigns targeting truck drivers and constructionworkers (Coimbra regional center).Treatment for patients and rehabilitation: the most important aspect ofthe anti-alcohol effort (five-week detoxification cure: 5000 cases treatedeach year by the Lisbon center (with only 20 beds) and 2500 cases bythe Coimbra center).

Research: Instituto da Vinha e do Vinho et Instituto do Vinho do Porto(Meeting of national counterparts for the European alcohol action plan,June 1995) (Health for All, WHO)

Activities at the Coimbra regional agency:- Prevention and treatment of alcohol-related problems- Coordination of anti-alcohol activities- Teaching and research on alcohol


No data available.

78

PRODUCTION

1980 1992 1995Spirits (pure alcohol) 802 000 (1994)Wine (hectoliters) 43 519 37 780 000 19 640 000Beer (hectoliters ) 20 027 000 26 082 000 25 313 000World Drink Trends, 1997





CONSUMPTION


1975 1990 1995 1996Wine (liters/person) 76.0 37.4 30.6 30.3Beer (liters/person) (a) 47.0 71.9 66.6 64.7Spirits (liters pure alcohol/person) 2.7 2.7 2.5 2.4

(est.)Total (liters pure alcohol/person) 14.2 10.8 9.5 9.3World Drink Trends, 1997(a) low-alcohol or non-alcoholic beers included




Population in 1996: 39,3 million inhabitantsGeography: 17 autonomous communityCurrency; Spanish peseta (ESP)Gross National Product in 1997: 11.887 ECU per capitaLife expectancy : Men 74,4 years – Women 81,6 yearsMortality in 1997:906,61 deaths per 100.000 inhabitantsMen: 189.500 deathsWomen: 166.800 deaths

Source: Eurostat

SPAIN

79


By age group

Prevalence 1987 1990 1995 199716-24 years 80.6% 68% 74.2% 69.50%25-44 years45-64 years

78.7%64.0%

70%57%

72.7%60.5%

72.40%59.00%

over 65 years 46% 40% 41.7% 39.82%National Health surveys, Ministry of Health and Consumer Affairs

The two age groups with the highest consumption level are, inincreasing order, 25-44 and 16-24 year-olds.A significant difference is observed between different regions withregard to prevalence of excessive drinkers and non-drinkers (NationalHealth survey 1993 and 1995, Ministry of Health and ConsumerAffairs).

Among young people

Percentage of young people having consumed during the 30 days preceding the surveyStudents 1994 199614-18 years 78.5% 66%Encuestas sobre drogas a problacion escolar, Government Delegation for the National Anti-drug program

Alcohol consumption in young people is currently an important problemfrom a social point of view. The latest national study carried out in 14-18 year olds by the Government Delegation for the National Anti-drugProgram in 1996 shows that alcohol is the most frequently consumeddrug, with a rate of 81.7% over the last 12 months. Prevalence andintensity of alcohol consumption increases with age. 39.9% of 14 yearold students have tried alcohol in the last month. That percentageincreases to 84.4% in 18 year olds. The study also shows that 41% ofstudents have gotten some time in their lives.Consumption occurs primarily during the weekend in pubs and night-clubs. Although beer is the leading drink, we note a trend towardsincreased consumption of spirits.The behavior of young people in terms of alcohol use is similar toNordic trends.Comments:- Road traffic accidents are the main causes of mortality in menbetween the ages of 1 and 34 and in women from 1 to 24 years, 15-24being the period of highest risk.- It appears that alcohol consumption can constitute early onset ofaddictive behavior and encourage use of other drugs. (EuropeanForum on Alcohol and Tobacco, December 11-13, 1997, CFES)

Developments over the past few years:

As in other Southern European countries, consumption of alcoholic

80

beverages has considerably decreased over the last ten years(decrease of 25% between 1980 and 1995), primarily due to reductionsin wine consumption.Over the last 5 years, consumption of wine, beer and spirits per personhas gradually decreased. Several studies have shown a change inconsumption behaviors, especially in terms of type of beverage andincrease in consumption during the weekend.Currently, over 60% of adults over 16 are regular drinkers.Approximately 4% are excessive drinkers (a high level of consumptionis defined at 526-700 cc pure alcohol per week, while over 701 ccconstitutes excessive consumption).


Changes in annual death rates related to alcohol consumption1989 1991 1993

Total (1) 13 636 13 491 12 980 (or 3.82% of total deathswith: (2)

number ofdeaths

AAF* ARM **

Cirrhosis 5416 70 5416Road traffic accidents 2470 (a) 40 2470Alcoholism:- alcohol poisoning- alcohol abuse- dependence syndrome- alcoholic psychosis

Total: 314 (b)6

1124651

100100100100

611

24651

Cancers 5890 50 to 75dependingon cancer

type

3555

SuicideHomicide

3037373

2546

759171

Other 428(1) From General sub-department of Epidemiology, Health Promotion, Health Education, Department of PublicHealth, Ministry of Health and Consumers Affairs* AAF Alcohol-attributable fractions** Estimated alcohol-related mortality (2) From European Forum on Alcohol and Tobacco, December 11-13, 1997, CFES(a) 23.7 per 100 000 inhabitants among 15-24 year-olds (37 per 100,000 for men, 9.8 per 100,000 for women)

According to a recent study (Merck, report, 1997), there are 1.6 million alcoholics, with 84% ofmen.


1977: Total estimated cost between 114 248 ESP and 269 440 millionESP (689 and 1624 ECU)

81

1994: hospital cost (treatment) estimated at between 34 209 and 57467 million ESP (206 and 346 ECU).(National studies)

Annual cost estimated at 637 717 million ESP or 3844 million ECU(cost direct: 228.429 million ESP or 1377 million ECU, indirect cost:409.288 million ESP or 2467 million ECU)


Legal age limit for purchase and consumption in public places:- age 16 (national law: Royal decree 08/ 1982 concerning publicactivities and events (Official State Bulletin 5-6/11/1982)- age 18 in certain autonomous communities (Castilla y Leon, Castilla-La Mancha, Basque country, Navarro, Catalonia,Galicia, Andalucia,Cantabria, Extreuadura, Murcia y, C. Valenciana).Restrictions on hours of sale: open during office hours.

ALCOHOL AND DRIVING

Royal Decree 13/1992 dated January 27th, 1992 (general regulationsfor road safety)

Legal BAC limits:! 0.8 g/l of blood for drivers of privately-owned vehicles.! 0.5 g/l for drivers of vehicles weighing over 3500 kg.! 0.3 g/l for drivers of public transportation vehicles.

Budget for the fight against drunken driving: 5 100 000 ECU Number of vehicles in 1996: 19 542 104 with 14 753 809 privately-owned vehicles Frequent suspension of driving license. Frequent random testing. (Meeting of national counterparts for the European alcohol action plan,June 1995) (Health for All, WHO)

82

ALCOHOL TAXATION

Royal decree-law 12/1996 dated July 26, 1996 (taxation on alcohol) Law 38/1992 dated December 28, 1992 (special taxes, regulatedstandards) Law 12/1996 dated December 30, 1996 (government budget 1997) Spirits: 114 000 ESP (687 ECU) per hectoliter of pure alcohol Wine and fermented beverages: no taxation Beers: between 386 and 1902 ESP (2.33 and 11.47 ECU) perhectoliter depending on the degree of alcohol.

ADVERTISING

General Act on Advertising 34/1988 Content: Advertising for beverages containing over 20% alcohol isprohibited on television as well as in all points of sale where the sale ofalcohol is forbidden. Law n° 25/1994 July 7, 1194 (adaptation of EEC directive 89/EEC tonational legislation) Advertising for alcohol must follow the principles outlined below: - no target populations under the legal age limit for consumption - no associations between consumption and any physical, social orsexual achievements, driving, or any therapeutic qualities. - no encouragement of immoderate consumption or use of a negativeimage of non-drinkers or sobriety. (European Forum on Alcohol andTobacco, December 11-13 1997, CFES) The autonomous regions have taken measures to limit advertising foralcoholic beverages. (ex. a ban on all TV Spirits advertising in theBasque Country).

ALCOHOL ABUSE PREVENTION MEASURES Governmental policy for the fight against alcoholism

There is no special agency responsible for alcoholism prevention. This is the responsibility of the Public Health Department, reporting tothe Ministry of Health and Consumption. Emphasis is placed on youngpeople and the student population. The same approach is utilized inthe fight against alcohol, tobacco and other drugs. Since 1989, this Minister has collaborated with the Ministry ofEducation, and also cooperates actively with the Autonomous Regions. The territorial structure of Spain, as defined in the Spanish Constitution

83

(Book VIII), has granted the autonomous regions a broad range ofpowers. External health problems – as defined in article 149.1.16 ofthe Constitution on basic legislation governing general health andcoordination of pharmaceutical products - are the exclusiveresponsibility of the government. The autonomous regions have theirown jurisdiction in the field of hygiene (Art 148.1.21 of the Constitution),but they are obliged to apply and ensure compliance with nationallegislation. Choices of prevention strategies for alcohol consumption must refer toactivities developed by the Central Government (Ministry of Health andConsumption), autonomous community governments (Health Board)and, for communication strategies, to local authorities (HealthCouncils). General policy: Prevention policies, while well-adapted to the country’s social,economic and cultural characteristics, should not divert attention fromthe considerable negative impact of excessive alcohol consumption. We are indeed confronted here with a public health problem withimportant implications in the areas of health, employment,transportation, commerce, justice and finance. There is thus no ideal way to address the problem, although anystrategy requires a global and multi-sectorial approach. Two complementary approaches are necessary: - reduction in overall consumption for the population as a whole, - actions specifically directed to heavy drinkers. Moreover, average consumption must take into account prevalence ofvarious alcohol-related problems (physical, psychological and social) inthe population. Any measure that may affect overall consumption will undoubtedly alsoimpact favorably on the prevalence of these problems. The following approaches are recommended: - information and education on health issues - reduction of availability and accessibility of alcohol - therapeutic intervention - community involvement Major educational campaigns have had a limited effect on alcoholconsumption, but they do increase public awareness of the problemand increase popular support for enforcement procedures. Over recent years, information campaigns implemented by the Ministryof Health have focused specifically on young people and students. Anagreement in this area was signed in 1989. Health education in theschools is common, supported by the educational and health systemswith the cooperation of autonomous regions. Over the past few years, anti-alcohol initiatives targeting young peoplehave increased on a national, regional, and local level. The Ministry of Health is developing prevention and educationalactivities within the framework of the Youth Program whose objective isto promote a healthy lifestyle and increase awareness of risks (alcohol,

84

drugs, cigarettes, road traffic accidents, unplanned pregnancies). The1994-1997 program has ended, and the new 1998-2000 program iscurrently being implemented. Prevention campaigns: Many campaigns have been carried out by the government as well asby autonomous and local authorities. Overview of these campaigns: - Targets: 61.5% target young people, 11.5% the general population,19% young people and the general population and 8% pregnantwomen. - Context: the anti-drug program at the level of autonomousgovernments and local councils. - The media: 73% of the campaigns use television and radio. - Content: information on problems related to alcohol, promotion of ahealthy lifestyle, and development of strategies to resist pressure,prevention of drunken driving and encouraging use of alternativetransportation methods, information on limits, limiting access to alcoholfor the youngest sectors of the population, information on treatmentcenters. - The messages: difficulty defining a healthy quantity of consumption.Messages are vary considerably depending on the targetedpopulations, and may focus on abstinence, awareness, mutual support,and moderation, among others. - Research: consumption and prevalence profile. Social and medicalrepercussions of alcohol consumption. - Treatment Primary care: There are health care services available to detect and evaluate alcoholconsumption levels and to help provide patients with information andadvice. Specialized care: Specialized health care units include health centers, hospitals, internalmedicine units, and detoxification units in certain hospitals - alcohol and driving Since 1962, an ongoing campaign has been implemented by roadsecurity authorities targeting the general public (television, radio, film,national press) and providing information on rsk (alcohol, speed, use ofseat-belt, etc.). Since 1992, a new activity has been developed to provide informationon damages caused by accidents as well as their social and familialconsequences. These campaigns are assessed yearly.

85

Non-governmental organizations - National Federation of Rehabilitated Alcoholics of Spain Therapy groups for alcoholics and their families. Information and prevention by alcoholics. - Alcoholics Anonymous Central Office Self-help groups; Conferences on independent therapy groups; Information; Conferences, conventions, and so forth; Information and prevention campaigns on alcoholism; Leisure activities that reinforce a community spirit; National conferences and congresses.

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PRODUCTION World Drink Trends 1997 in hectoliters 1980 1987 1995 1990 * 1996 ** Spirits 173 000

(pure alcohol) 609 000 657 805

Wine (hectoliters) - - 402 912 Beer (hectoliters) 3 759 000 5 305 000 4 711 000 4 150 048 * Meeting of national counterparts for the European alcohol action plan, June 1995 and ** Alkoholinspektionen (information provided directly by manufacturers. Note: spirit production corresponds tothe production of beverages and beer production includes three categories (light beer at 2.25% maximum, beer atbetween 2.25 and 3.5%, and strong beer at greater than 3.5% vol.). Production of beer 1991 1995 1996 1997 In 1,000 hl 4,738 5,309 4,805 4,858 Source: Les Brasseurs Européens CONSUMPTION In the general population Total population Population 15 years and

older World Drink Trends 1997 (b) 1975* 1990* 1995* 1996 1975 1990 1995 Wine (liters) 8.25 12.24 12.60 13.30 10.4 15.0 15.6 Beer (liters) (a) 60.20 59.80 64.50 59.10 58.2 58.0 66.8 Spirits (liters pure alcohol) 2.97 1.72 1.33 1.17 3.8 2.1 1.6 Total (liters pure alcohol) 6.30 5.50 5.20 4.90 7.6 6.4 6.2 (a) only beers above 2.5%. No data on low-alcohol and non-alcoholic beers. (b) Sales figures; CAN and National Institute of Public Health. Trends in alcohol and drug consumption in Sweden.Report for 1997 .

Spirits: 31% of consumption (in pure alcohol) in 1992 compared with50.7% in 1980. Wine: 29.1% of consumption (in pure alcohol) in 1992 compared with22.7% in 1980. Beer: 40% of consumption (in pure alcohol) in 1992 compared with26.7% in 1980

Changes in consumption from 1992 to 1997 (ten years and older)

Population in 1996: 8,9 million inhabitantsGeography: 24 subdivisionsCurrency: Swedish Crown (SEK)Gross National Product in 1997: 22.803 ECU per capitaLife expectancy: Men 76,5 years – Women 81,5 yearsMortality in 1997:1048,31 deaths per 100.000 inhabitantsMen: 46.700 deathsWomen: 46.600 deaths

Source: Eurostat

SWEDEN

87

Year Spirits Wine Beer Total 1992 1.96 1.84 2.53 6.33 1993 1.85 1.80 2.57 6.22 1994 1.72 1.86 2.73 6.31 1995 1.58 1.86 2.82 6.20 1996 1.45 1.86 2.60 5.90 1997 1.32 1.99 2.55 5.90

Official figures from stores, restaurants and bars. Undeclaredconsumption must be added to these figures. Official reports estimatethe latter at about 35% of registered consumption (illegal spirit stills,legal importation by individuals, alcohol consumption abroad, wine andbeer made in the home, smuggling). (CAN and National Board, Polling Instituteand TEMO)

Consumption of beer 1991 1995 1996 1997 In 1,000 hl 5,244 5,702 5,28 5,459 Per capita in liter 60.0 64.7 59.1 61.7 Source: Les Brasseurs Européens Consumption of wine 1994 1995 1996 In 1,000 hl 1,148 1,148 1,115 Per capita in liter 13.0 12.60 Source: L’Office International de la Vigne et du Vin By age group Age group / liter pure alcohol / year

1975 1994 boys

1994girls

1996boys

1996girls

12-15 years - 0.2 0.04 16-19 years - 2.9 1.60 4.9 2.2 20-24 years - 5.1 2.40 7.2 2.9 18-70 years - 7.1 2.50 7.4 2.9 Source: Polling Institute SIFO, TEMO, Swedish Council for Information on Alcohol and Other Drugs, Trends inalcohol and drug consumption in Sweden, report for 1997.

Developments over the past years: Sweden is among the European countries that consume the least. Over the past five years, there has been a slight decrease in total salesof alcoholic beverages. This decrease may have been compensatedfor by undeclared alcohol, mostly from legal sources. Note: True consumption is underestimated due to home-producedalcohol, tax-free sales, etc. Some believe that undeclared consumption

88

represents 25-30% of total sales. Between 1992 and 1994, alcohol consumption among adults andyoung people increased significantly (23% in young people between 16and 24 years of age) (National Plan of Action). On the other hand, consumption of unregistered alcohol must beincluded in the figures. Such consumption has probably increasedlately, at least for spirits. However, the proportion of non-registeredalcohol consumption in Sweden is unknown compared with othercountries. The unrecorded alcohol consumption in Sweden is highestfor spirits. It is likely that in countries with many independent alcohol producersthe proportion of unregistered sales of alcohol is extensive.

RISKS OF ALCOHOL ABUSE Swedish statistics (for 100 000

deaths linked to alcohol) (1) Report by Dr Sven

Andréasson, KarolinskaInstitute (2)

Years 1970 1990 1998 5263 deaths with: Total (number ofdeaths)

780 1877 1950

cancers - 964 (10 to 75%depending on type of

cancer) cirrhosis 8.12 7.58 6.67 168 (50%) road traffic accidents 7.5 8.2 5.2 310 (33%) alcoholism 2.79 4.53 3.27 503 (3) alcohol poisoning 0.29 (4) 1.90 1.38 other accidents - - - 693 (25%) suicides and criminalviolence

634 (40%) 86

(1) National Board of Health and Welfare, The National Causes of Death Register. Alkohol-ochnarkotikautvecklingen i Sverige, Rapport 97, Stockholm. Alcohol poisoning belongs to the ICD 980 diagnosticcategory, while alcoholism is classified as ICD 303. 1970 figures cannot be compared to those from 1990 and 1995. (2) These values, although old, may be used as a reference. Other official data are significantly underestimated. This table only includes detailed figures on deaths indirectly linked to alcohol, along with accidents and violence(totaling 2809 and 1723 respectively). The number of deaths directly linked to alcohol (alcoholism, psychosis,alcoholic poisoning on the one hand and cirrhosis, gastritis, cardiomyopathy on the other) total 731. (3) Deaths due to alcoholism, alcoholic psychosis and alcohol poisoning are included in the « alcoholism » categoryin this table. (4) According to statistics Sweden the low numbers are the result of the introduction of a new ICD-coding system.

Note: A large number of alcohol-related deaths are not reported assuch (« hidden population »). The real figure is estimated at between5,000 and 6,000 deaths per year due to alcohol (diseases, violence,accidents). In addition, the number of persons whose heavy drinkingthreatens to damage their health and professional status is estimatedat 300,000. Deaths attributable to alcohol:

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1974-1978: 3 per 100 000 inhabitants 1984-1986: 5.6 per 100 000 inhabitants Deaths from cirrhosis of the liver: 1974-1978: 12 per 100 000 inhabitants 1984-1986: 8 per 100 000 inhabitants 1992: 3 per 100 000 inhabitants* Deaths from alcoholism: 1974-1978: 3.5 per 100 000 inhabitants 1984-1986: 3 per 100 000 inhabitants (A hundred years with alcohol in Galliware Sweden and * SwedishAlcohol policy p37)

COSTS OF ALCOHOL ABUSE 1990/1991 Billion SEK Billion ECU Costs linked to production 20.10 2.32 production losses with: sick-leave mortality early retirement handicap others

54.90 17.10 14.80 13.10

1.80 8.50

6.35 1.98 1.71 1.51 0.21 0.98

cost of treatment with: medical social criminal protection

18.10 8.60 8.30 1.20

2.09 0.99 0.96 0.14

material damage with road traffic accidents others

2.00 0.75 1.24

0.23 0.09 0.14

cost of prevention with: prevention justice and police road safety others

4.90 2.45 1.47 0.49 0.49

0.57 0.28 0.17 0.06 0.06

BAE Johnson A (1992) 100 miljarder kostar supen, Göteborg: Sober.

90


The Alcohol Act 1994: 1738: regulation of conditions of sale foralcohol. 1974 law: 1738: access to alcohol All alcohol sales (wine, beer or spirits) of over 3.5% by a company orindividual are subject to delivery of a license granted by the NationalAlcohol Board The government holds a monopoly on retail sales through the RetailMonopoly Company (Systembolaget) *. There are currently 386 storesor outlets throughout the country. An authorization to sell alcohol in restaurants must be obtained fromthe local authorities. Restaurants that sell alcohol must also sell non-alcoholic beverages (1974 law: 1738 chapter 3 paragraph 6). Sale of beer at 3.5% or less is tacitly authorized if an authorization isgranted to a grocery store by the Public Health Committee (as is alsotrue for restaurants). Legal age limit for consumption of beverages containing 3.5% ofalcohol or more in public places: age 18 Legal age limit for purchasing alcohol: age 20 (1974 law: 1738Chapter 3 paragraph 8). Restrictions on hours of sale: - Sale of alcohol is authorized (in licensed restaurants) between 11:00and 01:00 (1974 law: 1738 Chapter 6 paragraph 4), but localauthorities may grant an extension until 05:00. - stores (points of sale) close on Saturdays and Sundays and are open from 10:00 to 18:00 - restrictions on points of sales: forbidden near schools or otherestablishments frequented by children. Since joining the European Union on January 1, 1995, Sweden hasbeen obliged to abandon the state monopoly on alcohol production.The government retains a monopoly on distribution of beveragescontaining over 3.6% of alcohol. Only certain shops belonging to thegovernment are allowed to sell these beverages. There is significantpressure from the Commission to oblige Sweden to give up thismonopoly. However, Sweden believes that this is the only means tocontrol excessive drinking and alcohol-related problems, and isunwilling to introduce competition and private interests into this sector.

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ALCOHOL AND DRIVING

Trafikbrottslagen (TBL) paragraph 4 of 1951: 649: severalamendments have been voted since this law was initially passed. Traffic Temperance Crimes Legislation dated February 1, 1994 Legal BAC limit: 0.2 g/l of blood since July 1990 Secondary limit: 1 g/l of blood Content of the law: - when driving with BAC limit of over 0.2 g/l: suspension of drivinglicense for a period of 2 months. - when driving with BAC limit of over 0.5 g/l: suspension of drivinglicense and cancellation of the license. - when driving with BAC limit of between 0.5 et 1 g/l: fine and prisonsentence of up to 6 months. When driving with a BAC limit of over 1 g/l (considered as a « seriouslyintoxicated » condition): serious fine and prison sentence of 1 to 2months (maximum 2 years). If there are serious injuries or death, thesentence may extend to 6 years. Budget for anti-alcohol programs: 2 500 000 ECU (not including cost ofpolice force) Total number of vehicles (all types included) on September 2, 1997: 5 370 338 with 3 731 489 privately-owned vehicles. Note: BAC testing has doubled between 1993 and 1994. By the end of1994, 1.8 million tests per year had been reported.

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ALCOHOL TAXATION Lag om alkoholskatt 1994:1564 Tax in SEK / liter / vol. % Tax in ECU / liter /vol. % Beer from 0.5 to 2.8% 0 0 over 2.8% 1.45 0.17 Wine (cider,...) from 1.2 to 2.25% 0 from 2.25 to 4.5% 9.20 1.06 from 4.5 to 7% 13.60 1.57 from 7 to 8.5% 18.70 2.16 from 8.5 to 15% 26.80 3.10 from 15 to 18% 44.50 5.14 Strong wines, etc. 1.2 to 15% 26.80 3.10 15 to 22% 44.50 5.14 Spirits 494 (per liter pure alcohol 57.1 (per liter pure

alcohol

VAT at 25% for all alcoholic beverages. High taxes on alcohol are an important part of the Swedish alcoholpolicy. The price of alcohol follows the level of general price increases. However, in reality the price of beer has tended to decrease since1990. For wine and spirits, the price has been decreasing since 1987.

ADVERTISING

The Alcoholic Drinks (Marketing) Act, 1978:763 (Applicable starting in January 1995) Advertising for all beverages containing over 3.5% alcohol is strictlyforbidden for all media (radio, television, films, dailies, magazines,billboards, sports sponsoring). The only exceptions include: a certainnumber of professional magazines, and restaurant and bar facilities(KOVFS 1979: 6 4.1) (Swedish Alcohol Policy, 1995). For light beer (between 2.25 and 3.5% alcohol), advertising is permittedbut subject to legal restrictions (inclusion of a message on moderation,for example). Restrictions on this type of advertising are currentlybeing revised, and will probably be modified by 1999. There are no restrictions on beverages with under 2.25% alcoholcontent. Advertising must be objective and moderate, both in terms of image

93

and text. Beer advertising is not permitted to target a population under age 20. Advertising is authorized in points of sale if recommendations areincluded (KOVFS 1979: 6). Note: access to satellite television has given Swedes manyopportunities to see advertising for alcohol on foreign channels. Inaddition, indirect advertising (travel agencies, luxury clothes, glasses,etc.) as well as sponsoring for sports events bypass regulations andrepresent a problem for Swedish authorities.

ALCOHOL ABUSE PREVENTION MEASURES Government policy in the fight against alcoholism

The general principle of the national anti-alcohol policy is to reduceavailability of alcohol and limit consumer demand. Sweden has joinedthe 1982 WHO project whose objective is to reduce alcoholconsumption by 25% by the year 2000, although this objective hasbeen officially recognized as unrealistic. Anti-alcohol policy is the responsibility of the Minister of Health andWelfare. Other ministers are responsible for enforcing laws and prevention. - Ministry of justice for legislation relative to drunken driving - Ministry of finance for alcohol taxation - Ministry of education and cultural affairs for information on alcoholand drugs in schools and for the general public. At a Parliamentary level, there are three committees each responsiblefor a given control sector: The Social Committee (prevention), theTaxation Committee (taxes), and the Justice Committee (drunkendriving). National organizations:

! National Public Health Institute: primary and secondary prevention,funding for research and preventive projects monitoring development ofalcohol and drug consumption

! The national alcohol board: licenses, control and statistics for sales! The National Board of Health and Welfare.! The Alcohol Retailing Monopoly: responsible for information on risks

related to consumption.! The Swedish council for information on alcohol and other drugs (CAN):

information, research and documentation.! The Alcohol Beverage Product Range Board: court of appeal for

decisions made by the Retailing Monopoly Company of the NationalAlcohol board.

! The National Board for Youth Affairs: questions relative to youngpeople The National Steering Group, created in 1994, is responsible for

94

implementing national policy. It reports to the Ministry of Health andWelfare, and since 1997 has been presided by the Minister of healthand welfare. The Group includes representatives from variousnational, regional, and local organizations, with a role in coordination ofprevention programs for alcohol and drugs. Its objective is to implement long-term prevention strategies designedto change Swedish behavior and prevent the rise of a new generationof heavy drinkers. Emphasis is placed on low-alcohol beverages and on limitingconsumption for each drink. The Retailing Monopoly Company, which holds a monopoly on retailsales, in addition to various associations and movements committed toencourage moderation, are trying to increase the popularity of low-alcohol beverages. Their objective is to increase sales of light wines,that is wines whose alcohol content is under 2.25%, to the detriment ofbeverages with a high alcohol content. In addition to national programs in the form of nation-wide informationcampaigns, priority is given to local actions (funding for actions carriedout on a local level and for organizations involved in prevention). Education of young people is important, either through training forpersonnel in contact with this population or information directlytargeting young people. There are special campaigns targeting on women. The National Board of Health and Welfare, responsible for treatmentissues, funds secondary prevention programs with medicalprofessionals. Experiments in prevention in professional contexts are ongoing. The fight against smuggling and violence is another important aspect ofSwedish policy. Reinforcement of customs controls has beenimplemented to fight against illegal alcohol sales, and areas at high riskfor alcohol-related violence are subject to increased police surveillance. There has been an increase in research funding, and updating andmonitoring of statistical data are important activities. An alcohol (and drug) research unit has just been set up under theresponsibility of the Stockholm University. It will coordinate researchthat up until now was carried out in many different academicinstitutions.

95

State subsidies State subsidies to associations working with social rehabilitation –38,130,000 SEK (4,407,496 ECU) * State subsidy to Swedish Council for Information on Alcohol and otherDrugs – CAN = 7,964,000 SEK (920,569 ECU) State subsidies to temperance associations and associations workingwith primary prevention through the State Committee for subsidies toassociations working with primary prevention = 18,247,000 SEK(2,109,194 ECU) Total = 64,341,000 Skr Project subsidies from National Public Institute = 10,000,000 SEK(1155.91 ECU) ** • *About 20,000,000 SEK (2,311,826 ECU) are grants to women

associations working with mistreated women and associationsworking with mistreated children. The remaining subsidy is allocatedto associations such as Links that work with the problems and socialcare of abusers. The subsidies are distributed by The NationalBoard of Health and Welfare.

• ** Subsidies for work done by associations working among childrenand youngsters from the State Inheritance Fund on alcohol and drugproblems.


PREVENTION Various organizations (such as ALNA) are involved in prevention ofalcohol and drug use in the workplace. The National Temperance Council of Sweden is an umbrellaorganization that includes all organizations playing a role in prevention.It brings together 14 temperance movements with a total of 221,000members, including the Christian committee representing the freechurches (about 250,000 members), the Swedish Church, and 24 localand regional temperance committees. Traditionally speaking, temperance movements recommend totalabstinence from alcoholic beverages. TREATMENT AND REHABILITATION Most of the treatment , is publicly financed, including that provided bynon-governmental organizations. A number of associations are implicated in treatment and rehabilitationas well as prevention. Twenty-seven associations (about 300,000members in women’s associations) cooperate with the WomenOrganizations Committee on Alcohol and Drug Issues (KSAN). SOCIAL PROBLEMS There are several associations ) that work with former alcoholics,

96

including "Links" (the Swedish association corresponding to AlcoholicsAnonymous), and Verdandi, which is connected to the labor party. The National Board of Health and Welfare finances NGOs involved intreatment, and the National Public Health Institute funds preventionactivities. The budget allocated to associations involved in primary prevention isapproximately 18.3 million SKr (2.12 million ECU), and a national boardis responsible for allocating funds. Funding for organizations involvedin secondary and tertiary prevention totals approximately 24 million Skr(2.77 million ECU).

Industrial contributions

In early 1997, a committee bringing together all actors implicated inalcohol was created, including production, insurance, and tutelaryauthorities. This committee is presided by the under-secretary of theMinistry of Health and Welfare and has two objectives:

! To arrive at a consensus on ways to influence the attitudes of thepopulation concerning beverages and to reduce relatedproblems.

! To launch a campaign against « home » production of alcoholicbeverages and illegal sales of spirits.

The Brewery Association is currently running, together with a non-violence organization run by young people that manages aninformation campaign on alcohol and violence among young people.

97

PRODUCTION in hectoliters World Drink Trends 1997 The Drink

Forecast Vol. 17,n°1, 1997

1980 1992 1995 1996 1996 * Purealcohol clearance

Spirits (pure alcohol) 4 876 000 815

Wine (hectoliters) - 15 882 Beer (hectoliters ) 64 830 000 55 887 000 56 800 000 2 285 (cider 283) Production of beer 1991 1995 1996 1997 In 1,000 hl 59,552 56,800 58,072 59,139 Source: Les Brasseurs Européens Production of wine 1994 1995 1996 In 1,000 hl 18 13 24 Source: L’Office International de la Vigne et du Vin

Population in 1996: 59 million inhabitantsGeography: 4 regionsCurrency: pounds streling (GBP)Gross National Product in 1997: 19.234 ECU per capitaLife expectancy: Men 74,4 years – Women 79,3 yearsMortality in 1997:1072,03 deaths per 100.000 inhabitantsMen: 301.700 deathsWomen: 330.800 deaths

Source: Eurostat

UNITED KINGDOM

98

CONSUMPTION In the general population (Liters per capita) World Drink Trends 1997

HMCustom in liters

andExcise of pure

(c) alcohol

1975 1990 1995 1996 1975 1990 1995 Wine 5.21 11.56 12.79 13.08 1.07 Cider 0.19 0.33 0.57 Beer (a) 118.50 113.20 100.90

(102.7 in the1995 edition)

102.80 5.64

Spirits (pure alcohol) 1.47 1.70 1.35 (1.33 in the

1996 edition)

1.39 1.90

Total (pure alcohol) (b) 6.80 7.70 7.30 7.60 8.80 9.28 8.92 (a) low-alcohol and non-alcoholic beer included (b) cider and fruit wine included (c) National data corresponds to the consumption of the over-14 population, with average alcohol levels per type ofbeverages as follows: beer (3.7% alcohol per volume), wine (12%), cider (4.2%) Consumption of beer 1991 1995 1996 1997 In 1,000 hl 63,038 59,129 59,894 61,114 Per capita in liters 109.0 100.9 102.3 103.6 Source: Les Brasseurs Européens Consumption of wine 1994 1995 1996 In 1,000 hl 6,732 7,392 7,243 Per capita in liters 12.0 13.0 12.5 Source: L’Office International de la Vigne et du Vin Total (in hectoliters) 1975 1990 1994 Wine 3 380 000 6 635 000 7 384 000 Beer 66 643 000 65 184 000 59 740 000 Spirits (pure alcohol) 841 000 988 000 886 000 Total per capita (purealcohol)

6 900 7800 7500

HM Customs and Excise

99

By age group Consumption(units/week) M F

16-24years

M F

25-34years

M F

35-44years

M F

45-54years

M F

55-64years

M F

65-74years

M F

Over 75years

M F

non-consumers 7 9 4 7 5 8 6 11 6 13 9 17 16 26 - from 1 1- 10 10-21

- from 1 1-7 7-14

7 32 22

15 41 20

5 32 22

16 43 19

7 32 23

15 43 17

6 33 22

19 38 17

9 36 21

24 39 12

16 38 17

33 31 10

20 36 16

21 38 16

over 21 over 14 31 15 36 15 33 16 32 15 28 11 20 9 13 7 Average/week 19.0 8.1 19.8 7.2 19.0 7.3 18.3 6.8 16.2 4.8 12.5 4.1 8.34 3.2

(OPCS, Health Survey for England 1993, HMSO 1995)

Excessive consumption/ Since 1984, the number of heavy drinkers has increased in both menand women. According to a 1994 study by OPCS, 27% of men and 13% of womenconsume more than threshold values. The heaviest drinking occurs inthe 25-34 age group for men and in the 35-44 age group for women.

Age group 1984

Men (a) Women (b) 1990

Men Women 1994

Men Women 18-24 35%

(11%) 15% (3%) 36%

(13%) 18% (4%) 35%

(11%) 20% (4%)

25-44 31% (8%) 11% (2%) 33% (9%) 13% (2%) 30% (7%) 15% (2%) 45-64 21% (5%) 8% (1%) 26% (6%) 10% (1%) 27% (6%) 12% (2%) 65 and over 12% (2%) 8% (0%) 14% (3%) 5% (1%) 17% (3%) 7% (1%) (a) consume over 21 units (more than 50 units) (b) consume over 14 units (more than 35 units) (OPCS Living in Britain, 1996)

In 16-24-year-olds, 32% of men and 17% of women claim theybecome drunk once a week on the average (compared with 12% and5% of the 16-64 year population.

100

Among young people Young people 11 years of age and younger Number ofunitsconsumedover the last 7days

7 years 8 years 9 years 10 years 11 years

0 68.3 76.9 55.5 63.8 53.0 57.6 37.7 41.7 39.1 44.2 1 unit 7.8 9.3 10.3 11.3 7.7 9.3 6.7 9.3 3.8 5.2 from 2 to 6units

from 7 to 10 2.7 1.8 5.1 3.6 6.9 5,7 10.9 10.2 11.5 10.4 from 11 to 14 1.2 1.0 2.6 1.4 3.7 2,3 6.5 5.0 8.8 6.1 from 15 to 20 1.2 0.3 1.8 0.9 2.6 2,1 5.3 3.8 6.9 4.2 Over 20 1.4 0.8 1.6 1.0 2.7 1.5 5.1 2.6 9.9 4.3 (Source: Balding - Exeter University, Schools Health Education Unit 1994)

The number of school-children whose consumption exceedsrecommended limits for adults was estimated in 1994 at 90,000.Consumption occurs essentially in the home or at friends’ houses.

Young people aged 11 to 15 years % having already consumed 11-12 years 74% 13-14 years 89% 15 years 96% (1997 study, European Alcohol and Tobacco Seminar, December 11-13 1997, CFES )

Among young people between the ages of 11 and 15, the percentageof those who drink every week has risen from 13% in 1988 to 17% in1994. Their level of consumption reached 5.4 units in 1990 and 6.4units in 1994. Alcohol consumption begins between the ages of 8 and 12, and themajority of 12-14-year-olds have some experience of drinking. Developments over the past years: Since 1982, consumption has stabilized. Beer remains the mostpopular beverage, although an increase in wine consumption has beenobserved over the past 25 years. The impact of « alcopops » onconsumption has not yet been evaluated.


Estimations of the number of deaths attributable to alcohol in GreatBritain (England and Wales) varies from 5,000 to 40,000 depending onsources (5,000 to 8,000 according to the Royal College of

101

Psychiatrists, 25,000 according to the Royal College of Physicians and40,000 according to the Royal College of General Practitioners). Alcohol-related deaths in England and Wales

1979 * 1988 1990 1994 1995 cirrhosis 1926 deaths

5.0 per 100 000

(men) 3.9 per 100 000

(women)

2801 deaths

6.1 per 100 000(men)

5.1 per 100 000(women)

3197 deaths

9.3 per 100 000(men)

6.2 per 100 000(women)

road trafficaccidents (%of BAC limitover 0.8

deaths (32% ) 5050 deaths(20% or 1010with BAC limit

over 0.8) **

760 deaths withBAC limit over

0.8


0.8


0.8

European Alcohol and Tobacco Seminar, December 11-13 1997, CFES * OPCS ICD 571 ** Department of Transport, 1988 Comments:! Cirrhosis: Beginning in 1979, pathology codes were used to quantify cirrhosis of the liver and chronic liver

diseases (ICD9 57) as such. Until 1978, estimations combined cirrhosis, alcoholism and other alcohol-relatedpathologies

- Since July 1984, alcohol-related deaths must be reported to the coroner. This practice has undoubtedly improvedthe reliability of death certificates- road traffic accidents: the official figure is considerably inferior to the reality. BAC limit testing not beingsystematic in the case of accidents, the number of deaths with BAC over 0.8 is probably higher than the officialstatistical figures, at about 20%. If we take into account pedestrian deaths with a BAC over the legal limit, thispercentage rises to 25. Furthermore, the percentage of road traffic accident deaths with positive BAC results thatare nevertheless under the legal limit is approximately 20%.

Cause of death 1970 1990 1995CancersICD 150ICD 155

no data 5924 6286

Cirrhosis 1392 3063 3612Alcoholism (ICD303,425,5, 305, 291, 980)

no data 540 873

Violence about 44% about 44% about 44%Other accidents about 30% of all accidents about 30% of all accidents about 30% of all accidentsFAS * about 30% of all accidents about 30% of all accidents about 30% of all accidentsSource: National Statistics and the * Royal College of Physicians

Total number of road traffic accidents (fatal, serious and light) withBAC limits over 0.8 g/l:1970: 363 000 (cannot be compared with the following years )1990: 20 4001995: 16 000(Source: Department of Transport, Road accidents, Great Britain, annual reports)

There is a one-thirds increase in deaths from alcohol-related hepaticpathologies between 1984 and 1994.

There are no direct statistics on illnesses or social problems related toalcohol, as these data are not collected in a systematic way. Mortalitydata remain controversial.

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Costs in 1990

Amount (millions of GBP) Amount (millions of GBP)Total 2461.42 3690.48with:Treatment 149.35 223.93Road traffic accidents/damage 138.62 207.93Social costs to industry 2122.14 3181.79Social costs/crime 80.07 120.05Prevention, research organizations 1.24 1.86(Social Costs of Alcohol: is it helpful to measure the social costs of alcohol used by Alan Maynard 1990


Licensing (Scotland) Act - 1976Licensing (Restaurant Heals) Act - 1987Licensing Act - 1988De-regulation Act - 1994 (authorizes magistrates to grant a« Children’s Certificate» to an « appropriate » pub, which allows theseestablishments to accept children under 14 years of age with adultsupervision. By the end of 1997, 3,530 certificates had been awardedsince January 1995.)

Mandatory license for shops and beverage distributorsLegal age limit for consumption: age 16 for beer and cider (with a meal)and age 18 for spirits and wine.Legal age limit for purchase: age 18 (penalty specified for infractions:400 pounds)Restrictions on hours of sale: open during the day for all days of theweek, including Sunday for pubs, with a later closing time on Fridayand Saturday, and flexible opening hours for shops.

Sale of alcoholic beverages is prohibited in sports facilities SportingEvents (Control of Alcohol etc. - Act 1985)

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ALCOHOL AND DRIVING

Road Safety Act 1967Transport Act - 1981Legal BAC limit: 0.8 g/lIntroduction in October 1967, of BAC level testing.May 1983: introduction of breathalyzers to test alcohol levels in exhaledairSpecified penalties:imprisonment for 6 months maximum and for up to 10 years in the caseof fatalities.Fine of 1000 to 5000 GBP (1500 and 7496 ECU).Suspension of driving license for 1 to 5 years.Experimental education/rehabilitation for drivers who violate the roadsafety code

Testing for suspect behavior or an accident.

Budget allocated to the fight against drunken driving: not availableNumber of vehicles in 1996: 26 302 000 (Transport Statistics in Britain)

Adoption of this law is estimated to have saved 5,000 lives and prevent200,000 injuries from 1967 to 1974. However, its efficacy slowlydecreased during the 70s. From 25% mortality on the roads prior to1967, the percentage fell to 15% in 1968 but rose again to 26% in 1971and 34% in 1974.The population of people 25 to 40 years old is the most heavilyinvolved in road traffic accidents with fatalities and alcohol.According to a 1990 study, 1% of 13,500 drivers tested between 19:00and 02:00 during the weekend had BAC levels over the legal limit.

ALCOHOL TAXATION

The United Kingdom is among the European countries with the highesttaxation rates.Breweries are exerting considerable pressure to decrease taxation onbeer, and are strongly opposed by health care organizations.

TVA: 17.5%

excise ratesSpirits (40%) 5.54 GBP (8.31 ECU) per 70cl bottleWine (11.5%) 105.3 pence (1.58 ECU) per 75cl bottleBeer (5%) 30.7 pence (0.46 ECU) per pint.

Taxation is heavy on beverages containing over 1.2% of alcohol.

ADVERTISING

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Alcohol advertising is subject to good conduct codes established byleaders in industry and advertising.

Advertising code of the Independent Television Commission andthe RA (Radio Authority) (application of the 1990 law on Radio andTelevision (1990 Broadcasting Act):Regulates the content of radio and television advertising: no targetingor inclusion of young people, no association of consumption withsuccess, no attribution of stimulating qualities, no association withdriving, etc.

(British Codes of Advertising and Sales Promotion datedFebruary 1, 1995 (latest revision) for other media (press, billboards,etc.)Alcoholic beverages: all beverages containing more than 1.2% alcoholper volume.

No printed media (magazines, newspapers, posters, etc.) may includealcohol advertising if over 25% of its reading public is under 18 yearsof age.

Advertising must not promote excessive consumption of low-alcoholbeverages.It must not give a poor image of activities that require completesobriety.

Sponsoring of sports events is authorized and subject to voluntaryrestrictions.

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ALCOHOL ABUSE PREVENTION MEASURES

Government policy in the fight against alcoholism

The Health Education Authority (HEA), an independent organizationfinanced by the government, is responsible for developing,coordinating and implementing anti-tobacco, drug and alcoholcampaigns.

National campaign to promote reasonable consumption.Assessment of the population’s awareness of recommended limits.

Education:National Curriculum Order for Science: children between the ages of 7and 11 must be informed on factors contributing to good health(particularly avoidance of substances such as alcohol), and childrenbetween 11 and 14 must be aware of the risks of alcohol abuse andthe effects of alcohol on the organism.


Alcohol ConcernAlcohol Education and Research CouncilDrinkline

Industrial involvement

In 1990, the Portman Group, an association of manufacturers,established the « Proof of Age » card to encourage compliance withthe legal age limit for purchase of alcohol. Available in points of sale, itattests that the age of the purchaser is 18 years or more.

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Société française de santé publiqueFrench Society of Public Health2, av. du Doyen Jacques Parisot

BP 7 F-54501 Vandoeuvre-lès-Nancy cedexFRANCE

Tel. (+33) -3 83 44 87 47 - Fax. (+33) -3 83 44 37 76email: [email protected]

Web pages: http://www.sfsp-publichealth.org

Daniel Oberlé, Executive Manager

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