Findings of the Irish National Drug & Alcohol Survey: would we ‘rather hide away the ugly reality’?

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This week saw the publication of the 2019-20 Irish National Drug and Alcohol Survey by the Health Research Board. 

The survey collections information on alcohol and tobacco consumption and drug use among the general population in Ireland. The 2019–20 NDAS collected information from 5,762 people aged 15 years and older across Ireland. 

There are many shocking statistics contained in the report relating to alcohol harm, but let’s start with one. For the first time – using a new analysis based on the DSM Five (Diagnostic and Statistical Manual the HRB found that the prevalence of alcohol use disorder (AUD) in the general population to be 14.8%, corresponding to one in every seven – or 578,000 adults in Ireland. According to the HRB, this means that about 1 in 5 drinkers (20%) have either a mild, moderate or severe AUD (11.6%, 5.4%, and 3.1%, respectively).  

This is quite an extraordinary figure! And what concerned has been raised? None. To paraphrase a recent contribution from an MP in the House of Commons, Dan Carden, we would ‘rather hide this ugly reality’. The deafening silence is the river of denial of our nation’s problematic use with alcohol.  

Breaking it down further over 8% of the drinking population, have a moderate or severe AUD While smaller in number this still equates to around a quarter of a million of our citizens many of whom might be expected to seek help. Among our youngest drinkers, 18-24 years old, AAI estimate that 45,000 young lives have fallen victim of Ireland’s most common drug. Yet, across all ages, only around 3,500 new presentations gained access to alcohol treatment services last year. 

But beyond this dreadful gap in timely treatment services there is also another, even larger cohort – over half of all drinkers, who seem unaware of their hazardous use of alcohol. This points to the need for much greater public awareness about the risk of drinking alcohol. 

Because not surprisingly, as the report notes, alcohol-related harm is most common among those with problematic drinking patterns. Those with AUD – at any point along the spectrum – are thirteen times more likely than low-risk drinkers to experience health issues, being involved in an accident or in a fight, experiencing role impairment, or negative impacts on their home life. 

On the lower end of the spectrum, this means things like missed work days, perhaps falling out with friends or family and a general loss of creative potential. At its worst this means an impact on health, increased risk of domestic abuse – either as a victim or perpetrator, and an increased risk of mental health problems, not just for the drinker but for his or her family members.  

Given the serious fallout from alcohol harm, one might wonder why more is not said about it; why is there never any reflection on the harms caused or the significant loss of creativity, enterprise or talent to our society that is self-evident in these figures. 

Unfortunately, the issue of alcohol-related harm simply does not get the attention it should. There is a myriad of reasons for this, not least because we have allowed the alcohol industry to be our adviser and educator. Their line: drink responsibly (the implication being: if you don’t, well, that’s your fault not ours!) has for years given an ambiguous message about alcohol. This unfettered marketing and promotion, coupled with a lobbying influence that transform economic power into political clout, has sustained the producers’ profits to the detriment of public health. 

This is changing thanks to the passage of the immensely important Public Health Alcohol Act. Although implementation is slow, the Act aims to advance better public health outcomes and bring momentum to a generational step change. 

What is required – to go hand in hand with the legislative changes that are afoot – is public awareness campaigns to counter the lifestyle myth that has been sold by the alcohol industry. Their largely unchallenged narrative beats a drum of positivity, success, togetherness, happiness, with no mention of the consequential harm to health, damage to relationships and great cost to the public purse. 

Indeed, such is the gap between the marketing of alcohol and the information about its harms, one might question, in such an environment, what chance does anyone have to develop a low-risk engagement with alcohol? 

This is further hampered because at a political level, the issue is not given the attention or resources it requires. Alcohol’s inclusion in the National Drugs Strategy was arguably an afterthought, and as the HRB report highlights:  “illegal drug use is the primary focus of many of the actions of the current strategy.”   

This is despite the fact that time and again, report after report, finding after finding, data shows that alcohol is Ireland’s biggest drug problem. Such denial is difficult to comprehend.  

AAI believes that in order to drive change in this arena of public health, Ireland urgently needs a dedicated national alcohol strategy and a Statutory Office, with delegated powers, budget, expertise and adequate resources to drive its delivery for a whole of population and generational change. 

As stated by the World Health Organisation, national governments should promote leadership, awareness and commitment in delivering public health measure to reduce alcohol harm. 

Ireland has a strong history of setting up statutory structures to deal with serious public health issues. For example, the National Office for Tobacco Control and the Road Safety Authority were both set up to deal with issues deemed national crises due to the number of deaths from tobacco use and from road fatalities.   

How many more shocking statistics around alcohol will we ignore before action is taken?