The national policy toward alcohol and substance use among juveniles: The case of Iceland

Transcription

1 The national policy toward alcohol and substance use among juveniles: The case of Iceland Abstract In this paper, the Icelandic national policy toward alcohol and substance use among juveniles is presented. Apart from Denmark, Iceland has generally looked to the Nordic countries for guidelines in it s alcohol policy and, in recent years, to the guidelines of the World Health Organization. In accordance with Nordic ways, Icelandic alcohol policy has always been restrictive, with an emphasis on high prices (through added tax), low visibility and state monopoloy on the sale of all alcohol. A. Introduction Iceland is a small, Nordic island in the Atlantic Ocean, only 103 thousand square kilometers in circumference. With a population of only 317, 630 persons as of January 1, 2010, populated areas are few but widespread throughout the country. 63% of the total population live in the greater metropolitan area of Reykjavik, roughly 32% live in smaller cities and towns around the country and only 5% live in rural areas. While Iceland has, like the other Nordic countries, traditionally been very homogeneous in the ethnic and cultural composition of it s people, more and more immigrants and refugees are moving into the country. In 1996, 1,4% of the population in Iceland was of foreign origin compared to roughly 8% in 2010 (Statistics Iceland). Iceland has always had a strict position on alcohol and other mind altering drugs. In fact, the sale of alcohol was prohibited in the country between the years of 1912 to 1932 (the ban was partly lifted in 1922 with regards to ligher wine but lifted altogether in 1932) ( Iceland has been struggling with alcohol ever since, with the country divided between those who have a more lenient stance and those who favor status quo. Manufacturing and selling of beer was however not allowed until 1989.

2 B. State of the art : How big is this problem in Iceland? Table 1. Official data on alcohol use among Icelandic adults Adults Total Male Female Alcohol consumption (pure alcohol in litres a year) 7,53 Abstainers-alcohol ever - % 5,1* 3,7* 6,6* Alcohol use last month - % Binge drinking (drinking more than 6 glasses at a time) - % Heavy drinkers (drinking 6 or more glasses at least one day a week) - % Alcohol abuse (DSM-IV) - % Alcohol addiction (DSM-IV) - % Source: Statistics Iceland ,7* 89* 86* NA ** ** NA ** ** NA NA As is evident from the table above (table 1), alcohol consumption in pure alcohol litres in 2007 is 7,53 litres per adult. The main consumption is beer, since it became legal in Numbers of monopoly outlets has been increasing and are in the year per inhab. over 15 years old. Opening hours have also changed and increased. The consumption figures for males and females are from a public survey in 2004 where 2000 persons aged years old responded (61% response rate). That year 86% of the population had consumed alcohol in the last 12 months (unfortunately there is no data for the year 2007). The results of the survey indicate that men drink more than women. When consuming alcohol, men consume 4,8 drinks on average while women drink 3,2 drinks in average. Looking at those who consume 5 drinks or more at least once a week the gender gap widens even more with 11,6% of the male respondents and 3,3% of the female respondents falling into that category.

3 Table 2. Alcohol consumption figures in general, consumption rates per capita, expenditures etc. (sales) Year Pure alcohol litres Beer Wine (less than 22% alcohol content) Spirits Carbonated alcoholic beverages ,09 2,41 0,97 1, ,56 2,64 1,18 1, ,91 2,89 1,25 1, ,14 3,03 1,38 1,73 0, ,32 3,12 1,52 1,68 0, ,53 3,29 1,67 1,58 0, ,52 3,35 1,79 1,39 0, ,71 3,49 1,91 1,31 0, ,05 3,67 1,95 1,33 0, ,2 3,78 1,97 1,36 0, ,53 3,95 2,04 1,46 0,08 Source: Statistics Iceland 2007 As table 2 shows, alcohol consumption in Iceland is on the rise. It went from 5,09 pure alcohol litres per capita in 1997 to 7,53 litres in Looking at alcohol consumption by category of beverages, one can see that while the consumption of beer, ligher wine and carbonated alcoholic beverages is on the rise, the same cannot be said for spirits. In 1997, average consumption per capita of spirits was 1,72 litres compared to 1,46 litres in 2007.

4 Alcohol consumption among Icelandic youth In Iceland, a country with a rather homogeneous population of just over , substance use among adolescents rose gradually during the 1990s. The proportion of 10th graders reporting that they smoked cigarettes on a daily basis increased from 15% to 23% from 1992 to 1998; those admitting that they had ever used hashish in their lives rose from 7% to 17% during the same period. The 1995 ESPAD survey revealed that adolescents in Iceland and other Nordic countries were more likely to become drunk than other European teenagers. In addition, alcohol-related accidents or injuries were more common in Iceland than in most other places in Europe, with 14% of Icelandic adolescents reporting having had such an incident. These findings show that adolescent substance use was a problem in western and particularly Eastern European countries, and especially in Iceland (Sigfusdottir et al, 2009). The Icelandic model: Evidence based youth prevention policy In the context of increasing substance use among the youth in Iceland, a group of Icelandic social scientists at the Icelandic Centre for Social Research and Analysis (ICSRA), a non-profit research institute in the City of Reykjavik and now affiliated with Reykjavik University, along with policy makers and practitioners in the field, began collaborating in 1990s in an effort to better understand the societal factors influencing substance use among adolescents and potential approaches to prevention. This resulted in the development of an evidence-based approach to adolescent substance use prevention that involved a broad range of relevant stake holders who worked together on this community-based, socially embedded and highly participatory effort. The Centre for Social Research and Analysis has been in the forefront ever since in collecting data on alcohol and substance use among youth in Iceland (Ibid). Since these data were collected, Iceland has seen a steady decline in adolescent substance use (see figure 1). In % of Icelandic 10 th graders reported to have gotten drunk at least once in the past 30 days. In 2003 had reduced to 28% and in 2010 it reached the all time low of 16%. The same goes for daily smoking and the use of hasish. It is believed that the decline is in large part due to the assiduous

5 efforts by Icelandic authorities to both reduce risk factors and strengthen a broad range of parental, school and community protective factors (Ibid) % Have become drunk in the last 30 days Smoke cigarettes daily Have used hashish at least once in their lifetime Source: Centre for Social Research and Analysis - ICSRA Figure 1. Proportion of Icelandic 10 th graders who reported to have become drunk in the last 30 days, smoke cigarettes daily and have used hashish at least once in their lifetime, Heavy drinkers in Iceland and treatment clinics According to SAA statistics (National Center of Addiction Medicine) every year around 2000 persons are admitted to treatment clinics for alcohol and drug addicts in Iceland in addition to those seeking help in outpatient units. In this group of people, individual patients, or 80%, were admitted to SAA Medical Clinics in The needs of these patients are evaluated at Vogur Hospital and those seeking help are then directed to the appropriate treatment venues. SAA runs a hospital and a detoxification clinic, Vogur, two outpatient units, two treatment clinics, three recovery houses and a social center. Around one hundred people are employed by SAA. Of those approximately two thousand individuals that enter the detoxification program each year, around eight hundred then continue in

6 the treatment program. Several thousand alcoholics, along with their friends and relatives, take advantage of the services offered by the SAA outpatient units and recovery houses each year. SAA's annual budget is around 500 million Icelandic kronur (approx. USD 6,0 million). According to SAA, many individuals who are admitted to treatment clinics, get reemitted, even numerous times. In the table below one can see that in individuals have been admitted once while 6412 have been admitted 2-5 times ( ). Re-emittance to Vogur treatment clinic Men % Women % Total % % % % % % % 342 7% % % 153 3% 622 4% Total

7 C. Policy toward alcohol and drugs: What is done on alcohol? A policy-typology and description Policy toward alcohol No Yes P. soft drugs No Yes Zero tolerance x Zero tolerance x Harm reduction x Harm reduction x Supply reduction x Supply reduction x Demand reduction x Demand reduction x In general, Icelandic policy toward alcohol can be described as a supply reduction policy (supply restriction) along with some emphasis on demand- and harm reduction. Officially this policy is mostly enforced through the restrictive sale of highly taxed alcohol (and restrictive access to it) public education on health- and social related problems of alcohol consumption, and treatment clinics for alcohol and drug addiction. In the past 15 years or so, the alcohol and substance use policy has grown increasingly evidence based, especially in the field of adolescents. Restrictive sale and access to alcohol in Iceland Restrictive sale of alcohol in Iceland can be traced back to the year 1912 when Icelandic authorities prohibitied all imports of alcohol into the country. Two years later this ban was extended to a total prohibition of alcohol sale in the country that lasted until 1922, when the government allowed alchohol sale in state-run alcohol stores only, except beer (beer was considered a gate-way beverage to heavier drinking among teenagers). Despite severe debates on the issue (will be discussed later), this state monopoly of alcohol sale is still in effect in Iceland (Olafur Haukur Arnason, 1988). At the founding year of The State Alcohol and Tobacco Company in Iceland (SATCI) in 1922, 7 state-run alcohol stores were opened. In 2010, there are 47 state-run alcohol stores in the country, 12 in the greater metropolitan area of Reykjavik and 35 spread around other areas in the country. While it is normal for the number of alcohol stores to grow in accordance with the growing number of people, the number of alcohol stores has by far exceeded the rate of population growth. In

8 1922, there was one alcohol store for every 13,597 persons. In 2010, this has been cut by more than half, to 6,758 persons per one store. In addition to the increasing number of alcohol outlets in the country, the sale of beer has been legalized along with the lengthening of opening hours (to eight o clock at night in some stores), and increased quality of service, such as on-thespot expert advice on wine selection. Also, the SATCI offers those that live further than 25 km away from the nearest alcohol outlet a free home delivery of alcohol. Beer was also legalized in 1989, af a hars debate for years (Ibid). Taxation of alcohol has been strictly enforced in Iceland. It is believed that high prices will prevent people from buying large quantities of alcohol, and therefore, reduce the frequency of intoxication. At the same time, taxing alcohol generates additional income for the state to use in it s harm reduction approaches such as maintaining treatment clinics and providing councelling for those in need. The taxation increases with the percentage of the alcohol content in the beverage, e.g. the more the alcohol content, the more it costs ( While Icelanders become full legal adults at the age of 18, legal drinking age and purchasing of alcohol is 20 years. This has been much debated through the decades but no changes have been made so far. Access to alcohol One of the main aims of state monopoliy on alcohol retail in Iceland is to limit youth social access to alcohol. This is being enforced in three ways. 1) First and foremost it is believed that state-run alcohol stores are more likely than private retailers to act responsibly towards youth, such as enforcing a strict ID (personal identification) policy. 2) Secondly, by confining alcohol to specialty stores it is hoped that Icelandic youth will be less aware of alcohol than if it were sold in regular supermarkets. 3) Thirdly, all advertising of alcohol with over 2,25% alcohol contents is forbidden in media. This is to hinder Icelandic youth from becoming knowledgable about alcohol and, therefore, desire it less (i.e. the visibility of alcohol is recuded).

9 Demand reduction: Education The government provides for education on the harms of alcohol and drug use in Icelandic schools and health clinics throughout the country. The education is being handled by 1) teachers, 2) nurses and nurses aids, and 3) specially trained police officers who travel from school to school to give lectures and/or handing out informative pamphlets. The schools attempt to educate the kids directly while the health clinics are more focused on the adults, such a expecting mothers and the parents of very young children. In addition to these standard education practices about the harms of alcohol and drug use, the government also lounches from time to time short term propaganda programs designed to reach the widest audience possible, such as visiting adult work places, and using media for advertising (see The Public Health Institute of Iceland online: Harm reduction Icelandic harm reduction approach is mostly enforced through extensive police surveillance in traffic in order to catch those who drive under the influence. Originally the main emphasis was on catching these drivers but over the years the measures also include prevention efforts, such as increasing police visibiliy on the roads and the use of surveillance cameras. In The Icelandic Health Plan the importance of prevention programs among Icelandic youth is stressed. The policy s main goal is to reduce the consumption of alcohol by restricting access to it and increase education on the harm of alcohol in Icelandic grade schools, health clinics and media ( The goals are: 1) reduce alcohol consumption of inhabitans 15 years old or older to an annual average of no more than 5,0 liters of pure alcohol and eliminiate alcohol consumption among those younger than 15. 2) Reduce consumption of alcohol and other drugs of those who are under aged by 25% (under 18 years) 3) Increase the availability of treatment clinics for alcohol and drug addiction.

10 In the formation of their alcohol policy, Icelanders have looked to the practices of other countries, mostly Norway, Sweden and Finland, and to the guidelines of The World Health Organization (WHO). The Nordic countries, with the exception of Denmark, have throughout most of the 20th century carried out alcohol policies with high taxes and the restriction of availability as central components. Other than in Denmark, alcohol controls are still quite stringent by international standards. Most policy changes in the Nordic countries (other than Denmark) have involved beer, not spirits or wine. The Nordic countries are located in the middle of the spirits belt and were traditionally spirits drinking countries. The consensus on the regulation of spirits has hardly been disputed. The conflicts on alcohol policy controls have therefore revolved around regulation of the weaker beverages. As was stated earlier, beer, usually the weakest beverage, has often been seen as a stepping stone, a threshold from the sober to the drinking world. More than any other alcoholic beverage, beer tends also to be linked to youth, a group that generally is perceived as a legitimate object of control (Olson, Olafsdottir & Room, 2002). Policy (alcohol use regulations by law) Alcohol Age limit Minimum age to purchase 20 Possession a criminal offence NR Consumption a criminal offence NR Purchase a criminal offence NR Jurisdiction of legislation NR = no restriction, = absolute restriction Soft drugs Minimum age to purchase Possession a criminal offence Consumption a criminal offence Purchase a criminal offence Jurisdiction of legislation Age limit Hard drugs Minimum age to purchase Possession a criminal offence Consumption a criminal offence Purchase a criminal offence Jurisdiction of legislation Age limit

11 Current debates While there has always been a consensun on the restrictions of spirits in Iceland, there have been growing debates on the legal drinking age and the abolition of the state monopoliy of wine and lighter alcoholic beverages. Numerous proposals on the lowering of the drinking age to 18 years and to allow grocery stores to sell wine and lighter liquor have been put before the Icelandic parliament in the past few years. None of these proposals have been passed as law. These debates are generally harsh, and center around the left/right axis in politics. Right wing activists are (mostly) in favor of the abolition of the state monopoly while left wing/center activists are against it. The drinking age issue is not as clear cut as the state monopoly, at least not when it comes to ideology. The fear that youth will drink more heavily once the drinking age has been lowered, has overruled the efforts to changes (Hildigunnur Olafsdottir, 1998).

12 References Hildigunnur Olafsdottir (1998). The Dynamics of Shifts in Alcoholic Beverage Preference: Effects of the Legalization of Beer in Iceland, The Journal of Studies on Alcohol and Drugs, 59. Room, Robin, Hildigunnur Olafsdottir and Borje Olsson (2002). Introduction chapter, in Robin Room (ed.)the effects of Nordic Alcohol Policies. The Nordic Council for Alcohol and Drug Research (NAD). Sigfusdottir, I.D., Thorolfur Thorlindsson, Alfgeir Logi Kristjansson, Kathleen M. Roe and John P. Allegrante (2009). Substance Use Prevention for adolescents: The Icelandic Model, Health Promotion International 24,1. Statistics Iceland. Statistics on Alchol Consumption (measured in sold litres),