Wednesday, 17 August 2011

America redefines alcohol addiction, Ireland redefines denial

Ireland has a lot to teach the world about alcohol, but perhaps not in the way it thinks. Having consulted 80 experts over four years The American Society of Addiction Medicine has published a new definition of addiction.  It confirms what, as the Los Angeles Times puts it, 'neuroscientists have been saying for years- that addiction is a chronic disease of the brain. There are stacks of studies to back up the chronic-disease theory – changes in brain circuitry, changes in the way that genes in the brain are turned on or turned off ...even after a person has given up a habit'. The new definition acknowledges the behavioral aspects of addiction, but concludes that “addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry”.  In other words addiction is not a matter of predisposition but is a condition caused by the consumption of addictive substances.

Professor Patricia Casey disagrees

 'But just because something’s widely accepted professionally doesn’t mean it’s widely accepted out there in the world', the Los Angeles Times continues. Sure enough in Ireland, the new home of alcoholism, Professor Patricia Casey is reported in the The Irish Examiner proving just that.  She tells us that the new definition is an "over-simplification" of the problem'. "By speaking of addiction as simply a brain illness we are in danger of being over-simplistic and of removing choice from our understanding," said Prof. Casey.  "It is important that those who are addicted accept that they have a choice and realise that, unlike certain mental illnesses, such as schizophrenia, their behaviour is not in the first instance determined by the neurochemistry," she said.

The personal choice argument suits Prof Casey's views but doesn't answer the facts.  Prof. Casey was criticised for over-extrapolating facts before, but in this instance she seems to be ignoring the research in favour of a message also spun widely by the alcohol industry.  As David Poley of the Portman Trust puts it, 'it is only through education, coupled with targeted interventions against misusers, that we shall ultimately change the drinking culture'. Or as drinkaware advise 'a predisposition towards alcohol can be inherited, or shaped by family attitudes ... occupations, such as high pressure sales jobs or ...people living through stressful events... may find they start to drink more heavily'.  In other words,  the industry want us to believe that the problem with addiction lies not in the substance but in the user.  Alcohol, they imply,  is not really an addictive substance at all, and the 'misusers' who let the side down for the safe-drinking majority are weak minded, emotionally damaged or just having a hard time. 

So are people cured of addiction, as Professor Casey is arguing, because they can choose to be unaddicted?  Or are they, as the new American Society definition says, struggling with an 'addiction characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response'?  Science, when not sponsored by the alcohol industry itself, supports the latter view.  Alcohol addiction 'at its core' says leading expert Professsor Nutt, is a 'state of altered brain function that leads to fundamental changes in behavior that are manifest by repeated use of alcohol'. Over time cravings and behaviours over-ride common sense until 'the situation is compounded by the occurrence of withdrawal reactions which motivate desperate attempts to find more of the addictive agent'.

Ireland itself now offers proof that it is wide availability coupled with a general acceptance of the over-consumption of alcohol that primarily drives addiction in society.  The government took the advice of the alcohol industry to heart in 1992 when it began a process of deregulation of sales and marketing restrictions and fell for the charms of 'self-regulation' lobbied for by a strong alcohol producing and publican's sector.  Since then alcohol consumption and alcoholism have rocketed.  In 2007 a European report found that while 19% of Germans, for example, drank too much 36% of Irish people binge every week and 72 % abuse alcohol on a regular basis.  And this year a European police study found that while on average one in fifty drivers across Europe are drunk, Ireland boasts on in eight. Or to take other figures from Europa, abstainers represented 39% of the Irish population in 1992, 17% in 1998 and 16% in 2002, and by 2007 only 11% had not actually binged during the last year.

So does Professor Casey think that this is explained by a collective 'choice' to drink more alcohol by more of the population?  During this time many socal changes have taken place, but nothing in Ireland's history seems to explain our unique and rampant alcoholism more than this deregulation which mirrors Ireland's other world class disaster, the deregulation of the banking sector over the same period.  It looks very much as if  the long term result of unregulated advertising, marketing and availability of alcohol has resulted in widespreaad addiction.  As the new definition puts it 'early exposure to substance use is another significant factor in the development of addiction'. Yes, Ireland has certainly managed that.

Wednesday, 3 August 2011

One in eight drivers in Ireland are drunk. Are the roads safe?

Superficially it seemed like a good year for road safety in Ireland.   The recession and emigration meant that traffic, and therefore road accidents, were down last year by 48% from ten years ago, (though up again in the first half of this year).  New legislation is set to enforce a lower drink drive level at 50mg, down from 80mg, to comply with European recommendations, and random breath tests are also to be implemented, which are known to reduce incidents of drink driving. 

But dig deeper and the story is not good.  There is little evidence that the legislative changes will be enforced.  There is neither the money nor the will to increase garda numbers or to supply gardai with the breath testing equipment that will make the changes possible.  Drink driving is responsible for one in three road accidents, but according to Alcohol Action Ireland 'nine out of ten drivers who survived crashes where someone died were not tested for alcohol while more than a third of drivers killed in crashes were not tested.' 

Even amongst the few drivers actually tested, conviction rates are poor.  As reported last August in the Sunday Independent 'almost one-in-five people arrested and charged with drink driving were not convicted'.  The Cavan/Monaghan district and Waterford city had the lowest conviction rates at 75 per cent, and Donegal, 'regarded as having one of the worst road safety records in the country, also had one of the lowest conviction rates, with only 79 per cent of those charged with drink driving being convicted'.  Of those actually sentenced, only 679 received prison sentences compared with 9,275 being fined or 112 given a community service order.  Amongst those apparently drink-driving were a TD who threatened a Garda for stopping him leaving the Dail, the wife of the current Minister for Justice and the Superintendent in charge of  the Garda Traffic Division who was driving a police car at the time.  Justice was swift and tough.  No action was taken for the TD, the politicians wife was fined and 'the Garda traffic superintendent 'suddenly retired' after his arrest and 'will get a 'golden handshake' of over €138,000 and a pension of more than €46,000 for the rest of his life'.

Seven times the European average for drink driving
The new legislation will actually make penalties much lighter for most drink drivers. 'Drivers caught with between 50mg and 80mg will receive a €200 fine and three penalty points if they do not challenge the penalties in court.  This is the first time in Irish history that a drink-driving conviction will not result in an automatic driving disqualification'.  So with little chance of being caught and a flat €200 fine with no questions asked if you are, it is not surprising to find Susan Grey, spokesperson for road safety group Public Against Road Carnage, saying that 'Ireland is still ambivalent about drink driving. "The drink-driving culture is still here and will remain here until people see a higher enforcement of the law.  We're seeing less and less checkpoints on the road and as well as that people aren't scared of getting caught."

With consequences like these, no wonder that Tispol, the European Police Traffic Network, found shocking evidence in its Europe wide check on drink driving, which saw police conduct 'almost one million breath tests in a seven-day period across 28 countries, of which more than 17,000 were positive'.  Having failed to supply figures for the previous Tispol survey, this time Ireland disgracefully and spectacularly topped the poll.  As reported in The Irish Examiner  'the rate of detection in Ireland for drink-driving was the highest among the states surveyed and more than seven times the European average. More than 13% of motorists tested here during the operation were above the legal drink-driving limit compared to the European average of just under 2%'.  Ireland also had the highest drug-driving rate at three times the European average, with 0.6% of drivers stopped showing positive.

Road safety experts blame 'a core group', and granny
What is equally alarming is the attitude of the Road Safety Authority whose chief executive Noel Brett told the Examiner that he was concerned about 'the high detection rates, particularly given that the drink-driving limit in Ireland is higher than most other EU countries'.  The Irish limit was in fact raised only recently to meet the European norm last year, but has not yet been enforced.  It is not the 'detection rate' that is worrying, it is the drink driving itself.  The detection rate, outside of this special TISPOL operation, is clearly not good and with one in eight drivers now drunk at the wheel word has clearly got round amongst drivers that there is very little chance of prosecution.

Nevertheless Mr Brett thinks that there is just "a core group of motorists who habitually persist in driving after consuming large quantities of alcohol".  How does he know? Are they all personally know to him?  Or is it because he knows that the courts are routinely letting convicted drivers back behind the wheel for another go?  His point seems to be that the hard drinkers are spoiling it for the rest who just like to offend occasionally.  Which fits with the views of a number of TD's who routinely pop up to defend the rural pub, or coroners like Dr Denis McCauley of Donegal, home of unsafe motoring, who argued 'that lowering the limits "would have a very negative affect on social interaction in rural Ireland", and called for further studies and consultation before enacting the measures'.

In fact the RSA itself seems determined to be kind to ordinary, decent drink-drivers. At a TISPOL road safety event hosted in Dublin in October the RSA claimed that the problem is not really the drinkers after all.  It is the 'largely undetected' number of drivers in Ireland with drugs in their system.  These, the RSA says, are 'now almost as big a problem as those engaged in dangerous drink driving'.  And this view was echoed by T.D.'s who raised the issue of drug-driving repeatedly in the DaĆ­l debate on road safety in May, managing to mention drug-driving 65 times, as many times as drink-driving was raised during the same debate.  But despite expert witness Professor Denis Cusack of the Medical Bureau of Road Safety's colourful description of 'the 19-year-old out of his head on speed or doped up granny on medications', it is hard to see how the 0.6 % of drivers on drugs equals the 13% on drink.  Drink-driving is twenty times the problem.  I'll take my chances with granny. 

However, in the interests of fairness, these doped up senior citizens were apparently treated nicely by the authorities too. 'Of 1,500 people tested positive for drug driving last year – just 831 were prosecuted'.  So that's alright then.