In a comment piece, international scientists argue that added sweeteners pose dangers to health that justify controlling them like alcohol. Here  Australian experts puts the arguments into context for Australian readers.

Feel free to use these quotes in your stories.  Any further comments will be posted here. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Prof Kerin O’Dea is Director of the Sansom Institute for Health Research in the Division of Health Sciences at the University of South Australia

“I agree with Lustig et al that added sugars in western diets are problematic.  I am quite comfortable with dietary sugars if they come from whole foods (i.e. fresh fruit and some vegetables) – as the sugar is diluted with water, fibre and a range of other nutrients.

With added sugars (in many drinks and an ever larger number of processed foods) the sweeteners are extra calories.  Sucrose is a disaccharide comprised of one molecule of glucose and one molecule of fructose. Glucose is an important energy source for most cells in the body. In contrast, fructose is taken up primarily by the liver  – and if you are over-consuming energy then it is converted efficiently to fat.  If you do not over-consume energy then fructose is not a problem.  However, added sugars are mostly in energy-dense processed foods or added to drinks, and frequently are over-consumed.

Much used to be made of the fact the fructose does not elicit significant insulin or leptin responses (low GI)  – however, it is now recognized that these two hormones are important satiety signals for the brain. Because of this I argue that fructose ‘gets under the satiety radar’.”

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Prof Leonie Segal is Foundation Chair of the Health Economics & Social Policy Group at the University of SA, with an international profile in the economics of nutrition. She was a member of the Ministers Preventative Health Taskforce

“A focus on added sugar is most timely, with increasing evidence of its negative health effects.

The public health arguments for intervening are indeed strong, with perhaps the most important consideration, not highlighted by the authors, the imperative of governments to protect vulnerable members of society, especially where the capacity for well-informed decision making is limited or non-existent.

Because eating habits and taste tend to be influenced by what we eat as infants and young children, an unhealthy habituation or addiction to sugar, which influences lifetime health, can be established from a very young age when the ability and capacity to make informed eating choices are simply unavailable. This provides a strong case for governments to intervene to encourage healthy food choices, by children and thus families. And as the authors argue excess sugar is a crucial aspect of current poor food choices and thus an important focus of such policies.

While at its extreme alcohol may have more damaging effects than sugar, excessive consumption of sugar is considerably more prevalent than excessive alcohol consumption, part of the reason why population level strategies make sense.”

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Prof Peter Clifton is Head of Nutritional Interventions at Baker IDI Heart and Diabetes Institute

“Alcohol toxicity is not just metabolic  – it causes violence and road deaths and sugar in any of its forms cannot compete with this statistic. Almost all of the evidence against sugar is epidemiological  – that is association not necessarily causation.

In intervention studies with fructose, up to 10% of calories show no metabolic effects while a few studies with fructose at 25% of energy do show a modest increase in triglycerides but not high enough to cause pancreatitis.

There are no controlled interventions that show feeding fructose or sucrose causes hypertension and none that show that a controlled reduction in sugar alone reduces blood pressure. However, there is evidence to show that increasing sugar-sweetened beverage intake does cause modest weight gain as the liquid calories are not compensated by a reduction in calories from other foods.

Sugar is just another form of over-consumed calories  – easily available and very palatable but no more metabolically deadly than starch or fat calories and certainly not equivalent to alcohol.”

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Dr Alan Barclay is an accredited practicing dietitian and nutritionist, Chief Scientific Officer for the Glycemic Index Foundation Ltd and head of research at the Australian Diabetes Foundation

“This commentary is a provocative piece intended to encourage debate. Many of the statements simply do not apply to Australia and on certain issues there is little evidence to support their views. ‘Sugar’ is not the issue, it is far more complicated than that.

The authors state that over the past 50 years, consumption of sugar has tripled worldwide. However, in Australia sugar consumption has dropped 23% since 1980. Despite this, during that time cases of overweight or obese people have doubled, whilst diabetes has at least tripled.

The authors believe that attention should be turned to ‘added sugar’, which they have defined as any sweetener containing the molecule fructose that is added to food in processing. The authors suggest that fructose can trigger processes that lead to chronic diseases including liver toxicity, however one would need to eat at least 135g, or about 32 teaspoons, of pure added fructose per day on top of what one already eats. Only one per cent of Americans eat more than 100g per day of total fructose. The only disease proven to be related to excess frequent sugar consumption is tooth decay  – a significant problem  – but even then, refined starch is at least equally as cariogenic but is rarely acknowledged as a problem.

Lustig and his colleagues claim that sugar should be regulated like alcohol because it is unavoidable, toxic, has potential for abuse and has a negative impact on society. However, it is certainly not unavoidable, it is only ‘toxic’ in unrealistic amounts and to suggest that consuming sugar is a form of abuse is one of the worst cases of puritanism that I have seen in a while. It’s worth noting that soft drinks and other non-core ‘party’ foods are already taxed (GST) in Australia.

Just like anything else, sugar should only be eaten in moderation. As we continue our research we are finding out more and more about the importance of refined starch and specific fatty acids and the average Australian can do a lot to improve their diet, but casting sugar as the ultimate villain and calling for regulation is misleading, unfounded and unnecessary.”

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[*The toxic truth about sugar, A Comment piece, Lustig et al., Nature, 2012 (482), pp27-29]

US researchers have studied over 121,000 nurses enrolled in the US Nurses’ Health Study which started in 1976. They compared the drinking habits of women when middle-aged with their later health status. The research suggests that women who had one standard drink of alcohol a day may be healthier than their peers who did not drink at all, who consume more than two drinks a day, or who consume four drinks or more at the one time. Australian experts provide comment on these findings and discuss the implications.

*Alcohol Consumption at Midlife and Successful Ageing in Women: A Prospective Cohort Analysis in the Nurses’ Health Study, Sun Q et al., PLoS Med, 8(9), 2011: e1001090. doi:10.1371/journal.pmed.1001090 will be published in the PLoS Medicine at 7am AEST Wednesday 7 September 2011.

Feel free to use these quotes in your stories. Any further comments will be posted here. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Professor Mike Daube is Professor of Health Policy at Curtin University, WA, where he is Director of the Public Health Advocacy Institute and the McCusker Centre for Action on Alcohol and Youth

“The reported benefits come from drinking at just about the lowest possible levels for regular drinkers – below even the upper levels recommended by the NHMRC [National Health and Medical Research Council].

This research will clearly need to be examined alongside all the other research on alcohol (and it is also research only on women).

Nobody should see this as justifying anything beyond very modest levels of drinking. Drinking beyond the NHMRC upper limits (no more than two standard drinks a day) is still the best way to reduce the risks of harm from alcohol.”

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Associate Professor Jayne Lucke is Principal Research Fellow at UQ Centre for Clinical Research at The University of Queensland

“This is an important paper showing that regular alcohol consumption by women in middle age is associated with better health at 70. It would be easy to misinterpret this study as evidence that drinking is good for you. Rather, the take home message is that regular small amounts of alcohol in middle age might be good for you. It is not healthy to drink more than currently recommended by the NHMRC. Also, drinking a small amount of alcohol may not cause women to age healthily – rather women who regularly drink a small amount may also have a number of other characteristics, such as good health, an active social life and a healthy appetite, that all work together to promote successful ageing.

It is important to note that women with serious drinking problems were excluded, and only 3% of the women drank at the highest level which was two to three glasses per day. These findings from the US Nurses’ Health Study are consistent with findings from the Australian Longitudinal Study on Women’s Health (ALSWH). Of almost 12,000 older Australian women aged 70-75 those who did not drink alcohol (or drank rarely) were more likely to die over a six year period compared to those who drank at low levels (Byles et al., 2006). Further evidence from the ALSWH shows that the relationship between drinking and disease may differ in young, middle-aged and older women. Young women who did not drink alcohol were less likely to have hypertension and asthma. Middle-aged women who did not drink were more likely to have hypertension, diabetes, heart disease and osteoporosis (and middle-aged women who drank at high-risk levels were more likely to have hypertension than women who drank at low-risk levels). Older women who did not drink were more likely to have heart disease and diabetes. The proportion of women who did not drink was higher at older ages: 9% of younger women did not drink compared to 34% of older women (Lucke et al., 2007).”

References:

Byles, J., Young, A., Furuya, H. & Parkinson, L. (2006) A drink to healthy aging: The association between older women’s use of alcohol and their health-related quality of life. Journal of the American Geriatrics Society, 54(9): 1341-1347.

Lucke, J., Waters, B., Hockey, R., Spallek, M., Gibson, R., Byles, J. & Dobson, A. (2007) Trends in women’s risk factors and chronic conditions: findings from the Australian Longitudinal Study on Women’s Health. Women’s Health, 3(4); 423-432.

Information about the Australian Longitudinal Study on Women’s Health can be found at www.alswh.org.au

The papers referenced are also available on request.

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Dr Lucinda Burns is Senior Lecturer at the National Drug and Alcohol Research Centre at the University of New South Wales

“The findings that women who drink a minimal amount have a modest increase in overall health are not a new finding to the literature but one that continues to cause controversy.

We know that alcohol has an increasingly detrimental effect on people as they age. This means that they are more likely to have problems such as falls, and the body does not heal as well from these accidents. These types of accidents can occur after drinking one or two drinks.

As we don’t have information on the consumption habits of women who died before 70, it may be the case that alcohol, even what may be regarded as a small amount, may have been a factor in these deaths.

There are many other ways of promoting healthy ageing other than drinking alcohol, which tends to become an increasingly solitary and lonely pursuit as people get older. For example, increasing the opportunity for meaningful social and cultural activities would seem more appropriate. As the authors note, ‘because this is an observational study, it is possible that the women who drank moderately share other unknown characteristics that are actually responsible for their increased chance of successful ageing.’

Another more appropriate public health message from the findings is that spreading the amount of alcohol consumed over the week is less harmful than drinking the same amount on one occasion.”

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Professor Julie Byles is Director of the Research Centre for Gender, Health and Ageing at the University of Newcastle and co-Director of the Australian Longitudinal Study on Women’s Health

“The research you quote is very similar to some studies we have done here in Australia. My interpretation of the findings is that in this age cohort of women, most drink not at all, or rarely or in moderation (up to 2 drinks per day).

Drinking habits of subsequent generations of women may not be the same, and these women may be more likely to engage in hazardous or harmful levels of alcohol intake. Reducing these hazards is a public health imperative.

For those who survive to 70 years, it seems that drinking up to 2 drinks per day is consistent with good health unless there is a clear specific reason to give up alcohol.

I don’t believe we have evidence that women should take up alcohol for their health, but there are other reasons to drink in moderation, and other benefits.

Attention to other aspects of healthy lifestyle are also important: not smoking, eating well and getting adequate exercise.”

Feel free to use these quotes in your stories. Any further comments will be posted here. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Professor Barry Watson is Director of CARRS-Q – The Centre for Accident Research & Road Safety – Queensland at the Queensland University of Technology

“I think that the move to .02 is certainly something that we need to consider and its certainly something that we need to encourage public discussion about. There is some evidence that it would be beneficial. There’s already a number of countries in the world that have a .02 or .03 limit including countries like Norway, Sweden and Japan. And while there is some evidence that the introduction of the lower limit in those countries reduced crashes, it’s difficult to be definitive about it because that counter measure in most of those countries was implemented along with other things, so it’s very difficult to disentangle the unique effect of the lower limit.

Having said that, there are some other good reasons for considering it: one is that at .05 people are impaired, I think more so than they probably realise, and research does suggest that your crash risk does increase and, by .05 is somewhere between one and a half to two times that of a sober driver.

The thing we’d need to bear in mind though is that any crash reductions would not necessarily be large but it may send a message to the community about the ongoing need to tackle the drink-driving problem. One thing I do think we need to be concerned about is the timing of a change like this because at the moment there is very strong support for drink driving initiatives like random breath testing. We would need to make sure there was reasonably strong community support for it so it didn’t undermine the support for our other drink driving initiatives. Therefore, I think the way forward here is for governments to really be undertaking more public education, to tell people about the dangers of driving even with small amounts of alcohol in their system and to really encourage people to voluntarily choose not to drink at all when they drive, so that in the future then if we move towards the .02 limit it wouldn’t be as big an adjustment for people.”

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Dr Alex Wodak is Director of the Alcohol and Drug Service at St. Vincent’s Hospital, Sydney

“The risk of a car crash with a blood alcohol of 0.05 is double that of a driver who has not consumed any alcohol. The risk at 0.08 is treble. It is worth reducing the maximum blood alcohol concentration to 0.02 for young and inexperienced drivers. But I expect that the law of diminishing returns would operate if the maximum blood alcohol concentration was reduced to 0.02 for older and more experienced drivers. But the measure we should be debating is alcohol tax reform. This is the single intervention best supported by evidence of effectiveness. Reducing road crash deaths and serious injuries will be among the benefits of alcohol tax reform. We should also be putting more emphasis on cutting back on the availability of our favourite drug. There are too many outlets and the outlets have too liberal conditions. The choice of policy changes to reduce harms from alcohol should be based on evidence of effectiveness, likely magnitude of benefit, risk of unintended negative consequences, cost-effectiveness and feasibility. Adjusting for distance travelled, the number of road crash deaths in Australia has declined by a whopping two thirds in the last 30 years.”

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Professor Jake Najman is Director of the Queensland Alcohol and Drug Research and Education Centre at the University of Queensland

A key paper in this debate is by Hingson et al 1994 where he looked at a range of US states which had changed their laws in regard to the permissible level of blood alcohol. He found there was no “magic” level…some US states have zero blood alcohol rules, while others have .02 or .05 or .08. the lower the level of permissible alcohol in the blood the greater the reduction in fatal motor vehicle crashes. There is, of course, the need to enforce whatever level is legislated…those drinking and driving need to be persuaded that they are likely to be apprehended if they drink and drive…but generally the lower the level of blood alcohol the lower the rate of fatal deaths attributed to drink driving. Of course there is a need to legislate in the face of public opinion…so a zero blood alcohol level, while the optimum for health, may not be acceptable…this is a political decision.

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Professor Mike Daube is Professor of Health Policy and Director of the Public Health Advocacy Institute of WA at Curtin University. He is also President of the Public Health Association of Australia

“This is an important proposal that deserves very careful consideration – and is probably inevitable over time. It is very encouraging that the Prime Minister has called for the issue to be considered nationally – the road toll is a national crisis. Even at the present levels, far too many people think that drinking just a bit more than the limits is acceptable, and that they can get away with it. Drink-driving is the cause of not only road crashes, but death and injury that are devastating for those affected and their families. We need to send out the strongest possible signals that drink-driving is totally unacceptable. Surely as a community we have to recognize that we cannot keep putting the lives of innocent members of the public at risk, just because somebody wants an extra drink or two.

The case for .02 is that it sends out the message loud and clear – we can no longer tolerate the carnage caused by drink-driving. We can wait forever for yet more evidence – or we can decide as a nation that we need to act now.”

Mike is also involved in the National Alliance for Action on Alcohol (NAAA) – A new national coalition of health and community organisations from across Australia to reduce alcohol-related harm. A media release on the new alliance is available here.

ONLINE BRIEFING | RAPID ROUNDUP

BRIEFING DETAILS:
DATE: Friday 6 March 2009
START TIME: 10am AEDT
DURATION: 45 min
VENUE: Melbourne

SPEAKERS

Prof Warwick Anderson is CEO of the National Health and Medical Research Council

Prof Jon Currie is Director of Addiction Medicine, St Vincent’s Hospital, Melbourne and University of Melbourne

Prof Elizabeth Elliott is Professor of Paediatrics & Child Health at University of Sydney, Children’s Hospital Westmead and Director of the Australian Paediatric Surveillance Unit.

PRESENTATIONS:

Full Briefing (WebEx):
View here | View PowerPoint (pdf)

Warwick Anderson’s Presentation:
Listen (mp3)

Jon Currie’s Presentation:
Listen (mp3)

Elizabeth Elliott’s Presentation:
Listen (mp3)

Q & A Session:
Listen (mp3)

Feel free to use these quotes in your stories that relate to the above story. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 8207 7415 or by email.

Professor Ann M Roche is Director of the National Centre for Education and Training on Addiction at Flinders University and was a member of the expert panel who developed the new guidelines.

“The new guidelines provide greater emphasis on the risks associated with alcohol and young people. In particular, those under the age of 15 are strongly advised not to drink alcohol at all, and extreme care is warranted in relation to alcohol use by those aged 15-18. There is an important message here for parents and those involved with young people in general. The guidelines indicate comparatively low levels of consumption are needed to avoid both short and long term risk of harm from alcohol. These guidelines usher in a new era of caution in relation to alcohol and substantially revises our views about what constitutes low risk drinking levels.

Paul Dillon is Director of Drug and Alcohol Research and Training Australia.

“It is made explicitly clear that the role of these guidelines is as a ‘technical document’ and not as a practical tool for the general public. It will now be interesting to see how the science is translated to credible messages that the average Australian family will be able to use on a day-to-day basis. Without a doubt some of the messages will be a terribly hard sell. Are Australians ready to accept that they should drink no more than four drinks on a single occasion? The science may be correct but it’s how we communicate it that is going to be the real issue here.”

Dr David Caldicott is an emergency doctor and recognised drug and alcohol expert based in Adelaide.

“Alcohol is unequivocally the most dangerous recreational drug being consumed in Australia today, in terms of the numbers of individuals being injured, and those being killed, both directly and indirectly, per annum. This is an unattractive fact for consumers of alcohol, those profiting from the sales of alcohol, and those with a political interest in the racier, but epidemiologically less significant field of illicit drugs. New guidelines from the independent NH&MRC – Australian Guidelines to Reduce Health Risks from Drinking Alcohol – will do nothing to reassure those groups that the Australian love of grog is merely a healthy, innocent diversion, and directly challenges the concept of the larrikins’ right to drink long, and to drink hard.

These well-considered and well-written guidelines address the health risks associated with alcohol on at least 2 important levels. The report distils down to 4 simple and easily understandable guidelines regarding lifetime risk, binge drinking, youth drinking and drinking in pregnancy, making them easily comprehensible by the members of the lay-public they seek to inform. For those who will try to dismiss this report (and there will be many), their work will be cut out – the detailed and densely referenced 188 pages are written by a list of contributors that reads like a Who’s Who of the best in Drugs and Alcohol research in the Southern Hemisphere.

This is a brave and comprehensive document, the timely release of which will make a significant contribution to the general understanding of the harms associated with alcohol consumption in Australia. It helps reassign alcohol to a more significant position in the spectrum of harm caused by recreational drugs. The authors have pulled few punches, and are no doubt prepared for an onslaught in response from the powerful Australian drinks lobby, and those in their pocket. The industry only has itself to blame; tepid attempts to address the dangers associated with alcohol consumption, and the derailing of efforts to mitigate the harms associated with them, have made a report such as this not only inevitable, but long overdue.”

Prof Elizabeth Elliott is Professor of Paediatrics & Child Health at University of Sydney, Children’s Hospital Westmead and Director of the Australian Paediatric Surveillance Unit.

“The new guidelines provide clear advice to women who are pregnant or planning pregnancy. Because no level of maternal alcohol intake has been established as ‘safe’ for the unborn child, the guidelines state that not drinking alcohol is the safest option. At the same time they emphasise that the risk of harm increases with increasing dose, frequency and duration of alcohol intake during pregnancy and that various unmeasurable factors in the individual woman may modify the level of risk. Furthermore, they suggest that women who have inadvertently drunk small amounts during pregnancy should be reassured that they are highly unlikely to have harmed their unborn child.”

Wayne Hall is Professor of Public Health Policy at the School of Population Health, University of Queensland

“The new NHMRC guidelines on low risk drinking are to be welcomed. First, they use a novel approach to estimating low risk levels of alcohol use that uses the same approach now used in medicine to indicate lifetime risk of heart disease.

Second, they specify separate low risk levels of drinking for acute harms (e.g. injury) and chronic harms (e.g. liver cirrhosis and cancers). Each is designed to keep the risk of harm at less than 1 in 100 over a life-time of drinking.

Third new levels are clearly defined and very clearly related to the research evidence on which they are based.

Fourth, the guideline for low risk of acute harm (4 drinks) is much like the old guideline, except that the same levels are used for men and women. Women achieve a higher blood alcohol level for the same amount as men, but the guidelines argue that their risk is about the same as men because women are less likely to do risky things than men.

Fifth, the level for low risk of chronic harm (2 standard drinks) makes it clear that someone who drinks nearly every day at below the “safe” levels for injury can still be at risk of liver disease. Two or fewer standard drinks keeps this risk under 1 in 100 over a lifetime.

Sixth, the guidelines have taken a more conservative course than community opinion on drinking by pregnant women and young people. These are nonetheless worth supporting. Alcohol use is optional during pregnancy and because of misinterpretation of “low risk” drinking it may be simpler to recommend no alcohol use during pregnancy. The guidelines for young people should prompt a long overdue public debate about alcohol use by young people.”

If you wish to speak to an expert, don’t hesitate to contact the AusSMC on 08 8207 7415.

Dr Alex Wodak is President of the Australian Drug Law Reform Foundation and Director of the Alcohol and Drug Service at St. Vincent’s Hospital, Sydney.

“The Rudd government is right to identify youth binge drinking in Australia as an area where action is badly needed. Rudd deserves praise for recognising that this area badly needs attention.

Interestingly, Rudd has said that he will be an evidence-based Prime Minister. The interventions best supported by evidence of effectiveness for reducing alcohol related problems in the community are slightly raising the price of alcoholic beverage (by slightly increasing tax) and slightly reducing the availability of alcohol ( e.g. reducing the number of outlets or slightly restricting conditions). Young people are particularly sensitive to price increases because of a smaller discretionary income. Rudd has already increased beer and spirits but this will mainly have the effect of shifting consumption to wine. If Rudd slightly increased alcohol-beverage taxes, community opposition can be overcome by dedicating (hypothecating) a small proportion of the tax to alcohol and drug prevention and treatment.

Clinical treatment for alcohol dependent people is also effective but most of the young people who drink in binges will only do so uncommonly. Therefore clinical interventions won’t have much impact on young people.

There is a lot of evidence to show that mass campaigns for alcohol are largely ineffective. If we are lucky we may see small and transient improvement.”

Dr David Caldicott is an emergency doctor and independent drug expert based in Adelaide.

“As a first foray into the political minefield that is Australian drug and alcohol policy, the new Labor Government’s initiative on binge drinking is to be generally applauded. The burden placed on emergency departments around Australia by the effects of alcohol is greater than that of all other illicit drugs combined, more so when the chronic toll is taken into account. Tackling a legal and ubiquitously consumed drug, popular amongst consumers and aggressively promoted and protected by powerful political lobbyists is a courageous move. Although not as glamorous as the populist tabloid “War on Drugs”, if successful, a campaign such as this will have far more significant and long reaching effects on the lives of young Australians.

There is no mention of tackling the advertising millions spent on attracting new drinkers to the drug, particularly younger drinkers aggressively targeted by producers of ever-emerging, ‘ready-to-drink’, high-alcohol formulations. This group of drinkers, especially young women, have been cynically exploited by the alcohol industry, prepared to badge and mix drinks to make them more appealing to the younger consumer. There is no reason why rules regarding this sort of mercenary marketing should not be every bit as harsh as those which now apply to cigarettes.

The issue of how to reach the hearts and minds of young Australians remains problematic. The Rudd government’s Liberal predecessors conducted a campaign against illicit drugs which set Australian drugs policy back thirty years, very successfully ‘poisoning the well’ as far as the credibility of the Government in the eyes of young consumers is concerned. Politicians must tread carefully when it comes to using shock tactics where young people are concerned. They may have worked for HIV/AIDS in the past, but this cohort of young Australians represents a very different demographic group. Emphasizing the danger of certain behaviours can have the paradoxical effect of increasing the glamour associated with that behaviour. This has been seen in the USA with an increase in marijuana consumption attributable to some anti-marijuana advertising campaigns. Campaigns based on wit and satire- such as the highly successful New South Wales “Speeding. No-one thinks big of you”, in which hoon drivers motivations are attributed to their diminutive genital size- are far more likely to enter into popular culture and spread virally, than campaigns designed by fifty year olds trying to anticipate what would scare them into changing their behaviour, when they were a ‘young ‘un’.

The statement that the campaign ‘will be evidence-based and non-political’ would mark this as a welcome landmark in 10 years of Australian drugs policy; whether it evolves as such depends on the resolution and resilience of our new leaders in Canberra.”

Richard Midford is an Associate Professor and Project Leader at the National Drug Research Institute, Curtin University, Western Australia

“I welcome this initiative by the Rudd government as it seeks to tackle the drug that causes most harm to our young people – alcohol. Weekend binge drinking is increasingly becomingnormal practiceamong many young people and we as a society need to change the culture that supports this behaviour. This requires a range of complementary measures including: responsible service in pubs to prevent drunkenness; restricting late openingwhen that causes problems; a rethink of alcohol advertising and marketing aimed at young people; better policing of sales to under 18 year olds; realistic, practical alcohol education in schools. Most young people will drink alcohol, we need an integrated national strategythatmakes responsible drinking the norm.”

Ms Carolyn Corkindale is a researcher in the Department of Sociology at Flinders University.

“Any intervention or media campaign addressing adolescent binge drinking should have as a main objective that young people learn about consequences, and in a manner that engages them affectively as well as cognitively.

This can be achieved by:

• Portraying personal, and felt consequences as well as straight information;

• Using multimedia to simulate the likely consequences which can include the aftermath of risky or unwanted sex, physical side effects of binge-drinking, uncontrolled aggression and violence, acceptance of illicit drugs, and the aftermath of drink driving;

  Showing the impact of these consequences on families and peers.

A mass media campaign (“Drinking: where are your choices taking you?”, National Alcohol campaign 2002), was launched in Australia in 2002. It was aimed at young people, and focused on alcohol misuse, portraying graphically the serious harm that could follow a poor choice. This campaign was successful (King et al, 2003).”