Liberalization of alcohol control legislation and it’s relation to alcohol consumption: lessons to be learnt from Lithuania Riga Dr. Aurelijus Veryga Kaunas University of Medicine Lithuanian National Tobacco and Alcohol Control Coalition National Health Board

Pure Alcohol Consumption Liters per capita Source: Department of Statistics to the Government of the Republic of Lithuania; WHO/Europe/European HFA Database

Alcohol Consumption Among Schoolchildren Source: ESPAD research data

Reported alcohol use during one drinking episode among women STD, 2005

Reported alcohol use during one drinking episode among men STD, 2005

Sales of Alcoholic Drinks Source: Department of Statistics to the Government of the Republic of Lithuania

Mental and Behavioral Disorders Due to Use of Alcohol for of Population Source: State mental health centre

Road Accidents Caused by Drunk Drivers Total (number of accidents) Drunk drivers (number of accidents) Deaths caused by drunk drivers (number of persons) Injured persons by drunk drivers (number of persons) Source: Lithuanian police traffic supervision service

Self reported problems to buy alcohol and tobacco (age 12-17) % Kaunas University of Medicine, 2004

Prognosis According to strategic marketing research company “Euromonitor International” during next five years due to rise of population income, liberal legislative base, and development of sell market Lithuanian alcohol market will rise for about 35.5 %... DELFI

Best Practices Minimum legal purchase age Minimum legal purchase age Government monopoly of retail sales Government monopoly of retail sales Restriction on hours or days of sale Restriction on hours or days of sale Outlet density restrictions Outlet density restrictions Alcohol taxes Alcohol taxes Random Breath Testing Lowered BAC limits Administrative license suspension Graduated licensing for novice drivers Brief interventions for hazardous drinkers Thomas F. Babor

Least Effective Practices Voluntary codes of bar practice Voluntary codes of bar practice Promoting alcohol-free activities Promoting alcohol-free activities Alcohol education in schools Alcohol education in schools College student education College student education Public service messages Warning labels Designated drivers and ride services Thomas F. Babor

Main Principles of Alcohol Control Policy in the Law on Alcohol Control 1995/2005 to reduce availability of alcohol beverages through taxation to limit promotion of the sale and consumption of alcoholic beverages to prohibit the means of promotion of buying and consumption of alcoholic beverages by youth to encourage legal persons who are engaged in alcohol business to join in implementing the State alcohol control policy to increase public awareness

Main Principles of Alcohol Control Policy in the Law on Alcohol Control 1995/2005 to sponsor action programs of health and temperance societies to promote the production and sale of non alcoholic beverages to promote the creation of a social environment free of alcohol to promote scientific research and dissemination of information to strengthen the cooperation with other Member States of the European Union and international organizations regarding the issues of the reduction of the consumption of alcohol.

The Main Purpose and Strategy Related to Alcohol Control Stated in Lithuanian Health Programme 1998 Main target: by the year 2010 to reduce alcohol consumption by 25 % To decrease annual alcohol production by 2 % ; To decrease annual alcohol production by 2 % ; To increase alcohol costs depending on the overall economic situation; To increase alcohol costs depending on the overall economic situation; To increase proportion of people not using strong alcoholic beverages; To increase proportion of people not using strong alcoholic beverages; To provide treatment and rehabilitation for all those suffering from drug and alcohol abuse; To provide treatment and rehabilitation for all those suffering from drug and alcohol abuse; To develop a system for the quantitative monitoring of alcohol use; To develop a system for the quantitative monitoring of alcohol use; To develop intersectoral collaboration in fighting alcohol abuse; To develop intersectoral collaboration in fighting alcohol abuse; To develop and implement the State Program of Alcohol Control. To develop and implement the State Program of Alcohol Control.

State Programme of Alcohol Control 1999 – 2011 as Long Term Target Progressively decrease alcohol consumption by 25 % until 2009; Progressively decrease alcohol consumption by 25 % until 2009; Drop of mortality from cirrhosis by 15 %; Drop of mortality from cirrhosis by 15 %; Decrease mortality from accidents related to consumption of alcohol by 25% ; Decrease mortality from accidents related to consumption of alcohol by 25% ; Reduce number of crimes committed in connection with alcohol; Reduce number of crimes committed in connection with alcohol; Reduce number of drunk drivers; Reduce number of drunk drivers; Implementation of alcohol prevention devoted especially for youth. Implementation of alcohol prevention devoted especially for youth.

Real changes in situation Alcohol control law was changed 24 times : Alcohol sales were allowed all 24 hours per day; Sale was allowed in fuel stations, sanatoriums, living houses; Limitation on time was canceled; Prices of alcoholic beverages fell down by 0,4 % while disposable cash income edged up by 21 %; Advertisement control was taken from State tobacco and alcohol control agency and given to Consumers rights protection agency which has no competence to do it; Alcohol production, import and sales are rising every year; Lowered fines for failures to comply with the requirements of Alcohol Control Law.

New initiatives: To legalize alcohol sale via internet; To legalize home made alcohol; To close State tobacco and alcohol control agency.

Main mistakes (I) Criminal negligence in Alcohol control law: …to extend priority to (in first redaction of he law … to stimulate…) production of alcoholic beverages by natural fermentation and import and sale thereof; … …at concerts, circus, discotheques, youth sport and leisure time events, other mass events, theatre presentations, movie and video film demonstration locations, except for retail outlets located at sites of such events. At mass events (except for events intended for children and adolescents of up to 18 years of age) the name and (or) trade mark of the undertaking which is sponsoring the event and is the producer and seller of alcoholic beverages whose sales are permitted at mass events, may also be displayed provided that by their content and form they do not contradict the requirements of legal acts; Other.

As result we have Few cases of teenagers alcoholic psychosis; Few cases of teenagers alcoholic psychosis; Many cases of teenagers drunk until status of coma; Many cases of teenagers drunk until status of coma; On September 1 st many children are drunk; On September 1 st many children are drunk; Teenagers do not treat beer and cider as alcohol. Teenagers do not treat beer and cider as alcohol.

Main mistakes (II) Main role in alcohol control is playing Ministry of Economy not a Ministry of Health; Alcohol is treated as simple product which production should be stimulated; Recommendations of health specialists (National Health Board, Universities) were not taken into account; No evidence based regulations were used at all; No leading institution responsible for implementation of prevention programs; Until last year no active alcohol control NGO’s.

Lessons to be learned There is not enough to have good legislation and program. There should be community movement (NGO’s) that will monitor how the law is implemented and will prevent form changes in the way of liberalization; Alcohol industry is not a partner, it is profit industry that will newer allow measures that will decrease incomes; Firstly evidence based measures should be used; Children are most vulnerable group and measures should be firstly related to protection of children from alcohol marketing; Health, not economy, structures in the Government and Parliament should be primarily responsible for alcohol control; National and international movement of alcohol control NGO’s is crucial; Best practice from international tobacco control should be used.

Thank You