1. Perspectives on ATOD Prevention Robert I. Reynolds, Director Center for Policy Analysis and Training Pacific Institute for Research and Evaluation

2. Drug “Capture” Rate Percent of Users Who Become Clinically Dependent Tobacco31.9% Heroin23.1% Cocaine16.7% Alcohol 15.4% Stimulants11.2% Marijuana 9.1% Source: National Comorbidity Survey Anthony, Warner, and Kessler

3. U.S. Economic Costs of ATOD Use, 1995 Total Costs = $415 Billion Sources: Harwood, Fountain, & Livermore, NIDA & NIAAA, 1998 Rice (unpublished) Institute for Health and Aging, UCSF, 1995

4. Question: ATOD Problems in the United States are: A.At epidemic proportions B.Steadily declining C.Both of the above

5. ATOD consumption in the U.S has declined over the past 20 years. Alcohol consumption is down. Tobacco consumption is down. Other Drug use is down.

6. Tobacco use has declined. Percent reductions in monthly tobacco use by age group (1985 to 2000) Age19852000 Percent Reduction 12-1729.4%15.6%47% 18-2547.4%42.9% 9% 26-3454.7%35.6%35% 35-up35.5%27.3%23%

7. Illicit drug use has decreased. Percent reductions in monthly illicit drug use by age group (1979 to 2000) Age19792000 Percent Reduction 12-1716.5% 9.7%41% 18-2538.0%15.9%58% 26-3420.8% 7.8%63% 35-up 2.8% 3.4%(21)%

8. Alcohol consumption has decreased in the past 20 years... Reduction in per capita consumption 1980-1999 (gallons of pure ethanol) 19801999 Percent Reduction Beer 1.381.259% Wine 0.340.326% Spirit 1.040.6438% All Beverages 2.762.2120%

9. Percent Reduction: Monthly Alcohol Use, 1979-2000 …and fewer youth are drinking now versus twenty years ago. Age19792000 Percent Reduction 12-1749.6%16.4%67% 18-2575.1%56.8%24% 26-3471.6%58.3%19% 35-up59.7%46.8%22%

10. In particular, fewer fatalities are alcohol-related. Percentage traffic fatalities related to alcohol (1982-2000)

11. What these successes have in common: changes in Social Norms policy interventions deterrence and enforcement

12. Changes in Social Norms Media Advocacy: “If you’re not in the news, you don’t exist” Media Advocacy is the strategic use of media to advance a social or public policy goal Media Advocacy is “Earned Media”

13. Policy Interventions To prevent ATOD problems, policy interventions must focus on the Availability of alcohol, tobacco, and other drugs. Effective policies address the –Price –Place –Product –Promotion… …of ATOD products

14. Deterrence and Enforcement Effective Deterrence requires the Perception of Certainty Swiftness Severity Active Enforcement is a Requirement for Effective Deterrence.

15. Essential Elements of Effective Prevention of ATOD Problems Public Support Enforcement Policies and Laws Preven- tion

16. Alcohol Markets and Problems: 2003

17. Global Market – Alcohol Spirits Sales Exceed 2 Billion Cases Annually CountryCase Volume China725 million cases Russia350 India249 Brazil195 Japan176 United States135 Korea79 Thailand76 Germany60 France37 Source: Mark Brown, President Sazerac Company, Inc. March 4, 2003

18. Product Categories – Alcohol Spirits Product CategoryCase Volume Baijiu725 million cases Vodka400 Whisky205 Cachaca200 Rum115 Brandy82 Shochu70 Soju70 Liqueurs51 Source: Mark Brown, President Sazerac Company, Inc. March 4, 2003

19. Global Burden of Disease (Disability-Adjusted Life Years) Attribution TobaccoAlcoholIllicit Drugs Worldwide 4.1%4.0%0.8% North America 8 - 15.9% 4 - 7.9%2 - 3.9% South America 2 - 3.9% 8 - 15.9% 1 - 1.9% Source: World Health Report 2002 World Health Organization

20. Myths about alcohol suggest alcohol is an “integral part of American life”. CEUDL “… the vast majority of consumers drink responsibly and in moderation…” From an industry website:

21. The real picture of “Drinking in America” is much different. Adults: Most adults do not drink or drink infrequently. Youth: Most young people do not drink. Prevention Policy: There is widespread support for policies to reduce alcohol-related harm. CEUDL

22. Most adults do not drink or drink infrequently. CEUDL Frequency of Drinking Among U.S. Adults 21 and Older, 2000 (past 30 days)

23. Most adults do not drink at a hazardous level. CEUDL Drinking Patterns among U.S. Adults 21 and Older, 2000 (past 30 days)

24. Alcohol sales depend on the heaviest drinkers. CEUDL Alcohol Consumed by Drinking Pattern Among Adult Drinkers, 2000 (past 30 days)

25. Binge drinkers are 20% of the population, but consume 80% of the alcohol. CEUDL Binge Drinkers, 2000

26. Most young people do not drink. CEUDL 15- to 17-year-olds18- to 20-year-olds Drinking occasions 01 to 45 or more Drinking Among Youth, 2000 (past 30 days) 94% 12- to 14-year-olds 17% 75% 8% 52% 25% 23%

27. Young drinkers tend to drink more heavily than adult drinkers. CEUDL Comparison of drinking patterns for adult and underage drinkers, 2000 (past 30 days) Nonbingers Bingers

28. Young bingers consume the majority of the alcohol for their age group. CEUDL 15- to 17-year-olds18- to 20-year-olds NonbingersInfrequent Bingers Frequent Bingers Percentage of Drinks Consumed by Drinking Pattern Among Underage Drinkers, 2000 94% 12- to 14-year-olds 34% 62% 4% 26% 70% 4% 45% 12- to 14-year-olds 8% 47%

29. What is the REAL message in “Designated Driver” programs?

30. Binge Drinking: Adverse Health Effects Suicide Alcohol Poisoning Hypertension Acute Myocardial Infarction Gastritis Pancreatitis Sexually Transmitted Diseases Meningitis Poor Control of Diabetes Interpersonal Violence (homicide, assault, domestic violence, rape, & child abuse

31. Binge Drinking is Increasing 1995 - 2001 Age19952001% Increase 18-208.815.374 21-2511.618.055 26-347.69.221 35-545.16.731 55 +1.92.742 All Ages35 Source: Timothy Naimi, et.al JAMA, 1/1/03 Rate of Binge-Drinking Episodes (Episodes/Person/Year among US Adults)

32. Binge Drinking is Increasing… Binge drinking episodes increased by 35% Binge drinkers reported impaired-driving 14 times more frequently than non-bingers. The majority of binge-drinking episodes (70%) occurred among those 26 or older. Moderate drinkers (average 1-2 drinks/day) accounted for almost as many binge drinking occasions as did heavy drinkers. Underage drinkers had the largest increase (74%) in the rate of binge-drinking. Source: Timothy Naimi, et.al JAMA, 1/1/03

33. Prevention Policy: There is widespread support for policies to reduce alcohol-related harm. CEUDL

34. In Order to Continue Our Progress and to Confront Our Challenges We Must: Change Social Norms. Adopt Policies impacting the Price, Place, Product and Promotion of ATOD availability. Increase Deterrence and Enforcement.