Unrecorded Alcohol Consumption Focus on the Americas

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Unrecorded Alcohol ConsumptionFocus on the
Americas

• Norman Giesbrecht Emma Haydon
• Centre for Addiction Mental Health
• Toronto, Ontario, Canada
• 1a Conferência Pan-Americana
• de Polícas Públicas sobre Álcool
• Brasília, Brasil
• November 28-30, 2005

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Topics

• Implications
• Dimensions
• Sources of information
• Estimates
• Contributing factors
• Policy implications
• Interventions
• Recommendations

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Implications of Unrecorded Alcohol Consumption

• Accuracy of drinking volume estimates
• studies of associations between consumption
  harm (or benefits) from alcohol
• impact of interventions
• cross-sectional and longitudinal research
• drinking patterns

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Implications of Unrecorded Alcohol Consumption
(2)

• Heavy consumption high risk drinking
• Easy access to untaxed alcohol
• High risk patterns
• Addition versus substitution
• Alcohol of questionable quality

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Implications of Unrecorded Alcohol Consumption
(3)

• Alcohol Policy
• Reduce revenue for the state
• Reduce profit for producers
• Distributors with compromised role re illegal
  alcohol
• Rational to undermine control measures

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Dimensions of Unrecorded Alcohol Consumption

• Legal
• home production of legal amounts
• consumption of non-beverage ethanol
• importation of legal amounts

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Dimensions of Unrecorded Alcohol Consumption (2)

• home production of illegal quantities
• sale of home produced alcohol
• mass produced illegal alcohol
• smuggling
• individuals
• large-scale operations

• Illegal

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Sources of Information

• Seizures by customs officials
• Police activities seizures
• Liquor inspector activities
• Cross-border traveler activity extrapolations
• Extrapolations using official statistics
• Self-reports

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Sources of Information

• Caveats challenges
• Useful method varies by country, region and time
  period
• Vested interests in the estimation process
• No one method produces comprehensive estimates,
  some only are based on a fraction
• Challenge of comparing combining divergent
  estimates

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Americas Recorded plus estimated Unrecorded

• Bermuda 12.9
• St. Lucia 10.5
• Bahamas 9.2
• Venezuela 8.8 2.0
• Argentina 8.6 1.0
• U.S. 8.5 1.0
• Canada 8.3 2.0
• St. Kitts 7.6

• Grenada 7.4
• Uruguay 7.0 2.0
• Barbados 6.7 - 0.5
• Paraguay 6.7 1.5
• St. Vincent 6.7
• Haiti 6.5 0
• Dom. Republ 6.1 1.0
• Panama 6.0 1.5
• Chile 6.0 2.0

Litres of absolute alcohol per capita aged 15
Recorded FAO 2003 Unrecorded estimates for after
1995 from Rehm Gmel 2001
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Recorded plus estimated Unrecorded (2)

• Columbia 5.9 2.0
• Guyana 5.8 2.0
• Suriname 5.8 0.0
• Costa Rica 5.5 2.0
• Brazil 5.3 3.0
• Peru 4.7 1.0
• Mexico 4.6 3.0
• Belize 4.5 2.0
• Guam 4.5

• Cuba 3.7 2.0
• El Salvador 3.5 2.0
• Bolivia 3.4 3.0
• Jamaica 3.4 1.0
• Trinidad
• Tobago 3.2 0.0
• Nicaragua 2.5 1.0
• Honduras 2.3 2.0
• Ecuador 2.0 1.0

Litres of absolute alcohol per capita aged 15
Recorded FAO 2003 Unrecorded estimates for after
1995 from Rehm Gmel 2001
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Americas Recorded Estimated Unrecorded Alcohol
Consumption

• Recorded consumption
• 1.99 to 12.92 litres per capita aged 15
• Estimated unrecorded consumption
• minus 0.5 to plus 3.0 litres per capita 15
• Unrecorded as a of total (recorded plus
  estimated unrecorded)
• 11 to 55

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Traditional local beveragesSelected countries
in Latin South America

• Honduras - Aguardiente
• Mexico - Pulque 7
• Paraguay - Abati
• Peru - Pisco, Chicha
• Suriname - Borgoe 38
• Trinidad
• Tobago - Babash
• Uruguay - Cana 38
• Venezuela - corn liquor

• Argentina - local beer 7
• Bolivia - Chicha 5-7
• Brazil - Cachaça 38-54
• Chile - Pisco 35
• Columbia - Rum 28
• Costa Rica - Guaro
• Ecuador - Aguardiente 40-70
• Guatemala - Chicha
• Guyana - Ti punch

These are examples not a comprehensive list
of beverages.
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Contributing Factors

• Restrictions on access to legal alcohol sales in
  host country
• Price, outlet density, hours of sale
• Inter-country differences in access to alcohol
• lower prices in adjacent jurisdictions
• high volumes allowed for legal personal
  importation

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Contributing Factors (2)

• Traditional and local beverages
• extensive tradition and quality
• Smuggling of other goods
• Tobacco from US to Canada in early 1990s
• Tolerance for illegal behaviour
• among general population
• among legal distributors or producers
• Geography and population density

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Policy Implications

• Legal illegal trade (particularly smuggling)
  used to justify proposed erosion of control
  policies
• questionable estimation procedures used
• Resource management inter-sectorial
  collaboration
• Impact on traditional and local beverages
• Quality control issues harm reduction

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Interventions

• Process
• Training
• Coordination
• International symposia
• Resource issues
• Data collection

• Outcome oriented
• Public education
• Mass media
• Warnings to distributors
• Inspections
• Law enforcement
• Enhance legal outlets
• Review of alcohol policies

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Recommendations

• Use multiple methods for data collection
• Subject estimates to peer review
• Consider cultural aspects and norms re
  traditional and local beverages
• Consider impact of unrecorded alcohol on high
  risk drinking dependence

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Recommendations (2)

• Coordinate control/interventions of unrecorded
  with harm reduction management of recorded sales
  of alcohol
• Build on evaluations of alcohol policies to
  develop interventions to manage unrecorded
  alcohol
• Conduct routine monitoring evaluation of
  interventions

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Acknowledgements

• Sunny Ba, Guilherme Borges,
• Mariana Cremonte, Laura Krech, Maristela
  Monteiro, Jürgen Rehm, Robin Room Maria Luiza
  Segatto