Primary Health Care European Project on Alcohol (PHEPA)
STRATEGY FOR GREECE
1
Primary Health Care European Project on Alcohol (PHEPA)
SUMMARY
The thoughtless and extended consumption of alcoholic drinks has consequences for the health
and social life of individuals, through intoxication, dependence and other biochemical repercussions
of alcohol, while at the same time contributing considerably to the increase of injuries and
subsequent
deaths
or
disabilities.
Moreover,
alcohol
consumption
has
important
social
consequences that concern the users’ environment and their families.
Besides being a drug of dependence, alcohol is a cause of some 60 different types of diseases and
conditions, including injuries, mental and behavioural disorders, gastrointestinal conditions,
cancers, cardiovascular diseases, immunological disorders, lung diseases, skeletal and muscular
diseases, reproductive disorders and pre-natal harm, including an increased risk of prematurity
and low birth weight1.
Data from the National Centre of Documentation and Information (EKTEΠN), report that roughly
200,000 individuals in Greece suffer from alcoholic dependence and 5,000 deaths are due to
causes related to alcohol abuse. From a Public Health point of view, alcohol is an important factor
of danger and there is an urgent need to develop a coherent strategy for confronting alcohol
problems. A strategy which will deal alcohol:
•
as a component of drinks, which is socially acceptable and constitutes part our social and
cultural delivery, but at the same time also
•
as a psychotropic substance, which is in a position to cause serious organic, mental and
social problems, as well as serious dependence, just like common narcotics.
This approach requires a plan of action which, taking into consideration the social and cultural
parameters, will aim on one hand at the protection of population and at the restriction of use and
abuse of alcohol and on the other hand at the reduction of the harmful consequences caused by it.
The National Action Plan2 acknowledges that prevention must play a key role in health care
system. Brief interventions can offer, in the present situation, a good option to decrease alcohol
consumption among hazardous drinkers and also the harm done by alcohol. The problem,
however, is that they are not adapted by primary health care professionals. This is why strong
political support is needed to implement brief intervention in primary health care, where most of
the population is attended yearly.
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Primary Health Care European Project on Alcohol (PHEPA)
INTRODUCTION
Greece is situated in south-east Europe, occupying the southernmost part of the Balkan Peninsula,
projecting into the Mediterranean Sea. It is surrounded by many islands in the Aegean, the
Mediterranean Sea and the Ionian Sea. The total area of Greece is 131,957 km2. Nearly 11 million
people live in this area, and the average population density is 80 inhabitants per km2. Athens is
the capital and the largest city of Greece about 65 per cent of the Greek population lives
nowadays in urban areas.
Alcohol use is generally perceived as a positive feature of social life. It has to be noted that
Greece has not had any history of temperance movements or alcohol prohibition like many
countries in North Europe. Instead, a long history of alcohol production and use has enabled the
Greek society to develop effective ways of dealing with the issue of regulation and control of
alcohol. These are often hidden regulations, constituting a part of everyday life and being thus
linked with unofficial socio-cultural structures rather than with official legal regulations and written
laws.
In recent epidemiological studies on nation-wide general population and school population
surveys, it has been shown that alcohol consumption patterns change, and alcohol-related
problems are increasing, especially in the younger age groups3,4,5. It seems that with the rapid
social and economical changes in the modern Greek society, more strict and systematic measures
as well as preventive programs have to be developed.
Greece is still lacking a central coordinating administrative body responsible for alcohol. There
have, however, been some developments towards a preventive alcohol policy in recent years.
Greece’s participation in the WHO-EURO Collaborative Study on Community Response to AlcoholRelated Problems and the acceptance of the European Alcohol Charter initiated by the WHO-EURO
in December 1995 have resulted in the Greek Ministry of Health taking some action on preventive
alcohol policy issues. The National Council on Alcohol, consisting of alcohol experts and
representatives from several ministries, has worked towards this end.
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Primary Health Care European Project on Alcohol (PHEPA)
THE USE OF ALCOHOL
The data on alcohol consumption includes figures for Greece only from 1961 on, and in the first
years only for beer and wine. The consumption of distilled spirits is recorded only from 1976 on.
Because of the lack of data, table 9.1 does not give any figures for the mid-1950s. Furthermore,
for the mid-1960s only the figures for beer and wine consumption are included. To get all figures
for the mid-1970s, it has been assumed that the average consumption of distilled spirits in the
years 1973-1975 was the same as it was in 1976. Since the production of distilled spirits was on
the increase in the 1970–1983 period this may be an overestimate. In converting beer and wine
consumption to pure alcohol consumption, the alcohol content of beer has been assumed to be 5
per cent by volume and that of wine 12 per cent by volume.
TABLE 9.1. Consumption of alcoholic beverages by beverage categories in Greece in litres of pure
alcohol per capita and as percentages of total recorded alcohol consumption in the years 1965,
1975, 1985 and 1995, five-year averages.
Total alcohol consumption
Consumption of distilled
spirits
Consumption of beer
Percentage of distilled spirits
Percentage of wines
Percentage of beer
1955
1965
1975
1985
1995
..
..
..
..
8.21
2.84
8.68
2.72
8.88
2.74
..
..
..
..
..
4.37
0.34
..
..
..
4.58
0.79
34
56
10
4.36
1.64
31
50
19
4.12
2.02
31
46
23
Source: World Drink Trends, 2002.
Total alcohol consumption was at the same level in the mid-1990s as in the mid- 1980s, and only
a little higher than in the mid-1970s (Table 9.1). According to the production data, the
consumption of distilled spirits was lower in the mid- 1960s than in the mid-1970s. Therefore it
can be claimed that the total alcohol consumption was on the increase in Greece both in the
1960s and in the 1970s, and has been stable since then.
The consumption of distilled spirits seems not to have changed during recent decades. The
consumption of wine has also been quite stable especially in the 1960s and 1970s. In the mid1980s wine consumption decreased quite heavily, but has again increased in the late 1980s and in
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Primary Health Care European Project on Alcohol (PHEPA)
the 1990s. Nowadays wine consumption per capita, in liters of the product, is about 35 liters a
year. At its highest it was 45 liters per capita at the beginning of the 1980s6.
Beer consumption has clearly increased from 5.3 liters per capita in 1961 to 40 liters in 2000
counted in liters of the product. Despite the growth in beer consumption, wine still accounts for
the greatest proportion of the total alcohol consumption. In the mid-1990s, nearly 50 per cent of
all alcohol consumed in Greece was in the form of wine. The corresponding figure for distilled
spirits was one third and for beer about one quarter6.
Greece has a very long history of production and consumption of wines, and drinking alcohol is a
traditional and socially accepted way of socialization among men, and more recently also among
women and young people. With regard to young people, drinking is considered a rite of passage
from adolescence to adulthood.
Particularly in rural areas, alcoholic beverages are consumed at meals every day and identified
with a traditional way of life. Not only is alcohol legally available, but people are also more or less
culturally obliged to drink on certain social occasions. However, this does not necessarily mean
that alcohol consumption, and especially wine consumption, reinforces or is related to social
problems. On the contrary, wine may be associated with spiritual qualities, since drinking in the
Greek society is often still integrated into social and religious structures, and under certain
circumstances drinking alcohol functions as a sign of social integration and socialization7,8,9,10.
These social and religious structures provide controls against excessive drinking, as do close
family and neighborhood ties in rural areas. Family and community control, in the form of
negative and non-permissive attitudes towards excessive drinking behavior, might play a
preventive part in the case of individuals susceptible to alcohol abuse and dependence11,12,13,14,15.
Socio-economic transformations as well as economic upheavals in recent decades have also
influenced the patterns of alcohol consumption7,16,17.
In some rural areas it is thought that red wine is good for the blood and can cure anemia, and it is
therefore given to young children as a medicament. Hot red wine with sugar and bread used to be
provided to young children for breakfast in some areas until the sixties. A statistical survey in
1984 estimated that about 1.6 per cent of households’ monthly expenditure was spent on alcohol.
The percentage was higher in rural areas, where much more drinking took place outside the home
than in urban areas13,14,16. However, traditional drinking patterns, like the association of drinking
with meals, family rituals, community or religious ceremonies and recreational activities, are still
practiced, and rural lifestyles have merged with the urban ones during the transitional post-war
modern Greek society14,17. In a recent household survey, conducted in 1998–1999, the
percentage of monthly expenditure on alcoholic beverages reached 3.2 per cent of the total
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Primary Health Care European Project on Alcohol (PHEPA)
expenditure on food. Households in greater Athens seem to spend slightly more, 3.6 per cent, on
alcoholic beverages than households in other urban areas or in rural areas, where the
corresponding percentage was 2.5 (Statistics of Household Surveys 1998–1999).
Before the Second World War wine was the main alcoholic beverage in Greece. Beer consumption
has risen rapidly in the post-war years, while wine consumption has remained fairly stable or even
decreased at certain periods17. Traditional distilled aromatic beverages, like ouzo, raki, tsikoudia
and tsipouro, are still very popular in Greece. However, an increase in the consumption of
imported distilled alcoholic beverages, like whisky, vodka, gin, tequila and rum, can be noticed
especially among younger generations. Despite all these developments, wine is still the most
prominent drink in Greece and wine also constitutes a significant element in the agricultural sector
of the Greek domestic economy17. Greeks also seem to prefer their own wine, as the market share
of imported wine was only 4 per cent at the beginning of the 1980s. At the same time the share of
domestic table wine was 73 per cent and the share of domestic quality wine 23 per cent18.
There are several reasons to doubt the official consumption figures. About one third of all wine is
produced by domestic means, and the excise duty rate for wine is set at zero. These two facts
mean that the quantity of wine produced and consumed may be an underestimate. Secondly,
home distillation is illegal, but it cannot be controlled in certain rural areas14. Therefore, recorded
figures for the consumption of distilled spirits may also underestimate the true consumption. And
thirdly, tourists visiting Greece consume a part of the alcoholic beverages sold in Greece and
recorded as the consumption of Greeks. Nowadays about 11 million tourists spend about 41
million nights in Greece annually. This means that if the tourists are drinking like local people or
like EU inhabitants on average they would consume about one per cent of all alcohol sold in
Greece19.
In 2000 the consumption of alcoholic beverages per capita was 79 liters calculated in liters of the
product. The consumption of commercial non-alcoholic beverages was 233 liters per capita,
consisting of 60 liters of coffee, 64 liters of soft drinks, 38 liters of milk, 20 liters of juices and 8
liters of tea. All these beverages have gained in importance since the mid-1980s6.
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Primary Health Care European Project on Alcohol (PHEPA)
THE HARM DONE BY ALCOHOL
From a health perspective, excessive drinking is a major cause of disease and injury, accounting
for 9.2% of disability-adjusted life years (DALYs)20. In Europe, mental and behavioural problems
due to alcohol are the fifth highest cause of DALYs, exceeded only by depression, coronary heart
disease, dementias and stroke.
The most obvious form of harm due to chronic excessive drinking is alcohol dependence, not
forgetting alcohol-related liver cirrhosis mortality, deaths due to hypertension and the correlation
between chronic heavy drinking and the risk of both haemorrhagic and ischemic stroke. In
addition, excessive drinking, especially if combined with cigarette smoking, contributes to the risk
of a range of cancers and it is well known that drinking in pregnancy can affect the pre- and postnatal development of the baby and lead in particular to Foetal Alcohol Syndrome (FAS).
Apart from negative consequences for physical health, excessive drinking is also associated with
poor mental health. Many psychiatric patients with serious mental illness have a substance misuse
problem, mostly involving alcohol and at the same time, roughly half of those attending drug and
alcohol services have a psychiatric disorder, most commonly depression or personality disorder.
Road accidents under the influence of alcohol are a major cause of harm due to alcohol
consumption. In 2005 in Greece, 28% of the total 1.311 deaths in road accidents were doe to the
influence of alcohol.
It should be noted that although no official statistics are available in Greece concerning the real
prevalence of alcohol-related harm, it is clear that alcohol is a causal factor in many diseases and
negative consequences cover a large number of areas – from family problems to absenteeism at
work to loss of life – making it impossible to gauge the significance of these harms by looking at
one area alone.
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Primary Health Care European Project on Alcohol (PHEPA)
MEASURES TO REDUCE THE HARM DONE BY ALCOHOL
It has already been mentioned that the general public in Greece has a strong belief that there are
no serious alcohol-related problems in the country. The officials in the state administration also
seem to share this view21. The incidence of alcoholism has also been considered to be low in
Greece17,22. This, together with the fact that the wine industry has contributed significantly to the
GDP, has led to the absence of a coordinated program concerned with alcohol-related problems.
Therefore, the implementation of the existing official alcohol control measures is not strictly
enforced.
Despite the absence of a comprehensive state preventive alcohol policy, the individual ministries
and organizations have developed a number of policy measures also affecting the alcohol field
since the 1950s. These measures mainly deal with the production, distillation and selling of
alcoholic beverages and with taxation controls, and more recently with drinking and driving. For
instance, all alcohol producers, including wine producers, need a license for selling and bottling
their products. This license has to be issued by the State Chemical Laboratory. Nevertheless, it
has been shown that home production, distillation and selling have not been effectively
controlled.
Awareness of the issue of preventing alcohol problems has, however, grown during the 1990s.
The current administrative structure of preventive alcohol policies in Greece involves the
following ministries and organizations:
•
Ministry of Health, Department of Mental Health, Section of Alcohol and Drug Prevention
was established in 1990. It is responsible mainly for secondary and tertiary preventive
activities.
•
Ministry of Education, Department of Health Education was established in 1992. This
department is responsible for organizing and implementing health education programs
and campaigns in selected schools in primary and secondary education.
•
Ministry of Culture, General Secretariat of Youth organizes programs for young people
outside school. It also approaches special youth groups, such as migrants, refugees,
ethnic and multicultural groups.
•
Ministry of Public Security, Traffic Police is responsible for the implementation of drunk
driving testing.
•
Organization Against Drugs (OKANA) was established in 1994. It is mainly offering its
services to illicit drug addicts. However, in its plan of activities for the years 2000–2004 a
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Primary Health Care European Project on Alcohol (PHEPA)
range of activities has also included alcohol and tobacco. In recent years, OKANA has
organized and financially supported preventive programs in local communities, and lately
in working places in collaboration with the Ministry of Labor and Health Promotion Agency
in Working Places23.
A policy measure that was introduced in the late 1990s is the implementation of breathalyzer
tests by the traffic police on main roads. The introduction of breathalyzer tests was partly a
result of the Alcohol Action Plan initiated by the World Health Organization’s Regional Office for
Europe (WHO-EURO) and the European Charter on Alcohol, which Greece signed during the Paris
Conference in December 12–14, 1995.
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Primary Health Care European Project on Alcohol (PHEPA)
THE EFFECTIVENESS AND COST EFFECTIVENESS OF
INTERVENTIONS FOR HAZARDOUS AND HARMFUL ALCOHOL USE IN
PRIMARY HEALTH CARE
There is strong evidence that screening and brief alcohol interventions delivered in PHC are
effective in leading to reduced alcohol consumption among hazardous and harmful drinkers, with
consequent benefits for patients’ health and welfare. There is also strong evidence that PHC brief
interventions are highly cost-effective and that they reduce the burden on PHC services.
However, even if the evidence is convincing both in effectiveness and cost effectiveness none of
those studies stems from investigations that are taking place in the Greek context, making the
results less powerful. There is a strong need for scientific evidence of brief intervention in the
Greek National Health system so that results be more convincing and better accepted by health
care professionals.
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Primary Health Care European Project on Alcohol (PHEPA)
CURRENT POLICIES AND ACTIVITIES
6.1 Policy decisions at National level
Greek Action Plan on Drugs was adopted in 2002. Alcohol activities were either implicitly
mentioned or with regard to prevention interventions and the support of self-help groups. The
need for a Greek Action Plan on Alcohol has been pointed out in the Annual Report of the Greek
REITOX Focal Point for Drugs 2004.
The prevention agencies in most cases implement alcohol-related interventions as part of a
broader mobilisation strategy regarding substance use.
In addition, the Ministry of Education and Religious Affairs implements Health Promotion
Programs in Primary and Secondary Education with a specific focus on alcohol use prevention.
Some prevention agencies organise special alcohol-focus activities in schools addressing
educators, pupils and parents.
The
University
Mental
Health
Research
Institute
(UMHRI)
conducts
regular
nationwide
epidemiological surveys among students (11-18 years old) by applying the methodology of
‘Health Behaviour in School-aged Children’ (HBSC-WHO) survey and the ‘European School Survey
Project on Alcohol and Other Drugs’ (ESPAD). The results are published in the Annual Reports of
the Greek REITOX Focal Point of the European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA) and disseminated to a national network of policy makers and professionals in the drug
and alcohol field.
The Strategic Inter-Ministerial Road Safety Programme “On the Road 2001-2005” was launched
to promote information campaigns against driving under the influence of alcohol (financed by the
European Commission) and the reduction of the number of deaths related
to road accidents.
Since May 2002 the message “Enjoy with responsibility” is included in the advertisements of
alcoholic beverages. The legal BAC in certain categories of drivers (professional and novice
drivers) was reduced from 0.50 to 0.20 gr of ethanol per litre of blood.
In May 2005 the Laboratory of Communication, Media and Culture of Panteion University in
collaboration with the alcoholic beverage company DIAGEO Hellas produced a CD-ROM titled
‘What counts in entertainment…’ with useful information with regards to alcohol consumption.
One of the six sectors is dedicated to Alcohol and Driving. The CD-ROM is addressed to university
level students.
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Primary Health Care European Project on Alcohol (PHEPA)
Presidential Decree 36 was launched in 1994 to prohibit minors under 17 from entering
nightclubs
and
bars
or
from
consuming
alcoholic
beverages
in
other
licensed
public
establishments, when unaccompanied by their parents of guardians.
6.2 National initiatives involving the wider alcohol industry
The Ministry of Health and Social Solidarity is in the process of discussion in order to suggest
effective ways and mechanisms to monitor and evaluate the situation of alcohol use and abuse in
Greece.
Within the framework of a recent European Research Institute on Risk Factors in Childhood and
Adolescence project (IREFREA) a prevention kit for substance use in recreational settings will be
developed which will include a training manual for professionals working in such settings.
The General Chemistry State Laboratory and Customs is responsible for the removal of products
which are not being promoted, marketed or retailed in accordance to the national legislation. The
content of media advertisements (Law 2328/1995, Presidential Decree 100/2000) is legally
restricted.
6.3 Specific issues
Licensing policy
Alcohol producers in Greece need a license to operate. The license is not, however, perceived as
a preventive alcohol policy measure but is required to ensure a good standard of quality of the
alcoholic beverages produced. The license to produce alcoholic beverages is granted by the
Ministry of Commerce and the State General Chemical Laboratory. The license includes specific
rules and regulations that have been in force since the mid-1940s concerning pure alcohol
production, in terms of the year of production, labeling of the contents, and sales and restrictions
of use by persons other than alcohol producers and pharmacists. The license is permanent. Also
the importers and wholesalers of alcoholic beverages need a license to operate. The license,
which has to be renewed periodically, is granted to the licensee by the Ministry of Economics,
Department of Trade, and the Chamber of Commerce. Also off-premise retailers of alcoholic
beverages need a license to operate. The license is permanent and it is granted by the local
municipalities and the prefecture authorities at the Department of Health. The license is,
however, not alcohol-specific. Also some on-premise establishments are required to have a
license. This concerns mostly bars that are restricted to certain rules by the police and the
prefecture authorities. Other restaurants are not required to have a license.
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Primary Health Care European Project on Alcohol (PHEPA)
Restrictions of availability
According to the Act 992/71 the legal age limit on off-premise purchases of distilled spirits has
been 18 years since 197118. Nowadays off-premise sales by stores specializing in retailing
alcoholic beverages is restricted by a Ministerial Decree (180/79), and the age limit is still 18
years for distilled spirits. For beer and wine there are no legal age limits, since these beverages
can also be purchased in a variety of places other than special liquor stores, like food markets,
kiosks, petrol stations, open-air canteens, bus or train stations and airports. For on-premise sale
of alcoholic beverages there is an age limit of 18 years on all alcoholic beverages, wine and beer
included. There is also an age limit of 18 years for consumption of alcoholic beverages in all
cafeterias, bars and discotheques. This age limit was introduced in 1989, but was not strictly
enforced until recent years. Alcoholic beverages are available in food markets or in specialized
liquor stores. The business hours for off- and on-premise sale of alcoholic beverages depend on
the type of premise. The restrictions on business hours are, however, not alcohol-specific but
apply to sale of all kinds of merchandise. Off-premise business hours are
– 8.00 a.m. – 9.00 p.m. for supermarkets,
– 8.00 a.m. - 11.00 p.m. for specialized liquor stores, and
– 24 hours for kiosks selling beer, on trains or long-distance bus stations, and airports.
For on-premise sale the business hours are until midnight or 1.00 a.m. for restaurants, and for
bars and discotheques they used to be until 3.00 a.m. or all night long. At the beginning of the
1990s the business hours of bars, discotheques, dancing clubs, taverns, etc. became a big issue.
Closing-time limits were strictly enforced, but only for less than two years. Presently, the
business hours for bars and discotheques should officially be until 2.30 a.m. The law is, however,
not at all strictly enforced and in practice this time limit is frequently violated. Especially in
summertime on the islands, bars and discotheques are open all night.
Alcohol taxation
The current method of alcohol taxation varies depending on the beverage category. For beer,
excise duties are levied on the basis of hectoliter per degree of Plato in the finished product, and
they are applicable to beer with alcohol content over 0.5 per cent alcohol by volume. For wine
and fermented beverages other than wine and beer, the excise duties are applied on the basis of
hectoliter of the product, but the actual excise rate has been set at zero Euros. The same is true
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Primary Health Care European Project on Alcohol (PHEPA)
for intermediate products with an alcohol content of less than 15 per cent by volume. Like wine
and other fermented beverages, the excise duty on intermediate products is also applied on the
basis of hectoliter of the product. The excise duty on distilled spirits is levied per hectoliter of
pure alcohol in the finished product. With regard to distilled spirits and intermediate products
over 15 per cent alcohol by volume, Greece applies reduced rates. For distilled spirits this
concerns ouzo. For intermediate products over 15 per cent alcohol by volume the reduced rate
concerns natural sweet wines. Besides the excise duty, a value added tax (VAT) of 18 per cent is
nowadays included in the price of all alcoholic beverages.
Alcohol advertising
There are currently no restrictions concerning alcohol advertising, sales promotion and
sponsorship. At the beginning of the 1990s there was, however, an effort made towards
decreasing the number of alcohol advertisements on television, and some regulations were
introduced by the Ministry of Social Security, including information against drunk driving.
Recently, the three public television channels have initiated a policy of decreasing alcohol
advertisements.
Education and information
There are very few activities on alcohol education and information compared to those which
concern illicit drugs. The situation seems to be slowly changing. However, education and
information activities are not coordinated or evaluated in any systematic way17. The following
programs and campaigns are or have been under way in Greece:
– A number of health education programs have been introduced in a selected number of
schools, mainly in the greater Athens area since the mid-1980s. These programs have
been supported by the Ministry of Education and the General Secretariat for Youth.
–
In recent years a campaign on alcohol risks in relation to driving has been introduced
by the Ministry of Health, thus increasing the public’s awareness on drunk driving.
Television and radio spots on drunk driving have been introduced by the Ministry of
Health, National Committee on Alcohol.
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Primary Health Care European Project on Alcohol (PHEPA)
Drunk driving
According to the regulations of the Ministries of Transport and Justice, a driver’s blood alcohol
concentration (BAC) level is not to exceed a level of 0.05 per cent. These regulations have not
been, however, effectively enforced until recently. Currently, the driver is considered to be
driving under the influence of alcohol if the BAC level is over 0.02 per cent.
The punishment for drunk driving is usually a fine. Punishments in general are not severe unless
the driver in question has been involved in a car accident. If the BAC level is higher than 0.1 per
cent, then the driver’s driving license may be suspended temporarily. From 1999 onwards, there
has been more systematic traffic safety law enforcement, with the implementation of
breathalyzer tests.
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Primary Health Care European Project on Alcohol (PHEPA)
INTEGRATING PREVENTIVE INTERVENTIONS IN PRIMARY HEALTH
CARE
The National Plan of Action for the restriction of harmful consequences of alcohol use in health
focus in the prevention. The strategy develops for the first time a completed raft of policies and
prevention measures, in order not only to decrease alcohol consumption but also to decrease the
harmful consequences of consumption.
7.1. Principles
The national Plan of Action 2008-20122 is conditioned by the following principles of European
Constitutive Chart for Alcohol:
1. All persons have the right to a life (family, work etc), which is protected from accidents,
violence and other negative consequences that result from the consumption of alcohol.
2. All persons have the right, from a very early age, to valid and unbiased information and
education regarding the consequences of alcohol consumption for health, the family and
society.
3. All children and adolescents have the right to grow up in an environment protected from
the negative consequences of alcohol consumption, as well as protected from the
promotion of alcoholic drinks.
4. All persons that have a dangerous level of consumption, as well as the members of their
families, have a right to accessible treatment and proportional care.
7.2. Practice based guidelines, protocols and aids
No specific guidelines exist in clinical practice in Greece. Most practitioners are adopting
guidelines directly from the American Medical Association or the WHO.
The clinical guidelines
produced by PHEPA are a welcome addition and efforts are made for the utilization in training
programs for Greek practitioners.
7.3. Training
As part of the national Plan of Action 2008-20122 an educational program has been prepared for
healthcare professionals on methods and techniques of alcohol detoxification but also on issues
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Primary Health Care European Project on Alcohol (PHEPA)
of
communication,
publicity,
briefing,
and
stigmatization,
referring
to
the
damaging
consequences of alcohol.
Objectives of the program:
–
The improvement of knowledge and skills of healthcare professionals who are involved
in services and programs of treatment and prevention of alcoholism.
–
The spread of knowledge in all network programs and activities for alcohol.
–
The improvement of knowledge and skills of healthcare professionals that are involved
in sectors of prevention, treatment and social rehabilitation.
–
The guarantee of quality of educational activities.
–
The essential and measurable increase in the number of educational programs and
participating professionals.
The National Centre of Confrontation of Dependences in collaboration with the sanitary regions
and the National Faculty of Public Health will work out a program of education of six months’
duration for primary and secondary healthcare professionals that are involved in services and
programs of prevention, treatment and social rehabilitation. A certificate of specialization will be
awarded which will be a basic criterion and condition of employment of workers in prevention
centers, detoxification clinics and rehabilitation centers. Special educational handbooks of good
practice on alcohology issues will be published, which will be distributed in the professionals of
health who work in the services of prevention, treatment and social rehabilitation. In addition the
National Centre of Confrontation of Dependences will organize special educational meetings and
meetings of work (workshop) on professionals for prompt and update briefing in treatments,
actions and programs.
7.4. Engaging primary health care providers
Proposals that are under consideration are:
Better and more integrated training will be a powerful way of engaging PHC providers. Giving
PHC providers the means of screening and simple counselling and the knowledge for
implementation makes them more willing to be involved in an area that they are not familiar
with.
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Primary Health Care European Project on Alcohol (PHEPA)
The possibility of some reimbursement to compensate for the time and disruption to routine
arising from their participation will also have a positive outcome.
A more and better informed population will have also a stronger motivation for demanding the
engagement of PHC professionals in the preventive central policy against hazardous and harmful
alcohol use.
7.5. Funding and reimbursement
The new National Health Plan will be supported by funding from the central government, but also
by local enhanced services, Municipalities and NGO’s.
7.6. Specialist support and knowledge centres
The support of specialist services would surely enhance the effectiveness of the programme. An
effort is being made towards the construction of a website by the Hellenic Society for the Study
of Addictive Substances, containing an Alcohol Management Database that will present evidencebased information about the management of alcohol problems. This is intended to be an essential
resource for those working on the management of alcohol problems in primary health care.
Also the National Centre of Confrontation of Dependences will have a key role when it
undertakes the planning and implementation of a special Portal for the prevention of
dependences. The national network site for dependences will provide information about:
–
National policy
–
The international environment
–
Modern epidemiological data on dependences and the consequences
–
Prevention programs
–
Detoxification services
–
Social rehabilitation services
–
Professional orientation
–
Possibility of communication between the user and his family
–
Scientific database
–
A bank of life experiences.
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Primary Health Care European Project on Alcohol (PHEPA)
In addition to the National Health Plan2, there exists the prospect of counseling services for the
prevention of alcohol dependence via telephone and internet «Quit –line 1031».
The objectives of this service will be:
–
The guarantee of available counseling services, 24 hours of the day, for the whole
population.
–
The exploitation of possibilities arising from the use of new technologies in the fight
against hazardous and harmful drinking.
–
The organization of individualized counseling services via internet.
Actions that are planned
The National Centre of Confrontation of Dependences will undertake:
–
The responsibility for setting up and operating a telephone help line for the prevention
of harmful and thoughtless alcohol use.
–
The responsibility for educating the workforce.
–
The responsibility to format and operate a specialized web page in the internet, to
provide general and individualized counseling services for alcohol prevention, using as
model similar services from other countries.
–
The continuous technical and scientific support of the web page.
–
The rendering of knowledge and information (questions, articles, games of knowledge
and sensitization)
–
The provision of individual or group advisory with interaction through the electronic
correspondence.
–
The creation of a specialized database (“bank of” information) based on the questions
and answers that will be offered
–
The responsibility for dissemination and projection for “quit-line” and web page, via
connections with other web pages, mass media etc.
–
The evaluation of the web site based on the numbers of page visits, teams that are
communicating, etc.
19
Primary Health Care European Project on Alcohol (PHEPA)
7.7. Monitoring the programme
National Authority of Co-ordination of National Action Plan
The co-ordination and monitoring of the National Action Plan will be assigned to a National
Committee of Co-ordination, which will include members from all involved in the plan
implementation institutions, governmental and not. The tenure of office of the Co-ordination
Committee will last as long as the Action Plan, and will not be affected by possible political
changes.
The competences of National Committee of Co-ordination will be:
–
The guarantee of intersectorial collaboration and the promotion of common action,
cooperation and collaboration of institutions.
–
The guarantee of international collaboration, in the frame of European Union and
international organisms.
–
The maximization of effectiveness of action, via co-ordination at national and
international level.
–
The guarantee of subsidiary and complementary action, at national and international
level.
–
The promotion of social attendance and joint responsibility in the fight against
alcoholism and alcohol abuse and, to this end, the activation of Society of Citizens.
–
The transparency and the guarantee of possibilities of social control for the action of
state in the field of alcohol.
–
The projection of a National Strategy against alcoholism and alcohol abuse, via the
creation of a social forum of dialogue, with the overall participation of public and social
institutions that are active in this sector.
–
The regular announcement and public discussion of objectives, action and annual
report of progress of National Action Plan for alcohol.
–
The organization of an annual program of national and regional events of public
consultation on alcohol and its consequences.
–
The promotion of public dialogue and account via the relevant network portal on the
internet.
20
Primary Health Care European Project on Alcohol (PHEPA)
–
The guarantee of benefit of data and information on public dialogue.
–
The publication of an annual national report of evaluation and progress.
Monitoring of Ministry of Health and Social Solidarity.
The Coordinating Committee will collaborate immediately with all institutions that are involved,
with the National Council of Public Health and the Central Council of Public Health and it will give
a report to the General Secretary of Public Health.
System of Control and Evaluation
The implementation of the Action Plan will be accompanied by a permanent process of Control
and Evaluation, aiming at the redefinition of objectives and the re-designing of action, for the
guarantee of effectiveness of the action plan.
The process of Control and Evaluation is connected:
(a) With the Indicators of the Follow-up to the Action Plan and
(b) With the permanent process of Public Account on the course of the Action Plan and its results.
The objectives of control and evaluation system are:
Creation of a system to collate data and follow-up indicators, for continuous and systematic
monitoring and evaluation of Action Plan progress.
The monitoring indicators will concern:
–
The extent and social-demographic characteristically of alcoholism and alcohol use.
–
The demand of treatment from alcoholics.
–
Hospitalization for causes related with alcohol.
–
Deaths from causes related with alcohol.
–
Mortality and the causes of death in alcohol abusers.
–
The frequency of relapse after treatment.
21
Primary Health Care European Project on Alcohol (PHEPA)
–
The behavior and the attitude of the general population.
7.8. Preparing for the introduction of the programme
The next step in the development of this strategy is to have it endorsed by the key national
organisations that are relevant to the implementation process.
7.9. Managing the programme
Ministry of Health and Social Solidarity, National Centre of Confrontation of Dependences,
Ministry of the Interior, Public Administration and Decentralization
7.10. Communicating about the programme.
At national level:
–
Media communication
–
Medical journals
–
Lectures in national congresses
–
Posters in national project meetings
–
Updated net pages
–
Training programs for primary healthcare professionals
At regional level:
–
Media communication (local newspapers, local radio and television)
For the implementation of a national campaign the following actions are planned:
–
All activities and programs of public briefing and information are included in the
competence and
are
coordinated
by
the National
Centre of
Confrontation
of
Dependences.
22
Primary Health Care European Project on Alcohol (PHEPA)
–
A plan by the National Centre of Confrontation of Dependences is under preparation for
the
organized
information
and
briefing
of
the
population
via
mass
media
communication, internet etc.
–
An extensive program of public information is being prepared against the dangers and
the harmful consequences of alcohol and for the possibilities of safe and responsible
consumption.
–
Special briefing and education is promoted for alcohol retailers and waiters, aiming at
the increase of responsibility in the sale of alcoholic drinks.
–
A special action is being promoted for selective information and prevention in socially
vulnerable populations.
–
Growth of social initiatives and activities of information and health education for alcohol
is encouraged and supported.
–
Pilot actions of promotion and support of alcohol-free forms of amusement are being
supported and carried out.
23
Primary Health Care European Project on Alcohol (PHEPA)
RESEARCH NEEDS
Some recommendations for future research
–
Studies of effectiveness.
–
Long-term follow-up studies.
–
Studies to investigate the effectiveness of targeted brief interventions (i.e., particular
groups of patients).
–
Economic evaluation of brief interventions.
24
Primary Health Care European Project on Alcohol (PHEPA)
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