The Impact of Alcohol
on the Health of
Southern Communities
A Report to Inform the Development of Local Alcohol
Policies by Southern District Councils
Prepared by Public Health South
1 July 2013
Executive Summary
Introduction
Alcohol is enjoyed by many responsible drinkers for its positive effects. However, alcohol is still “a
toxic substance with the potential to cause both immediate health harm, such as alcohol poisoning,
and longer-term health harms such as alcohol dependence, liver disease and a range of cancers.”1
Intoxication also increases the risk of injury, both intentional and unintentional.
The object of the new legislation covering the sale and supply of alcohol (Sale and Supply of Alcohol
Act 2012) is broader than that of previous legislation (Sale of Liquor Act 1989). The new legislation
includes the aim of minimising harm caused by excessive or inappropriate consumption of alcohol,
with harm being described as follows:
(a) any crime, damage, death, disease, disorderly behaviour, illness, or injury, directly or
indirectly caused, or directly or indirectly contributed to, by the excessive or inappropriate
consumption of alcohol; and
(b) any harm to society generally or the community, directly or indirectly caused, or
directly or indirectly contributed to, by any crime, damage, death, disease, disorderly
behaviour, illness, or injury of a kind described in paragraph (a).
Based on our analysis of hospital and survey data, this report describes the “harm to health” caused
by excessive or inappropriate alcohol consumption among the population of the Southern District
Health Board.
Findings
According to 2011/2012 New Zealand Health Survey results, a quarter of Southern District residents
are hazardous drinkers.2 We have the highest prevalence of hazardous drinking among all District
Health Board regions, and a statistically significantly higher prevalence than the national average
(25.1% versus 17.0%).
We extracted alcohol-related hospital discharge data for the 2008–2012 financial years from the
Dunedin, Southland, Lakes District and Wakari hospitals to examine trends in the number of patient
episodes including conditions wholly attributable to alcohol use. There were 6628 discharge records
for that period that contained a diagnosis for a condition wholly attributable to alcohol. The number
of patient episodes including alcohol-attributable conditions increased steadily and substantially
over the five-year period, beyond what we might expect from population growth.
1
Law Commission (2009). Alcohol in our lives. An issues paper on the reform of New
Zealand’s Liquor Laws (NZLC IP15). Law Commission, Wellington.
2
Hazardous drinking refers to an established drinking pattern that carries a risk of harming
physical or mental health, or having harmful social effects to the drinker or others. See
report for further details.
For some conditions, there were statistically significant increases in the annual number of patient
episodes over the five-year period. On average, there was a 10% annual increase in the incidence
rate of alcohol poisoning, and the number of patient episodes increased from 222 in 2008 to 446 in
2012. Dunedin Hospital showed the most marked increase in the number of alcohol poisoning cases,
particularly in the 18-24 year-old age group. Although the numbers remained relatively small
throughout 2008–2012, on average, there was a 46% annual increase in the incidence rate of
alcohol-induced acute pancreatitis, a 50% annual increase in the rate of alcoholic gastritis, and a 36%
annual increase in the rate of alcoholic hepatic failure. The many conditions partially attributable to
alcohol (such as cancers of the oesophagus and liver) were not examined. The true impact of alcohol
in terms of acute and chronic health conditions is therefore much higher.
From 24 January through 6 November 2012,3 patients presenting to the emergency departments of
the Dunedin, Southland and Lakes District hospitals were asked if alcohol contributed to their
presentation. Among those screened, 2579 presentations were identified as being alcohol-related.
The true number of alcohol-related presentations is likely to be much higher, because not all
patients were screened. The highest overall prevalence of alcohol-related presentations was
observed at Lakes District Hospital (Lakes District 12%; Dunedin 6%; Southland 5%). The estimated
minimum cost of the 2579 presentations known to be alcohol-related to the Southern District
Health Board (excluding treatment costs) was over 1.4 million dollars over a period of less than
one year. Some individuals were making multiple presentations for separate alcohol-related
conditions. In terms of age, the highest number of alcohol-related presentations was made by
patients aged 18–24 years, although the number of presentations made by 25-34 year olds to the
Lakes District Hospital was similarly high. All hospitals saw people under the legal age for purchasing
alcohol present with an alcohol-related condition. Underage patients represented 11% of all alcoholrelated presentations at Southland Hospital, 7% at Dunedin Hospital and 5% at Lake District Hospital.
The burden of alcohol-related presentations fell predominantly on the weekends, although the
distinction between weekdays and weekends was less clear at Lakes District Hospital, where the
weekday burden was high compared with the other hospitals. At all hospitals, the highest prevalence
of alcohol-related presentations occurred between midnight and 4 am. However, at Lakes District,
the prevalence remained relatively high between 4 am and 8 am.
The burden of alcohol-related harm to health does not fall exclusively upon the district’s hospitals.
Therefore, we surveyed other people and organisations that respond to alcohol-related problems
within the community. There was almost complete consensus among 518 health and allied
professionals that alcohol-related problems are evident in their district. Further, most stated that
the current level of availability of alcohol from licenced premises significantly contributes to these
problems. Over 80% of those surveyed said that alcohol has a major or leading role in violent crime,
domestic violence, accidents, injury and child neglect. There was strong support for increased
restrictions on alcohol availability. In particular, the majority of respondents felt that permitted
trading hours should be reduced, and that the number and location of licenced premises should be
subject to increased restrictions. Our survey data indicate that it is the licences of pubs, bars, taverns
and nightclubs, as well as those of bottle shops, convenience stores and supermarkets that should
3
With the exception of Southland Hospital, which commenced screening on 21 March 2012.
be policy targets. Few respondents stated that licenced restaurants and cafes play a role in alcoholrelated problems in their district.
Our Comments and Recommendations
This report will be sent to each of the councils within the Southern District Health Board
geographical boundaries along with a cover letter that identifies specific issues for each Council to
consider. It identifies the very significant role that alcohol plays in causing harm to the health of our
residents and the impact that this has on our health services. We confirm that alcohol-related harm
to health is indeed well and truly present within our own population. It is a major concern to us that
this harm is often accepted and normalised, and sometimes even glamorised. Despite alcohol’s
widespread use and appreciation, the fact remains that alcohol has inherent dangers as a
psychotropic drug, addictive substance, toxin and carcinogen. For this reason, regulations controlling
its availability, accessibility and promotion are well justified—particularly in light of the strong
commercial imperatives driving its sale and supply.
We urge all councils to:

Accept the findings of this report and acknowledge that excessive or inappropriate
consumption of alcohol is causing significant harm in our communities.

Read the comments from your local health professionals. These comments say it all—they
are relevant, specific and powerful. These are the informed opinions of your front-line
professionals who know best about the harm that alcohol is causing within your
communities.

Implement a Local Alcohol Policy that:
o
o
Restricts the trading hours of licensed premises. We confirm the SDHB position
statement on alcohol:

Restrict on-licences from selling alcohol after 2am

Restrict off-licenses to selling alcohol between 8am and 10pm
Restrict the location, number and density of all licensed premises to protect “the
amenity and good order of the locality (so that it is) pleasant and agreeable” (as per
the Sale and Supply of Alcohol Act 2012)
Contents
Executive Summary................................................................................................................................. ii
1
2
3
Introduction .................................................................................................................................... 1
1.1
Purpose ................................................................................................................................... 1
1.2
Background ............................................................................................................................. 1
1.3
Scope ....................................................................................................................................... 2
Overall health indicators of Southern District residents ................................................................ 3
2.1
Background ............................................................................................................................. 3
2.2
Lifestyle ................................................................................................................................... 3
2.3
Medical conditions .................................................................................................................. 4
Hospital discharges for wholly alcohol-attributable conditions, 2008–2012 ................................. 5
3.1
Background ............................................................................................................................. 5
3.2
Methods .................................................................................................................................. 5
3.3
Results ..................................................................................................................................... 5
3.3.1
3.4
4
Alcohol poisoning cases .................................................................................................. 7
Discussion................................................................................................................................ 9
Alcohol-related presentations to emergency departments in the Southern District ................... 10
4.1
Background ........................................................................................................................... 10
4.2
Methods ................................................................................................................................ 10
4.2.1
Sample........................................................................................................................... 10
4.2.2
Data ............................................................................................................................... 10
4.2.3
Analysis ......................................................................................................................... 10
4.3
Results ................................................................................................................................... 11
4.3.1
Response rates .............................................................................................................. 11
4.3.2
Assessment of sample selection bias ............................................................................ 11
4.3.3
Prevalence and characteristics of alcohol-related emergency department
presentations ................................................................................................................................ 11
4.4
Discussion.............................................................................................................................. 14
5
Health professionals’ attitudes toward local alcohol problems ................................................... 16
5.1
Background ........................................................................................................................... 16
5.2
Methods ................................................................................................................................ 16
5.2.1
Study design and instrument ........................................................................................ 16
5.2.2
Participant recruitment................................................................................................. 16
5.3
Results ................................................................................................................................... 17
5.3.1
Respondents ................................................................................................................. 17
5.3.2
The presence of local alcohol problems ....................................................................... 18
5.3.3
The severity of alcohol-related problems ..................................................................... 18
5.3.4
The role of alcohol in local problems ............................................................................ 19
5.3.5
The role of alcohol availability in alcohol-related problems......................................... 20
5.3.6
Respondent comments ................................................................................................. 21
5.4
Discussion.............................................................................................................................. 25
Appendix A ............................................................................................................................................ 27
Appendix B ............................................................................................................................................ 28
Appendix D ............................................................................................................................................ 30
Appendix E ............................................................................................................................................ 31
Appendix F ............................................................................................................................................ 32
List of Tables
Table 1 Trends in wholly alcohol-attributable patient episodes at Dunedin, Southland, and Lakes
District hospitals, 2008-2012 .................................................................................................................. 6
Table 2 Hospital catchment size and data collection dates .................................................................. 10
Table 3 Response rates obtained in the three EDs ............................................................................... 11
Table 4 The presence of local alcohol-related problems, by territorial authority ................................ 18
Table 5 The contribution of alcohol availability to alcohol-related problems...................................... 20
Table 6 Characteristics of presentations that were assessed versus those not assesseda ................... 28
Table 7 Proportion of respondents indicating the presence of major or severe alcohol-related
problems in each population group by territorial authority ................................................................ 29
Table 8 Proportion of respondents indicating the alcohol plays a major or leading role in local
problems, by Territorial Authority ........................................................................................................ 30
Table 9 Proportion of respondents agreeing or strongly agreeing that alcohol availability from
certain premise types plays a role in alcohol-related problems........................................................... 31
Table 10 Proportion of respondents agreeing or strongly agreeing that the availability of alcohol
should be addressed with licencing restrictions ................................................................................... 32
List of Figures
Figure 1. Age-standardized prevalence of hazardous drinking among adults aged 15 years and older
by district health board (DHB) (2011/12 National Health Survey). ........................................................ 4
Figure 2 Total number of patients episodes with a wholly alcohol-attributable condition, by year and
hospital.................................................................................................................................................... 7
Figure 3 Number of alcohol poisoning cases treated at Dunedin Hospital 2008–2012, by age............. 7
Figure 4 Number of alcohol poisoning cases treated at Southland Hospital 2008–2012, by age. ......... 8
Figure 5 Number of alcohol poisoning cases treated at Lakes District Hospital 2008–2012, by age. .... 8
Figure 6 Number of alcohol poisoning cases treated at Wakari Hospital 2008–2012, by age ............... 9
Figure 7 Number of alcohol-related presentations to the emergency departments by hospital, age
category and sex. Note that Southland Hospital did not collect data during Jan-Feb 2012. ............... 12
Figure 8 The nature of alcohol-related presentations. The pie charts show the proportion of each
condition among alcohol-related presentations. ................................................................................. 13
Figure 9 The proportion of presentations that were due to alcohol, by weekend versus weekday and
hospital. Weekdays: Monday 08:01-Friday 16:00; Weekends: Friday 16:01-Monday 08:00............... 14
Figure 10 The proportion of presentations that were due to alcohol, by time of day and hospital. ... 14
Figure 11 Age distribution of survey respondents................................................................................ 18
1 Introduction
1.1 Purpose
The purpose of this report is to help territorial authorities in the Southern District understand and
prioritise the alcohol-related issues to be addressed through the development of local alcohol
policies.
1.2 Background
Hazardous drinking is a serious social and public health problem in New Zealand. A comprehensive
review of New Zealand’s alcohol laws was undertaken by the Law Commission in 2008. Almost 3000
public submissions were made during this process, and the key issues raised were published in the
Law Commission’s final report entitled, Alcohol in Our Lives: Curbing the Harm.4
As a legislative response to the Law Commission’s report, the Sale and Supply of Alcohol Act 2012
repeals and replaces the Sale of Liquor Act 1989. The new act specifically requires the consideration
of disease and injury caused by excessive or inappropriate consumption of alcohol and empowers
territorial authorities to develop local alcohol policies that must be considered when making
licencing decisions.
The object of the new act is:
(a) The sale, supply, and consumption of alcohol should be undertaken safely and responsibly;
and
(b) The harm caused by the excessive or inappropriate consumption of alcohol should be
minimised.
The harm includes:
(a) any crime, damage, death, disease, disorderly behaviour, illness, or injury, directly or
indirectly caused, or directly or indirectly contributed to, by the excessive or inappropriate
consumption of alcohol; and
(b) any harm to society generally or the community, directly or indirectly caused, or directly or
indirectly contributed to, by any crime, damage, death, disease, disorderly behaviour, illness,
or injury of a kind described in paragraph (a).
Section 77 sets out the following licencing matters that can be addressed through local alcohol
policy:

4
Location of licenced premises by reference to broad areas
Law Commission (2010). Alcohol in Our Lives: Curbing the Harm (NZLC R114). Law
Commission: Wellington.
1

Location of licenced premises by reference to proximity to premises or facilities of particular
kinds

Whether further licences (or licences of a particular kind or kinds) should be issued for
premises in the district concerned, or any stated part of the district

Maximum trading hours

The issue of licences, or licences of a particular kind or kinds, subject to discretionary
conditions

One-way door restrictions
The policy must be produced, adopted, and bought into force, in accordance with the Act. Section 78
states that territorial authorities must first produce a draft policy.
1.3 Scope
The scope of this report aligns with section 78(4) of the Sale and Supply of Alcohol Act 2012:
The authority must not produce a draft policy without having consulted the Police, inspectors and
Medical Officers of Health, each of whom must, if asked to do so, make reasonable efforts to give
the authority any information they hold relating to any of the matters stated in subsection (2)(c)
to (g).
Of the matters listed in subsection (2)(c) to (g), the Medical Officers of Health for your district hold
information on (f) the overall health indicators of the district’s residents, and (g) the nature and
severity of the alcohol-related problems arising in the district.
The information held is presented in this report, and includes the following:

A description of overall health indicators of the Southern District’s residents.

A description of trends in the number of hospital patient episodes that include acute and
chronic diseases that are wholly attributable to alcohol.

A description of alcohol’s contribution to emergency department presentations.

A description of survey findings from health and allied professionals regarding the nature
and severity of the Southern District’s alcohol-related problems.
2
2 Overall health indicators of Southern District residents
2.1 Background
This section describes some overall health indicators of Southern District residents. The statistics are
taken directly from 2011/2012 New Zealand Health Survey results.5 The target population for the
survey is the usually resident population of all ages, including those living in aged-care facilities and
student accommodation. The target population excludes some non-private dwellings such as
prisons, hospitals, hospices and dementia care units, and some remote areas. Data for the 2011/12
New Zealand Health Survey were collected from July 2011 to August 2012. To facilitate comparisons
with other district health board regions, age-standardized prevalence estimates are reported. These
estimates control for differences in age structures of the underlying populations. Additionally,
temporal trends are indicated where data are available.
2.2 Lifestyle
For the Southern District, the 2011/12 age-standardized prevalence of reporting excellent, very good
or good self-rated health was 88.6%. This represents a decrease of 4.1% relative to the 2006/07
prevalence of 92.7%. The Southern District is the only heath board region in the country to show a
statistically significant decrease in the prevalence of excellent, very good or good self-rated health
over time.
Although we have a significantly higher prevalence of meeting physical activity guidelines compared
with the national average (67.4% versus 55.5%), almost a third of our population is obese (29.8%). In
terms of nutrition, 71% of us meet vegetable intake guidelines, although only 55.9% meet fruit
intake guidelines. Our nutrition estimates have been stable over time. However, the prevalence of
obesity has increased since 2006/07.
Compared with national averages, there is a significantly higher prevalence of current (24.1% vs.
19.8%) and daily smokers (22.9% vs. 17.7%) in the Southern District. Our smoking rates have also
increased over time, from 22.9% to 24.1% for current smokers, and from 22.1% to 22.9% for daily
smokers.
We have the highest prevalence of hazardous drinking among all district health board regions
(Figure 1), and a statistically significantly higher prevalence of hazardous drinking than the
national average (25.1% versus 17.0%).
5
Ministry of Health. (2012) Regional results from the 2011/12 New Zealand Health Survey.
Wellington: Ministry of Health. [Data table, available at
http://www.health.govt.nz/publication/regional-results-2011-12-new-zealand-health-survey]
3
Hazardous drinking refers to an established drinking pattern that carries a risk of harming physical or
mental health, or having harmful social effects to the drinker or others. It is defined as a score of 8 or
more on the 10-question Alcohol Use Disorders Identification Test (AUDIT).6
Compared to the national average (199.5 per 100 000 population) Otago has a higher rate of
alcohol-related hospital admissions in young people aged 15–24 years (215.3 per 100 000).
Alarmingly, Southland’s rate is much higher than the national average, at 317.6 per 100 000, which
corresponds to a statistically significant rate ratio of 1.59 (95% CI (1.39–1.82).7
Figure 1. Age-standardized prevalence of hazardous drinking among adults aged 15 years and older by district
health board (DHB) (2011/12 National Health Survey).
2.3 Medical conditions
In terms of medical conditions, 12.5% of our population have medicated high blood pressure, 9.5%
have medicated high blood cholesterol, 3.8% have diagnosed ischaemic heart disease, 1.1% have
diagnosed stroke, 4.8% have diagnosed diabetes, 12.3% have medicated asthma, 11.3% have
diagnosed arthritis, and 13.4% have chronic pain. None of these figures significantly differ from
national averages and there have been no significant changes over time. However, we have a
significantly higher prevalence of psychological distress compared with the national average (8.2%
versus 5.7%) and a higher prevalence of diagnosed common mental disorder.
6
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. (2001) The Alcohol Use Disorders
Identification Test, 2nd Ed. World Health Organisation: Geneva.
These data are from Craig L. (2013) The Determinants of Health for Children and Young
People in the Southern DHB: Overview of the 2012 Report. New Zealand Child and Youth
7
Epidemiology Service: Dunedin.
4
3 Hospital discharges for wholly alcohol-attributable
conditions, 2008–2012
3.1 Background
This section focuses on analysing alcohol-related patient episodes8 up to the latest available financial
year (ended 30 June 2012). Hospital discharge data are used to show the number of and temporal
trends in conditions wholly attributable to alcohol use (hereafter, alcohol-attributable). The term
‘wholly attributable’ means that the conditions were caused entirely by inappropriate or excessive
alcohol consumption.
3.2 Methods
Wholly alcohol-attributable patient episode data9 were extracted from discharge data for the 2008–
2012 financial years from the Dunedin, Southland, Lakes District and Wakari hospitals. Poisson
regression was used to test for significant changes in the number of wholly alcohol-attributable
patient episodes by year, for each condition. Chi-squared tests were used to check model fit to the
data. Results are presented as incidence rate ratios, which indicate percent changes in the incidence
rate of each condition for each increase of one year. A p value < 0.05 indicates statistical
significance.
3.3 Results
In total, 6628 people were discharged from one of the four Southern District Health Board hospitals
during 2008 through 2012 following treatment for a wholly alcohol-attributable condition (Table 1).
The number of patients with conditions directly caused by alcohol has increased substantially over
the past five years (Figure 2). There were statistically significant temporal trends in the number of
cases of alcohol poisoning, alcohol-induced acute pancreatitis, alcoholic cardiomyopathy, alcoholic
gastritis, alcoholic hepatic failure and mental and behavioural disorders due to alcohol. On average,
there was a 10% annual increase in the incidence rate of alcohol poisoning (that is, the Incidence
Rate Ratio (IRR) = 1.10). Although the numbers remained relatively small throughout 2008–2012,
there was a 46% annual increase in the incidence rate of alcohol-induced acute pancreatitis, a 50%
annual increase in the rate of alcoholic gastritis, and a 36% annual increase in the rate of alcoholic
hepatic failure. However, there were small annual decreases in the incidence rates of alcoholic
cardiomyopathy and mental and behavioural disorders due to alcohol (8% and 3%, respectively).
8
Patient episodes: Multiple admissions may be made by the same individual. Thus, ‘patient
episodes’ or ‘cases’ is used instead of ‘patients’.
9
ICD-10 codes: E244, F10, G312, G621, G721, I426, K292, K70, K860, T510, T511, T519,
X45.
5
Table 1 Trends in wholly alcohol-attributable patient episodes at Dunedin, Southland, and Lakes District hospitals, 2008-2012
Description
Alcohol poisoning
Alcohol-induced acute pancreatitis
Alcohol-induced chronic pancreatitis
Alcoholic cardiomyopathy
Alcoholic cirrhosis of the liver
Alcoholic fatty liver
Alcoholic fibrosis and sclerosis of liver
Alcoholic gastritis
Alcoholic hepatic failure
Alcoholic hepatitis
Alcoholic liver disease
Alcoholic myopathy
Alcoholic polyneuropathy
Degeneration of nervous system due to
alcohol
Mental and behavioural disorders due to
alcohol
Total
Year
2010
2011
367
352
9
15
7
3
9
16
17
22
5
5
0
2
8
25
8
10
7
4
7
11
1
1
4
2
4
4
2008
222
0
6
31
36
6
0
3
2
7
13
0
11
8
2009
232
6
0
14
16
5
0
7
5
10
11
0
2
4
931
739
843
1276
1051
1296
2012
446
15
2
18
36
5
2
25
14
10
8
1
0
10
Total
1619
45
18
88
127
26
4
68
39
38
50
3
19
30
p
<0.0001
<0.0001
0.010
0.450
0.410
<0.0001
0.007
0.515
0.080
0.944
IRR (95% CI)
1.10 (1.07–1.13)
1.46 (1.21–1.76)
0.82 (0.70–0.96)
0.95 (0.83–1.08)
0.90 (0.69–1.16)
1.50 (1.26–1.79)
1.36 (1.09–1.69)
0.93 (0.75–1.16)
0.85 (0.70–1.02)
0.99 (0.75–1.31)
914
1027
4454
<0.0001
0.97 (0.96–0.98)
1386
1619
6628
Notes: Dashes (-) indicate that there were insufficient cases for analysis. CI: Confidence interval. IRR: Incidence Rate Ratio
Bold type indicates statistically significant temporal trends for the corresponding condition.
6
Figure 2 Total number of patients episodes with a wholly alcohol-attributable condition, by year and hospital
3.3.1 Alcohol poisoning cases
Because the number of alcohol poisoning cases is large and significantly increasing over time, we
examined alcohol poisoning data by age group and hospital.
Figure 3 Number of alcohol poisoning cases treated at Dunedin Hospital 2008–2012, by age.
Overall, the number of alcohol poisoning cases at the Dunedin Hospital has increased steadily over
2008–2012, with the sharpest increase evident in the 18–24 year old age group (Figure 3). The
number of cases among people under the legal age to purchase alcohol has fluctuated over the
7
years, but was at its highest in 2012. There was also a noticeable spike in the number of alcohol
poisoning cases among 55-64 year olds in 2012.
Figure 4 Number of alcohol poisoning cases treated at Southland Hospital 2008–2012, by age.
The number alcohol poisoning cases among individuals younger than 18 years appears to be
decreasing over time at Southland Hospital (Figure 4). However, with the exception of 2012, the
number of cases among 18-24 years olds was concurrently increasing. There is a degree of interannual fluctuation in the number of cases among other age groups.
Figure 5 Number of alcohol poisoning cases treated at Lakes District Hospital 2008–2012, by age.
8
At Lakes District Hospital, the majority of alcohol poisoning cases were aged 18–24 years (Figure 5).
With the exception of 2012, an increasing trend was evident among this age group. There were very
few cases among individuals younger than 18 years or older than 45 years.
Figure 6 Number of alcohol poisoning cases treated at Wakari Hospital 2008–2012, by age
Like Dunedin Hospital, the number of alcohol poisoning cases at Wakari Hospital appears to be
steadily increasing over time (Figure 6). However, a different age distribution is evident at that
hospital, with relatively more patients in older age categories , reflecting the nature of the services
provided at this hospital.
3.4 Discussion
The total number of patient episodes due to wholly alcohol-attributable conditions has increased
from 1276 in 2008 to 1619 in 2012. This represents a 26.9% increase, far exceeding that of
population growth in the Southern District Health Board region, which over the same five-year
period ranged from 0% in Gore to 10.6% in Queenstown.10 The number of patient episodes involving
alcohol poisoning, alcohol-induced acute pancreatitis, alcoholic gastritis and alcoholic hepatic failure
has statistically significantly increased over the past five financial years. The analyses presented here
do not account for the many conditions partially attributable to alcohol (such as cancers, liver
disease and injuries). The true impact of alcohol in terms of acute and chronic health conditions and
injuries is therefore much higher.
10
Source: Statistics New Zealand
[http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/subnationalpop-estimates-tables.aspx]
9
4 Alcohol-related presentations to emergency departments in
the Southern District
4.1 Background
A considerable proportion of the burden of harm associated with alcohol misuse is borne by the
Southern District Health Board’s emergency departments. This section outlines the number and
proportion of presentations to emergency departments in the Southern District that are alcohol
related and describes the associated patient and presentation characteristics.
4.2 Methods
4.2.1 Sample
This research was conducted in the emergency departments of the Dunedin, Southland and Lakes
District Hospitals in 2012. All patients, regardless of age, were assessed on two measures: 1) selfreport of alcohol consumption in the past 24 hours, and 2) self-report of whether or not alcohol
contributed to their presenting condition. All individuals who were treated at one of the three
emergency departments were eligible for assessment. The total population served and the length of
data collection differed between the participating hospitals (Table 2).
Table 2 Hospital catchment size and data collection dates
Hospital
Dunedin
Southland
Lakes District
Approximate
population catchment
size
181 500
93 000
17 000–50 000
(seasonal)
Data collection period
24/01/2012 – 6/11/2012
21/03/2012 – 6/11/2012
24/01/2012 – 6/11/2012
4.2.2 Data
The dataset covers the period 24 January 2012 through 6 November 2012 (287 days). The data
include hospital, triage date, time and category; ICD-10 diagnosis; date of birth; sex; ethnicity and
discharge outcome. A further two variables were related to alcohol. The first indicated whether the
patient had consumed alcohol in the previous 24 hours (consumed), and the second indicated
whether their presentation was related to their own or others’ alcohol consumption (related). For a
complete description of how the data were structured for analysis, see Appendix A.
4.2.3 Analysis
Data collection was dependent on emergency department staff being willing to screen the patients
with the alcohol measures. Presentations were considered alcohol related if the patient or clinician
indicated that the presentation was related to the patient’s own or others’ alcohol consumption.
10
An examination of potential biases in patient assessment was made. Presentations that were
assessed for their association with alcohol were compared with those that were not assessed in
terms of patient and presentation characteristics. Comparisons were made using the Pearson Chisquared test, with Chi-squared statistic contributions compared for variables with more than two
categories to determine which categories likely accounted for significant differences.
4.3 Results
4.3.1 Response rates
In total, 55 946 presentations were made to the three emergency departments during the data
collection period. Administration of the alcohol screening varied between hospitals, with
information on alcohol’s contribution available for 60–70% of eligible presentations (Table 3).
Table 3 Response rates obtained in the three EDs
Presentations, n
Dunedin
Southland
Queenstown
Lakes
24-h consumption
Alcohol contribution
assessed, n
assessed, n
(response, %)
(response, %)
28 696
17 058 (59)
17 917 (62)
21 679
12 859 (59)
13 103 (60)
5571
3615 (65)
3909 (70)
4.3.2 Assessment of sample selection bias
Statistical comparisons between patients who were assessed and those who were not assessed are
reported in Appendix B. At Dunedin Hospital, there were minor assessment biases in terms of age,
presenting condition, day of the week, time of the day and triage category. At Southland Hospital,
there were minor assessment biases in terms of age, presenting condition and time of day. At the
Lake District Hospital, there were minor biases in terms of age and presenting condition. The
implications of these biases amount to an underestimation of the number of alcohol-related
presentations in certain groups and during certain times. They also weaken our ability to describe
the characteristics of alcohol-related presenters because we are unable to accurately compare
groups with different levels of screening.
4.3.3 Prevalence and characteristics of alcohol-related emergency
department presentations
Overall, 2579 (7%) emergency department presentations were alcohol related. Of them, 607 (24%)
required admission to hospital. Based on the non-resident cost11 per admission (of less than 24
hours duration), these presenters cost the Southern District Health Board at least $ 671 000 over a
11
Non-resident costs are the service costs charged to non-New Zealand residents attending
SDHB hospitals. They are the only cost data available at the time of writing.
11
period of less than one year. Based on the non-resident cost per attendance, the remaining 1972
presentations cost at least $ 761 000. Therefore, the total minimum cost of alcohol-related
emergency department presentations was over 1.4 million dollars. This figure is extremely
conservative, as it does not include diagnostic or treatment costs, such as those for X-rays and
specialist consultations, and it does not account for those admitted for more than 24 hours.
The 2579 alcohol-related presentations to the Southern District Health Board’s three emergency
departments do not represent 2579 unique individuals. At the Dunedin Emergency Department, the
1412 presentations were made by only 1114 individuals. At the Southland Emergency Department,
the 697 presentations were made by 528 individuals, and at the Lakes District Emergency
Department, the 470 presentations were made by 406 individuals. In one case, a 43 year old male
presented to the Dunedin Emergency Department with an alcohol-related condition on eight
separate occasions. Five alcohol-related presentations by the same person were not uncommon.
Figure 7 Number of alcohol-related presentations to the emergency departments by hospital, age category
and sex. Note that Southland Hospital did not collect data during Jan-Feb 2012.
Figure 7 shows that the Lakes District Emergency Department had relatively balanced numbers of
males and females presenting with an alcohol-related condition (hereafter, presenters). At the other
two emergency departments, males were more common among presenters than females. There was
less distinction between the number of presenters aged 18-24 and 25-34 years at the Lakes District
Emergency Department. At the other two emergency departments, particularly Dunedin, the
number of presenters aged 18-24 years was markedly high compared with the other age categories.
However, at all hospitals, a very wide age range was observed among presenters.
12
All hospitals saw people under the legal age for purchasing alcohol (hereafter, underage) present
with an alcohol-related condition. The number of underage presenters to Southland Hospital is
especially concerning, bearing in mind its smaller population size and shorter data collection period.
Figure 7 highlights subtle differences in the sex and age characteristics of those presenting to each of
the emergency departments, which likely reflect differences in the population characteristics of each
town.
Figure 8 The nature of alcohol-related presentations. The pie charts show the proportion of each condition
among alcohol-related presentations.
At all emergency departments, the greatest proportion of alcohol-related presentations was for
injury. Compared with the Dunedin and Southland emergency departments, a smaller proportion of
alcohol-related presentations at the Lakes District Emergency Department was due to acute
intoxication. Overall, the majority of presentations were for injury, followed by other illness, acute
intoxication and mental / behavioural disorder.
13
Figure 9 The proportion of presentations that were due to alcohol, by weekend versus weekday and hospital.
Weekdays: Monday 08:01-Friday 16:00; Weekends: Friday 16:01-Monday 08:00.
Figure 9 is presented to show the relative impact of alcohol-related presentations between
weekdays versus weekends and between emergency departments. The Lakes District Emergency
Department experienced a greater proportion of presentations being due to alcohol than the other
two hospitals. At all hospitals, a greater burden fell on the weekends. However, the weekday burden
was relatively high at Lakes District compared with the other two hospitals.
Figure 10 The proportion of presentations that were due to alcohol, by time of day and hospital.
Figure 10 shows that the highest burden of alcohol-related presentations fell between midnight and
4 am. The Dunedin and Southland hospitals showed a sharp drop in the prevalence of alcoholrelated presentations after 4am, but this was not seen to the same extent at Lakes District Hospital.
4.4 Discussion
In a period of less than 10 months, 1412 people presented to the Dunedin Emergency Department
with an alcohol-related condition. Of them, 94 were under the legal age to purchase alcohol. Over
the same period, there were 470 alcohol-related presentations to the Lakes District Hospital
Emergency Department, of which 26 were underage. Over a shorter period (less than 8 months),
there were 697 presentations to the Southland Hospital Emergency Department, of which 75 were
underage. The number of underage presenters at the Southland Hospital is particularly concerning
because it represents 11% of all alcohol-related presentations at that hospital. This is much higher
than Dunedin’s 7% and Queenstown Lakes’ 5%.
There were differences between hospitals in the weekend versus weekday prevalence of alcoholrelated presentations, suggestive of different drinking cultures between the populations served. For
example, in Queenstown, there was less distinction between weekend versus weekday in terms of
alcohol-related presentations. In Dunedin and Invercargill, the prevalence of alcohol-related
14
presentations was highest between midnight and 4 am, with sharp declines in the hours that follow.
However, in Queenstown, which has a higher density of licenced premises and longer opening hours
than the other cities, the prevalence of alcohol-related presentations remained high after 4 am.
Further, compared with the other hospitals, Lakes District had the highest overall prevalence of
alcohol-related presentations, a higher prevalence of alcohol-related conditions in older age
categories and a higher prevalence among females.
The response rates of 60% and 62% achieved in two of the emergency departments can be
considered a limitation of this report. Furthermore, data were not collected during the peak summer
weeks (late November through early January). An underestimation of the number and overall
prevalence of alcohol-related emergency department presentations is therefore probable.
15
5 Health professionals’ attitudes toward local alcohol
problems
5.1 Background
To provide policy makers with contemporary, local information, we surveyed health and allied
professionals’12 with experience in dealing with alcohol-related problems, about their attitudes
towards alcohol issues and the management of these issues by local government. We describe the
extent to which health and allied professionals consider various issues to be a problem in their
community and how big a role they think alcohol plays in them. Further, we quantify the proportion
of professionals that believe that the current availability of alcohol contributes to alcohol-related
problems in their district and the proportion that support local government measures to control
alcohol availability.
5.2
Methods
5.2.1 Study design and instrument
The design was a descriptive cross-sectional survey consisting of 18 questions. The survey
instrument was vigorously peer-reviewed by experts in qualitative survey design. Two questions
served as filters. Respondents who indicated that no alcohol problems were evident in their district
were taken straight to the demographic questions at the end of the survey. Later in the survey,
those who indicated that the current availability of alcohol from licenced premises does not
significantly contribute to local alcohol problems were taken to the demographic questions at the
end of the survey. Thus, for each survey item, the denominator used when calculating proportions
was the number of responses to that item, rather than the total number of survey respondents.
Ethical approval to carry out the study was obtained from the University of Otago Human Ethics
Committee (approval number 12/307).
5.2.2 Participant recruitment
The survey was open from 12 February through 8 May 2013. Survey participation was invited from
all general practitioners (GPs, n = 274) and all identified health and welfare organisations thought to
respond to community alcohol problems in the Southern District (n = 129). All clinical staff of the
Southern District Health Board were also invited to participate. Because our aim was to document
the nature and severity of alcohol-related problems arising in the district, we actively sought
feedback from professionals who deal with these problems in their work. A list of GPs working in
the Southern District was obtained from the Southern Primary Health Organisation. Health and
welfare organisations were identified using telephone and resource directories. Organisations
12
Health and allied professionals – professionals such as ambulance workers, clinical
psychologists, doctors, family support workers, mental health workers and nurses who work
in non-alcohol specific health services and whose clients and their families may have
alcohol-related problems.
16
providing only information and referral services, and those that worked exclusively with alcoholproblems (such as detox centres) were excluded. All potential participants (with the exception of
Southern District Health Board staff) were mailed an information sheet about the study and a letter
inviting them to follow a link and complete the online survey. The mail-out also included a reply-paid
envelope, which could be returned to indicate that the respondent did not deal with or see
problems related to alcohol use. One month after the invitation letters were sent, those who had
not completed the online survey or returned the reply-paid envelope were sent a reminder letter as
well as a paper version of the questionnaire and a reply-paid envelope. Clinical Southern District
Health Board staff were invited to participate via an advertisement on their intraweb.
For a 95% confidence level and a 5% margin of error, we calculated that a final sample size of 197
(for GPs and organisations) was required. This calculation was unable to be made for Southern
District Health Board staff.
5.3 Results
5.3.1 Respondents
In total, 117 General Practitioners completed the survey; a response rate of 43%. A further 83
responses were collected from individuals representing 79 community service organisations around
the district; a response rate of 62% (at organisation level). To minimise nonresponse bias, the
invitation letter included the option of declining the survey because the participant’s
“work/organisation does not see problems related to alcohol use.” Three general practitioners opted
out of the survey for this reason. The final number of completed surveys received from these two
participant groups was 200.
Completed surveys were also received from 318 Southern District Health Board staff. Because they
were not invited personally, response rates for this group were unable to be calculated. The final
number of surveys for analysis was 518.
In addition to response rate, the accuracy of a survey depends on the percentage of the
sample that picks a particular answer. It is easier to be sure of extreme answers than of
middle-of-the-road ones. We have calculated the margin of error for each survey item (based
on a 95% confidence level, the known response rates and the response distributions) and
included it in this report as an indicator of response accuracy. For example, 93% of
respondents indicated that alcohol-related problems were evident in their district. With a
margin of error of 2.5, we expect that if the entire population of health and allied
professionals in the Southern District was sampled, between 90.5% and 95.5% would indicate
that alcohol-related problems were evident.
The age distribution of survey respondents (Figure 11) does not indicate the presence of
nonresponse bias in terms of age. Although no data are available for comparison, we expect that this
distribution reflects that of people working in the occupations surveyed. In terms of sex, 67% of the
respondents were female and 33% were male. Similarly, we expect this distribution expects that of
our population of interest.
17
Figure 11 Age distribution of survey respondents
5.3.2 The presence of local alcohol problems
Overall, 93% (± 2.5%) of respondents said that alcohol-related problems were evident in their
district (Table 4).
Table 4 The presence of local alcohol-related problems, by territorial authority
Territorial Authority
Are alcohol-related problems
Total number of
evident in your district?
respondents
No (%)
Yes (%)
Waitaki District Council
6
94
18
Queenstown Lakes District Council
0
100
33
Central Otago District Council
0
100
26
Clutha District Council
0
100
17
Southland District Council
14
86
41
Gore District Council
0
100
11
Invercargill City Council
8
92
80
Dunedin City Council
8
92
227
Otago / Southland region*
8
92
65
Total
7
93
518
* These respondents indicated that their service covers the entire Otago / Southland region.
There were no significant regional differences (using a Chi-squared test) in the proportion of
respondents reporting the presence of alcohol-related problems in their district.
5.3.3 The severity of alcohol-related problems
The majority (85% ± 3.5%) of respondents indicated that major or severe alcohol-related problems
were evident among 18 to 24 year olds in their district. Many (62% ± 4.8%) also indicated the
presence of major or severe alcohol-related problems among people younger than 18 years and
among people aged 35 years or older. However, only 20% (± 4.0%) of respondents indicated major
or severe alcohol-related problems in tourists / domestic visitors (with the exception of respondents
18
from Queenstown Lakes, among which 77% indicated major or severe alcohol-related problems in
this group).
5.3.4 The role of alcohol in local problems
Respondents were asked about the nature of alcohol-related problems in their district. Specifically,
they were asked to indicate the role of alcohol in a list of problems. Responses to each listed
problem were not mandatory; it was clear from the data that respondents were not reporting
beyond their areas of expertise.
Overall:

90% (± 3.0%) reported that alcohol has a major or leading role in domestic violence

86% (± 3.4%) reported that alcohol has a major or leading role in violent crime

85% (± 3.5%) reported that alcohol has a major or leading role in accidents / injury

74% (± 4.3%) reported that alcohol has a major or leading role in child neglect

62% (± 4.8%) reported that alcohol has a major or leading role in sexually transmitted
infections

62% (± 4.8%) reported that alcohol has a major or leading role in unwanted pregnancies

57% (± 4.9%) reported that alcohol has a major or leading role in self-harm

57% (± 4.9%) reported that alcohol has a major or leading role in illness / disability

55% (± 3.5%) reported that alcohol has a major or leading role in absenteeism
19
5.3.5 The role of alcohol availability in alcohol-related problems
Overall, 78% (± 3.8) of respondents said that the current availability of alcohol from licenced
premises significantly contributes to alcohol-related problems in their district (Table 5).
Table 5 The contribution of alcohol availability to alcohol-related problems
Territorial Authority
Waitaki District Council
Queenstown Lakes District Council
Central Otago District Council
Clutha District Council
Southland District Council
Gore District Council
Invercargill City Council
Dunedin City Council
Otago / Southland region*
Total
Does the current availability of alcohol
from licenced premises significantly
contribute to alcohol-related problems
evident in your district?
No (%)
Yes (%)
25
75
10
90
16
84
31
69
30
70
27
73
31
69
20
80
23
77
22
78
Total number
of
respondents
16
31
25
16
27
11
55
167
43
391
There were no significant regional differences (using a Chi-squared test) in the proportion of
respondents reporting that the current availability of alcohol from licenced premises significantly
contributes to alcohol-related problems in their district. Respondents who did indicate that alcohol
availability from licenced premises significantly contributed to alcohol-related problems in their
district were invited to answer questions about the role of premises of specific licence types and
their sentiment towards local alcohol policy options.
In terms of licence types, the proportion of respondents that agreed or strongly agreed that alcohol
availability significantly contributed to alcohol-related problems in their district was 24% (± 4.2%) for
licenced restaurants and cafes, 89% (± 3.1%) for pubs, bars, taverns and nightclubs, and 91% (±
2.8%) for bottle shops, convenience stores and supermarkets.
There was good support for increased licencing restrictions. Specifically:

82% (± 3.8%) of respondents agreed or strongly agreed that there should be increased
restrictions on alcohol trading hours
20

71% (± 4.5%) of respondents agreed or strongly agreed that there should be increased
restrictions on the location of licenced premises

78% (± 4.1%) of respondents agreed or strongly agreed that there should be increased
restrictions on the number of licenced premises
5.3.6 Respondent comments
5.3.6.1 Overview
Many respondents commented that alcohol problems are more prevalent than people realise. The
negative effects of alcohol discussed by respondents from across the Otago and Southland region
included a lesser ability to make good choices and to take care of oneself, job loss, poor personal,
social and financial wellbeing; destabilization; mental health issues; and health consequences such
as diabetes, liver disease and obesity. Multiple respondents from Alexandra, Cromwell, Southland,
Dunedin and Mataura commented that alcohol misuse has huge impacts on families in their area in
terms of safety, basic needs and wellbeing.
Alcohol is also impacting service provision in the Otago and Southland Region. In particular, many
professionals commented that intoxicated persons are more difficult, and take much more time to
manage, often to the detriment of other patients. Some acknowledged that their services are unable
to meet demand. Further, some General Practitioners acknowledged that they “only see the tip of
the iceberg” and “probably don’t ask the right questions”. One commented that it is “hard to know
how much is hidden”. Many of the General Practitioners surveyed said that a minority of their
patients were majorly affected by alcohol use.
The comments received encompassed a broad spectrum of issues. What follows is a categorised
selection of comments presented to give an in-depth indication of the nature of alcohol-related
problems seen by specific individuals in specific locations.
5.3.6.2 Individuals
“A large portion of our clients only offend whilst intoxicated. If they didn’t drink alcohol or have its
influence in their lives they would be considered model members of society.” Police Officer,
Queenstown Lakes
“I think many elderly drink to cope with loneliness and being isolated because they are not as mobile
and unable to get out and about.” Inpatient Community Occupational Therapy, North Otago
“We have had at least one fatality in the area by a local involving alcohol. As a GP I am extremely
concerned about the drinking culture in our young people …” General Practitioner, Waitaki Valley
“A lot of clients/people we see are involved in the dairy industry. What we are seeing is that [the]
long hours of work and more days off system is resulting in heavy drinking to lower stress levels,
boredom, and to create the ability to stop thinking about work. This is resulting in neglect to family
life and parenting, poor budgeting, and violent outbursts. Individuals, who are isolating themselves
on these farms, only working and sleeping with no recreation time, are seen to be most at risk.”
Corps Officer, Central Southland
21
“Often patients do not realise that alcohol has a role in their situation or health, most do not realise
'safe' limits.” General Practitioner, Dunedin
“It’s not just alcohol use - with a majority of our clients whose lives are in disarray addiction is
usually an issue. When someone is unable to manage their lives as a result of their drinking/drugging
then usually a whole host of other issues in life are not managed as a result leading to child
neglect/abuse, relationship issues including family violence, financial stress, violence, drink
driving...” Clinical Manager, Hauora Maori, Dunedin
“I am concerned about the heavy binge drinking culture of our young people. This impacts their
education, employment and relationships. STI's are also very common with multiple sexual partners,
contributed to by alcohol abuse.” General Practitioner, Gore and rural Southland
“Young teenage clients drinking to excess, especially females, who are leaving themselves vulnerable
to harm from themselves and others.” Ambulance Officer, Gore
“[In students] Depression, academic achievement, sleep, court-police, stress, sexual health,
decreased motivation, fights, relationships, injuries, gastric problems, irritable bowel, risk of
stomach ulcers.” Nurse, Otago
“Drunk people pooing and weeing themselves in the cells is common. In three years of cell work,
100% of prisoners [I’ve seen] have drug or alcohol issues.” General Practitioner, South Dunedin
5.3.6.3 Family, children and relationships
“I work in child protection, with the care of sexually abused children, with the Gateway Program
(comprehensive assessments of children in CYFS care) and with the care of neonates whose parents
may have taken substances through the pregnancy that have had an impact on their newborn babe.
In each of these areas, I am alarmed at the extent to which alcohol has been a significant player.”
Paediatrician, Invercargill
“Huge impact on families, especially when associated with mental health issues. Impacts general
health, ability to pay accounts, eat properly, have social life.” Support Worker, Southland, Wakatipu,
Fiordland
“Leaves families economically poor, changes dynamics, and leads to abuse/neglect issues.” Social
Worker, Alexandra, Roxburgh, Maniototo
“Parental alcohol / substance abuse highly related to child abuse /neglect, partner violence /
violence by young people against parents, often comorbid with parental mental health issues in
relation to parenting.” Violence intervention programme co-ordinator, Otago
5.3.6.4 Sexual health and sexual assault
“Non-consensual sex more evident with increased alcohol consumption, may lead to rape, STDs,
unwanted pregnancies, poor self-esteem.” Registered Nurse, Dunedin
22
“Especially big concern around unborn, with woman participating in the binge culture [in] the same
[way] as men.” Child Protection Nurse, Invercargill
“More than 60% of the sexual assaults I have seen in the past 13 years have had >2 drinks. I.e.
majority involve alcohol for both victim and assailant.” General Practitioner, Dunedin
“Unplanned pregnancy is a major part of the role I have and many instances are related to alcohol.”
Social Worker, Invercargill and rural areas
5.3.6.5 Injury
“Most patients who present with head injuries (moderate to severe) would have been affected by
alcohol either directly or indirectly.” Consultant Neurosurgeon, Dunedin
“[We] treat a lot of alcohol related injuries, particularly in the weekends. Many require admission
overnight in the hospital.” Medical Officer, Queenstown
“They have drinking sessions and end up in hospital with injuries and broken bones.” Nurse,
Invercargill
“Prevalent problem leading to accidents and ill health. Leading cause of serious accidents.” General
Practitioner, Roxburgh
“People with an injury do not adhere to their treatment programme very well when drinking.”
Physiotherapy Outpatients, Dunedin
5.3.6.6 Mental health
“Alcohol and tobacco have devastating health, social and economic consequences in mental health
clients and their families. The problem is made worse by the poor outcomes of currently available
interventions. The only viable strategy is prevention.” Consultant Psychiatrist, Invercargill
“Alcohol is a significant factor in the lifestyle of chronically acute mental health patients, as are illicit
drugs. It has a considerable detrimental impact on people who are already marginalised, preventing
them from participating effectively and with purpose in society, owing to its combined impact with
poor diet, smoking and lifestyle choices.” Court Liaison Nurse, Invercargill
“Many clients describe self-medication with alcohol as a typical coping strategy they have used and
continue to use once they have been prescribed medications.” Registered Nurse, Invercargill
“Three quarters of the clients I see have alcohol-related issues. It destroys their livelihoods [and]
relationships, marital and children. It also impacts upon their mental health to a point where they
are admitted to the acute inpatient mental health unit.” Registered Nurse, Dunedin
“In mental health work I see that alcohol use is a major impediment to recovery from co-existing
mental health disorders.” Registered Nurse, Dunedin
23
5.3.6.7 Societal norms
“It is underrated how dangerous alcohol use is in this community. Alcohol use is normalised in South
Otago, especially by the 40+ population.” Social Work Supervisor, South Otago
“Many people have harmful effects from drinking at levels [considered] normal in this society.”
General Practitioner, Dunedin
5.3.6.8 Service impacts
“Patients with Korsakoff’s13 are disinhibited; they take a lot of time to manage. They verbally and
physically abuse staff caring for them. Often other patients suffer due to the impact of trying to
settle the most disruptive patient, whilst these others probably need the attention more” Nurse,
Dunedin
“It is responsible for wasting precious resources as people end up staying on the wards a lot longer
as alcohol interrupts the treatments.” Registered Nurse, Mental Health, Dunedin
“Plays a major role in most cases. We are seeing malnutrition in children. Huge call on our resources
due to clients using all money on addiction and therefore nothing left for food.” Social Worker,
Dunedin
“A lot of our presentations are related to alcohol, especially at certain times of the week. It is very
noticeable that since the drinking age has been lowered, the age of presentations related to alcohol
has decreased markedly.” Medical Officer, Emergency Department, Southland
“Alcohol addiction is featured in our work a lot, associated with depression and unhappy
relationships.” Case Worker, Eastern Southland and South Otago
“In rehabilitation we see those who have suffered brain injury as a result of alcohol-related activities
(i.e. assault/abuse/car accidents) or those who have developed Korsakoff’s later in life. This work
would make up ~10-20% of our caseload in the <65 year old population.” Physiotherapist, Otago &
Southland Region
“Significant impact where alcohol intake is significant and in after-hours work in relation to accidents
and mental health issues.” General Practitioner, Alexandra
“Eighty percent of our clients would have substance or alcohol addictions.” Education and Training
Coordinator, Mental Health, Invercargill
5.3.6.9 Availability
“We have a serious issue in Winton. For a town of 2000 people we have 3 bottle stores, 3 pubs and 1
supermarket, all who sell alcohol. There is no need for this. Let’s compare it to this: For a town of
13
Korsakoff’s Syndrome is a neurological disorder linked to chronic alcohol misuse.
24
2000 people, we have only 2 places to buy veges and milk. Where do our priorities sit?” Corps
Officer, Central Southland
“The main issue I see with youth admitted to my unit is that they go to the supermarket for cheap
alcohol prior to going out, and being able to get cheap alcohol at the supermarkets.” Registered
Nurse, Dunedin
“Removing alcohol from supermarkets would be a major step to reduce alcohol abuse.” General
Practitioner, Dunedin
“Cut back trading hours. I watched a guy stagger home from town at 6:30 am yesterday … so much
for pre-loading at home, he had clearly been getting served in town all night.” Registered Nurse,
Dunedin
“Pubs should close earlier, [I] have been called out several times to late night brawls / accidents with
drunken people” General Practitioner, Te Anau
5.4 Discussion
Because our aim was to document informed opinion, we surveyed 518 health and allied
professionals who directly respond to alcohol-problems in their district. There was almost complete
consensus among respondents that alcohol-related problems are evident in their district. Over 80%
believe that alcohol has a major or leading role in violent crime, domestic violence, accidents, injury
and child neglect. Further, most believe that the current level of availability of alcohol from licenced
premises significantly contributes to these problems.
There was strong support among our survey respondents for increased restrictions on alcohol
availability. In particular, the majority felt that permitted trading hours should be reduced, and that
the number and location of licenced premises should be subject to increased restrictions. Our survey
data indicate that it is the licences of pubs, bars, taverns and nightclubs, as well as bottle shops,
convenience stores and supermarkets that should be policy targets. Few experts believe that
licenced restaurants and cafes play a role in alcohol-related problems in their district.
From the comments made by those surveyed, it is clear that harmful drinking affects many facets of
the drinkers’ lives, not just their health. The comments also call attention to the innocent victims of
harmful drinking, such as the children subjected to maltreatment or abuse, and the women who
experience domestic violence and/or sexual assault. Major problems were described by experts
working in small communities, demonstrating that alcohol abuse is not just a city issue.
The response rates obtained in this survey (49% GPs, 62% organisations) are reasonably good for
those of its type. For example, a meta-analysis of 68 web-based surveys found a mean response rate
of 39.6%.14 Response representativeness, which is closely related to response rate, is an equally
important determinant of survey validity. In this survey we achieved geographical coverage in good
14
Cook C, Heath F, Thompson RL. (2000) A meta-analysis of response rates in web- or
internet-based surveys. Educational and Psychological Measurement 60(6): 821-836.
25
proportion to population size. Further, our participants’ age distribution showed no significant
biases, and we believe that it is reflective of people working in the surveyed occupations. Relatively
balanced numbers of GPs and allied health professionals were included in the survey, but a much
higher number of participants were clinical Southern District Health Board staff. We tried to
minimise nonresponse bias by providing an opt-out option (and a reply-paid envelope) based on the
statement, “my work/organisation does not see problems related to alcohol use”. Only three
participants opted out this way; however, non-response bias may still be present in this survey. It is
possible that the 51% of GPs and 38% or organisations that did not respond have more moderate
views on alcohol-related problems in the community. Nevertheless, we have documented that
among the 518 health and allied professionals surveyed, 93% stated that alcohol-related problems
were evident in their district, and 78% stated that the current level of alcohol availability contributes
to these problems.
26
Appendix A
Triage date and time variables were used to construct a dichotomous variable for ‘weekend’. A
weekend was considered as the period from Friday 16:00 to Monday 08:00. Triage time was
categorised into 4-hour intervals beginning at 0:01. Date of birth was used to calculate age at
presentation, which was further categorised into one of 9 groups for analysis. The 34 discharge
status and 26 ethnicity categories were collapsed into a final 18 and 19 categories for analysis,
respectively. Clinical presentation data (ICD-10 diagnosis) were classified into one of 4 categories for
analysis: injury (ICD-10 S00-T98, V01-Y98), mental/behavioural disorder (F00-F99, excluding F10),
other illness (A00-B99, C00-D48, D50-D89, E00-E90, G00-G99, H00-H59, H60-H95, I00-I99, J00-J99,
K00-K93, L00-L99, M00-M99, N00-N00) and intoxication (F100).
There were 1588 duplicate entries in the dataset, all of which were excluded from the analysis.
Because Southland Hospital did not commence alcohol-related data collection until 21 March 2012,
all observations from Southland Hospital prior to that date (n = 5461) were also excluded. This left a
total of 55 946 observations in the dataset.
27
Appendix B
Statistical comparisons between patients who were assessed and those who were not assessed are reported in Table 6. Differences in observed versus expected frequencies were tested by Pearson’s chi-squared test. Because the large
sample size increases likelihood of a significant p value, a conservative p value of < 0.001 was considered statistically significant evidence of assessment bias. Table 6 Characteristics of presentations that were assessed versus those not
assesseda
Dunedin
Southland
Lakes District
Not assessed
Assessed
Not assessed
Assessed
Not assessed N (%)
Assessed
N (%)
N (%)
N (%)
N (%)
N (%)
Age (years)
< 18
1756 (35)
3200 (65)
2124 (37)
3548 (63)
260 (26)
756 (74)
18–24
1788 (35)*
3314 (65)
1016 (36)*
1822 (64)
261 (25)
767 (75)
25–34
1195 (39)
1884 (61)
1137 (40)
1719 (60)
382 (30)
910 (70)
35–44
1129 (40)
1674 (60)
892 (40)
1359 (60)
271 (37)*
460 (63)
45–54
1168 (40)
1722 (60)
849 (40)
1249 (60)
150 (31)
332 (69)
55–64
1171 (40)
1729 (60)
741 (40)
1081 (59)
116 (32)
242 (68)
65–74
985 (37)
1634 (62)
737 (44)*
929 (66)
109 (32)
229 (68)
75–84
997 (36)
1702 (63)
730 (45)*
897 (55)
74 (35)
136 (65)
85+
590 (36)
1058 (64)
350 (41)
499 (59)
39 (34)
77 (66)
Sex
Male
5587 (37)
9015 (63)
4372 (40)
6859 (60)
965 (31)
2161 (69)
Female
5192 (38)
8902 (62)
4204 (40)
6244 (60)
697 (29)
1748 (71)
Presenting conditionb
Injury
3689 (40)
5575 (61)
2487 (32)*
5372 (68)*
759 (29)
1869 (71)*
Mental/Behavioural
92 (30)
216 (70)
87 (36)
153 (64)
27 (42)
37 (58)
Other illness
6981 (37)
11 709 (63)
5979 (44)*
7461 (56)
849 (30)
1951 (70)
Alcohol specific
12 (6)*
204 (94)*
5 (4)
108 (96)
1 (3)
34 (97)
Weekend / weekday
Fri 18:01–Mon 06:00
3776 (36)
6701 (64)*
3242 (40)
4853 (60)
615 (28)
1611 (72)
Mon 06:01–Fri 18:00
7003 (38)
11 216 (62)
5334 (40)
8250 (60)
1047 (31)
2298 (69)
Time of presentation
00:01–04:00
592 (25)
1736 (75)*
524 (40)
770 (60)
97 (23)
319 (77)
04:01–08:00
574 (34)
1118 (66)
503 (45)
625 (55)*
82 (31)
181 (69)
08:01–12:00
2473 (41)
3558 (59)
2013 (38)
3289 (62)
324 (31)
718 (69)
12:01–16:00
3058 (41)
4349 (59)
2177 (38)
3504 (62)
482 (31)
1055 (69)
16:01–20:00
2591 (39)
3996 (61)
2028 (39)
3147 (61)
414 (30)
985 (70)
20:01–00:00
1491 (32)
3160 (68)*
1331 (43)
1768 (557)
263 (29)
651 (71)
Triage category
1
76 (46)
91 (54)
41 (59)
28 (41)
7 (70)
3 (30)
2
1424 (35)
2641 (65)
432 (42)
602 (58)
77 (31)
171 (69)
3
3874 (35)*
7248 (65)*
3236 (42)*
4405 (58)
474 (27)
1263 (72)
4
4633 (40)
7090 (60)
4612 (38)*
7657 (62)
635 (37)
1690 (72)
5
722 (48)*
847 (52)*
255 (38)
411 (62)
469 (37)*
782 (63)*
a
Differences in observed versus expected frequencies tested by Pearson’s chi-squared.
Patients who left before a diagnosis was made were excluded from analysis of this variable.
*Denotes category with high contribution to the chi-squared statistic.
b
28
Appendix C
Table 7 Proportion of respondents indicating the presence of major or severe alcohol-related problems in each population group by territorial authority
Population
Waitaki
Queenstown
Lakes
Central
Otago
Clutha
Southland
Gore
Invercargill
City
Dunedin
City
Otago /
Southland*
Under 18s
18—24s
25—34s
35 years and
older
Tourists /
domestic
visitors
57
71
43
40
64
88
78
41
60
84
57
50
69
75
25
38
57
83
59
52
80
100
73
36
63
85
66
52
57
85
63
49
72
91
68
59
0
77
20
0
24
0
22
7
12
*Some respondents indicated that their organisation covers the whole Otago Southland region.
29
Appendix D
Table 8 Proportion of respondents indicating the alcohol plays a major or leading role in local problems, by Territorial Authority
Violent crime
Domestic
Violence
Child neglect*
Accidents /
Injury
Illness /
Disability
Sexually
transmitted
diseases
Unwanted
pregnancies
Absenteeism
Self-harm
Waitaki
Queenstown
Lakes
Central
Otago
Clutha
Southland
Gore
Invercargill
City
Dunedin
City
Otago /
Southland*
93
93
90
77
78
88
75
69
83
92
82
82
87
98
87
91
88
95
79
88
43
83
56
65
75
56
74
93
82
90
81
94
77
87
87
88
56
48
40
27
67
64
55
64
51
64
55
41
69
52
60
61
68
64
54
44
38
63
80
64
68
65
68
57
13
56
58
32
74
33
47
48
67
64
60
69
63
59
56
43
49
*Some respondents indicated that their organisation covers the whole Otago Southland region.
Note: Only respondents that reported that alcohol-related problems were evident in their district were invited to report the role of alcohol in specific problems.
30
Appendix E
Table 9 Proportion of respondents agreeing or strongly agreeing that alcohol availability from certain premise types plays a role in alcohol-related problems
Licenced
restaurants
and cafes
Pubs, bars,
taverns and
nightclubs
Bottle shops,
convenience
stores and
supermarkets
Waitaki
Queenstown
Lakes
Central
Otago
Clutha
Southland
Gore
Invercargill
City
Dunedin
City
Otago /
Southland
Region*
0
36
33
8
37
0
30
22
17
77
90
95
83
100
100
95
85
93
92
76
95
92
95
50
90
95
94
*Some respondents indicated that their organisation covers the whole Otago Southland region.
Note: Only respondents that reported that alcohol availability from licenced premises significantly contributes to alcohol-related harm in their district were invited to report
the role of different licence types.
31
Appendix F
Table 10 Proportion of respondents agreeing or strongly agreeing that the availability of alcohol should be addressed with licencing restrictions
Waitaki
Queenstown
Lakes
Central
Otago
Clutha
Southland
Gore
Invercargill
City
Dunedin
City
Otago /
Southland
Region*
Alcohol
trading hours
71
83
71
67
79
88
83
82
90
Location of
licenced
premises
54
63
38
33
72
86
63
85
70
Number of
licenced
premises
62
87
48
50
72
88
76
87
77
*Some respondents indicated that their organisation covers the whole Otago Southland region.
Note: Only respondents that reported that alcohol availability from licenced premises significantly contributes to alcohol-related harm in their district were asked about policy options.
The denominator is number of responses to the survey item.
32