Ronald Knibbe and Dike van de Mheen Ronald Knibbe and Dike van de Mheen Sacha Ruland

Alcohol consumption increases but prevention still lags behind

In Body
Written by  Loek Kusiak Wednesday, 05 February 2014 15:39

Excessive alcohol consumption fosters risk behaviour and addiction. But government action is often a long time coming, observe addiction researchers Ronald Knibbe and Dike van de Mheen. Health services for alcoholics may have greatly improved, but they are no substitute for changing drinking behaviour and preventing alcoholism in the first place. And until the government takes action, researchers must stay on its case.

Excessive drinking among young people takes its toll in the form of fatal traffic accidents, aggression and public nuisance. As of 2014, the legal age for buying alcohol in the Netherlands has increased from 16 to 18. “And rightly so. Five to seven years ago that was unthinkable. Scientists were laughed at; policymakers refused to take us seriously”, says Knibbe. “You have to keep on hammering away with your message.”

Research on addiction prevention benefits health and ultimately saves lives. This is the shared conviction of Knibbe, emeritus professor of Social Epidemiology of Alcohol and Drug Use at Maastricht University, and his successor Van de Mheen, endowed professor of Healthcare and Prevention of Risk Behaviour and Addiction. “Young people already known to the youth services are extremely vulnerable to substance abuse”, says Van de Mheen. “This is an underestimated problem, although that’s not to say these young people will necessarily become addicted. Today we no longer view addiction as a behavioural problem, but rather a brain disease.”

Self-control

Substance abuse and addiction, according to Knibbe, have been problems throughout history. “In 1880 people drank a lot, and in 1980 too. You also saw a lot of heroin addicts on the streets in the eighties, a problem that has decreased dramatically thanks to better addiction care. Now we have new drugs, like ecstasy and cocaine. What’s more, the average alcohol consumption tripled between 1960 and 1980, for both men and women. One in ten people aged 16 to 70 drinks too much and has problems with alcohol abuse. The better educated drink wine, while young people opt for beer or breezers, sometimes very early on.”

Alcohol abuse and binge drinking often arise through group behaviour. Yet research shows that lecturing young people about drinking for the ‘wrong’ reasons has little effect. “Instead, we have to promote self-control among young people, and social control via parents, teachers and associations”, says Knibbe. “The ban on serving drinks to intoxicated people also has to be enforced. Many fights were fought over this ban until it finally came into effect.”

Active commitment

“Influencing the behaviour of substance abusers requires patience”, says Van de Mheen. “But it can be achieved, in combination with the appropriate legal measures. Compare it with smoking. The smoking ban in the hospitality industry took forever to come into effect. But afterwards, many people quit smoking. Increasing the legal drinking age to 18 is also a major societal change, but one that’s now accepted. Early closing times for bars and clubs reduces alcohol consumption even further. All this knowledge we now have, we must dare to implement as a society.”

This, Van de Mheen emphasises, will require still more commitment and involvement from governments, schools, police and social workers, based on sound insight into the lives and experiences of vulnerable young people. “There are already examples of successful healthcare interventions, including just meeting with young people to discuss their alcohol or cannabis use. For older people – the silent drinkers – GPs have programmes that help them to identify problems before it’s too late. And online self-help, where people can test whether they’re developing an addiction, can prompt them to seek help sooner. There’s still a long way to go, but good collaborative initiatives have already been set in motion in youth care, education and neighbourhood addiction prevention. Youth care and addiction care were once viewed separately, but now these sectors work together more often.” Knibbe: “Thanks to insights acquired through scientific research, the past decades have seen a big push for professionalisation.”

Health benefits

The government should spend more on prevention, according to Van de Mheen. Of the total healthcare budget, less than 5% is earmarked for prevention. “It’s foolish to cut that even further. You have to start with prevention during primary school to see real health benefits and lower school dropout rates.”

“Governments and health agencies are often unwilling to take on board scientists’ recommendations for preventing substance abuse. This can be frustrating”, reflects Knibbe, a veteran of 30 years of research. “I’ve often said to policymakers: You could prevent so much, but you don’t. So you should feel guilty about the consequences.” Van de Mheen: “Policy decisions are only marginally based on scientific arguments. You have to continue to report on your findings, say it a thousand times.”

“Indeed”, agrees Knibbe. “Measures to prevent substance abuse and influence behaviour pay off, and at the same time we shouldn’t bully and judge users. These are messages we have to keep on putting out there.”

Dike van de Mheen (1963) studied Health Sciences at UM, where she is now endowed professor of Healthcare and Prevention of Risk Behaviour and Addiction. She is also director of the IVO, the national research institute for addiction problems (alcohol, tobacco, cannabis, hard drugs, etc.) and endowed professor of Addiction Research in the Department of Public Health at the Erasmus Medical Centre.

Ronald Knibbe (1947) started his research career in Maastricht in 1979. He remained at UM until his retirement in June 2012, from 2000 as professor of Social Epidemiology of Alcohol and Drug Use. His addiction research focuses on the Netherlands as well as other European countries.

 

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