The University of Auckland

“If Alcohol (Ethanol) Was Discovered Today, It

Would be Subject to Controls Under The Misuse of

Drugs Act.”

Lisa Zollo

ID #629635486

Supervisor: Matthew Russell, ESR Ltd.

5th October 2015

Word Count: 14,001

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Contents

1.0 Introduction…………………………………………………….………..…………2

2.0 History of Alcohol Consumption………………………….…………………….....4

3.0 Pharmacology of Alcohol……………………………………………………...…..5

4.0 Effects of Alcohol to the Human Body……………………………………..…......9

5.0 Alcohol – A Psychoactive Drug………………………………………………..…13

6.0 The Misuse of Drugs Act…………………………………………………….…...15

7.0 Current Legislation on Alcohol………………………………………………..….17

8.0 Comparison of Alcohol to Controlled Psychoactive Drugs…………………..…..18

9.0 Statistics on Alcohol Consumption in New Zealand……………………………...27

10.0 Involvement of Alcohol in Crime…………………………………………………29

10.1 Example 1………………………………………………………………....30

10.2 Example 2………………………………………………………….……...31

10.3 Example 3 ……………………………………………………………..….32

10.4 Example 4………………………………………………………..……..…32

10.5 Example 5………………………………………………………………....34

10.6 Example 6……………………………………………………………..…..36

10.7 Example 7……………………………………………………………..…..37

10.8 Example 8………………………………………………………..………..38

11.0 Medicinal Benefits of Alcohol – Do These Outweigh its Harmful Effects………39

12.0 Does Alcohol Fit the Description of a Class Controlled Drug?..............................41

13.0 Ways to Address the Issue of Alcohol Misuse……………………………………44

14.0 Conclusion………………………………………………………………………...47

15.0 References…………………………………………………………………………49

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1.0 Introduction

A legal psychoactive drug is widely available, one that caused the death of 3.3 million people

worldwide in 2010, including underage consumers and young teenagers who may have been

oblivious to the harmful risks (WHO, 2015). According to the World Health Organization,

this clear liquid is rapidly metabolised by the human body, then is distributed throughout the

body to affect every organ along the way. Responsible for potentially causing over 200

diseases such as cirrhosis of the liver and cancer, when misused it is believed by some that

this drug is more harmful to users and to others than certain illicit drugs such as ecstasy and

cannabis. People can become addicted from consuming it just once, and those who are

addicted will do anything, including crime and violence, to get their next fix. This drug has

great potential to cause harm to users, and to those around them. Although this drug has been

around for centuries, if it were discovered today, it would most likely be considered a class

controlled drug under the New Zealand Misuse of Drugs Act.

Alcohol is the most commonly used recreational drug worldwide. It is a highly addictive and

dangerous drug when consumed too often. Drug abuse, including alcohol abuse, refers to

“non-medical administration of a drug for its psychoactive effect, intoxication or altered body

image (despite knowing the risks involved)” (M. Russell, 2015, pers. comm., 30 April). For

centuries, alcohol has been used and abused by humans. Since alcohol has been around for so

long, it is well understood in terms of its effects and toxicity. Upon first consuming alcohol, it

delivers a euphoric effect to the individual, activating the reward pathway in the human brain.

A moderate amount of alcohol decreases motor coordination, impairs judgement and alters

the mood of the individual consuming it. In high concentrations and with continuous

consumption, alcohol can cause severe health effects to individuals, such as, cirrhosis of the

liver, heart disease and an increased risk of developing various forms of cancer (Wallner &

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Olsen, 2008). Alcohol is involved in a large volume of crime and violence not only in New

Zealand, but across the world. According to the New Zealand Police, at least one third of all

offences recorded by police officers in 2010 were committed by an offender, or multiple

offenders, who had consumed alcohol before committing an offence (New Zealand Police,

2010).

Ethyl alcohol (ethanol) is the psychoactive substance found in alcoholic beverages such as

beer, wine and liquor. In today’s society, its main use is for human consumption, however, it

is also has a number of valuable uses. It can be used as a renewable fuel source (as it can be

mixed with petrol), used in household cleaning products and for medicinal purposes such as

antiseptics and treatment for methanol poisoning (What is Ethanol? 2013). Although it has

some beneficial uses, in large amounts its toxic effects to the human body make it arguably

one of the most dangerous legal drugs widely available to the population. According to The

World Health Organization (2014), despite the known harmful effects of alcohol and its

ability to alter ones perception and emotional state, it still remains a low priority in public

policy. Having more controls put in place regarding alcohol consumption should start to

become a priority. Other psychoactive drugs, which have similar harmful effects on

individual health as alcohol, such as cannabis, are more tightly regulated under the Misuse of

Drugs Act. This essay will compare alcohol which is legal, to other psychoactive drugs,

which are illegal and tightly regulated, and therefore will discuss the following hypothesis,

“If alcohol (ethanol) were discovered today, it would be subject to controls under the

Misuse of Drugs Act”.

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2.0 History of Alcohol Consumption

Alcoholic beverages have existed for centuries, with evidence suggesting it has been used in

China since around 7,000 B.C (Foundation for a Drug Free World, 2015). Alcohol was

widely used for medicinal purposes in the sixteenth century. Peak distribution began in the

eighteenth century when Britain passed a law that encouraged the use of grains for making

spirits. It wasn’t until the nineteenth century that attitudinal changes began, (once the harmful

effects of alcohol became well known). It was during this time that promotion for moderate

use of alcohol instead of frequent consumption began. Eventually this lead to alcohol being

known as a potentially harmful beverage, and greater restrictions developed as a result.

In New Zealand, the European settlers introduced drinking, as the Maori traditionally did not

drink alcohol. As there were few restrictions placed on alcohol, intoxication became high in

the 1870s and in fact was twice as high as Britain. Many New Zealanders in the early

twentieth century wanted alcohol banned completely, as people could begin to see the health

effects of heavy drinking and social outcomes, such as violence (especially) towards women.

Restrictive laws were put in place which decreased the number of pubs and introduced

closing times. However, bans were never put in place as Central government earned revenue

from alcohol. Supermarkets could sell wine from 1989, and bars could continue to stay open

all night. The legal age to purchase alcohol in New Zealand was lowered in 1999 to 18 years.

In the 21st century, binge drinking became common in New Zealand, particularly among

young people, Pacific Islanders and Maori. With approximately $85 million spent each week,

alcohol is currently New Zealand’s most widespread drug (Phillips, 2015). According to the

Encyclopaedia of New Zealand, the most noticeable consequence was the availability of

alcohol to individuals, as the number of licensed premises available to purchase alcohol

increased from 1,000 premises in 1969 to 14,000 premises in 2010.

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Alcohol has become normalised into everyday behaviour. It can be consumed for cultural

reasons, entertainment, celebrations and social events and is not considered a harmful drug by

many people. According to the Health Promotion Agency, the English verb “to drink”

generally applies to alcohol rather than any other beverage (2014). This is a clear indication

of how alcohol has become a normal part of everyday life for many people. Alcohol legality

and restrictions on alcohol has become widely debated between health experts, researchers

and the general public, with mixed reviews on whether it is really as harmful as health

experts warn.

3.0 Pharmacology of Alcohol

The structure of ethanol (C2H5OH) is shown in Figure 1. It is an organic compound

containing a methyl group, methylene group and the hydroxyl group, which indicates it

belongs to the alcohol group. In its pure state, ethanol is a flammable, colourless liquid which

is made from the fermentation of sugars from various agricultural crops such as grapes,

barley and potatoes.

Figure 1: Structural formula of ethanol

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Figure 1: The structural formula of ethanol (C2H5OH), containing the various groups which make up

the molecule (What is Ethanol? 2013).

Once alcohol is consumed orally, it is absorbed almost completely from the duodenum, the

first section of the small intestine. This process mainly occurs through diffusion, as ethanol is

a small, lipophilic molecule which can easily cross the lipid membranes of cells (Guenther,

n.d.). There are many factors that affect absorption of alcohol, such as, the rate at which the

individual is drinking, whether any food was consumed with it, as well as the type and

quantity of alcohol consumed. Gender, age and body composition of the individual who is

consuming the alcohol, are also factors that affect the absorption rate. Following absorption,

alcohol is then distributed into the total body’s water, where it rapidly enters the central

nervous system before being carried out to every organ in the body. Effects from alcohol can

be felt within five to ten minutes after consumption, indicating how quickly it can exert its

effects on the body. Metabolism of the alcohol occurs next, primarily in the liver through a

two-step process, as shown in Figure 2.

The metabolism of alcohol follows zero order kinetics, where it is eliminated from the body

at a constant rate. Firstly, alcohol is oxidised to acetaldehyde by the enzyme alcohol

dehydrogenase with NAD+ as a co-factor. Secondly, acetaldehyde is converted to acetate

(acetic acid), by the enzyme aldehyde dehydrogenase. This step ensures that there is no build-

up of toxic acetaldehyde by converting it to acetic acid. As the acetaldehyde levels increase

and slightly build-up, the effects to the individual may include headaches, vasodilation and

flushing. Over 90% of alcohol consumed is metabolized, the rest is excreted.

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Figure 2: Alcohol Metabolism Pathway

Figure 2: The two-step process of alcohol metabolism in the human body. Step one converts ethanol

to acetaldehyde and step two converts this product to acetic acid (Guenther, TM, n.d.).

Rapid communication between cells in the brain occur through specialised cells called

neurons. Neurons communicate information to other cells through axons and receive

chemical messages from other neurons by dendrites. There are many proteins on the surface

of neuron membranes that allow small atoms that are charged to pass from one side of the

membrane to the other. These can be voltage-gated channels which allow neurons to send

rapid electrical signals, called action potentials (Lovinger, 1999). Another form of

transmission can be through chemical communication, which occurs at the synapse of the

neuron. The pre-synaptic neuron is where the chemical (neurotransmitter) is released from

vesicles at the axon terminal. It then binds to receptors on the post-synaptic neuron to exert

its effects, depending on the type of neurotransmitter it is.

Alcohol affects the central nervous system by causing a release of inhibition by activating

inhibitory pathways and interacting and modifying the function of some membrane-bound

1)

2)

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proteins. Neurotransmitters are chemicals that allow for signal transduction to occur along

neurons. Under normal conditions, the brain balances the neurotransmitters to allow the body

to function efficiently. Alcohol can cause an imbalance in neurotransmitters, affecting brain

function as it interacts with serotonin transmission in the brain. Serotonin is a

neurotransmitter that acts on the 5-hydroxytryptamine (5-HT) receptors in the brain and is

involved with controlling emotions, as well as motivation to perform certain activities and

behaviours, such as drug and alcohol abuse (Lovinger, 1999). Alcohol also increases GABA,

an inhibitory neurotransmitter which decreases neuronal excitability by activating protein

kinase C, causing sedation. This then inhibits neurotransmitters such as glutamate to be

released (which is the main excitatory neuron), as well as acetylcholine (which converts short

term memory to long term memory). This process is the main reason behind the blackouts

people can experience during intoxication, and the memory loss that may occur after.

Euphoria (a state of intense happiness and increase in self-confidence) occurs as dopamine

(D2) receptors are activated, causing a release of endorphins (Davies, 2003).

Figure 3: GABAA ligand-gated ion channel

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Figure 3: Diagram of the GABAA ligand-gated ion channel. This receptor is made up of five subunits.

Ethanol affects the alpha subunit, causing an increase in inhibitory neurotransmitters (Lovinger,

1999).

Alcohol interferes with the communication pathway in the brain, affecting the cognitive and

physical functions of the person consuming it. This may include affecting their mood,

behaviour, coordination and ability to think clearly and logically. Due to this action, alcohol

is known as a central nervous system depressant. When a person consumes alcohol, they

experience a psychoactive effect. The mesolimbic dopamine system, also known as the

‘reward pathway’, produces a euphoric response to alcohol, increasing dopamine levels

(Enoch, 2003). This process is a positive reinforcement for the individual consuming the

alcohol as they feel that alcohol is rewarding. The development of drug and alcohol addiction

occurs when the drug affects specific areas of the brain that increases the motivation of the

individual to continual use of the drug (Guenther, n.d.). When the brain is continually

exposed to alcohol, it begins to become tolerant or insensitive to its effects. Therefore, the

individual can consume more alcohol than someone who drinks moderately to become

intoxicated, as they have developed a tolerance to it.

4.0 Effects of Alcohol to the Human Body

Alcohol can have a number of effects on the body depending on the concentration of alcohol,

how much of it was consumed, type of alcohol consumed, gender and the body composition

of each individual. All these affect the individual’s blood alcohol concentration, a measure of

the concentration of ethanol in the blood over time. When consumed in low concentrations,

alcohol acts as a stimulant, causing an initial feeling of euphoria, which is rewarding to the

individual. It also causes disinhibition, affecting cognitive and emotional behaviours causing

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impaired judgement as a result of poor risk assessment (Health Promotion Agency, 2014). As

the dosage of alcohol increases, it can start to alter the mood of the individual by increasing

anger and unhappiness as well as impairing their motor function and causing their speech to

slur. In large doses, alcohol is described as being a depressant of the central nervous system,

as it slows down breathing rates dramatically. Higher concentrations (500 mg/dL or greater of

ethanol in the blood) can lead to vomiting and in extreme situations result in a coma,

respiratory failure or even death (Davies, 2003).

Figure 4: Levels of blood alcohol concentrations and corresponding symptoms

Figure 4: This table shows the blood alcohol concentration and the effects alcohol can have on the

body with increasing concentrations (Health Promotion Agency, 2014).

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Researcher Floyd Bloom conducted an in vivo study to analyse the effects of ethanol as a

central nervous system depressant on specific regions of the brain in rodents. He examined

the cerebellum, inferior olive, locus coeruleus and the hippocampus to determine the

intoxicating effects of alcohol within these four regions. In all four regions of the rodent’s

brain, alcohol intoxication caused sensitivity to various neurons. Based on the data from this

study, the sequence of events that occurs to each part of the brain is critical when studying

intoxication. Ethanol in low doses increased responsiveness to neurons in the locus coeruleus,

leading to inattention. Higher doses of ethanol to rodents activated the neurons of the inferior

olive, causing the increase formation of endogenous serotonin and also the increase of

acetylcholine from the hippocampus. Each region of the brain showed a varied response to

ethanol, indicating that there is a cellular basis for the effects and behavioural changes that

occur during intoxication, which occurs in humans also. Recognising the cellular changes and

the mechanisms of intoxication would assist in our understanding of alcohol dependence and

possibly allow for preventative measures for chronic alcohol consumption (Bloom, 1988).

Excessive and frequent drinking, also known as binge drinking, can cause a number of

serious health problems. Alcohol affects every organ in the human body, and can have long-

term effects to the liver, blood and immune system, bones, muscles, heart, the brain and

mental health, the lungs, the pancreas, the stomach and the reproductive organs (Health

Promotion Agency, 2014). According to the World Health Organization (2014), alcohol can

cause over 200 various diseases or injury to individuals. Liver cirrhosis, or damage to liver

cells, is a common diagnosis with long-term alcohol consumption and is often fatal. Fatty

liver is also an effect from alcohol abuse, as large lipid droplets can accumulate in liver cells

causing an enlarged liver. Various cancers are associated with continuous alcohol

consumption, as ethanol is a known carcinogen and has been found to increase the risk of

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developing a number of different cancers. These can include cancer to the liver, mouth, throat

and oesophagus. Heavy alcohol intake can also damage nerve cells in the brain, potentially

leading to memory problems, eye problems and difficulty in walking as it can effect balance

and motor coordination of an individual. With such severe possible health effects associated

with drinking, and a population which is now more educated than ever before on its

damaging effects, there is still a large proportion of the population who continue to consume

alcohol regularly. A 2013 survey from the Ministry of Health found that 80% of people

fifteen years and over consume alcohol in New Zealand (Health Promotion Agency, 2015).

Although this figure has dropped from 84% in 2006/2007, this figure is still alarmingly high

for an educated population, and may increase.

Consuming alcohol whilst pregnant can affect unborn babies and can cause miscarriages or

birth defects that may impair the growth and development of their brain as well as their

central nervous system (World Health Organization, 2014). When the child further develops,

this could lead to mental retardation, learning disabilities and behavioural problems as they

grow older. To avoid these risks The Ministry of Health (2010) advises women not to drink

alcohol in the lead up to, as well as during pregnancy.

Not only does alcohol abuse affect the individual drinking alcohol, it also affects the people

around them. Drink-driving is a serious crime that can cause motor vehicle accidents, which

in turn can affect a number of people. Violence, such as domestic violence, sexual assault,

child abuse and homicide is another effect of alcohol abuse. Studies have shown that alcohol

is a major factor contributing to a number of crimes across New Zealand and internationally,

all of which will be discussed further in this essay (World Health Organization, 2014).

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5.0 Alcohol – A Psychoactive Drug

As previously mentioned, ethanol is the psychoactive substance in alcohol. Psychoactive

drugs alter the consciousness, mood and the thoughts of the individual taking them. This

affects the normal perceptual, emotional and motivational mechanisms in the brain. Examples

of psychoactive substances include legal substances such as alcohol and tobacco, as well as

illegal drugs such as heroin, ecstasy and amphetamines. Communication in the brain is

altered by psychoactive substances such as alcohol. Brain cells (called neurons) normally

communicate with each other through neurotransmitters, which are messengers that are

released from the neuron. They send a chemical message by binding to receptors on the

neuron which is receiving the message. Psychoactive drugs work by mimicking the effects of

these endogenous neurotransmitters naturally occurring in the body, or they can interfere with

the normal brain function by obstructing its normal function or varying the way it releases or

stores particular neurotransmitters (World Health Organization, 2004). Psychoactive

substances have a number of different ways that they act in the brain, in order to cause an

effect. They can increase or decrease neuronal activity by binding to different types of

receptors in the brain, causing behavioural effects and eventually the development of

tolerance and dependence. They also affect regions in the brain which are associated with

motivation. This also has been found to cause substance dependence as the reward pathway

in the brain is activated (World Health Organization, 2004).

Common psychoactive drugs can be distributed into four main groups; depressants,

stimulants, opioids and hallucinogens. Depressants include alcohol, sedatives and hypnotics

which decrease the central nervous system activity and can reduce awareness and produce a

short-term feeling of relaxation. Stimulants have the opposite effect, in that they increase

activity in the central nervous system. Nicotine in tobacco products, cocaine, ecstasy and

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amphetamines are all examples of stimulant psychoactive drugs. These drugs produce

euphoria and increase alertness and energy. Morphine and heroin are examples of opioids and

are known to relieve pain as well as induce sleep. Hallucinogens cause delusions or

hallucinations which affect an individual’s perception. These psychoactive substances include

the naturally occurring substances such as mescaline and cannabis as well as the synthetic

substances such as LSD (New Zealand Law Commission, 2011). These drugs are all unique

in the way they act on receptors in the brain, however, they are similar in the way they

activate the reward pathway resulting in motivation and drug addiction.

According to The New Zealand Law Commission Report (2011) people have been using and

abusing psychoactive substances for thousands of years. Attitudes towards drug use are

continually changing over the years and the legality and controls of certain drugs have also

changed over time, depending on the type of drug and how it is used. Over a century ago,

people in New Zealand were legally able to purchase large amounts of opium without a

prescription, and opium and morphine were commonly prescribed to people for a range of

illnesses and even for the common cold. The drug started being regulated in the 1920s when

the known dangers and addictive properties of opium became better understood. New

Zealand’s drug laws were reviewed in the early 1970s, and The Misuse of Drugs Act was

developed in 1975. This Act prohibited, among other substances, the recreational use of

psychoactive drugs. However, the country continues to allow for recreational purposes, the

sale and promotion of two dangerous and toxic drugs (in high concentrations); ethanol and

nicotine.

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6.0 The Misuse of Drugs Act

The Misuse of Drugs Act (1975) is New Zealand’s drug regulation law which classifies

certain drugs into different classes based on their likelihood to cause harm to humans or to

society by its misuse. It does this by regulating the sale, importation and manufacture of

psychoactive drugs in New Zealand, and, restricting its use to medical and scientific purposes

only. According to the Ministry of Health, a controlled drug is one that is tightly regulated to

restrict the access and decrease the misuse of these drugs. Under section 3A of the Act, Class

A drugs refer to those that pose a very high risk of harm and include drugs such as cocaine,

heroin and methamphetamines to name a few. Class B drugs pose a high risk of harm and

include amphetamines, MDMA, cannabis preparations and opium. Class C controlled drugs

pose a moderate risk of harm, such as the cannabis plant or seed (New Zealand Legislation,

2014). In 2006, the New Zealand government introduced a new class, Class D, to include

‘party pills’ Benzylpiperazine (BZP). The classes of drugs represent a hierarchy of potential

to cause harm, with penalties increasing for any offence involving Class A and decreasing

when offences occur in Class B and Class C. The classes have two main purposes; firstly,

there is a primary classification to establish the penalty involved with dealing, possession or

use of the drug under the act. Secondly, Class B and Class C drugs are divided into sub-

classifications to control storage, prescribing and keeping records of those who deal with

controlled drugs (New Zealand Law Commission, 2011).

Like other psychoactive drugs that are classified under the Act, alcohol has some similarly

damaging effects. When the harm of alcohol abuse is well known questions are raised as to

why alcohol is not classified as a risk, and why it is not more tightly regulated. Health

professionals who specialise in drug addiction research have stated that if alcohol was a drug

that was discovered today and applied to the criteria that makes up The Misuse of Drugs Act,

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it would be categorised as a high risk Class B drug, and subject to controls under the act

(Sellman, 2010). According to The New Zealand Law Commission Report (2011) the

explanation for such variation in regulatory approaches of the Act is that the use of ethanol

can be both harmful, yet also beneficial for some purposes, depending on the context it is

used. The Misuse of Drugs Act tends to treat drugs as a criminal matter, rather than basing it

on its health effects when the concern should be about both (New Zealand Law Commission,

2011).

The Government asked for a review by the Law Commission of New Zealand’s drug law in

2007. A reform of the law was required as new psychoactive drugs were continually

emerging, and many felt that the current classification required adjustment. The fact is that in

none of the reforms and proposed reviews, has ethanol even been mentioned as requiring to

be under the control of Misuse of Drugs Act. The Law Commission reviews the Misuse of

Drugs Act and considers issues such as the harm of the drug to society, the best model for

controlling drug use, how new psychoactive substances should be treated and the appropriate

penalties for offences of the Misuse of Drugs Act (New Zealand Law Commission, 2011).

The Misuse of Drugs Act classifies psychoactive substances as class controlled drugs based

on their potential to cause harm to the individual and to others around them. Psychoactive

drugs work by acting on the central nervous system affecting how an individual behaves and

perceives situations, impairing their judgement and ability to make decisions. The New

Zealand Law Commission believes that the Misuse of Drugs Act should be modified and

aligned with the National Drug Policy. The current Act focuses more on the criminal aspect

of illegal drugs classified as class controlled drugs, rather than focusing on minimising harm

to individuals who take these drugs and those around them. It also fails to assist those with

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drug dependence and addiction issues who need support and help. There have been a number

of experts who are suggesting a reform of the current Act to further control psychoactive

substances that have a potential for misuse and abuse. Excluded in this suggestion, however,

are alcohol and tobacco, two highly addictive drugs that have the potential to cause harm.

Under this Act, substances must be assessed by the Expert Advisory Committee on Drugs

(EACD) and must fit certain criteria to be considered a class controlled drug. These criteria

range from how the drug affects the user and society, any risks to public health, whether the

therapeutic or medicinal (if any) benefits outweigh its risks, potential for the drug to cause

death by overdose and physical dependence or addiction of the drug to name a few (New

Zealand Parliamentary Library, 2003).

7.0 Current Legislation on Alcohol

The current legislation on alcohol consumption in New Zealand falls under the Sale and

Supply of Alcohol Act 2012. The purpose of the Act is to benefit communities by putting a

new system in place “to control the sale and supply of alcohol and to reform the law in regard

to sale, supply and consumption of alcohol” (New Zealand Legislation, 2015). Under this

Act, the minimum legal age for an individual to purchase alcohol is 18 years of age. There is

no minimum legal drinking age in New Zealand, so although those under 18 cannot purchase

alcohol themselves, they are allowed to consume it legally under supervision.

The Sale and Supply of Alcohol Act also regulates the promotion of alcohol in order to avoid

encouraging excessive alcohol consumption. This is achieved through limiting the display of

alcohol in supermarkets, banning the promotion of alcohol discounts of greater than 25% and

prohibiting the advertising of free alcohol to people. Alcohol can be sold at various venues,

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off-licenced venues including dairies and convenience stores and licenced venues such as

alcohol stores, bars and restaurants.

With these regulations in place, the aim is to overall decrease New Zealand’s alcohol

consumption and to reduce the harm that is caused from excessive drinking. This Act also

allows communities to express their opinions on matters regarding alcohol licensing in their

areas as well as establishing stricter rules on the types of places that can sell alcohol. Certain

local councils have banned alcohol in particular areas in the hope of reducing alcohol

consumption in that area. Breaches of any of the above restrictions and regulations under the

Sale and Supply of Alcohol Act could result in fines.

8.0 Comparison of Alcohol to Controlled Psychoactive Drugs

There are a number of arguments that suggest alcohol (a legal psychoactive drug), is more

harmful in terms of health and social effects to users and to others compared with cannabis, a

Class C controlled drug under New Zealand’s Misuse of Drugs Act. Cannabis has been

labelled as the most frequently used illicit, recreational drug in New Zealand whilst alcohol

still remains the most commonly used legal, recreational drug in New Zealand. The main

psychoactive component of cannabis is THC, which is hallucinogenic in high doses. A vast

amount of experimental studies have suggested that since cannabis has a relatively low

toxicity, there are much lower risks of developing short-term or long-term health effects

compared with alcohol’s risks (New Zealand Law Commission, 2011). Cannabis intoxication

can affect judgement, motor skills, reaction time and concentration, similar to alcohol

intoxication. Like alcohol, cannabis has a sedative effect on the body.

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Cannabis affects the circulatory system and although may not be harmful to healthy

individuals, it can be for those with pre-existing cardiovascular disorders. As it can affect the

respiratory tract, chronic bronchitis and lung cancer are potentially long-term effects

associated with smoking cannabis. Cannabis has also been found to increase short-term

mental health with effects such as psychosis and impaired motor function but these effects

can generally be reversed. According to a study by Van Ours and Williams (2012), although

there are certain risks involved with cannabis use, these are generally associated with long-

term use. The majority of individuals who have taken cannabis are not addicted or long-term

users. In addition, Van Ours and Williams argue that the risks of cannabis are far lower than

that of other illicit drugs in Class B such as amphetamines, with lower risks compared to

long-term alcohol consumption and tobacco smoking (Van Ours & Williams, 2012).

MDMA (Methylenedioxymethamphetamine), also known as ecstasy, is similar in structure to

the psychoactive drug amphetamine. Ecstasy is another psychoactive drug and is considered a

Class B controlled drug under the Misuse of Drugs Act. MDMA is a stimulant, its effects can

occur within thirty minutes of taking the drug and lasts for up to eight hours (Queensland

Government Australia, 2013). Like alcohol, ecstasy can cause euphoria, excess energy, and

an increased pulse. It can also cause hallucinations and altered perception. Since ecstasy

tablets are generally not ‘pure’, the effects can often be unpredictable depending on what

other substances are mixed with it (Patient, 2015). Post euphoria, the user may experience

depression and anxiety and could potentially develop serious health complications such as

liver, heart and kidney problems. In a worst case scenario, taking ecstasy could result in

death.

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Professor David Nutt, a well-known British psychiatrist and pharmacologist specialises in the

research of drugs and their effects on the brain, including addiction. He has written a number

of literature - some of the literature involves research from other scientists containing

scientific facts on the issue, his own research, and, experimental studies as well as his

professional opinions, RE: “if alcohol were discovered today, would it be illegal?” (Nutt,

2012). Professor Nutt believes that people consider alcohol to be an ‘acceptable’ drug

because of its legality, however, he argues if it were not legal this would probably not be the

case. As alcohol can be toxic to humans when misused, Professor Nutt suggests that if it was

discovered today, alcohol would possibly be illegal. Based on one of his experimental studies

(described below) Professor Nutt describes how he believes alcohol is more harmful than the

drug ecstasy. This comment has sparked debate and caused controversy between experts.

Executor of the National Drug Prevention Alliance, David Raynes, has criticised Professor

Nutt’s view that alcohol is more harmful than ecstasy, stating that his comments are unwise

and could potentially promote greater use of the illicit drug (The Telegraph, 2009). Although

Professor Nutt is not suggesting that ecstasy is not harmful and it should be legal, he is

suggesting that the government take more action to regulate alcohol as it should be

considered just as harmful.

In 2010 in the United Kingdom, a group of specialised experts in the pharmacology,

physiology, legal aspects and the social harm of drugs came together to rate 20 of the most

commonly used psychoactive drugs in the United Kingdom on basis of harm. This

classification system was created by British scientists David Nutt, Leslie King and Lawrence

Phillips on behalf of the Independent Scientific Committee on Drugs (ISCD), an independent

organisation of drug experts. Some of these drugs included heroin, ecstasy, cannabis, tobacco

and alcohol to name a few. For the purpose of this essay, we will be comparing alcohol to

21

cannabis and ecstasy only, two controlled drugs under the Misuse of Drugs Act. The study

used a Multi-Criteria Decision Analysis (MCDA) based approach to create sixteen criteria

based on harm, nine of these relating to the harm of the drug to the user itself and seven to the

harms the drug causes to others, not only in the United Kingdom, but worldwide. The harm

criteria is further categorised into groups of physical, social and psychological harm, three

categories considered to be most important in terms of harm. The group of experts took into

account subjective judgements as well as objective facts about the harm of the drugs. As new

psychoactive substances are constantly being developed, the rating scale was able to evolve

over time. This included factors such as dependencies, injury, wealth, mental impairment and

social factors such as relationship loss. The study also looked at the number of deaths each

drug caused per annum in the United Kingdom, as well as hospitalisations from these drugs.

Figure 5 below is a diagram describing the harm criteria that was created to analyse the 20

drugs in this experiment.

The MCDA approach involves a series of intensive meetings (known as decision

conferences) between a selected group of experts. MCDA models are valuable in that they

can analyse costs, benefits and risks in certain situations. The experts must all be in

agreement with their final subjective scores. According to Leslie King, MCDA has proven to

be quite effective in that it is a process that allows a group of experts to come to a rapid

agreement on each aspect (L. King, 2015, pers. comm., 25 September).

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Figure 5: MCDA approach to formulating harm criteria of psychoactive drugs.

Figure 5: This image shows the harm criteria formulated by the MCDA approach from scientists in

the UK to numerically rate 20 psychoactive substances on basis of harm (Nutt, King, Phillips, 2010)

All 20 psychoactive drugs were scored out of 100 points, 100 being the most damaging drug

based on the harm criteria, and 0 having no harmful effects. Weighting of the scores was

important as some criteria are more harmful than others, such as overdose and death cause by

the drug. Weighting ensures that the criteria are all equivalent in terms of harm, by

comparing all the drugs that were given a score of 100 across all the criteria in figure 5. To

score each drug, the experts had to work in two stages. Firstly, they had to assess the

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difference of harm directly, and secondly, they had to consider how much the difference in

harm really matters in a particular context (for example in crime or drug-related mortality).

The experts assessed the weight of harm within each cluster of criteria shown in figure 5, to

make sure that the units of harm were equivalent throughout all the criteria.

According to Leslie King (one of the authors from this paper), the team of experts took each

of the 16 harm criteria (as shown on the far right side of figure 5) and assessed the score of

each drug. The most harmful drug in respect to each criterion scored 100. The weighting

process involved looking at all of the 16 criteria where a drug scored 100, and were compared

pair-wise whilst considering the following question; “Does the score of 100 on this criterion

represent a higher level of harm than the score of 100 on the next criterion? If so then what

fractional weight is given to the second example?” (L. King, 2015, pers. comm., 25

September). For example, in the physical cluster group containing four harm criteria to users,

the weighting for drug-related mortality was found to be the biggest difference of the four,

and was therefore given a weight of 100. The second largest harm in the group was found to

be drug-specific mortality, which was given a weight of 80, as it was found to be 80% as

great as for drug-related mortality. Therefore, the score for all of the drugs on the drug-

related mortality scale was multiplied by 0.8. This resulted in a weighted score of 80 for

heroin, as opposed to its original score of drug-specific mortality, which was 100. The scores

that weighted 100 in each cluster were then compared between each other, “with the most

harmful drug on the most harmful criterion to users compared with the most harmful drug on

the most harmful criterion to others” (Nutt, King, Phillips, 2010). This was to ensure that the

units of harm on all scales were equated. The weighting process allowed “the harm scores to

be combined within any grouping, by adding their weighted scores” (Nutt, King, Phillips,

2010).

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According to King, this is of course partly subjective but states that experience has shown

that is a process that allows a large group of experts to come to an agreement on each aspect.

The results from the study are shown in figure 6 below, where the total harm score assigned

to each drug is shown above the bar. It is important to look at the graph in a two-dimensional

way, looking separately at harm to user versus harm to others, as these greatly affect the

score. Based on the results from this study, alcohol has been rated as being the most

damaging drug to others, whereas cocaine has been rated as being most harmful to the user.

Cannabis and ecstasy have a much lower harm scores to the user and to others compared with

alcohol. Based on its ability to cause great harm to others and evidenced through crime,

violence and other ways it has been shown to affect society, alcohol was given the overall

highest harm score (72) compared to all other psychoactive substances shown. Cannabis was

given a score of 20, and ecstasy a score of 9, relatively low considering its known harmful

effects.

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Figure 6: Graph displaying the numerical rating of 20 psychoactive substances based on the

MCDA approach.

Figure 6: Psychoactive drugs and their total harm score developed by the ISCD. The score

incorporates harm to the user (shown in blue) as well as harm to others (shown in red) (Nutt, King,

Phillips, 2010).

The team of experts in this study argue that alcohol is more harmful than ecstasy as it causes

tens of thousands of deaths annually from not only alcohol poisoning, but also from road

accidents and diseases associated with it such as liver cirrhosis and cancer. Ecstasy, causes

the death of approximately ten people each year, out of the half a million people who use it

weekly (Highfield, 2007). According to Professor Nutt, because alcohol has been used for so

long and has become socially acceptable in society, it will unlikely ever be criminalised. If it

were discovered today and we had all the knowledge of its harmful effects as we do now, this

would be a different story.

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There are limitations to this study by Nutt, King and Phillips which are important to consider.

Although many adults consume alcohol, far fewer have had any experience with

MDMA/ecstasy. This is a key reason as to why alcohol ranks much higher on the scale as a

more dangerous drug than ecstasy - it is consumed a lot more often. Many disagree with this

study, as the ISCD base this scale on their professional judgement and do not consider the

beneficial properties of certain drugs, or that some of these drugs are prescribed for medical

reasons. These rankings are also highly variable. Even though some drugs may have a similar

score, the mortality risk may be greater in some, whereas the potential to cause psychological

impairment or crime and violence may be higher than the mortality rate in others. The

experiment also does not take into account the legality of the drug or its availability. If some

of these psychoactive drugs were legal and more easily accessible, then they would have a

much higher ranking than alcohol. Although there are these limitations, the experiment

provided a way in which drugs could be compared between each other on basis of their harm.

However, it did come with large amounts of controversy, and has sparked debate between

other experts and health professionals.

As cannabis continues to be tightly regulated as a Class B controlled drug, alcohol use has

been tolerated for centuries without proper consideration of the evidence of its harmful

pharmacological and social effects to individuals. According to the New Zealand Law

Commission (2011), many argue for the reassessment of cannabis under the Misuse of Drugs

Act as evidence suggests that moderate cannabis use has few risks compared with legal drugs

such as alcohol. While many experts believe that alcohol is more dangerous when misused

than cannabis, this study has become quite controversial, as the experts present the harmful

effects of these drugs from a one-sided point of view only. Many critique the imperfections of

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this study, as determining the risks of drugs is much more complicated than numerically

rating them (Lopez, 2015). Since alcohol is the most consumed recreational drug worldwide,

the higher rates of death, injury and other effects from it would seem higher compared with

other psychoactive drugs, as it is consumed more often and in greater doses. Therefore it does

not seem appropriate to place alcohol at a higher rating for harm than some of the other

harmful drugs.

9.0 Statistics on Alcohol Consumption in New Zealand

The New Zealand Health survey was conducted over 2012 and 2013 to determine the amount

of alcohol New Zealanders consume. It provides valuable data regarding alcohol use and

misuse by individuals aged over fifteen years, across different populations including gender

and cultural background, all which may have an influence on alcohol consumption. The

intention of this survey was to analyse the data to assist government agencies, organisations,

researchers, education departments and the general public to determine the best possible way

to reduce alcohol misuse and harm to individuals in New Zealand (Ministry of Health, 2015).

Figure 7: Alcohol Consumption in 2012/2013 of People Aged 15+ in New Zealand.

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Figure 7: This graph depicts the alcohol consumption over one year of individuals in New Zealand

aged over 15. The graph shows the age group and the percentage of adults who drank. It also

tabulated gender differences and cultural differences.

The outcome of the survey indicated that 79% of individuals drank alcohol in this year, which

equates to approximately 2.8 million adults in New Zealand, out of a total population of

4.471 million in 2013 (Statistics New Zealand, 2013). According to this survey, males were

more likely to have consumed alcohol during 2012/2013, as opposed to females who

consumed less. European / other and Maori also consumed more alcohol during this period

compared with people of other cultural backgrounds.

Individuals who lived in more disadvantaged areas of New Zealand consumed less alcohol

(71% of people) compared to those who lived in more established areas of New Zealand

(84% of people). It was also alarming to find that over half of the teenagers in this survey

aged 15-17 had consumed alcohol during this year. The survey indicated that the most

frequent place to drink alcohol was at home, which could explain this large number.

According to the Ministry of Health, drinking alcohol from a young age such as those aged

15-17 increases the risk of alcohol induced harm in teenagers. It also increases the risk of

alcohol dependency and alcohol abuse when they become adults. From these statistics, it is

clear that drastic measures need to be taken in order to lower these statistics.

As mentioned previously Professor David Nutt, a well-known British psychiatrist and

pharmacologist specialises in the research of drugs and their effects on the brain, including

addiction. He believes society has classified alcohol as acceptable and something that is

completely different to other psychoactive drugs that get you ‘high’, even though it has a

similar mind altering effect. People happily drink to get ‘drunk’ as it they believe this is

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socially accepted and is even encouraged in certain cultures, although many believe that it is

wrong to take other drugs to get ‘high’. Nutt argues that this is not true, and society needs to

start changing the way they look at alcohol.

There have been 40,000 alcohol related deaths, 1.2 million violent incidents and 500,000

crimes that have been alcohol related. These alarming statistics have emerged from recent

annual statistics from the United Kingdom (Nutt, 2012). The statistics also revealed that over

40% of domestic violence and 50% of child protection cases have involved alcohol. Professor

Nutt also suggests that if it were discovered today, alcohol would not be legal as it is far too

toxic for human consumption. Many people ignore the research and data that has become

available regarding the effects of alcohol, others don’t consider it to be a drug given its

legality.

10.0 Involvement of Alcohol in Crime

Causing the death of millions of people worldwide each year, alcohol has been termed one of

the most dangerous recreational drugs. With its known hazardous health effects and potential

to cause harm and injury, approximately 80% of New Zealanders between the ages of 16-24

consumed alcohol at least once in 2013, (Health Promotion Agency, 2015). An alarming 600

– 800 people in New Zealand have died from alcohol related reasons each year. Disease isn’t

the only negative outcome for individuals who consume alcohol, as there is a strong link

between violent crime and alcohol. As discussed, alcohol affects the central nervous system

and can begin to affect a person’s mood by increasing anger and irritation. When alcohol

concentrations in the blood reach levels that cause this behaviour, the odds of committing a

crime and becoming violent increases. In 2010, The New Zealand Police estimated that at

least one third of all crimes that were reported to the police involved alcohol. Every single

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day, more than three hundred alcohol-related offences are committed in New Zealand (New

Zealand Police, 2010). These crimes may include drink driving, assault (including sexual

assault), child abuse, homicide and domestic violence. Alcohol abuse is an important, yet

adjustable factor in reducing violence and crime in society.

A large number of researchers agree that there is a connection between alcohol and violence

but many do not agree on why it is such a factor. Most theories that have been suggested can

be organised into models based on their assumptions. These models are; the disinhibition

model, the indirect casual model and the expectancy model. Parker and Rebhun suggested a

model in 1995 which is based around the “selective disinhibition theory”. This theory

suggests that alcohol effects an individual’s ability to interpret other people’s intentions and

actions, affecting their perception. Depending on the situation, this can allow aggression to

occur, causing negative social situations and psychological effects that can lead to violence to

make their point (Kuhns et. al, 2014). The indirect casual model is commonly used to explain

aggression associated with intoxication. This model assumes that any cognitive, emotional or

physiological changes that occur from drinking can result in alcohol related aggression

depending on the social situation. Kuhns et al describe the expectancy model’s difference

revolving around the individuals beliefs that they have learnt about alcohol from their

previous experiences which cause aggressiveness (as opposed to the pharmacology of

alcohol). There a number of different crimes where alcohol has been identified as playing a

major role. This is further discussed below.

10.1 Example 1

There have been a number of literature studies that have looked into the involvement of

alcohol in different crimes across New Zealand. A study by Boden J.M. et al examined

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alcohol misuse and criminal behaviour over a thirty year study in a New Zealand birth cohort

(2012). The study looked at whether alcohol dependency symptoms in individuals influenced

the likelihood of them committing an offence such as theft, use of a weapon, assault and

property damage. It also looked at whether age was a factor. This study was conducted as it

was suggested that there are three major issues that require further experimentation. One of

the issues raised was that crime and alcohol abuse is a reflection on an individual’s personal

and social behaviour if they are excessive alcohol drinkers. Secondly, they wanted to

determine whether age had an effect on the misuse of alcohol and crime. It is believed that

rates of alcohol misuse and crime is more likely to occur during adolescence and as a young

adult, however, there is little evidence to support this. Research needed to take into account

that alcohol misuse and crime may vary the type of offence that is committed as it would

more likely involve short term impulse actions such as assault, rather than offences that

require planning or pre-meditation. The results from the study by Boden et al indicated that

there were statistically significant associations between alcohol dependency and committing

an offence. Individuals in the cohort that showed higher levels of alcohol dependency

symptoms were more likely to have committed an offence. It also found that as age increased,

the chances of committing an offence decreased, suggesting that age is also a factor.

10.2 Example 2

Fergusson and Horwood (2000) studied alcohol abuse and crime and also found that alcohol

abuse or dependence was clearly related to a significant rise in rates of property crime as well

as violent crime. They studied a cohort of individuals between the ages of 14 and 21,

measuring the number of symptoms of alcohol abuse and their type of offence. They

achieved this by using a fixed-effects regression model which estimated the association

between rates of crime and the frequency of alcohol abuse symptoms. From the model, they

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estimated that every increase in alcohol abuse symptom to an individual, the rate of crime

increased by 1.10 and 1.15 times. Results from this study found that an increase in alcohol

abuse in young individuals evidently increased the rate of violent crimes and property crimes,

as demonstrated by the statistical value, P<0.0001 (Fergusson & Horwood 2000).

10.3 Example 3

One of the most commonly reported crime in New Zealand is sexual assault. It is thought that

when males drink, they feel power, strength and control which is highly associated with an

impaired perception about how to handle situations that can quickly get out of control.

Researcher Linda Hill has studied the connection between alcohol and violence in New

Zealand. A national survey of alcohol consumption was undertaken in 1988 and the results

found that 82% of women who reported to have been sexually assaulted in the previous 12

months said their offender had been consuming alcohol. Although this is an alarmingly high

figure, this source is over 20 years old and the statistics would therefore no longer be valid. A

literature review report was prepared for the Ministry of Justice New Zealand in 2008 by

Nina Russell. This review provided more recent statistics that incorporated a study from

2001, which found that approximately half of all sexual assault cases involve the

consumption of alcohol by the offender prior to the assault. This is an underestimate

however, as there are many cases that are often not reported to police (Russell, 2008).

10.4 Example 4

The number of homicide offenders who were under the effects of alcohol has been under

debate in a variety of studies as the estimates varied greatly from 83% in a study by Shupe in

1954 to 15% in a study by Varano and Cancino in 2001 (Kuhns et. al, 2012). This variability

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could be due to a number of differences across the studies, including sample size, as well as

random differences that were unobserved, making it difficult to review literature. Studies on

alcohol involvement in crimes such as homicide is difficult for researchers. While they can

obtain toxicology information on homicide victims, this evidence is generally not available

for the offenders - by the time they are convicted, the alcohol in their body has been

metabolised. This makes it impossible for researchers to accurately record blood alcohol

levels at the time of the offence, and therefore they rely on reports or observations from the

offender’s case notes.

A study by Kuhns et al in 2014 analysed 20 three different studies over the past 60 years,

which included information from a total of 28,265 homicide offences from 9 different

countries. They analysed literature by using ‘meta-analytical’ techniques which is a more

precise way of calculating the mean across studies and contains a database which can be

updated as new experimental studies arise. This study found that on average approximately

half of these homicide offences (48%) were committed by offenders who had consumed

alcohol at the time and 37% of offenders were intoxicated. These values were obtained by

focusing on two factors, firstly the proportion of offenders of homicides who tested positive

for alcohol in their system at the time of their offence and secondly the proportion of

offenders who were intoxicated. The proportions were converted to logit values (the inverse

of log), and were converted to the percentages as shown above. Converting to the inverse of

log allowed for different sample sizes across the studies to be taken into account. The table

shown in Figure 8 below is the results of the study which display alcohol involvement (if

any) in homicide offenders.

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Figure 8: Involvement of alcohol in homicide cases in various countries over the years.

Figure 8: Various studies have been undertaken to illustrate the involvement of alcohol in a number

of crimes, in this case homicide. From this table it is clear that alcohol is involved in majority of

homicide cases that have been analysed by these studies (Kuhns et. al, 2014).

This study outlines the difficulties in using information provided on alcohol consumption

prior to the offence based on reports, rather than from biological tests. Although over half of

homicides involve the offender consuming alcohol prior to committing the offence, it is

evident that alcohol is a major factor that is involved in crime. This study demonstrates that

alcohol is one of many possible factors that can contribute to homicide.

10.5 Example 5

Alcohol affects driving as it can slow down reaction time, affect problem solving, memory

and attention. Since legislation changed in December 2014, the legal drink driving limit in

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New Zealand must be less than 250 micrograms of alcohol per litre of breath and 50

milligrams of alcohol per 100 millilitres of blood for drivers over the age of 20. For drivers

under the age of 20, the blood alcohol concentration must be 0. Drink driving is a crime

causing approximately 30% of New Zealand’s fatal road accidents (Ministry of Transport,

2015). On an average day for New Zealand Police, approximately 100 offences out of the 340

people arrested each day are for drink-driving. In a 2012/2013 health survey by The Ministry

of Health, a cohort of regular drinkers in New Zealand were asked if they had driven a car in

the past twelve months whilst under the influence of alcohol. The survey found alarming

results, indicating that 17% of drinkers drove at least once in the past twelve months whilst

under the influence of alcohol. This is approximately 416,000 individuals in New Zealand

(Ministry of health, 2013). Figure 9 below shows a graph of the percentage of drinkers who

drove in the twelve months of 2012/2013 across a range of age groups and both genders. It

also took into consideration cultural background, to see if there were any obvious patterns.

The graph shows a peak in driving under the influence for the 20-24 aged group, then the

pattern decreased with age.

The survey found that male drinkers were more likely to drive after consuming alcohol.

Approximately 21% of males over 15 years of age drove under the influence of alcohol,

compared with approximately 12% of females over the age of 15.

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Figure 9: Graph depicting the percentage of people who consumed alcohol and drove over

2012/2013.

Figure 9: The graph illustrates the number of people who drove whilst under the influence of alcohol

in 2012/2013. Males and females were compared, as well as age groups and cultural backgrounds

(Ministry of Health, 2013).

10.6 Example 6

Simonsen et al conducted a study in 2012 which assessed the number of psychoactive

substances found in blood samples of 840 critically injured drivers that were admitted to

hospitals across Denmark. Psychoactive substances included alcohol, medicines and illicit

drugs. Statistics revealed that in 2005, over 41,000 people were killed in the European Union

from road accidents, and approximately 1.7 million were injured. It was believed that many

of these road accidents were associated with drivers having taken a psychoactive substance of

some sort. A method known as solid-phase extraction was carried out on the blood samples,

target drugs were then quantified. The results from this study indicated that a total of 284

drivers out of the 840 tested (34%) were positive for alcohol and / or other psychoactive

37

substances in their blood. Approximately 172 drivers (20.5%) tested positive for

psychoactive substances (methamphetamine for example) or medicinal drugs (such as

diazepam and tramadol) in their blood. The average age of those who tested positive was 36

years, and the majority were male drivers. Alcohol was the most common substance found in

the blood samples, and at levels higher than the legal driving limit for Denmark. Overall, this

study confirmed results from other studies which looked at psychoactive drugs and alcohol

associated with traffic accidents. Simonsen et al have suggested that police need to stop

drivers more frequently to test for alcohol and illicit drugs. This could be a valuable method

used to prevent driving under the influence and potentially lower the rate of traffic accidents

caused by those who have taken a psychoactive substance.

10.7 Example 7

A massive 71% of New Zealand secondary school students have consumed alcohol (Ministry

of Health, 2013). Stacey and Elvy from the University of Canterbury analysed data obtained

from a national survey from The New Zealand Alcoholic Liquor Advisory Council. They

obtained a sample of 1278 New Zealand teenagers, aged 14-17 to determine the relationship

(if any) between alcohol consumption, gender, age and their attitudes in regards to alcohol

and its role in society. Alcohol consumption has been persistently rising over the past 25

years, and people are beginning to drink at a younger age and more frequently. Binge

drinking among teenagers has become an issue in New Zealand. It is believed they are

increasingly consuming more alcohol, subsequently resulting in increased intoxication,

alcohol related offences and alcohol-related illnesses and complications within the body. The

contribution of alcohol in crime and violence among teenagers, including serious traffic

accidents, sexual assaults and other assaults, has become a major concern for police, health

38

professionals and researchers. This review found that most New Zealand teenagers are first

introduced to alcohol in their home, expanding to illegally drinking in public locations. The

legal age to purchase alcohol in New Zealand is 18. However, these restrictions have little

control over teenagers, as they increasingly find ways of obtaining alcohol.

The analysis involved a sample of 1278 teenagers aged 14-17, 651 male and 627 female.

Subjects were interviewed regarding their attitudes to alcohol and drinking, their personal

involvement in such situations, their medical history (if any) and other characteristics

including age, gender, race, religion and cultural beliefs. To analyse data, the authors used a

linear combination between two sets of variables (variables being age, gender and alcohol

consumption) and did a regression analysis. The results showed that 917 teenagers out of the

1278 sample have had a small quantity or more to drink of alcohol, slightly more being male.

Approximately 1 in 3 of the teenagers that drank were reported to consume alcohol on more

than three occasions per week. From the study, it was concluded that alcohol consumption is

certainly related to gender, age and attitudes in the 14-17 year old sample.

10.8 Example 8

There is evidently a strong association between alcohol and violent crime, including family

violence and child abuse. Alcohol abuse in parents can lead to child abuse, neglect and injury,

as well as the child developing problems with violence and substance abuse from the

psychological damage. The child may grow up not knowing any better and not learning from

their parents mistakes (Alcohol Healthwatch, 2006). According to the New Zealand Police,

alcohol is involved in approximately 34% of family violence, however, this figure is reported

to be higher as family violence tends to be under-reported to authorities (New Zealand Police,

2010).

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Family violence does not only include child abuse, it also correlates to domestic violence.

Alcohol fuels aggression causing people to feel powerful and in control, which is the main

cause of domestic violence. According to The Encyclopaedia of New Zealand (2015),

domestic violence is probably the most common form of crime in New Zealand, with many

cases remaining unreported. In 2008 it was estimated that police attended 72,482 domestic

dispute incidents in New Zealand.

Since alcohol is a major factor in a large amount of various crimes across New Zealand, it is

time for the government to restrict alcohol consumption in order to reduce crime and violent

behaviour associated with drinking alcohol. Regulating alcohol as a class controlled drug

under the Misuse of Drugs Act would most likely decrease crime rates in New Zealand, as

there would be greater penalties for breaching the Act. Other restrictions, such as reduction in

alcohol availability and greater monitoring of alcohol consumption could also be put in place.

11.0 Medicinal Benefits of Alcohol – Do These Outweigh its Harmful

Effects?

Although alcohol is known for its potentially harmful effects to human health, and, has been

shown to be involved in crime and violence, it is important to consider the valuable uses of

alcohol. According to the New Zealand Commission Report (2011), the explanation as to

why ethanol is not a class controlled drug under the Misuse of Drugs Act is because of its

ability to be used for beneficial purposes. Many believe that the benefits and the numerous

modern day uses of alcohol outweigh its risks, and would therefore not fit the description of a

class controlled drug.

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Ethanol is a renewable biofuel for cars, as it can be made from biomass material collected

from various plants. It is used to oxygenate the fuel, as well as to reduce greenhouse gas

emissions which contribute to air pollution. According to the U.S. Department of Energy,

over 95% of gasoline fuel in the U.S. contains ethanol (2015). It is also commonly used in

domestic burners which are used for heating as well as cooking.

Ethanol is a good solvent, and is miscible with both water and organic solvents. This property

enables it to be used in perfumes, deodorants, paints, methylated spirits and markers. We use

ethanol in our everyday lives, probably without even realising it. This is why we tend not to

consider is as fitting the description of a class controlled drug.

Although health experts warn against the harmful effects of ethanol when consumed in

alcoholic beverages, it has a number of medicinal benefits which some believe may outweigh

its overall risks. Ethanol is used in antiseptic and disinfectants as it has strong anti-bacterial

properties, killing organisms such as viruses and bacteria by dissolving their lipids and

denaturing proteins. As described, ethanol is a good solvent and used in a number of

medicines such as cough syrups. According to Guenther, ethanol is used in certain

therapeutic drugs for elderly patients, particularly in nursing homes. This drug improves

appetite, improves psychological wellbeing and aids in socialisation (Guenther, n.d.).

A standard treatment of severe methanol poisoning in individuals is ethanol. Methanol

poisoning results in metabolic acidosis, optic nerve generation and respiratory depression

(Ekins et al, 1985). A solution of ethanol is administered intravenously to patients suffering

methanol poisoning, and is a safe and effective treatment. The excess methanol is then

removed via kidney dialysis. Ethanol works by blocking the metabolism of methanol from

41

formaldehyde to formic acid, which is toxic to humans. A clinical study by Ekins et al treated

seven patients with methanol poisoning by intravenously giving them a 10% ethanol solution

then filtering their blood for excess methanol. All patients in the study survived, displaying

the effectiveness of this treatment if it is delivered quickly.

Research has suggested that drinking wine in moderation is beneficial for the circulatory

system and the heart. Moderation is the key word. Alcohol in moderation has been found to

lower the risk of cardiovascular disease as it raises levels of high-density lipoprotein (HDL)

levels in the blood, which protects against heart disease (Harvard School of Public Health,

2015). Further studies in this area are required, as many are still not convinced that there are

cardiovascular benefits from alcohol. It is also fair to say that many people do not know what

a moderate amount to drink is, therefore consuming more than the moderate amount which is

potentially harmful to an individual’s health.

Although there are some health benefits associated with alcohol, many argue that the risks

associated with alcohol misuse most certainly outweigh any benefits it may have. Even if

alcohol was a class controlled drug in the Misuse of Drugs Act, if necessary it would still be

able to be prescribed by doctors but greater controls and restrictions would be in place.

12.0 Does Alcohol Fit the Description of a Class Controlled Drug?

As stated in the Misuse of Drugs Act (1975), classification of a class controlled drug is based

on its risk to cause harm to the individual or to society by its misuse. Drug control is assessed

by the Expert Advisory Committee on Drugs (EACD) on the basis of the health and social

welfare of society as well as in terms of criminal justice. There is a more broad and detailed

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set of criteria that is considered when evaluating the risk of harm and classifying a drug under

the Act. According to the New Zealand Parliamentary Library (2003), these include;

1. The chance of drug abuse and misuse and its effects on society

2. The overall effects of the drug (including pharmacological and toxicological effects

as well as if it is a psychoactive substance)

3. Any risks associated to public health

4. If there is any therapeutic benefits of the drug that outweigh its risks

5. Whether or not the drug can cause death (i.e. any potential for overdose)

6. The ability of the drug to cause psychological or physical addiction and dependence

7. International classification of the drug

8. Any other matters relevant to the Minister of Health

When determining whether alcohol fits the description of a class controlled drug, the above

criteria needs to be addressed. Firstly, we know that alcohol is a drug that when abused

affects society - it is involved in alcohol induced crime and violence, such as theft, sexual

assault, child abuse and neglect. This is evidenced by the many case examples described, and

the statistics from the New Zealand police department.

Secondly, alcohol has harmful effects to human health, especially when abused. It is a

psychoactive drug that is a known carcinogen, which increases the chance of developing a

number of cancers and it affects the liver in large, continuous doses, causing liver damage. It

is also a risk to public health as it can affect children and unborn babies of pregnant women

that drink. As previously discussed alcohol is involved in a number of crime and violent

situations.

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Although there are some medicinal benefits and other valuable uses of alcohol, its risks

outweigh its benefits. The drug can cause death from various diseases associated with alcohol

consumption and also from blood alcohol concentrations greater than 400 mg/dL. Suicide is a

possible outcome and crimes such as homicide can cause the death of others, as perception

and judgement are greatly affected when intoxicated.

Individuals can become physically and psychologically dependent on alcohol. Alcohol is the

second most commonly abused drug in the world, following the other legal drug nicotine and

tobacco. This means that alcohol misuse is more common than the abuse of any other illegal

substance found on the Misuse of Drugs Act. Although alcohol is only banned in certain

countries, such as in some Islamic States, these effects should not be ignored, a reform of the

current Act should be considered to incorporate alcohol.

Many experts and researchers such as Professor David Nutt believe that if alcohol were

discovered today it would be classified as a Class B controlled drug. Class B drugs are those

that pose a high risk of harm and generally have both therapeutic benefits as well as potential

to cause abuse, which fits the description of alcohol well. Professor Nutt claims that a good

way to measure a drugs ability to cause harm when determining whether it should be

classified as a controlled drug or not is by comparing the costs of hospital admissions

associated with substance taken. For example, in the United kingdom cannabis leads to

approximately 1000 hospitalisations each year, whereas alcohol led to over 1 million

hospitalisations in 2011 (Nutt, 2011).

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Based on all the information described so far, would alcohol be classified as a class

controlled drug, and would it be subject to controls under the Misuse of Drugs Act if it were

discovered today? The answer to this would be yes.

The Misuse of Drugs Act 1975 was created to regulate illegal psychoactive substances in

New Zealand, a time where experts, politicians and the public were all debating drug laws,

and the need for greater restrictions. It was created following the ‘hippie’ culture in the 1960s

and 1970s where there was a spike in the use of illegal substances, mainly cannabis, opiates,

cocaine and psychedelics such as LSD. Since then, a lot has changed. These days, alcohol is

considered the most widely used recreational drug worldwide. Changes have been made in

other countries to legalise certain drugs originally restricted and new drugs and psychoactive

substances that should be restricted keep emerging. Research has been key to changing our

thinking towards certain drugs, as we have learnt more about addiction and the harmful

effects of alcohol compared to over forty years ago when the Act was created. Many find it

hypocritical that there are controls on the use of cannabis. Some believe the medical benefits

of cannabis outweigh its minimal harmful effects, whereas alcohol, the most abused drug in

New Zealand with greater health and social problems associated with it, is legal.

13.0 Ways to Address the Issues of Alcohol Misuse

In 2010, The World Health Organization sponsored the Global Strategy to Reduce the

Harmful Use of Alcohol, a guide to support a number of countries to implement legislation

that is effective in controlling alcohol consumption (WHO, 2010). The guide describes a

number of potential legislative ideas which could aid in the reduction and affordability of

alcohol, by increasing tax, reducing the availability of alcohol by regulating its sale, reduce

the marketing of alcohol to the public, stop drink driving and reduce consumption of alcohol

45

by children and teenagers through setting a minimum age for purchase and consumption. The

guide does not discuss whether alcohol should be listed as a class controlled drug under The

Misuse of Drugs Act, which is a potential thing to consider when discussing ways of reducing

alcohol consumption. The National Drug Policy of New Zealand encourages the need for a

drug reform of the 35 year old Misuse of Drugs Act, stating that it is outdated and fails to

“prevent and reduce the health, social, and economic harms that are linked to tobacco,

alcohol, illegal and other drug use” (Law Commission Report, 2011). Below are some

suggested ways experts believe will decrease excessive alcohol consumption and

consequently decrease alcohol related harm, in conjunction with the Global Strategy to

Reduce the Harmful Use of Alcohol and the New Zealand National Drug Policy.

1) Reducing the affordability of alcohol:

According to The World Health Organization, the lower the cost of alcohol is for purchase,

the higher the consumption by heavy drinkers and underage drinkers in particular, which in

turn could lead to a rise in alcohol related violence and harm. Increasing the tax on alcohol

would increase its sale price and decrease its affordability to many individuals. It is believed

that this would assist in decreasing alcohol consumption, particularly among heavy drinkers

and underage drinkers. There are a number of issues to consider if the government decides to

increase alcohol tax, such as, the potential for an increase in illegal production of alcohol and

importation.

2) Regulate the availability of alcohol:

A way which may potentially decrease the amount of individuals with alcohol dependence

and alcohol abuse may be to decrease the number of alcohol outlets and liquor stores. For

most New Zealanders, alcohol can be purchased within a short driving or walking distance.

46

According to a survey by The New Zealand Ministry of Health, 78% of New Zealand people

aged over fifteen years, live within a two minute drive (approximately 1.5 kilometres) of an

alcohol outlet. A study by Campbell et al, found that having a lower density of alcohol outlets

in neighbourhoods and communities could in fact reduce excessive alcohol consumption, and

consequently reduce alcohol related harm, crime, injury and violence in these areas. Alcohol

outlet density refers to the total number of areas / locations where alcohol can be purchased in

a given area or per population (Campbell, 2009). The World Health Organization believes

that controlling alcohol outlet densities in areas will effectively reduce alcohol related harm.

3) Regulate the marketing and advertisement of alcohol:

Advertisements are a common method alcohol companies use to promote this message, by

associating alcohol with parties, having friends and other leisure activities. In fact you rarely

see advertisements from alcohol companies displaying the accurate side of drinking too much

alcohol including health effects, car accidents, violence, child abuse and even suicide (World

Health Organization, 2015). Binge drinking, particularly among teenagers has become very

common, and therefore it should not be promoted as a part of everyday life. The marketing of

alcohol should be more tightly regulated, unless trying to display its harmful effects.

4) Greater penalties and effective monitoring:

Greater penalties for alcohol related crime and violence, as well as drink-driving should be

put in place to discourage it, and effective monitoring of this should accompany it. Banning

alcohol consumption in certain public areas may also help to decrease alcohol related crime

and violence in particular areas.

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5) Increase education of its harmful effects:

Education is important to spread awareness to those who may not be aware of the potentially

harmful effects to not only human health, but to social life and those around you. This would

be particularly useful in schools, to educate the youth about the dangers of binge drinking and

how it could lead to alcohol abuse in the future.

6) Potentially make alcohol a class controlled drug under the Misuse of Drugs Act:

Although it was discussed that if alcohol were discovered today, it would be subject to

controls under the Misuse of Drugs Act, there would be a large amount involved in changing

current legislation to include alcohol in the Act now. This could create public outrage, as

many would not agree on changing the legislation now, since alcohol has been consumed for

thousands of years and is considered part of many people’s daily lives. Since the government

makes a large sum of money from alcohol tax, and it is used in a number of other products

discussed, it could pose many issues. Even if not classified under the Act, experts such as

Professor David Nutt believe that alcohol should be regulated more effectively than it

currently is (Nutt, 2012).

14.0 Conclusion

Alcohol, the most commonly used recreational psychoactive drug worldwide, is harmful

when misused. According to the World Health Organization it has the potential to cause over

200 diseases such as cancer and liver cirrhosis. It increases crime rates, as the New Zealand

Police estimate that over 1/3 of their daily work involves attending a crime where alcohol has

been consumed by the victim or suspect. These crimes include violence, sexual assault, theft,

child-abuse, homicide and drink-driving. Alcohol is a legal drug, and when compared to other

psychoactive drugs which are class controlled drugs such as cannabis and ecstasy, it is clear

48

that alcohol can be just as harmful if not more, in some cases when misused. Although it has

certain medicinal benefits and other valuable uses, its harmful effects outweigh its useful

purposes.

Alcohol has been labelled as a socially ‘acceptable’ drug by society because of its legality

and widespread use. Experts such as Professor David Nutt believes if it was discovered today,

alcohol would be a class controlled drug, potentially Class B. This conclusion is based on not

only its harmful effects to human health, but to those around them who are also affected by

an individual’s drinking behaviour, such as innocent children and victims of crime. Based on

analysing studies from various scientists and drug experts, as well as looking into alcohols

association with crime and violence and addressing the criteria for a class controlled drug

under the Misuse of Drugs Act; if alcohol (ethanol) were discovered today, it would be

subject to controls under the Misuse of Drugs Act.

49

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