Brutal legacy of terrible twins

Most alcohol awareness campaigns focus on the health risks associated with alcohol use.

Yet a far more insidious consequence of alcohol use is often not spoken about or even ignored—the connection between alcohol use and lowered inhibitions is well documented, but counting the cost of this diminished responsibility can be shocking.

The World Health Organisation (WHO) has published extensive research on the connection between alcohol abuse and violence.

The WHO has recognised that interpersonal violence and harmful and hazardous alcohol use are major challenges to global public health.

Both place large burdens on the health of populations, the cohesion of communities and the provision of public services, including healthcare and criminal justice.

Globally, alcohol is responsible for 4% of all years of health lost through premature death or disability, ranging from 1, 3% in countries in the Middle East and the Indian subcontinent to 12, 1% in Eastern Europe and Central Asia.

Interpersonal violence results in about 520 000 deaths a year.

The organisation recognises that for every death resulting from interpersonal violence, scores of other victims require hospital treatment and many more remain untreated and unrecorded by either health or criminal justice agencies.

Although levels and patterns of drinking and rates of interpersonal violence vary widely between countries, across all cultures researchers say there are strong links between the two.

Each exacerbates the effects of the other, with a strong association between alcohol consumption and an individual’s risk of being either a perpetrator or a victim of violence.

How WHO links alcohol and interpersonal violence:

  • Harmful alcohol use directly affects physical and cognitive functions. Reduced self-control and ability to process incoming information makes drinkers more likely to resort to violence in confrontations, and reduced ability to recognise warning signs in potentially violent situations makes them appear easy targets for perpetrators.

  • Beliefs that alcohol causes aggressive behaviour can lead to the use of alcohol as preparation for involvement in violence, or as a way of excusing violent acts.

  • Dependence on alcohol can mean individuals fail to fulfil care responsibilities or coerce relatives into giving them money to buy alcohol or cover associated costs.

  • Experiencing or witnessing violence can lead to the harmful use of alcohol as a way of coping or self-medicating.

  • Uncomfortable, crowded and poorly managed drinking settings contribute to increased violence among drinkers.

  • Alcohol and violence may be related by common risk factors (such as anti-social personality disorder) that contribute to the risk of heavy drinking and violent behaviour.

  • Prenatal alcohol exposure resulting in foetal alcohol syndrome or foetal alcohol effects are associated in infants with increased risk of their maltreatment and with delinquent and sometimes violent behaviour in later life.

Why young men are most at risk
In 2000, there were an estimated 27 563 homicides in South Africa, implying a mortality rate of 64,8 per 100 000, almost eight times the global rate, making South Africa among the most violent countries in the world.

The Soul City Institute believes possible risk factors include economic inequality, poverty, high unemployment, rapid social change, corruption, poor rule of law, gender inequality, high firearm availability and collective violence, much of which is a legacy of the apartheid past.

The institute also points to substance abuse as a key risk factor, with 53% of victims of fatal and up to 73% of victims of non-fatal injury from interpersonal violence testing positive for alcohol in urban areas.

Victims of violence
The institute says males are the disproportionate victims of fatal violence, which was the second leading cause of death among males in 2000.

In 2004, the Non-Natural Mortality Surveillance System (NNMSS) recorded six male deaths from interpersonal violence for every female death.

Although it was clear that males were more often at risk of being killed or injured as a result of violence, they were also more frequently the perpetrators of violence against women and children.

South Africa men aged between 19 and 49 years were found to be the group most at risk, with that risk peaking from the age of 25 to 29.

More than half of the victims of fatal violence recorded in the NNMSS tested positive for alcohol. Added to this is the frequency of violent incidents reported over weekends and evenings when alcohol consumption peaks.

Studies
A further study of patients presenting to trauma units in Cape Town, Durban and Port Elizabeth found that, on average, more than half of the presenting patients for inflicted injuries tested positive for alcohol.

A similar study conducted at eight police stations in Cape Town, Durban, Port Elizabeth and Jo’burg found that between 6% and 23% were under the influence when arrested for a crime.

There have been a number of studies that also point to the fact that many men, guilty of interpersonal crimes, used alcohol as a premeditative way to gain courage to commit the crime, backing up the World Health Organisation’s findings, which point to the high usage of alcohol in gang initiations that involve crime.

The Medical Research Council’s Health Systems Research Unit (HSRU), together with the Alcohol and Drug Abuse Unit, recently conducted a study on 848 men in shebeens, pubs and taverns in two peri-urban areas on the outskirts of Cape Town.

Alcohol and HIV
The study consisted of men between the ages of 25 and 55. It found that men who consume large, uncontrolled amounts of alcohol pose a much higher risk of transmitting HIV to their spouses than those who consume alcohol moderately.

“These men tend to have a warped idea of their masculinity, their ego, and act [through] not through their confidence but their insecurity when drunk,” says Loraine Townsend of the HSRU.

Townsend says the men claim to have two or three partners so that there is always one to fall back on when in need. She says alcohol is an integral part of their social life and that shebeens offer an environment in which to consume uncontrolled amounts of alcohol and meet new sexual partners.

“The only people who can stop this are the bar owners who are supposed to restrict people from getting too drunk, but that is impossible considering the amount of money they stand to lose. The least they can do is place condoms in bathrooms.

“Government also needs to enforce policy and legislation to strengthen sexual education, knowledge about condom use and the dangers of mixing drugs with alcohol in public drinking places,” says Townsend.

The Phuza Wize Drink Safe Live Safe campaign being run by the Soul City Institute focuses on ways to lower the risk of violence and unprotected sex associated with alcohol consumption.

The campaign echoes many of the suggestions raised by the WHO, including changing the hours of trade, the legal age of alcohol purchase, restricting the number of liquor outlets in an area, and increasing excise taxes on alcohol.

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