Content warning: This story contains references to death, alcohol use and other sensitive issues.
Victorian Coroner Ingrid Giles recently released four reports about the deaths of men who had all died from alcohol use. These men were all in my age range, (40 to 66 years old), and their stories, like mine, demonstrated the features of alcohol dependence. Reading these tragic reports from the Coroner, I feel strong identification with each of their experiences and deep gratitude from having survived alcohol.
I have the unusual privilege of being someone with both lived experience of alcohol dependence and of working in alcohol policy for some years. This provides a unique perspective in understanding alcohol harm and responses. This is especially regarding alcohol dependence, which remains one of the most damaging alcohol harms, and yet one of the least understood and discussed public health issues. It is also quite common in Australia.
Data from the latest National Drug Strategy Household Survey indicates that almost one in ten Australians (9.2 per cent) who use alcohol, may be experiencing an alcohol dependence issue. Soon to be released analysis of the distribution of alcohol use shows that 10 per cent of drinkers use more than 50 per cent of the alcohol; and older men are most likely to be in that top 10 per cent.
In February, the Coroner also released a report into the death of Kathleen Arnold, making specific recommendations about online sales and rapid delivery of alcohol.
In these five reports, the Coroner said there are many alcohol-related deaths reported for investigation (at least 250 a year). She indicated this only scratches the surface as so many deaths are “classified as due to ‘natural causes’ and not usually be reported to the Coroner”.
As a result, the Coroner expressed an interest in exploring commonalities between the different cases that might point to potential areas for intervention to reduce alcohol-related harm.
However, the Coroner concluded she was “unable to identify any meaningful commonalities – the deaths were of people who had diverse socio-demographic profiles, patterns of alcohol use, mental health histories, and histories of engagement in treatment”.
The Coroner says this diversity reflects the range of circumstances in which people die from alcohol, which she suggests underpins a need for a range of strategies to address alcohol-related harm. She then did a review of such strategies, highlighting the policy consensus on pricing, taxation, regulation, healthcare, advertising, labelling, education and social attitudes.
Whilst the reports did tell stories of diverse circumstances, there were also some critical commonalities.
Each of the reports detailed increased use of alcohol despite consequences, noting both the inability to stop or cut back, and the inability to engage consistently with medical services and support. Consequences included relationship and work problems, recklessness and injuries and were intertwined with mental and physical health problems.
All these experiences I clearly identify with and together, they meet the medical criteria for alcohol use disorder.
While the Coroner stated they had diverse patterns of alcohol use, it’s important to note specific levels of alcohol use do not define alcohol dependence. The defining criteria is continued increased alcohol use despite persistent physical, social, financial or psychological consequences such as those described in the reports.
These men and I are the people who are targeted by the alcohol industry, not just for their greatest profits, but to blame and stigmatise with their ‘individual responsibility’ narrative.
In opposing effective regulation, the alcohol industry likes to point to the fact that overall, at the population level, Australians are using alcohol less. But what they don’t tell you, is that some subgroups are increasing their use, and the overall population-level harms from alcohol continue to increase. Alcohol costs 4,700 lives and $67 billion a year in Australia, which is currently experiencing the highest rates of alcohol-induced deaths in over 20 years.
And alcohol dependence represents the greatest burden of disease within the alcohol category of health impacts.
People like me experiencing alcohol dependence are at risk of experiencing all the same types of alcohol-related harms as people without dependence. Plus, we also experience significant additional (physical, social, financial or psychological) harms of dependence as shown in the stories in these reports. Yet despite the significantly higher levels of harms associated with alcohol dependence, it remains a misunderstood and deprioritised type of alcohol harm.
If you do something that hurts and harms, then you usually stop – but not with dependence. If you’re sick, most people will simply go to the doctor – but not with dependence. Dependence keeps making you sicker while also preventing you from accepting the help you need to get well.
Perhaps because of the complex and sometimes paradoxical psychological basis of alcohol dependence, it seems quite baffling to many – including to those of us experiencing it. ‘Why don’t they just stop?’ and ‘why won’t they accept help?’ are not just desperate questions from people closest to a person experiencing dependence. They are also questions by people who have not experienced the overwhelming powerful obsession of dependence, which locks out all other considerations.
Many people asking these questions are genuinely curious to understand, but there are also some who seek to exploit and stigmatise the harms experienced. Alcohol dependence is stigmatised and exploited by media, the alcohol industry and some politicians. Industry in particular tries to blame and shame individuals, saying the majority should not be ‘punished’ by regulatory protections put in place to help reduce alcohol harms in the community.
Beyond this exploitation and stigmatisation, research would suggest that alcohol dependence receives little attention as a policy issue, (other than its treatment being chronically underfunded). Part of the reason for this is to avoid the alcohol industry’s stigmatising ‘individual responsibility’ narrative, by focussing exclusively on populations. However, the same research suggests that ignoring dependence can contribute to sustaining the stigma that surrounds the condition and undermines efforts to address it.
We have always needed both population-based and targeted approaches, both prevention and treatment.
People experiencing alcohol dependence experience psycho-social symptoms that impair their decision-making capacity. This makes it difficult for us to navigate the service systems and to respond positively to population-based measures including public health messaging. The Guidelines for the Treatment of Alcohol Problems suggests public health messaging is more effective for people who use alcohol at low-risk levels who consequently use even less, but with minimal change in harms. Conversely, it says people using alcohol at high-risk levels appear less responsive and high rates of alcohol harm continue.
The Coroner’s role of helping to prevent deaths and to promote public health and safety, can best be served by governments implementing the recommendations she has made in these reports. Valuing, understanding and supporting people with alcohol dependence lived experience can also help prevent alcohol dependence from being ignored, marginalised or stigmatised.
Alcohol dependence was a terrifying and exhausting nightmare for me, but next month I will celebrate 25 years of sobriety. I’m grateful every day that alcohol did not kill me as it did the people in the Coroner’s reports.
Rodney Holmes is a Senior Policy Advisor at FARE. He shared his story through the Voices of Change program, read it here.
If you or someone you know needs support, please call Lifeline 13 11 14 or National 24/7 Alcohol and Other Drugs Hotline 1800 250 015
