Alcohol

A CONVERSATION WITH GEORGE SEBER

PICTURE THE SCENE: A hot summer’s day is drawing to a close, as tanned surfers walk up the beach with their hipster surfboards, following an afternoon riding perfect waves in the warm, turquoise water. A chilly-bin is pulled from the back of the retro van, ice-cold beers are cracked open and passed around the flawless guys and girls – sun-bleached hair still wet from the sea. There are smiles and laughter … a celebration of good times with great friends.

Now, I don’t know about you, but that looks like a mighty fine way to spend an afternoon. And the talented advertising gurus in the alcohol industry certainly want us to think that. Okay, most Kiwis don’t quite fit the above picture. (Few of us have perfect bodies – and warm, turquoise water with great surf is more myth than reality down-under!) But the cracking of a beer or …
(insert favourite drink here) definitely does fit, up and down the country.

Having a drink is part of our culture, with 79% of the population over the age of 15 imbibing within the last year.Rugby, racing and beeris an often-quoted mantra describing the interests of the typical Kiwi bloke – and the yard-glass is seen as a rite-of-passage for our young men.

But the damage alcohol causes our society is significant. More and more studies are showing that the innocent-looking scene above – Kiwis (young and old) enjoying a ‘bevvy’ or three – has a less pleasant side … one that the industry does its best to hide.

In their book Alcohol: a Dangerous Love Affair, George Seber and Dr Graeme Woodfield have examined nearly every aspect of alcohol and its involvement in our lives. It’s literally everything you need to know about booze.

We chatted to George, and asked what got him involved in a project like this …

GEORGE SEBER: A few years ago, I was invited by Dr Graeme Woodfield to join GALA (Group Against Liquor Advertising) and began writing submissions to the Law Commission, and later to the Government’s Select Committee on Alcohol. During our research, I became much more aware of the significant problems alcohol was causing – not only in New Zealand but globally. 

I’m also a trained counsellor with 17 years’ experience, so I know something about addictions. Plus, as a now 82-year-old, I have a fair bit of life experience – and I’ve seen firsthand the effects of alcohol in my extended family. 

So why write a book? Well, I’ve been writing books for most of my life (I’m currently working on book No.23) and probably need counselling for my writing addiction! The subject of alcohol had been on my mind for a while, so it wasn’t a difficult decision to make. 

GRAPEVINE: How come New Zealand has such a prominent drinking culture – and one that seems to have been with us for decades?

GEORGE: For the early immigrants from England and Europe, beer was a common part of the diet – it was treated as a normal commodity, like a cup of tea – and the culture was imported along with the immigrants! In colonial New Zealand alcohol was everywhere – there were plenty of places making and distilling it, and the drinking laws were quite lax. 

Traditionally, Māori didn’t drink alcohol – it wasn’t a part of their culture pre-European. In fact, they initially described it as waipiro – foul water! But from the 1850s, with increasing availability, Māori consumption soon grew. And for them, along with the early immigrants, alcohol eventually became a significant problem. Many times, during the mid-to-late 1800s, measures were introduced to try and restrict the sale of alcohol, and several leading Māori presented petitions supporting those restrictions. 

Interestingly, early colonial drinkers didn’t drink much beer. They preferred spirits and wine, as beer was expensive to transport. Brandy and rum were the most common, and until the mid-1860s the per-capita consumption of these drinks was about three-to-four times the UK level! Maybe their drinking made life easier for the hard-working settlers – who were mainly unmarried males.

Anyhow, the stage was set for a high alcohol intake – which has pretty much continued ever since.

GV: So how do we rate on a global scale with our drinking habits?

GEORGE: It’s actually tricky to come up with a number that represents drinking habits. Culture, and the various alcohol types within that culture, can have a big effect. For example, in Russia vodka became a major problem and reduced the life-expectancy of men substantially. But, overall, I don’t think we’re too different from Australia, the UK or the USA – we’re up there with the main players!

What I do know is that we spend more than $4-billion per year on alcohol. And, on average, Kiwi households spend the same on alcohol as they do on fruit and vegetables.

GV: You mention in your book that most Kiwis are poorly informed about the health aspects of alcohol. What is it exactly that we don’t know?

GEORGE: Well, the short answer is – a lot! To begin with, most people don’t know what a standard drink is, so they don’t know how much alcohol they’re actually consuming. And, unfortunately, the standard varies from country to country. Most countries, like ours, Europe and Australia, tend to follow the World Health Organisation (WHO) definition of 10 grams, which is the amount of alcohol our bodies can metabolise in one hour. So, if you drink one standard drink, then within one hour it should be cleared from your system. 

That roughly amounts to a can of 4% beer, or 30mls of spirits at 42%, or 100mls of wine at 12% … so they’re quite small amounts. You could have a moderate glass of wine and, without knowing it, you’re consuming two-and-half standard drinks! 

GV: I assume this can change, depending on your body-type, age, whether you’re male or female, and what shape you’re in?

GEORGE: Absolutely! In fact, it relates largely to how much water you have in your body. A bigger person will metabolise alcohol faster – men generally are bigger than women, and they also burn energy faster, so they can process alcohol quicker than women. 

Another thing most people aren’t aware of is that alcohol was classified as a group one carcinogen by the WHO in 1988 … which, to put it in context, is along with asbestos and formaldehyde! There’s clear evidence that alcohol causes a wide range of different cancers, like breast and prostate cancer.

In fact, breast cancer is the leading cause of alcohol-related deaths for both Māori and non-Māori women in
New Zealand! Just one standard drink per day can increase the risk of breast cancer, and with each extra standard drink, there’s an additional 10% extra risk. Three or more standard drinks per day is estimated to increase the risk by 40-50%. And there is no known safe threshold. 

Alcohol also contributes to large number of other health problems – such as atrial fibrillation, dementia, liver disease, and so on. There’s probably about 60 different diseases which alcohol has an effect on.

It’s linked to mental health issues – causing anxiety and depression. And the thing about anxiety is that people get anxious, so they drink … and that helps a bit. But then it wears off, and they get anxious again and drink more … so there’s this vicious circle between alcohol and anxiety. It’s a bit like the chicken and the egg … which comes first?!

It also compromises the immune system – so it’s no good for COVID-19!

GV: Wow! That’s not exactly great news … (hopefully people are still reading this article!)

GEORGE: No, it’s not great news, unfortunately. But it’s important we understand these things so people can make informed decisions! 

Another health aspect we should know about is how drinking after a strenuous workout is not a good idea. It can lead to dehydration as the body runs out of water, and dehydration can lead to headaches, dizziness and confusion. Not only that, but alcohol restricts healing after a sporting injury – it slows down the repair of exercise-induced muscle damage, blocking hormones that aid this process. If you have a soft-tissue injury, it’s even worse, opening up blood vessels at the injury site and encouraging swelling …

Look, if a person is serious about sport, they shouldn’t be drinking alcohol in the post-match or recovery period. The rugby after-game booze-up isn’t a great idea!

But worst of all is alcohol’s effect on pregnancy. Alcohol is a teratogen, which is anything that interferes with the normal development of a foetus (unborn baby). And when a woman drinks alcohol, so does the baby! A lot of women will stop once they know they’re pregnant. But, by then, the baby can be weeks old. Over 70% of Kiwi women report drinking alcohol during their first trimester, before they’re aware of their pregnancy. So, my advice is: if you’re wanting to have a baby – stop drinking now! Don’t wait until you find out you’re pregnant.

Sadly, some woman (around 10% of Kiwis) continue drinking right through their pregnancy. Foetal Alcohol Syndrome (FASD) is a major problem – and not just in New Zealand. Children born with FASD may experience such things as intellectual impairment, learning difficulties, behaviour issues, and growth impairment. And often they’re not diagnosed until later when suddenly they start experiencing problems.

Look, I could go on and on, but I won’t! However, even though it’s not a popular message, it’s clear that alcohol can have a considerable effect on our health and lifestyle. 

GV: The perception out there is that Kiwi men are big drinkers. But you list some startling stats about women and alcohol …

GEORGE: Yes. We’re finding that more Kiwi women are drinking alcohol – in particular ‘alco-pops’, which are flavoured spirits. These are marketed as ‘ready-to-drinks’ or RTDs, and they’re especially popular with young people. A recent study shows that New Zealand’s heaviest drinking group are females around age 24, who consume 23 litres of absolute alcohol (at least 99% pure ethanol) per year – compared with nine litres for the general population. 

It turns out that this group had the dubious honour of making it into the top five countries when it comes to the highest number of female drinkers per head of population, whereas Kiwi men don’t even feature in the top 10. 

What’s concerning, though, is that 46% of all liquor sold is consumed harmfully – it’s used in binge-drinking episodes.

GV: How do you define binge-drinking? 

GEORGE: Five standard drinks in a row – that’s 50 grams of pure alcohol. The definition varies depending on who you are, and where you live, but that’s a rough global measure. So, for example, if you have five beers in a row, that borders on binge drinking.

GV: So, here’s the big question: what’s the safe level of drinking?

GEORGE: The short answer is no amount of alcohol is good for us – there is no safe level! So, what we must do is minimise the risks that go with alcohol. It’s with us to stay, so somehow, we’ve got to have some controls – for ourselves as individuals, for our families, and for the community.

Various organisations put out recommendations – things like two or three standard drinks per day for men, or one or two for women. But what’s happening is that, as we get to know more about alcohol, the limits are coming down. For example, the latest recommendations suggest if you’re a woman, you shouldn’t have more than one standard drink a day. And some organisations, like Alcohol Health Watch, say you should have at least two alcohol-free days a week!

The actual amount you should drink in a week can vary a lot. At one stage I think it was 15 standard drinks for men, but now it’s more like 10 – which means if you have two a day, that’s five days, and you have two days left over, which are your drink-free days!

So, there’s no safe level as such, but there’s a level where you can minimise the harm. It’s like driving. When I go out in my car, I know there’s the risk of an accident. So I take precautions – I’m careful. I won’t drive at night if I can help it, or in bad weather. But the difference is, I have to drive. 

You don’t have to drink! But the same idea holds: there is a risk, you need to know what it is, and you need to minimise it.

GV: The ‘French paradox’ is often mentioned – the belief that the French are healthier (their ‘heart-health’) because, amongst other things, they drink lots of wine. But you argue that’s not the case, that the French aren’t healthier – right?

GEORGE: Yes. That claim is largely proven to be nonsense. Let me put on another hat. As a retired professor of statistics at Auckland University, I found that earlier studies on the cardiovascular effect of alcohol are flawed statistically because lifestyle factors aren’t properly taken into consideration. 

For example, people who drink moderately may have a healthier lifestyle – they tend to smoke less, be wealthier, more educated, less likely to be overweight … so it’s not the alcohol that produces it, it’s the lifestyle! 

Also, in many of the studies, they were placing former drinkers in with the number of abstainers. And they may be abstainers because of their poor health. Furthermore, when you ask drinkers how much they drink in a questionnaire, they tend to underestimate the amount they drink – and the more they drink, the more they underestimate!

Truth is, the French have their fair share of alcohol problems: they have four times the cirrhosis of the liver that we do in New Zealand … they have significant dementia problems … and they now have strong controls on liquor advertising, which they had to introduce for good reason: alcohol is a problem in France! 

So, forget about the French paradox!

Look, let me add this as an endnote. It may be that moderate drinking may have a slight cardio-vascular effect on the elderly, although that’s very debatable. But the thing is, any positive impact is totally overruled by the increased risk of cancer!

GV: Let’s talk alcohol and marketing. We know that the alcohol industry targets young people – for example, the development of RTDs and their presence in social media. Yet despite everyone knowing that (i) alcohol and youth are a terrible combination, and (ii) advertising does encourage drinking … it still happens! Just how big and powerful is the alcohol industry? And are we fighting a losing battle?

GEORGE: Well, some alcohol corporations have a combined wealth that’s greater than the gross national product of many non-industrialised nations! There are about five huge organisations based throughout the world who have many sub-organisations connected to them. They have lots of money and lots of power – and a significant influence on governments and public opinion. They use this power very effectively to hinder policies and laws that would ultimately make things much better for New Zealand society.

In 2009 the NZ Law Commission (led by Sir Geoffrey Palmer) was given the job of undertaking a comprehensive review of the liquor laws, because of mounting concern about alcohol-related harms. The results led to 153 recommendations. But some of the Commission’s most effective proposals to reduce these harms were ignored. So, nothing’s changed! We’ve still got the same alcohol problems – and the industry still needs to be reined in.

GV:  A lot of those recommendations were about reducing the social impact of alcohol. What’s the social harm, really?

GEORGE: Well, it’s enormous! Alcohol seems to be a part of almost everything that happens. For example, each year alcohol is associated with one third of all suicides … 62,000 physical assaults … 10,000 sexual assaults. And car crashes involving someone else’s drinking were responsible for an annual average of 5,535 injuries to innocent victims, including 60 deaths.

We all know that, when someone gets drunk, it can cause a lot of problems. The question is: how much alcohol does a person need to become obnoxious? A small amount has a sedative effect – you relax, you’re less uptight, it’s dance on the table-top time! But as you drink more, the whole thing changes. 

It varies from person to person, of course, but clearly, it has a huge effect on society, and the cost to New Zealand is billions of dollars. 

Socially, its impact is enormous! 

GV: Considering alcohol’s impact and the work you’ve done on this topic, do you have any thoughts around the effects of cannabis and its potential social harms – particularly with the upcoming referendum? 

GEORGE: I’m not really primed to answer that in a scientific way, but I’ve been following it closely – particularly with what’s happening internationally. And also in my role as a counsellor and the patients I’ve treated with cannabis-related problems. 

My initial response is not to legalise it, mainly because we don’t know enough – there haven’t been enough controlled studies. There’s anecdotal evidence that cannabis oil, particularly the oil without the THC, can be helpful for people suffering from pain. So, I’d like to see it tested properly, with thorough clinical trials, just like all the other morphine-type drugs.

But making it legal recreationally has the potential for too many dangerous things to happen. In Colorado, for example, the strength of the THC in some products has gone up hugely – and although they have some controls over that, it very quickly goes underground. It’s also been found to be associated with mental illness – which is an enormous problem here in New Zealand. So, looking overseas, it doesn’t give me any confidence that legalising it is the right thing to do.

But, more importantly, if the government can’t control alcohol, how can they control cannabis as well? There are too many things that aren’t in place for this to be able to work – we simply don’t know enough.

GV: Getting back to alcohol … we’re obviously not about to become a nation of teetotallers. That’s simply not going to happen, right? And despite all the evidence, a good number of us Kiwis are still going to enjoy the odd tipple. So, to clarify, how do you recommend we do this?

GEORGE: As I mentioned earlier, the latest recommendations suggest men should not have more than two standard drinks a day, and women only one, and both should have at least two alcohol-free days each week. And if you are drinking, you should spread them out and try to have non-alcoholic drinks spaced with alcohol – so you don’t have more than one standard drink an hour. 

Also, avoid salted peanuts (or anything salted) – they’re often provided free in bars to make you drink more!

And another thing: alcohol can affect your sleep – particularly the quality of your sleep. And there are good scientific reasons as to why. While some people will actually drink to go to sleep (and it may help initially), it ruins the quality of your sleep later on. We actually go through five stages of sleep: you’ve got to have the right amount of deep sleep, the right amount of dream sleep, etc … and alcohol messes up this balance, making you wake up tired. 

So, if you’re going to drink alcohol, drink it at dinner time – not late in the evening. And remember: if you have two standard drinks (which might be the equivalent of a glass of wine at dinner time), you’re going to need at least two hours to get it out of your system.     

---

DO I HAVE A DRINKING PROBLEM?

How can you tell if you have a drinking problem? The AUDIT-C test is a brief survey designed by the World Health Organisation (WHO) to identify at-risk drinking behaviours.

HOW IT WORKS:

Simply answer the three questions, then add up your scores for each question (score will be somewhere between 0-12).

1. How often did you have a drink containing alcohol in the past year?

Never	0
Monthly or less	1
Two to four times a month	2
Two to three times a week	3
Four or more times a week	4

2. How many drinks did you have on a typical day when you were drinking in the past year?

None, I do not drink	0
1 or 2	0
3 or 4	1
5 or 6	2
7 to 9	3
10 or more	4

3. How often did you have six or more drinks on one occasion in the past year?

Never	0
Less than monthly	1
Monthly	2
Weekly	3
Daily or almost daily	4

TOTAL

For men: A total score of 4 or greater indicates elevated risk for hazardous drinking

For women: A total score of 3 or greater indicates elevated risk for hazardous drinking.

The higher the score, the more likely it is that the person’s drinking is affecting his/her health and safety. 

---

Where to get help:

If you are concerned about your own drinking or that of someone close to you, contact the free Alcohol Drug Helpline on Ph 0800- 787-797 (24 hours a day – 7 days a week), free text 8681 or visit their website alcoholdrughelp.org.nz or alcohol.org.nz for the Health Promotion Agency (freephone, 0508 258 258). 

There are some apps that may be helpful, e.g. the Daybreak app – found in all app stores. (https://medicalxpress.com/news/2019-09-daybreak-app-halves-alcohol-months.html).

For advice around alcohol and pregnancy, visit the Ministry of Health’s website www.healthed.govt.nz for a list of resources.