The alcohol-related deaths of teenagers Brian Murphy and Lynsey O'Brien have left their grieving parents with unresolved questions about what exactly happened. There is a disturbing randomness to both these tragedies, in which alcohol, one might argue, was the real killer, writes Kate Holmquist
"These are unbelievable tragedies and every parent is asking 'could that be my child?' " says Conor Farren, consultant and adolescent psychiatrist in Dublin.
Murphy was 18 years old when he was caught up in a drunken brawl outside Club Anabel at Dublin's Burlington Hotel. Two young men have done time for violent disorder, but State Pathologist Marie Cassidy recently concluded that the injuries themselves would not normally be expected to cause or even contribute to death. The most likely cause of Murphy's untimely death was the complication of his head injuries by alcohol-induced apnoea and brain swelling, she said.
Fifteen-year-old Lynsey O'Brien was on a drinking binge shortly before she fell into the sea from a cruise-liner. Her parents, Paul and Sandra, have desperately sought answers as to how this could have happened to their daughter.
These two high-profile cases are only the visible indication of the many more alcohol-related tragedies that do not reach public consciousness. Forty per cent of all fatal accidents and 48 per cent of criminal offences are alcohol-related. A study by public health specialist Dr Declan Bedford has found that 33 per cent of drivers and 77 per cent of passengers who die in road crashes have been drinking.
The Irish are binge-drinkers and always have been, but our increased disposable income has allowed us to indulge this weakness, Farren argues. When an Irish male decides to take a drink, on six out of 10 occasions he binges (takes five or more drinks), EU statistics show. Irish women binge on three out of 10 "nights out" and, increasingly, "nights in". Our teenagers learn from us.
"I do believe that the appropriate word is 'crisis' in relation to the massive rise in alcohol consumption in the last 10 years," Farren says. "There are many more hundreds - indeed thousands - of cases of injury, tragedy, disease and addiction that may not reach the level of immediate death, but they equally pervade and destroy the lives of vast numbers of people."
He notes the significant increase in young women dying of acute liver failure as further evidence of the crisis.
In young men, the 41 per cent increase in alcohol consumption between 1993 and 2003 was paralleled by a 44 per cent increase in suicide. Alcohol-induced despair was often to blame for these deaths, Farren says.
"This increase in suicide amongst young men is unprecedented in the late 20th century in western Europe and it is directly related to the increased availability of alcohol," he says, citing research by Dr Bedford that 93 per cent of Irish males under 30 who kill themselves have alcohol in their blood.
"You have parents serving life sentences of guilt, seeking an explanation as to why a happy, normal young man with a good job, a car and a girlfriend has committed suicide, when in fact the only explanation is the massive increase in heavy and binge-drinking," says Bobby Smyth, consultant child and adolescent psychiatrist in the Department of Public Health and Primary Care at Trinity College Dublin.
Alcohol profoundly affects brain development and function in teenagers (see panel), while also sowing the seeds of later addiction problems. Irish teenagers have the highest binge-drinking rate in Europe, with one-third of 15- and 16-year-olds bingeing regularly, so it's not surprising that under-age public drunkenness has increased four-fold since 1996. But teens should not be scapegoated: the average person aged over 15 is drinking between 12 and 14 litres of alcohol per year, while in the 18-25 age group the average is 18 litres per year, double the European average of nine litres.
The State's alcoholic drinks industry is worth €6.6 billion to the economy annually, according to Euromonitor International, an independent consumer research group that analyses Irish consumer lifestyles for private industry. But the cost to Irish society is €3 billion per year, rather than the Government's estimate of €2.6 billion, argues Dr Joe Barry of the Department of Public Health and Primary Care at TCD.
The net benefit to the economy of €3.6 billion has to be measured against the priceless lives lost as well as the longer-term health issues. One in five Irish adults has an alcohol problem, a survey of 2,290 patients in 10 GPs' surgeries found. In a major Dublin teaching hospital, 28 per cent of all patients admitted for all causes had alcohol problems and a further 5 per cent were binge-drinkers.
IRISH CHILDREN DON'T see this dark side. Rather, they have the highest expectations in the EU as to the benefits of alcohol, according to the European Schools Project on Alcohol and Drugs (ESPAD). Dr Ann Hope, former alcohol policy adviser to the Department of Health, surveyed Irish children and found that they were influenced by alcohol advertising aimed at the over-18s and that sports sponsorship made young males associate alcohol with masculinity.
She has stated that between 1997 and 2002, advertising of alcohol increased by up to 228 per cent on TV, by 136 per cent on billboards and by 116 per cent at cinemas - much of it aimed at selling spirits-based alcopops to young people. At the same time there was a 185 per cent increase in juvenile alcohol- related offences, and intoxication of youngsters in public places increased by 245 per cent.
The Government-appointed Strategic Task Force on Alcohol advised sporting organisations to find an alternative to drinks sponsorship, which, it stated, embeds alcohol in young people's lives. This hasn't happened. The task force also recommended that the State protect children by legislating to reduce their exposure to advertising, but the Fianna Fáil-PD Government opted for a voluntary code.
"Drink responsibly", reads the drinks industry slogan at the bottom of its billboard ads for alcohol. However, 30 years of international research has found that such voluntary industry codes of public education are "useless", according to Prof Griffith Edwards, of the National Addiction Centre, University of London. In Dublin this week to deliver the White Social Policy Lecture at TCD, Edwards has advised the World Health Organisation and the US White House on alcohol policy.
"The difference between good and bad alcohol policy is not an abstraction, but very often a matter of life and death," he says.
The Irish Government has adopted what have are seen internationally as the worst practices and ones that don't work, he argues, such as alcohol education in schools and colleges, public service messages, warning labels and voluntary codes of bar practice. Edwards also says the international evidence is irrefutable that exposure to repeated high-level alcohol promotion inculcates pro-drinking attitudes and increases the likelihood of heavier drinking, predisposes minors to drinking well before the legal age of purchase and promotes and reinforces perceptions of drinking as positive, glamorous and relatively risk-free.
Edwards argues that the Government has betrayed the people by taking an approach that has been proven not to work.
"The Government is aware of the scientific evidence," he says. "Banning advertising with the consent of the people would be effective. Raising the price of alcohol is effective. Limiting availability to certain days of the week or to government stores is effective. Voluntary codes are ineffective.
"Where the Government betrays the people is where it pursues policies without telling the public that these are ineffective policies. It would be wrong to demonise the drinks industry, but the industry should not be allowed a seat at the table with the Government while it is developing alcohol policies."
THE GOVERNMENT HAS taken the side of the vested interests of the drinks industry, says Dr Joe Barry.
"They tell you that they are not marketing to young people, but of course they are," he says. "The Oireachtas Committee called for an all-out ban on advertising and Micheál Martin, when he was minister for health, wanted a watershed ban on TV alcohol advertising before 10pm. The industry got Mary Harney to agree to the voluntary code, even though there is no evidence that it will work."
Farren believes that the Government "has given total laissez-faire to the drinks industry. Self-regulation is no regulation. Meas [ the drinks industry's public awareness promotion group] is operating under the guise of public health, when in reality the drinks industry, which it is a part of, is encouraging people to drink".
Smyth agrees: "The dominant influence on young people's attitudes to alcohol is the drinks industry, but the Government ignores the warnings of public health doctors and puts advertising in the hands of the drinks industry, which acts in the interests of its shareholders, which is not the same as the public health doctor's interest in protecting the health of Irish citizens.
"You would imagine that a Government responsible for the health of Irish people would listen to public health doctors, but the bottom line is that it doesn't. The drinks industry gets a more effective hearing than doctors do."
Dr Shane Butler, of the Addiction Studies Centre at TCD, comments: "The evidence has been marshalled in the Special Task Force on Alcohol. It's now a question of whether the Government will accept the evidence. You can understand that a Government with a PD element will be reluctant to do anything that is seen as negative for the drinks industry. While it has to be said that very few countries have got it absolutely right, the difference for us is the dramatic increase in alcohol abuse since the early 1990s.
"Yet we have no set of management structures providing an integrated response, as we do with the National Drugs Strategy," Dr Butler adds.
In response to questions about the effectiveness or otherwise of voluntary codes, the Tánaiste and Minister for Health, Mary Harney, states that the Alcohol Marketing and Communications Monitoring Body, chaired by Peter Cassells, is overseeing the implementation of the voluntary code. The Tánaiste is awaiting the annual report of the monitoring body before deciding on future action with regard to legislation on the issue of alcohol advertising.
"Negotiations with the industry stakeholders are ongoing and will include the issue of sponsorship," Harney says.
Many of the 100 recommendations of the task force have been implemented, she adds, and the department is currently considering the report of the working group on alcohol, established as part of the special initiative on tackling alcohol and drug misuse in the national agreement, Sustaining Progress, before taking further action.
Traditionally, there has been a cultural ambivalence to alcohol, but as the dark side of our Celtic Tiger binge is becoming more evident, public ambivalence is rapidly being replaced by realism.
Eighty-five per cent of Irish people now believe that the Government should do more to tackle alcohol- related problems and 54 per cent are prepared to to pay an additional excise tax targeted at the problem.
"The evidence is there. It's up to the Government to do something. It's for the political system to decide," says Dr Butler.