Tim StockwellTim Stockwell

Centre for Addictions Research of BC, Centre for Addictions Research of BC, University of VictoriaUniversity of Victoria

Preventing violence in and around late-night drinking venues:

A review of the international evidence

CARBC and BC Mental Health and Addictions Research Network public seminar, SFU Harbour Centre, Vancouver, 23 February, 2009.

‘Three bowls do I mix for the temperate; one to health, which they empty first, the second to love and pleasure, the third to sleep. When this bowl is drunk up, wise guests go home. The Fourth bowl is ours no longer, but belongs to violence; the fifth to uproar, the sixth to drunken revel, the seventh to black eyes, the eighth is the policeman’s, the ninth belongs to biliousness, and the tenth to madness and hurling the furniture.’

Eubulus 375 B.C.

Bars, booze and violence in BC: Bars, booze and violence in BC: A time to take stock?A time to take stock?

BC Provincial health officers report on alcohol

and public health, December 2008

Evidence of increasing alcohol-related harm

and violence

Proposals before Vancouver city council to

extend hours of liquor service: the right way

forward?

Number of Liquor Authority and Agency/Private Liquor Stores, BC, 1992-2008

Age 15+ per capita alcohol consumption in BC and Canada, 1997/8-2007/8

Canada (StatCan)

British Columbia (StatCan)

British Columbia (BC AOD Monitoring)

6.5

7

7.5

8

8.5

9

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Litre

s of

eth

enol

per

per

son

Figure 17: % Serious Injury Crashes that Involve Alcohol, BC and Canada, 1995-2005

Figure 20: Provincial Net Income from the Control and Sale of Alcoholic Beverages, BC

Physical availability Affordability Consumption +8% Hazardous drinking Hospital visits +3.4% Alcohol-related crashes +11%

In BC since 2002….

In Vancouver CBDIn Vancouver CBD

In late 2003 hours of service for bars

increased from 2 AM to 4 AM

Number of liquor “seats” in

entertainment district increased from

1000 to 6700

Marked increase in calls for assistance,

fights, assaults and stabbings reported

by police

Apparent impact on late-night calls to VPD

Apparent impact on fights recorded by VPD

Apparent impact on assaults recorded by VPD

Two recent CARBC reviews on Two recent CARBC reviews on violence and licensed premisesviolence and licensed premises

1. For Alberta Gaming and Liquor Commission:

28 literature reviews and special reports (5 Canadian;

24 international)

39 descriptive and analytic studies (12 Canadian; 27

international)

30 intervention studies (3 Canadian; 27 international)

2. Crime Prevention and Community Safety (In press)

Review of public health and safety impact of changes

to opening hours of bars and restaurants (48 studies)

Ratings of EvidenceRatings of Evidence

O Limited investigation, inconclusive data

Evidence is contra-indicative

Warrants further research

Evidence for implementation.

Evidence for outcome effectiveness

Evidence for effective dissemination

Five guiding principlesFive guiding principles

Ensure retail prices are not too low

Reduce intoxication levels

Create stress-free drinking

environments

Set clear house rules

Establish credible deterrence against

irresponsible practices

16

Dose-response relationships Dose-response relationships between alcohol consumptionbetween alcohol consumption

and harms and harms

At the individual and population levelsAt the individual and population levels For harms caused by both short and long-For harms caused by both short and long-term effects of alcoholterm effects of alcohol

0

1

2

3

4

5

6

BAC Level %

Od

ds R

ati

o Risk of Violent versus Accidental Injury Risk of Violent versus Accidental Injury

for Different BAC Levelsfor Different BAC Levels

Chi square for linear association p<.0001Source: Macdonald et al, 2005

Operator Best PracticesOperator Best Practices

Responsible Beverage Service Responsible Beverage Service ‘‘Safer Bars’ – violence preventionSafer Bars’ – violence prevention

Plastic/shatterproof glasses Plastic/shatterproof glasses

Food service with alcoholFood service with alcoholManage the flow of late-night customersManage the flow of late-night customers

Screen for underage drinkersScreen for underage drinkers

Self breath testing machinesSelf breath testing machines

19

Freo Respects YouFreo Respects You RBS Project RBS ProjectLang et al, Australian J Public Health, 1998Lang et al, Australian J Public Health, 1998

8 ‘high risk’ intervention sites, 7 control8 ‘high risk’ intervention sites, 7 control Feedback from police, risk assessment, RBS Feedback from police, risk assessment, RBS training, mystery shopperstraining, mystery shoppers Patron exit BAC’s reduced, no change in house Patron exit BAC’s reduced, no change in house policies, age ID checking or service refusalpolicies, age ID checking or service refusal One premise changed house policies, refused One premise changed house policies, refused service and # patrons with high BACsservice and # patrons with high BACs Can work with strong management supportCan work with strong management support Collaboration: 23 changes to WA Liquor ActCollaboration: 23 changes to WA Liquor Act

20

The Safer BarsThe Safer Bars Project ProjectGraham et al, Graham et al, Drug and Alcohol ReviewDrug and Alcohol Review, 2004, 2004

Based on detailed studies of violent barsBased on detailed studies of violent bars Risk assessment: patron flows, atmosphere, Risk assessment: patron flows, atmosphere, screening, supervision, closing time screening, supervision, closing time 3 hour training program: early intervention, 3 hour training program: early intervention, clear house rules, team work, controlling clear house rules, team work, controlling anger, conflict resolution skills anger, conflict resolution skills 18 intervention sites – large Toronto clubs18 intervention sites – large Toronto clubs 12 month reductions in violence vs. 15 12 month reductions in violence vs. 15 control sites, best if low staff turnover.control sites, best if low staff turnover.

Regulatory Best PracticesRegulatory Best Practices

Raise or maintain pricesRaise or maintain prices[& Tax on alcohol content] [& Tax on alcohol content]

Raise the minimum legal drinking ageRaise the minimum legal drinking age

Restrict happy hours/discounting Restrict happy hours/discounting Restrict days and hours of serviceRestrict days and hours of serviceMandatory third-party insuranceMandatory third-party insurance

Enforcement of liquor lawsEnforcement of liquor laws

Restrict density of liquor outletsRestrict density of liquor outlets

Set taxes and prices according to ethanol content

Principle of using price to control Principle of using price to control alcohol use is well-establishedalcohol use is well-established

Meta-analysis by Gallet (2007):Meta-analysis by Gallet (2007):Identified 132 studies, 1945-2003 and concludes: Identified 132 studies, 1945-2003 and concludes:

A 10% increase in price leads to an average of a 5% A 10% increase in price leads to an average of a 5% decrease in consumptiondecrease in consumption

Meta-analysis by Wagenaar et al (in press):Meta-analysis by Wagenaar et al (in press):Identified 112 studies worldwide (1823-2007) with Identified 112 studies worldwide (1823-2007) with 1007 estimates and conclude: 1007 estimates and conclude:

A 10% increase in price leads to a 4.4% decrease in A 10% increase in price leads to a 4.4% decrease in consumption and 2.8% for heavy drinkersconsumption and 2.8% for heavy drinkers

Low alcohol beerThere are 38 varietiesof beer in Australiacontaining between 2.5% and 3.5% alcohol. We have found 3 inBC liquor stores.

Increasing Market Share of Low Increasing Market Share of Low Alcohol Beer (<3.8%) in AustraliaAlcohol Beer (<3.8%) in Australia

0

20

40

60

% S

har

e o

f B

eer

Mar

ket

NSW VIC SA TAS QLD WA NT

State

'89 '99

Source: Australian Associated Brewers

Tax per Drink for Canadian Beer

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

0.50% 2.50% 3.50% 4% 5% 8.00%

% Alcohol by Volume

$ p

er S

D $GST/SD$PST/SD$Excise Tax/SDTotal Taxes/SD

Price incentives for drinking different strength coolers in BC, 2005/6

Strength N of brands

Mean alcohol content

% Cooler market -5+ % alc

Mean $’s

per SD

Mean $ per

L of drink

5.0-5.9% 35 5.06 12.90 2.74 8.07

6.0-6.9% 14 6.10 9.38 1.94 6.87

7.0% 91 7.00 77.73 1.33 5.41

Total 140 6.43 100.00 1.74 6.22

Set effective minimum drink prices and index to cost of

living

Cheapest alcohol in BC Liquor Stores Cheapest alcohol in BC Liquor Stores per standard drink, August 2008per standard drink, August 2008

>6% beer @ 75 cents

7% coolers @ 71 cents

40% spirits @ 86 cents

11.5% wine @ 91 cents

>20% fortified wine @ 62 centsMinimum mark-ups in BC not increased since 1994 for

beer, 1995 for wine and 1998 for spirits, recommendation to update not accepted

Recent moves to apply minimum Recent moves to apply minimum pricing to alcohol in Canadapricing to alcohol in Canada

Minimum prices of $2.50 per drink set in both

Alberta and Nova Scotia in 2008

6.5% increase for packaged beer in Ontario,

November 2008

Recommendation from BC provincial health

officer in December 2008

Longer hours, more civilised drinking?

32

Impact of changes to Impact of changes to trading hours of bars and restaurantstrading hours of bars and restaurants

Stockwell and Chikritzhs (in press), Crime Prevention and Stockwell and Chikritzhs (in press), Crime Prevention and Community SafetyCommunity Safety

48 studies over four decades, mostly from 48 studies over four decades, mostly from the UK, USA, Australia and Canadathe UK, USA, Australia and Canada Only 14 included both baseline and control Only 14 included both baseline and control measures, all peer-reviewedmeasures, all peer-reviewed Of these 11 reported significant impacts on Of these 11 reported significant impacts on at least one outcome in predicted directionat least one outcome in predicted direction 4 of these high-quality studies focused on 4 of these high-quality studies focused on violence – all found significant impactsviolence – all found significant impacts

0

1

2

3

4

5

Before After Before After

Impact of extended trading hours on rates of Impact of extended trading hours on rates of assaults in Perth Hotels, 1991-1995assaults in Perth Hotels, 1991-1995

Extended TradingPremises

Other Premises

Assaults/M

onth

Source: Chikritzhs and Stockwell (2002), Journal of Studies on Alcohol

Targeted regulation of high risk licensed premises

Kalgoorlie, Western Australia

Assaults and drink-driving offences linked toAssaults and drink-driving offences linked toKalgoorlie licensed premisesKalgoorlie licensed premises

37

NSW Alcohol LinkingNSW Alcohol Linking ProgramProgramWiggers et al, Drug and Alcohol Review, 2004Wiggers et al, Drug and Alcohol Review, 2004

All 400 licensed bars in 2 police districtsAll 400 licensed bars in 2 police districts For 6m all officers recorded if alcohol For 6m all officers recorded if alcohol involved and location of last drink involved and location of last drink Safety audit of high risk bars and feedback Safety audit of high risk bars and feedback by police by police 15% reduction in violent incidents 3 months 15% reduction in violent incidents 3 months post intervention compared with control post intervention compared with control districtsdistricts

Enforcement of liquor laws regarding intoxication: need

for credible deterrence

Classic US Study: Law enforcement versus server training

% Service refusal for ‘pseudo patrons’ (McKnight and Streff, 1992)

1012

3

16

54.3

47.7

41

4.3 5.6

12

16.7 17.5

0

10

20

30

40

50

60

Pre Post Pre Warning Cite-1 Cite-2

Partial InterventionFULL Intervention

Server Training 1986 Enforcement 1990-1991

Avoid high concentrations of late-night liquor outlets in one

district

Relationship between alcohol-related assaults Relationship between alcohol-related assaults and number of bars and restaurants in and number of bars and restaurants in Melbourne, Australia (Livingston, 2007)Melbourne, Australia (Livingston, 2007)

0

5

10

15

20

25

30

0 20 40 60 80 100

# of on-premise liquor licences

# of

alc

ohol

-rel

ated

ass

aults

per

yea

r

Predicted assaults (non-linear)

Predicted assaults (linear)

Community mobilisationCommunity mobilisation0 to0 to

Early intervention with children and Early intervention with children and adolescentsadolescents

Public education campaigns Public education campaigns Alcohol education in schoolsAlcohol education in schools

Collaboration between police, licensees and Collaboration between police, licensees and

civic authorities (e.g. Accords)civic authorities (e.g. Accords)

43

Police-Licensee AccordsPolice-Licensee Accords Signed agreements usually covering RBS, Signed agreements usually covering RBS, happy hours, door charge and police supporthappy hours, door charge and police support May involve staff trainingMay involve staff training Self-regulation and, to a degree, targeted Self-regulation and, to a degree, targeted law enforcement law enforcement Some short term tangible benefits in Some short term tangible benefits in violence reduction violence reduction Benefits not consistent and maybe short-Benefits not consistent and maybe short-termterm Accords can be fragileAccords can be fragile

A sustainable and effective regulatory A sustainable and effective regulatory system to prevent alcohol-related harmsystem to prevent alcohol-related harm

Accurate and well-publicised monitoring

Credible deterrence and graded penalties

Incentives for violence prevention

Opportunities for local community input

Effective controls on physical availability

Pricing policies to promote health and safety

Clear legislation to support effective enforcement