Does Australia need to rethink its relationship with alcohol and pride in its drinking culture?
Do you have an alcoholic drink or two most nights? A landmark study published in the British Journal of Cancer recently warns you might be more at risk of developing cancer than you think.
According to the study, five in every 100 Australians who exceed 14 drinks a week will develop cancer by age 85. The absolute risk of developing alcohol-related cancer at age 85 was 17.3 per cent for men and 25 per cent for women who were drinking less than 14 drinks a week.
This is a risk increase of 4.4 per cent for men and 5.4 per cent for women, compared to those who only have between 0 and 1 drinks per week.
While alcohol has long been known to be a risk factor for developing cancer, this latest research adds to a long list of health impacts linked to regular alcohol consumption, such as mental health issues, increased risk of diabetes, heart disease and liver failure.
For many Australians, having a drink after work is a way to wind down after a long day. While sharing a bottle or two on the weekend with family and friends is time-honoured tradition. This became more frequent in times of lockdown during the COVID-19 pandemic.
But is an increased risk of cancer enough to change your drinking habits?
The findings prompted us to ask a range of UQ experts: Does Australia need to rethink its relationship with alcohol and pride in its drinking culture?
Dr Dolly Baliunas
School of Public Health
Scientists have known for more than two decades that alcohol consumption is causally related to several cancers. For most cancers, the association is generally linear and accumulates over a lifetime. Two things about this may give people pause:
- there is no ‘safe level’ of alcohol consumption below which cancer risk is zero
- most of the risk is related to cumulative alcohol consumption, even when done in moderation, and not just heavy episodic drinking.
The impact of alcohol consumption on cancer varies by age group. Worldwide in 2016, the proportion of cancer deaths attributable to alcohol consumption ranged from 13.9 per cent of cancer deaths among people aged 30–34 years to 2.7 per cent of cancer deaths among people aged 80–84 years. Somewhat confusingly, the actual number of alcohol attributable cancers is greater in the older age group, but because the background rate of cancers is so much higher in old age, alcohol is responsible for a smaller proportion than in the younger age group.
What can be done about it? Well, in a country, how much cancer is attributable to alcohol consumption is driven by peoples’ historical drinking over the course of their lifetimes and not just the drinking that is happening now. So, even if massive changes in drinking were to suddenly happen across Australia, it would take many years to see an effect on cancer and the impact would be greater on cancers more strongly related to alcohol consumption.
In contrast, there are other health conditions where effects would be realised very quickly, such as injuries and deaths due to road traffic accidents. This is an important point because of all the alcohol-attributable burden of disease in Australia, most is not due to cancer (other things outweigh the cancer risk, such as alcohol-use disorders, intentional and unintentional injuries, and liver disease), and two-thirds of the burden happens in males and in younger age groups.
Widespread changes that significantly reduce alcohol consumption would ultimately impact all the alcohol-related health conditions..
Professor Monika Janda
Professor in Behavioural Science
Faculty of Medicine
As a behavioural scientist I am interested in cancer prevention and early detection and how we can support people to lead a lifestyle that will reduce their cancer risk as much as possible.
In Queensland, avoiding the midday sun or protecting one’s skin, smoking cessation and retaining a healthy weight are lifestyle behaviours most would be familiar with and that have been promoted by cancer researchers, clinicians and cancer charities for a long time. However, the World Cancer Research Fund, a global organisation devoted to cancer prevention, now also recommends limiting alcohol consumption. This is because alcohol is implicated in many cancers developing by damaging the delicate cells that line many of our digestive organs such as the mouth, throat, oesophagus, stomach and bowel, and has also been found to be associated with liver cancer, where the alcohol is processed. Alcohol is also associated with breast cancer in women.
It’s often difficult to change behaviours if they have become a habit, such as having a glass of wine most nights.
Here are a few easy ways to break that habit:
- Take a pledge to avoid alcohol for a short time – for example, join the Dry July campaign, which raises critical funds for cancer organisations throughout Australia. This will support a worthwhile cause and give you a month break from your usual alcohol habits. It can raise your awareness for how much you usually drink, and that it is easy to go without alcohol once you change your habits.
- Replace your favourite drink with alcohol-free alternatives. There are now many different brands of zero alcohol beers and wines available and many amazing recipes for mocktails.
- Choose to drink water instead or go for a walk when you usually relax with a drink. For many of us, having a drink is associated with stress-relief. This can be achieved with other behaviours, such as meditation or a mindful walk around your neighbourhood. The physical activity of a walk also helps with cancer prevention, so it’s a double bonus.
Associate Professor Nicholas Carah
School of Communication and Arts
Faculty of Humanities and Social Sciences
Director of the Foundation for Alcohol Research and Education
The evidence tells us that Australia’s drinking culture is bad for our health and relationships. What if it is also bad for our culture? This is a different sort of question to ask and try to answer. But, I think it is an important one.
Alcohol affects the way we spend our free time and socialise with our friends, the way we live in our homes and with our families, and the way our public spaces are designed and used. If we look at nightlife precincts, we might ask why are these parts of our cities are organised around the high volume consumption of alcohol. Could they be organised around a more diverse range of cultural pastimes and interests that privilege forms of cultural expression and social interaction that aren’t centred around alcohol consumption?
If the ‘after dark’ zones of our city were more deliberately organised around a larger range of pastimes like live music, performing arts, cultural festivals and food would this create a better kind of public culture? We might ask similar questions about the growth of big box liquor retailers in our cities and suburbs over the past decade or two, or the types and size of pubs and bars we have in our neighbourhoods.
We should look to the businesses that produce and profit from our drinking culture and ask ourselves is this a good way to live? Does this industry make our neighbourhoods more liveable, do they promote better and more inclusive forms of social and cultural life?
Questions about our drinking culture are not only about health and safety, they should also be about our opportunities to live a ‘good life’ in our little pocket of the world.
Different people have been impacted in different ways through being forced to work from home. Many people appreciated the extra time with their families – it seemed the nation’s mental health as a whole improved through not having to commute – but it was tough on some people who lived by themselves and for whom work was a social activity in its own right.
At the initial stages of lockdown, people had to work from home by themselves in isolation. But after some restrictions were eased, we saw other interim arrangements, such as workmates meeting at one person’s house so that two or three of them could work collaboratively together. These sort of hybrid arrangements are probably going to become more regular.
I think that while 2020 was a tough year, it has opened up a lot of possibilities. The traditional office was really designed pre-internet and pre-communications, so people needed to be in the office. What this year showed is that it is possible to use these tools to work productively remotely, giving more flexibility in the workplace. People working from home can organise their time better. This greater flexibility has the potential to lead to happier employees.
While respondents from Australia were not among the highest to report pre-drinking practice, more than 60 per cent of respondents indicated that this was common practice. Pre-drinking behaviour is not a static behaviour when broken down by age and gender. A follow-up paper I led with Dr Cheneal Puljevic highlighted that pre-drinking behaviour varied across the sexes and by age. Male respondents were typically more likely to report pre-drinking behaviour, with the peak of the activity for men and women occurring around the age of 20. However, this is still a common practice for respondents heading into their 30s.
The socialisation, routines and habits around drinking need to be considered for Australians to rethink their relationship with alcohol. Recent research from our team has been looking into ‘health warning labels’ and how these may change drinking behaviour.
Dr Cheneal Puljevic
Research Operations Manager
School of Public Health
One of my areas of research is with the Global Drug Survey (GDS), the world’s largest annual online survey of people who use drugs, run in multiple countries. A major GDS study, authored by Dr Emma Davies from Oxford Brookes University in the United Kingdom, is exploring responses to alcohol health-information labels among 75,969 respondents from 29 countries.
Respondents were shown seven health information labels (topics were heart disease, liver, cancer, calories, violence, taking two days off and the myth of benefits of moderate drinking), and were asked if they were aware of the information, believed it, if it was personally relevant, and if it would change their drinking habits. While the study is still under review, we found an overall lack of awareness about the risks of alcohol use among Australian respondents, particularly about the associations between alcohol consumption and the risk of cancer.
These findings strongly support the inclusion of clear, noticeable warning labels on alcohol products, just like the ones we see on cigarettes. However, as people often become fatigued to such messages, it’s also important that messages on alcohol warning labels are continually rotated, to keep the information new.
In 2020, the GDS also ran a special edition COVID-19 survey to offer insights into the impact COVID-19 has had on people who use alcohol and other drugs, such as their mental health and relationships.
Using this data, we found that 37 per cent of Australian respondents reported drinking earlier in the day compared to pre-pandemic times, and 46 per cent reported increased drinking (including frequency, amount and/or instances of binge drinking) since this time. Those who reported increased drinking commonly said it was because of boredom (60 per cent), having more time (52 per cent), and spending more time drinking with their partner or household (40 per cent).
Furthermore, those who reported drinking earlier in the day were also more likely to report having a mental health conditions, meaning that drinking earlier in the day may be linked to worsened mental health outcomes. These findings highlight the need for increased availability of resources for those experiencing poor mental health and/or increased alcohol use because of the COVID-19 pandemic.
If you are interested in reducing your alcohol use, please check out the Global Drug Survey’s Drinks Meter app, a free app that provides instant and anonymous feedback on your drinking behaviours.