1. Unrecorded Alcohol Consumption Focus on the Americas Norman Giesbrecht & Emma Haydon Centre for Addiction & Mental Health Toronto, Ontario, Canada 1 a Conferência Pan-Americana de Polícas Públicas sobre Álcool Brasília, Brasil November 28-30, 2005

2. Topics Implications Dimensions Sources of information Estimates Contributing factors Policy implications Interventions Recommendations

3. Implications of Unrecorded Alcohol Consumption Accuracy of drinking volume estimates – studies of associations between consumption & harm (or benefits) from alcohol –impact of interventions –cross-sectional and longitudinal research –drinking patterns

4. Implications of Unrecorded Alcohol Consumption (2) Heavy consumption & high risk drinking – Easy access to untaxed alcohol –High risk patterns –Addition versus substitution –Alcohol of questionable quality

5. Implications of Unrecorded Alcohol Consumption (3) Alcohol Policy – Reduce revenue for the state – Reduce profit for producers –Distributors with compromised role re illegal alcohol –Rational to undermine control measures

6. Dimensions of Unrecorded Alcohol Consumption Legal –home production of legal amounts –consumption of non-beverage ethanol –importation of legal amounts

7. Dimensions of Unrecorded Alcohol Consumption (2) Illegal –home production of illegal quantities –sale of home produced alcohol –mass produced illegal alcohol –smuggling individuals large-scale operations

8. Sources of Information Seizures by customs officials Police activities & seizures Liquor inspector activities Cross-border traveler activity & extrapolations Extrapolations using official statistics Self-reports

9. Sources of Information Caveats & challenges: –Useful method varies by country, region and time period –Vested interests in the estimation process –No one method produces comprehensive estimates, some only are based on a fraction –Challenge of comparing & combining divergent estimates

10. Americas: Recorded plus estimated Unrecorded* Bermuda 12.9 St. Lucia 10.5 Bahamas 9.2 Venezuela 8.8 + 2.0 Argentina 8.6 + 1.0 U.S. 8.5 + 1.0 Canada 8.3 + 2.0 St. Kitts 7.6 Grenada 7.4 Uruguay 7.0 + 2.0 Barbados 6.7 - 0.5 Paraguay 6.7 + 1.5 St. Vincent 6.7 Haiti 6.5 + 0 Dom. Republ 6.1 + 1.0 Panama 6.0 + 1.5 Chile 6.0 + 2.0 * Litres of absolute alcohol per capita aged 15+: Recorded FAO 2003; Unrecorded estimates for after 1995 from Rehm & Gmel 2001

11. Recorded plus estimated Unrecorded (2)* Columbia 5.9 + 2.0 Guyana 5.8 + 2.0 Suriname 5.8 + 0.0 Costa Rica 5.5 + 2.0 Brazil 5.3 + 3.0 Peru 4.7 + 1.0 Mexico 4.6 + 3.0 Belize 4.5 + 2.0 Guam 4.5 Cuba 3.7 + 2.0 El Salvador 3.5 + 2.0 Bolivia 3.4 + 3.0 Jamaica 3.4 + 1.0 Trinidad & Tobago 3.2 + 0.0 Nicaragua 2.5 + 1.0 Honduras 2.3 + 2.0 Ecuador 2.0 + 1.0 * Litres of absolute alcohol per capita aged 15+: Recorded FAO 2003; Unrecorded estimates for after 1995 from Rehm & Gmel 2001

12. Americas: Recorded & Estimated Unrecorded Alcohol Consumption Recorded consumption –1.99 to 12.92 litres per capita aged 15+ Estimated unrecorded consumption –minus 0.5 to plus 3.0 litres per capita 15+ Unrecorded as a % of total (recorded plus estimated unrecorded) –11% to 55%

13. Traditional & local beverages* Selected countries in Latin & South America Argentina - local beer 7% Bolivia - Chicha 5-7% Brazil - Cachaça 38-54% Chile - Pisco 35% Columbia - Rum 28% Costa Rica - Guaro Ecuador - Aguardiente 40-70% Guatemala - Chicha Guyana - Ti punch Honduras - Aguardiente Mexico - Pulque 7% Paraguay - Abati Peru - Pisco, Chicha Suriname - Borgoe 38% Trinidad & Tobago - Babash Uruguay - Cana 38% Venezuela - corn liquor * These are examples & not a comprehensive list of beverages.

14. Contributing Factors Restrictions on access to legal alcohol sales in host country – Price, outlet density, hours of sale Inter-country differences in access to alcohol –lower prices in adjacent jurisdictions –high volumes allowed for legal personal importation

15. Contributing Factors (2) Traditional and local beverages –extensive tradition and quality Smuggling of other goods –Tobacco from US to Canada in early 1990s Tolerance for illegal behaviour –among general population –among legal distributors or producers Geography and population density

16. Policy Implications Legal & illegal trade (particularly smuggling) used to justify proposed erosion of control policies –questionable estimation procedures used Resource management & inter-sectorial collaboration Impact on traditional and local beverages Quality control issues & harm reduction

17. Interventions Process –Training –Coordination –International symposia –Resource issues –Data collection Outcome oriented –Public education –Mass media –Warnings to distributors –Inspections –Law enforcement –Enhance legal outlets –Review of alcohol policies

18. Recommendations Use multiple methods for data collection Subject estimates to peer review Consider cultural aspects and norms re traditional and local beverages Consider impact of unrecorded alcohol on high risk drinking & dependence

19. Recommendations (2) Coordinate control/interventions of unrecorded with harm reduction management of recorded sales of alcohol Build on evaluations of alcohol policies to develop interventions to manage unrecorded alcohol Conduct routine monitoring & evaluation of interventions

20. Acknowledgements Sunny Ba, Guilherme Borges, Mariana Cremonte, Laura Krech, Maristela Monteiro, Jürgen Rehm, Robin Room & Maria Luiza Segatto