1. Children and Alcohol Andreas Crede

2. Introduction Legal age for alcohol consumption 18 years in South Africa Attempts to increase legal age to 21 years Alcohol consumption in SA estimated at 16.7 litres of pure alcohol per drinker per year ( Addiction Action Campaign Website ) Ranks amongst the highest in the world SA consumes ±6 billion litres of alcoholic beverage per year

3. Introduction Alcohol related harm accounts for 7.1% of all deaths and 7.0% of disability adjusted life years in 2000( Schneider, Norman, Parry et al 2007) 1.1 million life years lost 3 rd largest contributor to death and disability (after sexually transmitted diseases and interpersonal violence) Homicide and violence (40%), alcohol use disorders(15%) and road traffic injuries (15%) 1/3 sexual assault victims under influence of alcohol (Addiction Action Campaign)

4. Introduction SA rate of alcohol consumption ±28% (45% males and 17% women) of population 15 years and older (SA Demographic and Health Survey 1998) 1996 R1.7 billion spent on alcohol related trauma, disease and lost productivity (Parry 2008) Very little data available for paediatric population in South Africa

5. Children and Alcohol Data from 1 st South African National Youth Risk Behaviour Survey 2002. 49.1% of high school learners used alcohol (56.1% vs 43.5%) 31.8% had used alcohol in month prior to survey, 23.0% binge drink in previous month 12.0% (15.8% vs 9.0%)had 1 st alcoholic beverage before age 13 yrs

6. Children and Alcohol Alcohol consumption increased with age – 43.4% 14 yrs, 56.0% 17yrs. Race also predictor of alcohol consumption: eg 86% of white youth vs 44% black youth. International trend towards overall reduction in youth drinking (Monitoring the Future Survey, 1975-1993)

7. Why Worry? Excessive alcohol consumption related to increased morbidity and mortality More likely to drive with intoxicated driver (learn-about-alcoholism.com) Reduced sexual inhibition and therefore increased HIV and other STI transmission and teenage pregnancy (Cook & Clark, 2005, and many other studies) Higher rates of school truancy Future academic problems

8. Why Worry? 40% of people drinking before age 13yrs will develop alcohol dependance/ abuse at some stage in life (alcoholfreechildren.org) 28% suicides in 9-15yr old alcohol-related May be sign of social/ family problems Future interpersonal problems

9. Our Responsibility Legal vs Moral Little guidance from government or HPCSA as to where exactly our responsibility lies in South Africa

10. Legal Guidance Child Care Act 1983 Children’s Bill of Rights Act in the best interest of the child Ensure safety of child Report suspected abuse to relevant social worker

11. Moral Guidance Driven by personal beliefs/ experiences Often against personal beliefs/values Not always in immediate best interest of child May conflict with law

12. Case 1 14 year old male Found unconscious at side of road Brought to ED by ambulance Found to be intoxicated with alcohol Parents contacted once awake Child assaulted in ED by mother

13. Case 2 2 males 15yrs and 17yrs Disturbed while stealing alcohol Jumped out of 2 nd story window 1 unharmed 1 bilateral tib-fib fratures Both intoxicated Who to inform?

14. Case 3 15 year old female Brought by friends after a night out Intoxicated, semi-conscious Friends leave without giving contact details Child says she doesn’t want to be admitted and won’t give parent’s contact details as she is afraid that they will beat her if they find out.

15. Resources Available Hospital Social Worker Claro Clinic – 021 595-8922 Tharagay House - 021 762-2425 Alcoholics Anonymous - 021 510-2288 Kenilworth Clinic - 021 763-4500 1 st Step - 021 423-6431 Addicition Action Campaign Website Local police University ethics department

16. Questions?