sheet - alcohol use in South Africa
Alcohol and Drug Abuse Research Group, Medical Research Council
of acute alcohol intoxications in South Africa
misuse is causally implicated in a range of chronic health
problems (e.g. cirrhosis of the liver). However, many of the
primary effects of alcohol misuse occur from episodes of acute
alcohol intoxication is associated with increased mortality
and morbidity arising from intentional and non-intentional
alcohol intoxication is also associated with unsafe sexual
practices and increased risk of contracting a sexually transmitted
misuse, combined with poor nutritional status, increases susceptibility
to opportunistic diseases by compromising the immune system.
misuse of alcohol during pregnancy has been linked to fetal
alcohol syndrome in infants.
misuse also impacts on the criminal justice system, with evidence
of associations between drinking at risky levels, committing
crime, or being a victim of crime.
a few statistics that highlight the particular burden experienced
by South Africa from alcohol abuse:
statistics (2002) – MRC/UNISA
In Cape Town, Durban, Gauteng, and Port Elizabeth (PE), 45%
of all non-natural deaths had blood alcohol concentrations
(BACs) greater than or equal to 0.05g/100ml (Durban: 37%,
Gauteng: 40%, Cape Town 53%, PE: 61%). The national figure
was 46%. Levels of alcohol were particularly high for transport-related
deaths and homicides, with 63% of transport-related deaths
and 69% of homicides in PE, for example, having levels above
the legal limit for driving (0.05g/100ml).
unit statistics (2001) – MRC
In Cape Town, Durban and PE, 39% of trauma patients had breath
alcohol concentrations (BrACs) greater than or equal to 0.05g/100ml
(Durban: 22%, Cape Town 36%, PE: 57%). Levels of alcohol were
particularly high for transport- and violence-related injuries
with, for example, 73% of patients with violence-related injuries
in PE and 46% of patients with transport-related injuries
in Cape Town having levels above the legal limit for driving
Demand for specialist treatment services (2003) – MRC
Of 5886 persons treated at 52 specialist substance abuse treatment
centres in Cape Town, Durban, Gauteng, Mpumalanga, and PE
in the first half of 2003, 52% reported having alcohol as
their primary drug of abuse, with a further 13% having alcohol
as a secondary drug of abuse.
alcohol syndrome – FARR/Wits (1997-2003)
In research conducted in the Western Cape (Wellington), the
prevalence of FAS among Grade 1 learners was found to be 46
per 1000 in 1997 and 75 per 1000 in 1999. Similar research
conducted in Gauteng and De Aar in 2001, and Upington in 2003
found FAS prevalence rates of 19, 103 and 75 (estimate) per
and risky sex (2003) - MRC
Research conducted in Atteridgeville among persons aged 25-44
years found a significant positive association between various
measures of alcohol use (past month use, frequency and problem
use) and having multiple sexual partners or sexual relations
that are regretted in the past 3 months. For example, the
correlation between quantity of alcohol consumed and the number
of sexual partners (lifetime) was 0.436 (p<0.001).
and family violence (2000) – MRC
Between one-third to a half of arrestees in Cape Town, Durban,
and Johannesburg charged with offences categorised as “family
violence” reported being under the influence of alcohol
at the time of the alleged offence.
failure and absenteeism (1997) – MRC/UCT
Among grade 8 and 11 learners in Cape Town a significant association
was found between past month use of alcohol and the number
of days absent from school and repeating a grade. For example,
the odds of repeating a grade at school was found to be 60%
higher for learners who consumed alcohol.
other statistics visit our SACENDU
to address alcohol abuse in South Africa
international experience (e.g. Babor et al. 2003) the following
strategies to address alcohol abuse are likely to be most effective:
Regulating physical availability
Implementing a coherent and enforceable policy regarding liquor
Effective restrictions or controls on access (limits on
days and hours of business and addressing public drunkenness;
restrictions on (i) sale of alcohol to drunk persons,
(ii) the supply of liquor to employees, (iii) the sale/supply
of harmful alcohol or packaging, and (iv) restrictions
on outlet locations (especially at/near educational institutions,
petrol stations, residences, multi-dwelling housing units,
places of worship); regulating the types of liquor sold
in supermarkets and grocery and convenience stores; preventing
the purchasing by minors or supply to minors; regulating
the use of alcohol in motor vehicles; and prohibiting
the sale of alcohol through vending machines).
Adequate education and training of the public at large
and persons who own or manage liquor outlets or who serve
Strengthening community input in the process of allocating
liquor licenses and dealing with complaints, requiring
stricter regulations on those liquor outlets in residential
areas not in business nodes or along corridors, implementing
a programme for encouraging existing unlicensed outlets
to become licenced and to move to business nodes or corridors.
Ensuring improved enforcement and handling of complaints.
Providing increased access to information and improved
Increasing levels of taxation on different alcohol products
towards to international levels
In particular, malt beer should be raised to the international
average total tax burden of 37 per cent and commercial
sorghum beer and sorghum powder should be increased to
approximately 50 per cent of that of malt beer (as a percentage
of retail sales price).
Implement more effective drink-driving counter-measures
Random-breath testing of drivers (both professional and
ordinary drivers) needs to be increased as a matter of
Allowance should also be made for automatic administrative
license suspension in cases where drivers are caught with
alcohol levels above the allowable limits (0.05 g/100
ml for ordinary drivers and 0.02g/100 ml for professional
Implement a policy of graduated licenses for novice drivers,
whereby persons who receive a driver’s license for
the first time are not allowed any alcohol in their systems
while driving for a period of 3 years.
Allow traffic police to test alcohol levels of pedestrians.
Implement brief interventions for high-risk drinkers
Such interventions typically consist of one to two sessions
of counseling and education. The intention is to motivate
high-risk drinkers to moderate their alcohol consumptions.
This is generally done in primary care settings.
Implement effective treatment programmes for drinkers dependent
for alcohol dependence can occur in an outpatient or an
Three models of treatment have been shown to be effective
in treating alcohol dependence: Twelve Step Facilitation
(based on the Minnesota model and AA principles); Motivational
Enhancement Therapy (also known as Motivational Interviewing);
and Cognitive Behavioural approaches that include relapse
After treatment, treatment gains tend to be better maintained
if the person becomes actively involved in AA or other
recovery support groups and develops family and peer relationships
that are supportive of recovery.
serious consideration should be given to bring labeling on alcohol
containers up to the standard of other products. Labels should
content and standard servings ( list (i) the number
of standard drinks per container and the amount of alcohol
in a standard serving, and (ii) the South African Food Based
Dietary Guidelines on sensible drinking alcohol: no more than
two standard drinks per day for women or three drinks per
day for men).
information and ingredients. Labels should list calories
per serving so consumers concerned about excess weight could
put alcoholic beverages in the context of their diet, and
labels should list ingredients so that consumers can compare
beverages in terms of food allergies.