We have a problem in Ontario. We expect the best services possible from our provincial government, but we don’t want to pay higher taxes. This creates a dilemma: how to get money into the public purse to pay for the services we demand without taxing folks. Enter two ‘exciting’ options: more profits from alcohol by increasing sales, and from gambling by increasing gambling venues. The people of Ontario benefit both ways, don’t we? More fun times through more drinking and more playtime through more gambling, AND all that extra money goes to socially needed causes! What’s there to object to about that?
The top 10% of drinkers consume over 50% of alcohol that is sold…most, if not all, of those individuals would qualify for some sort of addiction treatment.
Let’s just focus for a minute on alcohol, because we are getting an accelerating patter of news stories over the past weeks and months about allowing alcohol sales in grocery stores across the province. So what should we be concerned about? First of all, we know that presently over half of the alcohol consumed in Canada is consumed by the 10% of drinkers who drink the most. Let me say that again: the top 10% of drinkers consume over 50% of alcohol that is sold! Here’s the kicker: the evidence suggests that most, if not all, of those individuals would qualify for some sort of addiction treatment. Alcohol use disorder, in the DSM5, exists along a spectrum from mild to severe. We know that about 5% of drinkers would meet criteria for severe alcohol use disorder. The data suggest that at least another 5% have mild to moderate symptoms. Some reports suggest that the number is higher, but let’s just keep it simple and say 10% of drinkers who drink the most would meet diagnostic criteria for some form of addiction treatment. What does this have to do with public policy? For one thing, we need to think about the fact that half the money that Ontario makes on alcohol sales currently comes from people who have an alcohol use disorder. How should we be feeling about that, especially if we espouse to be caring community? Why do we want to weaken current public policy in order to increase alcohol sales revenues, when half of current alcohol revenue comes from people experiencing harms from drinking and are eligible for treatment services because of that fact?
The reality is that for many people alcohol causes harm. It affects individuals, their families, their workplaces, their choice of leisure time, their mental and physical health. Alcohol is a factor in about 30% of cases of acquired brain injury, in 50% of reports of domestic violence. In fact, when the costs of current alcohol consumption are factored in and compared with the benefits, it comes out a net loss. Those of us who provide addiction treatment services know the real stories of individuals and their families all too well. And all of us, if we thought about it, would realize the downside of alcohol consumption, not just in the news, but in our own families, in our colleagues, in our friends, in our neighbourhoods, perhaps even in ourselves. And that should caution us against expanding the sale of alcohol and encourage us to look to other approaches to government revenues, including increasing the purchase price. For more on revenue generating options see this recent blog by Norman Giesbrecht.
The reality is that for many people alcohol causes harm.
If you look at alcohol prices and sales practices across the provinces, you will see some interesting differences. Quebec has beer available in corner stores, has the cheapest prices, and has the highest rates of consumption. Ontario is somewhere in the middle in terms of pricing. But if you want to raise more revenues, why not just raise the price? The consumer price index in Canada has increased by nearly 10 points in the past 5 years, but the price of alcoholic beverages has increased by less than 3 points. Effectively, in Ontario, alcohol costs less, compared to other products, than it did 5 years ago. If we want more money from alcohol sales, price it to at least keep up with inflation.
One last observation about alcohol from a clinical perspective: over half the people who use specialized addiction services in Ontario give alcohol as their primary substance of abuse. If there is one drug to focus on to make an impact on the harms of addiction in our communities, that drug is alcohol. If we were to add a nickel (5 cents) to the cost of every standard drink consumed in Ontario (we consume over 4 billion standard drinks every year), we would have over $200M to invest on preventing, treating and researching addictions. Currently, Ontario spends only 3/4th that amount on all specialized substance use treatment services, alcohol and illicit drugs combined. We need a more robust addiction strategy that takes more action to prevent and treat alcohol and drug problems. One way to fund it is take money off the top as people spend it consuming alcohol, not by promoting consumption by making alcohol more available.