We know South Africans drink too much - this is why
Being single and boozing in a shebeen or nightclub are two factors linked to high alcohol consumption in SA
If you drink alcohol out of a container that’s above the average size, you’re eight times more likely to be a heavy drinker.
The finding, across all types of drink, is one of the most striking outcomes of new research that aimed to find out why South Africans drink so much more than adults elsewhere.
Other factors linked to heavy drinking are being single and doing most of your boozing in nightclubs, someone else’s home or a shebeen.
Researchers from the Medical Research Council and Boston University medicine school in the US found: The heaviest drinkers account for 94% of all alcohol consumed;
70% of men and 30% of women are heavy drinkers;
93% of all alcohol is consumed on heavy-drinking occasions;
Stout and beer are the drinks most clearly linked to heavy drinking, while only cider reduces its likelihood; and
People who mainly drink at restaurants have the lowest risk of heavy drinking.
Data for the study, which looked at 713 adults in Tshwane, came from the SA arm of the International Alcohol Control study in 2014.
Writing in the journal Substance Abuse Treatment, Prevention, and Policy, Charles Parry of the MRC alcohol research unit said 53% of the sample were heavy drinkers.
Parry and colleagues defined heavy drinking as consuming eight standard drinks (men) or six drinks (women) at any location at least monthly. They said this was an “extreme” definition that went beyond World Health Organisation guidelines.
Seventy-two percent of people who drank from containers that were above-average size were heavy drinkers.
People who had never married were almost three times more likely to be heavy drinkers than married people, and those who were separated had 4.45 times the odds of heavy drinking as married people.
Parry said SA’s history provided clues to the country’s heavy drinking compared with others in the international study.
“At the end of apartheid, South Africa inherited a large number of informal alcohol outlets existing outside of the formally regulated business sector,” he said.
“Shebeen owners were often undeterred by consequences established using the regulatory framework. In addition, shebeens were an integral part of the social fabric of South Africa, as there were often few recreational opportunities outside of these establishments.”
National alcohol policy did little to control heavy drinking, said Parry. “South Africa does not have national restrictions on the days, hours, location, or density of alcohol outlets, and it uses voluntary/self-regulation for most types of advertising and product placement.
“Other factors likely to play a role in South Africa’s extremely high levels of heavy drinking include high levels of poverty and social inequality, and experience of and exposure to interpersonal violence.”
Parry said the role of the alcohol industry was also key to understanding SA’s heavy drinking. “[The industry] often argues that alcohol-related problems only affect a subset of drinkers and the majority of drinkers consume alcohol ‘responsibly’, but these data strongly contradict that conclusion,” he said.
The findings about how container size promoted heavy drinking also pointed to the alcohol industry. “Beer containers in South Africa often contain two or more standard drinks,” he said, and some beer now came in litre bottles that were three times the size of a standard 330ml drink.
Parry said the study underscored the importance of legislative plans to: Raise the minimum legal alcohol purchase age from 18 to 21;
Establish a 500m buffer between alcohol outlets and other outlets or sensitive locations such as schools and places of worship;
Hold alcohol manufacturers and suppliers liable for damages resulting from consumption of their products; and
Introduce new curbs on alcohol advertising. The lead author of the new study, Pamela Trangenstein from Boston University, said: “Given the atypically high prevalence of heavy drinking among South African drinkers, upstream approaches like the policies outlined in the [proposed new laws] have the potential to prevent a wide array of harms by focusing on a common root cause: alcohol.”