Response to commentaries

Abstract

We appreciate the thoughtful points made by the commentators on our paper regarding preventing intoxication at bars 1. Rossow 2 raises the difficulty in finding acceptable criteria for intoxication that will be agreed upon by all, noting that the hospitality industry may not accept criteria that researchers consider reasonable. However, we would argue that the setting of criteria is a political rather than a technical problem. Interventions to prevent drinking and driving also encountered measurement controversy from those who found a blood alcohol level (BAL) criterion as too arbitrary—namely, that BAL does not provide a valid indicator of impairment, because people's impairment at specific BALs will differ depending on their experience with and tolerance for alcohol. Thus, it was a political as well as a technical decision that defined a certain BAL as per se ‘impaired’ or ‘illegal’ for driving, regardless of the drinker's experience with alcohol or visible signs of impairment, with this decision backed by research on impairment at different BALs. In the same way, given the political will to do so, it should be possible to adopt a specific standard for intoxication of bar patrons (e.g. showing all the following signs of intoxication: staggering, slurring words, losing balance, etc.) which, with current technology, could be easily backed up by video evidence of these signs if needed for prosecution. A problem with enforcement of serving laws in many jurisdictions is that, although serving intoxicated people is prohibited, intoxication is a gradient, not an all-or-nothing phenomenon, and jurisdictions often have no precise standard for when a person should be considered legally intoxicated from the perspective of serving practices. Even where extensive information is provided about the signs of intoxication (e.g. https://assets.justice.vic.gov.au/vcglr/resources/013e425a-b64b-42ea-bf8b-cccc2e85f74a/intoxicationguidelines.pdf), guidelines do not identify which and how many criteria need to be satisfied for a violation to have occurred. Therefore, similar to drinking driving prevention, it is a matter of political will to define per se intoxication, backed by research demonstrating that people showing specific observable signs of intoxication are, indeed, intoxicated by other objective criteria (e.g. high BAL). Recent research engaging bar patrons on the street has successfully shown that such identification can be made very reliably 3. We agree with Rossow that lack of political will is a challenging impediment to overcome in preventing bar-related intoxication. It is not only a matter of the hospitality industry protecting their economic interests, but also the broader economic benefits that many communities experience from a vibrant night-life. Again, there may be a lesson to be learned from drinking driving prevention, namely, focusing enforcement, at least initially, on high levels of intoxication. Initially, BALs for impaired driving were set relatively high (e.g. 0.10), with various jurisdictions lowering the cut-off with growing acceptance of this approach to prevention 4. Thus, as we note in the paper, a focus of enforcement on criteria reflecting severe intoxication might be less in conflict with local industry and ‘Corporate Social Responsibility’ (CSR) generally than a general focus on vaguely defined ‘intoxication’. For one thing, very inebriated individuals are more likely to experience more personal harms and cause more social and economic problems for society and the bar itself. Moreover, this focus would be consistent with CSR self-interests in promoting ‘responsible drinking’. However, as noted by Pantani 5, this does not mean that addressing intoxication should be left to the industry to manage—there is ample evidence that effective prevention cannot be achieved through self-regulation or voluntary accords alone (see e.g. 6). Although the industry may be more amenable to enforcement efforts that focus on extreme intoxication, previous experience suggests that industry preference is to avoid any enforcement, which they have managed successfully in many jurisdictions to date by focusing on both the gradient and the ambiguity of intoxication. There is no guarantee that enforcement focused only on severe intoxication will have a broad impact on intoxication of bar patrons generally; however, this approach provides a start towards more systematic and meaningful enforcement and is likely to be more effective than the status quo, which is an almost total lack of enforcement. It could also result in licensees and producers being more willing to adopt strategies that reduce risk of intoxication while maintaining profitability, such as promoting lower alcohol content drinks, as noted by Anderson 7. The injuries and violence associated with intoxication in night-time economies are mostly preventable, and this debate has demonstrated clearly that, along with more research and creativity, the key factor is political will. Many communities want to reduce night-life-related intoxication and related problems, but such efforts are currently hampered by the success of the hospitality industry in disputing intoxication charges. We argue that this problem can be addressed by applying lessons from impaired driving, especially defining and adopting a clear and enforceable standard for enforcement. None.