A teenage girl dies after being smashed into by a car driven by a drunkard. A group of intoxicated youngsters carry in a bleeding friend, stabbed during a petty argument. A tearful woman sits quietly while a nurse bandages the gash in her head inflicted by her drunk partner.

These alcohol-related incidents are common in hospital casualty units throughout South Africa.

They are the grim result of South Africa’€™s classification as one of the world’€™s hardest drinking nations, where 10-12 litres of pure alcohol per adult were consumed in 2000.

The point is, we just don’€™t know when to stop. A quarter to a third of all drinkers get drunk over weekends rather than enjoying a few quiet tipples, according to the SA Demographic and Health Survey.

The consequences of this heavy drinking are severe. In 2002, almost half the victims of “non-natural” deaths (mainly homicides and car accidents) were over the legal limit of 0.05g of alcohol per 100ml of blood.

Alcohol played a role in over half (53%) of all homicides, including 76.7% of stabbings, according to the National Injury Mortality Surveillance System (NIMSS), which investigates the causes of ‘€œnon-natural’€ deaths.

In 2000, up to half the people charged with “family violence” in Cape Town, Durban and Johannesburg said they were drunk at the time of the offence. In De Aar in the Northern Cape, the mental development of one in10 children has been permanently damaged by their mothers drinking while pregnant ‘€“ one of the highest rates of foetal alcohol syndrome in the world.

‘€œThe social cost associated with alcohol abuse is conservatively estimated to be R9-billion, or one percent of our gross domestic product,’€ says Professor Charles Parry, who directs the Medical Research Council’€™s Alcohol and Drug Abuse Research Group.

But how does government clamp down on alcohol abuse without becoming what Dr Chan Makan of the Industry Association for Responsible Alcohol Use (ARA) describes as a “nanny state”?

ARA, which represents the country’€™s major liquor companies including SABMiller and KWV, supports a number of responsible drinking campaigns.

Most players agree that banning alcohol has not worked anywhere in the world. In apartheid South Africa, the selective ban on alcohol for black people gave rise to the hundreds of thousands of illegal shebeens that today are very difficult to regulate.

Even the SA National Council on Alcoholism and Drug Dependence (SANCA), which helps to rehabilitate alcoholics, believes that a ban on alcohol would be counter-productive.

Instead, says SANCA Durban’€™s Walter Petersen, communities need to be taught how to drink responsibly and the sale of alcohol to young people needs to be tightened up.

‘€œThe liquor trade seems to have targeted the most vulnerable, the youth,’€ says Petersen. ‘€œThese so-called designer drinks are promoted as being different to hard alcohol.’€

While he also supports warnings on the bottles, Petersen says the main weapon against excessive drinking is education, but that this is ‘€œa long term, slow moving process’€.

Last year, the health department promised to publish regulations to “counter the intensive promotion of alcohol consumption”, including “limiting advertising times for alcoholic products and introduction of warning labels on these products”.

Regulations have not yet been published, although the health department’€™s acting director of the substance abuse directorate, Sifiso Phakathi, claims these will be ready ‘€œsoon”.

However, provinces have the power to regulate how liquor is sold and the Western Cape has been working on this for a number of years. Its draft liquor policy, which was published for comment last year, is expected to come before the legislature this year.

According to the draft policy, it will be an offence to be drunk in public or to sell alcohol to drunk people. It will be illegal to drink in vehicles while driving or parked in public places.

It will also be illegal for employers to provide alcohol to employees as part of their wages.

Shebeens that have traditionally operated from people’€™s homes will be encouraged to relocate to more suitable areas ‘€œthrough a programme of incentives and enforcement’€.

But regulating alcohol consumption is complicated and difficult. Phakathi says government’€™s alcohol interventions are ‘€œin so many ways similar to the tobacco interventions’€.

But unlike smoking, there is some merit in moderate drinking with a fairly substantial body of research showing that moderate drinkers are at less risk of heart attacks than teetotallers.

ARA’€™s Makan warns that, if liquor manufacturers are forced to put warning labels on their bottles, they might well counter by advertising the benefits of moderate drinking ‘€“ something they have voluntarily refrained from doing.

But Parry, who was part of the panel that drafted the Western Cape policy, believes that promoting the merits of moderate drinking is inappropriate in South Africa with our large youth population and patterns of heavy drinking.

“The benefits of moderate drinking are typically for older people, men over 40 and postmenopausal women, and can be gained from as little as a drink every other day,” says Parry. “These benefits can also be obtained in other ways such as by exercise, giving up smoking or taking an aspirin. Drinking to intoxication certainly negates any positive effects of alcohol use,’€ he warns.

Makan also says that banning drink advertisements has little effect on liquor consumption, as advertising primarily influences brand loyalty.

‘€œThere is a high level of alcohol abuse in De Aar, for example, but that community has little exposure to alcohol advertisements,’€ he says.

‘€œThe risk factors for alcohol abuse are poverty, lack of recreation, unemployment and poor education,’€ adds Makan. ‘€œYou can’€™t address alcohol abuse without addressing these.’€

Parry believes government’€™s response to alcohol abuse is inadequate and fragmented.

For him, priorities are to enforce no alcohol sales to those under the age of 18, to increase taxes to international levels and to implement a coherent policy for liquor outlets, including ensuring that unregistered shebeens are brought into the regulated market.

He also believes in more effective drink-driving measures. These include many more random breathalyser tests, a graduated license policy for newly licensed drivers whereby they will not be permitted to drink and drive for three years after obtaining a drivers license, license suspensions for drivers above the legal limit and counselling for high risk drivers.

But as Linda Dhabicharan, director of Childline KwaZulu-Natal, says in the latest issue of ‘€œChildren First’€: ‘€œIndividuals do not become violent because they are drunk. They get drunk to become violent. Alcohol allows people to engage in deviant behaviour as they wish, without holding themselves responsible for the outcome.’€

To address effectively the root causes of alcohol abuse, many other social factors including poverty and the disintegration of families, will need to be addressed.

E-mail Kerry Cullinan