Alcohol and substance use among adults and juveniles in Poland

Alcohol and substance use among adults and juveniles in Poland:
Facts, policy and attitudes (April 2011)
Project: AAA PREVENT, Workpackage 4
Jacek Moskalewicz, Phd,
Agnieszka Pisarska M.A.
Correspondence to: Jacek Moskalewicz ([email protected])
Institute of Psychiatry and Neurology, 9 Sobieskiego Str., 02-957 Warsaw, Poland
Word count: Introduction: 511 words. State of the art: 1303 words. Policy: 1535 words. Attitudes:
1400 words. Manuscript text (total): 5432 words. 8 tables, 1figure
Abstract
The aim of the report is to present data on alcohol and other drug use as well as tobacco smoking,
with special attention paid to consumption patterns among 12-18 years old. A number of data
sources were used including statistics collected by the Central Statistical Office (GUS) and the
Institute of Psychiatry and Neurology, surveys carried out by Public Opinion Research Center (CBOS),
ESPAD and HBSC studies, local surveys and the WHO data.
Poland belongs to the ten top alcohol consumers in Europe. The rapid increase in alcohol
consumption in the 1990s was strongly associated with the
socio-economic transition. A highly
centralised system of alcohol control with focus on supply reduction was replaced by liberal alcohol
legislation while distribution of alcohol was privatised.
Current policy is focused on alcohol
education targeting mostly school children as well as zero tolerance policy towards the under-aged.
Another pillar of contemporary alcohol policy is specialised alcohol treatment.
Parallel to rising alcohol consumption among adults, prevalence of drinking and drug taking rose
among youngsters. Comparison with other countries shows, however, that prevalence of drinking
among young Poles is a bit lower.
1
A. Introduction
Poland is the medium size country with approximately 38 million of inhabitants living on 312 679
square kilometres with population density of 122 persons on a square kilometre. More than half of
the Polish inhabitants (61%) live in towns with more than 20. 000 inhabitants (GUS, 2009)1.
Currently Poland belongs to the ten top alcohol consumers in Europe. The rapid increase in alcohol
consumption in Poland in the 1990s was strongly associated with the socio-economic transition
which led to significant liberalization of alcohol control. Physical availability and affordability of
alcohol had remarkably increased. Number of alcohol outlets rose from about 30 thousand to about
200 000 while relative price of vodka declined several times (Moskalewicz & Wieczorek 2010)2. The
opening of the borders and more intensive diffusion of consumption patterns as well as marketing
strategies of alcohol industries are also underlined
in literature as factors which created and
reinforced alcohol demand, “particularly for new drinks and in new groups of drinkers” (Wojtyniak
et al., 2005 p. 1786)3. Many of these strategies were targeted at young people, “combining youth
culture with beer consumption” (Moskalewicz, 2000, p. 574) 4.
Data collected among representative sample of Polish adults (18-year-olds+) by Public Opinion
Research Centre in the beginning of 2010 indicated that about half of adult Poles (50%) claim that
they drink alcohol only from time to time on special occasions. Small group of respondents declared
frequent or rather frequent alcohol use (7%). Approximately 20% of respondents answered that
they never had alcohol (CBOS, 2010)5.
In 2007 recorded per capita consumption was to 9.6 litres of ethanol and unrecorded consumption
amounted to 3.7 litres (13.3 total). Beer is the most popular alcohol beverage constituting more
than half of the recorded adult alcohol consumption while spirits constitutes one third and wine
around 12% (WHO, 2011)6. Currently, Poland is fifth beer consumer per capita in Europe after the
Czech Republic, Ireland, UK and Germany (Moskalewicz, Wieczorek 2009)7.
1
GUS (2009) Area and population in the territorial profile in 2009. Central Statistical Office. Warszawa
2
Moskalewicz J., Wieczorek Ł. (2009) Dostępność, konsumpcja alkoholu i konsekwencje picia – trzy dekady doświadczeń
(Affordability and availability, alcohol consumption and consequences – three decades of experiences). Alkoholizm i
Narkomania, 22 , 4, 305-337.
3
Wojtyniak B., Moskalewicz J., Stokwiszewski J., Rabczenko D. (2005) Gender-specific mortality associated with alcohol
consumption in Poland in transition. Addiction, 100, 1779-1789.
4
Moskalewicz J. (2000) Alcohol in the countries in transition: the Polish experinces and wider context. Contemporary Drug
Problems, 3, 561-592.
5
Feliksiak M. (2010) Postawy wobec alkoholu (Attitudes toward alcohol). Public Opinion Research Center (CBOS). Warszawa.
6
WHO (2011) Global Status Report on Alcohol.
2
Approximately 30% of adults smoke cigarettes (38% males and 23% of females). This result was
confirmed in two independent studies, i.e., the Central Statistical Office (GUS) study conducted in
2004 among 18+ respondents and the Public Opinion Research Center (OBOP) study conducted in
2007 among
15+ respondents. Cigarettes smoking was most prevalent among 40-year–olds
(Piekarzewska, 2004; Feliksiak, 2007)8 9. It is worth adding that between 2004 and 2009 proportion
of adults
smoking cigarettes regularly degreased from 30% to 26% (Zajenkowska–Kozłowska &
Piekarzewska, 2009)10.
Illegal drug use among adult population was much less prevalent. In the GUS study only 1,5% of
adults respondent confirmed cannabis use during their life (Sierosławski, 2006)11. According to OBOP
data 4% of adults 18+ used illegal drug in their life. It is worth adding that illegal drug- mainly
marihuana use was reported by younger respondents only. In the OBOB study nobody from the group
of 35-year-olds and older respondents
confirmed illegal drug use. Moreover, two thirds of
respondents do not make distinction between soft and hard drugs, in particular older respondents
were ignorant with this regard (Feliksiak, 2007)12.
B. State of the art : How big is this problem in your country?
Alcohol use among adults
Between 1990 and 2007 recorded alcohol consumption increased by 50% from 6 litres to over 9
litres of pure alcohol per capita. According to estimations for 2006 per capita alcohol consumption
exceeded 12 litres (recorded 8.9 litres, unrecorded 2.3 litres) (Moskalewicz & Wieczorek, 2009) 13
and 14.4 litres per inhabitants aged 15+. Respective figure for drinkers only would reach 18 litres
per drinker (28.5 for males and 7.5 for females).
7
Moskalewicz J., Wieczorek Ł. (2009) op.cit.
8
Piekarzewska M. (2006) Palenie tytoniu przez osoby dorosłe (Cigerettes smoking among adults). (in.) Stan Zdrowia
Ludności Polski w 2004. Central Statistical Office (GUS), Warszawa.
9
Feliksiak M. (2007) Postawy wobec wybranych substancji psychoaktywnych (Attitudes toward selected psychiactive
substances). Public Opinion Research Center CBOS). Warszawa.
10
Zajenkowska-Kozłowska, A., Piekarzewska M. (2009) Europejskie Ankietowe Badanie Zdrowia w 2009. Notatka
informcyjna. (European Health Interview Survey in 2009). Central Statistical Office (GUS), Warszawa.
11
Sierosławski J. (2006) Używanie substancji psychoaktywnych innych niż alkohol i tytoń przez osoby dorosłe w wieku 15-64
lata (Other than alcohol and tobacco substance use among adults aged 15-64). (in.) Stan Zdrowia Ludności Polski w 2004.
Central Statistical Office (GUS), Warszawa
12
Feliksiak M.(2007) op. cit.
13
Moskalewicz J., Wieczorek Ł. (2009) op. cit.
3
Table 1 about here
Substance use among youth
There are three sources of data on alcohol and drug consumption among adolescents used in this
report.
First source is
Health Behaviour in School-Aged Children (HBSC)
- international study
related to the health of 11, 13 and 15-year-old adolescents. HBSC has been conducted in Poland
since 1990 (Mazur et al., 2007)14. Second source of data is European School Survey Project on
Alcohol and Drugs (ESPAD) related to substance use among 15-16 year- and 17-18-year-old students,
conducted in Poland since 1995 (Sierosławski, 2007)15. In order to describe a history of substance
use among youth in the period of political and economical transformation we also present data of
Mokotów Study, local project conducted in Warsaw since the mid-1980s (Ostaszewski & Pisarska,
2008)16.
Despite some methodological differences between HBCS and ESPAD, measures of alcohol
consumption, drunkenness and cannabis use are highly co-related between both surveys (Hibell, et
al., 2007)17.
Alcohol
As can be seen from table 2 results of HBSC study showed that at the age of 11-12 years
approximately 50% of Polish adolescents ever tried alcohol beverages (55% of boys and 50% of girls).
Moreover, data of 15-year-old HBSC respondents indicated that 22% of them drunk first alcohol
drink at the age 11 or earlier. HBSC data also indicated that 10% of 11-12-year-old students were
drunk at least ones in their life (14.4% of boys and 6% of girls). Between age 12 to 16 alcohol
consumption among students increases steadily and by the age of 16 years approximately 90% of
14
Mazur J., Woynarowska B., Kołoło H.(2007) Zdrowie subiektywne, styl życia i środowisko psychospołeczne młodzieży
szkolnej w Polsce. Raport techniczy z badań HBSC 2006 (Subjective health, life style and psychosocial environment of
school-children in Poland. HBSC 2006 technical report). Instytut Matki I Dziecka, Warszawa.
15
Sierosławski, J. (2007) Używanie alkoholu i narkotyków przez młodzież szkolną. Raport z ogólnopolskich badań ankietowych
zrealizowanych w 2007 r. IPiN (Alcohol and drug use among school children. The ESPAD Polish report). Warszawa
http://parpa.pl/download/Raport%20ESPAD%202007%20Polska1.pdf
16
Ostaszewski, K., Pisarska, A. (2008) Trends in adolescent substance use: The Mokotów study 1988-2004. Drugs: Education,
Prevention & Policy, 15, 4, 378-394.
17
Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., Kraus, L. (2007) The 2007 ESPAD
report. Substance use among students in 35 European countries. The Swedish Council for Information on Alcohol and Other
Drugs (CAN), The European Monitoring Centre to for Drugs and Drug Addiction (EMCDDA) Council of Europe, Pompidou
Group. http://www.espad.org/documents/Espad/ESPAD_reports/2007/The_2007_ESPAD_Report-FULL_091006.pdf
4
Polish students reported alcohol use during their life (Mazur et al., 2007)18. ESPAD data showed
that at the age of 17-18-year only 5% of boys and girls remain abstainers (Sierosławski, 2007)19.
Graph 1 about here
Current alcohol use (i.e. drinking alcohol at least once in the past month) was reported by 50%
(HBSC) and 57% (ESPAD) of 15-16-year-olds. Among 17-18-year-old ESPAD respondents 80% reported
current alcohol use and more than half of them was drunk at least once during the past year. Girls
in Poland still drink less than boys. For example, according to ESPAD data 76% of 17-18-year-old
girls in comparison to 83% of boys have drunk alcohol and 23% of girls in comparison to 41% of boys
got drunk at least once in the past month.
On the other hand, data gathered among 15-year-old
Warsaw students showed that until 2000 boys much more frequently than girls drank high amounts
of alcohol and got drunk but between 2000 and 2004 girls caught up with boys in current alcohol use
and drunkenness. In 2008 more 15-year-old girls than boys (52.8 vs 47.2; p<0.05) reported current
alcohol
use but
as before year 2000 more boys than girls (25% vs 18,1%: p>0.01)
reported
drunkenness at least once during the last month. These gender-specific changes in current alcohol
use among Warsaw students were much stronger that those observed in the national ESPAD study.
Beer is the most popular alcohol beverage among Polish students. According to HBSC data 22.5% of
11-12-year olds drank beer while 11.2% of them drank wine and 3.4 drank spirits in their life. ESPAD
data related to the prevalence of different alcoholic beverages are presented in table 3. As can be
seen, among older students beer is also the most prevalent beverage,
however, a half of 17-18-
year-olds drank vodka during the past month.
Table 3 around here
Comparison with other countries shows that prevalence of drinking among young Poles is a bit
lower. Proportion of 15 -16-year-old students reporting alcohol use at least once in their life is very
close to the ESPAD average (i.e. 90%). However, percentages of students using alcohol during the
last month are lower in Poland (57% versus 61%), getting drunk in the last year (31% versus 39%) and
having five or more drinks in one occasion in the last month (36% versus 43%).
There are no data on hospital intake of young people due to alcohol intoxication. However, the data
on out- and in-patient admissions due to alcohol disorders (F10) are available showing that a
number of people aged 18 years and younger in out-patient treatment varied between 1400-1700
(16.5 – 21.5 per 100 thousand) in the years 2005-2008 while those in residential treatment from 130
to 213 (1.5-3.0 per 100 thousand). Despite relatively low numbers, treatment data suggest growing
18
Mazur et al., (2007) op. cit.
19
Sierosławski (2007) op. cit.
5
trend in alcohol-related problems among adolescents (IPiN, 2005-2008)
20
. This trend is confirmed
by the police which identified over 19 thousands of the insober under-aged while 10 years earlier
less than 11 thousand (http://www.statystyka.policja.pl).
Trends
Political, cultural and economic transformation initiated in 1989 had a strong effect on healthrelated behaviours among Polish youth – including substance use. Alcohol consumption, cigarettes
smoking and illegal drug use by students increased rapidly by the mid-1990s. For example, Warsaw
Mokotów Study showed that between 1988 and 1996 percentage of 15-years-old abstainers
decreased form 25.5% to 10%. At the same time proportion of current alcohol users increased from
30% to 51% and proportion of student who got drunk in the last 30 days increased form 7.5% to 20%
(Ostaszewski & Pisarska, 2008)21. Between 1996 and 2008 prevalence of alcohol use stabilised, with
only one exception. In 2008 proportion of abstainers increased to 17% and this trend was especially
significant among 15-yer-old girls (Ostaszewski et al., 2009)22.
The results of the Mokotów Study
illustrating substance use trends among adolescents during the process of transformation
are
consistent with the ESPAD and HBSC data (Woynarowska & Mazur, 2000; Sierosławski, 2007;
Okulicz-Kozaryn & Borucka,2008)23 24 25.
Tobacco
According to Mokotów Study percentages of adolescents who had experiences with cigarettes
smoking during their life increased significantly between 1988 and 2000 from 21% to 33%. However,
between 2000 and 2004 proportion of smokers decreased to 26%. ESPAD survey showed similar
20
Zakłady psychiatrycznej oraz neurologicznej opieki zdrowotnej. Roczniki statystyczne 2005-2008. Instytut Psychiatrii i
Neurologii, Warszawa
21
Ostaszewski K.. Pisarska A. (2008) op. cit.
22
Ostaszewski K., Bobrowski K., Borucka A., Cybulska M., Kocoń K., Okulicz-Kozaryn K., Pisarska A. (2009) Raport techniczny
z realizacji projektu badawczego pn. Monitorowanie zachowań ryzykownych młodzieży. Badania mokotowskie (Technical
report on the project "Monitoring of youh risky behaviors. The Mokotow Study").
http://www.ipin.edu.pl/Raport_Badania_Mokotowskie.pdf
23
Woynarowska B., Mazur J. (2000) Zachowania zdrowotne i zdrowie młodzieży szkolnej w Polsce i innych krajach.
Tendencja zmin w latach 1990-1998 (Health related behaviours and health among school-children in Poland and other
countries. Trends of changes between 1990-1998). Katedra Biomedyczna Podstaw Rozwoju i Wychowania. Wydział
Pedagogiczny Uniwersytetu Warszawskiego. Warszawa.
24
25
Sierosławski J. (2007) op. cit.
Okulicz-Kozaryn, K., Borucka, A. (2008) Warsaw adolescent alcohol use in period of social change in Poland: Cluster
analyses of five consecutive surveys, 1988 to 2004. Addictive Behaviors. Vol. 33, 439-450.
6
results, i.e. decreasing trends had been observed between 2003 and 2007 (Sierosławski, 2007)26.
Differences between boys and girls in cigarettes smoking disappeared. It was evidenced by ESPAD
survey data (table 3). Moreover, Mokotów Study from 2008 showed that almost identical proportion
of girls (8.7%) and boys (8.2%) reported daily smoking (Ostaszewski et al., 2009)27. International
comparisons indicated that the lifetime and 30-days prevalence of cigarettes smoking among young
Poles were below the ESPAD average (Hibell et al., 2007).
Illegal drugs
Before the transformation, the illicit drug of choice in Poland was so called kompot home-made
opioid from domestic poppy straw. Kompot is an injectable fluid composed of variety of opiates
including morphine, codeine and heroin. Political and social change had brought a rapid increase in
both supply of and demand for new drugs. Drug market in Polish cities is not that different now
from those of large capitals of Western Europe countries (Moskalewicz, 2002)28. Currently, the most
prevalent illegal substance in Poland is marihuana as in other European countries. For example,
approximately 18.5% (HBSC) or 16% (ESPAD) 15-16-year-old
students reported smoking cannabis
during their life (table 3). Polish students, however, were below the ESPAD average in lifetime
marihuana use and close to average in current marihuana use (6% versus 7% ESPAD average). It is
worth adding, that prevalence of tranquilisers or sleeping pills without prescription was much higher
among Polish students, i.e. three time more frequent than ESPAD average (Hibell et al., 2007)29.
C. Policy toward alcohol and drugs: What is done on alcohol? A policy-typology and
description
Alcohol policy
By the mid-1980’s Poland had a highly centralised system of alcohol control with focus on supply
reduction. Alcohol production was monopolised by the State, except for cheap fruit wines. Alcohol
distribution was also controlled by the state as majority of shops, including grocery shops belonged
to huge co-operatives supervised by the state apparatus. Alcohol imports and experts were also run
exclusively by the State foreign trade companies. Alcohol Law On Upbringing in Sobriety and
Counteracting Alcoholism imposed that the number of alcohol outlets should be determined every
year by the Council of Ministers; relevant resolutions limited a number of outlets to 30 thousands.
26
Sierosławski J. (2007) op. cit.
27
Ostaszewski K. et. al., (2009) op. cit.
28
Moskalewicz J. (2002) Drugs in countries of Central and Eastern Europe. Editorial. European Addiction Research, 8, 4, 157-
158.
29
Hibell B. et al., (2007) op. cit.
7
Alcohol prices were determined centrally, by the Minister of Finances. Affordability was low; an
average monthly pay could buy around 30 bottles of vodka only.
Sales of any alcohol for minors below 18 years old was prohibited.
School education was in a
toddling stage in contrast to so called anti-alcohol propaganda targeting adults and consisting in
posters and folders with simple deterrent messages.
Specialist alcohol treatment constituted another pillar of alcohol policy. Poland had around 400
alcohol out-patient clinics and over 3 000 beds for alcoholics.
Public drunkenness was decriminalised as early as in the mid-1950’s. Parallel, a network of so called
sobering-up stations was established. The sobering-up stations had clearly harm reduction
character. Persons found heavily drunk in public places and less frequently at home could be
brought to the station to overnight. Some basic services were offered including bathing and morning
meal. Annually over 300 thousand people were kept to prevent public nuisance but also to prevent
injuries, criminal victimisation and also freezing in the winter time. Nevertheless, the sobering up
stations were perceived as punitive institution limiting personal liberty. In addition, a client had to
pay much for this service.
Already in 1989 centralised system of alcohol control broke due to rapid de-monopolisation and
privatisation of the economy. Huge semi-legal imports of alcohol led to rapid accumulation of
capital laying foundation of market economy. Distribution of alcohol was privatised and a number of
alcohol outlets multiplied to around 150 thousands in a course of few years to exceed 200 thousands
in the 2000’s. Affordability of alcohol increased too as combined effect of growing incomes and
lenient tax policies; currently an average monthly pay can buy four times more vodka than 25 years
earlier.
Alcohol legislation has substantially been liberalised. In particular, beer has achieved special status
and become excluded from majority of existing restrictions no matter its alcohol content. In result,
strength of beer increased by half from less than 4% to almost 6%.
All premises limiting alcohol availability in terms of the number of outlets, hours of operation were
delegated to local communities. Fees for alcohol licences were paid to local councils apparently in
order to fuel local alcohol policies. To increase their budgets local authorities were very keen to
offer alcohol licences. Alcohol control policies lost their advocates. Focus of alcohol policy shifted
towards alcohol education targeting mostly school children as zero tolerance policy towards the
under-aged was continued or even reinforced (Moskalewicz, Zieliński 2003)30. Besides official ban
alcoholic beverages are perceived by Polish students as easy to get. For example, 60% of 15-16 year-
30
Moskalewicz J., Zieliński A. (2003): Forgotten or neglected experiences with community action on alcohol. Nordic Studies
on Alcohol and Drugs. English Supplement, 20, pp. 5 -11.
8
old students were of the opinion that beer is very easily available for them, 46% perceived wine as
very easy to get and for 39% respondents vodka is easily available (Sierosławski, 2007)31.
Alcohol advertising had been formally banned already in 1982. In the 1990’s alcohol lobbies fought
for legalisation. Parallel, breweries massively advertised non-alcoholic beer clearly evading existing
law. Huge billboards and ads in newspapers were regularly shown targeting young people and
women. Eventually, in 2000 beer advertising was permitted with a long list of restrictions as regards
content (Dąbrowska, 2002)32. Currently, beer ads may be shown on television, radio and cinemas
between 20:00 and 6:00 as well as on billboards. However, a warning message has to be added
covering one fifth of the billboard.
According to the Law on Upbringing in Sobriety and
Counteracting Alcoholism:
“Advertisement and promotion in the territory of the country of any alcoholic beverage shall be
prohibited, except for beer, advertisement and promotion of which shall be permitted provided
that the same:
1.
is not targeted at the under aged,
2.
does not present the under aged,
3.
does not associate drinking alcohol with physical fitness or vehicle driving,
4.
does not include any statements that alcohol is a medical, stimulating, calming drug or a mean
to resolve personal problems,
5.
does not promote excessive alcohol drinking,
6.
does not present abstinence or reasonable alcohol drinking in a negative way,
7.
does not promote the high percentage of alcohol content in alcoholic beverages as a feature
improving their quality,
8.
does not form any associations with:
9.
sexual attractiveness,
10.
relaxation or leisure,
11.
learning or work,
12.
personal or professional success”.
In 1993 the State Agency for Prevention of Alcohol-related Problems was established as a
specialized government agency subordinated to the Minister of Health. The agency was set to
perform the following tasks (http://www.parpa.pl/):

preparation of a draft National Program for the Prevention and Solving of Alcohol-Related
Problems and a draft allocation of funds for its implementation;
31
Sierosławski J. (2007) rep. cit.
32
Dąbrowska K. (2002) Marketing alkoholu w Polsce (Alcohol marketing in Poland). Alkoholizm i Narkomania, 15 (4), 433-
445.
9

giving expert opinions and preparing alcohol and alcohol-related bills and action plans;

providing information and education, preparing expert opinions, and developing and
implementing new methods of prevention and solving alcohol-related problems;

providing advice to local authorities, institutions, associations and individuals who implement
tasks related to the prevention and solving of alcohol-related problems;

cooperating with municipal and provincial authorities in the area of prevention and solving of
alcohol-related problems;

coordinating and initiating actions that boost effectiveness and accessibility of detoxification
treatment services to the addicts and their families;

commissioning and financing tasks regarding the solving of alcohol-related problems;

cooperating with international organizations and institutions that operate in the field of
solving of alcohol-related problems;

intervening in the cases of infringing provisions stipulated in the "Law on upbringing in sobriety
and counteracting alcoholism" and appearing at courts as a public prosecutor.
The agency focused its activities on alcohol education, including school education and public
campaigns, launched continuous activities against family violence, raised problems of codependence and adult children of alcoholics. Huge efforts are made in alcohol treatment whose
capacity had to be substantially increased as a number of clients grew several times over last two
decades.
Key documents in the area of alcohol policy are:
Law on Upbringing in Sobriety and Counteracting Alcoholism of 1982 with hundreds of amendments
National Program of Prevention and Resolving Alcohol Related Problem 2011-2015
Drug policy
In 1985 Poland adopted a comprehensive Law on Drug Abuse Prevention which regulated both drug
supply and demand reduction. The law de-penalised drug possession without limiting its amount.
The de-penalisation was not followed by any increase in drug consumption. In contrary, prevalence
of drug use tended to decline for next five years. Treatment, and in particular therapeutic
community approach were made a major response to drug problem in Poland (Świątkiewicz et al.,
1998)33. Therapeutic communities run by health sector and even more often by NGO’s mushroomed
all over the country. A drug user was perceived first of all as a poor victim of drug use deserving
sympathy and treatment.
33
Świątkiewicz G., Moskalewicz J., Sierosławski J. (1998) Therapeutic Communities as a Major Response to Drug Abuse in
Poland, (in.) H. Klingemann & G. Hunt (eds.) Drug Treatment Systems in an International Perspective. Drugs, Demons and
Delinquents, Sage Publications, Thousand Oaks, London, New Delhi.
10
Harm reduction measures including syringe exchange and free provision of condoms were quickly
introduced as a response to outburst of HIV epidemic among injecting drug users (IVDUs) in the late
1980’s. These measures combined with intensive education about safer injecting and save sex led to
the substantial reduction of new infections from over 800 in 1989 to less than 300 in 1990 (Kulka &
Moskalewicz, 1998)34. Since then a number of new infections among IVDUs has varied between 250
and 300 for next 20 years.
Since the beginning of the 1990’s public debate on drugs has became dominated by criminal
aspects. The media exaggerated prevalence of drug use claiming that a number of drug addicts soon
would have become higher than that of alcohol addicts. Demands to introduce more punitive policy
were increasingly more frequent. In 1997 a new Law on Counteracting Drug Abuse was passed.
Penalties for drug-specific crimes were made more severe and drug possession was penalised except
for small amounts for personal use. In 2000 that exception was cancelled. Number of drug-related
crimes increased remarkably from several thousands in 1996 to 15 thousand in 1998, 20 000 in 2000
and 70 thousand around 2005. In 2005 new law was adopted which offered numerous options for
suspending criminal procedure. Number of drug-specific crimes levelled off.
In the last ten years new actors emerged in the drug policy. On the one hand, there has been a
movement demanding legalisation of cannabis. On the other hand, the so called drug policy network
became visible demanding comprehensive drug policy with focus on harm reduction, re-allocation of
resources from therapeutic communities to wider application of methadone maintenance, and depenalisation of drug possession.
Key documents in the area of drug policy:
Law on Counteracting Drug Addiction
National Programme on Counteracting Drug Addiction 2011-2015
D. Cultural attitude towards alcohol and drug use
There is a long tradition of surveys on social problems in Poland (Kwaśniewski, 1991)35 . For years
alcoholism was perceived among the most important social problems. In the mid-1990’s higher
34
Kulka Z., Moskalewicz J. (1998) Wpływ wymiany igieł i strzykawek na zakażenia HIV wśród narkomanów opiatowych w
Polsce (The effect of a needle and syringe exchange program on HIV infections among opiate users in Poland). Alkoholizm i
Narkomania, 1 (30), 29-40.
35
Kwaśniewski J. (1986) Problemy społeczne w świadomości zbiorowej (Social problems in public awarness). (in.)
Zagrożenia społeczne i warunki oraz środki ich przewyciężania. Część II. Zakład Narodowy im. Ossolińskich, Wrocław.
11
position in the ranking of social problems achieved unemployment and poverty (Moskalewicz,
Świątkiewicz 1998)36.
In the 2000’s alcoholism successfully competes in public perception with economic problems. In the
study carried out in 2008 respondents had to rank ten social problems such as economic crime,
crime against person, drug abuse, alcoholism and alcohol abuse, poor access to health services,
drop in living standards, family violence, street violence, drinking by youth and unemployment. Of
these problems unemployment, alcoholism, and economic crimes were indicated as the social
problem number one by around 15% of respondents. If percentages of respondents ranking problems
as number
1, 2 and 3 are summed up, alcoholism becomes a problem number one with 42%,
followed by unemployment – 36% and drop in living standards – 34%. In this ranking, drug abuse is
located as number 5 which is higher compared to previous years. Drinking by youth occupied a lower
position.
Majority of respondents expressed opinion that legal drinking age should be 18 but approximately
20% recommended a threshold of 21 years as regards vodka. On the other hand, 15-17% would
accept beer drinking by youngsters aged 15-17 years. Seventy seven per cent support a statement
that alcohol is not a commodity as any other and its distribution should be controlled by the State.
Every fourth respondent would be in favour of diminishing number of alcohol outlets while 2% only –
in favour of increasing distribution network (Fudała, 2008) 37.
Family attitudes
Parents of teenagers seem to be more restrictive as regards drug use and tobacco smoking
compared to alcohol. Over 90% of parents in Warsaw would demand total ban on drug use and
smoking while one third would accept alcohol drinking on special occasions by their teenage
children (Okulicz-Kozaryn, 2007)38
Public opinion (commercials - promotion, media, opinion-leaders)
Education Campaigns
Since its establishment the State Agency for Prevention of Alcohol Related problems has conducted
several educational campaigns addressed to young and adults (including alcohol sellers).
36
Moskalewicz J., Świątkiewicz G. (1998) Transitions on the Map of Social Problems (in.) J. Moskalewicz & Ch. Tigerstedt
(eds.) Public Opinion on Social Problems. A Survey around the Baltic Sea, NAD, Helsinki.
37
Fudała M. (2008) Wzory konsumcji alkoholu w Polsce. Raport z ogólnopolskich badań ankietowych (Alcohol use patterns in
Poland. National survey report). CBOS, Warszawa.
38
Okulicz-Kozaryn K. (2007). Picie alkoholu i oczekiwania z tym związane a praktyki wychowawcze w rodzinach nastolatków
(Alcohol use and alcohol expectances and their relation to parental practices). Świat Problemów, 2-3 (169/170), 16-20.
12
Survey 21 (1996); Let’ protect youth (1996); Joy without alcohol – Holidays without Risk (1998);
Alcohol Steals Freedom (1998);Do not Poison Yourself (2001).
More recently the Agency has organized two campaigns:

Alcohol: Minors not Allowed - first and second edition (2003-2005)
The campaign under the slogan: Your opposition matters was aimed at reduction of selling alcohol
to minors and changing behaviour of sellers and witnesses of selling alcohol to minors. Sellers were
encouraged to check the documents certifying the age of young people who wanted to buy alcohol.

Find out if your Drinking is Safe (2009 -)
The campaign targeted general population and youngsters. Its objective is to reduce the number of
people who drink in hazardous or harmful way and to disseminate knowledge on damages related to
alcohol consumption. In the campaign a prevention message is sent to the young people via website
www.niebotak.pl. (No, Because).
School policies
According to the law schools and local communities are obliged to draft and implement alcohol and
drug prevention programmes. Their quality, however, is evaluated as low (Ostaszewski i Bobrowski
2008; Łukowska 2010; Okulicz-Kozaryn et al., 2010) 39
40 41
. Schools offer mainly lectures on harms
associated with substance abuse while local councils organise public festivities, shows, contests and
alike. There is no evidence whatsoever supporting impact of these measures on alcohol and drug
consumption.
Schools are supposed to be alcohol and drug-free. The alcohol law states that “It shall be forbidden
to sell, serve, or consume any alcohol beverage: within premises of a school or other educational
and/or guardian establishment, or a student home (dormitory)” (Art. 14.1).
39
Łukowska K. (2010) Profilaktyka w praktyce czy praktyka w profilaktyce? (Prevention In practice or practice in prevention?)
Świat Problemów, 19204), 5-10.
40
Okulicz-Kozaryn K., Borucka A., Pisarska A. (2010) Stan promocji zdrowia w Polsce na przykładzie województwa
mazowieckiego (The level of mental health promotion in Poland on the example of the Masovian region). (in.) K. OkuliczKozaryn and K. Ostaszewski (eds.) Promocja zdrowia psychcznego w Polsce. Badania i działania. Część druga. Instutyt
Psychiatrii i Neurologii. Warszawa
41
Ostaszewski K., Bobrowski K. (2008). Polityka i profilaktyka. Bariery w rozwoju programów opartych na naukowej wiedzy
(Policy and prevention: barriers in evidence-based programs development).
K. Okulicz-Kozaryn and K. Ostaszewski (eds.)
Promocja zdrowia psychcznego w Polsce. Badania i działania. Instutyt Psychiatrii i Neurologii. Warszawa.
13
A few years ago some schools applying zero tolerance approach used restrictive measures to identify
alcohol and drugs in students, including searches in bags, drug testing and even called the police
with dogs to detect drugs. These measures were eventually suspended as having no legal grounds. It
became clear that school staff has no right to ask students to provide urine samples for drug tests
(Węgrzecka-Giluń, 2005)42.
Alcohol at work
In Poland, alcohol at work is prohibited. According Art. 14. 2 of Law on Upbringing in Sobriety and
Counteracting Alcoholism: “It shall be forbidden to sell, serve, or consume any alcohol beverage
within premises of an enterprise and of an employees cafeteria”. Prevalence of drinking at the work
place diminished substantially , in particular among blue collar workers.
E. Conclusions
Polish experience confirms once more and again that substantial political and social changes are
very likely to affect alcohol consumption and in consequence burden of alcohol related harm. In this
specific case, increased power of the market forces at the expense of those represented by the
State, rapid privatisation of the economy led to dismantling of the centralised system of alcohol
control. Its availability as well as affordability increased almost overnight followed by rapid growth
in consumption. Grey alcohol economy laid foundations for Polish capitalism. New, promising
market tempted international alcohol companies, first of all brewers. New products and marketing
technologies were applied parallel to ruthless political lobbying. Beer consumption increased three
times while overall alcohol consumption doubled with significant share of unrecorded consumption
placing Poland among the biggest alcohol consumers in EU.
Focus of alcohol policy shifted from alcohol control to school based education and treatment.
Despite serious investments in alcohol treatment and two-fold increase in a number of patients,
alcohol-related mortality has been on the rise.
High tide of alcohol consumption and overall climate of liberalisation as well as smart marketing
targeting youth had pronounced impact on drinking among under-aged. Prevalence of drinking has
42
Węgrzecka-Giluń J. (2005) Narkotesty … i co dalej?. Rozmowa z Elżbietą Czyż -pracownikiem Helsińskiej Fundacji Praw
Człowieka i Biura Rzecznika Praw Obywatelskich (Drug tests… and what then. Interview with Elżbieta Czyż from The Helsinki
Foundation for Human Rights and The Human Right Defender Bureau). Remedium, November, 26-29.
14
substantially increased; proportion of drinkers is currently similar among older teenagers and
adults.
Despite reaching majority of school children alcohol education mostly consisting in ad hoc initiatives
had not prevented the increased alcohol and substance use among youngsters. Even high quality,
expensive programmes are not very likely to counterbalance
wet environment where alcohol
outlets located at every corner as well as supermarkets and fuel station offer variety of drinks round
the clock.
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practices). Świat Problemów, 2-3 (169/170), 16-20.
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przykładzie województwa mozawieckiego (The level of mental health promotion in Poland on the
example of the Masovian region) (in.) K. Okulicz-Kozaryn and K. Ostaszewski (eds.) Promocja
zdrowia psychcznego w Polsce. Badania i działania. Część druga. Instutyt Psychiatrii i Neurologii.
Warszawa
18. Ostaszewski K. & Bobrowski K. (2008). Polityka i profilaktyka. Bariery w rozwoju programów
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17
Table 1. Alcohol use official data - adults
Adults
Alcohol consumption (pure alcohol in litres a year)
Total
43
Male
Female
13.3
21.5
5.5
Abstainers – alcohol ever - % 44
14.3
6.8
20.9
Alcohol use last month - % 45
79
NA
NA
Binge drinking (5 or more drinks at a time past 12 months) - %46
71
NA
NA
19
NA
NA
NA
4.50
1.05
NA
NA
NA
Heavy drinkers (5 or more drinks at least once in a week) - %
Alcohol abuse (DSM –IV) - %
(alcohol use disorders 15+)
Alcohol addiction (DSM-IV) - %
43
44
45
48
47
Average 2003 -2005 (WHO, 2011)
Eurobarometer 2010
Moskalewicz J. (2006) Spożycie alkoholu (Alcohol consumption) (in.) Stan Zdrowia Ludności Polski w 2004. Central
Statistical Office (GUS), Warszawa.
46
Eurobarometer 2010
47
Eurobarometer 2010
48
WHO (2011)
18
Graph 1. Alcohol use among Polish youth
100
90
80
70
60
50
40
30
20
10
0
91,2
89,2
94,9
94,6
82,9
76,1
73,8
72,6
60,4
54,1
54,8
50,1
girls (alcohol ever)
boys (alcohol ever)
girls (alcohol last month)
11.7year-olds
13.7year-olds
15-16year-olds
17-18year-olds
boys (alcohol last month)
Source: HBSC, 2006; ESPAD, 2007
19
Table 2. Substance use among adolescents
Youngsters
HBSC 2006 (N = 5489)*
11.7 (N = 1550)
ESPAD 2007 (N = 8959)
13.7 (N = 1682)
15.7 (N= 2287)
15 – 16 (N = 4459)
17 – 18 (N = 4500)
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Alcohol ever %
52.4
54.8
50.1
73.2
73.8
72.6
93.3
92.5
94.1
90.2
91.2
89.2
94.8
94.9
94.6
Alcohol last month %
N. A.**
N. A.**
50.9
56.0
46.4
57.3
60.4
54.1
79.5
82.9
76.1
Drunk last year %
N. A.
N. A.
41.2
47.1
35.8
39.8
43.4
36.5
56.0
64.2
48.4
Binge drinking %
N. A.
N. A.
N.A.
36.3
44.0
34.0
52.5
61.0
41.0
Smoking tobacco life time
prevalence %
11.7
Soft drugs life time
prevalence %
N.A.
Hard drugs life time
prevalence %
N.A.
16.4
7.2
31.0
33.9
28.3
58.9
63.1
55.1
53.1
55.0
51.2
67.9
68.0
67.5
N.A.
18.5
24.0
13.4
15.7
20.8
10.8
27.9
36.9
19.5
N.A.
N.A.
7.0
9.0
5.0
16.0
20.0
13.0
XTC
2.5
2.7
2.0
4.2
5.4
3.0
Amphetamine
3.8
3.9
3.5
7.8
9.3
6.1
Heroine
1.4
1.5
1.2
1.7
3.0
0.5
Cocaine
1.8
2.1
1.3
2.5
3.8
1.2
Alcohol abstainers ever %
9.8
8.8
10.8
5.2
5.1
5.4
* HBSC report includes only data of cohort of students born in the same year excluding older students from the class under the study. Polish ESPAD report includes data of all students from the class under
the study. ** No data on alcohol in general, beverage-specific breakdowns only are available
20
Table 3. Drinking of beer, wine and vodka during the last 30 days (from Sierosławski, 2007)
Age
15-16-year-olds
17-18-year-olds
Type of beverages
%
Beer
60.3
Wine
22.6
Vodka
30.3
Beer
78.8
Wine
31.0
Vodka
50.8
Table 4. General policy towards alcohol and soft drugs
Policy toward alcohol
Zero tolerance
No
Yes

P. – soft drugs
No
Yes
Zero tolerance

Harm reduction

Harm reduction

Supply reduction

Supply reduction

Demand reduction

Demand reduction

21
Table 5. Policy (alcohol use regulations by law)
Alcohol
Age
Soft drugs
limit
Minimum age to
purchase
18
Consumption a criminal
offence
AR
offence
NR
offence
AR
offence
purchase
AR
offence
AR
Consumption a criminal
NR
Purchase a criminal
NR
limit
Possession a criminal
Consumption a criminal
Purchase a criminal
offence
purchase
Age
Minimum age to
Possession a criminal
NR
Hard drugs
limit
Minimum age to
Possession a criminal
offence
Age
offence
NR
Purchase a criminal
AR
offence
AR
NR = no restriction,
AR = absolute
restriction
22
Table 6. Rating of the practical implementation of restrictions concerning alcohol
Irregular,
Regular,
None,
Weak,
mostly
rather
Systematic,
lacking
formal
formal
efficient
strong
Awareness (of authorities)

Frequency and consistency of control

Toughness of punishments

Table 7. Availability of alcohol
None
Partial
Full
State (government) monopoly for selling
alcohol beverages in retail stores

Wine
and
None
Wine only
spirits
All
Restrictions on density of shops with
alcohol

hours or
None
days
both
Restrictions on business hours and days
for sale

None
Yes
Community programs for raising

awareness
Mandatory training of alcohol servers

Alcohol servers liability for damages
caused

Advertising restrictions for printed
media

Advertising restrictions in broadcast

Advertising restrictions on billboards

Beer excise
97 PLN (24 euro) per 100 litres
Wine excise
158 PLN (40 euro) per 100 litres
4960 PLN (1250 euro) per 100 litres
Spirit excise
of 100% ethyl alcohol
23
Table 8. Alcohol and traffic and marketing restrictions
None
Rare
Occasional
Often
Very often

Breath testing for drivers
Legal blood alcohol limit – adults (0.2 mg/dl)
legal blood alcohol limit – young drivers (0.2 mg/dl)

Mandatory penalty for exceeding legal limit
graduated licensing for young drivers

Restrictions on alcohol use during cycling, skiing,
snowboarding, etc.

Restrictions on commercial communication

(promotion) targeting young people
Consumers information or warning labels on alcohol
beverages

24