Published in October 2006, Smoking, Alcohol and Drug Use in Cork and Kerry 2004 1 reviews substance use in the former Southern Health Board area and compares findings with an earlier study conducted by the same author, Dr Timothy Jackson, in 1996.

The survey was divided into two parts. The first part was administered by an interviewer and covered a number of topics – general views on the respondent’s local area, knowledge of specific drugs, usage of tobacco and alcohol, attitudes about drugs and how they should be dealt with in the community, leisure activities and demographic information. The second part was a self-completion questionnaire which related to usage of drugs (including injecting drug use) and personal knowledge of people who had received or might need professional advice for alcohol- or drug-related problems. This article will focus on the findings in relation to alcohol consumption and drug usage. An article examining community perceptions of substance misuse issues will be included in the next issue of Drugnet Ireland.   

The methodology of the 2004 study was similar to that used in 1996. The survey was a multi-staged, quota-controlled household survey with random starting points. The target population was people living in the three main regions of the former Southern Heath Board (SHB): Cork City, Cork County and Kerry County. The main sample consisted of 1,512 respondents, aged between 15 and 44 years and divided equally between the three regions, with approximately 500 respondents from each region.

In order to boost the number of those involved in substance use detected by the survey, a booster sample was also used. This targeted populations where there was considered to be greater risk of substance misuse. The booster sample consisted of approximately 900 respondents aged between 15 and 24 years from the most deprived urban areas of each region. The only changes to the methodology between 1996 and 2004 were in relation to the booster sample. In order to increase statistical robustness it was increased from 600 to 900 and the areas of deprivation were based on the Small Area Health Research Unit index. The final analysis was based on 1,508 respondents from the main sample and 909 from the booster sample. 

The survey found that alcohol remained the dominant substance of misuse in terms of prevalence and problem use. Alcohol consumption was measured in units, where 1 unit is equal to a glass of wine, a measure of spirits or a half pint of beer, cider or alcoholic lemonade. Problem or dependent alcohol use was measured by responses to the four CAGE screening questions (see report for details). Eighty-one per cent of respondents were current drinkers, with the rate for women (79%) almost equal to that for men (82%). The rate of current drinking had increased by 3% since 1996.

Twenty-six per cent of men and 17% of women drank in excess of guidelines. This figure had doubled for women since 1996. Twenty-two per cent of men and 11% of women were CAGE-positive, indicating problem or dependent use of alcohol. Men drank an average of 18 units and women an average of 9 units per week. This represented a 30% increase in women’s weekly consumption compared to 1996. Binge drinking was common for some respondents, with 50% of men and 25% of women reporting that they had drunk to excess three or more times in the previous month.

The percentages of men in each of three categories of problem alcohol use had not changed significantly since 1996, with Category 1 (excessive drinking) at 17%, Category 2 (problem drinking) at 8% and Category 3 (problem and dependent drinking) at 4%. However, women’s alcohol consumption had moved into more damaging categories. Those in Category 1 doubled to 13%, Category 2 trebled to 3% and Category 3 increased to 1%. Of the respondents aged under 18 years, 41% (47% of boys and 32% of girls) were current drinkers (a drop of 3%). The proportion of this age group that reported having been drunk (87%) had increased by 15% since 1996.

Drugs were categorised into cannabis, stimulants, opiates, hallucinogens, sedatives and solvents. Drug use was classified according to whether the substance was ever taken (lifetime use), taken in the last year (recent use) or taken in the last month (current use). The use of cannabis (in all forms) had doubled since 1996, with 32% reporting lifetime use, 14% reporting recent use and 7% reporting current use of the drug. The use of stimulants in general and ecstasy in particular had also doubled since the previous survey in terms of both lifetime use (stimulants 10% and ecstasy 7%) and recent use (stimulants 4% and ecstasy 2.5%).  

The numbers using cocaine and heroin remained low but there were marked increases in usage of these drugs since 1996. Lifetime use of cocaine increased from 1.1% to 6% and recent use increased from 0.4% to 2.5%. Lifetime use of crack increased from 0.3% to 2%. The author points out that, while the actual prevalence levels are still low, ‘the increases show a serious trend’. Lifetime use of opiates doubled to 2% and recent use increased from 0.3% to almost 1%. Lifetime use of heroin increased from 0.2% to 1.6% and recent use increased from 0.2% to 0.5%.

When the three main regions were compared, Cork City showed the highest rates for all modes of drug use. Lifetime use was 41%, compared to 30% elsewhere. Recent use was 18%, compared to 14% in Kerry County and 11% in Cork County. While there were significant increases in all categories of drug use in all three regions, this was particularly true in Cork County and Kerry County where rates of drug use doubled or tripled.

The author compared the study findings in relation to alcohol and drugs with a number of recent studies carried out to estimate substance use in the community. The findings regarding alcohol consumption were consistent with the NACD general population survey 2002/2003, the MWHB Secondary Schools Survey 2002, the European School Survey Project on Alcohol and Other Drugs 2003 and the Health Behaviour in Secondary School Children 2002 study. While the findings in relation to drug use were comparable to many school studies and other population lifestyle studies, overall drug use was much higher than the levels reported in the NACD general population survey 2002/2003. This may be due to methodological differences between the two studies. The NACD survey used direct interviewing throughout, but drug-use data in this study were gathered using a confidential self-completion questionnaire. Research suggests that self-administered questionnaires lead to increased reporting of drug use, especially of stigmatising drugs, while direct interviewing may bias respondents towards what they perceive to be more socially acceptable answers (see report for references). The author stated that the increases in drug use found in this study were reflected in the data on problem drug use in the SHB reported to the National Drug Treatment Reporting System.

1. Jackson TMR (2006) Smoking, Alcohol and Drug Use in Cork and Kerry 2004. Cork: Department of Public Health, HSE South.