Slovenia's story – an eight years struggle for alcohol legislation

Dr Zdenka Cebasek-Travnik

Slovenia's story begins in 1994 at the first meeting of the counterparts to the European Alcohol Action Plan. It was the first opportunity to meet representatives of the countries that had already succeeded in reducing their alcohol consumption. In working groups we discussed the situation in each country represented. Slovenia was (and still is) an example of a typical wet culture where alcohol is cheap, easy to come by, and frequently used by everybody. There were only two main pieces of alcohol legislation – the ban on the advertising of alcohol (from the time when Slovenia was part of Yugoslavia) and the law on road traffic safety, by which random testing on alcohol was introduced. But there were no limits of age, time or location for the selling alcohol, so literally anyone could have bought it twenty fours hours a day.

There were no prevention activities as far as alcohol problems were concerned. Any prevention money in the state budget was used mainly in the field of illicit drugs – despite the fact that the extent of alcohol problems was (and still is) about one hundred times greater. There was a lack of epidemiological data and public awareness of the harm, done by alcohol was extremely low. The only aspect comparable to European Union countries was the treatment system for alcoholics and their families.

As a national counterpart to the EAAP, I felt very depressed and powerless, even hopeless, when a counterpart from France tried to encourage me: "Don't worry. Things will be better. Your story reminds me of my country many years ago. With an effective national alcohol policy you can change them. But remember – changes will be very slow and a 'time unit' for change is about four or five years. I wish you good luck." That was in 1994, when I just arrived from The United States of America, where I spent a year at the Johns Hopkins University in Baltimore studying a substance abuse programme which included both alcohol and drug policy.

The term "alcohol policy" was very new to me. It was not used in the Slovenian language before and we had to find a suitable translation. The same was true of the European Alcohol Action Plan, which needs eight words to be understood (Evropski akcijski na_rt za zmanj_evanje _kodljive rabe alkohola). In fact, Slovenia had its temperance movement more than hundred years ago and some kind of national alcohol policy thirty years ago. But they had little or no impact on alcohol consumption, because no legislation on alcohol use was in force.

I was appointed as a national counterpart to the EAAP in 1994. Shortly after the meeting in Vienna, I had my first struggle with the Minister of Health. I was accused of causing considerable harm to the international conference 'Wine and Health', which was held in Ljubljana in November 1994. I had told journalists that wine was not as good for health as the participants in the conference were claiming. The journalists were confused by the contradictory messages and decided not to report the issue. The Mnistry of Health had sponsored the conference, as a way of teaching the Slovenian people to drink less harmfully. I tried to explain to the Minister what the role of a national counterpart should be but that was my last official appointment with him.

Over the next years Slovenia got new governments and new ministers of health. Most of them did not like to meet me in my role as an EAAP counterpart. There was a time when I was 'persona not grata' at the Ministry and I had to find other allies. I started with journalists. Some of them - mostly women, in fact - were interested in my work as a clinician treating alcoholics and only a few were interested in alcohol policy. I wrote some articles and sent them to our biggest newspapers, but they were not published. I asked editors what was wrong with them – the answer was, "Who are you that I should publish your article?" Many years later I was told the truth – the content of my articles was not acceptable to the newspaper proprietors.

In the meantime, some journalists became tired of drugs and drug problems and 'rediscovered' alcohol and wrote good articles on the subject. They even got used to asking me questions on alcohol policy and I was recognised as an expert in the field. Together with some other professionals, we made some progress on the prevention front and created programmes for children and families. Public awareness started to rise.

A new era in Slovenian alcohol policy started when Dr Dusan Keber, professor at the School of Medicine, started to write columns on public health in our biggest newspaper. He wanted to write on alcohol problems too and asked me to meet him. He came to my office and instead of fifteen minutes he stayed for two hours and left with a big bag of literature on alcohol policy. Afterwards we had a number of discussions on the issue and he asked me what would be the first important thing to do. "Alcohol legislation," was my answer, "I do not have the power to bring it before Parliament." A few months later Dr Keber became Minister of Health. At the time of our conversations I was unaware of this possibility. He did not forget our discussions and soon invited me to bring forward proposals for a law on alcohol, supporting preparations for the law throughout the process. In 2003 the Law on alcohol was adopted by the Slovenian Parliament. After two 'time units' of alcohol policy described by my French colleague, Slovenia got a law that restricted access to alcohol and provided an official background for a national alcohol policy.

As a national counterpart from a "wet culture" country, I would like to make some other comments regarding alcohol policy. These are the recommendations which arise from my work:

How does one start an alcohol policy when the country has:

• a low budget for alcohol prevention and a high one for illegal drugs

• low interest among the media which are occupied with illegal drugs

• the need for change in public opinion on alcohol.

Firstly, it is very important to involve the media. Try to identify interested journalists and their media. It might well be that, as in Slovenia, those interested journalists are female. Invite them on an individual basis and show them your work and ideas. Be provocative but not insulting, present the opposite case when conferences that favour alcohol occur, arouse the professional curiosity of journalists, at such significant times as the run-up to elections prepare questions and ask for clarification from politicians.

Draw attention to the alcohol industry's marketing policy and advertisements when they are specifically aimed at youth.

It is not at all easy to win support from the community, but here are some ideas:

• get your message to people where they spend their time - shopping centres, bars, discos, public events – rather than expecting them to come to such events as lectures

• target all generations

• do not be moralistic:

• • no prohibition

• • reward sobriety

the use of non-governmental organisations is important - people usually do not believe the politicians. NGOs are able to develop advocate groups to support the law or other alcohol policy issues in a much more effective way. In Slovenia the most influential is the foundation "Z glavo na zabavo" (a free translation might be "You can choose – Win or loose") which organises leisure activities in public places (pubs, discos, sports stadiums, supermarkets) alongside the Agency for Traffic Safety. Alcohol is not prohibited, but only sober participants can get awards. Further information is available at http://www.fundacija-zgnz.sl

The next important step is to find potential allies in the health system, road safety agencies, insurance companies, non-alcoholic beverages industry, the Church and political parties. If motivated, they all can promote ideas of alcohol policy with no additional funds.

The health system has proved very reluctant in accepting any procedures for dealing with alcohol problems. But proper education for health workers (school of medicine, school of nursing, other educational programmes) can make a difference. Be creative in promoting education for health workers (Workshop: "How to sell prevention?") and in interesting patients (Brochures: "Where are the borders?").

Finally, how to involve politics and politicians? I suggest the "Slovenian way":

• be patient, wait for the appropriate time (could be some years),

• be aware, identify the people who could give significant help (that have enough power and are not compromised by alcohol associations)

• do not miss any opportunity to tell them about the problem

• get them involved – ask questions at public meetings.

Finally, here are some tips for those who recognised themselves at the beginning of this story. If your country has no alcohol policy, you can act as a catalyst that will enable changes:

you can start without money, but to make the enterprise useful and effective in the long run, stabile funding is needed – state budget

• use a systemic approach for all projects – Who has got a problem?

• get the media involved – use their power, but be realistic

• recognise and use the help of politicians "now"– they come and go

• And do not be offended if you are not invited to the launch of the law on alcohol even if you initiated it. If it is good – it will work and you will know that your work had an impact. If it does not work, wait for proper time and suggest changes.

Dr Cebasek-Travnik is the Slovenian Counterpart to the European Alcohol Action Plan.