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New Research Directions in Alcohol Policy

New Research Directions in Alcohol Policy. What scientific research can offer to: the public the policymaker the practitioner and the academic community. WHAT’S NEW IN ANOC2? New developments in epidemiological research, including alcohol’s role in the global burden of disease

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New Research Directions in Alcohol Policy

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  1. New Research Directions in Alcohol Policy What scientific research can offer to: the public the policymaker the practitioner and the academic community

  2. WHAT’S NEW IN ANOC2? • New developments in epidemiological research, including alcohol’s role in the global burden of disease • A new chapter on the global structure and strategies of the alcohol industry  • Revised ratings of 42 policy-related strategies and interventions based on continued growth of the knowledge base • New understandings of the policymaking process at the local, national and international levels

  3. The Alcohol Public Policy Group Thomas Babor University of Connecticut (USA) Raul Caetano University of Texas (USA) Sally Casswell Massey University (New Zealand) Griffith Edwards National Addiction Centre (United Kingdom) Norman Giesbrecht University of Toronto (Canada) Kathryn Graham Centre for Addiction and Mental Health (Canada) Joel Grube University of California (USA) Linda Hill University of Auckland (New Zealand) Harold Holder University of California (USA) Ross Homel Griffith University (Australia) Michael Livingston University of Melbourne (Australia) Esa Österberg Institute for Social Research (Finland) Jürgen Rehm University of Toronto (Canada) Robin Room University of Melbourne (Australia) Ingeborg Rossow National Institute for Alcohol and Drug Research (Norway)

  4. Why alcohol is no ordinary commodity: Relations among alcohol consumption, mediating variables and consequences

  5. WHO Global Burden of Disease Project • A new approach to measuring health status • Developed estimates of mortality from over 100 major causes of death for the entire world and for major geographical regions • Quantifies not only the number of deaths but also the impact of premature death and disability on a population • A single quantitative measurement of the overall “burden of disease” • First estimates of the proportion of mortality and disability attributable to risk factors, including tobacco, alcohol, poor water, unsafe sex, etc.

  6. Leading risk factors for disease (WHR 2002) in emerging and established economies (% total DALYS)

  7. The alcohol industry and global alcohol consumption • Globalization of production, trade and marketing of alcohol products • The brewing and spirits industries involved in new product design (e.g., alcopops, light beer), marketing to young people, and policy development, especially in developing countries  • Research on industry’s structure, functions and effects on alcohol consumption is sparse, under-funded, and methodologically challenging • Growing evidence that self-regulation of industry is ineffective in preventing marketing to young persons

  8. Strategies and Interventions Reviewed and Evaluated • Pricing and Taxation • Regulating Physical Availability • Altering the Drinking Context • Education and Persuasion • Regulating Alcohol Promotion • Drinking-Driving Countermeasures • Treatment and Early Intervention

  9. Ratings of 42 Policy-relevant Prevention Strategies and Interventions • Evidence of Effectivenessa – the quality of scientific information • Breadth of Research Supporta – quantity and consistency of the evidence • Tested Across Culturesa, e.,g. countries, regions, subgroups aRating Scale: 0, +, ++, +++, (?)

  10. Strategies and Interventions Reviewed and Evaluated • Pricing and Taxation

  11. Policy High taxes, prices Assumption Reduce demand by increasing economic cost of alcohol relative to alternative commodities Assumptions Underlying Alcohol Taxation and Other Price Controls

  12. Pricing and Taxation

  13. Pricing and Taxation Evidence suggests that: • People increase their drinking when prices are lowered, and decrease their consumption when prices rise. • Adolescents and problem drinkers are no exception to this rule. • Increased alcoholic taxes and prices are related to reductions in alcohol-related problems, including crime, traffic accidents and mortality rates • Alcohol taxes are thus an attractive instrument of alcohol policy because they can be used both to generate direct revenue and to reduce alcohol-related harm.

  14. Strategies and Interventions Reviewed and Evaluated • Regulating Physical Availability

  15. Policy Restrictions on time, place, and density of alcohol outlets Assumption Reduce demand by restricting physical availability – increase effort to obtain alcohol and thereby reduce total volume consumed as well as alcohol-related problems Assumptions Underlying Restrictions on Alcohol Availability

  16. Regulating Physical Availability

  17. Regulating Alcohol Availability • Restrictions on availability can have large effects where there is popular support for these measures. • For young people, laws that raise the minimum legal drinking age reduce alcohol sales and problems • The cost of restricting alcohol availability is cheap relative to the costs of health consequences related to drinking, especially heavy drinking. • Erosion of post-Prohibition availability controls suggests that public support is waning except for restrictions on young persons’ drinking

  18. Strategies and Interventions Reviewed and Evaluated • Modifying the Drinking Context

  19. Modifying the Drinking Context • Many prevention measures seek to re-define the contexts or change the environments where alcohol is typically sold and consumed (e.g., bars and restaurants), under the assumption that such changes can reduce alcohol-related aggression and intoxication • Options include training bar staff, imposing voluntary house policies to refuse service, enforcement of regulations, community mobilization to influence problem establishments

  20. Modifying the Drinking Environment

  21. Regulating the drinking context • Training programs for bar staff can have modest effects on patrons’ intoxication level and aggression • Sustained impact may depend on enforcement • Approaches targeting high risk environments (training, enforcement, environmental design) are easier to implement than other intervention strategies

  22. Strategies and Interventions Reviewed and Evaluated • Drinking-Driving Countermeasures

  23. Policy Drink-driving countermeasures Assumption Reduce drink driving though deterrence, punishment and social pressure Assumptions Underlying Drink-driving Policy Options

  24. Drinking-Driving Countermeasures

  25. Summary: Drinking-Driving Countermeasures • Consistently produce long-term problem reductions of between 5% and 30%. • Deterrence-based approaches, using innovations such as Random Breath Testing, yield few arrests but substantial accident reductions. • Another effective measure is the use of graduated licensing for novice drivers, which limits the conditions of driving during the first few years of licensing.

  26. Policy Regulating alcohol advertising and other marketing Assumption Reducing exposure to marketing that normalizes drinking and links it with social aspirations will slow recruitment of young drinkers and reduce heavier drinking Social modeling of excessive drinking contributes to underage drinking problems Assumption Underlying Regulation of Alcohol Marketing

  27. Policy Options • No regulation • Industry self-regulation • Partial bans • Total bans

  28. Restrictions on Marketing

  29. Policy Provide information to adults and young people especially through mass media and school-based alcohol education programs Assumption Health information increases knowledge, changes attitudes and prevents drinking problems Assumptions Underlying Education and Persuasion Policy Options

  30. Education and Persuasion

  31. Summary: Education Strategies • The impact of education and persuasion programs tends to be small at best. • When positive effects are found, they do not persist. • Among the hundreds of studies, only a few show lasting effects (after 3 years) (Foxcroft et al. 2003) • Even comprehensive programs may not be sufficient to delay initiation of drinking or sustain small reductions after program • Programs with multiple interactive components that resemble family therapy and brief intervention seem to have some potential • Many programs show to be ineffective continue to be used

  32. Strategies and Interventions Reviewed and Evaluated • Treatment and Early Intervention

  33. Treatment and Early Intervention Services • During the past 50 years there has been a steady growth in high income countries in the provision of specialized medical, psychiatric, behavioral and social services to people with alcohol use disorders • More than 40 therapeutic approaches have been developed • Systems of specialized services are now typical of many industrialized countries

  34. Policy Increase availability of treatment programs Conduct screening and brief intervention in health care settings Assumption Problem drinking is responsive to various therapeutic interventions Heavy drinkers can be motivated to drink moderately before they acquire alcohol dependence Assumptions Underlying Treatment and Early Intervrention

  35. Treatment and Early Intervention

  36. Minimum legal purchase age Government monopoly Restriction on hours or days of sale, outlet density Alcohol taxes Lower alcohol strength Random Breath Testing Lowered BAC limits Administrative license suspension Graduated licensing for novice drivers Brief interventions for hazardous drinkers Treatment and detox Best Practices

  37. What scientific research indicates • Alcohol is no ordinary commodity • The mechanisms of harm have been elucidated in terms of genetics, pathophysiology, neuroadaptation, psychological development, social learning and environmental influences • Effective interventions have been identified, offering practitioners and policymakers a wide variety of policy options • Research can explain and inform, but it cannot alter the course of alcohol epidemics unless there is public support and political will

  38. Conclusion: What scientific research can offer • Alcohol is no ordinary commodity • The mechanisms of harm have been clearly elucidated in terms of genetics, pathophysiology, neuroadaptation, psychological development, social learning and environmental influences • Effective interventions can prevent and change the course of alcohol problem epidemics; ineffective alcohol controls can create or exacerbate alcohol problem epidemics • Research can explain and inform, but it cannot change history unless there is public support and political will

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