Alcohol policies : Evidence: effective policy measures

Policies reducing supply and availability are the most effective

A broad body of evidence shows that policies restricting the supply and availability of alcohol are the most effective in reducing health and social harm caused by alcohol. Examples of such policies are those on taxation, a minimum legal drinking age, reduced hours of sale, and policies on number, type or location of sales outlets. Drink-driving countermeasures are also effective if vigorously enforced. Additionally, drink-driving can be reduced by server training and server-liability. Some evidence indicates that restricting advertisements leads to reduced alcohol consumption and alcohol-related harm.

In contrast, programmes and policies that are directed at the individual, such as school-based educational programmes have limited effect. There is one exception: brief interventions by primary health care professionals directed at hazardous drinkers are effective in reducing the harm caused by alcohol (Anderson & Baumberg, 2006; Babor et al., 2003; Edwards, 2001; Chisholm et al., 2004; Chisholm et al., 2006; Cnossen, 2006).Also cost-effectiveness studies show that taxation ia strong policy. In regions with high-risk alcohol use, such as most European countries, taxation has the greatest and most cost-effective impact on reducing the average burden of high-risk alcohol use (Chisholm et al., 2004; Chisholm et al., 2006; Cnossen, 2006). For more information on the effectiveness of different interventions see details

Ratings of strategies and interventions.

Effective policy focuses both on total consumption and on risky drinking

Alcohol policy measures should combine both policies directed at the whole drinking population and measures directed at more risky drinkers with more detrimental drinking patterns (Babor, 2002; Edwards, 2001; Allamani et al., 2001). This is because many alcohol-related harms stem mainly from alcohol consumption in the general population, rather than from alcohol consumption by a specific group of risky drinkers. Therefore, reducing the total alcohol consumption will result in a reduction in alcohol-related public health problems, while implementing interventions focused on high-risk drinking, like interventions to reduce drink-driving, will result in a reduction of specific types of harm, such as accidents. Interventions directed at drinkers in general will however also affect heavy and risky drinkers (Edwards, 2001; Babor, 2002; Farrell et al., 2003; Cooke & Moore, 2002). For more information on average volumes of consumption, drinking patterns and their consequences see Alcohol use >> Consequences for individuals and society.

Community prevention programmes have potential

Community prevention programmes have the potential to effectively reduce alcohol-related harm. In community prevention programmes several partners work together, and different types of prevention measures are combined in one programme within a community (e.g. a city). Results of experiments vary. Some show substantial reductions in high-risk drinking and related harm, while others show minimal results (Stafström, 2007; Sweet & Moynihan, 2007 2007; Stafström et al., 2006; NIAAA, 2006; Holder et al., 2000; Holder, 1998). The European project Building Capacity has as one of it goals to develop knowledge on community alcohol action.The fact that community prevention can have big effects, confirms that a comprehensive approach is best for alcohol prevention policies. Experts have concluded this for local as well as regional and international levels (Edwards, 2001; Horlings & Scoggins, 2006).

The evidence-base for effective alcohol policy is geographically limited

The evidence base for effective alcohol policy is still largely dominated by studies from North America, Northern Europe, Australia and New Zealand. However, this evidence is also of significance for Europe as a whole (Anderson & Baumberg, 2006). Categories of policies that have been researched are mentioned in Alcohol use >> Interventions.

Kuunders M (RIVM). Evidence: effective policy measures. In: EUPHIX, EUphact. Bilthoven: RIVM, <http://www.euphix.org> EUphact\ Health policies\ Tackling health determinants\ Alcohol policies, 15 May 2008.

Literature and data sources

Allamani A, Hope A, Byrne S, Room B, ECAS research team. Lessons from the ECAS study: comments and policy implications. In: Norström T, editor. Alcohol in postwar Europe: consumption, drinking patterns, consequences and policy responses in 15 European countries. Luxemburg: European Commission, 2001.

Anderson P, Baumberg B. Alcohol in Europe: a public health perspective. London: Institute of Alcohol Studies, 2006.

Babor T. Linking science to policy. The role of international collaborative research. Alc Res Health, 2002; 26(I).

Babor TF, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, et al. Alcohol: No ordinary commodity. Research and public policy. Oxford: University Press, 2003.

Chisholm D, Doran C, Shibuya K, Rehm J. Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. Drug Alcohol Rev, 2006; 25: 553-565.

Chisholm D, Rehm J, Ommeren M van, Monteiro M. Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. J Stud Alcohol, 2004; p. 782-293.

Cnossen S. Alcohol taxation and regulation in the European Union. Den Haag: CPB Discussion Paper, 2006; 76.

Cooke PJ, Moore MJ. The economics of alcohol abuse and alcohol-control polies. Health Aff, 2002; 21(2): 120-133.

Edwards G. Alcohol policy: securing a positive impact on health. In: Rehn N, Room R, Edwards G, editors. Alcohol in the European Region – consumption, harm and policies. Copenhagen: WHO Regional Office for Europe, 2001.

Farrell S, Manning WG, Finch MD. Alcohol dependence and the price of alcoholic beverages. J Health Econ, 2003; 22: 117-147.

Holder H. Alcohol and the community. A systems approach to prevention. Cambridge: Cambridge University Press, 1998.

Holder HD, Greunewald PJ, Ponicki WR, Treno AJ, Grube JW, Saltz RF, et al. Effects of community-based interventions on high-risk drinking and alcohol-related injuries. JAMA, 2000; 283(18): 2341-2347.

Horlings E, Scoggins A. An ex ante assessment of the economic impacts of EU alcohol plicies. Final version. Leiden: RAND Europe, 2006.

NIAAA, National Institute on Alcohol Abuse and Alcoholism. Underage drinking. Why do adolescents drink, what are the risks, and how can underage drinking be prevented? Alcohol Alert, 2006; January.

Stafström M, Ostergren P, Larsson S, Lindgren B, Lundborg P. A community action programme for reducing harmful drinking behaviour among adolescents: the Trelleborg Project. 2006; 101(6): 813-823. Addiction, 2006; 101(6): 831-823.

Stafström M. Preventing adolescent alcohol use. Processes and outcomes of a community-based intervention in Trelleborg. Malmö: Lund University, 2007.

Sweet M, Moynihan R. Improving population health: the uses of systematic reviews. New York: Milbank Memorial Fund, 2007.