Alcohol: No Ordinary Commodity. A summary of the book

This article summarizes the contents of Alcohol: No Ordinary Commodity—Research and public policy ( Babor et al. 2003 ). The first part of the book describes why alcohol is no ordinary commodity, and presents epidemiological data on the global burden of alcohol‐related problems. The second part of the book reviews the scientific evidence for strategies and interventions designed to prevent or minimize alcohol‐related harm: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drinking‐driving countermeasures, regulating alcohol promotion, education and persuasion strategies and treatment services. The final section considers the policymaking process on the local, national and international levels, and provides a synthesis of evidence‐based strategies and interventions from a policy perspective.     

Alcohol industry involvement in policymaking: a systematic review

Aims

To summarize the substantive findings of studies of alcohol industry involvement in national or supranational policymaking, and to produce a new synthesis of current evidence.

Methods

This study examined peer‐reviewed journal reports published in the English language between 1980 and 2016 of studies of alcohol industry involvement in policymaking. Included studies were required to provide information on data collection and analysis and to have sought explicitly to investigate interventions by alcohol industry actors within the process of public policymaking. Eight electronic databases were searched on 27 February 2017. The methodological strengths and limitations of individual studies and the literature as a whole were examined. A thematic synthesis using an inductive approach to the generation of themes was guided by the research aims and objectives.

Results

Twenty reports drawn from 15 documentary and interview studies identify the pervasive influence of alcohol industry actors in policymaking. This evidence synthesis indicates that industry actors seek to influence policy in two principal ways by: (1) framing policy debates in a cogent and internally consistent manner, which excludes from policy agendas issues that are contrary to commercial interests; and (2) adopting short‐ and long‐term approaches to managing threats to commercial interests within the policy arena by building relationships with key actors using a variety of different organizational forms. This review pools findings from existing studies on the range of observed impacts on national alcohol policy decision‐making throughout the world.

Conclusions

Alcohol industry actors are highly strategic, rhetorically sophisticated and well organized in influencing national policymaking.     

Predictors of College Student Support for Alcohol Control Policies and Stricter Enforcement Strategies

Objectives: With alcohol-related problems remaining a concern on college campuses, prevention efforts are increasingly directed to addressing the environmental factors that encourage consumption. This study examined students' support for alcohol control policies, correlates of that support, and actual vs. perceived peer support. Methods: Telephone interviews were conducted with a random sample of 510 college students. We conducted a three-step hierarchical regression analysis to examine predictors of policy support. Levels of personal and perceived peer support for alcohol control policies were compared. Results: Findings revealed a high level of policy support among students, with variability in support by gender, alcohol consumption levels, and drinking and driving tendencies. Additionally, compared to the percentage of students who supported each policy, a smaller percentage thought other students were supportive. Conclusions: Results provide valuable insights to inform the development of media campaigns and other environmental management initiatives.     

Alcohol control policies and alcohol consumption by youth: a multi-national study

Aims The study examined relationships between alcohol control policies and adolescent alcohol use in 26 countries. Design Cross‐sectional analyses of alcohol policy ratings based on the Alcohol Policy Index (API), per capita consumption and national adolescent survey data. Setting Data are from 26 countries. Participants Adolescents (aged 15–17 years) who participated in the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) or national secondary school surveys in Spain, Canada, Australia, New Zealand and the United States. Measurements Alcohol control policy ratings based on the API; prevalence of alcohol use, heavy drinking and first drink by age 13 based on national secondary school surveys; per capita alcohol consumption for each country in 2003. Analysis Correlational and linear regression analyses were conducted to examine relationships between alcohol control policy ratings and past 30‐day prevalence of adolescent alcohol use, heavy drinking and having first drink by age 13. Per capita consumption of alcohol was included as a covariate in regression analyses. Findings More comprehensive API ratings and alcohol availability and advertising control ratings were related inversely to the past 30‐day prevalence of alcohol use and prevalence rates for drinking three to five times and six or more times in the past 30 days. Alcohol advertising control was also related inversely to the prevalence of past 30‐day heavy drinking and having first drink by age 13. Most of the relationships between API, alcohol availability and advertising control and drinking prevalence rates were attenuated and no longer statistically significant when controlling for per capita consumption in regression analyses, suggesting that alcohol use in the general population may confound or mediate observed relationships between alcohol control policies and youth alcohol consumption. Several of the inverse relationships remained statistically significant when controlling for per capita consumption. Conclusions More comprehensive and stringent alcohol control policies, particularly policies affecting alcohol availability and marketing, are associated with lower prevalence and frequency of adolescent alcohol consumption and age of first alcohol use.     

UK Alcohol Treatment Trial: client-treatment matching effects

Aim To test a priori hypotheses concerning client–treatment matching in the treatment of alcohol problems and to evaluate the more general hypothesis that client–treatment matching adds to the overall effectiveness of treatment. Design Pragmatic, multi‐centre, randomized controlled trial (the UK Alcohol Treatment Trial: UKATT) with open follow‐up at 3 months after entry and blind follow‐up at 12 months. Setting Five treatment centres, comprising seven treatment sites, including National Health Service (NHS), social services and joint NHS/non‐statutory facilities. Treatments Motivational enhancement therapy and social behaviour and network therapy. Measurements Matching hypotheses were tested by examining interactions between client attributes and treatment types at both 3 and 12 months follow‐up using the outcome variables of percentage days abstinent, drinks per drinking day and scores on the Alcohol Problems Questionnaire and Leeds Dependence Questionnaire. Findings None of five matching hypotheses was confirmed at either follow‐up point on any outcome variable. Conclusion The findings strongly support the conclusion reached in Project MATCH in the United States that client–treatment matching, at least of the kind examined, is unlikely to result in substantial improvements to the effectiveness of treatment for alcohol problems. Possible reasons for this failure to support the general matching hypothesis are discussed, as are the implications of UKATT findings for the provision of treatment for alcohol problems in the United Kingdom.     

Addiction research centres and the nurturing of creativity. The Korean Institute on Alcohol Problems (KIAP)

The aim of this paper is to provide an account of the history, current status and vision of the Korean Institute on Alcohol Problems (KIAP). In the context of increasing alcohol consumption, rising second‐hand effects and industry‐friendly government policy, the Korean College Alcohol Study (KCAS) was established in the Republic of Korea in 1999, and changed its name to the Korean Institute on Alcohol Problems (KIAP) in 2005. KIAP's mission is to decrease alcohol consumption and its related harms by promoting research, advocating policy, developing intervention programmes and preparing media communications. Since 1999, KIAP has published scientific papers and books in alcohol research and used the internet and other media for dissemination of specialized information to the general population. In the last decade, KIAP has trained front‐line alcohol researchers, and advanced domestic and international networks to promote evidence‐based alcohol control policy in Korea. The light of hope shines brightly as KIAP grows and establishes critical linkages to move forward in its mission.     

The Alcohol Dependence Syndrome, 30 years later: a commentary. the 2006 H. David Archibald lecture

AIMS: Major classification systems for alcohol use disorders (DSM-IV and ICD-10) contain elements of the 1976 Edwards and Gross formulation of the Alcohol Dependence Syndrome (ADS). However, issues remain about the criteria that identify Alcohol Dependence (AD) as distinct from Alcohol Abuse (AA) in DSM-IV and Harmful Use in ICD-10. These issues, in part, have their roots in changing historical perceptions of alcohol use and its problems. We discuss current diagnostic criteria for AA and AD, collectively called Alcohol Use Disorders (AUDs), in the context of their historical evolution; research progress in understanding alcohol problems, including alcohol dependence; new findings on the severity of AUDs as classified by DSM-IV; and the role of alcohol consumption patterns in future classifications of AUDs. METHODS: This paper is based largely on the 2006 H. David Archibald Lecture. Parts of the original lecture have been modified to reflect more recent findings from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) of the US National Institute on Alcohol Abuse and Alcoholism (NIAAA). RESULTS: The original Edwards and Gross ADS construct is supported by advances in biological and behavioral science over the past 30 years. New findings indicate that DSM-IV AA and AD are not diagnostically distinct entities, but represent a continuum of severity of AUDs. The ADS criteria may best represent one quantifiable dimension of alcohol use problems and this scale can be related to that of the frequency of harmful patterns of drinking. CONCLUSION: The Edwards and Gross ADS criteria can be used as the basis for beginning the development of scalable multi-dimensional criteria for diagnosing AUDs in new initiatives to revise DSM-IV and ICD-10.     

Japan: alcohol today

AIMS: The purpose of this paper is to outline alcohol availability, alcohol consumption and related harm, alcohol control policy and prevention programmes in Japan, few of which have been discussed in either the Japanese or English literature. METHODS: Data were collected primarily from the following two sources: statistics and survey results issued by the national government, including surveys funded by the government; and papers published since 2000, identified by searching the MEDLINE and Igaku-Chuo-Zasshi databases. These data were assessed regarding their quality and summarized. Some data presented here were produced specifically for this review. RESULTS: Although per capita alcohol consumption has tended to decline for more than 10 years, it has remained at a high level. Diversification of the drinking population has progressed rapidly, specifically in women, among whom alcohol consumption has increased sharply. Cross-sectional data suggest that alcohol consumption is associated with serious health and social consequences. Existing longitudinal data suggest that alcohol-related problems, especially health problems, have increased steadily over the past several decades, with few exceptions, including alcohol-related fatal road traffic accidents. Alcohol policy and prevention programmes have not developed to a level that can control these problems adequately. Specifically, the high availability of alcoholic beverages, including the lack of restrictions on sales and advertising and decreasing prices, are noted. CONCLUSIONS: This review provides basic information regarding alcohol availability and alcohol consumption and related harm that may facilitate the improvement of existing alcohol control measures in Japan and encourage the development of new alcohol control measures. This research revealed the scarcity of longitudinal data regarding alcohol consumption and its consequences, and the lack of several important variables, such as disability adjusted life years, for improving our understanding of the comprehensive status of alcohol in Japan.     

Alcohol use disorders in the elderly: a brief overview from epidemiology to treatment options

Alcohol-use-disorders (AUDs) afflict 1-3% of elderly subjects. The CAGE, SMAST-G, and AUDIT are the most common and validated questionnaires used to identify AUDs in the elderly, and some laboratory markers of alcohol abuse (AST, GGT, MCV, and CDT) may also be helpful. In particular, the sensitivity of MCV or GGT in detecting alcohol misuse is higher in older than in younger populations. The incidence of medical and neurological complications during alcohol withdrawal syndrome in elderly alcoholics is higher than in younger alcoholics. Chronic alcohol abuse is associated with tissue damage to several organs. Namely, an increased level of blood pressure is more frequent in the elderly than in younger adults, and a greater vulnerability to the onset of alcoholic liver disease, and an increasing risk of breast cancer in menopausal women have been described. In addition, the prevalence of dementia in elderly alcoholics is almost 5 times higher than in non-alcoholic elderly individuals, approximately 25% of elderly patients with dementia also present AUDs, and almost 20% of individuals aged 65 and over with a diagnosis of depression have a co-occurring AUD. Moreover, prevention of drinking relapse in older alcoholics is, in some cases, better than in younger patients; indeed, more than 20% of treated elderly alcohol-dependent patients remain abstinent after 4 years. Considering that the incidence of AUDs in the elderly is fairly high, and AUDs in the elderly are still underestimated, more studies in the fields of epidemiology, prevention and pharmacological and psychotherapeutic treatment of AUDs in the elderly are warranted.     

What are the policy lessons of National Alcohol Prohibition in the United States, 1920–1933?

National alcohol prohibition in the United States between 1920 and 1933 is believed widely to have been a misguided and failed social experiment that made alcohol problems worse by encouraging drinkers to switch to spirits and created a large black market for alcohol supplied by organized crime. The standard view of alcohol prohibition provides policy lessons that are invoked routinely in policy debates about alcohol and other drugs. The alcohol industry invokes it routinely when resisting proposals to reduce the availability of alcohol, increase its price or regulate alcohol advertising and promotion. Advocates of cannabis law reform invoke it frequently in support of their cause. This paper aims: (i) to provide an account of alcohol prohibition that is more accurate than the standard account because it is informed by historical and econometric analyses; (ii) to describe the policy debates in the 1920s and 1930s about the effectiveness of national prohibition; and (iii) to reflect on any relevance that the US experience with alcohol prohibition has for contemporary policies towards alcohol. It is incorrect to claim that the US experience of National Prohibition indicates that prohibition as a means of regulating alcohol is always doomed to failure. Subsequent experience shows that partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement.