What are the most effective and cost-effective interventions in alcohol control?

Summary

The issue

Europe plays a significant role in the production, trade and consumption of alcoholic beverages; it also carries a heavy social and economic burden of alcohol-related problems. Alcohol consumption is estimated to be responsible for about 10% of the total disease burden, increasing the risk of liver cirrhosis, certain cancers, high blood pressure, stroke and congenital malfunctions, among other problems. Furthermore, it increases the risk of many social problems such as family disintegration, absenteeism, poor productivity, financial hardships, unintentional injuries, traffic accidents, criminal behaviour, violence, homicide and suicide.

Findings

There is substantial evidence showing that an increase in alcohol prices reduces consumption and the level of alcohol-related problems. In most countries and especially in countries with low alcohol tax rates, tax-induced price increases on alcohol beverages lead to increases in state tax revenues and decreases in state expenses related to alcohol-related harms. The effects of price increases, like the effects of other alcohol control measures, differ among countries, depending on such factors as the prevailing alcohol culture and public support for stricter alcohol controls. However, the effects on alcohol-related harms are definite and the costs low, making it a cost-effective measure.

In addition, stricter controls on the availability of alcohol, especially via a minimum legal purchasing age, government monopoly of retail sales, restrictions on sales times and regulations of the number of distribution outlets are effective interventions. Given the broad reach of all these measures, and the relatively low expense of implementing them, they all are highly cost-effective.

Furthermore, most measures against drunk-driving, such as sobriety check points, random breath testing, lowered blood alcohol concentration limits, suspension of driver’s licenses, graduated licensing for novice drivers, and brief interventions for hazardous drinkers also receive high effectiveness ratings. There is good research support for these drunk-driving interventions. Thus these interventions are applicable in most countries and are relatively inexpensive to implement and sustain.

Server liability and enforcement of on-premise regulations combined with community mobilization seem to be strategies with some impact without being too costly. However, they do not reach off-premise drinking. Server training in responsible beverage service is unlikely to have an effect if it is not backed by the threat of suspending the licenses of those who continue to serve underage drinkers or intoxicated patrons.

If youthful drinking is seen as a specific alcohol policy problem, increasing the legal age limit for purchasing or selling alcoholic beverages is the most immediate and effective measure. Various educational approaches have been developed to reduce alcohol consumption. Although they are growing in popularity, there is little evidence of their effectiveness. Similarly, current research findings only show limited effects both on advertising and advertising bans.

Policy considerations

Most of the interventions mentioned are highly cost-effective, in that they are associated with considerable benefit at a generally low money cost. The most effective approach is to implement multiple policies of the following strategies: increase in alcohol prices, reducing the availability of alcohol, and measures against drunk driving and underage drinking.