• Main messages: Sensible drinking to reduce alcohol related harm
Sensible drinking is defined as up to:
- 3-4 units a day for men
- 2-3 units a day for women
- Different messages are appropriate for young people, pregnant women and different circumstances eg driving.
• Size of the Problem
- NHS responses to alcohol related problems cost around £150 million per year (Maynard A 1992)
- 13,000 violent incidents take place in or near licensed premises each week (Home Office 1999)
- 46% of firms of UK firms report problems of alcohol misuse among employees (IPD 1999)
- The broad consensus is that alcohol related deaths have risen from 28,000 to around 33,000. This represents an increase of a third since 1984. The increase is even steeper among those under 45. (ONS 1997).
- With regard to accidents, alcohol is estimated to be a factor in 20-30% of all accidents (Honkanen, R 1993)
• Research of effective health promotion approaches
Reducing overall consumption
The traditional public health approach has concentrated on a reduction in overall consumption as a means of reducing alcohol-related harm. This has led to an emphasis on alcohol control measures such as the number and location of sales outlets, licensing regulations, drinking age restrictions, advertising and sponsorship restrictions, criminal penalties for drink/driving and the use of fiscal policy to increase the price of alcohol. Education has focused on minimizing drinking and the avoidance of dependence. The basic message for all drinkers is “drinking less is better”.
Research on alcohol policies in Nordic countries show that those countries that restrict retail outlets for alcohol (Sweden, Finland, Norway and Iceland) have a much lower rate of liver cirrhosis than Denmark, which has no such policy but relies on fiscal controls.
Evidence from economic studies is consistent in suggesting that price is a determinant of alcohol consumption. This may have more effect on some drinkers than others. There is no consensus as to whether heavy drinkers are responsive to price, but Sutton and Godfrey (1995) pooled information on UK males aged 18-24 over the years 1978-90 and found that the heaviest drinking groups were the most sensitive to price. Studies in the USA have also shown young drinkers to be particularly sensitive to price changes.
• Harm Minimisation
Research on “Responsible Beverage Service” which involves the training of alcohol servers accompanied by responsible house policies (no cheap drink promotions, happy hours etc) and management and community support, has been shown to be effective in reducing alcohol impairment and intoxication.
In December 1995 it became law in Australia for all alcohol, imported or manufactured to include a statement on the packaging expressing the number of “standard drinks” to one decimal place. Alcohol Concern are promoting this measure in the UK using “a unit” instead of a “standard drink”. This measure aims to increase knowledge about what constitutes a unit of alcohol and makes counting the amount you drink in a day or a week considerably easier.
In 1999, many of the big drinks companies entered into a voluntary agreement with the government to introduce unit labelling as soon as it became practically possible with depletion of current stock. Locally, Matthew Clark plc have introduced unit labelling on their alcohol containers.
Alcohol container warning labels are mandatory in the US, Mexico and India. In the US impact evaluation has been carried out following the introduction of legislation in November 1989. By 1994 about half of all drinkers were aware of the label and were being reached by some of its messages.
The past decade has seen a significant reduction in alcohol-related traffic fatalities. This has been brought about by changes in the law. – introduction of the breathalyzer and heavy penalties for drink driving offenders.
Other studies have suggested that exposure to education on alcohol may even lead to increases, rather than decreases, in levels of use. (Kinder et al, 1980; De Haes, 1987; Plant and Plant, 1992; Hawthorne et al, 1995 also cited by Plant and Plant.) The provision of “alcohol education” for adolescents and students in schools and colleges may increase awareness or factual knowledge but so far has not been proven to be effective in reducing problem drinking.
There is considerable support in the research literature for a “brief interventions” approach in order to help individuals with drink problems. (Bien et al, 1993.) The results have been less clear for women than for men and reviews of brief intervention studies have been criticized for paying insufficient regard to important differences between types of intervention and for failing to differentiate between treatment seekers and non-treatment seekers. (Heather, 1995.)
A brief intervention can take a number of forms:
- advice about drinking from a professional
- the issue of a self help manual
- feedback from assessment measures
- limited counselling
- any combination of such measures
Self–help manuals have been demonstrated to have a positive impact for men and women in a number of studies. (Heather et al, 1990; Barblett, 1993.)
• Web Sites
Barblett, A., (1993) “Marketing the drinksafe women’s manual” Health Promotion Journal of Australia, Vol 3 No 1, pp 58-62.
Bien, T. et al (1993) “Brief Interventions for alcohol problems” Addiction, Vol 88, pp 315-336.
Heather, N., (1995) “Interpreting the evidence on brief interventions for excessive drinkers: the need for caution.” Alcohol and Alcoholism, Vol 30, No 3 287-296.
Heather, N., (1990) “Assisted natural recovery from alcohol problems: effects of a self-help manual with and without supplementary telephone contact.” British Journal of Addiction Vol 85, 1177-1185.
Home Office (1999) “Alcohol and Crime: Taking stock”, Crime Reduction Research Series Paper no3″, Policing and Reducing Crime Unit, the Home Office London
Honkanen, R (1993) “Alcohol in home and leisure injuries” Addiction, vol 88 p939,944
Institute of Personnel and Development (IPD) 1998
Laurent Chenet et al (1997) “Alcohol Policy in Nordic Counties” BMJ No 7088.
Leung and Phelps, (1993) “My Kingdom for a drink ….” In Hilton and Bloss (eds) Economics and the Prevention of Alcohol Related Problems, Rockville, MD, National Institute on Alcohol Abuse and Alcoholism Research, Monograph No 25, US Department of Health and Human Services, pp 1-31.
Maynard A (1989) “Controlling legal addictions” London: Macmillan
-Maynard A ((1992) “Social Costs of Alcohol”, Yorkshire Addictions Research, Training and Information Consortium
Nuffield Institute for Health (1993) “Brief Interventions and Alcohol Use” Effective Health Care No 7.
Office for National Statistics 1997 HMSO
Plant, Single and Stockwell (eds) (1997) “Alcohol – Minimising the harm – what works?” Free Association Books.
Plant and Plant (1997) “alcohol Education and Harm Minimisation” in Plant, Single and Stockwell (eds) (1997) “Alcohol – Minimising the harm – what works?”
Saltz, R. (1997) “Prevention Where Alcohol is Sold and Consumed: Server Intervention and Responsible Beverage Service” in Plant, Single and Stockwell (eds) (1997) “Alcohol – Minimising the harm – what works?” Free Association Books.
Stewart and Sweedler (1997) “Driving Under the Influence of Alcohol” in Plant, Single and Stockwell (eds) (1997) “Alcohol – Minimising the harm – what works?” Free Association Books.
Sutton and Godfrey 1995 “A grouped data regression approach to estimating economic and social influences on individual drinking behaviour” Health Economics, 4: 237-47.
Plant, Single and Stockwell (1997) Alcohol – Minimizing the harm – what works? Free Association Books is stocked in the Health Promotion Resource and Information Centers.