Alcohol Policy Research and Alcoholic Beverage Control ... - nabca

Back to Table of Contents4.2 How does one determine an optimal balance of policies to provide fair access toresponsible drinkers while restricting sales in ways that reduce alcohol-related risksand harms? What methods are available for identifying best practices and theirapplicability to a particular state?Only recently has this research agenda—choosing the most cost-effective alcohol policy mix to fit theeconomic development and cultural conditions of a jurisdiction (including its rates and patterns of drinkingand associated social and health harms)—begun to be seriously considered, and research in this area is justbeginning. Most of the thinking has had an international focus involving follow-ups to the efforts to examinemortality and disabilities resulting from alcohol use disorders (alcohol abuse and alcoholism) in the contextof World Bank and World Health Organization studies of the Global Burden of Disease. There are markedregional differences in the disease burden associated with alcohol. In the Americas (the region as a whole),alcohol has found to be the most important single preventable risk factor contributing to burden of disease,larger even than smoking, obesity, and high blood pressure.Regarding specific approaches to selecting an optimal set of alcohol policies for a jurisdiction there is notyet a solid, widely-endorsed methodology. Cost studies in the US help identify the larger contributors forexample, injuries, criminal justice, health system and alcohol treatment costs. Efforts at NIAAA to updatethese are currently underway, as are efforts to calculate disability adjusted life years associated with alcohol andrelated conditions using large-scale public data sources. In principle, by analogy to a country, a state’s profileof drinking patterns and harms, together with its population characteristics and economic and infrastructureresources, could help determine the relative expected effectiveness and cost effectiveness of various strategiesfor abating alcohol problems. Countries or states may both have different capabilities for implementingstrategies that strengthen policies to reduce drinking problems like increasing alcohol taxation, enhancingon- and off-premise point-of-sale regulations including retail monopoly practices where present, increasingenforcement of DWI laws or altering the legal BAC limits, increasing screening, brief intervention and referralto treatment (SBIRT) programs, and the like, and may also expect different results from such strategies if theyare implemented, depending on the country or state’s unique drinking patterns and resources. As discussedbelow, public sentiment for such legislative and regulatory measures may also affect the viability of particularapproaches. Although a beginning has been made, alcohol policy development (how to encourage passageof evidence based alcohol-related laws) remains more a political art than a science. It has been observed thatthe role of research tends to be more justificatory than initiatory, with some noteworthy exceptions such asmainly in the area of laws aiming to reduce drinking driving.Key Articles Cited In Section 4.2Anderson, P., Chisholm, D., & Fuhr, D. C. (2009). Effectiveness and cost-effectiveness of policiesand programmes to reduce the harm caused by alcohol. Lancet, 373(9682), 2234-2246.This is an extremely comprehensive, current review of the evidence for effectiveness of alcohol policiesand programs, one of several Lancet papers in this edition focused on Alcohol and Global Health. It isbroadly framed for relevance to both developed and developing countries, and most often it cites recentkey reviews on particular alcohol policy topics. It breaks policies considered into 9 “target areas”: (1)Education and information, (2) Health-sector Response, (3) Community programs, (4) Drink-driving policiesand countermeasures, (5) Addressing the availability of alcohol, (6) Addressing the marketing of alcoholicbeverages, (7) Pricing policies, (8) Harm reduction and (9) Reducing the public health effect of illegally andinformally produced alcohol. In addition to marshalling current evidence of effectiveness it notes that studiesof social costs have been done in many countries, addressed by Rehm et al., in a companion Lancet article90Back to Table of Contents