Best practices in
preventing alcohol
problems
International evidence base
Øystein Bakke, FORUT
Development and welfare in Malawi
– the case of alcohol problems
Thematic session 3: Alcohol Policy
Knowledge base
vs.
Knowledge base
• Evidence based
best practices
• Smokescreen
draws attention away
from effective policies
vs.
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Asahi Breweries, LTD.
Bacardi-Martini
Beam Global Spirits & Wine
Brown-Forman Corporation
Diageo PLC
Heineken N.V.
InBev
Molson Coors
Pernod Ricard
SABMiller PLC
Scottish & Newcastle
Recapture: Best Practices
• Minimum legal
purchase age
• Government
monopoly of retail
sales
• Restriction on hours
or days of sale
• Outlet density
restrictions
• Alcohol taxes
• Sobriety check points
• Lowered BAC limits
• Administrative license
suspension
• Graduated licensing for
novice drivers
• Brief interventions for
hazardous drinkers
Least Effective Practices
• Voluntary codes
of bar practice
• Promoting
alcohol-free
activities
• Alcohol education
in schools
• College student
education
• Public service
messages
• Warning labels
• Designated drivers
and ride services
Alcohol: No ordinary commodity
• Opportunities for effective,
evidence-based alcohol policies are
more available than ever to better
serve the public good.
• Alcohol policies that limit access to
alcoholic beverages, increase the
price of alcohol, and enforce laws
and regulations through deterrence,
are likely to reduce the harm linked
to specific drinking patterns and per
capita consumption.
How harm is generated
• There is strong evidence that
alcohol related harm is directly
related to the aggregate amount of
alcohol consumed in a particular
population
• The more people who drink and the
more they drink, the bigger the
problem
Implications for prevention
• Reduce overall consumption
– Delay initiation of use
– Reduce heavy alcohol use
– Reduce population consumption
• Minimise harmful patterns of
consumption
– Change harmful behaviours associated with
alcohol use
– Insulate alcohol use from special situations
(e.g. driving)
Comprehensive strategy
The simple assumption does not work:
Knowledge > Attitudes/values > Action
A comprehensive and
integrated strategy
is more likely to work
Prevention and policy
• Alcohol prevention and policy goes hand
in hand
– Policy measures reduce consumption and
harm
– Information campaigns and education
programs are not effective means to change
drinking behaviour
– Campaigns may create a more receptive
climate to policy control
– Complementary strategies will be more
effective than single strategies
The prevention triangle
Control policies
Education
Mobilization
• A broad set of interventions
• Interlinked and coordinated
• Each type of interventions serve
their specific purpose
Control policies
A top-down approach
Regulation of markets by governments to reduce the
availability of a substance and to guarantee - from a
health/social point of view - safest possible production
and distribution system.
Education
Mobilization
Control policies
• The owner of a national strategy is the
state:
– Need to involve several state actors,
including Ministry of Health or Social
Welfare, law enforcement, the judiciary, and
the Ministry of Finance
• Contribution of the alcohol industry
– only in the context of their roles as
producers, distributors and marketers of
alcohol, and not in terms of alcohol policy
development or health promotion. (WHO
Expert Committee – Recommendation no. 9)
Education
Control policies
Mobilization
Education:
Provide information and training and influence values
– to help people to decide and act adequately in their
respective settings
Mobilization
Control policies
Education
Mobilization:
Make alcohol and drug prevention a part of the
agenda for social/political movements, link the issue
to other key policy issues and involve leadership and
members in practical activities.
Checklist for local context
• Which types of substances are
available and are being used?
– Homemade traditional
beverages
– Industrially produced
traditional beverages
– Domestic production
of international
beverages
– Imported international
alcohol brands
• Illegal Drugs?
Checklist for local context
• Who are the users?
– Proportion of non-users and users
– Gender differences
– Age differences
• Situations of use?
– Regularity, amount?
– Kind of situations?
– Risky situations
– Risky patterns
Checklist for local context
• The consumption
context?
– Traditional context
– Ritual context
– Poverty context
(urban or rural)
– Modernity context
(Westernized
values,
globalization)
– Crisis context
(conflict, war,
disaster)
Checklist for local context
• The consequences of alcohol and drug
use?
– Which are the most frequent negative consequences of taking alcohol and drugs;
– for the users themselves; for their family;
Checklist for local context
• The consequences of alcohol and drug
use? (cont.)
–
–
–
–
for friends, colleagues, neighbourhood;
for the local community
for the society at large?
Which do you consider to be the most
serious problems following substance
abuse?
– Which consequences are the most
detrimental from a development perspective?
Checklist for local context
• Distribution
systems?
– Who are the
producers or the
sources for the
various substances?
– Who are the
distributors and
retailers?
– Which other vested
interests are
involved?
Checklist for local context
• Level of
alcohol
consumption?
– Recorded
consumption
– Un-recorded,
legal
consumption
– Consumption
of illegal
beverages
Checklist for local context
• The use-values of the
substances?
– Which values are
attributed to the substance
use, by the users or the
surroundings?
– Cultural values
– Social values
– Economical benefits
– Psychological effects
– Physical effects
Checklist for local context
• What are the means available to
constrain the availability of alcohol?
– … and to structure consumption into
the least harmful forms?
• How are taxes on alcohol collected?
• How well informed are politicians
and decision- makers?
– Is there a need to disseminate public
information on these topics, to create
an sustain political support for
effective alcohol policies?
Alcohol in Devloping Societies
• The most effective approaches to
reducing alcohol problems regulate
alcohol’s availability and the conditions of
its use.
• The research evidence clearly indicates
that governments possess the powers
and policy levers to reduce and prevent
alcohol problems.
• Developing systems for regulating the
alcohol market to reduce alcohol related
problems is an essential task for
developing states.