Alcohol Issues INSIGHTS
Publisher: Benj Steinman
Editor: Eric Shepard
Vol 27, No 1
published monthly
New York Law Commission Provides Plenty of
Food for Thought Re Alcohol Policy/Regulation
As noted in our December 24, 2009 update, the New
York Law Review Commission published a 350-page
report last month after an extensive review of the
state’s alcohol beverage control law and its administration. The very wide-ranging report -- actually part
two following a fall 2009 preliminary review – focuses
primarily on how the “dysfunctional” state liquor
administration should and can be repaired. But it also
touches on several broader alcohol policy issues and
shows how advocacy positions can become received
truth. It remains to be seen whether legislators follow
the thinking and/or prescriptions in the report, but it
may become a model for other state reviews or policy
changes. In most matters, the commission takes a
notably even-handed perspective, carefully balancing
consumer, business and public health interests. Elsewhere, it reads like public health advocacy. Here are
some key quotes from the review that address alcohol
policy matters and approaches.
•
“No one should underestimate the importance
of regulating beverage alcohol even as social
change makes its consumption more readily
acceptable. Balancing the need for vigilance
and social acceptability while also taking into
account the desire to promote craft beverage
alcohol industries in this state is no easy task.”
•
“Regulating a product that presents both a potential threat to the public’s health, safety and
welfare while providing considerable tax revenue for the state as well as significant opportunity for economic development requires
careful consideration.”
January, 2010
•
“Promotion of temperance and moderation
through the enforcement of the law is also an
important component of regulation of beverage alcohol.”
•
“We recommend that the Legislature consider
providing some flexibility in the application of
the rule” that bans alcohol licensees within 200
feet of a school or house of worship, “for example, when the school or house of worship
waives it.”
•
“The SLA is unable to make prevention of underage drinking a statewide priority.” Lack of
inspections, inconsistent enforcement and lack
of oversight cause the agency to “neglect public health” and has led to “industry abuses.”
The commission recommends “proactive steps
to enforce underage drinking laws,” including
beefed up enforcement and follow-up.
On the underage issue, the commission defers to the
findings of the New York State Advisory Council on
Underage Consumption. It included a two-page letter
with recommendations made last spring by the Council. While acknowledging that underage age drinking
measures have declined in New York and nationally,
the letter and its recommendations basically embrace a
control of consumption perspective and approach
with scanty support for these positions. The law
commission voices support for the 3-tier system and
wholesalers as its “lynchpin.” Advocates of strict state
regulation will embrace some of report’s language:
For example:
“Deregulation will increase accessibility and availability and increase sales to youth. Public health research
over the past few decades has demonstrated conclu-
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sively that increases in per capita alcohol consumption
are associated with increases in alcohol problems.
This is as true for the youth population as for the adult
population.” Any liberalization “which has the effect
of boosting overall sales will necessarily result in increases in underage alcohol-related problems (and
their consequences) in New York State. “
“Compliance checks show that as many as 50% of onsite and off-site premises serve or sell alcohol to minors and any expansion of alcohol sales…will ultimately translate into increases in underage drinking. “
Ironically one the first priorities of the Law Review
Commission and the current SLA has been to clear up
a backlog of license applications for new licenses.
“Youth are more susceptible to media pressure, and
any expansion of the alcohol industry carries with it
an aggressive advertising and marketing campaign
often targeting youth and young adults. Research has
well documented targeted advertising to both youth
and especially to young adults on college campus.”
Also: “Research has found that higher alcohol outlet
density has been associated with higher quantities of
alcohol consumed by teenage drinkers, adolescent
binge drinking, adolescent drinking and driving, rising with a drinking driver and Latino youth arrest
rates for violent crimes.” (None of this research is
footnoted.) The Council wanted the state to expand the
200-foot rule “to least 500 feet.”
While the Law Review Commission seeks to promote
craft brewers, the Council believes that “selling beer at
farmer’s markets or sponsoring brewing festivals and
increasing the number of micro-breweries, distilleries
and wineries will only further blur the boundaries in
keeping youth and young adults alcohol free.”
The report acknowledges that the state’s ban of wine
sales in grocery stores “has been the subject of intense
debate during the past two years,” including legislative proposals to lift the ban. But the commission
punted, saying the issue deserved a “complete and
independent analysis of its economic consequences”
that it lacked the time and experience to perform.
The wide-range and large number of issues and recommendations made by the Commission and the
Council -- together with a legislature that has its
hands full with acute budget and other matters -probably preclude many of them from being acted
upon. But industry and public health interests alike
have a new “document” upon which to rely to ad-
vance their interests in New York and elsewhere. Ref 1
In the Research: Japanese Study Links Drinking
to Better Heart Health, But Not Stroke Risk
One of the first studies in Japan to assess the relationship between drinking, diabetes and heart health
found that “non-daily to daily alcohol intake were
associated with a reduction in cardiovascular and allheart disease mortality in Japanese men with diabetes,
as in men without diabetes.” The finding is important
because, as the authors point out, “alcohol intake is
often discouraged in today’s clinical practice,” especially for diabetics. But, in this study of over 4,000
Japanese men followed for 19 years, diabetics who
drank every day had a 62% reduced risk of death from
acute myocardial infarction (compared to “never
drinkers”) and a 56% reduced risk from non-AMI
heart disease. Diabetics also had a 44% reduced risk
for cardiovascular disease. Daily drinkers among
men without diabetes enjoyed a 28% reduced risk for
AMI, a 32% reduced risk for non-AMI and a 9% reduced risk for death from cardiovascular disease.
Among the non-daily drinkers, diabetics still had a
50% reduced risk of all heart disease death and a 39%
reduced risk for cardiovascular disease death. Nondaily drinkers who were not diabetic had even lower
risks for heart and CVD death than never-drinkers,
59% and 47% respectively. (The study did not measure amount consumed.)
Interestingly, while other studies have linked moderate/regular drinking to reduced risk of stroke, the
Japanese study did not find a significant association
between regular drinking and stroke. Nor did the
just-published results from the Physician’s Health
Study in Massachusetts, which looked at the effect of
drinking on risk of stroke and “functional outcomes
after stroke.” In that study of nearly 22,000 physicians
followed for nearly 22 years, only the lightest drinkers
– 1 drink per week – had a statistically significant reduced risk of stroke compared to those who drank less
than 1/week, about a 20% reduction. And it would be
very difficult to believe that a single drink/week could
have a causal effect on stroke or any other health issue.
Similarly, the lightest drinkers “had the lowest associated risk for any of the [negative] outcomes” among
those who had suffered a stroke. “Higher alcohol
consumption showed no association with functional
outcome after stroke,” the authors added. While other studies have linked moderate drinking to reduced
stroke risk, the difference here “may be explained by
the longer follow-up time and thus the aging of the
cohort,” the authors suggested. “Moderate to light
alcohol consumption may reduce the risk of stroke in
shorter follow-up periods but has reduced influence in
long periods.” Ref 2
California Study Links Outlet Densities to Injuries, Assaults Among Young People
Should local communities limit the number of alcohol
outlets to reduce alcohol-related harms? Public health
advocates argue that the research suggests limits are in
order (see the recommendation by the NY Council
above). Industry members tend to question that evidence, given the size of the effects, the details of the
findings and the complexity of the issue. A new study
from California is not likely to end the debate in either
direction. A group of researchers from the Pacific
Institute for Research and Evaluation looked at demographic data, outlet densities and injuries from accidents, assaults and traffic crashes by zip code in California for the year 2000. The injury/crash data came
from hospital discharges, so the injuries were relatively severe. The authors did not measure any alcohol
consumed or specifically alcohol-related injuries,
crashes or assaults. They correlated injuries among
18-20 yr-olds and 21-29 yr-olds with on- and offpremise outlet densities by zip code. The authors also
tried to factor in different demographic data on racial
make-up, income and other measures that may have
had an impact on injury levels.
Their key findings about the potential impact of outlet
densities (demographic characteristics had their own,
separate associations): 1) among 18-20 yr-olds “only
densities of off-premise outlets were positively related
to numbers of accident, assault and traffic injuries”;
bar/restaurant densities were not linked to injuries
among those below the minimum purchase age; 2)
among 21-29 yr-olds “densities of off-premise outlets
were positively related to numbers of accident, assault
and traffic injuries. Densities of bars or pubs were
related to a greater number of assaults. Densities of
restaurants were related to greater numbers of traffic
injuries.” The effects appear to be modest, but statistically significant. The data suggested that “a 10% increase in off-premise outlets within a zip code was
associated with an increase in the 6 problem measures
from 0.9% to 1.6%. A 10% rise in local restaurants or
bars was associated with increases of less than 1% in
traffic or assault injuries, respectively, among the older
age group.” Also: “A 10% rise in off-premise outlets
in neighboring communities was associated with a
1.7% increase in accident injuries in the younger group
and a 1.5% decrease in traffic accidents among the older
group.” (Our emphasis.) Beyond the correlations, the
nature of the link between density and injuries remains elusive. The data “does not allow us to ascertain the mechanisms by which these problems occur,”
the authors point out. It could be simply a matter of
easier access and frequency of use. “Or is the presence
of alcohol outlets related to other, as yet unmeasured
structural processes occurring in these areas?” the
authors ask. At some point, data on actual “drinking
patterns, social interactions around drinking and related behaviors and modes of alcohol access” will
have to find their way into these studies, the authors
acknowledge.
In any case, the study joins others that appear to link
increased density with increased negative outcomes.
And it will be so cited. Indeed, scientific newswire
stories on the California study included a response
from veteran alcohol outlet research Richard Scribner
(not one of the authors): “From a prevention perspective, this represents an important refocusing of priorities, away from targeting the individual to targeting
the community.” Ref 3
Brief Interventions: In Person and Anonymous
Programs Help Reduce Problematic Drinking
Two recent studies from Canada found that both faceto-face interventions and those done by the subject
alone can reduce harmful consumption. The first
study looked at how brief sessions to motivate repeat
DWI offenders can be effective in reducing their risk of
driving while intoxicated in the future. DWI recidivists, “especially those with significant alcohol problems, pose a greater risk for traffic safety relative to
first time offenders without alcohol problems,” noted
authors. It has been found that anywhere from 78% to
90% of repeat DWI offenders are dependent on alcohol, so clearly any intervention that can reduce likelihood that they will drink and drive is a positive step.
Adding to the problem, authors of this study point out
that many recidivists “do not participate in mandated
alcohol evaluation and intervention programs, or continue to drink problematically after being re-licensed.”
In this study, 217 repeat DWI offenders (aged 18 or
older with at least 2 DWI convictions), submitted to
either a 30 minute Brief Motivational Interviewing
(BMI) or were given information-advice. Researchers
found that while both interventions “revealed significant declines in risky drinking,” a BMI with recidivists
“resulted in a 25% reduction in risky drinking days at
12-month follow-up.” The study also found that exposure to a BMI “produced significantly greater improvement at a 6-month follow-up in a biomarker of
alcohol abuse and a behavioral measure related to
recidivism risk.”
Motivational interviewing is described by authors as
“a therapeutic approach that seeks to enhance intrinsic
motivation to change by exploring and resolving ambivalence and incorporates an emphatic patientcentered yet directive counseling style.” In discussing
positives for BMI with recidivists, the authors acknowledge that overall outcomes regarding participation in DWI intervention programs “appear positive,”
however “the magnitude of their benefits is modest,
especially in so-called ‘hardcore’ offenders.” Also,
delays in processing DWI offenders may lead to long
delays in recidivists’ participation in DWI intervention
programs “that could reduce their alcohol-associated
risks is also deferred.” Protracted delays in participation in DWI intervention “has been associated with
heightened risk of continued drinking and driving.”
To reduce risk of recidivism and to the public at large,
“we need to identify effective brief interventions for
offenders that can be deployed opportunistically in
venues where they may be reached,” they concluded.
Meanwhile, face-to-face interventions may not be the
only type that can help change problematic drinking
behavior. In what is described as “the first evaluation
of its kind,” researchers at the Centre for Addiction
and Mental Health (CAMH) in Canada, found problem drinkers reduced their typical weekly drinking by
30% when using an internet site called CheckYour
Drinking.net. They found this result was sustained for
both a 3- and 6-month follow-up period for the 170
participants. “An unfortunate reality is that many
problem drinkers do not seek treatment,” said lead
author John Cunningham. “While getting help from a
health care professional is ideal, there are barriers to
access such as concerns about stigma, a desire to handle problems on one’s own, or simply because treatment is not readily available,” he added. Access to
sites like CheckYourDrinking “can help reduce these
barriers by allowing people to seek help in their own
home.” When using the CYD site, participants complete a brief online assessment of their alcohol consumption patterns. They then receive a “Personalized
Drinking Profile” which includes “normative feedback
pie charts that compare the participant’s drinking to
others of the same age, sex and country of origin,” and
also a “summary of the participant’s severity of alco-
hol problems.” A profile on CYD usually takes about
10 minutes to complete.
Even with the benefit of anonymous intervention
however, the authors noted that almost one-third of
participants who the CYD intervention was available
to did not access it. So granting access alone does not
guarantee problem drinkers will use tools available to
them. “Indeed, no one intervention is an ideal solution and a sensible option for promoting access to care
is to increase the variety of research-based interventions available so that problem drinkers can choose
one (or several) that is suitable to them.” Ref 4
In the States Just a few weeks into 2010 and new
policy proposals are popping up in communities
across the US. Not waiting for the outcome of the
Food and Drug Administration’s investigation into
caffeinated alcohol beverages, the Washington State
Liquor Control Board requested legislation to ban the
drinks. Rep. Tami Green introduced a bill for consideration this year that would prohibit the sale in Washington of “any caffeinated or stimulant-enhanced malt
beverage, “ defined as a beverage “to which is added
caffeine or other stimulants including, but not limited
to, guarana, ginseng, and taurine, and contains at least
one-half of one percent alcohol by volume.”
In Virginia, the newly elected governor continues to
advocate a plan to “get Virginia out of the retail liquor
business,” though he has yet to provide details, AP
reports. The NY governor has proposed allowing
sales of wine in grocery stores. South Dakota legislators are looking at a bill that would allow Sunday and
holiday sales of liquor on- and off-premise. New Jersey’s outgoing governor signed a bill to allow liquor
tastings…. The Memphis City Council is considering
a ban of single-serve beer in its downtown area….
The City of Huntington Beach, CA may ban alcohol
games like beer pong for all on-premise outlets. Ref 4
Cheers,
References
1 The New York State Law Revision Commission, “Report of the
Alcohol Beverage Control Law and its Administration,” December
15, 2009.
2 Nakamura, Y, et al, “Alcohol Intake and 19-year Mortality in
Diabetic Men: NIPPON DATA80,”Alcohol, Vol 43, December
2009. 635-641; Rist, P, et al, “Alcohol Consumption and Functional
Outcome After Stroke in Men,” Stroke, Vol 41, January 2010, 141146.
3 Grunewald, P, et al, “Ecological Associations of Alcohol Outlets
with Underage Youth and Young Adult Injuries,” Alcoholism:
Clinical and Experimental Research, Vol 34, No 3, March 2010.
4 Brown, T, et al, “Brief Motivational Interviewing for DWI
Recidivists Who Abuse Alcohol and Are Not Participating in
DWI Intervention: A Randomized Controlled Trial,” Alcoholism: Clinical and Experimental Research, Vol 34, No 2, February
2010, 292-301; Cunningham, J, et al, “A randomized controlled trial
of an internet-based intervention for alcohol abusers,” Addiction,
104, December, 2009, 2023-32.