Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol (original) (raw)
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This paper reviews the evidence for the eff ectiveness and cost-eff ectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the infl uence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are eff ective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also eff ective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-eff ective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more eff ective pricing policy than a simple increase in tax.
PsycEXTRA Dataset
Introduction 1 2. A brief summary of methodological issues 3 3. The aggregate social costs of alcohol 5 4. Estimating the Feasible Minimum in practice 7 4.1 The Arcadian Normal 7 4.2 Exposure-based comparators 9 4.3 The effectiveness of interventions 11 4.3.1 The basis for the choice of effective policies 11 4.3.2 Difficulties in aggregating the economic benefits of individual policies 4.3.3 Retaining the protective health benefits of moderate alcohol consumption 5. The intervention choices 5.1 Alcohol taxation 5.1.1 Potential reductions in social costs from the use of alcohol taxation 5.2 Bans on alcohol advertising 5.2.1 Potential reductions in social costs resulting from advertising bans 5.2.2 The impact of alcohol advertising bans on the overall social costs of alcohol abuse 5.2.3 The estimated impact of alcohol advertising bans on the social costs of alcohol-attributable road accidents 5.2.4 Maintaining advertising bans iv 5.3 Measures to reduce drink driving 5.3.1 Greater enforcement of random breath testing 5.3.2 Reducing the blood alcohol concentration level 5.3.3 Conclusions from the research evidence 5.3.4 Potential reductions in social costs from anti-drink-driving policies 5.4 Brief interventions for reducing hazardous alcohol consumption 5.4.1 The impact of brief interventions on the overall social costs of alcohol abuse 6. Effective interventions whose benefits cannot be evaluated 6.1 Control of drinking environments 6.2 Alcohol ignition locks 6.3 Guidelines for low-risk drinking 6.4 Standard drinks labelling and health warnings on drinks containers 6.5 Other interventions 7. Summary of results 8. Conclusions 8.1 Policy implications 8.2 Methodological implications 9. Research recommendations 9.1 Policy effectiveness 9.2 Alcohol demand elasticities 9.3 Time periods over which policy benefits accrue 9.4 The macroeconomic impact of alcohol interventions 9.5 Revision of the avoidable cost guidelines Appendix A. Methodological issues A1. The nature of avoidable costs A2. Reasons for estimating avoidable costs Priority for substance abuse expenditures Appropriate targeting of specific problems Identification of information gaps and research needs Provision of baseline measures to determine the efficiency of drug policies and programs
American Journal of Preventive Medicine, 2010
A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specifıed quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the fınal review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also signifıcantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modifıed by such factors as disposable income and the demand elasticity for alcohol among various population groups. (Am J Prev Med 2010;38(2):217-229) Published by Elsevier
Alcohol Abuse: Cost Effectiveness and the Economic Impact of Policies and Programs
If the analysis of cost and of the effectiveness of interventions in the area of alcohol abuse were simple, interventions would also be simple. The fact that interventions are demonstrably difficult, and that it is no simple matter even to demonstrate any intervention effect at all, should warn us that work on costeffectiveness cannot profitably be conducted on the basis of the somewhat simplistic assumptions on which many previous attempts were founded. One such assumption has been the primacy of the message. Knowledge of health risk is comparatively easy to assess, and if it could be assumed that knowledge of the risks of a particular behavior translated seamlessly into an avoidance of that behavior, then population surveys would translate with comparative ease into numerical data on the effect of any particular intervention. Regrettably, this is not so. Information, even information systematized into education and resulting in communication, does not necessarily alter behavior. Behavior is influenced by such a multiplicity of personal, social, and environmental factors that it becomes increasingly difficult to determine the influence of any intervention on any outcome. Another such assumption has been the universal undesirability of alcohol. Cost analyses of alcohol abuse have hitherto been largely conducted as if alcohol were a substance like tobacco, with no threshold toxicity level and no health benefits. This approach merged alcohol abuse, which was by definition undesirable, with total alcohol use, and simply modified the latter to extract the former. Alcohol abuse estimates have thus been made on the basis of total consumption statistics 1 . , for example, estimated that if all drinkers consumed no more than the recommended limit, consumption would fall by 30 percent and, therefore, 1 Or, in some studies, on production statistics; the relation between national production statistics and national consumption statistics, the latter mainly derived from selfreport data of variable accuracy, is also problematic.
Public alcohol policy: current directions and new opportunities
Clinical pharmacology and therapeutics, 2008
Alcohol policy has been shown to have an impact on the incidence and prevalence of alcohol "addiction," or alcohol use disorders (AUDs), as currently defined by the International Classification of Diseases, volume 10, or by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. We will mainly use the term "addiction" to depict a state involving loss of control over intense urges to consume alcohol, even at the expense of adverse consequences. This definition goes beyond pure "physiological dependence." We will use the term AUD when referring to statistics based on the above-described definitions. In this overview we identify the pathways in the relationship between alcohol policy and addiction, present the empirical evidence, and draw conclusions. Special emphasis will be put on treatment policy.