The costs of hazardous alcohol consumption in Germany

The Impact of Raising Alcohol Taxes on Government Tax Revenue: Insights from Five European Countries

BACKGROUND AND OBJECTIVE

Reducing the affordability of alcoholic beverages by increasing alcohol excise taxation can lead to a reduction in alcohol consumption but the impact on government alcohol excise tax revenue is poorly understood. This study aimed to (a) describe cross-country tax revenue variations and (b) investigate how changes in taxation were related to changes in government tax revenue, using data from Estonia, Germany, Latvia, Lithuania and Poland.

METHODS

For the population aged 15 years or older, we calculated the annual per capita alcohol excise tax revenue, total tax revenue, gross domestic product and alcohol consumption. In addition to descriptive analyses, joinpoint regressions were performed to identify whether changes in alcohol excise taxation were linked to changes in alcohol excise revenue since 1999.

RESULTS

In 2022, the per capita alcohol excise tax revenue was lowest in Germany (€44.2) and highest in Estonia (€218.4). In all countries, the alcohol excise tax revenue was mostly determined by spirit sales (57-72% of total alcohol tax revenue). During 2010-20, inflation-adjusted per capita alcohol excise tax revenues have declined in Germany (- 22.9%), Poland (- 19.1%) and Estonia (- 4.2%) and increased in Latvia (+ 56.8%) and Lithuania (+ 49.3%). In periods of policy non-action, alcohol consumption and tax revenue showed similar trends, but tax level increases were accompanied by increased revenue and stagnant or decreased consumption.

CONCLUSIONS

Increasing alcohol taxation was not linked to decreased but increased government revenue. Policymakers can increase revenue and reduce alcohol consumption and harm by increasing alcohol taxes.

Implementing Approach-Bias Modification as Add-On to Varieties of Clinical Treatment for Alcohol Use Disorders: Results of a Multicenter RCT

INTRODUCTION

Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches.

METHODS

A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment.

RESULTS

Return rates of the post-treatment assessments varied greatly between clinics, often being low (18-76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists.

DISCUSSION/CONCLUSION

ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence.

Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany

BACKGROUND

Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example.

METHODS

A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC).

RESULTS

Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85-0.88).

CONCLUSIONS

Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.

Prävention und Kostenkontrolle im Gesundheitswesen

Hintergrund

Das deutsche Gesundheitswesen hat mit hohen Kosten zu kämpfen. Neben den aktuellen finanziellen Belastungen im Zusammenhang mit der Coronapandemie verfolgt die deutsche Bevölkerung mehrheitlich einen ungesunden Lebensstil der zukünftig zu weiteren Neuerkrankungen und assoziierten Kosten führen wird.

Ziel der Arbeit

Dieser Beitrag skizziert, wie mit Hilfe von Routinedatenanalysen der Gesetzlichen Krankenversicherung (GKV) Ansatzpunkte für Maßnahmen auf allen Ebenen der Prävention entwickelt werden können, die effektiv Krankheitsentstehungen verhindern, -progresse reduzieren und die Fähigkeit zur Beitragszahlung absichern können. Diese sollen durch effektives Gesundheitsmarketing Versicherte zu gesundheitsverbessernder Leistungsinanspruchnahme animieren.

Material und Methode

Es wird eine Idee entwickelt und diskutiert, in der ergänzend zu den bestehenden Möglichkeiten der GKV auf präventives Gesundheitsverhalten hinzuwirken, Ergebnisse der Sekundärdatenanalyse für Präventionsmaßnahmen und -verhalten nutzbar gemacht werden können.

Ergebnisse und Schlussfolgerung

Eine Machine-learning-gestützte Analyse bildet den Kern einer Klasse von Prädiktionsmodellen für die Prävention von Krankheiten. Diese Modelle setzen an unterschiedlichen Patientenmerkmalen in den Routinedaten der GKV an und liefern Empfehlungen für Präventionsmaßnahmen, die für eine zielgerichtete und kosteneffektive Ansprache beispielsweise mittels mHealth genutzt werden können. Die hohen Einsparungspotenziale im Gesundheitswesen sowie die Möglichkeiten der Gesetzlichen Krankenkassen diese datenanalytisch gestützt zu erschließen eröffnen eine sinnvolle Perspektive zu nachhaltiger Kostenkontrolle.

Compassion Fatigue, Compassion Satisfaction, Burnout and Alcohol Use Among Dental Hygienists

AIMS

The purpose of this study was to investigate the relationship between demographics, compassion fatigue (CF), compassion satisfaction (CS), burnout (BO) and alcohol use among dental hygienists (DHs).

METHODS

The web-based survey consisting of two validated instruments [Alcohol Use Disorders Identification Test (AUDIT) and Professional Quality of Life] to measure alcohol use, CF, CS and BO was conducted with a convenience sample of DHs (n = 963).

RESULTS

The completion rate was 81.6% (n = 786). Nearly one in five DHs (19.1%) reported having their alcohol consumption influenced by the Coronavirus disease 2019 pandemic at least moderately. The number of hours worked per week (x) and AUDIT scores (y) were fully mediated by BO (m) (P < 0.001); the average number of hours worked per week (x) and AUDIT scores (y) were fully mediated by CF (m) (P < 0.001); the average number of patients seen per day (x) was a predictor of AUDIT scores (y) when partially mediated by BO (m) (P < 0.001); and age (x) was a predictor of AUDIT scores (y), mediated by CS (m). Results showed that one in four DHs could qualify for binge drinking (25.6%, n = 177) and 15.1% experienced blackout drinking episodes within the past year (n = 118).

CONCLUSION

Mediating relationships exist between demographics, CF, CS, BO and alcohol use among DHs. More research needs to be conducted on alcohol use and CF among DHs and protective factors that may reduce the risk of BO, CF or alcohol use.

[Potential impact of increased alcohol taxes on the alcohol-attributable burden of disease in Germany: a modelling study]

Hintergrund

Deutschland gehörte im Jahr 2019 zu den Ländern mit dem weltweit höchsten Pro-Kopf-Alkoholkonsum, welcher wesentlich zur Krankheitslast beiträgt.

Fragestellung

In dieser Modellierungsstudie schätzen wir, wie viele alkoholbedingte inzidente Krankheits- sowie Todesfälle in Deutschland im Jahr 2019 hätten vermieden werden können, wenn die derzeitigen Verbrauchssteuern auf Alkohol um 20 %, 50 % und 100 % erhöht worden wären.

Methodik

Ausgangspunkt für die Modellierung sind die spezifischen Verbrauchssteuern auf alkoholische Getränke in Deutschland. Drei Szenarien wurden unter der Annahme, dass die resultierende Steuererhöhung vollständig in den Verkaufspreis übertragen wird, und unter Verwendung von getränkespezifischen Preiselastizitäten modelliert. Mittels des sich daraus ergebenden Rückgangs im jährlichen Pro-Kopf-Konsum und der krankheitsspezifischen Risikofunktionen wurde die vermeidbare alkoholbedingte Inzidenz bzw. Mortalität geschätzt. Berücksichtigt wurden alkoholbedingte Erkrankungen des Herz-Kreislauf- und Verdauungssystems, Alkoholabhängigkeit, Epilepsie, Infektionskrankheiten sowie Verletzungen und Unfälle.

Ergebnisse

Insgesamt hätten durch eine Verdoppelung der spezifischen Verbrauchssteuern auf Alkohol im Jahr 2019 bis zu 200.400 alkoholbedingte Erkrankungs- und Verletzungsfälle sowie 2800 Todesfälle vermieden werden können. Dies entspricht knapp 7 % der berücksichtigten alkoholbedingten Krankheits- bzw. Todesfälle in Deutschland.

Diskussion

Alkoholbedingte Erkrankungen und Verletzungen sind vermeidbar und eine Erhöhung der spezifischen Verbrauchssteuern auf alkoholische Getränke in Deutschland könnte die alkoholbedingte Krankheitslast substanziell reduzieren.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03528-9) enthalten.

The effect of alcohol sales restrictions on alcohol poisoning mortality: Evidence from Russia

This paper examines the tough anti-alcohol legislation recently introduced in Russia, which due to regional variation allows it to be used as a natural experiment. The effect of the restricted trading hours on alcoholic poisoning mortality is estimated. To establish a causal link, difference-in-differences and synthetic controls are used. The main conclusion is that the sales restrictions lead to higher alcohol poisoning mortality, which implies that more toxic alcohol surrogates serve as substitutes for commercially available alcohol.

MRI Analysis Of the Water Content Change In the Brain During Acute Ethanol Consumption Via Quantitative Water Mapping

AIMS

Alcohol consumption influences the water balance in the brain. While the impact of chronic alcohol misuse on cerebral water content has been the subject of several studies, less is known about the effects of acute alcohol misuse, with contradictory results in the literature. Therefore, we investigated the effects of acute alcohol intoxication on cerebral water content using a precise quantitative magnetic resonance imaging (MRI) sequence.

METHODS

In a prospective study, we measured cerebral water content in 20 healthy volunteers before alcohol consumption and after reaching a breath alcohol concentration of 1 ‰. A quantitative MRI water mapping sequence was conducted on a clinical 3 T system. Non-alcoholic fluid input and output were documented and accounted for. Water content was assessed for whole brain, grey and white matter and more specifically for regions known to be affected by acute or chronic alcohol misuse (occipital and frontal lobes, thalamus and pons). Changes in the volume of grey and white matter as well as the whole brain were examined.

RESULTS

Quantitative cerebral water content before and after acute alcohol consumption did not differ significantly (P ≥ 0.07), with changes often being within the range of measurement accuracy. Whole brain, white and grey matter volume did not change significantly (P ≥ 0.12).

CONCLUSION

The results of our study show no significant water content or volume change in the brain after recent alcohol intake in healthy volunteers. This accounts for the whole brain, grey and white matter, occipital and frontal lobes, thalamus and pons.

Production Losses Associated with Alcohol-Attributable Mortality in the European Union

The economic aspects of alcohol misuse are attracting increasing attention from policy makers and researchers but the evidence on the economic burden of this substance is hardly comparable internationally. This study aims to overcome this problem by estimating production losses (indirect costs) associated with alcohol-attributable mortality in 28 European Union (EU) countries in the year 2016. This study applies the prevalence-based top-down approach, societal perspective and human capital method to sex- and age-specific data on alcohol-related mortality at working age. The alcohol-attributable mortality data was taken from estimates based on the Global Burden of Disease Study 2016. Uniform data on labor and economic measures from the Eurostat database was used. The total production losses associated with alcohol-related deaths in the EU in 2016 were €32.1 billion. The per capita costs (share of costs in gross domestic product (GDP)) were €62.88 (0.215%) for the whole EU and ranged from €17.29 (0.062%) in Malta to €192.93 (0.875%) in Lithuania. On average, 81% of the losses were associated with male deaths and mortality among those aged 50-54 years generated the highest burden. Because alcohol is a major avoidable factor for mortality, public health community actions aimed at limiting this substance misuse might not only decrease the health burden but also contribute to the economic welfare of European societies.

Erfassung des riskanten Alkoholkonsums bei Studierenden deutscher Hochschulen

Zusammenfassung. Theoretischer Hintergrund: Der Alcohol Use Disorders Identification Test (AUDIT) und die Kurzform AUDIT-C sind etablierte Screeninginstrumente, u. a. zur Erkennung des riskanten Alkoholkonsums. Fragestellung: Validierung und Bestimmung der Cut-Off-Werte beider Screenings für Studierende deutscher Hochschulen. Methode: Auf Basis zweier Querschnittsanalysen (1. Hochschule für angewandte Wissenschaften; n = 490, 60 % männlich; 2. drei Universitäten; n = 1456, 47 % männlich) erfolgten die Analysen anhand des, mittels Mengen-Frequenz-Indizes erhobenen, externen Kriteriums von > 60 bzw. > 120 Gramm Reinalkohol pro Woche (Frauen / Männer) bzw. eines praktizierten Rauschtrinkens. Zusätzlich erfolgte eine Erfassung Alkohol-assoziierter Probleme. Ergebnisse: Die Verbreitung des riskanten Alkoholkonsums im letzten Monat betrug 53 % bzw. 56 % und war mit signifikant mehr alkoholbedingten Problemen assoziiert. Die Testgüte beider Screenings war gut bis exzellent. Die optimalen Cut-Off-Werte betrugen für den AUDIT ≥ 5 Punkte, für den AUDIT-C ≥ 4 Punkte bzw. jeweils ≥ 4 bei Frauen und ≥ 5 bei Männern. Schlussfolgerungen: Aufgrund seiner Kürze kann insbesondere der AUDIT-C als valides und ökonomisches Screeninginstrument des riskanten Alkoholkonsums bei Studierenden empfohlen werden.