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Allamani A, Beccaria F, Einstein S. A Commentary on the Limits of Alcoholic Beverage Policies. Alcohol Alcohol 2018; 52:706-714. [PMID: 29016702 DOI: 10.1093/alcalc/agx048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/10/2017] [Indexed: 11/13/2022] Open
Abstract
Providing one set of policy measures for all countries as if they were a single, homogeneous entity does not appear to be evidence-based, according to recent research on the effectiveness of alcoholic beverage control policies. Contextual and cultural determinants-social, economic, demographic, cultural and political-appear to be major factors of influencing change in drinking trends, drinking patterns and drinking-related harms. The variable interplay between contextual determinants and alcohol control policy measures implies diverse impacts on consumption and harm according to time, and to the different countries and groups of countries. In addition, epidemiology research manifests some limitations when applied to alcohol drinking and results are transferred from one culture to another. The conditions of individual cultures and countries should be considered when planning and evaluating alcohol control policies.
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Affiliation(s)
- Allaman Allamani
- Agenzia Regionale di Sanità, Villa la Quiete alle Montalve, via Pietro Dazzi 1, 50141 Firenze, Italy
| | | | - S Einstein
- Silver School of Social Work, New York University, NY 10003-6654, USA
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Shield KD, Gmel G, Gmel G, Mäkelä P, Probst C, Room R, Rehm J. Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines. Addiction 2017; 112:1535-1544. [PMID: 28318072 DOI: 10.1111/add.13827] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/04/2017] [Accepted: 03/15/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. METHODS The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. RESULTS The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men. CONCLUSIONS If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision.
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Affiliation(s)
- Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gerrit Gmel
- School of Electrical Engineering and Telecommunications, University of New South Wales, Kensington, Australia
| | - Gerhard Gmel
- Epidemiology and Statistics Section, Addiction Suisse, Lausanne, Switzerland
| | - Pia Mäkelä
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare THL, Helsinki, Finland
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Wettlaufer A, Cukier S, Giesbrecht N, Greenfield TK. The marketing of responsible drinking: competing voices and interests. Drug Alcohol Rev 2012; 31:231-9. [PMID: 22489309 PMCID: PMC3325503 DOI: 10.1111/j.1465-3362.2011.00403.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS This paper contrasts health-oriented low-risk drinking guidelines (LRDGs) with social drinking marketing and popular advice on the amount of alcohol to be provided for social occasions. The questions addressed include:What is the underlying evidence base and rationale for health-oriented versus socially oriented drinking guidelines?What are the recommended amounts of alcohol per person from the LRDGs and from popular advice? DESIGN AND METHODS This paper draws on existing research, archival data, websites, print media and key informant interviews. The focus is on recent information on LRDGs and social drinking indicators in Canada, the USA, Australia and the UK. RESULTS There is extensive epidemiological research indicating the associations between drinking pattern and risk for chronic disease and trauma as well as certain potential health benefits from drinking small amounts regularly. This body of evidence is one resource for government or medically sanctioned LRDGs in many jurisdictions. In contrast, for those planning social events where liquor is served, information is available from the hospitality industry, retailers and liquor control boards.While some overlap exists between these two sources of information, in some contexts normative recommendations support drinking at potentially dangerous levels. DISCUSSION AND CONCLUSIONS The inconsistency among the different guidelines highlights one of the challenges of conveying health information on a drug that is integrated into social life and used extensively. It also reflects a siloed approach to alcohol policy—where retailing and harm reduction practices are managed by different sectors of government that seldom reflect a coordinated response.
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Affiliation(s)
- Ashley Wettlaufer
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada.
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Room R, Rehm J. Clear criteria based on absolute risk: reforming the basis of guidelines on low-risk drinking. Drug Alcohol Rev 2011; 31:135-40. [PMID: 22168584 DOI: 10.1111/j.1465-3362.2011.00398.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ISSUES The paper discusses the approach behind the Australian Guidelines to Reduce Health Risks from Drinking of 2009. The Guidelines involved a new approach to the central conundrum of low-risk drinking guidelines: how to set a guideline threshold on smooth risk curves. APPROACH The context of the 2009 Guidelines is discussed in terms of previous Australian guidelines and of risk analyses and threshold setting for other risks to health and well-being, such as environmental and food toxins. The Guidelines were accordingly based on new lifetime risk modelling of absolute risk, with specification of the risk attached to the guideline thresholds of 1 in 100 lifetime mortality risk. The Guidelines thus specify no more than two Australian standard drinks a day, and no more than four drinks on any occasion. IMPLICATIONS AND CONCLUSIONS The approach described brings alcohol guidelines within a general analytical frame of guidelines and standards for hazards to health. At the level of 1 in 100 lifetime risk, there is little justification for different guidelines for men and women. On grounds of differential risk, separate guidelines for young adults might be considered, but could not be based on lifetime risk.
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Affiliation(s)
- Robin Room
- School of Population Health, University of Melbourne, Melbourne, Australia.
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