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BMJ. Mar 1, 2008; 336(7642): 455.
Published online Feb 22, 2008. doi:  10.1136/bmj.39496.556435.80
PMCID: PMC2258338

Tackling alcohol misuse in the UK

Thomas F Babor, professor and chairman

Higher alcohol taxes and restricting availability are more likely to succeed than partnerships with industry

Nations, like people, can develop a pathological pattern of alcohol misuse. Ever since the Blair government consolidated its alcohol control policy around a “partnership” with the alcohol drinks industry,1 the United Kingdom has been anything but united about how to deal with the nation’s alcohol problems.2 3 While some people have seen collaboration with industry as a way of “disabling the public interest,”2 the ostensible rationale was to involve alcohol producers and retailers in new initiatives—such as voluntary limits on advertising, safer packaging, and codes of good conduct—to make town centres safer at night. In response to mounting evidence that this approach is not working,3 this week the BMA voices its opinion on how the problem should be tackled through the release of a report on alcohol misuse.4

According to the report the long wave of increasing alcohol consumption—which has moved the UK into eighth position in the hard drinking nations of Europe—did not occur by chance. It was facilitated by the progressive dismantling of previously effective alcohol control policies through deregulation and trade liberalisation, exemplified by 24 hour a day opening.

Although the connection between deregulation, consumption, and alcohol related problems is admittedly complex, the BMA report makes a good case for a combination of new regulatory measures, controls on consumption, and approaches to minimise harm. The evidence base for effective alcohol policy reviewed in the report is impressive. Universal strategies like increased alcohol taxes can drive down per capita consumption, especially in younger drinkers, and targeted approaches such as early intervention and specialised treatment are effective ways to deal with hazardous and harmful drinkers.5 The BMA’s recommendations are organised into six areas: controlling access to alcohol, promoting responsible industry practices, introducing measures to reduce drink driving, promoting health education and healthy living, encouraging early intervention and treatment, and supporting international cooperation on alcohol control (see box).

Main alcohol control policies recommended in BMA report

Control access to alcohol

  • Reduce easy access to alcohol through controls on hours of sale and outlet density
  • Increase alcohol taxes in a way that outpaces inflation and is proportionate to the amount of alcohol in the product

Promote responsible industry practices

  • Strict enforcement of licensing laws (for example, use test purchases to monitor sales to underage drinkers)
  • Prohibit irresponsible promotional activities, such as marketing of flavoured alcoholic drinks (“alcopops”) to young people

Implement measures to reduce drink driving

  • Reduce the legal blood alcohol limit from 80 mg/100 ml to 50 mg/100 ml
  • Permit use of random roadside alcohol testing without prior suspicion of intoxication

Education and health promotion

  • Include in all product labels and alcohol advertisements the standard UK guidelines for alcohol consumption

Early intervention and treatment

  • Conduct routine alcohol screening and brief intervention in medical settings to reduce hazardous drinking
  • Fund a national initiative to expand specialised treatment for excessive drinkers

International cooperation on alcohol control

  • Support alcohol control initiatives through the European Union and World Health Organization

According to the report, the cost of implementing and sustaining these policies would be offset by the revenues gained from increased alcohol taxes. Conspicuously absent from the recommendations are measures to expand school based alcohol education,6 which is politically popular and easy to implement but ineffective. Instead, the emphasis should shift to public awareness campaigns that specify safe drinking limits (no more than 21 units each week for men, 14 for women) and heighten the perception that drink driving laws will be enforced. Finally, the report suggests that alcohol policy needs to have a global vision, one that moves towards the adoption of an international policy framework modelled after the World Health Organization’s framework convention on tobacco control (www.fctc.org).

Although expert committee reports have been seen before in the UK,1 7 8 a policy to control alcohol has never been proposed with as much authority, vision, and hard evidence to back up its recommendations. The BMA report shows that effective alcohol policies are available, tested, and ready to be implemented. What is refreshing in the report is the absence of exaggerated claims and platitudes, which make it more likely that its recommendations could return the UK to its former status as a temperate nation.

Notes

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

References

1. Prime Minister’s Strategy Unit. Alcohol harm reduction strategy for England 2007. www.cabinetoffice.gov.uk/strategy/work_areas/alcohol_misuse.aspx
2. Room R. Disabling the public interest: alcohol strategies and policies for England. Addiction 2004;99:1083-9. [PubMed]
3. Anderson P. A safe, sensible and social AHRSE: new Labour and alcohol policy. Addiction 2007;102:1515-22. [PubMed]
4. BMA. Alcohol misuse: tackling the UK epidemic London: BMA, 2008
5. Room R, Babor TF, Rehm J. Alcohol and public health. Lancet 2005;365:519-30. [PubMed]
6. Foxcroft D, Ireland D, Lister-Sharp DJ, Lowe G, Breen R. Longer-term primary prevention for alcohol misuse in young people: a systematic review. Addiction 2003;98:397-411. [PubMed]
7. Welsh Assembly Government. Working together to reduce harm. The substance misuse strategy for Wales: 2008-2018. 2008. http://wales.gov.uk/consultations/currentconsultation/housandcomm/workingtogether/?lang=en
8. Academy of Medical Sciences. Calling time, the nation’s drinking as a major health issue. 2004. www.acmedsci.ac.uk/download.php?file=/images/project/CallingT.pdf

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