Contributions from Alcohol Research to the Formation and Analysis of Alcohol Policy

Abstract

Alcohol policies are often based on a combination of political expediency, commercial interests, historical tradition, common sense, public health need, crisis intervention, and a scientific understanding of what works. Of all the factors influencing alcohol policy, scientific understanding is perhaps the most important but the least influential route to effective ways to minimize or prevent alcohol-related problems. How can the social, biological, political and population sciences take their proper place in the alcohol policy-making process? Despite the growing strength and professionalism of alcohol science throughout the world, there is no cadre of career scientists who are trained and experienced in the development, implementation and evaluation of alcohol policies. Nor have national and international agencies charged with alcohol research and health policies been effective in mobilizing the kind of political support necessary to sustain an ongoing program of policy initiatives that could be systematically evaluated from a public health perspective. Nevertheless, during the past 25 years a grassroots movement has emerged from the community of alcohol research professionals to bring science and policy into a closer alignment. The articles collected in this issue of Contemporary Drug Problems are part of this movement. Ingeborg Rossow's paper reviews the international epidemiological evidence on the social costs of alcohol, showing that both heavy drinking over time and acute intoxication on specific drinking occasions increase the risk of suicidal and violent behavior. Beyond the identification of important gaps in the knowledge base, she discusses the implications of the findings for prevention strategies aimed at both high-risk groups and at the general population of drinkers. The paper also provides some intriguing insights into the collateral damage resulting from the effects of alcohol problems on third parties such as children, spouses and other family members. Maggie Brady's paper deals with the indigenous minorities living in four developed countries where socioeconomic marginalization has been associated with a distinct drinking pattern (opportunistic binge drinking). The article explores the question of how applicable national alcohol policies are to the alcohol-related problems of indigenous people. Using a combination of social history, social anthropology and epidemiology, the review synthesizes a broad array of evidence in a way that can inform the policy-making process on both the local and national levels. Therese Reitan's paper looks at the public health crisis in the former Soviet Union and its relation to alcohol consumption patterns. The Gorbachev-era restrictions on alcohol and the subsequent economic transition to open markets constitute a monumental natural experiment in alcohol control policies that, according to this analysis, may account for dramatic fluctuations in male mortality rates during that period. Although there is no simple answer to the question of how alcohol affects mortality, the epidemiological detective work described in this paper clearly shows that alcohol policies have strong cultural and historical roots that are only temporarily affected by the broader political and economic environment. Economic transition and its relation to alcohol problems is also the subject of Jacek Moskalewicz's paper on Poland during the 1990s. But unlike the situation in the former Soviet Union, the one in Poland shows a different set of relationships among economic factors, drinking patterns, and alcohol-related problems-a relationship that suggests that alcohol policies need to be integrated with the prevailing social, economic and political forces in order to be effective. Finally, Kate Graham provides a more focused review of the evidence on alcohol policies designed to prevent problems within relatively circumscribed drinking environments. …