Alcohol Sales Research Articles

Gun Free Zones in Alcohol-Serving Establishments and Risk for Firearm Violence: A Cross-Sectional, Geospatial Study in Texas.

To date, there have been no peer-reviewed studies in the United Statesestimating the impact of gun-free zonepolicies in alcohol-serving establishments on rates of firearm violencein and aroundsuch establishments. In this study, we utilized a cross-sectional design to estimate the impact of Texas's 51% alcohol law, which prohibits the carrying of firearms in establishments that generate over half of their revenue from alcohol sales. The analysis focused on the difference in shooting incidents in and around establishments with and without firearm carrying prohibitions in 2021 and 2022. After adjusting for establishment type (bar/restaurant), alcohol sales volume, census tract level demographic factors, and the number of nearby restaurants and bars, results indicated that gun-prohibiting bars experienced significantly fewer shootings compared to those that allowed guns. Specifically, establishments that were gun-prohibited had 37% fewer shootings within 50m than those that were gun-allowing, with a 95% confidence interval ranging from 60% fewer to 0.2% fewer. This association was more prominent in bars than in restaurants. The protective association with gun-prohibited status diminished with increased distance from the establishments; results were not significant at 100m. Our study findings align with research suggesting that gun-free zones can reduce firearm violence. However, future studies using quasi-experimental designs that can better support causal inference are needed to support such a conclusion, as are studies exploring the efficacy of such policies in various settings and over longer periods.

Alcohol outlet density and adolescent drinking behaviors in Thailand, 2007-2017: A spatiotemporal mixed model analysis.

This study aimed to explore the relationship between alcohol outlet density and the proportion of alcohol consumption among Thai adolescents. We utilized the alcohol consumption data from the 2007, 2011, and 2017 Tobacco and Alcohol Consumption Survey in Thailand. We analyzed the relationships between alcohol sales license figures and consumption behavior using a spatiotemporal mixed model. Our data had two levels. The upper (provincial) level featured alcohol sales license density (spatial effect), the years of survey (temporal effect), and the social deprivation index. The lower (individual) level included the demographic data of the adolescents. A total of 9,566 Thai adolescents participated in this study, based on surveys conducted in 2007 (n = 4,731), 2011 (n = 3,466), and 2017 (n = 1,369). The density of alcohol sales licenses increased the odds for the one-year current drinker category (odds ratio [OR] = 1.08, 95% confidence interval [CI], 1.04-1.45), especially in male adolescents (OR = 1.09, 95% CI, 1.04-1.14). Furthermore, it increased the odds for the heavy episodic drinker category for female adolescents (OR = 1.23, 95% CI, 1.05-1.44). Increased alcohol sales licenses are associated with higher alcohol consumption among Thai adolescents. This highlights the need for government organizations to develop and apply strategies to reduce the number of licenses for the sale of alcohol.

Effects of legal age change on adolescents’ perception of access to alcohol in Portugal

Abstract Background Adolescents and young adults are a group particularly vulnerable to the effects of alcohol consumption. In Portugal, legislative changes in 2013 and 2015 prohibited the sale of alcoholic beverages to under-18s. This study aimed, first, to evaluate the impact of these policy shifts on the perceived access to alcohol among Portuguese adolescents, and second, to assess the different impacts across gender and socioeconomic strata. Methods Data from the ESPAD survey, spanning 1995-2019, was used. A quasi-experimental difference-in-differences study design was employed, using Finland, Norway, and Sweden as controls. The perceived access to beer, wine, and spirits among 16-year-old adolescents was used as outcomes, adjusted for gender and parental education. Results were also stratified by gender and by parental education status. Results After the increase in the minimum age for alcohol sales, there was a higher perceived easiness of access to beer (coef=0.018, p = 0.001) and a decline in spirits (coef=-0.088, p = 0.022), with no changes in wine. Male adolescents exhibited a decrease in the perception of access to spirits (coef=-0.100, p = 0.007) and wine (coef=-0.049, p = 0.049), while changes in the perception of access to beer were non-significant. Similar patterns were observed in female adolescents, yet non-significant for wine or spirits. These positive impacts on beer and negative impacts on spirits were observed in the different socioeconomic groups; wine was the exception, with only the highest-education group showing a decrease in the perception of access (coef=-0.056, p = 0.011). Conclusions In this study, the effect of raising the minimum age for alcohol sales in Portugal varied according to the alcoholic beverage, gender, and, for wine, according to the socioeconomic group. These findings suggest limitations in the policy’s effectiveness and equity. Future research should delve into the underlying causes to optimize health-promoting policies. Key messages • Portugal’s alcohol policy changes led to differential impacts on the perception of access to alcohol, with an impact in higher alcohol content beverages. • The impact of alcohol policy changes also differed across gender and socioeconomic status, with a stronger effect on male adolescents and higher socioeconomic strata.

Effect of a small increase in off-premises trading hours on alcohol sales in Norway: A stepped-wedge cluster-randomized controlled trial.

Evidence of the effect of limiting off-premises alcohol trading hours is still scarce. This study tested the effect of a small extension in trading hours on alcohol sales in alcohol monopoly outlets in Norway. The extension of trading hours was implemented within a stepped-wedge cluster-randomized trial design. Eligible state monopoly outlets (n = 229) were clustered into trade districts (n = 62), which were block-randomized to one of three sequences regarding date of implementation: 1 September 2020 (n = 21 districts, 82 outlets), 1 December 2020 (n = 21 districts, 73 outlets) and 1 March 2021 (n = 20 districts, 74 outlets). Outcomes were followed-up for a 1-year period. Study participants were state monopoly outlets in urban and rural trade districts in all parts of Norway. Monthly alcohol sales in litres of pure alcohol per trade district and per outlet were measured from March 2020 to March 2022 (primary outcome). We applied a linear mixed-effect model with two-way fixed effects within a difference-in-difference framework. As a robustness check we considered the effects of cross-border trade and effects in subgroups of outlets. Trading hours in monopoly outlets were extended by 1 hour on Saturdays. The extension was permanent. Pre-intervention periods and not-yet-treated units served as control conditions. We did not find a statistically significant effect of the small extension in trading hours on monthly alcohol sales (i) per trade district [average treatment effect: -185.5litres, 95% confidence interval (CI) = -1159.9, 788.9] and (ii) per outlet (-35.3litres, 95% CI = -142.1, 72.0). These findings were consistent across estimation methods and model specifications. There is no clear evidence that a small extension in off-premises trading hours affected alcohol sales in monopoly outlets in Norway.

A simple and low-cost method for determination of methanol in alcoholic solutions

Methanol poisoning can occur through consumption of methanol-containing alcohols, especially in areas where production, distribution, sale and consumption of alcohol is lawfully prohibited. Due to its toxic potency, determination of methanol in alcoholic solutions is important. The aim of the present study was to develop a rapid, simple and inexpensive method for quantification of methanol in alcoholic solutions that uses minimal equipment available in most laboratories. The method developed is based microdistillation and chromotropic acid, which can be conducted without sophisticated instruments or personal. The system consists of a micro-tube suspended in a falcon tube to function as a collector. Methanol is separated from wine by microdistillation at 90°C in water bath and converted to formaldehyde in the collector. The collector contains an acidic permanganate solution that converts methanol to formaldehyde. Formaldehyde was then quantified by use of chromotropic acid in concentrated sulfuric acid. Experimental variables were optimized by using central composite design (CCD). Method detection and quantification limits were 183mgL−1 and 584mgL−1, respectively. The percent relative standard deviation (RSD%) were between 6.4 and 7.9. Accuracies were between 89.6% and 92.4%. Concentrations of methanol in five alcoholic solutions were between 2.9×104 and 3.0×104, mg/L, v/v (ppm). Due to its simplicity and cost effectiveness, this method can be used for routine, real-time determination of methanol in alcoholic solutions.

Perceived social measures and drinking behavior during the COVID-19 pandemic in Thailand.

During the COVID-19 pandemic, national policymakers implemented many public health social measures to cease the spread of the disease, while, those interventions also affected population health behaviors, including drinking alcohol. We analyzed national survey data of 7731 respondents to investigate drinking behavioral patterns, as well as measure the strength of association between social measures and alcohol consumption among the Thai populations during the COVID-19 pandemic. We demonstrated that perceptions on temporary suspension of entertainment events and a ban on alcohol sales during the pandemic were significantly associated with alcohol consumption behaviors. Specifically, the negative perceptions of these social measures were associated with the increase of drinking: OR = 1.42; 95% CI = [1.19, 1.69] and OR = 2.50; 95% CI = [2.11, 2.97], respectively. We recommended to assess the long-term effects of targeted social measures on drinking behavior, especially the post pandemic.

Estimating the alcohol-related burden of child maltreatment among Māori in Aotearoa, New Zealand.

To assesses the alcohol-related burden of child maltreatment among Māori in Aotearoa New Zealand. We compared the risk of child maltreatment among Māori (0-17 years) exposed to parents with alcohol-related hospitalisation or mental health/addiction service use. We also conducted a sensitivity analysis to estimate the number of cases of maltreatment that could be attributed to alcohol among Māori. A cohort study of 16,617 Māori aged 0-17 and their parents from 2000 to 2017 was conducted using the Statistics New Zealand Integrated Data Infrastructure. A Bayesian piecewise exponential model estimated the risk of time to first child maltreatment event. This analysis used data from child protection, hospital, mortality and police records, and specifically focused on the risk associated with exposure to parents with an alcohol-attributable hospitalisation or mental health/addiction service use event. Potential confounders for both parents and Māori (0-17 years) were included. We calculated a population-attributable fraction to estimate the proportion of maltreatment cases that could be attributed to alcohol in 2017. Results showed a 65% increased risk for young Māori exposed to parents with heavy alcohol use. We estimated 17% of substantiated child maltreatment among Māori could be attributed to parental hazardous alcohol consumption. Severe or hazardous alcohol consumption among parents is a risk factor for child maltreatment among Māori. Māori alcohol consumption and harm are symptomatic of wider inequities related, among other things, to the ongoing effects of colonisation, as well as gaps in the regulation of alcohol sales.

Alcohol purchases through online stores and mobile applications in the late phase of the COVID-19 pandemic in Poland.

Aim: Online alcohol sales have grown rapidly, but their impact on alcohol consumption and harms is not well understood. This study explores the association between online alcohol purchasing and drinking behaviours during the late phase of COVID-19 pandemic in Poland. Design: A nationally representative survey was conducted in May 2022 of 2000 Polish residents aged 18-50 years selected from a probability-based web panel. Measures included past-year alcohol purchasing through e-stores, food/delivery apps and retail apps. Alcohol consumption was quantified using the Beverage-Specific Quantity-Frequency method. Logistic regression was used to identify sociodemographic and behavioural correlates of online alcohol purchasing. Results: Of the study respondents, 19% purchased alcohol through e-stores, 17% via delivery apps and 15% with retail apps. Spirits were commonly purchased in e-stores (57%), while beer was purchased via apps (58%-60%). Most online buyers took advantage of price promotions (69%-75%) and reported some kind of age verification (67%-68%). Higher odds of online purchasing were found among men (adjusted odds ratio [aOR] 1.38-1.54), younger drinkers (aOR 1.65-2.04) and to some extent university graduates (aOR 1.75 for e-stores purchases). Compared to moderate drinkers, risky (aOR 2.32-3.02) and harmful drinkers (aOR 5.06-6.61) showed substantially increased odds of buying alcohol online. Conclusion: Results suggest online alcohol purchasing, especially through mobile apps, is linked to more excessive drinking. Apps enable easy access to alcohol anytime anywhere, circumventing policies restricting sales to minors and intoxicated persons. With youth drinking declining globally, online sales are an emerging issue for public health. Restricting mobile app-based alcohol delivery could be an important policy measure to curb excessive drinking enabled by digital sales.

Assessing the societal value of health lost to alcohol use in India compared to excise taxes on alcohol sales.

We retrospectively studied the societal value of lost health due to alcohol use and compared it with excise taxes on alcohol sales for India in 2019. We estimated the overall alcohol-attributable disease burden using disability-adjusted life-years (DALY) for India and its 30 states for all causes with alcohol use as a risk factor from the GBD 2019 Study. The societal value of lost health was calculated using value of life-year (VLY) approach by multiplying region-specific factors from 'Global Health 2035', 2019-2020 GDP per capita and DALYs. We acquired the national and state-level (top 10 states) alcohol sales excise taxes from the Reserve Bank of India. Net losses were assessed by subtracting the revenue collected from excise taxes from VLY. All values are in Indian rupees (INR). The societal value of health lost due to alcohol use in India was 6.2 (95% uncertainty interval 4.8, 7.8) trillion INR in 2019. The absolute state-level values varied from 7.3 (4.7, 10.4) billion INR in Mizoram to 1.1 (0.8, 1.4) trillion INR in Maharashtra. The per capita values ranged from 950.2 (642.9, 1285.3) INR for Bihar to 61,332 (39,273.7, 87,288.5) INR for Mizoram. Nationally, excise tax collection from alcohol sales was 1.8 trillion INR depicting a net loss of 4.4 (3.1, 6.0) trillion. Maharashtra had the largest absolute and per capita net loss. These are novel estimates depicting the net losses due to alcohol use in India with direct policy implications to disincentivise sales and adequately raise taxes.

Local government officials’ account of barriers to regulating physical availability of alcohol in Nigeria

Background This study explored local government (LG) officials’ perspectives on barriers to regulating physical alcohol availability using three effective policies: alcohol licensing, alcohol outlet density, and hours and days of alcohol sale in Southwest Nigeria. Methods 31 semi-structured interviews were conducted with 34 officials (director of finance, revenue collectors, and rate officers) in 24 LG across 3 Southwestern Nigerian States (Lagos, Ogun, and Oyo). Their perceptions on barriers to regulating physical alcohol availability were discussed. Interviews were recorded, transcribed verbatim, and analyzed using Iterative Categorisation. Results Accounts of the LG officials reveal political complexities and structural barriers to regulating the physical availability of alcohol. Five major barriers were identified: lack of political will, economic benefits over public health, absence of a database on alcohol outlets, weak judiciary system, and insufficient personnel and funding. Participants reported how the government lacked the political will to formulate and implement national regulations on alcohol licensing and outlet density. LGs prioritized economic benefits from alcohol outlets over public health. Conclusion Regulating physical availability of alcohol at local levels will require the empowerment of LGs through formulating national regulations on alcohol licensing and alcohol outlet density, sufficient funding, and strengthening the judicial system at local levels.

The effects of alcohol sale bans on children: The case of Russia

Alcohol control policies are implemented to reduce alcoholism and related harms around the globe. This work examines the effects of a policy that restricted when alcohol could be purchased on child outcomes in Russia. To identify causal impacts, I exploit variation in the timing and severity of the restriction, which was implemented in Russian states between 2005 and 2010. Utilizing household survey data and a difference-in-differences estimation approach, I find that the policy has improved children’s physical health, with younger children being more affected, and additionally has decreased a variety of risky behavior indicators. Potential mechanisms for these effects include alcohol consumption, parental employment, household income, family stability, and time use. This work demonstrates that policies controlling parental substance access can have important effects on child health.

Peculiarities of management of enterprises in the sphere of production and sale of alcoholic beverages in Ukraine under conditions of uncertainty

The subject of this study is a set of practical aspects of business management in the market of alcoholic beverages in Ukraine. The object of the study is the process of implementing entrepreneurial activity under conditions of uncertainty. The purpose is to summarise the algorithm of enterprise management in the sphere of alcohol business under conditions of uncertainty and to develop recommendations for improving its efficiency. By interviewing experts, using the methods of observation, synthesis and generalisation, the paper proposes to use certain management tools to improve the efficiency of activities under conditions of uncertainty. The alcohol market has always been, on the one hand, a certain indicator of socio-economic changes, and on the other hand, a testing ground for innovative management tools, as the high marginality of this product and relatively low entry barriers required dynamic changes from within. However, in times of crisis, uncertainty, and even more so in times of war, the requirements for the quality of management increase significantly. That is why it is advisable to analyse the theoretical aspects and practical features of the implementation of management innovations that have been applied at Ukrainian enterprises engaged in the production and sale of alcohol.

Exploring predictors of substance use disorder treatment engagement with machine learning: The impact of social determinants of health in the therapeutic landscape

BackgroundImproved knowledge of factors that influence treatment engagement could help treatment providers and systems better engage patients. The present study used machine learning to explore associations between individual- and neighborhood-level factors, and SUD treatment engagement. MethodsThis was a secondary analysis of the Global Appraisal of Individual Needs (GAIN) dataset and United States Census Bureau data utilizing random forest machine learning and generalized linear mixed modelling. Our sample (N = 15,873) included all people entering SUD treatment at GAIN sites from 2006 to 2012. Predictors included an array of demographic, psychosocial, treatment-specific, and clinical measures, as well as environment-level measures for the neighborhood in which patients received treatment. ResultsGreater odds of treatment engagement were predicted by adolescent age and psychiatric comorbidity, and at the neighborhood-level, by low unemployment and high population density. Lower odds of treatment engagement were predicted by Black/African American race, and at the neighborhood-level by high rate of public assistance and high income inequality. Regardless of the degree of treatment engagement, individuals receiving treatment in areas with high unemployment, alcohol sale outlet concentration, and poverty had greater substance use and related problems at baseline. Although these differences reduced with treatment and over time, disparities remained. ConclusionsNeighborhood-level factors appear to play an important role in SUD treatment engagement. Regardless of whether individuals engage with treatment, greater loading on social determinants of health such as unemployment, alcohol sale outlet density, and poverty in the therapeutic landscape are associated with worse SUD treatment outcomes.

How can agent-based modelling provide new insights into the impact of minimum unit pricing in Scotland?

In recent years we have gained insight into the impact of minimum unit pricing (MUP)-a legal floor price below which a given volume of alcohol cannot be sold-on population-level reductions in alcohol sales, consumption and harm. However, several questions remain unanswered including how individual-level purchasing changes impact the local economy (e.g., balance between on-licence and off-licence outlets), lead to long-term population-level trends (e.g., youth drinking) and social harms (e.g., violence). Agent-based modelling captures heterogeneity, emergence, feedback loops and adaptive and dynamic features, which provides an opportunity to understand the nuanced effects of MUP. Agent-based models (ABM) simulate heterogeneous agents (e.g., individuals, organisations) often situated in space and time that interact with other agents and/or with their environment, allowing us to identify the mechanisms underlying social phenomena. ABMs are particularly useful for theory development, and testing and simulating the impacts of policies and interventions. We illustrate how ABMs could be applied to generate novel insights and provide best estimates of social network effects, and changes in purchasing behaviour and social harms, due to the implementation of MUP. ABMs like other modelling approaches can simulate alternative implementations of MUP (e.g., policy intensity [£0.50, £0.60] or spatial scales [local, national]) but can also provide an understanding of the potential impact of MUP on different population groups (e.g., alcohol exposure of young people who are not yet drinking). Using ABMs to understand the impact of MUP would provide new insights to complement those from traditional epidemiological and other modelling methods.

Does a place of last drink initiative affect the likelihood of alcohol sales to obviously intoxicated patrons?

Although the sale of alcohol to obviously intoxicated patrons (i.e., overservice) is illegal in 48 U.S. states, the likelihood of overservice at bars and restaurants has exceeded 80% across multiple studies, states, and decades. Place of last drink (POLD) enforcement is one proposed strategy to address alcohol overservice. When law enforcement agents respond to an alcohol-related incident, they ask the individuals involved where they had their last alcoholic beverage. POLD information is recorded and ideally systematically reviewed to identify locations that are frequently places of last drink. Law enforcement or other agencies may follow up with or penalize the alcohol license holder at these locations. We compared the likelihood of overservice in communities conducting POLD with communities that did not conduct POLD in Minnesota. Pseudo-intoxicated patrons acted out signs of obvious intoxication while attempting to purchase alcohol at 396 bars and restaurants in 26 communities conducting POLD and 26 comparison communities. We calculated rates of alcohol sales to the pseudo-intoxicated patrons overall and in POLD communities versus comparison communities. The overall sales rate to the pseudo-intoxicated buyers was 98%. Rates of sales were 99% at establishments in POLD jurisdictions and 97% in comparison jurisdictions. There were no common characteristics, such as perceived gender/age of the server/bartender or crowdedness of the establishment, among the seven establishments that refused alcohol service. Our study shows that, as currently implemented in Minnesota, POLD does not reduce the overservice of alcohol at a jurisdiction level. More research is needed to identify interventions that yield sustained reductions in the overservice of alcohol.

The effect of COVID‐19 lockdown periods and societal restrictions on blood product usage in adult trauma patients: A retrospective observational study

Background. Blood products, though potentially lifesaving, are a scarce and costly resource. Trauma injuries, which contribute to the demand for these resources, increase in proportion to alcohol consumption. South Africa’s COVID-19 lockdown measures included a ban on alcohol sales and curfews.Objective. To investigate the effect of these societal measures on blood product usage. Methods. We retrospectively compared medical patient data from the South African National Blood Service database of red cell concentrate (RCC) usage in four disciplines during the COVID-19 period with data from the 3 years preceding the pandemic. We also examined trauma case patterns using an institutional database from the Harry Gwala Regional Hospital (HGRH) Emergency Department during the same periods. Results. In total, 16 922 RCCs at HGRH and 528 734 RCCs in KwaZulu-Natal were issued across the four disciplines, from March 2017 - March 2021. RCC usage significantly decreased among trauma patients at institutional and provincial levels during the COVID-19 period (provincial pre-lockdown mean 10.99 units per day; SD 6.89, 95% CI 10.63 - 11.35 v. lockdown 7.46 units per day; SD 5.42, 95% CI 6.14 - 8.79; p<0.01). Further, RCC usage significantly increased during the weekend immediately following the lifting of the first alcohol ban, along with a significant decrease in the number of trauma patients seen during hard lockdown periods. Conclusions. Societal restrictions, including curfews and banning alcohol consumption, decreased the use of RCCs in trauma patients. Government policies aimed at reducing alcohol-related traumatic injuries would likely have a significant impact on RCC usage.

Safeguarding South African schools: Civil society action against alcohol sales in educational settings

The Southern African Alcohol Policy Alliance (SAAPA) in South Africa vehemently opposed Clause 8 of the Basic Education Legislation Amendment Bill (BELA) allowing alcohol sales at schools. This stance was grounded in the 2016 National Liquor Policy, advocating for distance between schools and liquor outlets. SAAPA's multifaceted approach included engaging government, experts, media advocacy, social mobilisation, and active participation in the legislative process. Their efforts, culminating in over 5000 submissions and an oral presentation, led to the removal of Clause 8 in September 2023. This success underscores the pivotal role of civil society in shaping evidence-based policies for public health and child welfare.

Global alcohol policy implementation in Thailand: A narrative review

Alcohol consumption is growing in emerging economies. Thailand is an upper-middle-income emerging economy in Southeast Asia where the alcohol market has been under an oligopoly, which political groups are attempting to amend. The Thai Ministry of Public Health works in close partnership with the non-profit sector in alcohol control, and has recently adapted the World Health Organization’s (WHO) SAFER initiatives as part of the national alcohol agenda. In light of these ongoing changes, we conducted a narrative review with the following objectives: (1) to describe the development of alcohol control policy strategies in Thailand; and (2) to describe the current situation on alcohol policy implementation. We performed a search of the published and grey literature in both Thai and English languages using keywords related to topics of interest, and reviewed data on SAFER's effectiveness using a group of indicators (policy-attributable health outcomes). We found that Thailand has laws and regulations covering various domains of SAFER. However, gaps do exist with regard to regulation of alcohol outlet density, relatively low alcohol sales permit fees, control of online and surrogate marketing of alcoholic products, and enforcement of drinking-and-driving deterrence measures, among others. A review of the indicators showed that annual per capita alcohol consumption (APC) and prevalence of drinkers have remained constant since 2008, whereas the prevalence of binge-drinking has been on a decline since 2014. However, deaths attributable to alcohol have increased in both men and women. The findings of this narrative review may have implications for policymakers and stakeholders in behavioral health.

Evaluating the impact of minimum unit pricing (MUP) on alcohol sales after 3years of implementation in Scotland: A controlled interrupted time-series study.

On 1May 2018, Scotland introduced minimum unit pricing (MUP), a strength-based floor price below which alcohol cannot be sold, throughout all alcoholic beverages. The legislation necessitates an evaluation of its impact across a range of outcomes that will inform whether MUP will continue beyond its sixth year. We measured the impact of MUP on per-adult alcohol sales (as a proxy for consumption) after 3 years of implementation. Controlled interrupted time-series regression was used to assess the impact of MUP on alcohol sales in Scotland after 3 years of implementation, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on-trade alcohol sales (in off-trade analyses) and substitution between drink categories (in drink category analyses) as covariates. Weekly data were assessed on the volume of pure alcohol sold in Scotland and EW between January 2013 and May 2021, expressed as litres of pure alcohol per adult. The impact of MUP on total (on- and off-trade combined), off-trade and on-trade alcohol sales was assessed separately. The introduction of MUP in Scotland was associated with a 3.0% (95% confidence interval = 1.8-4.2%) net reduction in total alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. This reflects a 1.1% fall in Scotland in contrast to a 2.4% increase in EW. The reduction in total alcohol sales in Scotland was driven by reduced sales of beer, spirits, cider and perry. The reduction in total sales was due to reductions in sales of alcohol through the off-trade. There was no evidence of any change in on-trade alcohol sales. Minimum unit pricing has been effective in reducing population-level alcohol sales in Scotland in the 3 years since implementation.

Alcohol-related liver disease: A global perspective

Alcohol-associated liver disease (ALD) represents one of the deadliest yet preventable consequences of excessive alcohol use. It represents 5.1 % of the global burden of disease, mainly involving the productive-age population (15-44 years) and leading to an increased mortality risk from traffic road injuries, suicide, violence, cardiovascular disease, neoplasms, and liver disease, among others, accounting for 5.3 % of global deaths. Daily alcohol consumption, binge drinking (BD), and heavy episodic drinking (HED) are the patterns associated with a higher risk of developing ALD. The escalating global burden of ALD, even exceeding what was predicted, is the result of a complex interaction between the lack of public policies that regulate alcohol consumption, low awareness of the scope of the disease, late referral to specialists, underuse of available medications, insufficient funds allocated to ALD research, and non-predictable events such as the COVID-19 pandemic, where increases of up to 477 % in online alcohol sales were registered in the United States. Early diagnosis, referral, and treatment are pivotal to achieving the therapeutic goal in patients with alcohol use disorder (AUD) and ALD, where complete alcohol abstinence and prevention of alcohol relapse are expected to enhance overall survival. This can be achieved through a combination of cognitive behavioral, motivational enhancement and pharmacological therapy. Furthermore, the appropriate use of available pharmacological therapy and implementation of public policies that comprehensively address this disease will make a real difference.