Prevention Of Alcohol-related Harm Research Articles

Early Drinking Onset and Subsequent Alcohol Use in Late Adolescence: a Longitudinal Study of Drinking Patterns

PurposeThe age of drinking onset is a central concept for both policy and prevention of alcohol-related harm, yet evidence on the predictive value of the age of onset is lacking. This study compares alcohol outcomes of adolescents who started to drink early with those who started later, and tests if associations are moderated by other explanatory factors. MethodsData from a two-wave longitudinal prospective cohort survey with a Swedish nationwide sample of 4,018 adolescents aged 15/16 years at baseline (T1) and 17/18 years at follow-up (T2) were used. Outcome variables at T2 were Alcohol Use Disorders Identification Test (AUDIT)–C, risky drinking, and binge drinking monthly or more often. A vast number of explanatory factors at T1 were controlled for. ResultsEarly drinking onset predicted later higher AUDIT-C scores (β = 0.57, p value < .001), and higher probability of risky drinking (odds ratio = 1.95, 95% confidence interval = 1.56–2.44), and binge drinking (odds ratio = 1.38, confidence interval = 1.06–1.81), controlled for other explanatory factors. If binge drinking frequency at T1 was included, the associations remained for AUDIT-C and risky drinking, but not for binge drinking at T2. No significant interactions between early drinking onset and the explanatory factors were found. DiscussionEarly drinking onset predicts subsequent higher alcohol consumption in late adolescence. Adolescents who had an early drinking onset drank more after 2 years than their peers who started later. The age of drinking onset is an independent predictor of alcohol use outcomes, beyond the effect of age of binge drinking onset.

Prevention of alcohol related harm though preconception care: A scoping review of barriers and enablers.

To understand the perspectives of healthcare practitioners and women of reproductive age regarding addressing prevention of an alcohol exposed pregnancy before conception. A scoping review of mixed methods, qualitative and quantitative research was conducted. Medline, CINAHL, EMBASE and PsychInfo databases were searched for literature published by March 2022. Data were extracted and synthesized. Twenty-three studies were included. Views varied between healthcare practitioners and women about addressing alcohol with women before pregnancy. Healthcare practitioners agreed prevention was important but believed they were ill-prepared to provide support, and that it might be intrusive if women were not contemplating pregnancy. Whereas women would welcome advice from healthcare practitioners, particularly if offered during appointments or visits for services related to reproductive health. A knowledge deficit about pregnancy and fetal harms from alcohol was expressed by both healthcare practitioners and women. Investment in alcohol education and skills training for healthcare professionals is required to ensure a coherent message is communicated across services, and that shared decision making about healthcare between service users and health professionals is facilitated. Future research should explore implementation of interventions to prevent alcohol exposed pregnancy in settings where women are seeking reproductive health support.

Preventing Alcohol-Related Harm in East Africa: Stakeholder Perceptions of Readiness across Five Countries.

While alcohol-related harm is a recognized public health priority, the capacity to address and mitigate its harm is lacking, primarily in low-income countries. Recent developments including new tools that can assess readiness for preventing alcohol-related harm, specifically in low-resource settings, can be used to determine strengths and opportunities for supporting, planning, and resource allocation. In this study, we determined the perceptions of readiness and capacity for the prevention of alcohol-related harm across East Africa among stakeholders engaged in such work. We conducted a cross-sectional survey in 2020, distributed by the East Africa Alcohol Policy Alliance to their member alliances and stakeholders across five countries in East Africa (i.e., Burundi, Kenya, Rwanda, Tanzania, and Uganda). The survey included modified measures from the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) short form, organizational size and funding, research capacity and priorities, and perceptions related to alcohol prevention and harm both locally and in the region. Analyses were computed based on 142 persons/organizations completing the survey. In terms of general readiness, the overall adjusted aggregate score for East Africa was 39.70% (ranging from 30.5% in Burundi to 47.0% in Kenya). Of the 10 domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol prevention (8.43), institutional links and resources (6.15) and legislation, mandates and policies (5.46) received the highest scores. In contrast, measures pertaining to resources (i.e., material, human, technical, and informal) received the lowest score. Our results demonstrate substantial variability in the readiness to address alcohol-related harm across East Africa. The highest capacity was noted for knowledge towards alcohol prevention, institutional links, and legislative mandates and policies. However, important gaps were noted in terms of attitudes towards alcohol prevention, the will to address the problem, as well as material, human, and informal resources, which need to be urgently addressed to strengthen capacity for addressing and mitigating the significant toll of alcohol-related harm in the region.

A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy.

Alcohol-related harm is a growing concern globally and particularly in West Africa. However, tools for assessing the readiness for prevention of alcohol-related harm in low-resource settings have been lacking. We modified the WHO tool, the Readiness Assessment for the Prevention of Child Maltreatment Short Form (RAP-CM), to assess readiness for the prevention of alcohol-related harm across West Africa. We conducted a cross-sectional survey in the fall of 2020, distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders, predominantly community-based organizations (CBOs) and non-governmental organizations (NGOs), across 7 countries in West Africa (N=140). The survey included modified measures from the RAP-CM short form. In terms of general readiness, the overall adjusted aggregate score for West Africa was 45.0% (ranging from 42.9% in Liberia to 52.7% in Senegal). Of the ten domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol-related harm prevention (8.3) and legislation, mandates, and policies (6.7) received the highest readiness scores. The lowest readiness scores were observed for human and technical resources (2.5), attitudes toward preventing alcohol-related harm (2.7), and the will to address the problem (2.9). Our results demonstrate substantial variability across domains in the readiness to address alcohol-related harm with clear strengths and limitations for future priority setting and capacity building. The barriers to progress include attitudes toward alcohol-related harm prevention, lack of willingness to address the problem, and limited human and technical resources available. These barriers need to be mitigated to address the high burden of alcohol-related harm in the region and to inform both practice and policy.

A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy

A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy

Understanding alcohol-related indicators from population surveys: answering the "Five W's of Epidemiology".

The harmful use of alcohol is a major risk factor for the global burden of disease, and public policies are the most effective strategies to prevent it. Population-based surveys are milestones for planning, implementing, and monitoring those policies. However, there are numerous ways to measure alcohol consumption which may result in different indicators. Researchers and stakeholders should find common ground in the understanding of these measures to avoid misinterpretation and confusion in the field. Answering to the "Five W's Epidemiology", when interpreting alcohol-related information, may improve the communication, as well as reproducibility and comparability of research findings. This paper aims to exemplify this approach by describing some indicators from the World Health Organization's Global Information System on Alcohol and Health (GISAH) and the corresponding data available from the latest Brazilian household surveys. Notably, none of the Brazilian surveys reports on all the nine selected GISAH indicators, and only two provided the necessary methodological details to be fully reproducible. A stronger agenda is of the utmost importancefor advancing in the monitoring and prevention of alcohol-related harms in Brazil.

Midwives’ views on alcohol guidelines: A qualitative study of barriers and facilitators to implementation in UK antenatal care

ObjectiveMidwives play an important role in health promotion and prevention of alcohol-related harm, but previous research has suggested that although most midwives report advising on abstinence, evidence exist that women are informed that “some” alcohol is not harmful. The aim of this qualitative study was to explore midwives’ views on implementation of the 2016 Chief Medical Officers’ alcohol guidelines in antenatal care in the UK. MethodsFocus groups and individual interviews with 22 midwives working in maternity and educational settings in the UK were conducted either in person or over telephone. Data were subjected to thematic analysis. ResultsConflict between guidelines from different sources and lack of knowledge of the abstinence advice issued in the Guidelines were barriers to discussing abstinence. Communication with women and building relationships were key facilitators supporting alcohol discussions. How alcohol was addressed appeared to vary across the UK with no uniform approach. Building a trusted relationship was believed to be the way in which women can disclose alcohol use, though the first antenatal contact was not always viewed as the best time to discuss what was considered a personal matter. ConclusionDespite the release of new guidance in 2016, there was little recognition and awareness of these among midwives. Midwives were by default guided by other national clinical sources or guidelines. Future research should explore how practice-based interventions can address systemic and interpersonal factors to support health professionals to implement the Guidelines, and ensure that women are provided support to change unhealthy behaviours.

Alcohol, youth and sport: recommendation and good practice examples from the FYFA European project.

Focus on Youth Football and Alcohol (FYFA) is a European project (EC, 3rd Health Program, HP-PJ-2016) involving research institutions from Belgium, Finland, Italy, Poland, Slovenia and the UK. The Istituto Superiore di Sanità (ISS), was the project leader of Work Package 5: "Review of national policies and practice in six Member States related to alcohol, young people, sport, marketing and football." The aim of WP5 was to determine the status quo of the policies and practices to reduce heavy episodic drinking related to young people, alcohol and sport at national level. This work investigates knowledge, attitudes and perceptions of experts from sport settings and from the prevention area giving insights on the perceived obstacles and facilitators, whenever available, to promote strategies to reduce alcohol related harm in youth within sport contexts. The presented work describes laws, regulations and attitudes. Furthermore, the results help identifying areas requiring development, highlighting examples of good practices. It emerges that prevention of alcohol-related harm to youth is important within sport settings and should be a priority for all FYFA countries. Despite the presence of regulations, there is a low level of knowledge and enforcement at national level and in the sport contexts; and there is the need of cooperation across organizations to implement alcohol policies for youth within sport settings. More efforts and resources are needed to overcome the main obstacles for effective implementation of alcohol policies, such as regulations on advertising and sponsorship, and alcohol selling, serving and consumption for young players. It is necessary to implement information strategies, prevention initiatives, training programs and to support the dialogue between sporting and prevention settings.

How do parents and friends accommodate alcohol consumption in young Thai people? A qualitative focus group study

Despite a magnitude of quantitative data demonstrating the influence of parents and friends on youth drinking, few qualitative studies have explored these relationships in non-Western settings, including Thailand. This study aims to explore the perceived roles of parents and friends in influencing young Thais’ drinking. The data come from seventy-two 20–24-year-old students participating in focus groups. This study found that young people’s first alcohol experiences were often introduced by family members early in their childhood. Later in adolescence, their social contexts shifted from the family unit to focus more on their friends. They perceived drinking to be a norm and drank to enhance social conformity. Parental communication and approaches appeared to be critical in influencing youth drinking patterns. Surprisingly, especially in the context of limited information about the prevention of alcohol-related harm, young people created a self-regulated harm reduction intervention using a designated light drinker. This study suggests that family-support interventions should be introduced in conjunction with social norms and peer-based interventions to enhance parents’ awareness about their influences on youth drinking. The agency of the young people in this study also suggests that self-regulated harm reduction approaches may be considered to complement the abstinence-standpoint policy in Thailand.

Bartenders' and Rum Shopkeepers' Knowledge of and Attitudes Toward "Problem Drinking" in Saint Vincent and the Grenadines.

Harmful alcohol use encompasses a spectrum of habits, including heavy episodic drinking (HED) which increases the risk of acute alcohol-related harms. The prevalence of HED in Saint Vincent and the Grenadines (SVG) is 5.7% among the overall population aged 15years and older and 10.2% among drinkers. Responsible Beverage Service interventions train alcohol servers to limit levels of intoxication attained by customers and decrease acute alcohol-related harms. The objectives of this study were todetermine bar tenders' and rum shopkeepers' knowledge of and attitudes toward problem drinking and willingness to participate in server training. Researchers used convenience and purposive sampling to recruit 30 participants from Barraouile, Kingstown, and Calliaqua to participate in semi-structured interviews designed to explore study objectives. Results and conclusions were derived from grounded theory analysis. Heavy episodic drinking is common but not stigmatized. Heavy drinking is considered a "problem" if the customer attains a level of disinhibition causing drunken and disruptive or injurious behavior. Bartenders and rum shopkeepers reported intervening with visibly intoxicated patrons and encouraging cessation of continued alcohol consumption. Participants cited economic incentives, prevention of alcohol-related harms, and personal morals as motivators to prevent drunkenness. Respondents acknowledged that encouraging responsible drinking was a legitimate part of their role and were favorable to server training. However, there were mixed opinions about the intervention's perceived efficacy given absent community-wide standards on preventing intoxication and limitations of existing alcohol policy. Given respondents' motivation and lack of standardized alcohol server training in SVG, mandated server training can be an effective strategy when promoted as one piece of a multi-component alcohol policy.

Delivering information and brief advice on alcohol (IBA) in social work and social care settings: an exploratory study

Social workers and practitioners working in social care are potentially key players in the prevention of alcohol-related harm and harm reduction for people using services and their carers. This requires attention to workforce development alongside the selection of appropriate tools to support prevention strategies. We report findings from a UK exploratory study into the potential of using Identification and Brief Advice (IBA) as a tool for screening and prevention in social work and social care settings. Thirty-six social workers and social care practitioners attended one of two training workshops on IBA in the South East of England. Pre and post-workshop surveys (n = 35 and n = 20, respectively) and four post-workshop focus groups (n = 36) were conducted with participants to explore the application of IBA taking into account the paradigmatic shift towards prevention and holistic approaches indicated in recent UK legislation and policy. Four themes emerged from the findings: (1) perceptions of the social work/social care role in responding to alcohol problems, (2) ethical concerns, (3) time conflicts and problems of delivering IBA and (4) the role of training. Further studies are needed to evaluate the effectiveness of motivational techniques and tools that social workers can use to promote preventative practise for alcohol-related harm. Different strategies are required to engage and support those working in social care to increase proactive engagement with problematic alcohol use in everyday practise settings.

Alcohol Use and the Older Adult Woman

Annual screening for risky alcohol use is key to the prevention of alcohol-related harm in the older adult women. Along with an increase in the number of older adult women is a parallel upward trend of alcohol use. Because adverse health effects from alcohol use are greater on the older woman, it is essential that nurse practitioners have the knowledge and competency to provide early intervention using the evidenced-based Screening, Brief Intervention, and Referral to Treatment approach. The purpose of this article is to provide an overview of the Screening, Brief Intervention, and Referral to Treatment approach as it applies to the older female.

Hazardous alcohol use among doctors in a Tertiary Health Center.

Background:Doctors have been identified as one of the key agents in the prevention of alcohol-related harm, however, their level of use and attitudes toward alcohol will affect such role.Aim:This study is aimed at describing the pattern of alcohol use and the predictors of hazardous drinking among hospital doctors.Setting:Study was conducted at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.Design:A cross-sectional survey involving all the doctors in the teaching hospital.Materials and Methods:All the consenting clinicians completed a sociodemographic questionnaire and alcohol use was measured using the 10-item alcohol use disorder identification test (AUDIT) and psychological well-being was measured by the 12-item General Health Questionnaire (GHQ-12).Statistical Analysis Used:Statistical analyses were done using the Statistical Package for Social Sciences version 16. Chi-square tests with Yates correction were used to describe the relationship between respondent's characteristics and AUDIT scores as appropriate.Results:There were a total of 122 participants. Eighty-five (69.7%) of them were abstainers, 28 (23%) were moderate drinkers, and 9 (7.3%) hazardous drinkers. With the exception of age, there was no significant relationship between sociodemographic status, years of practice, specialty of practice, and hazardous alcohol use. Experiencing stress or GHQ score above average is significantly associated with hazardous drinking.Conclusion:Hazardous drinking among hospital doctors appears to be essentially a problem of the male gender, especially among those older than 40 years. Stress and other form of psychological distress seem to play a significant role in predicting hazardous drinking among doctors.

Do flexible alcohol trading hours reduce violence? A theory-based natural experiment in alcohol policy

Alcohol-related violence is a pressing public health concern. In 2005, the government of England and Wales took a controversial approach to preventing violence by removing restrictions on opening hours for alcohol outlets, thus increasing the availability of alcohol. The policy aimed to remove fixed closing times, which it claimed was contributing to urban violence occurring at peak closing times. It proposed to reduce violence and disorder by installing systems of ‘staggered closing times’. This policy was criticised for overlooking established public health principles prioritising the control of alcohol availability in the prevention of alcohol-related harm. In this study, we treated the removal of trading hour restrictions as a natural experiment to test competing theoretical principles about the relationship between alcohol availability and violence. Our study took place in the City of Manchester over a four-year period 2004–2008. Detailed trading records for over 600 alcohol outlets were obtained, as were police records for all violent incidents. We found considerable variation in the implementation of extended trading hours across the city, which affected area-level exposure of changes in alcohol availability and staggered closing times. To isolate the effect of these changes on violence, we performed a dose–response analysis to examine whether improved staggering of closing hours (or increased alcohol availability) was associated with decreases in violence. We found no evidence to support the government-proposed hypothesis that staggered closing reduces violence. We also found no support for the alternative hypothesis; that increase alcohol availability would result in increased violence. This study provides an example of how better evidence can be generated from natural experiments by placing added emphasis on theory, causal mechanisms and implementation science.

Prevalence of and Associations With Papsak Wine Consumption Among Farm Workers in the Western Cape Province, South Africa

Until it was banned in 2007, inexpensive, atypically packaged wine, colloquially termed "papsak," was popular in poorer South African communities, which suffer a high burden of disease from alcohol. This study describes the prevalence of alcohol and papsak consumption, problem drinking (defined by a potentially problematic CAGE score of ≥2), and their associations among farm workers in the Western Cape Province. A cross-sectional analytical study was conducted in two farming areas using cluster sampling of farm worker households. Interview data from 347 male and 114 female respondents were analyzed. Among respondents, 69% (95% CI [63.1, 74.3]) were current drinkers. Among drinkers, 50.6% (95% CI [41.9, 59.3]) preferred papsak and 73% (95% CI [65.5, 79.3]) had potentially problematic CAGE scores (CAGE ≥ 2). Papsak drinkers were more likely to have CAGE scores of 2 or more than drinkers of other alcoholic beverages (adjusted odds ratio = 2.8, 95% CI [1.4, 5.5]). Increasing levels of socioeconomic deprivation predicted both current drinking and preferred papsak consumption. Additional risk factors for preferring papsak were age 35 years or older, being married, being Coloured, and residing in the district in which papsak was produced. Current drinking and symptoms of problem drinking were substantially higher in these farm workers compared with general provincial population levels. CAGE scores of 2 or more among female farm workers exceeded provincial estimates by 3.5 times. Problem drinking was strongly associated with papsak consumption, most likely because of affordability; however, the significant association between residence near papsak production and preferred papsak consumption highlights the consequence of easy access. Restrictions on papsak were warranted and may contribute to the prevention of alcohol-related harm in marginalized communities.

Trends in alcohol prevalence, age of initiation and association with alcohol-related harm among South African youth: Implications for policy

To understand alcohol use trends and alcohol-related harm among youth in South Africa (SA) between 1998 and 2008, and discuss implications for the current alcohol policy process. A review was conducted of 4 national prevalence and 2 sentinel surveillance studies. Data were extracted to Epi Info (version 7) and chi-square analyses undertaken. RESULTS. Lifetime alcohol use remained stable but high at 20 - 25% and 49.1 - 49.6% according to South African Demographic and Health Survey (SADHS) and Youth Risk Behaviour Survey (YRBS) data, respectively. Age of initiation remained stable; 12% of adolescents initiated alcohol use prior to age 13 years. Significant gender differences existed with more males having ever consumed alcohol, engaged in binge drinking, and driven or walked under the influence of alcohol (DUI and WUI, respectively). Binge drinking among females increased significantly from 27% to 36% (SADHS) and 18% to 27% (YRBS). DUI and WUI increased. Homicide/violence, suicide and unintentional deaths were significantly associated with blood alcohol concentration (BAC). Although SA has made significant strides in alcohol control and prevention of alcohol-related harm over the past decade, early alcohol initiation remains a concern and binge drinking is increasing, especially among females. Significant associations exist between BAC and alcohol-related fatalities. Findings imply that regulatory policies are inadequate; additional efforts are required to ensure that control strategies translate into a reduction in harmful alcohol use by SA youth.

Visioner och Sätt att Verkställa Dem: Nyckelaktörers Åsikter om Lokal Alkoholpolitik

This study is based on an analysis of discussions of local experts on the prevention of alcohol-related harms. Dismantling of the centralized and hierarchical alcohol control system in Finland has shifted responsibilities from the state to the local level, and restructured the system of alcohol policy and prevention. At the state level greater emphasis is now placed on supporting and enabling local work, and the local level is expected to co-ordinate multiprofessional team work on a broad basis. In this process the roles and responsibilities of different actors are being reconfigured. The substudy is a part of the Local Alcohol Policy (PAKKA) demonstration and evaluation project. This particular sub-study focuses on the possibilities and factors influencing sustainability of local interventions. The data were gathered in four group discussions. The discussion groups consisted of various actors influential in the professional fields of alcohol retail and the restaurant business, liquor licensing and surveillance, the police, and municipal harm prevention. The thematic discussion was facilitated by a researcher. The discussions were videotaped and transcribed and analysed by using the group as the unit of analyses. The participants explored ways of resolving the pressures caused by the decentralizing of alcohol prevention to the local level, and conceptualized the role and position of preventive work amid the changes in the alcohol administration. The different groups had similar views on the difficulties and obstacles faced by local prevention of alcohol-related harms. All of them also discussed the balance between public and private responsibility. The groups differed from one another in terms of how they saw the relationship between alcohol markets, civil society and the public sector. They also differed in how optimistic they were about the future of local work in the prevention of alcohol-related harms. The analysis reveals a kind of an empowerment story about the future possibilities of local alcohol policy.

Public opinion and community-based prevention of alcohol-related harms

Aim: This article looks at alcohol policy opinions from the point of view of the possibilities and frames for creating local alcohol control policy. Local action against harms related to drinking is a compromise between different points of view, and the question of public support is important for community-based prevention. Data and analyses: The respondents of a postal questionnaire were asked if they supported different alcohol policy measures, and logistic regression analyses were carried out to examine the impact of the demographic characteristics, drinking measures and observations of alcohol-related harms in the community. Results: The wide majority of the population supported such measures suitable for community-based prevention as enforcement of the minimum legal age to purchase alcohol, surveillance of restaurants and shops, and the ban to sell alcohol to a drunken person. Decreasing numbers of outlets of restaurants or their opening hours were least popular. There was a relationship between drinking habits and alcohol policy opinions. Abstainers and moderate drinkers were most likely to support all alcohol policy measures examined, whilst heavier drinkers were least likely to support them. There was a connection between awareness of alcohol problems in one's locality, and favourable opinions on alcohol control measures. The result is similar with the ones found earlier in other countries. Conclusion: Potential members of local alcohol policy coalitions seem to have some similarities in different countries.

A study on effectiveness of local alcohol policy: Challenges and solutions in the PAKKA project

To an increasing degree, alcohol policy and prevention in the Nordic countries is expected to be carried out on the local level as the free-trade agreements and international harmonization of alcohol taxes and regulations are limiting the scope of traditional national alcohol policies. In recent reviews on the effectiveness of alcohol political interventions the recommended strategy for local communities is to combine community mobilization with various types of environmental strategies focused on the supply of alcoholic beverages. The PAKKA project continues the international tradition of research on community-based prevention of alcohol-related harms. In this paper we discuss the challenges and solutions of evaluating community-based prevention projects, using the recently started ‘PAKKA’ (Local Alcohol Policy) project as a concrete example. The PAKKA project relies on a mixed-intervention strategy attempting to change the local social, economic and physical environment related to risky and under-age drinking. In measuring the project's effectiveness a quasi-experimental research design is used. In our research design we have had to tackle three interconnected problems: the problems of causality in a multi-component population level study, the problem of generalizability and the complex role of the researcher.

Drinking Patterns and Their Consequences.

More than 20 years ago Kettil Bruun and colleagues (1975) published Alcohol Control Policies in Public Health Perspective , which subsequently became known as the ‘Pink Book’ on account of its striking cover. This work brought together a multidisciplinary group of the world's experts in this field and summarized the state of knowledge at that time. While they examined a wide range of evidence and public health responses, the concept for which it became most famous was the linkage between the average per capita consumption of alcohol and adverse consequences. This provided scientific credence for the prevention of alcohol-related harm through control measures, including taxation and supply, at a population level. In essence the message was that increasing price and limiting availability are effective methods of preventing alcohol-related harm. This conclusion was, and remains, understandably unattractive to the alcohol industry, whose employees and shareholders have a vested interest in increasing the availability and consumption of alcohol. Governments, particularly those in alcohol-producing countries, also have a vested interest in alcohol consumption by virtue of tax revenue and employment created by the alcohol industry, although this is clearly offset by the economic costs of alcohol-related problems. It is perhaps not surprising therefore that the successor to the Pink Book, Alcohol Policy and the Public Good (Edwards et al. , 1992), aroused opposition from the alcohol industry. As with the earlier version, Griffith Edwards brought together an international expert group to review the evidence …