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CORK Bibliography: Government Policies, Alcohol

38 citations. January 2011 to present

Prepared: March 2012

Alexander B. The Globalization of Addiction: A Study in Poverty of the Spirit. New York: Oxford University Press, 2011

To take the broadest possible view, it might be said that scientific modern medicine has failed when it comes to addiction. There are no reliable methods to cure it, prevent it, or take the pain out of it. There is no durable consensus on what addiction is, what causes it, or what should be done about it. Meanwhile, rates of addiction continue to increase around the world. This book argues that the cause of this failure to control addiction is that the conventional wisdom of the 19th and 20th centuries focused too single-mindedly on the afflicted individual. This was to overlook the obvious fact that prevalence differs markedly between societies. For example, it can be quite rare in a society for centuries, and then become common when a tribal culture is destroyed or a highly developed civilization collapses. Also of significance is that when addiction becomes common, people become addicted/dependent not only to alcohol and drugs, but other persuits be it money or power or sex or gambling or video games. Emphasis is made that a societal focus does not deny individual vulnerability and individual differences, but it simply removes them from the foreground of attention. The case is made that the nature of the emergent globalized free market society in conducive to the emergence of addiction. It subjects people to pressures towards individualism and competition, dividing rich and poor alike from the close social and spiritual ties that heretofore constitute human life. People adapt to their dislocation by finding the best substitutes for a sustaining social and spiritual life that they can, and addiction serves this function all too well. The case is made that the problems of addiction require not only the efforts of the helpfing professions but social and political initiatives that can reshape society with sufficent force to enable people to find social integration and meaning in everyday life, forces that would make it less imperative to fill their inner void with addictions.

Copyright 2011, Project Cork

Biglan A. Corporate externalities: A challenge to the further success of prevention science. Prevention Science 12(1): 1-11, 2011. (107 refs.)

The full benefit of prevention science will not be realized until we learn how to influence organizational practices. The marketing of tobacco, alcohol, and food and corporate advocacy for economic policies that maintain family poverty are examples of practices we must influence. This paper analyzes the evolution of such practices in terms of their selection by economic consequences. A strategy for addressing these critical risk factors should include: (a) systematic research on the impact of corporate practices on each of the most common and costly psychological and behavior problems; (b) empirical analyses of the consequences that select harmful corporate practices; (c) assessment of the impact of policies that could affect problematic corporate practices; and (d) research on advocacy organizations to understand the factors that influence their growth and to help them develop effective strategies for influencing corporate externalities.

Copyright 2011, Springer

Burkhart G. Environmental drug prevention in the EU. Why is it so unpopular? (editorial). Adicciones 23(2): 87-100, 2011. (92 refs.)

Adolescents go through changes in their neurobehavioural and psychosocial functioning that can result in their desire to conform to peer norms taking predominance over cognitive impulse control mechanisms. This can help explain why, when peers are present, adolescent behaviour may not be significantly modified by what they know about risks and consequences. This finding has implications for prevention as it points to the importance of responses that actively target the environment in which substance use takes place, and where social norms are formed and supported. In practice however, across Europe information-only prevention approaches - despite a weak evidence for their effectiveness - continue to be most commonly used. Why this is the case is the question addressed by this editorial. A definition for environmental prevention is also provided: as strategies that aim to alter physical, social and economic environment without relying on persuasion. Boundaries of the definition with health promotion are discussed and the available evidence for the efficacy of this perspective reviewed, as is the information on the availability of environmental prevention within Europe. These data do not support the contention made by some member states that their prevention strategies are comprehensive and cover all addictive substances. Overall, although environmental approaches are becoming more common, they are disproportionately found in the North of Europe, and are most noticeable in three areas: at the macro-level in tobacco bans and alcohol policies, in strategies to improve the school environment and ethos, and in local level policies to regulate recreational settings.

Copyright 2011, Socidrogalcohol

Capps B. Libertarianism, legitimation, and the problems of regulating cognition-enhancing drugs. Neuroethics 4(2, special issue): 119-128, 2011. (47 refs.)

Some libertarians tend to advocate the wide availability of cognition-enhancing drugs beyond their current prescription-only status. They suggest that certain kinds of drugs can be a component of a prudential conception of the "good life" they enhance our opportunities and preferences; and therefore, if a person freely chooses to use them, then there is no justification for the kind of prejudicial, authoritative restrictions that are currently deployed in public policy. In particular, this libertarian idea signifies that if enhancements are a prudential 'good' for the user, then this can also be construed as a moral good for all rational agents. If this argument is successful, there can be no substantial distinction between the categorical benefits of enhancement, and what is labeled as an enhancement technology. In this paper, I argue that the exclusivity of egotistical choice, and an uncritical deployment of enhancement as a prudential good, underplays the role of a social and political community when creating a procedurally just and effective public policy. Principally, the argument is devoid of any ethical system to permit the external-and therefore public-appreciation of the social context of moral decisions. In effect, libertarian arguments of this sort must disregard any ideas of public ethics, because the liberty to use whatever means available to gain a socio-economic advantage actually extinguishes any professed legitimation strategy. Escaping the procedural aspects of public policy, which are considered integral to authoritative coherence, results in the erosion of any moral obligations. Thus, in a libertarian society, disenfranchised individuals-such as those harmed through addiction-are the unlucky or superfluous product of a liberal and 'progressive' society.

Copyright 2011, Springer

Carkaxhiu L; Huseyin K; Berisha M; Botica MV. Problem of substance misuse and lack of national strategy in Kosovo. Central European Journal of Public Health 19(2): 108-114, 2011. (40 refs.)

The aim of this project was to explore the problem of substance misuse among adolescent town dwellers in Kosovo, as a result of lack of a national strategy related to this problem. Design: 261 students from 4 secondary schools took part in cross sectional survey performed in October 2005. The survey was carried out in Gjilan town in south-east of Kosovo. Main results: From all questioned students, 36% smoked cigarettes every day, 12.6% consumed alcohol occasionally and 1.4% consumed all kind of drugs regularly. Girls consumed more cigarettes, whereas boys consumed more alcohol and other drugs. The prevalence of substance misuse was higher among students in their last year of high school attendance. Students in Gjilan continue to smoke, consume alcohol and drugs despite their knowledge about the adverse health consequences of substance misuse, but in the same time, most of them consider information and counselling the best way of substance misuse prevention. Conclusions: The prevalence and trends of substance misuse among students in our survey indicates that it is time to start acting. It is assumed that results of survey may be a very useful source of information for policy-makers, government and ministry of health in developing and implementing national strategy that would address the most important issues in connection with addiction among adolescents.

Copyright 2011, National Institute of Public Health (Czech Republic)

Casswell S. Alcohol harm: The urgent need for a global response. (editorial). Addiction 106(7): 1205-1207, 2011. (19 refs.)

Cavanaugh D; Kraft MK; Muck R; Merrigan DM. Toward an effective treatment system for adolescents with substance use disorders: The role of the states. Children and Youth Services Review 33(1, special issue): s16-s22, 2011. (14 refs.)

A 2002 national expert panel found that the treatment system for adolescents with substance use disorders was inadequate and underdeveloped. The panel recommended immediate improvement in five areas: youth-serving agency collaboration, treatment system financing, workforce development, the implementation of evidence-based practices, and family involvement in all aspects of treatment. In 2004, the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA), designed the State Adolescent Substance Abuse Treatment Coordination Grant program (SAC) and implemented it in 2005 to address the critical need in the field. This paper reviews the adolescent substance use disorders treatment system, discusses selected drivers for change and the design of the SAC grant program, and summarizes some of the program's results. Both quantitative and qualitative data analysis document that substantive systems development occurred within each of the sixteen grantees and that federal-state partnerships are useful in creating systemic change.

Copyright 2011, Elsevier Science

Dave D; Mukerjee S. Mental health parity legislation, cost-sharing and substance-abuse treatment admissions. Health Economics 20(2): 161-183, 2011. (37 refs.)

Treatment is highly cost-effective in reducing an individual's substance abuse (SA) and associated harms. However, data from Treatment Episodes (TEDS) indicate that per capita treatment admissions substantially lagged behind increases in heavy drug use from 1992 to 2007. Only 10% of individuals with clinical SA disorders receive treatment, and almost half who forgo treatment point to accessibility and cost constraints as barriers to care. This study investigates the impact of state mental health and SA parity legislation on treatment admission flows and cost-sharing. Fixed effects specifications indicate that mandating comprehensive parity for mental health and SA disorders raises the probability that a treatment admission is privately insured, lowering costs for the individual. Despite some crowd-out of charity care for private insurance, mandates reduce the uninsured probability by a net 2.4 percentage points. States mandating comprehensive parity also see an increase in treatment admissions. Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. Supply constraints mute effect sizes, suggesting that demand-focused interventions need to be complemented with policies supporting treatment providers. These results have implications for the effectiveness of the 2008 Federal Mental Health Parity and Addiction Equity Act in increasing SA treatment admissions and promoting cost-sharing.

Copyright 2011, Wiley-Blackwell

Durrance CP; Golden S; Perreira K; Cook P. Taxing sin and saving lives: Can alcohol taxation reduce female homicides? Social Science & Medicine 73(1): 169-176, 2011. (56 refs.)

With costs exceeding $5.8 billion per year, violence against women has significant ramifications for victims, their families, the health care systems that treat them, and the employers who depend on their labor. Prior research has found that alcohol abuse contributes to violence against both men and women, and that stringent alcohol control policies can reduce alcohol consumption and in turn some forms of violence. In this paper, we estimate the direct relationship between an important alcohol control measure, excise taxes, and the most extreme form of violence, homicide. We use female homicide rates as our measure of severe violence, as this measure is consistently and accurately reported across multiple years. Our results provide evidence that increased alcohol taxes reduce alcohol consumption and that reductions in alcohol consumption can reduce femicide. Unfortunately, a direct test of the relationship does not have the power to determine whether alcohol taxes effectively reduce female homicide rates. We conclude that while alcohol taxes have been shown to effectively reduce other forms of violence against women, policy makers may need alternative policy levers to reduce the most severe form of violence against women.

Copyright 2011, Elsevier Science

Eriksson C; Geidne S; Larsson M; Pettersson C. A research strategy case study of alcohol and drug prevention by non-governmental organizations in Sweden 2003-2009. Substance Abuse Treatment, Prevention and Policy 6: e article 8, 2011. (83 refs.)

Background: Alcohol and drug prevention is high on the public health agenda in many countries. An increasing trend is the call for evidence-based practice. In Sweden in 2002 an innovative project portfolio including an integrated research and competence-building strategy for non-governmental organisations (NGOs) was designed by the National Board of Health and Welfare (NBHW). This research strategy case study is based on this initiative. Methods: The embedded case study includes 135 projects in 69 organisations and 14 in-depth process or effect studies. The data in the case study has been compiled using multiple methods - administrative data; interviews and questionnaires to project leaders; focus group discussions and seminars; direct and participatory observations, interviews, and documentation of implementation; consultations with the NBHW and the NGOs; and a literature review. Annual reports have been submitted each year and three bi-national conferences. Reflections on preventions have been held. Results: A broad range of organisations have been included in the NBHW project portfolio. A minority of the project were run by alcohol or drug organisations, while a majority has children or adolescents as target groups. In order to develop a trustful partnership between practitioners, national agencies and researchers a series of measures were developed and implemented: meeting with project leaders, project dialogues and consultations, competence strengthening, support to documentation, in-depth studies and national conferences. A common element was that the projects were program-driven and not research-driven interventions. The role of researchers-as-technical advisors was suitable for the fostering of a trustful partnership for research and development. The independence of the NGOs was regarded as important for the momentum in the project implementation. The research strategy also includes elements of participatory research. Conclusions: This research strategy case study shows that it is possible to integrate research into alcohol and drug prevention programs run by NGOs, and thereby contribute to a more evidence-based practice. A core element is developing a trustful partnership between the researchers and the organisations. Moreover, the funding agency must acknowledge the importance of knowledge development and allocating resources to research groups that is capable of cooperating with practitioners and NGOs.

Copyright 2011, BioMed Central

Gordon R. An audit of alcohol brand websites. Drug and Alcohol Review 30(6): 638-644, 2011. (36 refs.)

Introduction and Aims. The study investigated the nature and content of alcohol brand websites in the UK. Design and Methods. The research involved an audit of the websites of the 10 leading alcohol brands by sales in the UK across four categories: lager, spirits, Flavoured Alcoholic Beverages and cider/perry. Each site was visited twice over a 1-month period with site features and content recorded using a pro-forma. The content of websites was then reviewed against the regulatory codes governing broadcast advertising of alcohol. Results. It was found that 27 of 40 leading alcohol brands had a dedicated website. Sites featured sophisticated content, including sports and music sections, games, downloads and competitions. Case studies of two brand websites demonstrate the range of content features on such sites. A review of the application of regulatory codes covering traditional advertising found some content may breach the codes. Discussion and Conclusions. Study findings illustrate the sophisticated range of content accessible on alcohol brand websites. When applying regulatory codes covering traditional alcohol marketing channels it is apparent that some content on alcohol brand websites would breach the codes. This suggests the regulation of alcohol brand websites may be an issue requiring attention from policymakers. Further research in this area would help inform this process.

Copyright 2011, Wiley-Blackwell

Hall W; Chikritzhs T. The Australian alcopops tax revisited. (editorial). Lancet 337(9772): 1136-1137, 2011

Heilig M; Warren KR; Kunos G; Silverman PB; Hewitt BG. Addiction research centres and the nurturing of creativity. Addiction 106(6): 1052- 1060, 2011. (12 refs.)

The aim of this paper is to present a concise account of the history, mission, structure and some recent achievements of the US National Institute on Alcohol Abuse and Alcoholism (NIAAA). Created by the US Congress 40 years ago, the NIAAA has evolved from an entity charged mainly with building a national system of alcoholism treatment services to one with responsibility for developing, nurturing and supporting the biomedical and behavioral science foundation necessary to reduce the significant domestic and global public health impact of alcohol use disorders. The NIAAA is unique in that it functions both as a funding agency, supporting research at universities and other external, or 'extramural' research institutions, and is also a research institution itself, where alcohol research is carried out in-house, or 'intramurally'. Of a $450.2 million 2009 Congressional Appropriation, approximately 90% was devoted toward the former and approximately 10% towards the latter objective. The current NIAAA Strategic Plan builds on a new organizing principle for long-range research planning, based on a life-span perspective that recognizes that human biology and behavior continue to change throughout life and changes occurring throughout the life-span affect individuals' drinking patterns as well as the decisions they may make to change their drinking habits or to seek help for alcohol use problems. Within this framework, major efforts are currently being devoted to educating practitioners on clinically useful, science-based assessment and treatment methods that exist today, and development of personalized new treatments for tomorrow.

Copyright 2011, Society for the Study of Addiction

Herrick C. Why we need to think beyond the 'industry' in alcohol research and policy studies. Drugs: Education, Prevention and Policy 18(1): 10-15, 2011. (34 refs.)

The alcohol policy debate demands greater critical reflection on the complex and disaggregated nature of the alcohol industries in contrast to their frequent characterization as a coherent, monolithic and singular entity with a common goal. Such reflection is necessary in order to rethink the linked assumption that drinkers are vulnerable victims of the activities of industry and, in so doing, to start moving beyond the UK's current policy development impasse in creative and plausible ways.

Copyright 2011, Taylor & Francis

Herttua K; Makela P; Martikainen P. An evaluation of the impact of a large reduction in alcohol prices on alcohol-related and all-cause mortality: Time series analysis of a population-based natural experiment. International Journal of Epidemiology 40(2): 441-454, 2011. (50 refs.)

Background: We examined the effect of a large reduction in the price of alcohol that occurred in Finland in 2004 on alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases (CVDs) from which alcohol-attributable cases were excluded. Methods: Time series intervention analysis modelling was applied to the monthly aggregations of deaths in Finland for the period 1996-2006 to assess the impact of the reduction in alcohol prices. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. Analyses were carried out for men and women aged 15-39, 40-49, 50-69 and > 69 years. Results Alcohol-related deaths increased in men aged 40-49 years, and in men and women aged 50-69 years, after the price reduction when trends and seasonal variation were taken into account: the mean rate of alcohol-related mortality increased by 17% [95% confidence interval (CI) 1.5, 33.7], 14% (95% CI 1.1, 28.0) and 40% (95% CI) 7.1, 81.7), respectively, which implies 2.5, 2.9 and 1.6 additional monthly deaths per 100 000 person-years following the price reduction. In contrast to alcohol-related mortality, CVD and all-cause mortality decreased: among men and women aged > 69 years a decrease of 7 and 10%, respectively, in CVD mortality implied 19 and 25 fewer monthly deaths per 100 000 person-years, and a decrease of 7 and 14%, respectively, in all-cause mortality similarly implied 42 and 69 fewer monthly deaths. Conclusion: These results obtained from the time series analyses suggest that the reduction in alcohol prices led to an increase in alcohol-related mortality, except in persons < 40 years of age. However, it appears that beneficial effects in older age, when CVD deaths are prevalent, counter-balance these adverse effects, at least to some extent.

Copyright 2011, Oxford University Press

Humphreys K; Wagner TH; Gage M. If substance use disorder treatment more than offsets its costs, why don't more medical centers want to provide it? A budget impact analysis in the Veterans Health Administration. Journal of Substance Abuse Treatment 41(3): 243-251, 2011. (41 refs.)

Given that many studies have reported that the costs of substance use disorder (SUD) treatment are more than offset by other savings (e.g., in health care, in criminal justice, in foster care), why haven't health care system managers rushed to expand treatment? This article attempts to explain this puzzling discrepancy by analyzing 1998-2006 data from the national Veterans Affairs (VA) health care system. The main outcome measures were annual cost and utilization for VA SUD-diagnosed patients. The key independent variable was the medical centers' annual spending for SUD treatment. There was no evidence that SUD spending was associated with lower medical center costs over time within the medical center that paid for the treatment. Health care system managers may not be influenced by research suggesting that the costs of SUD treatment are more than fully offset because they bear the cost of providing treatment while the savings largely accrue to other systems.

Copyright 2011, Elsevier Science

Johnson BA; Messing RO; Charness ME; Crabbe JC; Goldman MS; Harris RA et al. Should the reorganization of addiction-related research across all the National Institutes of Health be structural? The devil is truly in the details. (editorial). Alcoholism: Clinical and Experimental Research 35(4): 572-580, 2011. (22 refs.)

The recent proposal to dissolve the National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse and create a new institute for substance use, abuse, and addiction will require significant effort by the staff of both institutes, the Advisory Councils, and outside experts to overcome complex challenges that could threaten its success. Although integration of the grants portfolios can be achieved, harmonization of goals and policies related to legal use of alcohol versus illegal consumption of drugs will present serious challenges. Consolidating the infrastructure of the 2 existing institutes would entail avoiding encroachment on grant funding. A new institute for substance use, abuse, and addiction would require an enormous amount of cooperation from other institutes as the portfolios of research on alcohol, tobacco, and other drug abuse should logically be transferred to the new institute. In the near term, a structural reorganization would be less efficient and more costly than the individual institutes are currently. Increasing efficiency and reducing costs over time will necessitate careful strategic planning. Success in this difficult task would be made easier and less costly by first implementing carefully placed building blocks of increasing functional reorganization. The newly created institute should increase opportunities for specialization within disorders of addiction, attract new leadership, and build a novel strategic plan that will energize scientists and staff and incorporate ideas of stakeholders to advance the public good in preventing and treating alcohol, tobacco, and all addictions. Attention must be paid to the devil in the details.

Copyright 2011, Research Society on Alcoholism

Knudsen HK; Abraham AJ; Oser CB. Barriers to the implementation of medication-assisted treatment for substance use disorders: The importance of funding policies and medical infrastructure. Evaluation and Program Planning 34(4): 375-381, 2011. (28 refs.)

Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.

Copyright 2011, Elsevier Science

Lachenmeier DW; Taylor BJ; Rehm J. Alcohol under the radar: Do we have policy options regarding unrecorded alcohol? International Journal of Drug Policy 22(2): 153- 160, 2011. (67 refs.)

Background: According to the World Health Organization, the public health impact of illicit alcohol and informally produced alcohol should be reduced. This paper summarizes and evaluates the evidence base about policy and intervention options regarding unrecorded alcohol consumption. Methods: A systematic review of the literature using electronic databases. Results: The literature on unrecorded consumption was sparse with less than 30 articles about policy options, mostly based on observational studies. The most simplistic option to reduce unrecorded consumption would be to lower recorded alcohol prices to remove the economic incentive of buying unrecorded alcohol. However, this may increase the net total alcohol consumption, making it an unappealing public health policy option. Other policy options largely depend on the specific sub-group of unrecorded alcohol. The prohibition of toxic compounds used to denature alcohol (e.g. methanol) can improve health outcomes associated with surrogate alcohol consumption. Cross-border shopping can be reduced by either narrowing the tax differences, or stricter control. Actions limiting illegal trade and counterfeiting include introduction of tax stamps and electronic surveillance systems of alcohol trade. Education campaigns might increase the awareness about the risks associated with illegal alcohol. The most problematic category appears to be the home and small-scale artisanal production, for which the most promising option is to offer financial incentives to the producers for registration and quality control. Conclusion: Even though there are suggestions and theories on how to reduce unrecorded alcohol consumption, there is currently no clear evidence base on the effectiveness or cost effectiveness of available policy options. In addition, the differences in consumption levels, types of unrecorded alcohol, culture and tradition point to different measures in different parts of the world. Thus, the recommendation of a framework for moving forward in decision making currently seems premature. Instead, there is a need for systematic research.

Copyright 2011, Elsevier Science

Lancaster K; Hughes CE; Spicer B; Matthew-Simmons F; Dillon P. Illicit drugs and the media: Models of media effects for use in drug policy research. Drug and Alcohol Review 30(4): 397-402, 2011. (64 refs.)

Issues. Illicit drugs are never far from the media gaze and although identified almost a decade ago as 'a new battleground' for the alcohol and other drug (AOD) field there has been limited research examining the role of the news media and its effects on audiences and policy. Approach. This paper draws together media theories from communication literature to examine media functions. We illustrate how each function is relevant for media and drugs research by drawing upon the existing literature examining Australian media coverage during the late 1990s of escalating heroin-related problems and proposed solutions. Key Findings. Media can influence audiences in four key ways: by setting the agenda and defining public interest; framing issues through selection and salience; indirectly shaping individual and community attitudes towards risk; and feeding into political debate and decision making. Each has relevance for the AOD field. For example, media coverage of the escalating heroin-related problems in Australia played a strong role in generating interest in heroin overdoses, framing public discourse in terms of a health and/or criminal issue and affecting political decisions. Implications and Conclusion. Media coverage in relation to illicit drugs can have multifarious effects. Incorporating media communication theories into future research and actions is critical to facilitate understanding of the short-and long-term impacts of media coverage on illicit drugs and the avenues by which the AOD field can mitigate or inform future media debates on illicit drugs.

Copyright 2011, Wiley-Blackwell

Macdonald S; Stockwell T; Luo JS. The relationship between alcohol problems, perceived risks and attitudes toward alcohol policy in Canada. Drug and Alcohol Review 30(6): 652-658, 2011. (29 refs.)

Introduction and Aims. Approval of alcohol policies by the public in democratic countries is critical for instituting social change. With respect to alcohol policies, mounting research indicates that a higher price per unit of ethanol is an effective approach for reducing alcohol-related problems, yet surveys have found this approach is usually unpopular. The purpose of this paper is to assess the relationship between amount of drinking and support for various alcohol policies. Design and Methods. A secondary analysis was conducted on the Canadian Addictions Survey, a randomised telephone survey of over 10 000 Canadians. The relationship between the amounts of drinking reported by the respondents was examined in relation to the perceived seriousness of alcohol problems in their communities and the endorsement of several alcohol policies. Results. Increased amount of drinking was significantly related to lower perceptions of drinking-related risks. Furthermore, heavier consumers had less favourable attitudes than lighter drinkers and abstainers toward alcohol policies, such as increased taxation. Aggregated data across the 10 Canadian provinces showed a strong effect size (r = -0.515, P = 0.128) between endorsement of alcohol taxation and rates of hospital separations for alcohol. Discussion and Conclusions. Results from this study show that the more that people drink, the more they oppose taxation. The implications of these findings are that as alcohol problems in communities become worse, the population may become more resistant to effective alcohol policies. Strategies are suggested for implementing effective policies.

Copyright 2011, Wiley-Blackwell

Mauldin JA. All smoke and no fire? Analyzing the potential effects of the Mental Health Parity and Addiction Equity Act of 2008. Law & Psychology Review 35: 193, 2011. (122 legal refs.)

... The way in which mental health services have been and continue to be regulated in this country cannot be understood without a general understanding of the larger historical context of mental health treatment. ... Specifically, the bill would have required services considered essential to the treatment of severe mental illness to be provided in a manner that "(1) was not more restrictive than coverage provided for other major physical illnesses; (2) provided adequate financial protection to the person requiring the medical treatment . . . ; and (3) was consistent with effective and common methods of controlling health care costs for other major physical illnesses." ... The GAO further found, the net effect is that consumers in states without more comprehensive laws have often seen only minor changes in their health benefits, resulting in little or no increase in their access to mental health services, and that the costs associated with the federal law have been negligible for most health plans. ... The provision reduced the incentive for insurance companies and benefit providers to make long-term shifts toward mental health parity in hopes of nonrenewal. ... What It Does In rising to support the MHPAEA, Representative Pallone stated, "the legislation before us will fully ensure equity in the coverage for mental illness and substance abuse disorders by requiring that group health plans with mental health coverage offer that coverage without the imposition of discriminatory financial requirements or discriminatory treatment limitations." ... The PPACA attempts to broaden access to care by requiring most citizens to purchase health insurance, creating state-based insurance exchanges where some individuals will be eligible for premium and cost-sharing benefits, penalizing employers whose employees obtain coverage through the exchanges, and extending Medicaid eligibility.

Copyright 2011, University of Alamba

Miller P; Dunlop A. Rhetoric, reality and research: What they mean for achieving the best possible treatment system for addiction-related problems. (editorial). International Journal of Drug Policy 22(3): 196-197, 2011. (17 refs.)

Naimi TS. The cost of alcohol and its corresponding taxes in the U.S:. A massive public subsidy of excessive drinking and alcohol industries. American Journal of Preventive Medicine 41(5): 546-547, 2011. (8 refs.)

The cost-per-drink metric facilitates a comparison with current alcohol taxes, which can be derived on a per-drink basis. This, highlights perhaps the most important contribution of this study, which is to illustrate the gross disparity that exists between the cost of alcohol consumption and its taxes. Based on federal tax rates for standard alcohol beverage categories (5% alcohol-by-volume [ABV] beer; 12% ABV wine; and 40% ABV liquor), and after weighting those taxes on the basis of beverage-specific consumption in the U.S. and standard drink size (14 g of ethanol per drink), the average federal tax in the U.S. is approximately 8.5 cents per drink. Further, since federal alcohol taxes are based on a fixed amount per volume of alcohol, they continuously erode as a result of inflation. For example, the federal beer tax has declined by 41% in real terms since it was last adjusted in 1991. Historically, alcohol taxes accounted for approximately 40% of federal revenues; they now account for less than 0.5% of revenue. States typically have substantially lower taxes on alcohol than does the federal government (approximately 5 cents per drink). Moreover, although these state taxes are enacted primarily through volume-based excise taxes (similar to federal taxes), in some cases they include ad valorem taxes (alcohol-specific taxes based on a percentage of the price) or general sales taxes. In Massachusetts, my home state, the weighted average tax per drink is only 2.6 cents,4 which is levied in the form of volume-based excise taxes. In addition, as in a number of other states, alcohol is not subject to the state's 6.25% sales tax or any ad valorem taxes, meaning that alcohol is taxed far less than items such as durable medical equipment, automobiles, or other general merchandise. The study's estimated $1.90 cost per drink in 2006 has increased to $2.13 per drink in 2011, after adjustment for inflation. Because federal plus state taxes are (and were) approximately 14 cents per drink, this is a current disparity between cost and tax of approximately $2 per drink. In addition, this study found that 41.5% of costs were incurred by drinkers themselves, meaning that 58.5% of costs (or approximately $1.25 per drink in 2011 and $1.11 in 2006) were external to drinkers, a disparity of $1.11 per drink for external costs in 2011 and $0.97 per drink in 2006. Therefore, in 2006 alone, the 117.4 billion standard drinks consumed in the U.S. resulted in $113.9 billion in net (i.e., un-recouped) external costs that accrued to the general public; for comparison, this was almost half the size of the federal budget deficit that year.

Copyright 2011, American College of Preventive Medicine

Nicholls J. UK news reporting of alcohol: An analysis of television and newspaper coverage. Drugs: Education, Prevention and Policy 18(3): 200-206, 2011. (26 refs.)

Aims: To identify patterns in the representation of alcohol-related stories in the UK news media. To consider what kind of stories are reported and how reports are framed through thematic focus, imagery and the selection of sources by journalists. Methods: Quantitative content analysis of seven daily newspapers and four television news programmes over two sample periods: 20 December 2008-2 January 2009 and 15-22 March 2009. Findings: News reporting strongly emphasizes negative outcomes, especially violence, drink-driving and long-term health impacts - specifically liver disease. Reports of celebrity drinking are commonplace. Public health perspectives play a central role in the framing of alcohol-related stories. There is a clear gender divide: male drinking is associated with violence, while female drinking is associated with simply appearing drunk. Supermarkets are identified as a central cause of problem drinking, and cheap alcohol is seen as a greater threat than relaxed licensing laws. Conclusions: Compared to previous studies, the ''normalization'' of drinking in news reporting has declined. Public health advocates have successfully established themselves as key sources for alcohol stories. However, there remains no consensus on public health policy initiatives.

Copyright 2011, Taylor & Francis

Pawson R; Wong G; Owen L. Known knowns, known unknowns, unknown unknowns: The predicament of evidence-based policy. American Journal of Evaluation 32(4): 518-546, 2011. (66 refs.)

The authors present a case study examining the potential for policies to be "evidence-based." To what extent is it possible to say that a decision to implement a complex social intervention is warranted on the basis of available empirical data? The case chosen is whether there is sufficient evidence to justify banning smoking in cars carrying children. The numerous assumptions underpinning such legislation are elicited, the weight and validity of evidence for each is appraised, and a mixed picture emerges. Certain propositions seem well supported; others are not yet proven and possibly unknowable. The authors argue that this is the standard predicament of evidence-based policy. Evidence does not come in finite chunks offering certainty and security to policy decisions. Rather, evidence-based policy is an accumulative process in which the data pursue but never quite capture unfolding policy problems. The whole point is the steady conversion of "unknowns" to "knowns."

Copyright 2011, Sage Publications

Rehm J; Patra J; Gnam WH; Sarnocinska-Hart A; Popova S. Avoidable cost of alcohol abuse in Canada. European Addiction Research 17(2): 72-79, 2011. (15 refs.)

Aims: To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002. Methods: A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse. Results: It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales. Conclusion: The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree.

Copyright 2011, Karger

Rieckmann TR; Kovas AE; Cassidy EF; McCarty D. Employing policy and purchasing levers to increase the use of evidence-based practices in community-based substance abuse treatment settings: Reports from single state authorities. Evaluation and Program Planning 34(4): 366-374, 2011. (53 refs.)

State public health authorities are critical to the successful implementation of science based addiction treatment practices by community-based providers. The literature to date, however, lacks examples of state level policy strategies that promote evidence-based practices (EBPs). This mixed-methods study documents changes in two critical state-to-provider strategies aimed at accelerating use of evidence-based practices: purchasing levers (financial incentives and mechanisms) and policy or regulatory levers. A sample of 51 state representatives was interviewed. Single State Authorities for substance abuse treatment (SSAs) that fund providers directly or through managed care were significantly more likely to have contracts that required or encouraged evidence-based interventions, as compared to SSAs that fund providers indirectly through sub-state entities. Policy levers included EBP-related legislation, language in rules and regulations, and evidence-based criteria in state plans and standards. These differences in state policy are likely to result in significant state level variations regarding both the extent to which EBPs are implemented by community-based treatment providers and the quality of implementation.

Copyright 2011, Elsevier Science

Saddichha S; Manjunatha N; Khess CRJ. Legislative control of alcohol use: Is it an unmet need of public health policy? Recommendations for India and other developing nations. Journal of Substance Use 16(5): 367-371, 2011. (28 refs.)

Background: Even though prevalence of alcohol use in the world is very high, it has not been brought under legal control contrary to other substances like opium, cocaine, cannabis, etc. Aim: To demonstrate similarities in both alcohol and opioid dependence by comparing and contrasting the course of clinical dependence and arguing for similar legal controls for alcohol as is present for opioids. Conclusion: This study recommends alcohol to be treated at par with opioids and calls for legislations for the control of alcohol uniformly across the world, as a public health policy, on the lines of the Framework Convention for Tobacco Control.

Copyright 2011, Informa Healthcare

Saylor DK. Heavy drinking on college campuses: No reason to change minimum legal drinking age of 21. (editorial). Journal of American College Health 59(4): 330-333, 2011. (38 refs.)

The recent Amethyst Initiative argues that a minimum legal drinking age (MLDA) of 21 has created a culture of heavy alcohol use on college campuses by making drinking clandestine and extreme. This group and others argue that lowering the MLDA will reduce the problem of obinge drinkingo on college campuses. However, such a policy change would remove one of the most researched and supported policies in the nation's alcohol control arsenal. There is little evidence that other interventions or policies are capable of working on the same broad level as MLDA 21, and there could also be a deleterious ripple effect in related legislation because MLDA 21 works in conjunction with other drinking laws. In addition, historic and international experiences with a lowered MLDA indicate there are serious social and public health consequences. Instead of removing efficacious interventions, we must remain committed to implementing and enforcing evidence-based practices and legislation.

Copyright 2011, Heldref Publications

Shaffer DK; Hartman JL; Listwan SJ; Howell T; Latessa EJ. Outcomes among drug court participants: Does drug of choice matter? International Journal of Offender Therapy and Comparative Criminology 55(1): 155-174, 2011. (76 refs.)

The link between drug and alcohol abuse and criminal behavior is clearly illustrated in the literature. The options of how to respond to these offenders, however, has widely fluctuated over time. Currently, many states have reconsidered their "get tough" approach to one that is more rehabilitative in nature. One particular community-based intervention that has gained in popularity is the drug court model. The literature on drug courts is generally supportive; however, there is a need to examine effectiveness by target population. The purpose of this study is to explore recidivism rates of drug court clients by drug of choice. Using a 2-year follow-up period, this study finds that drug of choice does not significantly influence either successful graduation or arrest. Policy implications are discussed.

Copyright 2011, Sage Publication

Szmigin I; Bengry-Howell A; Griffin C; Hackley C; Mistral W. Social marketing, individual responsibility and the "culture of intoxication". European Journal of Marketing 45(5): 759-779, 2011. (52 refs.)

Purpose - Social marketing initiatives designed to address the UK's culture of unhealthy levels of drinking among young adults have achieved inconclusive results to date. The paper aims to investigate the gap between young peoples perceptions of alcohol consumption and those of government agencies who seek to influence their behaviour set within a contextualist framework. Design/methodology/approach - The authors present empirical evidence from a major study that suggests that the emphasis of recent campaigns on individual responsibility may be unlikely to resonate with young drinkers. The research included a meaning-based and visual rhetoric analysis of 261 ads shown on TV, in magazines, on billboards and on the internet between 2005 and 2006. This was followed by 16 informal group discussions with 89 young adults in three locations. Findings - The research identified the importance of the social context of young people's drinking. The research reveals how a moral position has been culturally constructed around positioning heavy drinking as an individual issue with less regard to other stakeholders and how the marketing agents function in this environment. Calls to individual responsibility in drinking are unlikely to succeed in the current marketing environment. Research limitations/implications - The qualitative research was limited to three geographical locations with young adults between the ages of 18 and 25. Practical implications - The authors explore implications for social marketing theory and for UK alcohol policy. In particular, the authors suggest that the social norms surrounding young people's drinking need to be acknowledged and built into "sensible" social marketing campaigns. The authors suggest that shame, fear and guilt appeals should be replaced with more constructive methods of ensuring young people's safety when they drink. Originality/value - From the theoretical perspective of contextualism, the paper brings together empirical research with young adults and a critical analysis of recent social marketing campaigns within the commercial context of a "culture of intoxication". It provides both a critique of social marketing in a neo-liberal context and recognition of issues involved in excessive alcohol consumption.

Copyright 2011, Emerald Group Publishing

Tobin C; Moodie AR; Livingstone C. A review of public opinion towards alcohol controls in Australia. (review). BMC Public Health 11: article 58, 2011. (60 refs.)

Background: Increasing concern about the negative impact of alcohol on the Australian community has renewed calls for tighter regulatory controls. This paper reviews levels of and trends in public support for liquor control regulations, regulation of alcohol promotions, and alcohol pricing and taxation reforms in Australia between 1998 and 2009. Methods: Six electronic databases and twenty public health and alcohol organisation websites were searched for research literature, reports and media releases describing levels of public support for alcohol controls. Only studies which randomly selected participants were included. Results: Twenty-one studies were included in the review. The majority of the Australian public support most proposed alcohol controls. Levels of support are divided between targeted and universal controls. Conclusions: Implementation of targeted alcohol policies is likely to be strongly supported by the Australian public, but universal controls are liable to be unpopular. Policy makers are provided with insights into factors likely to be associated with higher public support.

Copyright 2011, BioMed Central Ltd

Vaughn M. Addiction and criminal justice: Empirical findings and theory for advancing public safety and health. (editorial). Journal of Criminal Justice 39(3, special issue): 205-206, 2011. (14 refs.)

Wettenhall R. State enterprise for ethical reasons: Mostly alcohol and tobacco. Policy Studies 32(3, special isssue): 243-261, 2011. (83 refs.)

The impact of the global financial crisis (GFC) in 2007-2010 directed attention once more to the role of the state in the economy, with many observers accepting that that role would be larger in the foreseeable future than it had been during the privatising era of the later twentieth century. But the interventions of the GFC period and the debates about them focused very largely on commercial functions - banking and industrial production. Going beyond these particular interventions and debates, there has always been a strong, though often forgotten, case for government intervention for ethical rather than commercial reasons. This article reviews that case as it manifests itself in the alcohol and tobacco industries, with a brief indication that the betting/gambling industry presents many similar features.

Copyright 2011, Taylor & Francis Ltd

Wicki M; Gmel G. Hospital admission rates for alcoholic intoxication after policy changes in the canton of Geneva, Switzerland. Drug and Alcohol Dependence 118(2-3): 209-215, 2011. (43 refs.)

Background: In February, 2005, the canton of Geneva in Switzerland prohibited the off-premise sale of alcoholic beverages between 9pm and 7am, and banned their sale in gas stations and video stores. The aim of this study is to assess the impact of this policy change on hospital admission rates for alcoholic intoxication. Methods: An interrupted time series analysis of this natural experiment was performed with data on hospitalisations for acute alcoholic intoxication during the 2002-2007 period. The canton of Geneva was treated as the experimental group, while all other Swiss cantons were used as the control group. Results: In the experimental site, the policy change was found to have a significant effect on admission rates among adolescents and young adults. Depending on the age group, hospitalisation rates for alcoholic intoxication fell by an estimated 25-40% as the result of restricted alcohol availability. Conclusions: Modest restrictions on opening hours and the density of off-premise outlets were found to be of relevance for public health in the canton of Geneva. In light of this finding, policy makers should consider such action as a promising approach to alcohol prevention.

Copyright 2011, Elsevier Science

Williamson L. 'For Debate': NICE but Needy: English guidance on managing alcohol dependence is not backed up by government alcohol policy. (editorial). Alcohol and Alcoholism 46(6): 647-650, 2011. (36 refs.)

Zador PL; Howard JM; Rauch WJ; Ahlin EM; Duncan GD. Latency periods between alcohol-related traffic violations: Implications for recidivism. Traffic Injury Prevention 12(4): 297-305, 2011. (38 refs.)

Objective: Before October 1, 2002, Maryland's regulations for relicensing drivers with 2 recorded alcohol-related traffic violations distinguished between offenders with 5 or more years between their first and second violations and those with less than 5 years. Our research examined whether this policy was supported by differential probabilities of recidivism and violation-free survival. Methods: We compared recidivism rates and survival probabilities among the 2 latency subgroups and 2 control groups (first offenders and drivers with no previous alcohol-related traffic violation). Data were extracted from Maryland's driver record database and segregated files and analyzed by age quintiles using Cox proportional hazards models containing identifiers for risk factors, including prior violations. All drivers (N = 64,536) were matched on age quintile. gender, and month of offenders' index violations. Effects of violation histories on survival and recidivism probabilities were measured by contrasts of regression coefficients. Results: Among second offenders, the shorter latency subgroup consistently had higher recidivism and lower violation-free survival than the longer latency subgroup, whose rates fell between those of first offenders and the shorter latency subgroup. Although highly significant, the subgroup differences were small and paled by comparison to differences between first and zero offenders in probability of a subsequent violation. Conclusions: An earlier study that showed similar overall recidivism for these latency subgroups helped encourage Maryland to change its regulations governing license reinstatement. New regulations issued October 1, 2002, focused on 2 alcohol violations "during any period of time" where investigation indicated alcoholism or unaddressed alcohol problems. To obtain relicensure, these offenders could be required to enter or complete a lengthy certified alcohol treatment program. Our current results are consistent with these requirements. License reinstatement should be primarily guided by the extent of alcohol impairment, especially because both latency subgroups showed higher risks of recidivism than first offenders, who themselves had comparatively high risk.

Copyright 2011, Taylor & Francis