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4.

Best practice
in prevention

4.1 Current activity Though not explored in detail in this paper, the
concept of the prevention paradox assists in
Considerable activity aiming to prevent
understanding prevention approaches in the
alcohol-related harm is currently under way in
areas of public health and public safety. This
Australia. The extent to which the considerable
approach suggests that more (net) harm may
preventative desire and activity (planned or
be prevented through universal interventions
under way) is likely to be effective, and how
focusing on the majority who are less seriously
well this activity reects an evidence-based
involved in harmful alcohol/drug use, rather
approach, is considered in the next section of
than through interventions that only target the
this paper. In general, the measures that are
smaller proportion of high-risk users.
most often called for by community members
tend to be the least effective, while the most
WHAT WORKS IN ALCOHOL-
effective measures are the least popular and are
RELATED PREVENTION?
thus probably the most difcult for governments
to introduce, usually requiring strong leadership The following discussion is informed by recent
and well-planned implementation. reviews of the available research evidence.
This includes:
WHAT IS PREVENTION IN THIS AREA?
Q the World Health Organizations (WHO)
The stated aim of Australias current National international review of alcohol-related
Drug Strategy is to prevent the uptake research and public policy[13]
and minimise the harmful effects of drug
Q a recent Australian research monograph
use in Australian society. Known as harm
on the prevention of substance use, risk
minimisation, this approach has been dened
and harm[7]
as encompassing:
Q a recent update of the latter, with
Q Supply reduction strategies designed
a focus on prevention interventions
to restrict the harmful supply of drugs
targeting adolescents.[41]
Q Demand reduction strategies designed
Other recent reviews have also been drawn upon,
to prevent the uptake of harmful drug use
to a lesser extent, including Stockwell 2004,[42]
Q Harm reduction strategies to reduce Loxley et al. 2005[7, 43] and NDRI 2007.[36]
drug-related harm for individuals
The conclusions reached in the WHO report[13]
and communities.
with regard to the respective strengths and
The approach of harm minimisation, while weaknesses of different types of interventions,
complex and requiring continuing support according to the available international research
from public advocates, is based on scientic evidence, are summarised in Table 6. Included in
evidence and underpins the denition of this table are Australian-authored evaluations of
prevention adopted for the review of alcohol- the equivalent interventions provided by Loxley
related interventions in this paper. It can et al.[7] and Toumbourou et al.[41] The scales
encompass universal as well as targeted used to rate the interventions by the respective
interventions (both selective: particular high- authors are summarised in Table 5 below.
risk sub-populations; and indicated: those with
emerging problems).

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Table 5: Key to the rating scales shown in Table 6
EVIDENCE OF BREADTH OF AUSTRALIAN
RATING EFFECTIVENESS RESEARCH SUPPORT TEST ACROSS CULTURES EVALUATION

0 Lack of effectiveness No studies undertaken Not tested Limited investigation

Limited effectiveness 1 well-designed study Tested in 1 country Evidence for


completed implementation

Moderate effectiveness 24 studies completed Tested in 24 countries Evidence for outcome


effectiveness

High degree of 5+ studies completed Tested in 5+ countries Evidence for effective


effectiveness dissemination

? No evidence available N/A

Warrants further
research

Evidence is
contra-indicative

This rating scale applies to the WHOs The types of interventions for which there is
international review [13] and Australian somewhat less evidence of effectiveness
reviews.[14]. are, in order:

Of the 39 interventions listed in Table 6, at least 5. Altering the drinking context


half of these are universal (targeted at the whole
6. Regulating promotion
population) and approximately half are targeted
at high-risk groups. The international review 7. Education and persuasion
by Babor et al. concludes that interventions
targeting the whole population generally have
There are differences in the ratings of some
higher effectiveness ratings and are less costly
interventions between the international
to implement and maintain, on average, than
review[13] and the Australian review.[7]
those targeting high-risk groups.[13] In general,
(for example, the treatment of alcohol
the types of interventions that are considered
problems and mass media campaigns).
most effective according to the ratings are,
Also, importantly, it should be recognised
in order:
that although the effectiveness of some
1. Regulating physical availability. interventions do not rate highly, in some
cases this may be due to the limited
2. Taxation and pricing.
research evidence that is available to
3. Drink-driving countermeasures. inform the rating (for example, advertising
4. Treatment and early intervention. content controls).

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Table 6: Ratings of policy-relevant strategies and interventions
CROSS-
BREADTH OF CULTURAL COST TO AUSTRALIAN
STRATEGY OR INTERVENTION EFFECTIVENESS RESEARCH TESTING IMPLEMENT EVALUATION
Regulating physical availability Total ban on sales High
Minimum legal purchase age Low
Hours and days of sale restrictions Low
Restrictions on density of outlets Low
Staggered closing times for bars and clubs
Server liability Low
Different availability by alcohol strength Low
Taxation and pricing Alcohol taxes Low
Hypothecated tax to pay for treatment / prevention
Setting oor prices / banning discounting
Drink-driving countermeasures Sobriety checkpoints Moderate
Random breath testing Moderate
Lowered BAC limits Low
Administrative licence suspension Moderate
Low BAC for young drivers Low
Graduated licensing for novice drivers Low
Designated drivers and ride services 0 Moderate
Ignition interlocks
Treatment and early intervention Brief intervention in primary health settings Moderate
Alcohol problems treatment High
Thiamine supplementation
Workplace interventions
Mutual help/self-help attendance Low
Mandatory treatment of repeat drink drivers Moderate
Altering the drinking context Bans on serving intoxicated persons Moderate
Training staff to prevent intoxication / aggression Moderate ( if not enforced)
Voluntary codes of bar practice 0 Low ( if not enforced)
Enforcement of on-premises regulations and laws High
Promoting alcohol-free events 0 High
Community mobilisation High
Plastic or tempered-glass serving containers
Food service
Regulating promotion Advertising bans ? Low
Advertising content controls ? Low
Education and persuasion Alcohol education in schools 0 High
College student education 0 High
Parent education ? Moderate
Public service messages / Mass media campaigns Moderate
Warning labels / National drinking guidelines 0 Low

Source: Adapted from Babor et al. (2003),[13] Loxley et al. (2004),[7] Toumbourou et al. (2007)[41]

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4.2 Regulating the physical Liquor licensing systems or planning controls
availability of alcohol can potentially be used to limit the number
of places where alcohol can be sold. In
Regulating physical availability refers to the
recent years in Australia there has been a
accessibility or convenience of the alcohol
signicant liberalisation of licensing laws and
products, and relates to policies that aim to
a corresponding growth in outlets, both on-
prevent alcohol-related harm through controls
and off-premises. Recent research from three
on the condition of sale to the drinker as a
states,[45-49] has demonstrated consistent links
retail customer.[13] In Australia, there has been
between the availability of alcohol in a region
a recent review of the evidence for restricting
and the alcohol-related problems experienced
the sale and supply of alcohol by the National
there. In particular, these studies have linked
Drug Research Institute.[36] While regulation
rates of violence to density of alcohol outlets. A
of the economic availability of alcohol (i.e.
longitudinal study in Melbourne has highlighted
the price of alcohol) is, currently, exclusively a
that changes in the number of outlets in an
federal responsibility in Australia, via measures
area are directly related to changes in the
such as taxation, the physical availability of
rates of night-time assaults occurring there.
alcohol is generally regulated by state and
The links between outlet density and other
territory governments, and to a limited extent
outcomes are less clear cut, although some
by local governments.
international evidence suggests higher outlet
Restricting the hours and days of sale of alcohol density is related to higher rates of: risky alcohol
is a standard component of alcohol policy consumption,[50] motor vehicle accidents,[51]
and regulation, and there is a substantial body risky sexual behaviour,[52] pedestrian injury,[53]
of international and Australian work that has child maltreatment[54] and neighbourhood
examined the impact of changes to trading amenity problems.[55] The results of this
hours for licensed premises on levels of alcohol research are clear: liberalising alcohol
consumption and rates of related harms. Most availability is likely to increase alcohol-related
Australian studies have shown that increased problems. The results certainly call into question
trading hours have been accompanied the general assumption behind actions in
by signicantly increased levels of alcohol recent decades that have been made in
consumption and/or harms.[36] A recent accordance with National Competition Policy
Australian study by Chikritzhs and Stockwell[44] such as the state-led liberalisation of liquor
found that small extensions of trading hours licensing regimes that the number of a type
for licensed hotels in Perth, Western Australia, of outlet should be determined by market
signicantly increased the numbers of drink- demand for the product, without consideration
driver road crashes. More specically, this study of community amenity or impacts.
demonstrated that the relationship between
Apart from issues of outlet density, there is the
trading hours and increased drink-driver road
question of whether particular types of outlets
crashes was mediated by the quantity of
or their design and location are particularly
alcohol purchases. The National Drug Research
likely to cause problems. There is good
Institute (NDRI) reports that several studies have
evidence that certain premises contribute
indicated that young males and regular heavy
disproportionately to problems,[32] highlighting
drinkers are especially likely to take advantage
the need to further examine the types of outlets
of longer trading hours.[36]
that are related to assaults. Further data, such
Restrictions on density of outlets can be as alcohol sales, opening hours, capacity and
achieved by requiring minimum distances venue style, could provide substantial insights
between outlets or limiting the number of into how different outlets contribute to the
outlets in a particular location. effect of outlet density on assault.

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more commonly associated with drink-driving.
GROWTH IN ALCOHOL OUTLETS [36] The NDRI also observes that while most
While not completely deregulated, liquor studies identify wine as a comparatively low-risk
licensing laws and regulations in most beverage, a study by Stockwell et al. (1998)
jurisdictions have been signicantly relaxed [56] found that certain types of wine that offer
over the past decade, generally coinciding high alcohol content at a relatively low price
with the required reviews under the National were strongly associated with hospitalisations
Competition Policy. One of the effects of this for alcohol-related road injuries, falls, assaults
has been a proliferation in the number of and suicides. Some small regional or remote
new licensed premises in some jurisdictions communities in Australia, with relatively large
(see Fig. 8). Indigenous populations, have introduced sales
bans on cask wine and cask fortied wine.
Along with an increase in the total number
According to the NDRI,[36] evaluations of some
of licensed premises, there has been
of these bans show that such restrictions can
an increase in the numbers of premises
result in reduced alcohol-related harm in the
with extended trading hours, the numbers
communities where the bans exist.
of licences to sell packaged liquor
(i.e. take away) and over time, an increased The issue of the server liability for injuries to
concentration of licences held by just a intoxicated people or third parties affected by
few businesses. the actions of a person affected by alcohol is
a complex and controversial area of the law.
[57] In the US, Dram Shop laws and court
decisions under common law in many states
allow people injured through the actions of an
intoxicated person to recover damages from
a licensee or licensed premises owner. Such
licensees are, in most Dram Shop legislation,
also vicariously liable for their employees
actions in serving an (intoxicated) patron.[57]
Loxley et al. report[7] that studies show Dram
Shop laws have a modest deterrent effect, and
that the underlying rationale for discouraging
service of intoxicated persons is sound and
there is no likelihood of adverse consequences.
A recent Australian review of the key aspects
Figure 8: Number of liquor licences by year, of law and the implications of recent court
Victoria, 1986 to 2006 decisions has reported that there is now a less
Source: Consumer Affairs Victoria, unpublished data
onerous duty of care imposed on licensees and
Restricting availability by alcohol strength is their staff with regard to the consequences of
known to be an effective intervention, both serving alcohol.[58] (See also the discussion of
internationally and in Australia. In Australia, responsible service of alcohol (RSA) interventions
it has been estimated that full-strength beer in Section 4.6 of this paper).
makes the largest single contribution to all risky
Minimum legal purchase age refers to the age
and high-risk alcohol consumption (39%).[21]
at which alcohol can actually be purchased
The National Drug Research Institute (NDRI)
by a person. This is distinct from the age at
reports that studies that have examined the
which alcohol can be consumed, sometimes
relationship between alcoholic beverage type
referred to as the legal drinking age.
and levels of alcohol-related harm have found
increasing evidence that beer consumption is

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The distinction is important because while all In New South Wales, it is now an offence to
state and territory laws in Australian prohibit supply alcohol to minors in a private home
a minor from purchasing alcohol, they do not without the direct approval of a parent or
necessarily prohibit consumption in certain guardian. This has often been referred to as the
circumstances. Babor et al. emphasise that NSW secondary supply law. While the impact
consistent enforcement of laws regarding of this law on youth drinking is not yet known,
purchase age is critical if reduced alcohol legislation of this kind has been welcomed
consumption and related harm among young by advocates against alcohol-related harm
people is to be achieved.[13] Although the and there is currently considerable lobbying
minimum legal purchase age for alcohol in all of government to support the introduction of
Australian jurisdictions is 18 years, the average similar laws in other Australian jurisdictions.[60]
age at which Australians have their rst full
Another example of restrictions on the physical
serve of alcohol is 17 years, and as detailed
availability of alcohol, which is known to be
earlier in this paper, there is a high prevalence
effective in reducing alcohol-related harm
of underage drinking that has not changed
in some Australian Indigenous communities,
signicantly in the past 20 years. In the US,
is referred to as dry community declarations.
where the minimum legal purchase age for
[36] Some remote Indigenous communities in
some time ranged between 18 and 21 years,
Western Australia, the Northern Territory and
several studies have found that increasing the
South Australia have declared themselves dry,
age limit is an effective means of reducing
using provisions of state/territory legislation.
road crash death and injury among teenagers
The key element of such dry area declarations
and young adults. The NDRI reports[36] that
is a combination of Indigenous community
some studies have also found that the higher
control and statutory authority, along with
legal minimum drinking age is associated with
police enforcement for ensuring that dry
reductions in alcohol consumption among
community declarations reach their potential.
young people. There is, therefore, some
Evidence suggests that although there are
evidence that raising the purchase age to
shortcomings (for example, sly grogging) and
21 can reduce teenage drinking, as well as
associated costs to this approach, overall
harms. Kypris account[59] of recent attempts
there are reductions in consumption and
to increase the minimum purchase age in
alcohol-related harm. It should be noted
New Zealand to 20 demonstrated that popular
that dry community declarations are distinct
debate convinced a majority of the public that
from local dry area alcohol bans, as the latter
raising the age would be an appropriate way
relate to restrictions on drinking in designated
to reduce young peoples harm from drinking.
public places and are usually imposed
Toumbourou et al. here in Australia have
where there are high rates of alcohol-related
recommended that a rst step in this direction
public disorder.[36] While local dry area bans
would be better monitoring of alcohol-related
have been found to decrease public order
developmental harms using longitudinal and
problems in designated areas, overall it is not
other developmental research.[41]
yet fully known if they reduce public order
It must be acknowledged that consumption offences, alcohol-related hospitalisations or
of alcohol by children and adolescents in the police detentions of intoxicated persons. Often
home and in certain social settings is often dry area restrictions simply displace drinkers
sanctioned by parents, often in the belief that to other areas where there are no, or fewer,
it is relatively harmless or might be helpful in restrictions, and dry area declarations are often
educating young people about alcohol.[60] seen as inherently discriminatory because of
The majority of young Australians who report the negative impacts on Indigenous people
drinking at home also report parents as being already at risk of alcohol problems.[36]
the primary suppliers of their alcohol.[61]

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Currently receiving considerable attention 4.3 Taxation and pricing
in some Australian jurisdictions are measures
The price of alcohol clearly impacts on
related to restricting the hours of sale of alcohol,
consumption patterns. There are more than
known as lockouts. These do not restrict trading
50 studies from around the world showing
hours per se, however, because outlets are
that when alcohol increases in price,
permitted to continue trading until their usual
consumption is reduced.[12, 39-42] The World
closing times. However, after a certain time,
Health Organization (WHO) is one of many
such as 2:00am or 3:00am, new patrons and
international and national health organisations
those wishing to re-enter the premises are not
that strongly endorse the use of increased
permitted to do so. Lockouts aim to reduce the
alcohol taxation (higher prices for alcohol
movement of people between clubs after a
products) as an effective preventative strategy
certain time, since it is this movement of people
to reduce alcohol-related harm.[62] At the
between venues that police have reported
same time, it is important to recognise that
as being a major cause of alcohol-related
there is a complex relationship between price
incidents late at night. There are examples
and consumption.[63, 64] Patterns of alcohol
of lockout programs in operation in locations
consumption can vary considerably according
throughout Australia, such as in Ballarat and
to individual factors such as the age, sex and
Bendigo in Victoria, and across Queensland,
income levels of the drinker. Other factors such
where a 3.00am lockout now applies to all
as availability, the cultural setting, the marketing
late-night licensed premises. The Victorian
and image of the product are also important.
government has also trialled a 2.00am lockout
Studies consistently show that lower socio-
throughout four inner-city municipalities of
economic groups and people with limited
Melbourne. The NDRI reports[36] that, as
disposable income (young people, Indigenous
yet, there is limited formal evidence of the
groups and heavy drinkers) are more directly
effectiveness of lockout programs, in part
impacted by the price of alcohol products.
because they often occur as one element
Higher income drinkers tend to drink more
within a range of programs aimed at reducing
expensive alcohol, and while price may lead
late-night alcohol-related problems (for
them to reduce their consumption marginally,
example, CCTV cameras, street lighting, public
they are also able to alter drinking preferences
transport, police presence).
to cheaper alternatives.[65, 66] The nature
While they are not usually focused solely on of the alcohol product is also a key variable.
issues that relate to the physical availability An Australian study identied considerable
of alcohol, community-based prevention variations in price elasticity (the amount that
programs have become increasingly price needs to change before it impacts on
popular in recent years because of emerging consumption) for different alcohol products.
understandings of how environmental and It concluded that spirits are twice as price
social conditions contribute to alcohol sensitive as wine and beer.[67]
problems.[7] A detailed discussion on the
Given the complexity of the relationship
range and scope effects of community based
between alcohol price and consumption,
programs is not provided here, but can be
increasing alcohol taxation does not necessarily
obtained elsewhere (see Loxley et al. 2007:[7]
lead to a linear reduction in the levels of
pp166167).
alcohol-related harm. It is important that the
relationship between the price of individual
alcohol products and consumption amongst
particular groups of drinkers is carefully
modelled against known price elasticity and
existing consumption patterns.

23
While increasing the price through taxation Within some categories there are various
is likely to lead to a reduction in per capita concessions and exceptions. Smaller wineries,
consumption, increasing the price of individual for instance, are largely exempt from their value
products may not necessarily achieve this goal. added tax (the Wine Equalisation Tax) for all
In some cases, product-based changes can cellar door sales.
create opportunities for new products and
Recent estimates show that the Australian
drinking patterns that increase levels of harm.
Government will collect over $6 billion as a
[68] In this context, it is important to recognise
result of the production and consumption of
that the production costs of alcohol products
alcohol during the 2008/09 nancial year.[68, 4]
vary considerably between product types
However, a substantial disparity exists between
(eg spirits are relatively inexpensive to
the amount of tax revenue received by the
manufacture compared to beer and wine
Australian Government from risky drinking
products) which in turn has a bearing on the
compared with the overall amount spent in
cost price to consumers.
attempting to prevent harmful consumption
Australias alcohol tax system can best be of alcohol. For example, it has been estimated
understood as a constantly changing reection that Australian adolescents (aged 1217 years)
of the history of alcohol consumption in Australia, spent approximately $217 million on alcoholic
and the status of various alcohol products. beverages in 2002, netting the Australian
It also reects changing powers of taxation Government approximately $112 million in tax
between state and territory governments and revenue.[69] This means that for every dollar
the Australian Government. As a consequence, spent on alcohol interventions aimed at
different products wine, spirits, beer, ciders, adolescents, the government receives around
fortied wines are all taxed differently. The $7 in alcohol tax revenue.[69]
excise duties arrangements can generally be
The current taxation rates translate into a wide
described as a volumetric tax system, because
variety of taxation per standard drink of alcohol
the amount of excise duty depends on the
(see Fig. 13). For those who argue that alcohol
volume of alcohol contained in the particular
should be taxed according to the amount of
product. Wine equalisation tax can be described
alcohol in each product and container, the
as an ad valorem tax system, because the rate
current system represents a massive distortion
of tax depends on the value of the retail selling
of this principle.
price of the particular product. Customs duties
are a combination of both volumetric and ad
valorem systems. GST is set at a xed rate of 10%
of the product price, on top of all other taxes
(see Table 7).

Table 7: Summary of the types of alcohol taxes


applied by category of alcohol product

BEER SPIRITS & RTDS WINE CIDER

GST Yes Yes Yes Yes

Excise duty Yes Yes No No

WET No No Yes Yes

Customs duty (ad valorem) No Yes (imported) Yes (imported) No

Customs duty (volumetric) Yes (imported) Yes (imported) No No

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$1.00

$0.87 $0.87
$0.90
$0.81

$0.80
Excise or WET payable per standard drink:

$0.70

$0.60
$0.52

$0.50
$0.39
$0.40
$0.32
$0.26 $0.28
$0.30

$0.16 $0.19
$0.17
$0.20

$0.10
$0.04 $0.05

$-

Light beer Cask Wine Port, Sherry Mid strength Packaged Bottled Wine Full strength Packaged Packaged Bottled Wine Brandy Pre-mix ed Whistky ,
on tap beer on tap light beer beer on tap mid strength full strength spirits / Rum,
1 2
beer beer RTDs Vodka,
Liqueurs

Ty pical ABV: 2 12.5 20 3 2 14 5 3 5 14 37 3.0 - 9.0 22 - 43

Figure 13: Tax payable per standard drink* As a consequence, low-alcohol beer increased
of alcohol, various products, Australia, as at its sales very signicantly and captured
1 August 2008* approximately 20% of the total Australian
Note: *Includes a 1.15% ABV excise-free concession for beer. WET payable beer market.[70]
per standard drink of wine is based on a four-litre cask of wine selling
for $13 (incl. GST) [Cask Wine], a 750ml bottle of wine selling for $15
(incl. GST) [Bottled Wine 1], a 750ml bottle of wine selling for $30 The Northern Territorys Living with Alcohol
(incl. GST) [Bottled Wine 2] and a 750ml bottle of port selling for $13
(incl. GST) [Port, Sherry]. A standard drink is equal to 0.001267 litres or
program provides another example of how
10 grams of pure alcohol. changes in price through government taxation
As noted above, Australia has been through increases contributed to a reduction in per
a continuous process of change in relation capita consumption. In 1992, the Northern
to the taxation and pricing of various alcohol Territory government used a hypothecation
products. There are three changes that are approach by placing a levy of 5 cents per
particularly interesting to note. In the late 1980s, standard drink on the sale of alcohol products
states and territories adopted various forms with more than 3% alcohol by volume
of licensing for all alcohol sales. As part of this and used the revenue to fund a range of
system, most jurisdictions offered low-alcohol alcohol-prevention measures in the territory.
beer (less than 3.5% alcohol by volume) for [71] Evaluations of the Living with Alcohol
a signicant concession in fees. The license program found that the increase in price had
fee concession translated into cheaper low- contributed to a major reduction in the level
alcohol beer and, in combination with intense of alcohol-related harm within the Northern
market competition in the beer market and Territory.[72, 73]
the introduction of harm-reduction measures Over the last 15 years, there have been a series
such as random breath testing, created of changes in the level of excise and taxation
an ideal environment for low-alcohol beer. applied to various forms of the ready to drink
Producers recognised the benet of investing (RTD) product segment of the Australian
considerable developmental and marketing alcohol market.
investment into low-alcohol beer.

25
These changes have resulted in major shifts in ensure there were strong nancial incentives
drinking patterns across Australia, particularly in for the production of lower alcohol products
relation to brown spirit pre-mixed drinks (mostly (for example, low-strength beer, wine and
around 5% alcohol by volume in 375ml cans) RTDs), and so that the highest-risk alcohol
and white spirit pre-mixed bottled drinks (mostly products (i.e. spirits, which can more easily
around 5% alcohol by volume in 375ml bottles). cause overdose) are taxed at an appropriately
With each price change, sales of these RTDs higher rate. In combination with a volumetric
have increased or decreased quite signicantly. taxation system, in which all products are taxed
While there is considerable evidence that these according to alcohol content, all products
increases and decreases in sales represent could effectively have a oor price based on
shifts in product preferences (market share) their alcohol content in a 300ml container.
rather than shifts in per capita drinking, the
Modelling this alcohol taxation system would be
patterns of consumption have clearly been
a very challenging exercise, particularly when
directly inuenced by taxation and pricing.
health advocates have very limited access to
There is substantive evidence that the higher
actual sales data. As noted above, competing
the price, the lower the consumption of these
in the alcohol market requires extensive market
products, and the lower the price, the higher
testing and monitoring. This generates a level
the consumption of these products. Perhaps
of detailed information that is not available
just as importantly, the shifts in consumption
to health researchers and policy makers.
patterns are more marked amongst the young
Perhaps just as importantly, this model would
and lower social-economic groups.[2, 68, 74]
have a negative impact on some segments
The principle of alcohol taxation reform most particularly cask wine and cider while
often discussed by public health advocates advantaging other market segments spirits
is usually that of applying excise taxes to all and spirit-based RTD products. It would be very
categories of alcoholic beverages. That is, difcult to gain broad political support for such
taxing the beverages on their alcohol content, a model, given the level of public and political
as a mild discouragement of consumption. opposition from powerful alcohol producers.
Along with taxation reform of this kind, there There has been some modelling undertaken
have been calls to raise the price of the that considered a range of alcohol taxation
cheapest forms of alcohol. This is referred to scenarios that would move the alcohol excise
as the oor price of alcohol. Given that price and taxation system closer to a true volumetric
is being used as the lever, it is the oor price base, while remaining revenue neutral within
that should be given more attention in order to each market segment. These models are publicly
achieve a real shift in per capita consumption, available, but have attracted limited support
rather than just product preference. Within this as they increase the price of cask wine and
context, it is important to acknowledge that ciders while more expensive wines are reduced
the impact of any increase in the oor price in price.[36] Until public health researchers and
for alcohol will impact more on young people, advocates have access to accurate sales data,
Indigenous communities, heavy drinkers and and economic modelling can be implemented
lower socio-economic groups. on the combination of oor price and a more
volumetric approach to alcohol taxation, it
It appears that the most likely model that
is difcult to strongly put forward a particular
can effectively reduce alcohol-related harm
model. At the same time, there is a substantive
would be based on an across-the-board
history in Australia that illustrates the danger of
excise model that also includes regulating the
changing taxation levels of particular products
oor (minimum) price, especially with regard
without considering the implications both on
to small containers. The excise tax could
consumption patterns and the development
be scaled within different product types to
and marketing of alternative alcohol products.

26
4.4 Drink-driving countermeasures the impressive cost effectiveness of random
breath testing. RBT is considered a superior
Drink-driving laws and the associated programs
method of enforcing drink-driving laws than
of enforcement and social marketing are
sobriety checkpoints, which only check drivers
considered to be one of the great public
who are judged to have been drinking.[13] In
health success stories of the late 20th century. In
Australia, creating the public perception that
Australia, state and territory laws allow a Blood
there is a high chance of being caught drink
Alcohol Content (BAC) of up to 0.05% while
driving through RBT has been achieved by a
driving for full licence holders, 0.00% for learner
combination of high-visibility policing (road
drivers and 0.00 per to 0.02% for provisional
blocks, booze buses) and frequent social
drivers, depending on the state or territory. Those
marketing campaigns that emphasise the
who operate commercial aircraft, public or
likelihood of drink drivers being detected.[7]
heavy vehicles, commercial vessels, machinery
and mobile plant or farm equipment must Among the range of punishments for drink
observe the BAC restrictions required by their driving, the penalty that appears to have
employer, as well as those required by law. For had the most consistent impact is licence
most adults, drinking no more than two standard suspension.[13] Increasing the severity of nes
drinks on an occasion will maintain their BAC and imposing penalties such as imprisonment
below 0.05%. The evidence for the deterrent for drink driving have not been shown to result in
effect of such laws is strong, although the effects reduced rates of drink driving or car accidents.
can erode over time and hence some countries [13] However, it is estimated that up to 70% of
have continued to lower BAC limits.[13] From the people who lose their licence continue to drive
1970s, Australian states world leaders in driving while unlicensed, as the risk of apprehension
down rates of drink-driving through random is relatively low.[43] The major concerns with
breath tests and other means. disqualied drivers continuing to drive are
that it undermines the effectiveness of licence
There is some evidence, albeit tentative, that
suspension and is also linked to a range of
having lower BAC limits for young drivers
other high-risk behaviour such as repeated
reduces the risk of road fatalities, especially if
drink driving and speeding.[43] Court diversion
the BAC limit is 0.00%.[7] More broadly, there is
of drink drivers to educative and mandatory
good evidence that lower BAC limits, delayed
treatment interventions and the incapacitation
access to full licence and curfews for young
of vehicles using ignition interlock devices are
drivers can be effective in reducing drink driving
regarded as effective means of increasing
among young people; graduated licensing
compliance with licence suspension and
schemes can potentially incorporate all of these
reducing recidivism.[7, 13]
measures within a single system.[13]
While there is no evidence that on-premise
Random breath testing (RBT) has been shown
designated driver programs produce negative
to be effective in several countries, including
effects, the impact of such programs is very
Australia, in reducing road crashes, injuries and
modest and even with concerted promotions
fatalities.[7] The dening feature of RBT is that
they only produce a small positive effect.[13]
any motorist at any time may be required to
An Australian review of these schemes was
take a breast test, and there is nothing they
somewhat more supportive, pointing to research
can do to inuence their chances of being
ndings that the programs do have some
tested.[13] Research suggests that there is a
positive inuence on the behaviour of young
strong tendency for motorists to comply with
people in selecting a sober driver, and that
drink-driving laws in jurisdictions that use RBT
given the cost of such programs is usually borne
programs because of the uncertainty about
by licensed premises, there is no opportunity
the real risk of detection.[13] Herein lies part of
cost in recommending such schemes.[7]

27
4.5 Treatment and early intervention These included the Coordinator of Alcohol and
Drug Education in Medical Schools (CADEMS)
This paper considers treatment and early
that supported curriculum development for
intervention as essential components of
undergraduate medical students, a range
a preventative approach to the harmful
of General Practice trials (especially in New
consumption of alcohol. While treatment and
South Wales, sometimes in association with
prevention are traditionally viewed as separate
other specic interventions including tobacco
and sometimes unrelated activities, it is critical
and even efforts to develop a combined risk-
that they be embraced as part of a holistic
screening instrument for a number of conditions)
approach to tackling alcohol problems from
and studies of the use of screening instruments
a public health perspective. While treatments
(especially AUDIT) in hospital settings. Follow-up
are primarily designed to serve the needs of
has been patchy, and even where the uptake
individuals, there are a number of ways that
and utility under experimental conditions was
treatment can also have a positive impact
promising, the longer term effort and cost
at a whole-of-population level:
required to achieve widespread involvement has
Q By raising public awareness not been sustained. With a sense of dj vu, the
of alcohol problems authors note a recent study of the effectiveness
of brief interventions in hospital emergency
Q Inuencing national and
departments, which suggests that these can
community agendas
potentially reduce subsequent alcohol-related
Q Involving health professionals in injuries signicantly.[75] For assessments and
advocacy for prevention brief interventions to become part of routine
Q Providing secondary benets for families, practice of doctors, nurses and other health
employers and road users.[13] professionals, an approach at the health
system level accompanied by funding
Brief interventions in primary health settings. For and promotion is needed. It is unrealistic
early-stage alcohol problems, brief interventions to expect overstretched health service
are consistently identied as a key ingredient in providers to implement brief interventions
a comprehensive alcohol-prevention strategy without reimbursement or other recognition.
because they are regarded as relatively
inexpensive, they take very little time and While this paper especially addresses primary
they can be implemented by a wide range prevention, it is worth noting that there remains
of health and welfare professionals.[7] Their a serious lack of accessible and available
benet as preventative measures arises from evidence-based treatment services for later
the relative effectiveness in treating early-stage stage alcohol dependence and other alcohol-
problem drinking, obviating the need for later related disorders across Australia (in private and
more intense and costly treatment.[43] Brief public as well as in city and remote locations).
interventions are designed to motivate high-risk With a still evolving specialist clinical workforce,
drinkers to moderate their alcohol consumption, there remains a relative vacuum for training
and typically involve one to three sessions before and professional development at senior clinical
or soon after the onset of problem drinking.[13] levels, and it is this group that ultimately set the
standard and nature of practice in any eld.
In Australia, brief interventions, as yet, are a A comment from a senior clinician on the more
relatively untapped opportunity, due in part recent development of Medicare support for
to the need for greater recognition of the role private practice GPs and clinical psychologists
that the primary health workforce can play. is pertinent: it means that I get all these patients
[43] Efforts during the 1980s and early 1990s to treated under the mental health items with
introduce more systematic screening, early fundamental alcohol-related problems
identication and potentially brief or extended where alcohol was not properly managed.
responses were variously tried.

28
Workplace interventions. Australian workplaces options include motivational interviewing, brief
are another setting with great potential for brief interventions, social skills training, community
interventions with at risk drinkers. There are two reinforcement approach, relapse prevention
main rationales for workplace interventions and some aversion therapies.[7] There is
with regard to the harmful consumption evidence that mutual help programs such as
of alcohol: to improve productivity; and to 12-Step Facilitation Therapy, which encourages
improve workplace safety.[7] In the Australian attendance at Alcoholics Anonymous (AA)
context, approaches to workplace alcohol meetings, are particularly effective for severely
issues are inuenced by occupational health dependent drinkers with low levels of social
and safety laws and polices, and devising support.[7] Although popular and widely
prevention strategies must be considered in used, there are also treatments that have little
this context. Historically, alcohol problems in evidence of efcacy, including insight-orientated
the workplace have been dealt with through psychotherapy, confrontation counselling,
employee assistance programs (EAPs) and relaxation training, general alcoholism
employers policies on alcohol and drug use; counselling, education and milieu therapy.[7]
however, there has been insufcient research Pharmacotherapies for alcohol dependence
to determine the effectiveness of EAPs in include disulram, naltrexone and acamprosate.
responding to and/or preventing alcohol Reviews have found that naltrexone and
issues in the workplace.[7] Nonetheless, EAPs acamprosate are the safest and most effective
do provide the potential opportunity for of the three pharmacotherapies in the long
interventions that are known to be effective, and intermediate terms, respectively.[7]
such as brief interventions for high-risk drinkers.
Thiamine supplementation. A unique
A recent study of alcohol consumption
preventative measure to address the risk of
by Australian workers and the impact on
serious brain damage from thiamine deciency
absenteeism has pointed to the need for
(known as Wernicke-Korsakoffs syndrome)
workplace education to inuence young
that can result from heavy consumption of
employees attitudes and behaviours regarding
alcohol over many years, along with poor
alcohol use.[76] The study also suggests that
nutrition, is thiamine supplementation. Since
there is a need to take a whole-of-workplace
1991, all baking our in Australia has been
approach when designing and implementing
supplemented with thiamine as a universal
prevention strategies that target both problem
method to increase thiamine levels in the diet
drinkers and workers who drink at short-term
of at risk populations.[7] This is included here
risk levels, even infrequently, because the
as an example of a preventative measure
latter have an elevated risk of alcohol-related
that requires ongoing consideration, as there
workplace absenteeism.[76] Others have
has since been advocacy for the removal of
pointed to the need for addressing structural
supplements (including thiamine) by the pure
factors in the workplace as a more sustainable
food advocates and there is concern that the
prevention measure, such as reducing stressful
reach of thiamine in bakers our might not be
working conditions that may lead to health-
the most cost-effective population measure in
damaging behaviour such as the harmful
preventing this condition.[78]
consumption of alcohol.[77]
Since the 1980s, sobering-up centres have
Alcohol problem treatment. Internationally, and
been established in many parts of Australia,
particularly in Australia, the evidence base with
particularly Indigenous communities, as
regard to the treatment of alcohol problems is
humane forms of care for publicly intoxicated
very well developed and is now at the stage
individuals, and as an alternative to individuals
of determining what is best practice rather
being arrested and held in police cells and
than attempting to determine if treatment
watch houses.[34]
can work.[7] Effective alcohol treatment

29
However, there have been very few evaluations It is clear that effective law enforcement is
of sobering-up centres, despite their popularity the key ingredient to ensure the efcacy of
in Australia.[79] In many ways, sobering-up strategies that aim to alter drinking contexts as
centres function primarily as a broad harm- a way of preventing the harmful consumption
reduction measure, rather than as a treatment of alcohol. While all Australian jurisdictions do
program. As Brady et al. describes them,[80] have bans on serving intoxicated persons and
sobering-up centres are not a detoxication underage persons, it is the extent to which these
centre, nor are they aimed at long-term laws are adequately enforced that determines
rehabilitation; rather, their role is to keep people their effectiveness. Similarly, although very
out of police custody to reduce alcohol- popular, the effectiveness of responsible
related harm and to offer practical care in a service of alcohol (RSA) programs (also referred
safe environment for a limited time, including to as responsible beverage service, RBS) is
protection, shelter and food. Nevertheless, they also contingent on proper enforcement.[36]
could provide an opportunity for interventions Without concerted efforts by police and/or
that can be effective. liquor licensing authorities to enforce existing
liquor laws, the imposition of RSA policies and/
Sometimes related to these are night patrols,
or training, while potentially raising awareness
which are a particularly common alcohol
of relevant issues, has limited impact on the
harm-reduction strategy in many Indigenous
behaviour of servers or intoxication levels of
communities.[7] Night patrols provide transport
patrons.[36] When highly publicised, the threat
to safe locations for intoxicated persons,
of substantial nancial penalty has been
particularly in remote areas.[7] Evaluations of
shown to be particularly effective at motivating
the effectiveness of night patrols, on their own,
behaviour change among licensees, which
as an intervention is somewhat equivocal,
has in turn resulted in reduced levels of alcohol-
although they have been rated as being
related harms, but it is not clear whether
effective in communities in reducing alcohol-
such nancial penalties remain effective in
related violence and getting intoxicated
the long term without frequent and highly
people off the streets.[7]
visible examples of enforcement.[36] There
is evidence of RSA programs being effective
4.6 Altering the drinking context when they include a mandatory component
Because drinking takes place in a social, combined with effective enforcement.[13]
cultural and community context, it follows While mandatory server training has led to an
that the harmful consumption of alcohol or increase in the number of servers undertaking
the harmful consequences of this may be training, program quality and content differ
prevented or ameliorated though strategies signicantly between jurisdictions, and the high
that modify this context.[13] Such harm- mobility of the workforce makes it difcult to
reduction measures are important elements of sustain and monitor.
an overall alcohol policy, as they are generally Mosher et al. assessed training programs
more socially and politically palatable. offered by states and territories that have either
However, harm-reduction measures should mandatory or incentive-based laws, and found
not be considered as an equal substitute for that the quality of programs is generally low,
the measures known to be most effective, as with only two jurisdictions meeting minimum
measures that aim to alter the drinking context standards.[81] A further criticism of RSA training
are comparatively under-evaluated and programs has been that they focus solely on
generally possess less potential for reducing training servers, and do not include a more
alcohol-related harm.[13] comprehensive community plan to address
wider environmental issues, a factor that limits
their potential.[82] To date, only a limited

30
number of RSA training programs have been There are many possible components of
evaluated in Australia.[36] In addition to training accords, such as RSA, drink discounting bans,
bar staff in the responsible service of alcohol, trained security personnel, provisions of food,
there have also been programs designed to use of safe glassware and alcohol containers,
train staff in managing aggressive behaviour, and environmental modications to reduce
given the reality that some patrons may have conict and thereby reduce the risk of violence.
become already intoxicated elsewhere and [7] Few accords have been formally evaluated,
that some aggressive behaviour may not be and among those that have, most have
necessarily alcohol-related at all.[13] There have been unable to demonstrate effectiveness
been very few evaluations of such programs, in either the short- or (particularly) long-term
although there is evidence that they can reduction of alcohol-related harms.[36] The
improve staff and patron interactions generally, appeal of accords probably rests more on the
but the long-term sustainability of these development of local communication networks,
improvements relies on maintaining training the facilitation of local input, a sense of local
and standards of practice.[13] control and improving public relations through
open negotiations than in the actual reduction
Proactive policing or intelligence-led policing
of harm. Even so, improved communication
has been successful in some parts of the
and participation may also be perceived as
world and has been partially adopted in
desirable and worthwhile outcomes in some
some Australian jurisdictions.[13] It involves
circumstances. Loxley et al. acknowledge
monitoring alcohol-related incidents in and
that there is no doubt that accords can be
around licensed premises, combined with
an effective vehicle for introducing some
regular police visits to the licensed premises
harm-reducing practices into licensed
that are most often linked to alcohol problems.
drinking venues; however, it is recommended
For example, the New South Wales police
that voluntary regulation such as this is
have adopted a system of enforcing liquor
accompanied by effective law enforcement.[7]
laws through the collection of data such as
feedback to police about alcohol-related The promotion of alcohol-free events, while
crimes that have followed drinking at a popular in many countries, including Australia,
specic licensed premises.[83] Known as the has not been found on its own to be effective
Alcohol Linking Program, the intelligence-led in reducing alcohol problems.[36] Alcohol
enforcement system has been shown to reduce restrictions for large sporting and leisure events
alcohol-related crime, and similar approaches have usually been implemented as part of
are now being trialled and implemented in a range of initiatives, making it difcult to
other jurisdictions. determine their specic impact.[36] Based on
evidence that some injuries from alcohol-related
Voluntary codes of bar practice typically take
violence were linked to the use of drinking
the form of liquor accords in Australia. The
glasses and bottles as weapons, a number of
emergence of liquor accords as a means of
licensed premises around the world now serve
reducing alcohol-related problems in late-night
alcohol only in toughened glass or plastic
entertainment centres began in Victoria in the
containers.[13] However, the soundness of this
early 1990s, and since then there has been a
approach has been called into question by a
rapid proliferation throughout several states.[36]
study that found that injuries to bar staff actually
Accords are local, community-based
increased when toughened glass was used.[13]
initiatives to involve licensees, other businesses,
local government authorities, community Providing food service on premises that serve
representatives and police, but which are alcohol, as a way of encouraging eating
implemented and largely coordinated by while drinking and hence reducing the effects
the latter to reduce alcohol-related harm of alcohol, is a popular element in liquor
in the late-night drinking environment.[36] accords.[7]

31
However, the specic contribution of making 4.7 Regulating promotion
food available on licensed premises as a
Alcohol marketing and promotion is a
way of preventing intoxication has not been
global activity, with the largest corporations
determined, and in the case of certain foods
promoting their products across the world.[13]
(for example, salty snacks) there may actually
Marketing strategies include an integrated
be a risk of the opposite effect on alcohol
mix of advertising on television, radio, print
consumption.[7]
media, point of sale promotions, product
Community mobilisation has been used to design (including the packaging and naming
raise awareness of problems associated with of alcohol beverages) and the internet.
on-premises drinking, develop specic solutions Sponsorship of sports and cultural events is also
to problems and pressure licensees to take a common marketing strategy used by alcohol
responsibility for some of the impacts on the companies, particularly in Australia. The key
local community, such as noise, litter and anti- questions from a public perspective are:
social behaviour.[13] There is no set formula by
Q what is the impact of marketing and
which community action projects operate, as
promotion on overall consumption
each project has differing aims and objectives,
and particularly the misuse of alcohol
often in response to localised problems.[36]
in the community?
Studies overseas support the view that when
community mobilisations are implemented as Q what are the most effective measures for
comprehensive, evidence-based strategies preventing the adverse impacts of alcohol
and are well funded, they can inuence server marketing and promotion?
behaviour, drinking behaviour and levels of
Total alcohol advertising expenditure in
alcohol-related harms associated with licensed
Australia in 2007 was reported to be $128 million
premises.[36] Although some relatively small
(see Table 8). However, this gure is highly
community mobilisation projects are currently
conservative, given that it generally relates
under way in Australia, results from evaluative
to the advertising of products rather than of
studies are yet to be published.[36] In general,
alcohol outlets, for which alcohol advertising
community mobilisation approaches have at
expenditure is now very signicant. Nor
least a temporary effect on licensed premises in
does it include sponsorship, below the line
terms of serving practices and patron behaviour
advertising or internet advertising, the latter
but in the longer term they often tend not to be
being a signicant growth area in recent years.
implemented in a systematic way, and prove to
In Australia, the main sectors in which alcohol
be expensive and difcult to sustain.[13]
adverting expenditure occurs, and through
which the greatest exposure is achieved, are
through commercial television advertising (38%)
and outdoor advertising (32%). Globalised
alcohol manufacturers (for example, Diageo;
Pernod Ricard Pacic) are among the biggest
spending advertisers in Australia. The amount
spent on advertising by spirits and wine
producers combined, now equals that of the
traditionally dominant beer market in Australia,
reecting an increasingly competitive alcohol
beverage market.

32
Table 8: Alcohol advertising in Australia by sector, advertiser and beverage category, 2007

PERCENTAGE $ ANNUAL BEVERAGE PERCENTAGE


SECTOR SHARE RANK ADVERTISER MILLIONS CHANGE CATEGORY SHARE
Metro TV 33% 1 Diageo 19.1 29% Beer 47%
Regional TV 5% 2 Carlton & United 14.4 -24% Spirits 26%
Beverages
Metro press 5% 3 Tooheys Brewery 14.0 10% Wine 21%
Regional 1% 4 Boag J & Son 9.9 13% Premix / 6%
press cider
Magazines 14% 5 Pernod Ricard 6.9 60%
Pacic
Radio 5% 6 Beringer Blass Wine 5.3 93%
Estates
Cinema 5% 7 Southcorp Wines 4.8 191%
Outdoor 32% 8 Suntory 4.8 421%
Direct mail 1% 9 Carlton Special 4.7 238%
Beverages
10 Heineken 3.9 36%
Others not in top 10 39.9 -5%

Source: Nielsen Media Research AdEx 2008


The Australian Association of National
Advertisers Code of Ethics covers general
The impact of advertising on individuals can be
advertising issues. Other applicable laws and
seen as having both immediate effects, such
codes include:
as inuencing decision making with regard to
brand preference, as well as longer term effects Q The Trade Practices Act
such as reinforcing pro-drinking messages.[13] In Q State and territory fair trading legislation
this way, it is both the content and frequency of
exposure to advertising that can have an impact Q The Commercial Television Industry
on individuals attitudes and behaviours. The Code of Practice
impact of alcohol advertising on young people Q The Commercial Radio Code of Practice
is an area where there has been considerable
Q The Outdoor Advertising Code of Ethics.
research, but of somewhat poor quality, yielding
conicting results that range from positive The Commercial Television Industry Code of
associations between young people who Practice states that advertisements can only
have been exposed to and/or enjoy alcohol be shown during M, MA or AV classication
advertising and an increased risk of harmful periods. However, on weekends and public
consumption of alcohol, to negative associations holidays, alcohol advertisements can be shown
or inconclusive results.[7] Numerous studies as an accompaniment to the live broadcast
have found a link between alcohol advertising of a sporting event. Alcohol advertising is
and alcohol-related knowledge, beliefs and covered in detail by the Alcohol Beverages
intentions of young people.[84] Advertising Code (ABAC) Scheme. The main
aims of the scheme are to ensure that alcohol
Unlike tobacco advertising, which was banned
advertising presents a responsible approach
in Australia in 1995, there are no alcohol
to drinking, and does not have appeal to
advertising bans in Australia, although some
children or adolescents. Among other rules in
restrictions, including advertising content
the code, the administration of the following
controls, do apply (see further below). In
is often questioned by community members:
Australia, alcohol advertising is subject to a
Advertisements for alcohol beverages must not
number of different laws and codes of practice.
depict the consumption or presence of alcohol

33
beverages as a cause of or contributing to said or shown. It is estimated that only 3% of the
the achievement of personal, business, social, total adult population are aware of the existing
sporting, sexual or other success (ABAC 2008, ABAC scheme and know what it relates to.[87]
Clause C (i)).[85] Among the 30% of people who reported being
concerned about any alcohol advertising,
The ABAC Scheme is funded and administered
only 2% had made a formal complaint. Some
entirely by the alcohol industry. Commonwealth
of the reasons why those who were concerned
and state and territory governments are involved
did not make a complaint included the belief
through one government representative on the
that it would not achieve anything (30%), not
ABAC Management Committee.
having time (25%) and not knowing who/how/
Despite the ABAC Schemes rules, which where to complain (15%). ABAC currently has
discourage advertising that has strong or no powers to sanction advertisers who breach
evident appeal to children or adolescents, the code rules; however, a Senate Committee
research shows that a substantial amount of inquiry currently under way is considering
alcohol advertising is communicated to young proposed federal legislation that would
people. For example, several advertisements for introduce sanctions on advertisers who breach
alcoholic beverages screened on television in the code, which would be determined by an
metropolitan Melbourne were found to be more independent adjudicating panel.[88]
likely to reach 13- to 17-year-olds than adults
In 2003, the Ministerial Council on Drug Strategy
(see Table 9).
considered a report on the effectiveness of
Table 9: Advertising on metro Melbourne the ABAC Scheme that identied the following
television, year to March 2005 issues of concern:

RELATIVE Q The current system does not address public


EXPOSURE health concerns about alcohol advertising
(OF 1317 and use. In particular, most complaints
TOTAL -YEARS-OLDS
ANNUAL FREQUENCY VS 1829
about alcohol advertising are dealt with
PRODUCT SPEND OF ADS -YEAR-OLDS) under the general advertising complaints
Heineken $ 94,000 110 1.12 resolution system rather than the alcohol-
Lager specic system.
Cougar $ 45,000 103 1.04
Bourbon Q The high dismissal rate for complaints about
Archers $ 57,000 110 1.04 alcohol advertisements heard by the ASB
Spri
Schnapps does not engender community condence
Bundaberg $ 36,000 88 1.06 in the complaint system and may
Rum Dry &
Lime Mix discourage people from making complaints
Orlando $ 89,000 34 1.11 about alcohol advertisements.
Jacobs
Creek
Sparkling Q The general public is largely unaware of
Rose
the complaint resolution system and, in
Source: King, Taylor and Carroll (2005)[86]
particular, how to make complaints.

As a self-regulatory scheme, ABACs Q The system lacks transparency. In particular,


effectiveness largely depends on the there is insufcient reporting of the
independence of its complaints body with outcomes of complaints.
the powers to sanction.[43] Recent research
Q The current system does not apply to all
has revealed that less than three in 10 (28%)
forms of advertising; for example, packaging,
people surveyed reported an awareness
electronic advertising, sponsorships, point of
of restrictions or regulations covering the
sale advertising and promotions.
advertising of alcohol, in terms of what can be

34
Q The effectiveness of the current system be strongly supported from a public health
is compromised by the amount of time perspective, but it is important that its message
taken to resolve complaints (MCDS 2003, not be compromised. Although rare, there are
unpublished). examples of well-planned and implemented
counter-advertising programs that have had
While some of these concerns have been
some success, particularly in building support for
addressed, pressure remains to move to a more
public health-oriented alcohol controls,[13] and
tightly regulated advertising environment with
there is very strong evidence from other public
strict government controls. The WHO recently
health areas such as tobacco about the value
recommended that governments be supported:
of such approaches.
Q to effectively regulate the marketing of
alcoholic beverages, including effective
4.8 Education and persuasion
regulation or banning of advertising and of
sponsorship of cultural and sports events, International reviews of education and
in particular those that have an impact on persuasion strategies suggest that even with
younger people adequate resources, such approaches have
limited potential for success on their own.[13]
Q to designate statutory agencies to be
Part of the reason for this is the counter effect
responsible for monitoring and enforcement
of powerful forces that underpin unsafe and
of marketing regulations
unhealthy drinking cultures, such as the price,
Q to work together to explore establishing a availability and promotion of alcohol products.
mechanism to regulate the marketing of Recent Australian research for the development
alcoholic beverages, including effective of a national alcohol social marketing initiative
regulation or banning of advertising and reports that the challenge for communication
sponsorship, at the global level. is that intoxication is closely linked to alcohol
per se. When we simply asked participants
One of the most formidable obstacles to
about their earliest memories in relation to
effective education and persuasion strategies
alcohol there was an overwhelming tendency
regarding alcohol (which are discussed in the
to leap to their rst drunk experience. Further,
next section below) is product advertising by the
these experiences were recalled with a sense
alcohol industry that intentionally promotes pro-
of pride and nostalgia, even though the stories
drinking messages to the general population,
inevitably involved some embarrassment.[89]
much of which also reaches young people. In
A key element to the success of social
response, the governments of some countries
marketing in the public health area is effective
have sponsored counter-advertising programs.
integration with and reinforcement by other
[13] These might include public services
complementary strategies.[7] For instance,
announcements, or warning messages within
the success of social marketing in promoting
actual product advertisements. However,
quitting smoking and road safety, including
studies suggest that counter-advertising usually
anti-drink-driving campaigns, is indicative that
has only limited effectiveness, often because
education and persuasion strategies can be
it is communicated at low frequencies and in
effective when coupled with other measures
poorer quality productions compared to alcohol
such as support services, changes to the
beverage advertising.[13] In contrast, counter
environment, regulation and enforcement.
advertising in the tobacco eld is of proven
effectiveness, primarily because in that context Throughout the world, alcohol education in
hard-hitting messages were possible (essentially schools is an enormously popular approach to
that the tobacco industry was not in business addressing the issue of harmful consumption of
for the consumers good). Counter advertising alcohol among young people. The traditional
may be a more politically realistic option than alcohol education programs that are based
banning advertising altogether, and should

35
on an informational approach, while still very However, guidelines do potentially full an
common, have not been shown to prevent or important function as supporting information
reduce the harmful consumption of alcohol by for other measures known to be effective,
young people, and in some cases have actually such as brief interventions in primary care, and
been counterproductive by stimulating an as the basis for health promotion messages
interest in drinking among young people.[13] and social marketing campaigns. In Australia,
In recent years, there has been a shift towards the current alcohol guidelines.[91] are under
normative education, which aims to correct review. New draft guidelines prepared for
young peoples perceptions about their peers public consultation are due to be nalised and
drinking and thus de-normalise the harmful released in late 2008. The new draft guidelines
consumption of alcohol.[13] While this makes have been informed by updated modelling
intuitive sense, it has been found that such on the health risks of drinking, which have
school-based educational interventions, in produced new estimates of the lifetime risks
general, produce only modest results that are of alcohol-related harm. Emerging evidence
short-lived unless accompanied by ongoing also indicates that previous studies claiming
booster sessions. Importantly, given there are the signicant health benets of alcohol
considerable risks involved in school-based consumption have tended to overestimate the
education, it has been recommended that effects. The consultation draft indicates the
investment in such programs be accompanied main changes are expected to include a new
by a proportionate investment in evaluation.[7] simplied, universal guideline level for alcohol
There are some examples of sound outcomes intake for both short-term and long-term risks,
but these are relatively unusual. These generally a new guideline with special precautions for
involve whole-of-community efforts and they children and adolescents, and a new guideline
are usually associated with a close evaluation for pregnant or breastfeeding women.[18]
that ensures they are implemented (with
Warning labels on alcohol products, while not
modications through feedback) as planned. In
required in Australia, have a high level of public
Australia, these include the School Health and
support. Evaluations of alcohol warning labels
Harm Reduction Project (SHAHRP) in Western
are generally limited to the US experience,
Australia[43] and the Gatehouse Project in
where labels were implemented in 1989. While
Victoria, whose primary target was reduced
there is some evidence of effects on knowledge
school bullying but where the side benet was
and attitudes, there is no evidence that warning
a comparative reduction in the use of tobacco
labels inuence drinking behaviour.[92] By
and alcohol.[90] Related to alcohol education
contrast, the tobacco labelling experience
programs for school students are parent
offers strong evidence that warning labels can
education programs. While some reviews cite
be effective, not only in increasing information
promising signs of effectiveness, in general there
and changing attitudes but also in changing
remains a lack of research to fully determine the
behaviour. These successes of tobacco warning
value of such programs.[7]
labels suggest that alcohol warning labels
Low-risk drinking guidelines have been should be graphic and attention-getting,
adopted in many countries, including Australia, should occupy a considerable portion of the
to provide advice on the health risks and package surface, and should involve rotating
benets of drinking at various levels for the and changing messages.[92] Perhaps most
general adult population, and for particular importantly, they should complement and be
sub-groups. Despite their popularity, there complemented by a wider range of strategies
is very little research that demonstrates the aimed at changing drinking behaviour.
effectiveness of guidelines.[13]

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