tag:theconversation.com,2011:/africa/topics/alcohol-consumption-19474/articlesAlcohol consumption – The Conversation2024-03-18T18:24:24Ztag:theconversation.com,2011:article/2222672024-03-18T18:24:24Z2024-03-18T18:24:24ZCheers to health? Uncovering myths around the health benefits of moderate drinking<figure><img src="https://images.theconversation.com/files/582572/original/file-20240318-22-wdfo1c.jpg?ixlib=rb-1.1.0&rect=15%2C31%2C3270%2C2206&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many studies exaggerated the benefits of moderate drinking due to methodological flaws known as selection biases.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The notion that enjoying a casual beer or sipping on your favourite wine could not only be harmless but actually beneficial to one’s health is a tantalizing proposition for many. This belief, often backed by claims of research findings, has seeped into social conversations and <a href="https://www.cbc.ca/news/science/moderate-drinking-may-be-heart-healthy-says-new-research-1.293437">media headlines</a>, painting moderate alcohol consumption in a positive light. </p>
<p>As researchers at the Canadian Institute for Substance Use Research, we find ourselves frequently revisiting this topic, delving deep into the evidence to separate fact from wishful thinking. Can we confidently say, “Cheers to health?”</p>
<h2>Unpacking beliefs about moderate drinking</h2>
<p>The <a href="https://doi.org/10.1046/j.1360-0443.2001.96464113.x">commonplace belief</a> that moderate drinking can be beneficial to health can be traced back to the 1980s when researchers found an association suggesting that French people were less likely to suffer from heart disease, despite eating a diet high in saturated fat. </p>
<p>This contradiction was thought to be explained by the assumption that the <a href="https://doi.org/10.5344/ajev.2011.11013">antioxidants and alcohol found in wine</a> might offer health benefits, leading to the term “<a href="https://doi.org/10.1016/S0140-6736(94)92883-5">French paradox</a>.”</p>
<p>This concept reached a broader audience in the 1990s, following a segment on the American news show <em>60 Minutes</em> which had a <a href="https://doi.org/10.1108/07363769410058894">profound impact on wine sales</a>. Later <a href="https://doi.org/10.1111/j.1360-0443.2012.03780.x">research expanded on this idea</a>, suggesting that frequently drinking small amounts of any type of alcoholic beverage might be good for health.</p>
<p>This idea was formalized into what is now known as the <a href="https://doi.org/10.1016/j.jacc.2017.07.710">J-shaped curve hypothesis</a>. Put simply, the J-shaped curve is a graphical representation of the apparent relationship between alcohol consumption and death or disease. According to this model, abstainers and heavy drinkers are at higher risk of certain conditions, <a href="https://doi.org/10.1111/j.1360-0443.2012.03780.x">such as heart disease</a>, compared to moderate drinkers, whose risk is lower.</p>
<figure class="align-center ">
<img alt="An illustration of the J-shaped Curve." src="https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The J-shape curve is a graphical representation of the apparent relationship between alcohol consumption and death or disease. According to this model, abstainers and heavy drinkers are at higher risk compared to moderate drinkers, whose risk is lower.</span>
</figcaption>
</figure>
<h2>Current perspectives on moderate drinking</h2>
<p>People used to think that tobacco use was good for health, <a href="https://doi.org/10.1017/S0025727300012333">historically describing it as a remedy for all disease</a>. As scientific understanding has advanced, however, tobacco use has been increasingly recognized as a <a href="https://iris.who.int/bitstream/handle/10665/372043/9789240077164-eng.pdf?sequence=1">leading cause of preventable disease and death</a>.</p>
<p>Like tobacco, alcohol was once used in medicine and has since become recognized as a <a href="https://doi.org/10.1016/S0140-6736(22)02123-7">major cause of preventable mortality and illness</a>. For instance, recent global estimates suggest <a href="https://doi.org/10.1016/S2468-2667(19)30231-2">alcohol is responsible for 5.3 per cent of all deaths</a>. </p>
<p>Furthermore, in Canada, the revenue generated from selling alcohol does not come close to covering the damage it causes, leaving the government <a href="https://www.uvic.ca/research/centres/cisur/assets/docs/cape/cape3/fed-results-en.pdf">$6.20 billion short every year</a>. However, much of these costs can be attributed to heavy drinking. </p>
<p>So where does this leave moderate drinkers? We recently set out to answer this question by analyzing data from over 4.8 million people from more than 100 studies, covering more than 40 years. </p>
<p>We found that many studies exaggerate the benefits of moderate drinking due to methodological flaws known as <a href="https://doi.org/10.1111/add.13451">selection biases</a>. No matter if we <a href="https://doi.org/10.1001/jamanetworkopen.2023.6185">analyzed the studies as one big group</a>, using statistical methods to try and lessen these mistakes, or if we <a href="https://doi.org/10.15288/jsad.23-00283">separated the good studies from the not-so-good ones</a>, one thing was clear: moderate alcohol consumption does not appear to offer the health benefits once believed.</p>
<h2>Explaining the contradiction</h2>
<p>Selection biases represent data distortions caused by how research participants are selected. Such biases lead to unfair comparisons between groups, which skews analyses towards finding a J-shape curve. Essentially, it is like comparing two runners in a race, where one wears heavy boots and the other wears lightweight running shoes. Concluding that the second runner is more talented misses the point; it is not a fair comparison.</p>
<p>Here are five examples of selection bias in the context of the alcohol J-shaped curve which can accumulate as people age:</p>
<ol>
<li><p><a href="https://doi.org/10.1016/S0140-6736(88)92890-5">Poor health, less alcohol</a>. As health declines, especially in older age, people often reduce their alcohol consumption. Not distinguishing between those who cut back or quit for health reasons can falsely indicate that moderate drinking is healthier.</p></li>
<li><p><a href="https://doi.org/10.1136/jech-2013-202576">Unhealthy lifetime abstainers</a>. Comparing moderate drinkers with individuals who have never consumed alcohol due to chronic health issues may falsely attribute health advantages to alcohol consumption.</p></li>
<li><p><a href="https://doi.org/10.1016/j.amepre.2005.01.011">Moderate in other ways.</a> Moderate drinkers often lead balanced lifestyles in other areas, too, which may contribute to their perceived better health. It is not just moderate drinking, but also their healthier overall opportunities and choices, such as better health-care access and self-care, that make them seem healthier.</p></li>
<li><p><a href="https://doi.org/10.1177/009145090403100304">Measurement error.</a> Assessing alcohol consumption over a short period of time, like a week or less, can lead to a misclassification of drinkers. Heavy drinkers who happened to not consume alcohol during the week of assessment would be incorrectly classified as abstainers, for example.</p></li>
<li><p><a href="https://doi.org/10.1111/add.13709">Early alcohol-attributable deaths.</a> The inevitable exclusion of individuals who may have died from alcohol-related causes before a study of older people starts can result in a “healthy survivor” bias, overlooking the earlier detrimental effects of alcohol.</p></li>
</ol>
<h2>Continuing the conversation</h2>
<p>We should be skeptical of results suggesting that moderate drinking is healthy because selection biases can muddy the waters. For instance, multiple implausible J-shape curve relationships have been published, <a href="https://doi.org/10.1002/hep.510230513">including between moderate drinking and liver disease</a>.</p>
<p>We are well aware that this news might not be what you were hoping to hear. <a href="https://doi.org/10.1080/08870446.2024.2316681">It might even stir up feelings of unease or skepticism</a>. For many people, limited alcohol consumption <a href="https://doi.org/10.1007/s40750-016-0058-4">is enjoyable</a>. However, it is not without risk and it is important for people to understand these risks to make informed decisions about their health.</p>
<p>The risks are reflected in the 2023 <a href="https://www.ccsa.ca/sites/default/files/2023-05/CGAH-Drinking-Less-is-Better-en.pdf">Canadian Drinking Guidance</a>. The guidance attempts to “meet people where they are at,” suggesting that one to two drinks per week represent a low risk of harm, three to six drinks a week represent a moderate risk, and seven or more drinks a week represent an increasingly high risk. Ultimately, they enable people to make informed decisions that best suit their health and well-being.</p><img src="https://counter.theconversation.com/content/222267/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s time to revisit the evidence for the health benefits of moderate drinking, and separate fact from wishful thinking. Can we confidently say, ‘Cheers to good health?’James M. Clay, Postdoctoral Research Fellow, Canadian Institute for Substance Use Research, University of VictoriaTim Stockwell, Scientist, Canadian Institute for Substance Use Research and Professor of Psychology, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231362024-02-24T14:08:11Z2024-02-24T14:08:11ZNigeria’s ban on alcohol sold in small sachets will help tackle underage drinking<figure><img src="https://images.theconversation.com/files/577320/original/file-20240222-16-aset0i.jpg?ixlib=rb-1.1.0&rect=3%2C6%2C1075%2C801&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sachet alcoholic drinks on display. </span> <span class="attribution"><span class="source">Kofo Belo-Osagie</span></span></figcaption></figure><p><em>On February 5, 2024, Nigeria’s National Agency for Food and Drug Administration and Control <a href="http://tinyurl.com/4h3usb97">announced</a> a ban on alcoholic beverages sold in sachets or bottles less than 200ml. The agency asserts that the ban will, among other benefits, protect underage children from easy access to alcohol. However, the Federal House of Representatives, Nigeria’s lower chamber of the national assembly, has asked that the ban be <a href="https://www.vanguardngr.com/2024/02/suspend-ban-on-alcoholic-drinks-in-sachets-pet-bottles-reps-tell-nafdac/#:%7E:text=The%20House%20of%20Representatives%20Committee,its%20investigation%20into%20the%20matter.">suspended</a> pending investigation. Medical sociologist Emeka Dumbili, who has <a href="https://scholar.google.com/citations?hl=en&user=Fek70KoAAAAJ&view_op=list_works&sortby=pubdate">researched</a> issues around young people’s use of alcohol and other psychoactive substances, explains why he believes the ban is needed and how it can work.</em></p>
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<h2>How bad is youth alcohol consumption in Nigeria?</h2>
<p>Alcohol consumption is growing among young Nigerians. Although alcohol consumption is not new to Nigerian society, historically only adults consumed it because drinking <a href="https://www.jstor.org/stable/220883?casa_token=WZLoim3ESs4AAAAA%3AUuAurxn7QSnHDbLh2bkJW-ftyWhRhU61T2zqeXGqQTroqQbjlAySCrq30jij75tlAh7lN5Fa08n3P3G4CKBHIne1ewsKxNjM4EJnNzxJKfy_O2XUDwxe">signified that one was an elder</a>. Unwritten rules constrained youths from drinking palm wine, which was the only available alcoholic beverage then. It was believed they were too immature to handle the intoxicating effects of alcohol. Nowadays, a rising number of Nigerian adolescents and young adults consume alcohol. Some even see drinking as <a href="https://link.springer.com/chapter/10.1007/978-3-031-04017-7_6">fashionable</a> and those who abstain as old fashioned. </p>
<p>Studies have shown that young Nigerians are consuming more alcohol. For example, studies published in <a href="https://www.ajol.info/index.php/njp/article/view/110285">2015</a>, <a href="https://journals.sagepub.com/doi/abs/10.1080/08897077.2021.1944952">2021</a> and <a href="https://www.ajol.info/index.php/jcmphc/article/view/245152">2023</a> found a 30%, 34% and 55.8% drinking prevalence among youths in Nigeria. </p>
<p>These statistics suggest that there will be more alcohol-related problems such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601673/">brain underdevelopment or damage</a>, alcohol-induced <a href="https://journals.sagepub.com/doi/full/10.1177/00220426231184151">sicknesses, truancy, violence, injuries</a> and death among young people than there used to be. </p>
<p>Existing studies not only show that youths are drinking, but reveal heavy drinking and drunkenness. These findings also echo a <a href="https://www.who.int/publications/i/item/9789241565639">World Health Organization report from 2018</a> which showed that the 22.5% prevalence of heavy episodic drinking among Nigerians aged 15 to 19 years was among the highest on the African continent. </p>
<h2>How do liquor sachets contribute to the problem?</h2>
<p>Research has shown that several factors are responsible for youth alcohol consumption in Nigeria. Chief among them is <a href="https://books.google.ie/books?hl=en&lr=&id=qnOyDwAAQBAJ&oi=fnd&pg=PR7&dq=Global+status+on+alcohol&ots=a2ksQEocgr&sig=dgRbP_sCOyG2LXTySU2dfuIvMMk&redir_esc=y#v=onepage&q=Global%20status%20on%20alcohol&f=false">unregulated alcohol marketing</a>. Alcohol corporations in Nigeria increasingly use aggressive marketing strategies, <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2016.1202930">advertising and sales promotions</a> such as buy-two-get-one-free that make different brands of such alcohol readily <a href="https://journals.sagepub.com/doi/10.1177/00220426221135765">available, accessible and affordable</a>.</p>
<p>Alcoholic beverages packaged in less than 200ml plastic bottles and sachets are affordable and widely available in retail shops, supermarkets, roadside kiosks and eateries in Nigeria. </p>
<p>They are also sold close to <a href="https://academic.oup.com/alcalc/article-abstract/58/6/628/7272955">primary and secondary schools</a>, where children spend time away from their parents. This is against international standard practices. </p>
<p>Sachet alcoholic beverages are also easy to carry and can be concealed from adults because of their small size. Young people can easily buy and drink them.</p>
<p>Another reason why sachet drinks are a problem is that they are spirit-based beverages with <a href="https://punchng.com/sachet-alcohol-ban-nafdac-lists-health-risks-as-firms-fear-losses/">high potency</a>. They can contain between <a href="https://www.ajol.info/index.php/ahs/article/view/194922">40% and 60%</a> alcohol, which is potentially <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2019.1615035">more harmful</a>. </p>
<p>There’s another reason too, related to another growing problem in Nigeria. Many youths now use different types of herbal sachet and plastic bottle alcoholic beverages as <a href="https://link.springer.com/article/10.1186/s12889-016-3163-1">aphrodisiacs</a> and <a href="https://www.ajol.info/index.php/ahs/article/view/194922">sex enhancers</a>. A <a href="https://www.ajol.info/index.php/ahs/article/view/194922">2020 study</a> found that 33.6% of adolescents used sachet alcohol before their last sexual intercourse. </p>
<h2>How effective are bans of liquor products?</h2>
<p>Well-coordinated enforcement of the ban can check the availability of sachet alcoholic beverages. This should reduce accessibility, consumption and related harms among young people. </p>
<p><a href="https://www.jsad.com/doi/abs/10.15288/jsad.2021.82.511">Uganda</a> has a ban, which has reduced the availability and consumption of sachet alcohol in that country. <a href="https://www.tandfonline.com/doi/abs/10.1080/00036840110102743?casa_token=HVq94RCTjUQAAAAA:ARU9QJAFeresjhcYe3pNfNixDCdRcGYRmMqLQeONqFVAQGwZTMs5uMennGxfeivRxElYLdCgj4mw">Research</a> in western countries has also shown that banning alcohol advertising reduces consumption. </p>
<p>For the ban to be effective, Nigeria should learn from <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-020-00280-8">Malawi’s</a> experience. There, the ban on sachet alcohol failed to produce the desired results due to the lack of coordinated and effective enforcement.</p>
<h2>Do state institutions in Nigeria have capacity to enforce the ban?</h2>
<p>It requires coordinated effort. As a regulatory body, the National Agency for Food and Drug Administration and Control may not implement the ban without the support of federal law enforcement agencies like the police. </p>
<h2>What else can be done to deal with youth drinking?</h2>
<p>Dealing with the problem of alcohol consumption among youths goes beyond placing a ban on sachet alcoholic beverages. Many young people in western countries are shunning alcohol consumption due to the rising awareness of the problems associated with drinking and also because of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13132">reduced peer pressure</a>. The decline in youth drinking in the west may also be due to effective policy implementation on alcohol marketing and the increased <a href="https://www.degruyter.com/document/doi/10.2202/1935-1682.1637/html">minimum drinking age</a>, especially in countries such as the US.</p>
<p>Nigerian agencies should learn from the reasons why youths in the west are avoiding alcohol. This will help when designing and sharing information to educate Nigerian youths and the public on the dangers of using sachet alcoholic products. </p>
<p>The awareness campaign should highlight the short- and long-term positive effects of the ban. This is important so that alcohol producers and marketers will not form alliances that will frustrate the purpose.</p>
<p>To disseminate information widely, social media platforms where young people are increasingly active should be prioritised without neglecting the traditional media. Health NGOs and other charities should also help spread information on the ban’s benefits, including the idea that “health is wealth”. </p>
<p>Nigeria should increase the minimum purchasing age from 18 to 21 years and enforce such regulations to deter early alcohol initiation and consumption.</p>
<p>To prevent the failure of the sachet alcohol ban, the federal government should ensure it’s enforced without corruption.</p><img src="https://counter.theconversation.com/content/223136/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emeka Dumbili receives funding from Alexander Von Humboldt Foundation, Germany (2019-2022). </span></em></p>The sachet alcoholic drinks ban in Nigeria can curb youth alcohol consumption. But government must improve enforcement and awareness strategies for success.Emeka Dumbili, Assistant Professor and Ad Astra Fellow, University College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2054562023-06-16T12:37:40Z2023-06-16T12:37:40ZCan we train our taste buds for health? A neuroscientist explains how genes and diet shape taste<figure><img src="https://images.theconversation.com/files/531177/original/file-20230609-22954-t3e9qh.jpg?ixlib=rb-1.1.0&rect=90%2C10%2C6619%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are increasingly learning that early diet can shape taste preferences but that our taste buds can also be trained to prefer healthier foods.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-female-nerd-holds-ice-cream-and-broccoli-royalty-free-image/679524590?phrase=vegetables+versus+sweets&adppopup=true">RichVintage/E+ via Getty Images</a></span></figcaption></figure><p>Have you ever wondered why only hummingbirds sip nectar from feeders?</p>
<p>Unlike sparrows, finches and most other birds, hummingbirds <a href="https://www.insidescience.org/video/why-hummingbirds-have-sweet-tooth">can taste sweetness</a> because they <a href="https://doi.org/10.1126/scisignal.2005818">carry the genetic instructions</a> necessary to detect sugar molecules.</p>
<p>Like hummingbirds, we humans can sense sugar because our DNA contains gene sequences coding for the <a href="https://theconversation.com/a-taste-for-sweet-an-anthropologist-explains-the-evolutionary-origins-of-why-youre-programmed-to-love-sugar-173197">molecular detectors</a> that allow us to detect sweetness. </p>
<p>But it is more complex than that. Our ability to sense sweetness, as well as other tastes, involves a delicate dance between our genetic makeup and the foods we encounter from the womb to the dinner table.</p>
<p>Neuroscientists <a href="https://scholar.google.com/citations?user=2LAmkegAAAAJ&hl=en">like me</a> are working to decipher how this <a href="https://doi.org/10.1007%2Fs11154-016-9360-5">intricate interplay between genes</a> <a href="https://doi.org/10.1016/j.tem.2020.11.011">and diet</a> shapes taste.</p>
<p>In <a href="https://sites.lsa.umich.edu/dus-lab/">my laboratory</a> at the University of Michigan, we are diving deeply into one specific aspect, which is how <a href="https://doi.org/10.1016/j.cub.2022.07.063">consuming too much sugar dulls the sense of sweetness</a>. Taste is so central to our eating habits that understanding how genes and the environment shape it has crucial implications <a href="http://health.euroafrica.org/books/dietnutritionwho.pdf">for nutrition</a>, <a href="https://www.who.int/publications/i/item/9789240039919">food science</a> and <a href="https://doi.org/10.1093/ajcn/nqaa302">disease prevention</a>.</p>
<h2>The role of genes in sensing taste</h2>
<p>As with hummingbirds, the <a href="https://www.webmd.com/diet/features/science-how-we-taste">human ability to discern what food tastes like</a> depends on the presence of taste receptors. These molecular detectors are found on the sensory cells, which are housed inside the taste buds, the sensory organs on the surface of the tongue. </p>
<p>The <a href="https://theconversation.com/a-taste-for-sweet-an-anthropologist-explains-the-evolutionary-origins-of-why-youre-programmed-to-love-sugar-173197">interactions between taste receptors and food molecules</a> give rise to the five basic taste qualities: sweetness, savoriness, bitterness, saltiness and sourness, which are transmitted from the mouth to the brain via specific nerves.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram of a taste bud, with arrows pointing to the taste pore, a taste receptor cell and taste cells." src="https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=476&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=476&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=476&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=599&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=599&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532282/original/file-20230615-17-tk80ew.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=599&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A diagram of a taste bud, indicating different types of cells and the sensory nerve.</span>
<span class="attribution"><span class="source">Julia Kuhl and Monica Dus</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>For instance, when sugar binds to the sweet receptor, it signals sweetness. Our innate preference for the taste of some foods over others is rooted in how the tongue and the brain <a href="https://doi.org/10.1038/486S16a">became wired during our evolutionary history</a>. Taste qualities signaling the presence of essential nutrients and energy, like salt and sugar, send information to brain areas linked to pleasure. Conversely, tastes that alert us to potentially harmful substances, such as the bitterness of certain toxins, are connected to those that make us <a href="https://doi.org/10.1016/j.cub.2013.04.010">feel discomfort or pain</a>.</p>
<p>While the presence of genes encoding for functional taste receptors in our DNA allows us to <a href="https://doi.org/10.1038/486S16a">detect food molecules</a>, how we respond to these also depends on the unique combination of taste genes we carry. Like ice cream, genes, including those for taste receptors, come in different flavors. </p>
<p>Take, for instance, a taste receptor for bitterness called TAS2R38. Scientists <a href="https://doi.org/10.3389%2Ffgene.2019.01272">found small changes in the genetic code</a> for the TAS2R38 gene among different people. These genetic variants affect how people perceive the bitterness of vegetables, berries and wine. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/C4rdqXXzPGU?wmode=transparent&start=45" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Aside from allowing us to taste the wide variety of flavors in foods, taste also helps us distinguish between foods that are healthy or potentially harmful, such as spoiled milk.</span></figcaption>
</figure>
<p>Follow-up studies have suggested a link between those same variants and food choice, particularly with respect to <a href="https://www.reuters.com/article/us-alcohol-taste-genes/genes-influence-taste-and-possibly-use-of-alcohol-idINKCN0HL23U20140926">vegetable and alcohol consumption</a>. </p>
<p>Many more variants exist in our gene repertoire, including those for the sweet taste receptor. However, whether and how these genetic differences <a href="https://doi.org/10.1016/j.cofs.2021.07.001">affect our taste and eating habits</a> is still being worked out. What is certain is that while genetics lays the groundwork for taste sensations and preferences, experiences with food can profoundly reshape them. </p>
<h2>How diet influences taste</h2>
<p>Many of our innate sensations and preferences are molded by our <a href="https://www.npr.org/2011/08/08/139033757/babys-palate-and-food-memories-shaped-before-birth">early experiences with food</a>, sometimes before we’re even born. Some molecules from the mother’s diet, like garlic or carrots, reach the <a href="https://www.npr.org/2011/08/08/139033757/babys-palate-and-food-memories-shaped-before-birth">fetus’s developing taste buds via the amniotic fluid</a> and can affect the appreciation of these foods after birth.</p>
<p>Infant formula can also influence food preferences later on. For example, research shows that infants fed with formulas that are not based on cow’s milk – which are more bitter and sour because of their amino acid content – are more accepting of bitter, sour and savory foods such as vegetables after weaning than <a href="https://doi.org/10.3945/ajcn.2009.27462o">those who consume cow milk-based formula</a>. And <a href="https://theconversation.com/why-kids-shouldnt-eat-added-sugar-before-they-turn-2-according-to-a-nutritional-epidemiologist-173398">toddlers who drink sweetened water</a> strongly prefer <a href="https://doi.org/10.1007%2Fs11154-016-9360-5">sweet beverages as early as age 2</a>.</p>
<p>The effect of food on our taste predispositions doesn’t stop in early life: <a href="https://doi.org/10.1016/j.tem.2020.11.011">What we eat as adults</a>, especially our sugar and salt intake, can also shape how we perceive and potentially choose food. <a href="https://media.nutrition.org/wp-content/uploads/2020/01/NIH-Workshop-Slides-Beauchamp.pdf">Cutting down on sodium</a> in our diet decreases our preferred level of saltiness, whereas consuming more makes us like saltier foods.</p>
<p>Something similar occurs with sugar: <a href="https://doi.org/10.3945/ajcn.115.112300">Reduce sugar in your diet</a> and you may find food sweeter. Conversely, as <a href="https://doi.org/10.1016/j.cub.2022.07.063">research in rats</a> and <a href="https://doi.org/10.1016/j.celrep.2019.04.027">flies</a> suggests, high sugar levels may dull your sensation of sweetness.</p>
<p>Although we researchers are still working out the exact how and why, studies show that high sugar and fat intake in animal models <a href="https://doi.org/10.1016/j.tem.2020.11.011">dampens the responsiveness of taste cells</a> and <a href="https://doi.org/10.1016/j.cub.2022.07.063">nerves to sugars</a>, modifies the number of taste cells available and even flips <a href="https://theconversation.com/what-you-eat-can-reprogram-your-genes-an-expert-explains-the-emerging-science-of-nutrigenomics-165867">genetic switches</a> in the <a href="https://doi.org/10.7554/eLife.83979">taste cells’ DNA</a>.</p>
<p>In my lab, we’ve shown that these taste alterations in rats return to normal within weeks when the <a href="https://doi.org/10.1016/j.cub.2022.07.063">extra sugar is removed from the diet</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Artistic image of a white lab rat standing on its high legs to sniff a chocolate dessert." src="https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531463/original/file-20230612-19-vqd4x5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Animal studies have helped inform how high sugar intake affects taste and eating.</span>
<span class="attribution"><span class="source">Irina Ilina</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Illness can also influence taste</h2>
<p>Genetics and food aren’t the only factors that affect taste. </p>
<p>As many of us discovered <a href="https://theconversation.com/covid-19-smell-and-taste-how-is-covid-19-different-from-other-respiratory-diseases-139543">during the height of the COVID-19 pandemic</a>, <a href="https://doi.org/10.1038%2Fs41598-022-11864-8">disease can also play a role</a>. After testing positive for COVID-19, I couldn’t tell the difference between sweet, bitter and sour foods for months. </p>
<p>Researchers have found that about 40% of people infected with SARS-CoV-2 <a href="https://doi.org/10.1093/chemse/bjac001">experience impairment in taste and smell</a>. In about 5% of those people, these <a href="https://doi.org/10.1136/bmj-2021-069503">taste deficits persist</a> for months and years. </p>
<p>Although researchers don’t understand what causes these sensory alterations, the leading hypothesis is that the virus <a href="https://doi.org/10.1038/d41586-022-01627-w">infects the cells that support the taste and smell receptors</a>.</p>
<h2>Training taste buds for healthier eating</h2>
<p>By shaping our eating habits, the intricate dance between genes, diet, disease and taste can affect the risk for chronic diseases.</p>
<p>Beyond distinguishing food from toxins, the brain uses taste signals as a proxy to estimate the filling power of foods. In nature, the stronger a food tastes – in terms of sweetness or saltiness – is directly connected to its nutrient levels and calorie content. For example, a mango contains five times the amount of sugar than a cup of strawberries, and this is why it tastes sweeter and is more filling. Thus, taste is important not just for food enjoyment and choice, <a href="https://doi.org/10.1016%2Fj.physbeh.2021.113419">but also for regulating food intake</a>.</p>
<p>When taste is altered by diet or disease, <a href="https://doi.org/10.1016%2Fj.physbeh.2015.05.036">sensory and nutrient information could become “decoupled</a>” and no longer provide accurate information to our brains about portion size. Research shows this may also occur with <a href="https://www.washingtonpost.com/business/2020/03/10/common-artificial-sweetener-might-be-making-you-fatter-sicker-new-study-says/">consumption of</a> <a href="https://theconversation.com/whos-recommendation-against-the-use-of-artificial-sweeteners-for-weight-loss-leaves-many-questions-unanswered-206175">artificial sweeteners</a>.</p>
<p>And indeed, in recent studies in invertebrate animal models, our lab discovered that the changes in taste caused by <a href="https://doi.org/10.1016/j.celrep.2019.04.027">high dietary sugar intake</a> <a href="https://doi.org/10.7554/eLife.54530">drove higher eating</a> by <a href="https://doi.org/10.1016/j.cub.2022.11.039">impairing these food predictions</a>. Notably, many of the eating
patterns and brain changes we observed in flies have also been <a href="https://theconversation.com/diet-can-influence-mood-behavior-and-more-a-neuroscientist-explains-185360">discovered in</a> people who ate foods high in sugar or fat or who had high body-mass index. This raises the question of whether these effects also arise from taste and sensory alterations in our brains. </p>
<p>But there is a silver lining to the adaptable nature of taste. Since diet shapes our senses, we can actually train our taste buds – and our brains – to <a href="https://doi.org/10.1093/advances/nmaa151">respond and prefer foods with lower quantities of sugar</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK50956/">salt</a>.</p>
<p>Interestingly, many people already say that they <a href="https://monell.org/big-data-says-food-is-too-sweet/">find foods overly sweet</a>, which may not be surprising since between 60% to 70% of <a href="https://www.nytimes.com/2016/05/22/upshot/it-isnt-easy-to-figure-out-which-foods-contain-sugar.html">grocery store foods contain added sugar</a>. Reformulating foods tailored to our genes and the plasticity of our taste buds could be a practical and powerful tool to <a href="https://www.who.int/publications/i/item/924120916X">enhance nutrition, promote health and decrease the burden of chronic disease</a>.</p><img src="https://counter.theconversation.com/content/205456/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monica Dus is a tenured faculty at The University of Michigan College of Literature, Science, and the Arts in Ann Arbor, MI. She receives funding from the National Science Foundation, the National Institute of Health, the Sloan Foundation, the Rita Allen Foundation, and the Klingenstein Foundation; she is also a 2023 Guggenheim Fellow. Monica is the Junior Councilor for the Association for Chemoreception Sciences, on the Advisory Board for the Trends in Endocrinology & Metabolism journal, on the Editorial Board for the Chemical Senses journal, and the Natural Sciences representative to the University of Michigan Faculty Senate. </span></em></p>Research is clear that what we eat can drive our test preferences as early as 2 years of age.Monica Dus, Associate Professor of Molecular, Cellular, and Developmental Biology, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2057002023-05-29T13:10:10Z2023-05-29T13:10:10ZDrink up, it’s closing time: South African study calculates that limiting opening hours will save lives<figure><img src="https://images.theconversation.com/files/527034/original/file-20230518-17-8xdcj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Cristi Lucaci/Shutterstock</span></span></figcaption></figure><p>South Africans are among the heaviest drinkers in the world. The country has the highest per capita rate of <a href="https://www.who.int/publications/i/item/9789241565639">alcohol consumption</a> in Africa. Excessive drinking is especially widespread in the Western Cape. Research <a href="https://dgmt.co.za/wp-content/uploads/2023/02/Minumum-Unit-Pricing-Phase-1.1-Modelling-Impact-of-MUP-15112021-FINAL-1.pdf">estimates</a> that per capita alcohol consumption in the province is between 30% and 40% higher than the national consumption. </p>
<p>Alcohol use contributes to <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7771-4">over 200</a> different diseases, injuries and conditions. It is also a risk factor for gender-based violence and <a href="https://www.westerncape.gov.za/assets/departments/health/mortality_profile_2016.pdf">violent crime</a>. </p>
<p>In a bid to reduce alcohol-related harms in the province, the Western Cape government has <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">proposed</a> a policy to restrict trading hours for onsite alcohol consumption. International <a href="https://pubmed.ncbi.nlm.nih.gov/28647704/">research</a> shows that reducing trading hours is an effective way to curb alcohol consumption and its associated harms. This type of policy is also supported by the <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">World Health Organization</a>. </p>
<p>My colleagues and I at the University of Cape Town recently conducted a modelling <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">study</a>. We wanted to determine the health and economic impacts of restricting the hours of onsite alcohol consumption. </p>
<p>We considered three latest closing-time scenarios: midnight, 1am and 2am. Data for the model baseline was drawn from national surveys on alcohol consumption, the national treasury’s annual budget reviews and publications from Statistics South Africa and the South African Medical Research Council. </p>
<p>We estimated the impact of each of the proposed closing times on the number of cases and deaths associated with certain health conditions. The study also assessed the policy’s impact on alcohol expenditure, excise tax, value added tax and retail revenue. Finally we estimated the impact on the cost of combating alcohol-related crime in the Western Cape.</p>
<p>Our <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">results</a> make it clear that limiting the hours for onsite consumption of alcohol will save lives. It will also prevent alcohol-related diseases and injuries, and reduce hospital and crime prevention costs.</p>
<p>On the other hand, national tax revenue and revenue to the alcohol industry will decrease. </p>
<h2>The findings</h2>
<p>We looked at how the policy might affect public health costs of six alcohol-related conditions. We also factored in the hospital costs of treating these conditions. The conditions we looked at were: road injury; intentional injury; liver cirrhosis; HIV; TB; and breast cancer. </p>
<p>Model estimates suggest that all closing-time scenarios correspond to decreases in six areas. These are: </p>
<ul>
<li><p>alcohol consumption</p></li>
<li><p>number of deaths due to the six alcohol-related conditions</p></li>
<li><p>number of cases of these six conditions</p></li>
<li><p>hospital costs of these conditions</p></li>
<li><p>cost of combating alcohol-related crime</p></li>
<li><p>revenue from alcohol sales and alcohol taxation.</p></li>
</ul>
<p>We estimated how much lower the number of cases of the six conditions would be over the next 20 years. The cases averted were:</p>
<ul>
<li><p>163,800 to 453,000 under the midnight closing-time scenario </p></li>
<li><p>88,700 to 220,300 (1am scenario) </p></li>
<li><p>12,600 to 28,300 (2am scenario). </p></li>
</ul>
<p>Correspondingly, the total hospital cost saving over the next 20 years is between: </p>
<ul>
<li><p>R326.8 million and R890.2 million (midnight scenario)</p></li>
<li><p>R130.5 million and R381.2 million (1am)</p></li>
<li><p>and between R18.7 million and R46.0 million (2am). </p></li>
</ul>
<p>(At the time of publication the <a href="https://www.xe.com/currencyconverter/convert/?Amount=1&From=USD&To=ZAR">exchange rate</a> was R19.42 to the US$) </p>
<p>In the year following the policy’s introduction, tax revenue (excise and value added tax) on alcohol sales is expected to decrease by between R100 million and R333 million under a midnight closing-time scenario. Under the 1am scenario it would fall by between R54 million and R179 million. And in the 2am scenario tax revenue would fall by between R9 million and R27 million. </p>
<p>Retail revenue would decrease by between R328 million and R1,093 million (midnight closing time), between R176 million and R587 million (1am) and between R27 million and R89 million (2am).</p>
<h2>What this all means</h2>
<p>The Western Cape government has expressed a clear commitment to protecting health in the Alcohol Harms Reduction <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">White Paper</a>. Introducing uniform trading-time restrictions for onsite retailers of alcohol is a good first step. </p>
<p>A midnight closing time restriction is the most pro-health policy option.
A 2am closing time is the most pro-industry. But the <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">research</a> does suggest that, from a public health standpoint, the 2am closing time still represents a modest improvement on the status quo.</p>
<p>Applying <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">evidence-based policies</a> to reduce alcohol consumption is necessary to reduce alcohol-related harms and deaths. The possibility of limited economic costs should not be a deterrent to this policy objective.</p>
<p>The alcohol industry may also point to the direct, indirect and induced job losses resulting from this policy. Concerns about employment losses are genuine and valid. But employment losses are only one side of the issue and should be considered with caution. One needs to consider the overall effects of the policy on employment. Jobs will be created in sectors attracting new demand as people spend some of their money on goods and services other than alcohol. It is nearly impossible to predict the number of jobs that will be created directly because of the policy, or because of the lives saved and lengthened.</p>
<h2>What more needs to be done</h2>
<p>Whatever closing time the government chooses, this policy won’t solve every problem. It will need to be enacted alongside other policy interventions geared towards reducing alcohol consumption and its associated harms. </p>
<p>These policies <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">include</a> banning alcohol advertising; adopting a minimum alcohol unit price; reducing the legal limits for drinking and driving; and making it easier for people to get counselling and medically assisted treatment if they struggle with alcohol dependence.</p>
<p>A comprehensive policy framework that targets alcohol consumption at an individual and societal level will be required to combat alcohol-related illness and death, and the adverse health, economic and social consequences.</p><img src="https://counter.theconversation.com/content/205700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This modelling study on which this article is based was commissioned and funded by the DG Murray Trust, an organisation which Sam has collaborated with as a consultant. Sam Filby works for the Research Unit on the Economics of Excisable Products based at the University of Cape Town. Her research conducted at the University of Cape Town is funded by the African Capacity Building Foundation through the Bill & Melinda Gates Foundation, Tax Justice Network Africa (also through the Bill & Melinda Gates Foundation), the CDC Foundation, and Cancer Research UK. Sam is also CIO of byegwaai, an app-based smoking cessation program. </span></em></p>Alcohol use contributes to over 200 different diseases, injuries, and conditions. It is also a risk factor for gender-based violence and violent crime.Sam Filby, Research Officer, Research Unit on the Economics of Excisable Products, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1990822023-05-02T21:44:36Z2023-05-02T21:44:36ZDoes our gut microbiota really influence our health and life expectancy?<figure><img src="https://images.theconversation.com/files/507937/original/file-20230202-11974-o90i7b.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C991%2C561&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Certain factors can disrupt the gut microbiota. These include our diet, alcohol consumption, antibiotics and inflammatory bowel disease.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The intestinal microbiota is the set of bacteria and viruses that live inside your gut. Microbiota perform a variety of functions, including digesting food and protecting against specific pathogens. </p>
<p>There are several things that can <a href="https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fecal-transplant">disrupt the gut microbiota</a>, including diet, alcohol consumption, antibiotics and inflammatory bowel disease. These cause imbalances, known as “dysbiosis” which, in turn, are associated with a <a href="https://doi.org/10.1128/mBio.01492-17">wide array of chronic diseases</a>. </p>
<p>In the last decade, the results of hundreds of studies in animal models have suggested that gut dysbiosis may play a role in several metabolic disturbances. Furthermore, in rodents, the implantation of certain bacteria <a href="https://doi.org/10.1038/nm.4236">could influence weight and metabolic profile</a>. What’s more, transferring the gut microbiota from a thin mouse to a heavy mouse allows it to lose weight. Is this too good to be true?</p>
<p>Respectively a student and a full professor in the Department of Medicine at Université Laval, our goal is to identify new therapeutic targets for chronic diseases and healthy life expectancy by using an approach based on genetic epidemiology. This short article aims to summarize and contextualize our recent research work <a href="https://doi.org/10.1186/s12967-022-03799-5">on the gut microbiota</a>.</p>
<h2>The importance of a causal link</h2>
<p>Scientists have suggested that eating certain foods such as dietary fibre, antioxidant-rich fruits and red meat may have an effect <a href="https://doi.org/10.1056/NEJMoa1109400">on the gut microbiota</a>. Some even suggest that microbiota could become a therapeutic target for the prevention or treatment of certain chronic diseases. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="conceptual illustration of the gut microbiome" src="https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The gut microbiota is the set of bacteria and viruses in our gut. It is involved in various functions, such as the digestion of food and protection against certain pathogens.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>For the microbiota to become a therapeutic target of interest, it is essential to establish a causal link between the characteristics of the gut microbiota and chronic diseases. A causal link suggests that modifying the microbiota <a href="https://doi.org/10.1016/j.cell.2019.12.025">would decrease the risk of developing a disease</a>. However, while several observational (non-experimental) studies in humans have identified statistical associations between <a href="https://doi.org/10.1016/j.febslet.2014.09.039">various markers of gut microbiota and chronic disease</a>, causality has not been clearly established. </p>
<p>For example, it is not known whether gut dysbiosis is the cause or consequence of disease (reverse causation). It is also not known whether both are influenced by other “confounding” factors that are associated with both gut microbiota and chronic disease. One could think, for example, of the quality of <a href="https://doi.org/10.1038/s41586-020-2881-9">our diet, our weight or our alcohol consumption</a>. </p>
<p>So, the aim of our work was to determine whether there is a direct and causal relationship between gut microbiota and metabolic markers such as weight, eight chronic diseases and human longevity using a genetic approach called Mendelian randomization.</p>
<h2>The power of genetic data</h2>
<p>Mendelian randomization attempts to establish causal links from genetic data. To do this, Mendelian randomization uses genetic variants (frequent changes in our genome sequence called nucleotide polymorphisms) that are strongly associated with a risk factor (gut microbiota), to establish a causal link with a dependent variable (health markers and diseases), <a href="https://theconversation.com/voici-comment-les-lois-de-la-genetique-nous-aident-a-prevenir-les-maladies-chroniques-144153">as described in a recent article</a>. Since the variations in our genome are established at the time of embryo formation and remain stable throughout our lives, this natural randomization experiment is not subject to reverse causality bias, since the presence of disease does not influence our genetic code. It is also not subject to the effect of confounding factors, since the genetic variations used are specifically associated with the characteristics of the gut microbiota. </p>
<p>We included genetic data from tens of thousands of individuals from several cohorts. We identified genetic variants associated with 10 fecal and blood metabolites. The metabolites included are small molecules produced by the gut microbiota that have previously been associated with gut dysbiosis and certain diseases. We also identified genetic variants of dozens of microbial taxa (e.g. a species, genus or family of bacteria). We studied nine cardiometabolic traits (weight, blood pressure, blood lipids, insulin, etc.) as well as eight chronic diseases: Alzheimer’s disease, depression, Type 2 diabetes, fatty liver disease, atherosclerotic coronary artery disease, stroke, osteoporosis and renal failure. We also studied the effect of these factors associated with gut microbiota on healthy life expectancy and longevity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="figure representing several molecules" src="https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=642&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=642&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=642&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=807&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=807&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=807&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Small organic molecules called metabolites are produced by gut bacteria. These molecules could reach organs such as the liver and the brain. However, their role in the development of chronic diseases and life expectancy is controversial.</span>
<span class="attribution"><span class="source">(Benoît Arsenault)</span>, <span class="license">Fourni par l'auteur</span></span>
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</figure>
<p>We hypothesised that, in the light of previously published data, a causal link would be revealed between gut dysbiosis and chronic diseases associated with aging.</p>
<p>However, contrary to our hypothesis, this Mendelian randomization analysis did not show significant effects of gut microbiota on metabolic factors and chronic diseases. Seven associations between certain microbial parameters and chronic diseases associated with aging appear to be potentially causal, but their effect is small and we cannot rule out the possibility that these associations happened by chance. Overall, the results offer little support for the hypothesis that the gut microbiota has a significant effect on our weight, metabolism and risk of developing chronic diseases.</p>
<h2>Results that call for caution</h2>
<p>These results suggest that the previously observed associations may not be causal. The associations could be explained by the diseases themselves (reverse causality bias) or by confounding factors (confounding bias) such as diet, medication, smoking, metabolic health, or others. However, these findings are consistent with the results of four recent randomized clinical trials showing that transferring gut microbiota from thin to heavyweight individuals does not lead to <a href="https://doi.org/10.3390/nu11102291">any weight loss or significant improvement in metabolic profile</a>.</p>
<p>Mendelian randomization is a method that has several advantages over observational studies. However, these results need to be contextualized. It is entirely possible that the genetic parameters we used to predict the metabolites and microbial species associated with gut dysbiosis do not fully capture the complexity of the gut microbiota. This would diminish our ability to identify meaningful associations. Therefore, studies with larger sample sizes and better characterization of the gut microbiota and its metabolites will be needed to determine whether certain gut bacteria play a key role in the etiology (the study of causes) of chronic disease and longevity.</p>
<p>Although the impact of gut dysbiosis on chronic disease appears to be limited, gut health is important for other aspects of human health. For example, the microbiota prevents other harmful bacteria from colonizing our gut. In addition, it allows us to digest certain nutrients (e.g. dietary fibre) that would otherwise <a href="https://doi.org/10.1136/bmj.k2179">be rejected by our bodies</a>. </p>
<p>Therapies that modulate the gut microbiota have recently been approved by U.S. health authorities for the prevention of <em>C. difficile</em> infections (a bacterium that causes diarrhea and other serious intestinal diseases). Our results, along with results from clinical studies less prone to reverse causality and confounding bias, do not, however, support a significant effect of gut dysbiosis on chronic disease. </p>
<p>These results support the conclusion that the potential of the microbiota as a therapeutic target for chronic diseases is, at present, low. We urge health professionals and the general public to be cautious about diagnostic tests based on gut microbiota to diagnose health problems that are not validated by the relevant health authorities. </p>
<p>Most importantly, we urge health professionals to avoid recommending specific interventions based on the mere fact that they would influence the parameters of the gut microbiota.</p><img src="https://counter.theconversation.com/content/199082/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Éloi Gagnon has received funding from the Fonds de recherche du Québec - Santé (FRQS).</span></em></p><p class="fine-print"><em><span>Benoit Arsenault has received research funding from the Canadian Institutes of Health Research, the Fonds de recherche du Québec - Santé, the Institut universitaire de cardiologie et de pneumologie de Québec Foundation, Pfizer and Silence Therapeutics.</span></em></p>A new study shows that the gut microbiota has little or no effect on our weight, metabolism and risk of developing chronic diseases.Éloi Gagnon, PhD Candidate, Université LavalBenoit Arsenault, Chercheur au Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec et Professeur titulaire au Département de médecine, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1950982022-12-15T22:21:29Z2022-12-15T22:21:29ZWant to pre-drink before going out? It probably won’t save you money, and can be risky to boot<figure><img src="https://images.theconversation.com/files/497578/original/file-20221128-16-ee63oq.jpg?ixlib=rb-1.1.0&rect=0%2C194%2C4104%2C2544&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Louis Hansel/Unsplash</span></span></figcaption></figure><p>You’re catching up with a few friends before you go out. Everyone’s having a drink, listening to some tunes, and the mood is good. A ride share is pulling up in the driveway – everyone quickly finishes their drinks and piles into the car, headed to a gig where more alcohol will be consumed. </p>
<p>This is the typical pre-drinking scenario – drinking alcohol in one place, typically someone’s home, before drinking more somewhere else, such as a pub, club or event.</p>
<p>You might be familiar with pre-drinking (colloquially known as <a href="https://www.vichealth.vic.gov.au/media-and-resources/media-releases/experts-warn-against-preloading-on-alcohol-ahead-of-schoolies-week">pre-loading</a>) and think nothing much of doing it.</p>
<p>In reality, it’s a complex behaviour that has been of great interest to health psychologists and public health strategists <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12525">for the past 15 years</a>.</p>
<p>And as popular as it is, pre-drinking isn’t without risk.</p>
<h2>Why do people pre-drink?</h2>
<p>The considerable public health effort to reduce excessive drinking in licensed venues has meant some drinkers appear to have abandoned the traditional “pub to club” model in favour of a “<a href="https://www.emerald.com/insight/content/doi/10.1108/17459261211235119/full/html">home to pub to club” version</a>.</p>
<p>You can understand the appeal – compared to a busy venue, someone’s house is likely to be less noisy, less cramped, and probably doesn’t include a cover charge.</p>
<p>In Australia, a common reason people cite for pre-drinking is the relatively cheaper cost of pre-purchased alcohol compared with prices at a licensed venue.</p>
<p>Indeed, behavioural economists have observed <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13254">we tend to be quite discerning</a> when figuring out the most cost-effective way to drink.</p>
<p>Add our <a href="https://www.ato.gov.au/business/excise-on-alcohol/lodging,-paying-and-rates---excisable-alcohol/excise-duty-rates-for-alcohol/">complex taxation system</a> and public health initiatives such as <a href="https://industry.nt.gov.au/publications/business/policies/floor-price">minimum unit pricing</a> to the mix, and it’s no surprise we are looking for ways to get a buzz on the cheap.</p>
<h2>More than money?</h2>
<p>Outside Australia, evidence shows alcohol price is less of a driver for pre-drinking. <a href="https://link.springer.com/chapter/10.1007/978-3-030-66941-6_13">Other motivational themes</a> have emerged – mainly from psychological research in North America and Europe. </p>
<p>These include the “enhancement” aspect of pre-drinking itself (as the opening scenario illustrates), controlling alcohol consumption in situ (such as only drinking your preferred brand), or in anticipation of less access to alcohol later on (think long lines for beer at the footy).</p>
<p>Generally, the aim of pre-drinking appears to be getting “sufficiently intoxicated” before going out.</p>
<p>But one motive, commonly mentioned by men, has been labelled as “<a href="https://www.sciencedirect.com/science/article/pii/S0306460315000829">intimate pursuit</a>”. This is where hanging out during pre-drinks is used to built rapport with someone you might be romantically interested in. </p>
<p>Although these themes are generally endorsed by Australian pre-drinkers, cost is still an important driver of our pre-drinking, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12138">especially among young Australians</a>.</p>
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Read more:
<a href="https://theconversation.com/trying-to-cut-back-on-alcohol-heres-what-works-179664">Trying to cut back on alcohol? Here's what works</a>
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<p>In <a href="https://link.springer.com/article/10.1007/s10865-014-9573-6">our research</a>, we asked participants about the cheaper cost of pre-drinking, alongside these other motives. It was the strongest predictor of pre-drinking, and also predicted participants’ experience of alcohol-related harm over the previous 12-month period.</p>
<p>Surprisingly, some people report that pre-drinking <a href="https://www.emerald.com/insight/content/doi/10.1108/DAT-12-2013-0055/full/html">doesn’t save them that much money</a>. </p>
<p>From a psychological perspective, this may be because alcohol affects our “<a href="https://link.springer.com/article/10.1007/s00213-008-1284-7">inhibitory control</a>”. Although our goal with having pre-drinks is to keep total alcohol expenditure down, the drunker we get, the harder it is to resist buying another round.</p>
<h2>The unique harm of pre-drinking</h2>
<p>Unfortunately, research consistently shows pre-drinking is uniquely linked to excessive alcohol consumption, and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12274">alcohol-related harm</a>.</p>
<p>One reason may be that <a href="https://pubmed.ncbi.nlm.nih.gov/18387749/">we drink faster while pre-drinking</a>, relative to sitting on a pint at the pub. This means pre-drinkers may reach higher levels of intoxication, more quickly.</p>
<p>This can be <a href="https://www.sciencedirect.com/science/article/pii/S0306460312003334">highly dependent on a range of factors</a> – for instance, who we are pre-drinking with, and whether or not people are playing drinking games.</p>
<p>Adding to the risk, people tend to be pretty bad at <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1465-3362.2011.00374.x">estimating how much they are drinking</a>. </p>
<p>Sadly, the “sweet spot” of a buzz can quickly give way to increasing levels of alcohol intoxication – and increased risk of alcohol-related harm. </p>
<figure class="align-center ">
<img alt="close-up of friends clinking four beers together" src="https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The more you’ve had to drink, the harder it can be to keep track.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/_8KV86shhPo">Giovanna Gomes/Unsplash</a></span>
</figcaption>
</figure>
<h2>How can pre-drinking risks be minimised?</h2>
<p>Research shows pre-drinking serves important practical and social functions – catching up with friends in a more relaxed environment, and warming up for a night out.</p>
<p>As such, it is unlikely we will eliminate pre-drinking entirely, but we can try to make it a bit less risky. </p>
<p>One challenge for pre-drinking is that people may drink out of whatever vessel is around – say, a mug – and will <a href="https://www.ingentaconnect.com/content/ben/cdar/2008/00000001/00000002/art00007">find it difficult</a> to keep track of their consumption.</p>
<p>Licensed premises serve alcohol in standardised containers such as pints and schooners, or use measured pours. So, having schooners or jiggers on hand when pre-drinking would be a good place to start.</p>
<p>Health psychologists often promote “protective behavioural strategies” – things that help keep our alcohol consumption under control. For example, we can set ourselves a drink limit, or set a timer between drinks to slow our intake. <a href="https://www.tandfonline.com/doi/10.1080/10826084.2019.1686025">Work is ongoing</a> to investigate how these strategies might be better tailored to the pre-drinking context.</p>
<p>Ultimately, if you’re planning a pre-drinking session before an event, it’s a good idea to make sure there are plenty of non-alcoholic or low-alcohol options, and food – <a href="http://www.safeparty.com.au/party-safe-for-hosts/">as you would with any party</a>.</p>
<p>The most important thing pre-drinkers can do is keep an eye on each other, making sure everyone makes it to the event, has a good time, and gets home safely.</p>
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Read more:
<a href="https://theconversation.com/australians-are-embracing-mindful-drinking-and-the-alcohol-industry-is-also-getting-sober-curious-160931">Australians are embracing 'mindful drinking' — and the alcohol industry is also getting sober curious</a>
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<img src="https://counter.theconversation.com/content/195098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kim M Caudwell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You might think it’s fine to have a few with friends before heading for a night out, but alcohol-related harms actually increase with pre-drinking.Kim M Caudwell, Lecturer - Psychology | Chair, Researchers in Behavioural Addictions, Alcohol and Drugs (BAAD), Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1956252022-12-01T11:29:39Z2022-12-01T11:29:39ZAs young people in rich countries drink less alcohol, elsewhere youth drinking is on the rise – podcast<figure><img src="https://images.theconversation.com/files/498241/original/file-20221130-20-yy30j2.jpg?ixlib=rb-1.1.0&rect=126%2C49%2C4547%2C3062&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drinking is going out of fashion among young people in some parts of the world, but not others. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-party-people-men-women-drinking-126810821">Kzenon via Shutterstock.</a></span></figcaption></figure><p>The amount of alcohol young people drink in many high-income countries has seen a marked decline since the early 2000s. But in many developing countries, the opposite is happening. In this episode of <a href="https://theconversation.com/uk/topics/the-conversation-weekly-98901">The Conversation Weekly</a> podcast, we talk to three experts studying trends in young people’s drinking habits to find out why and we explore the questions this raises about the way young people see themselves and their place in the world. </p>
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<p>Japan’s national tax agency raised eyebrows around the world in August when it launched a campaign urging more young people <a href="https://www.bbc.co.uk/news/world-asia-62585809">to drink alcohol</a>. Its reason was economic: an ageing demographic and changing habits during the COVID pandemic meant a drop in tax revenue from alcohol sales.</p>
<p>But while Japan’s reaction to the issue may be unusual, it’s by no means the only country where young people are drinking less alcohol. High-income countries in Europe, North America and Australasia are seeing significant declines in the amount and frequency that young people drink, after a peak in around 2003. </p>
<p>“Drinking in all forms is going down,” says Amy Pennay, a research fellow at La Trobe University in Melbourne, Australia. “Abstinence rates are rising. People are drinking less frequently and people are drinking less on an occasion when they do drink,” Pennay explains. The sharpest declines are in the under 18s, but there’s also been a flow-on effect in most high-income countries to 18- to 24-year-olds. </p>
<p>Pennay is part of a group of researchers in Australia, the UK and Sweden analysing trends in youth drinking. One of her colleagues in Sweden, Jonas Raninen at the Karolinska Institute in Stockholm, has been tracking drinking trends among young Swedes born in 2001 as part of a longitudinal study. “I would say that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835253/">17 is the new 15</a>,” he says, explaining the overall decline is also pushing up the age at which people start drinking.</p>
<p>Taking all this data together, researchers are beginning to pinpoint the reasons why declines in youth drinking are happening in <a href="https://theconversation.com/why-are-young-people-drinking-less-than-their-parents-generation-did-172225">these high-income countries</a>. They’re finding just how different life is for today’s teenagers compared to those entering adulthood 20 years ago. “Alcohol has become for young people something that’s gone from being … a reward and pursued, to something that’s really avoided,” she explains.</p>
<p>Elsewhere in the world, however, developing countries are seeing the opposite: an increase in how much young people drink. Emeka Dumbili, a lecturer at Nnamdi Azikiwe University in south-eastern Nigeria, has been <a href="https://www.researchgate.net/profile/Emeka-Dumbili">studying youth drinking in the country</a> since 2012. In his interviews with young people aged 18-25, he’s found an increase in the number who tell him that they drink, even if it’s a small amount. “Some of them are initiating consumption either before they come to university, as early as 13 years or even lower than that. And many people who didn’t drink before they got to university began to drink immediately they come to university,” he says.</p>
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Read more:
<a href="https://theconversation.com/some-young-nigerians-say-heavy-drinking-is-fun-controls-must-keep-pace-with-culture-170404">Some young Nigerians say heavy drinking is fun: controls must keep pace with culture</a>
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<p>Listen to the full episode via <a href="https://podfollow.com/the-conversation-weekly/view">The Conversation Weekly</a> podcast to find out more about the reasons for these different trends in youth drinking around the world. </p>
<p>This episode was produced by Mend Mariwany and Katie Flood, with sound design by Eloise Stevens. It was written by Gemma Ware, who is also the executive producer. Our theme music is by Neeta Sarl. </p>
<p>You can find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/">theconversationdotcom</a> or <a href="mailto:podcast@theconversation.com">via email</a>. You can also sign up to The Conversation’s <a href="https://theconversation.com/newsletter">free daily email here</a>. A <a href="https://cdn.theconversation.com/static_files/files/2786/Ep83_Youth_Drinking_Transcript.pdf?1694013681">transcript of this episode</a> is now available.</p>
<p>Listen to The Conversation Weekly via any of the apps listed above, download it directly via our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a>, or find out <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">how else to listen here</a>.</p><img src="https://counter.theconversation.com/content/195625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonas Raninen has received funding from the Swedish Research Council. Amy Pennay receives funding from the Australian Research Council. She has previously received funding from the National Health and Medical Research Council, BeyondBlue, Victorian Health Promotion Foundation, New South Wales Health and the National Drug Law Enforcement Research Fund. She is a member of the Kettil Bruun Society.</span></em></p><p class="fine-print"><em><span>Emeka Dumbili has received funding from the Tertiary Education Trust Fund (Nigeria), and fellowship funding from the Alexander Von Humboldt Foundation. </span></em></p>Young people in high-income countries now drink much less than their counterparts 20 years ago. But the opposite is happening in developing countries. Why? Listen to The Conversation Weekly podcast.Gemma Ware, Editor and Co-Host, The Conversation Weekly Podcast, The ConversationDaniel Merino, Associate Science Editor & Co-Host of The Conversation Weekly Podcast, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927702022-10-26T15:08:22Z2022-10-26T15:08:22ZIn France, the tough debate about hunting and alcohol<p>Over the last <a href="https://www.theguardian.com/world/2022/nov/28/france-three-people-injured-over-weekend-in-latest-hunting-incidents">weekend of November alone</a>, a 26-year-old hiker was shot in the arm while walking in the Alpilles mountains in Provence and a 64-year-old man, in the stomach, in Dordogne. Lead pellets also hit a 58-year old man in Brittany.</p>
<p>The link between these gruesome incidents? They were all caused by careless hunters.</p>
<p>All the more timely, then, is the French Senate’s report released in September, which called for a <a href="http://www.senat.fr/notice-rapport/2021/r21-882-notice.html">ban on alcohol and narcotics while hunting</a> alongside for a spate of <a href="https://www.lefigaro.fr/actualite-france/le-senat-propose-un-taux-maximal-d-alcoolemie-pour-la-chasse-20220916">measures</a> similar to those applied to drink-driving. On 25 October, the government released a <a href="https://www.lemonde.fr/planete/article/2022/10/25/delit-d-alcoolemie-demi-journees-sans-chasse-les-pistes-envisagees-par-le-gouvernement-pour-ameliorer-et-garantir-la-securite-a-la-chasse_6147294_3244.html">policy roadmap</a> comprising some of these suggestions, including restrictions on drinking. “Hunting involves an arm. Like driving, it is not compatible with a high blood-alcohol concentration,” the secretary of state for ecology, Bérangère Couillard, said. The Elysee is now awaiting to hear feedback from hunting federations with the view to formulating decrees by early 2023 at the latest.</p>
<p>The president of France’s National Hunters’ Federation (FNC), Willy Schraen, has retorted that <a href="https://www.marianne.net/societe/agriculture-et-ruralite/le-velo-bourre-cest-dangereux-aussi-nouvel-argument-du-patron-des-chasseurs-pour-esquiver-le-debat">“a drunk guy on a bike is dangerous, too”</a>, apparently forgetting French drink-driving laws <a href="https://www.securite-routiere.gouv.fr/chacun-son-mode-de-deplacement/dangers-de-la-route-velo/bien-circuler-velo">also apply to cyclists</a>.</p>
<p>The French hunting chief’s remark would not hold water in other countries, where representative organisations advise hunters to abstain from alcohol. Absent an EU-wide legislation on the matter, national legislation in states such as <a href="https://gestiberian.com/2017/01/27/sanciones-por-cazar-con-copas/">Spain</a>, <a href="https://www.rtbf.be/article/ouverture-de-la-chasse-quels-sont-les-droits-et-obligations-des-chasseurs-et-des-promeneurs-11076343">Belgium</a> and <a href="https://www.jagdverband.de/vor-und-waehrend-der-jagd-ist-alkohol-tabu">Germany</a> restrict drinking while in possession of a firearm. Or take, for example, the official website of <a href="https://www.hunter-ed.com/newyork/studyGuide/Alcohol-and-Drugs/20103502_138053/">a US agency for hunting education</a>, which states that</p>
<blockquote>
<p>“consuming alcohol before or during the hunt increases the risk of incidents because it impairs coordination, hearing, vision, communication, and judgement”.</p>
</blockquote>
<p>This may seem like common-sense advice, but alcohol is still integral to the world of hunting, both in France and farther afield.</p>
<h2>Hunting while drunk</h2>
<p>In the United States, where the general population consumes <a href="https://donnees.banquemondiale.org/indicateur/SH.ALC.PCAP.LI?locations=US">20% less</a> alcohol than in France, a <a href="https://www.tandfonline.com/doi/full/10.1080/01639625.2019.1631069">recent survey</a> carried out on a representative sample of 2,349 young adults found that 23% of male hunters had at some point hunted while inebriated.</p>
<p>And in France? Although there is an absence of hard data, the Senate report tentatively ventures that a “small minority” of people have hunted while under the influence of alcohol. However, the senators offer more precise statistics regarding deaths and serious accidents in hunting, 9% of which are attributable to a hunter’s state of inebriation.</p>
<p>Unfortunately, the report ignores most international data available on the topic, failing to mention that in the US, <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.78.12.158">drunkenness is involved in 15% of hunting accidents</a>. Also overlooked is an extensive Danish study of 1,800 hunters, which revealed the risk of firearm-related accidents <a href="https://journals.lww.com/jtrauma/Abstract/2009/12000/Firearm_Related_Hunting_Accidents_in_Denmark.21.aspx">was directly proportional to the hunters’ alcohol intake</a>.</p>
<p>Moreover, the recent Senate report does not clarify how alcohol significantly raises the risk of accidents. But we have managed to pinpoint three contributing effects of inebriation.</p>
<h2>Locomotion and motor coordination</h2>
<p>A study conducted at a Swiss A&E service showed a third of the hunting-related injuries there resulted from falls – for example, <a href="https://www.hindawi.com/journals/emi/2015/284908/">when shooters tumbled from tree-stands</a>. Alcohol is conducive to this type of incident, particularly by interfering with the <a href="https://doi.org/10.1016/j.alcohol.2008.04.004">inner ear and cerebellum</a>, which regulate balance. This has a negative impact on the hunter’s anticipation and motor coordination skills.</p>
<p>Other <a href="https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-3-243">research</a> demonstrated that when individuals were instructed to avoid obstacles while walking on a treadmill, their reaction times were significantly longer, even at low levels of alcohol intake.</p>
<h2>Visual and hearing impairment</h2>
<p><a href="https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-2008-1050922">Alcohol also impairs peripheral vision</a>, thus affecting judgement and accuracy in angles of fire. This is what causes double vision and <a href="https://link.springer.com/article/10.3758/BF03207543">blurred vision</a>, by disturbing the action of muscles that control visual focus. It enhances <a href="https://pubmed.ncbi.nlm.nih.gov/415330/">glaring</a>, by slowing down the muscles responsible for opening and closing the pupil in response to surrounding light levels.</p>
<p>Over the long term, <a href="https://theconversation.com/alcool-et-autres-substances-pourquoi-leur-dangerosite-est-elle-sous-estimee-par-les-usagers-159369">high alcohol intake</a> alters <a href="https://pubmed.ncbi.nlm.nih.gov/26465148/">colour perception</a> and promotes the emergence of <a href="https://pubmed.ncbi.nlm.nih.gov/34055263/">chronic diseases</a>, such as <a href="https://pubmed.ncbi.nlm.nih.gov/20443769/">cataracts</a>. It can lead to <a href="https://www.tandfonline.com/doi/full/10.1080/02713683.2021.1942070">age-related macular degeneration</a> (AMD), a condition characterised by <a href="https://theconversation.com/la-degenerescence-maculaire-est-la-premiere-cause-de-cecite-au-pays-comment-la-prevenir-154683">damage to the central region of the retina</a>.</p>
<p>Alcohol even <a href="https://pubmed.ncbi.nlm.nih.gov/33341812/">deteriorates our hearing</a>. In one study, subjects who had consumed alcohol were found to have significantly poorer hearing abilities compared to those who had not.</p>
<h2>Errors of judgement</h2>
<p>Once the extent of alcohol’s effects on sight and hearing are better understood, the range of stories that pop up in local newspapers – such as the man who ended up <a href="https://www.lyonmag.com/article/90723/beaujolais-le-chasseur-ivre-vise-un-lievre-et-tire-sur-son-ami">riddled with buckshot</a> when his hunting companion mistook him for a hare – become less of a surprise.</p>
<p>According to France’s <a href="https://www.ofb.gouv.fr/la-securite-la-chasse">Biodiversity Agency</a> (OFB), hunting accidents are often the result of carelessness and bad judgement. The OFB reminds hunters that, once fired, the projectiles can reach a distance of up to five kilometres (three miles). When a target is far away or moving, how can a hunter guarantee – drunk or sober – that their bullet doesn’t <a href="https://france3-regions.francetvinfo.fr/auvergne-rhone-alpes/haute-savoie/ouverture-du-proces-du-chasseur-accuse-avoir-tue-vetetiste-haute-savoie-1900586.html">hit a mountain biker</a>, a <a href="https://www.20minutes.fr/faits_divers/2338343-20180918-limoges-fillette-grievement-blessee-chasseur-tirait-faisan">ten-year-old girl playing by the river</a> or a <a href="https://www.lavoixdunord.fr/1143614/article/2022-02-22/femme-de-25-ans-tuee-lors-d-un-accident-de-chasse-ce-qu-sait-sur-ce-drame">young hiker</a> ?</p>
<h2>Drinking makes for riskier decision-making</h2>
<p>The choice of whether to pull the trigger or hold fire is dependent on another dimension. According to the Senate report:</p>
<blockquote>
<p>“More than two thirds of accidents result from gross misconduct that contravenes basic safety rules. Moreover, some one hundred incidents per year lead to devastating consequences, whereby shots are fired at vehicles or homes.”</p>
</blockquote>
<p>Assessing risks and perceiving the consequences of our actions are two processes that are <a href="https://pubmed.ncbi.nlm.nih.gov/33065446/">notoriously affected by inebriation</a>.</p>
<p>A 2015 study demonstrated this effect using a straightforward method, which involved presenting two jars filled with cards to bar patrons, aged 18 to 43. The subjects were told that they could earn a prize if they found a winning card. In the jar on the right, 50% of the cards were winners, whereas the probability of winning was not given for the jar on the left. The results showed that the drunk men (but not the women) <a href="https://pubmed.ncbi.nlm.nih.gov/25642202/">more often chose the riskier option</a>. Could this be likened to the scenario of taking a shot in the dark in the hopes of hitting a target?</p>
<h2>A major factor in human aggression</h2>
<p>By directly affecting the prefrontal cortex, alcohol disturbs <a href="https://onlinelibrary.wiley.com/doi/10.1002/hup.1194">executive cognitive functions</a>, which are involved in our ability to consider or maintain multiple options simultaneously in order to solve problems, as well as our attention skills, our action inhibition skills, and <a href="https://compass.onlinelibrary.wiley.com/doi/10.1111/j.1751-9004.2007.00051.x">our ability to control aggression</a>. In fact, alcohol is the psychoactive substance most often linked to <a href="https://www.dunod.com/sciences-humaines-et-sociales/drogues-alcool-et-agression-equation-chimique-et-sociale-violence">human aggression on a global scale</a>.</p>
<p>Of course, it’s not alcohol but hunters who have <a href="https://www.ledauphine.com/france-monde/2019/11/17/en-20-ans-les-chasseurs-ont-tue-plus-de-400-personn">shot 400 people dead</a> in the past two decades in France and injured thousands more. (And it should be noted that alcohol is responsible for <a href="https://www.inserm.fr/wp-content/uploads/2021-05/inserm-expertisecollective-alcool2021-synthese.pdf">almost a million deaths</a> in instances not related to hunting).</p>
<p>Given that alcohol has clearly been identified as an avoidable risk factor, however, it seems wise to ban its consumption for those using rifles and shotguns in woodland areas frequented by the public. When consuming alcohol, hunters threaten the lives of others, and their own as well.</p>
<hr>
<p><em>Translated from the French by Enda Boorman for <a href="http://www.fastforword.fr/en">Fast ForWord</a>.</em></p><img src="https://counter.theconversation.com/content/192770/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurent Bègue-Shankland has received funding from the Inter-ministerial Mission for the Fight against Drugs and Addictive Behaviour (MILDECA).</span></em></p>A recent French Senate report calling on a ban on alcohol use while hunting has prompted the wrath of the country’s hunting lobby. Do its arguments hold water?Laurent Bègue-Shankland, Addictologue, Professeur de psychologie sociale, membre de l’Institut universitaire de France (IUF), directeur de la MSH Alpes (CNRS/UGA), Université Grenoble Alpes (UGA)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1909622022-09-30T00:00:03Z2022-09-30T00:00:03ZViral infections including COVID are among the important causes of dementia – one more reason to consider vaccination<figure><img src="https://images.theconversation.com/files/487396/original/file-20220929-20-v6jfow.jpg?ixlib=rb-1.1.0&rect=35%2C141%2C4671%2C2815&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Sven Hoppe/picture alliance via Getty Images</span></span></figcaption></figure><p>With more of us living into old age than at any other time, dementia is increasing steadily worldwide, with major individual, family, societal and economic consequences. </p>
<p>Treatment remains largely ineffective and aspects of the underlying pathophysiology are still unclear. But there is good evidence that neurodegenerative diseases – and their manifestation as dementia – are not an inevitable consequence of ageing. </p>
<p>Many <a href="https://blogs.otago.ac.nz/pubhealthexpert/dementia-update-on-causes-and-prevention-including-the-role-of-covid-19/">causes of dementia</a>, including viral infections, are preventable.</p>
<p>COVID and other viral infections are centrally involved in insults to the brain and subsequent neurodegeneration. COVID-positive outpatients have a more than three-fold higher risk of Alzheimer’s and more than two-fold <a href="https://www.frontiersin.org/articles/10.3389/fneur.2022.904796/full">higher risk of Parkinson’s disease</a>. </p>
<p>A study of almost three million found risks of psychiatric disorders following COVID infection returned to baseline after one to two months. But other disorders, including “<a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext">brain fog</a>” and dementia, were still higher than among controls two years later.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1569302974811308032"}"></div></p>
<p>Among more than six million adults older than 65, individuals with COVID were at a <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad220717">70% higher risk than the uninfected</a> for a new diagnosis of Alzheimer’s disease within a year of testing positive for COVID. </p>
<p>More than 150,000 people with COVID and 11 million controls have been involved in a <a href="https://www.nature.com/articles/s41591-022-02001-z">study</a> of long-term consequences of acute COVID infection. A year after infection, there was an overall 40% higher risk (an additional 71 cases per 1000 people) of neurologic disorders, including memory problems (80% higher risk) and Alzheimer’s disease (two-fold higher risk). These risks were elevated even among those not hospitalised for acute COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/these-12-things-can-reduce-your-dementia-risk-but-many-australians-dont-know-them-all-191504">These 12 things can reduce your dementia risk – but many Australians don't know them all</a>
</strong>
</em>
</p>
<hr>
<p>SARS-CoV-2, the virus that causes COVID, can <a href="https://rupress.org/jem/article/218/3/e20202135/211674/Neuroinvasion-of-SARS-CoV-2-in-human-and-mouse">invade brain tissue</a>. Other viruses can also cause direct damage to the brain. A study of almost two million people showed the <a href="https://pubmed.ncbi.nlm.nih.gov/35723106/">risk of Alzheimer’s was markedly lower</a> in those who had been vaccinated against influenza.</p>
<h2>The cost of dementia</h2>
<p>Dementia is characterised by <a href="https://www.who.int/en/news-room/fact-sheets/detail/dementia">progressively deteriorating cognitive function</a>. This involves memory, thinking, orientation, comprehension, language and judgement, often accompanied by changes in mood and emotional control. </p>
<p>It is one of the major causes of disability among older people. Worldwide prevalence exceeds 55 million and there are almost ten million new cases annually. It is the seventh leading cause of death. In 2019, the estimated global cost of dementia was US$1.3 trillion and rising.</p>
<p>The best known form of dementia – Alzheimer’s – was <a href="https://pubmed.ncbi.nlm.nih.gov/8713166/">first described in 1907</a>. Dementia is generally described as developing in three stages:</p>
<ul>
<li><p>impairment of memory, losing track of time and becoming lost in familiar places</p></li>
<li><p>further deterioration of memory with forgetfulness of names and recent events, becoming confused at home, losing communication skills and personal care habits, repeated questioning, wandering</p></li>
<li><p>increased difficulty walking, progressing to inactivity, marked memory loss, involving failure to recognise relatives and friends, disorientation in time and place, changes in behaviour, including lack of personal care and emergence of aggression.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/omicron-specific-vaccines-may-give-slightly-better-covid-protection-but-getting-boosted-promptly-is-the-best-bet-190736">Omicron-specific vaccines may give slightly better COVID protection – but getting boosted promptly is the best bet</a>
</strong>
</em>
</p>
<hr>
<h2>Treatments largely unsuccessful</h2>
<p>There are no cures and no resounding treatment successes. Management involves support for patients and carers to optimise physical activity, stimulate memory and treat accompanying physical or mental illness. </p>
<p>Dementia has a <a href="https://www.who.int/en/news-room/fact-sheets/detail/dementia">disproportionate impact on women</a>, who account for 65% of dementia deaths and provide 70% of carer hours. </p>
<p>We may know less about the pathology of dementia than we imagined: some key data are under scrutiny for <a href="https://www.science.org/content/article/potential-fabrication-research-images-threatens-key-theory-alzheimers-disease">possible inappropriate manipulation</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/alzheimers-theory-undermined-by-accusations-of-manipulated-data-but-does-not-bring-dementia-research-to-its-knees-187713">Alzheimer's theory undermined by accusations of manipulated data – but does not bring dementia research to its knees</a>
</strong>
</em>
</p>
<hr>
<p>But we do know about many of the causes of dementia and therefore about prevention. In addition to viral infections, there are at least four other contributing causes: <a href="https://pubmed.ncbi.nlm.nih.gov/19782001/">cardiovascular disease</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/30833374/">type 2 diabetes</a> (especially if untreated), <a href="https://pubmed.ncbi.nlm.nih.gov/29653873/">traumatic brain injury</a> and <a href="https://www.bmj.com/content/357/bmj.j2353">alcohol</a>.</p>
<p>The brain has its own immune system – cells called microglia. These play a role in brain development, <a href="https://www.nature.com/articles/s41588-022-01149-1">account for 5-10% of brain mass</a> and become activated by damage and loss of function. They are also <a href="https://pubmed.ncbi.nlm.nih.gov/23622250/">implicated in Alzheimer’s</a> and their inflammation has been shown to be <a href="https://pubmed.ncbi.nlm.nih.gov/23254930/">central to its pathology</a>.</p>
<h2>Dementia is preventable</h2>
<p>In the absence of effective treatment, prevention is an important goal. The association with viral infections means we should pay careful attention to vaccine availability and uptake (for influenza, COVID and any future variants) and place greater emphasis on combatting misinformation regarding vaccines.</p>
<p>The association with atherosclerosis and stroke, as well as diabetes, supports primary prevention that involves healthier diets (plant-based diets low in salt and saturated fats), physical activity and weight control.</p>
<p>Alcohol consumption is a major problem globally. We have allowed high intake to be normalised and talk about no more than two glasses per day as though that is innocuous. Despite the myth of some beneficial aspects of alcohol, the <a href="https://www.thelancet.com/article/S0140-6736(18)31310-2/fulltext">safest intake is zero drinks per week</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1575274580788355074"}"></div></p>
<p>This requires a complete <a href="https://pubmed.ncbi.nlm.nih.gov/19560606/">national rethink</a> around the availability and acceptability of alcohol as well as assistance with alcohol addiction and treatment of alcohol-related disorders.</p>
<p>Traumatic brain injury is associated with sport and, more importantly, falls and car crashes. It is recognised as a global priority and there is increasing awareness of the preventability of falls among older people. The management of head injuries is being ramped up in contact sports. </p>
<p>However, data on the impact of best management of the initial injury on subsequent risk of dementia are lacking and <a href="https://pubmed.ncbi.nlm.nih.gov/29381704/">risk remains elevated</a> even 30 years after the initial trauma.</p>
<p>The evidence that dementia has preventable causes, including viral infection, should better inform policy and our own behaviour.</p><img src="https://counter.theconversation.com/content/190962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Donne Potter does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older people with COVID are at higher risk of a new Alzheimer’s diagnosis within a year of testing positive. Vaccination against viral infection remains one of several important preventative measures.John Donne Potter, Professor, Research Centre for Hauora and Health, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1791762022-04-20T12:17:46Z2022-04-20T12:17:46ZBeer and spirits have more detrimental effects on the waistline and on cardiovascular disease risk than red or white wine<figure><img src="https://images.theconversation.com/files/458683/original/file-20220419-15105-khdsoe.jpg?ixlib=rb-1.1.0&rect=20%2C61%2C6869%2C2623&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are working to tease apart how various alcohol types contribute to weight gain and disease risk.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/six-drinks-royalty-free-image/157333486?adppopup=true">pixhook/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Drinking beer and spirits is linked to elevated levels of <a href="https://doi.org/10.1259/bjr/38447238">visceral fat</a> – the harmful type of fat that is associated with an increased risk of cardiovascular disease, metabolic syndrome, and other health complications – whereas drinking wine shows no such association with levels of this harmful fat and may even be protective against it, depending on the type of wine consumed. In fact, we found that drinking red wine is linked to having lower levels of visceral fat. These are some of the key takeaways of <a href="https://doi.org/10.1002/osp4.598">a new study</a> that my colleagues and I recently published in the Obesity Science & Practice journal. </p>
<p>Although white wine consumption did not influence levels of visceral fat, our study did show that drinking white wine in moderation might offer its own unique health benefit for older adults: denser bones. We found higher bone mineral density among older adults who drank white wine in moderation in our study. And we did not find this same link between beer or red wine consumption and bone mineral density.</p>
<p>Our study relied on a large-scale longitudinal database called <a href="https://www.ukbiobank.ac.uk/">the U.K. Biobank</a>. We assessed 1,869 white adults ranging in age from 40 to 79 years who reported demographic, alcohol, dietary and lifestyle factors via a touchscreen questionnaire. Next, we collected height, weight and blood samples from each participant and obtained body composition information using a direct measure of body composition called <a href="https://radiology.ucsf.edu/blog/dxadexa-beats-bmi-using-x-ray-exam-measure-body-composition-fat-loss">dual-energy X-ray absorptiometry</a>. Then, we used a statistical program to examine the relationships among the types of alcoholic beverages and body composition. </p>
<h2>Why it matters</h2>
<p>Aging is often accompanied by an increase in the problematic fat that can lead to heightened cardiovascular disease risk as well as by a <a href="https://doi.org/10.1177/1759720X11430858">reduction in bone mineral density</a>. This has important health implications given that nearly 75% of adults in the U.S. <a href="https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/overweight-obesity-adults-H.pdf">are considered overweight or obese</a>. Having higher levels of body fat has been consistently linked to an increased risk for acquiring many different diseases, including <a href="https://doi.org/10.1161/CIR.0000000000000973">cardiovascular disease</a>, <a href="https://doi.org/10.1056/NEJMoa021423">certain types of cancer</a>, and <a href="https://doi.org/10.1056/NEJMoa0801891">a higher risk of death</a>. And it’s worth noting that national medical care costs associated with treating obesity-related diseases total more than <a href="https://doi.org/10.18553/jmcp.2021.20410">US$260.6 billion annually</a>.</p>
<p>Considering these trends, it is vital for researchers like us to examine all the potential contributors to weight gain so that we can determine how to combat the problem. Alcohol has long been considered one possible driving factor <a href="https://doi.org/10.1007/s13679-014-0129-4">for the obesity epidemic</a>. Yet the public often hears conflicting information about the potential <a href="https://doi.org/10.1111/psyp.12134">risks</a> and <a href="https://doi.org/10.1016/j.mayocp.2013.11.005">benefits</a> of alcohol. Therefore, we hoped to help untangle some of these factors through our research. </p>
<h2>What still isn’t known</h2>
<p>There are many biological and environmental factors that contribute to being overweight or obese. <a href="https://doi.org/10.1007/s13679-014-0129-4">Alcohol consumption</a> may be one factor, although there are <a href="https://doi.org/10.1111/j.1753-4887.2011.00403.x">other studies</a> that have not found clear links between weight gain and alcohol consumption. </p>
<p>One reason for the inconsistencies in the literature could stem from the fact that much of the previous research has traditionally treated alcohol as a single entity rather than separately measuring the effects of beer, cider, red wine, white wine, Champagne and spirits. Yet, even when broken down in this way, the research yields mixed messages.</p>
<p>For example, <a href="https://doi.org/10.1093/oxfordjournals.aje.a117556">one study has suggested</a> that drinking more beer contributes to a higher waist-to-hip ratio, while <a href="https://pubmed.ncbi.nlm.nih.gov/17416040/">another study</a> concluded that, after one month of drinking moderate levels of beer, healthy adults did not experience any significant weight gain.</p>
<p>As a result, we’ve aimed to further tease out the unique risks and benefits that are associated with each alcohol type. Our next steps will be to examine how diet – including alcohol consumption – could influence diseases of the brain and cognition in older adults with <a href="https://www.nia.nih.gov/health/what-mild-cognitive-impairment">mild cognitive impairment</a>. </p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/179176/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brittany Larsen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research has been inconclusive on the degree to which drinking alcohol leads to the growth of harmful fat. But a new study suggests that beer and spirits are far bigger culprits than wine.Brittany Larsen, Ph.D. Candidate in Neuroscience & Graduate Assistant, Iowa State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1298542020-01-14T13:48:20Z2020-01-14T13:48:20ZHow Prohibition changed the way Americans drink, 100 years ago<figure><img src="https://images.theconversation.com/files/309806/original/file-20200113-103971-1ankvjp.jpg?ixlib=rb-1.1.0&rect=49%2C98%2C2946%2C2236&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prohibition did little to ease Americans' love of liquor.</span> <span class="attribution"><span class="source">AP Photo</span></span></figcaption></figure><p>On Jan. 17, 1920, one hundred years ago, <a href="https://timesmachine.nytimes.com/timesmachine/1920/01/16/106359667.html?pageNumber=1">America officially went dry</a>. </p>
<p><a href="https://www.theguardian.com/theguardian/from-the-archive-blog/2011/may/23/guardian190-prohibition-in-america">Prohibition</a>, embodied in the U.S Constitution’s 18th amendment, <a href="https://www.law.cornell.edu/constitution/amendmentxviii">banned the sale, manufacture and transportation of alcohol</a>. Yet it remained <a href="https://www.history.com/news/10-things-you-should-know-about-prohibition">legal to drink</a>, and <a href="https://www.smithsonianmag.com/history/tiny-french-archipelago-became-americas-illegal-warehouse-during-prohibition-180967868/">alcohol was widely available</a> throughout Prohibition, which ended in 1933.</p>
<p>I am reminded of how easy it was to drink during Prohibition every time I go to the <a href="https://www.omnihotels.com/hotels/bretton-woods-mount-washington/dining/the-cave">hotel in New Hampshire</a> that hosted the <a href="https://www.worldbank.org/en/about/archives/history/exhibits/bretton-woods-monetary-conference">Bretton Woods Conference</a>, which created the modern international monetary system after World War II. The hotel, now known as the Omni Mount Washington Resort, boasts a <a href="https://www.bostonglobe.com/lifestyle/travel/2015/09/12/breaking-law-north-country-speakeasy-the-cave-toasts-its-bootlegging-legacy/VmJPAyqjSfMwdQmH3izJZP/story.html">basement speakeasy</a> called <a href="https://www.omnihotels.com/hotels/bretton-woods-mount-washington/dining/the-cave">The Cave</a> that served illegal liquor during Prohibition. </p>
<p>The last time <a href="http://businessmacroeconomics.com/">I</a> was in The Cave I began wondering, given how prevalent Prohibition-era speakeasies appear to have been, what effect banning alcohol had on consumption rates. </p>
<p>Moreover, are we drinking any more today than we did before prohibition?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=597&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=597&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=597&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bootleggers smuggled bottles of Scotch whiskey in hollowed-out loaves of bread.</span>
<span class="attribution"><span class="source">AP Photo</span></span>
</figcaption>
</figure>
<h2>Consumption begins to drop</h2>
<p>The <a href="http://prohibition.themobmuseum.org/the-history/the-road-to-prohibition/the-temperance-movement/">Prohibition movement began</a> in the early 1800s based on noble ideas such as boosting savings, reducing domestic violence and improving family life. </p>
<p>At the time, alcohol usage was soaring in the U.S. Some estimates by alcohol opponents put consumption at <a href="https://www.neh.gov/humanities/2011/septemberoctober/feature/going-dry">three times what it is today</a>. Activists thought that prohibiting its sale would curb excess drinking. Their efforts were very effective. </p>
<p>But while Prohibition is often portrayed as a sharp change that happened with <a href="https://www.pbs.org/kenburns/prohibition/roots-of-prohibition/">one last national call for drinks</a> just before the stroke of midnight, thousands of towns throughout the country <a href="https://www.neh.gov/humanities/2011/septemberoctober/feature/going-dry">had gone dry well before that</a>. More bans took effect during World War I in an effort to save grain. </p>
<p>So to consider the impact of Prohibition on drinking habits, it’s a good idea to start in the years leading up to it. And given that beer, wine and spirits all have different alcohol content, we’ll use the number of “standard” drinks a person consumes to make our comparison. A <a href="https://www.niaaa.nih.gov/what-standard-drink">standard drink contains</a> about 14 grams of pure alcohol. This is the amount of spirits in a 12 ounce beer, a five ounce glass of wine or a 1.5 ounce shot of hard liquor.</p>
<p>From 1900 until 1915 – five years before the 18th Amendment passed – the <a href="https://pubs.niaaa.nih.gov/publications/surveillance113/tab1_17.htm">average adult drank</a> about 2.5 gallons of pure alcohol a year, which is about 13 standard drinks per week. Consumption fell sharply by 1916, with the average falling to two gallons a year, or 10 drinks a week. </p>
<p>The Prohibition movement and the local dry laws that preceded it appeared to already be having an impact.</p>
<p><iframe id="mjDxu" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/mjDxu/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Drinking rebounds</h2>
<p>Tracking consumption gets a bit trickier after 1920. </p>
<p>Prohibition meant the federal government no longer had a way to measure how much alcohol people were consuming. So to get around the missing information, <a href="https://www.jstor.org/stable/2006862">researchers have used</a> data on arrests for drunkenness, deaths caused by cirrhosis of the liver, deaths by alcoholism and how many patients were admitted to hospitals for alcoholic psychosis. Put together, the numbers <a href="https://www.nber.org/papers/w3675">suggest alcohol consumption</a> dropped sharply in 1920, falling to about one-third of what people drank before Prohibition. </p>
<p>Starting in 1921, however, alcohol consumption rebounded quickly and soon reached about two-thirds of pre-Prohibition levels. One likely reason is that the U.S. experienced a <a href="https://www.u-s-history.com/pages/h1362.html">severe recession in 1920 and 1921</a>. When the economy recovered in 1922 to start the <a href="https://www.forbes.com/sites/timreuter/2014/10/21/how-to-succeed-in-business-and-government-without-really-trying-calvin-coolidge-and-the-roaring-twenties/#518032f31f60">roaring 20s</a> people were more able to afford illegal liquor.</p>
<p>In the decades after Prohibition ended on Dec. 5, 1933, with the repeal of the 18th Amendment, consumption remained relatively subdued. But by the 1960s and ‘70s, Americans were swilling just as much alcohol as in the early 1900s. </p>
<p><a href="https://pubs.niaaa.nih.gov/publications/surveillance113/tab1_17.htm">Today Americans drink on average</a> about 2.3 gallons of pure alcohol a year, which is about 12 standard drinks a week, about the same amount they drank before Prohibition. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Revelers in Chicago celebrate the end of Prohibition in 1933.</span>
<span class="attribution"><span class="source">AP Photo</span></span>
</figcaption>
</figure>
<h2>Prohibition’s legacy</h2>
<p>The era of Prohibition left many legacies. </p>
<p>One result is American’s <a href="http://theconversation.com/why-bland-american-beer-is-here-to-stay-91737">preference for pale bland beers</a>. Drinking also moved from public spaces like <a href="https:/www.doi.org/10.2105/AJPH.2005.065409">saloons into the home</a>.</p>
<p>More negatively, some claim it created organized crime as <a href="https://www.jstor.org/stable/1017691">violence soared</a> and <a href="http://prohibition.themobmuseum.org/the-history/the-rise-of-organized-crime/the-mob-during-prohibition/">mobsters enriched themselves</a>. It also meant states and the federal government, which relied heavily on excise taxes from liquor taxes to fund their budgets, <a href="https://www.pbs.org/kenburns/prohibition/unintended-consequences/">turned to income taxes</a> to help make up for the gap. And ultimately it did not result in a significant or lasting drop in alcohol consumption.</p>
<p>For these reasons, many people believe <a href="https://www.cato.org/sites/cato.org/files/pubs/pdf/pa157.pdf">it was a failure</a>, which should give pause to policymakers and others pushing for a ban on <a href="https://www.who.int/china/activities/banning-smoking-from-the-workplace">smoking</a> or <a href="https://time.com/5685936/state-vaping-bans/">vaping</a>. </p>
<p>And even the person most responsible for drafting Prohibition legislation, U.S. Rep. <a href="https://www.docsteach.org/documents/document/volstead-act">Andrew Volstead</a>, was <a href="https://www.alcoholproblemsandsolutions.org/hypocrisy-prohibition-alcohol-u-s/">no teetotaler</a> himself, suggesting even those who push such bans can’t even abide by them.</p>
<p>So, as an economist, I believe if you want to stop people from doing something injurious to their health, <a href="https://www.ncbi.nlm.nih.gov/books/NBK217454/">raising the price</a> works better than a ban. That’s how the U.S. <a href="https://www.forbes.com/sites/niallmccarthy/2018/07/26/poll-u-s-smoking-rate-falls-to-historic-low-infographic/#79cac19a3351">cut the share of adult smokers</a> from 40% in the 1970s to 16% by 2018.</p>
<p>The 100th anniversary of Prohibition reminds us that bans rarely work. </p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/129854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jay L. Zagorsky does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The era of Prohibition, which began in 1920 and ended in 1933, left many legacies – more modest drinking was not among them.Jay L. Zagorsky, Senior Lecturer, Questrom School of Business, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1211152019-08-12T20:03:40Z2019-08-12T20:03:40ZQueenslanders are among our heaviest drinkers on nights out, and changing that culture is a challenge<figure><img src="https://images.theconversation.com/files/287143/original/file-20190807-84240-1kugd6f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Queenslanders are drinking heavily when they go out and breathalyser tests show most don't realise how drunk they are.</span> </figcaption></figure><p><em>This is the second in a <a href="https://theconversation.com/au/topics/quantem-74665">series of articles</a> discussing a <a href="http://statements.qld.gov.au/Statement/2019/7/26/evaluation-of-measures-to-tackle-alcoholfuelled-violence">recently released</a> <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">comprehensive evaluation</a> of the Queensland government’s <a href="https://www.legislation.qld.gov.au/view/html/asmade/act-2016-004#">2016 policy reforms to tackle alcohol-fuelled violence</a> and the implications for liquor regulation and the night-time economy in Queensland and Australia. A <a href="http://quantem.info/">summary report</a> is also available.</em></p>
<hr>
<p><a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">Our evaluation</a> of the Queensland government’s 2016 “<a href="https://www.thepremier.qld.gov.au/newsroom/alcohol-fuelled-violence.aspx">Tackling Alcohol-Fuelled Violence</a>” (TAFV) policy has found Queenslanders are still drinking more heavily than people in other states when going out at night. </p>
<p>Despite <a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">significant reductions in serious assaults and other health-related outcomes</a>, reported levels of aggression are also high. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">Lessons from Queensland on alcohol, violence and the night-time economy</a>
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<p>Queenslanders report much higher levels of aggression than reported in our previous studies, which asked the same question in <a href="http://www.deakinvpg.info/dashed">Canberra, Hobart</a>, <a href="http://www.deakinvpg.info/pointed">Melbourne, Sydney, Perth, Wollongong, Geelong</a> and <a href="http://www.deakinvpg.info/dante">Newcastle</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=331&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=331&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=331&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=416&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=416&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=416&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Table 1. Percentage of interviewees who report being involved in aggression in and around night-time entertainment precincts in the previous three months.</span>
<span class="attribution"><a class="source" href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Female patrons reported experiencing more of all types of aggression than men across all precincts. The next article in this series highlights the worrying number of women who experience unwanted sexual attention while out.</p>
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<p>
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Read more:
<a href="https://theconversation.com/unwanted-sexual-attention-plagues-young-women-going-out-at-night-121116">Unwanted sexual attention plagues young women going out at night</a>
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<p>To measure the impact of the 2016 policy changes on alcohol consumption, illicit drug use and aggression, our research teams conducted <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4811-9">street intercept surveys</a> on Saturday nights in Fortitude Valley (Brisbane), Surfers Paradise and Cairns between 2016 and 2018. All participants were breathalysed. Every fifth person was invited to participate in a saliva drug swab. </p>
<p>Across the precincts, 4,401 people – 57% of them male – completed surveys. </p>
<h2>Blood alcohol concentration (BAC)</h2>
<p>Half of patrons’ blood alcohol concentration (BAC in g/dL) readings were over 0.077 (the median value, with a range of 0.000-0.300) in Fortitude Valley, 0.086 (range 0.000-0.290) in Surfers Paradise and 0.087 (range 0.000-0.289) in Cairns. The highest reading, 0.300, is six times the legal driving limit.</p>
<p>These median BAC levels are much higher than other, previously studied cities. The results highlight the challenges of achieving change in Queensland’s drinking culture.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=277&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=277&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=277&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=348&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=348&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=348&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Table 2. Patrons’ median blood alcohol concentration (BAC in g/dL) and range of readings.</span>
<span class="attribution"><a class="source" href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Interestingly, most patrons are more drunk than they <em>think</em> they are. Before undertaking a breath test patrons were asked to guess their level of intoxication. For example, in Cairns, patrons’ median guess of their BAC reading was 0.070, compared to the measured median of 0.087. </p>
<h2>Pre-drinking</h2>
<p>High alcohol consumption when going out to night-time entertainment precincts includes <a href="https://academic.oup.com/alcalc/article/54/4/378/5486344">pre-drinking</a> (drinking at home before going out; also known as pre-gaming, pre-partying or pre-loading in other countries). As our research teams have documented <a href="http://www.deakinvpg.info/pointed">since 2012</a>, pre-drinking has continued to increase. </p>
<p>With 84% of all patrons reporting pre-drinking before going out, Queensland shows higher levels than in most other previously studied cities. </p>
<p>Overall, male patrons drank significantly more than female patrons when pre-drinking. In Fortitude Valley, though, female patrons were significantly more likely to pre-drink than males.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/womens-alcohol-consumption-catching-up-to-men-why-this-matters-67454">Women's alcohol consumption catching up to men: why this matters</a>
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<p>It’s a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12525">common belief</a> that patrons choose to pre-drink to avoid buying more expensive drinks while they’re out in bars or clubs. But we found patrons who reported pre-drinking were more likely to drink more heavily across the night. They also reported drinking for longer than those who did not pre-drink.</p>
<p><a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">Our report</a> also shows the rate of pre-drinking across the precincts remained mostly stable in the two years after the TAFV policy was introduced in 2016. This suggests it did not affect rates of pre-drinking.</p>
<h2>Illicit drug use</h2>
<p>Rates of self-reported illicit drug use varied between precincts, from 13% of patrons in Fortitude Valley to 25% of all patrons in Surfers Paradise.</p>
<p>Ecstasy was the most commonly used illicit substance reported by patrons (5.5%), followed by cannabis (4%).</p>
<p>Among those who completed saliva drug swabs, the most commonly detected substances were amphetamines in Fortitude Valley and Cairns. In Surfers Paradise, however, it was methamphetamine; with 23.5% of patrons interviewed in Surfers Paradise testing positive for the substance.</p>
<p>Although rates of illicit drug use fluctuated in the two years after the TAFV policy was introduced, overall rates remained largely stable. This indicates the policy did not result in a clear increase or decrease in illicit drug use.</p>
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<strong>
Read more:
<a href="https://theconversation.com/fact-check-only-drugs-and-alcohol-together-cause-violence-12466">Fact check: only drugs and alcohol together cause violence</a>
</strong>
</em>
</p>
<hr>
<h2>So what does it all mean?</h2>
<p>Historically, Queensland has high levels of harmful consumption of alcohol, especially in high-risk groups. Around <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2017-18%7EMain%20Features%7EAlcohol%20consumption%7E100">46% of Queenslanders</a> have exceeded single-occasion risk guidelines in the past year, higher than in New South Wales and Victoria. </p>
<p>There has been significant investment in education campaigns across social media and in schools. Despite this, Queenslanders continue to show hazardous levels of alcohol consumption, illicit drug use and experiences of aggression. </p>
<p>Changing cultural patterns relating to pre-drinking and alcohol-related harms will not be easy. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12274">Previous research</a> suggests further tightening of licensed venues’ trading hours will help. Our report recommendations include introducing a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26098040">minimum unit price on alcohol</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19594797">promoting low-risk drinking guidelines</a> at all points of sale across Queensland. </p>
<p>Our report also recommends trialling live music early in the night to try to bring people into entertainment districts earlier. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tighter-alcohol-licensing-hasnt-killed-live-music-but-its-harder-for-emerging-artists-121117">Tighter alcohol licensing hasn't killed live music, but it's harder for emerging artists</a>
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</em>
</p>
<hr>
<p>Despite the promising results of government policy efforts to date, our evaluation suggests the work to reduce alcohol-related harm across Queensland is not finished. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/factcheck-can-you-change-a-violent-drinking-culture-by-changing-how-people-drink-38426">FactCheck: can you change a violent drinking culture by changing how people drink?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/121115/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Ferris receives funding from from Australian Research Council and Australian National Health and Medical Research Council, grants from State (Tasmania, Victoria, Queensland) and Federal Governments, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, University of Queensland, National Institute of Health, Global Drug Survey. He is affiliated with the Global Drug Survey and the Queensland Mental Health Commission.</span></em></p><p class="fine-print"><em><span>Cheneal Puljevic was a member of the research team led by Deakin University (Peter Miller) and The University of Queensland (Jason Ferris) to evaluate the Queensland Government’s “Tackling Alcohol-Fuelled Violence” (TAFV) legislation.</span></em></p><p class="fine-print"><em><span>Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Central Australian Aboriginal Congress, Northern Territory government, Australian Rechabites Foundation, Northern Territory Primary Health Network, Lives Lived Well, Queensland government and Australian Drug Foundation, travel and related costs from Queensland Police Service, Queensland Office of Liquor Gaming and Racing and the Australasian Drug Strategy Conference. He has acted as a paid expert witness on behalf of a licensed venue and a security firm. </span></em></p><p class="fine-print"><em><span>Barbara Wood does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even after ‘Tackling Alcohol-Fuelled Violence’ policies took effect in 2016, Queenslanders still drink more heavily on nights out. Reported levels of aggression are higher than in other states too.Jason Ferris, Associate Professor, Program Leader for Research and Statistical Support Service and Program Leader for Substance Use and Mental Health, Centre for Health Services Research, The University of QueenslandBarbara Wood, Research Assistant, The University of QueenslandCheneal Puljević, Research Fellow, Centre for Health Services Research, The University of QueenslandPeter Miller, Professor of Violence Prevention and Addiction Studies, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/909212018-02-08T05:44:32Z2018-02-08T05:44:32ZDoes a sugar tax cause alcohol sales to spike? The research doesn’t give a decisive answer<figure><img src="https://images.theconversation.com/files/204690/original/file-20180204-19948-1j8cqgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's no direct evidence that taxing sugary drinks will lead to more consumption of alcohol.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Consuming sugar-sweetened drinks is associated with a <a href="https://theconversation.com/health-check-how-much-sugar-is-it-ok-to-eat-57345">range of health issues</a> including weight gain and obesity. These are risk factors for diabetes, heart disease, high blood pressure, strokes and certain cancers. </p>
<p>Taxing these drinks is an <a href="https://theconversation.com/taxing-sugary-drinks-would-boost-productivity-not-just-health-79410">effective means of reducing their consumption</a> and related health issues – as well as generating revenue for the government.</p>
<p>A recent study in the <a href="http://jech.bmj.com/content/early/2018/01/11/jech-2017-209791">Journal of Epidemiology and Community </a> set out to test whether a sugar tax might impact on other behaviours affecting public health, along with whether such a tax would prompt people to choose no- or low-calorie drinks.</p>
<p>The researchers ended up finding an <em>association</em> between higher soft-drink prices and higher demand for some alcoholic beverages in terms of family food and drink purchases. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/clearing-up-confusion-between-correlation-and-causation-30761">Clearing up confusion between correlation and causation</a>
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</em>
</p>
<hr>
<p>They did not find that a sugar tax, let alone higher soft drink prices, <em>caused</em> people to drink more lager, as <a href="http://www.dailymail.co.uk/health/article-5302821/Sugar-tax-soft-drinks-drive-alcohol-consumption.html">news reports suggest</a>. In fact, the study provided no direct evidence a sugar tax will lead alcohol sales to increase. </p>
<h2>How was the study conducted?</h2>
<p>In this study, researchers from the London School of Hygiene & Tropical Medicine estimated elasticity of demand on non-alcoholic and alcoholic drinks in the UK, based on households’ response to price differences in sugary drinks. </p>
<p>They used existing consumer survey expenditure data collected between 2012 and 2013 from nearly 32,000 households. </p>
<p>Households recorded their individual groceries and drinks they had purchased and brought home using scanned bar codes (or manually entered them if there was no bar code). The researchers tracked how much the household spent, where they purchased, the day of purchase and volume of beverage purchased. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">Australian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives</a>
</strong>
</em>
</p>
<hr>
<p>They didn’t track consumption, or drinks which were bought and consumed elsewhere (for instance, in a bar or at a tuckshop), just the purchase of these products. </p>
<p>The researchers then compared how much one family bought and brought home of each beverage type when faced with a particular set of prices, against how much another family bought of each beverage type with a different set of prices. </p>
<h2>What were the results?</h2>
<p>The results were mixed, with variations between beverage types and income groups. There were several key outcomes.</p>
<p>In families where the price paid for high sugar-sweetened beverages such as Coke and Red Bull was higher, there were greater purchases of lager (such as Stella Artois, Beck’s or Corona), but less purchasing of spirits. </p>
<p>Where the price paid for medium sugar-sweetened drinks (including Fanta, Sprite and Powerade) was higher, there were fewer purchases of beer, lager and wines, but more of spirits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sugar-tax-is-not-nanny-state-its-sound-public-policy-59059">Sugar tax is not nanny state, it's sound public policy</a>
</strong>
</em>
</p>
<hr>
<p>Higher prices for diet or low sugar-sweetened drinks were associated with higher purchases of all alcoholic beverages except spirits, for which purchases were less. </p>
<p>Taking into account also relationships with other categories of drinks, the study concludes that a price increase for medium sugar-sweetened drinks would have the most significant positive impact from a public health perspective, given the drinks’ impact on dietary sugar and energy intake.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The amount of alcohol bought and drank outside of the home wasn’t taken into account in the study.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/AMwYylKQsUc">Photo by Julia Nastogadka on Unsplash</a></span>
</figcaption>
</figure>
<h2>How we should read the results</h2>
<p>In principle, elasticity is about what happens over time when there is a change – such as a new tax – which results in a higher price. </p>
<p>But the study was not actually measuring the effects of change in price over time. Rather, it correlated how much one family bought of each beverage type when faced with a particular set of prices against how much another family bought of each beverage type with a different set of prices. </p>
<p>But because the study isn’t actually measuring and correlating the change that elasticities would measure – a new tax and the change in consumption over time – it offers no direct evidence of what would happen in case of a change like a new tax, and should not be interpreted as having done so.</p>
<p>It is commonplace in economics to estimate elasticities this way, as a kind of modelling of what might happen with an actual price change, so it is not wrong for the authors to follow this common procedure. We just need to be careful how we interpret the results. </p>
<p>The study results indicate that an increase in the price of sugar-sweetened drinks potentially has both positive and negative impacts, from a public health perspective, on the consumption of alcoholic beverages. It suggests more nuanced price options across different ranges of beverages should be considered rather than a single tax only on high-sugar-sweetened beverages. </p>
<h2>What else should we take into account?</h2>
<p>The study’s measure of the amount of alcoholic beverages purchased was the number of bottles/containers of alcohol purchased – not the total units of pure alcohol (standard drinks) purchased. The demand for alcohol may not be accurately measured given different alcoholic beverages have different alcohol strengths and are in different sizes of containers.</p>
<p>And while the study looked at relationships between prices of sugar-sweetened drinks and consumption of other non-alcoholic and alcoholic drinks, the impact on other sugary products was not taken into account. For instance, <a href="https://www.sciencedirect.com/science/article/pii/S1570677X15000611">previous studies</a> suggest higher prices of sugar-sweetened drinks may have people substituting their sugar intake through things like sweets. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-sugary-drinks-tax-could-recoup-some-of-the-costs-of-obesity-while-preventing-it-69052">A sugary drinks tax could recoup some of the costs of obesity while preventing it</a>
</strong>
</em>
</p>
<hr>
<h2>The paper’s unspoken contribution: counting the calories in alcoholic drinks</h2>
<p>The paper takes for granted that the calories in alcohol drinks count when thinking about avoiding obesity. But alcohol is often overlooked when we are thinking about calories and obesity. </p>
<p>And it is not easy for consumers to take the calories in alcohol drinks into account. Unlike for every other packaged food or drink sold in Australia, the caloric content does not have to be listed on the label of alcoholic beverages. So one important contribution of the article is to underline that, aside from being intoxicating, alcoholic beverages are also high in calories.</p>
<p>As the paper points out, a bottle of lager beer contains slightly more calories than a can of Coca-Cola. This means arguments for discouraging obesity with a tax on drinks might well be directed at alcohol content as well as sugar content.</p><img src="https://counter.theconversation.com/content/90921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research centre Robin Room heads receives funding from federal government research bodies, the Foundation for Alcohol Research and Education, VicHealth, Australian state government commissions, the U.S. National Institutes of Health and the World Health Organization.</span></em></p><p class="fine-print"><em><span>The research centre Heng Jiang works for receives funding from federal government research bodies, the Foundation for Alcohol Research and Education, VicHealth, Australian state government commissions, the U.S. National Institutes of Health and the World Health Organization.</span></em></p>A recent study was reported as saying a sugar tax would have us drinking more alcohol. But the study didn’t establish this fact. The results were mixed with no evidence one thing caused another.Robin Room, Professor, Centre for Alcohol Policy Research, La Trobe UniversityHeng Jiang, Research Fellow, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/817512017-09-04T20:10:38Z2017-09-04T20:10:38ZHedonism not only leads to binge drinking, it’s part of the solution<figure><img src="https://images.theconversation.com/files/184303/original/file-20170901-2020-1j54niu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hedonism and pleasure is what drives much binge drinking. So let's provide people with alternative ways of having fun, but without the alcohol.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/701390977?src=U-oR1Gbf0XRP-rVEEzlkSw-1-65&size=huge_jpg">from www.shutterstock.com</a></span></figcaption></figure><p><em>This is the second article in our three-part series on <a href="https://theconversation.com/au/topics/hedonism-and-health-41470">hedonism and health</a>. Today, we look at the complex relationship between hedonism and binge drinking – part cause, part solution.</em></p>
<hr>
<p>Hedonism – the pursuit of pleasure, enjoyment, or fun – might sound like a strange way to tackle binge drinking. After all, we usually associate hedonism with triggering binge drinking in the first place.</p>
<p>While hedonism is associated with <a href="http://journals.sagepub.com/doi/10.1177/1741659005057641">self-obsession and “doing one’s own thing” without considering the consequences</a>, there’s more to it.</p>
<p>Researchers looking at why people binge drink have found hedonism can be used to reduce drinking rates.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/beer-bongs-and-baby-boomers-the-unlikely-tale-of-drug-and-alcohol-use-in-the-over-50s-82753">Beer, bongs and baby boomers: the unlikely tale of drug and alcohol use in the over 50s</a>
</strong>
</em>
</p>
<hr>
<h2>How drinking can be pleasurable</h2>
<p>Drinking in Australia is a cultural pastime that dates back to the 1700s where it was a way of <a href="http://library.la84.org/SportsLibrary/SportingTraditions/1993/st0902/st0902c.pdf">dealing with the boredom and restrictions of everyday life</a>. We may even owe our Aussie accent to the <a href="http://www.theage.com.au/comment/the-fourth-r-missing-from-australian-education-20151025-gkhv8k.html">drunkard slur in the convict voice</a>.</p>
<p>Since then, researchers have looked at what leads people to drink, including hedonistic reasons, like fun and playfulness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184305/original/file-20170901-23986-wkjy3y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinking with friends helps people bond, relax after a hard week and provide stories to tell afterwards.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/600583274?src=_BiEfT5jnUMkXnIUVnpCwg-1-8&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>There are many reasons why people drink today. But just like the convicts before them, people can drink because they’re bored or don’t have any <a href="https://eprints.qut.edu.au/83729/">entertaining alternatives</a>. Hedonic drinking allows people to <a href="http://journals.sagepub.com/doi/10.1177/1741659005057641">“let go” and indulge without thinking about the risks or consequences</a>.</p>
<p>Binge drinking with other people increases pleasure so drinking with friends is more pleasurable than drinking alone. Drinking in a group can make people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748736/">feel euphoric</a>, a very enjoyable feeling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/feeling-euphoric-on-a-low-carb-diet-the-effect-on-your-brain-is-similar-to-an-illicit-drug-76303">Feeling euphoric on a low-carb diet? The effect on your brain is similar to an illicit drug</a>
</strong>
</em>
</p>
<hr>
<p>Drinking also <a href="http://www.sciencedirect.com/science/article/pii/S0277953616301344">relaxes people, increases momentary feelings of happiness</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1521-0391.2013.00316.x/full">reduces inhibitions</a>. One of the people interviewed for an <a href="https://eprints.qut.edu.au/72910/">international study</a> about binge drinking said:</p>
<blockquote>
<p>I think people start drinking on a night out to “lubricate” conversation and to make them feel more relaxed. It takes away nerves of talking to the opposite sex and helps to lose inhibitions about dancing, singing, etc. It also helps people forget about current stresses in their life - none of these seem to matter when you’re drunk. So it serves as escapism from the daily grind.</p>
</blockquote>
<p>Binge drinking can also increase the overall social experience by providing <a href="http://russellwebster.com/Context%20of%20underage%20drinking.pdf">stories to tell friends</a> (or to post on social media) afterwards.</p>
<p>While alcohol isn’t seen as a necessary part of a social occasion, it can enhance <a href="https://eprints.qut.edu.au/83729/">pleasure</a> through social connectedness and intimacy.</p>
<p>People also drink to get drunk on purpose as a form of “<a href="http://www.ijdp.org/article/S0955-3959(07)00209-5/abstract">calculated hedonism</a>”. This helps people chill out or de-stress after a difficult week of work or study. And in an example of how people can moderate their hedonism, if people have a commitment the day after a night out, they are <a href="https://eprints.qut.edu.au/83729/">less likely to binge drink</a>.</p>
<h2>Using hedonism to tackle binge drinking</h2>
<p>So, if hedonism motivates binge drinking what else could also provide this hedonistic benefit? What alternatives could we provide to meet the hedonistic needs of social connectedness, relaxation and happiness?</p>
<p>That’s where the field of <a href="http://www.aasm.org.au/">social marketing</a> comes in. Social marketing uses familiar marketing concepts (traditionally used, for instance, to market consumer goods) to improve social problems.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=306&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=306&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=306&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=385&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=385&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184314/original/file-20170901-21670-5aqe7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=385&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Traditional marketing sells alcohol. But social marketing can make it easier and desirable for people to drink responsibly, or to abstain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/691578403?src=L3_iQzoZCEZbXM5UiMAaQg-1-30&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>So in the case of binge drinking, social marketers create the <a href="http://www.jstor.org/stable/1251972">motivation, opportunity and the ability</a> to drink moderately or abstain.</p>
<p>There have been several successful examples of campaigns or strategies that have met people’s hedonistic needs, but without drinking.</p>
<p>The <a href="http://thensmc.com/resources/showcase/sub21">SUB21 campaign</a> in the UK designs activities for young people such as nail art, bicycle repairs and BMX bike riding to come together and recreate that “Friday feeling” without drinking. This campaign reduced binge drinking levels, public drinking and alcohol purchases over a 12 month period.</p>
<p>Playing a game online or on your phone stimulates the <a href="https://www.psychologytoday.com/blog/the-compass-pleasure/201110/video-games-can-activate-the-brains-pleasure-circuits-0">pleasure centre of the brain</a> and provides hedonistic benefits through the release of the happy hormones (dopamine and serotonin).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pleasure-centre-how-video-games-affect-young-brains-4303">Pleasure centre: how video games affect young brains</a>
</strong>
</em>
</p>
<hr>
<p>So, designing a game that not only provides hedonistic benefits, but also needs low or no alcohol levels to succeed can promote behaviour change. </p>
<p>For instance, social marketers developed a game called <a href="http://www.tandfonline.com/doi/full/10.1080/10495142.2014.988081">Risky Ride</a> for high-school students to demonstrate the effects of drinking on physical ability and control. This reduced their intentions to binge drink.</p>
<p>Then there are campaigns that tap into the fact that alcohol reduces inhibitions and allows people to have fun because they don’t care what people think. Creating a non-judgemental environment can do the same. </p>
<p>For instance, the <a href="http://nolightsnolycra.com/the-nlnl-story">No Lights No Lycra</a> dance community uses dim lighting and unpretentious venues to allow people to express themselves through dance.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/DzdXemuyBTg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The No Lights No Lycra movement provides opportunities for letting yourself go, but without the alcohol or the self-consciousness.</span></figcaption>
</figure>
<p>And the <a href="https://www.hellosundaymorning.org/">Hello Sunday Morning</a> program has online and social media channels to help people share moderate drinking experiences with friends. </p>
<p>So hedonism can not only fuel binge drinking, by providing alternative pathways to pleasure, it can also help tackle the problem. Social marketing can work alongside alcohol regulation, policy and health promotion advertising to look for innovative ways of meeting hedonistic needs with reduced or no alcohol. </p>
<p>Business and social enterprise can also get involved as opportunities will arise for goods and services linked to these innovative ways of having fun without binge drinking.</p>
<hr>
<p><em>Read other articles in our hedonism and health series:</em></p>
<p><em><a href="https://theconversation.com/what-is-hedonism-and-how-does-it-affect-your-health-78040">What is hedonism and how does it affect your health?</a></em></p>
<p><em><a href="https://theconversation.com/why-we-remember-our-youth-as-one-big-hedonistic-party-78995">Why we remember our youth as one big hedonistic party</a></em></p><img src="https://counter.theconversation.com/content/81751/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hedonism has a complex relationship with binge drinking – part cause, part solution. Here’s why.Rebekah Russell-Bennett, Social Marketing Professor, School of Advertising, Marketing and Public Relations, Queensland University of TechnologyRyan McAndrew, Social Marketer & Market Researcher, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/803242017-08-01T02:43:10Z2017-08-01T02:43:10ZBottleshops affect people’s health, so our laws need to reflect that<figure><img src="https://images.theconversation.com/files/176714/original/file-20170704-7743-lz50qf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bottleshops affect the health and well-being of people across the suburb, not just the health of people who buy the alcohol.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/468197348?src=W-DofKvtWqLEfLTIiy-AVg-1-13&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>When a new alcohol supermarket opens up in your neighbourhood you might think it’s a great place to get a cheap bottle of wine. But what if one is set to open in a disadvantaged area with a high number of existing outlets, high rates of alcohol-related crime and domestic violence?</p>
<p>Bottleshops aren’t like other shops. There’s growing evidence their <a href="https://www.saxinstitute.org.au/wp-content/uploads/Community-impact-of-liquor-licences-1.pdf">location and density</a> influences the health and well-being of the people in surrounding areas, particularly in disadvantaged areas.</p>
<p>Yet, <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12666/pdf">our research reveals</a> when liquor licences and development applications for new bottleshops are considered in court, their public health impact is seldom taken into account.</p>
<h2>What if there are lots of other bottleshops nearby?</h2>
<p>The 20% of Australians who live in the poorest areas are <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129556756">1.6 times as likely</a> as the richest 20% to have two or more chronic health conditions like heart disease and diabetes. Yet bottleshops are disproportionately located in <a href="https://www.ncbi.nlm.nih.gov/pubmed/22313705">areas of socioeconomic disadvantage</a>, potentially adding to the disease burden of an already disadvantaged area.</p>
<p>Local communities with higher densities of alcohol outlets tend to have <a href="http://www.sciencedirect.com/science/article/pii/S1353829215000349#bib45">poorer health</a>, with much higher rates of hospitalisations and premature deaths, particularly due to cirrhosis (long-term liver damage). The link is stronger in poorer communities.</p>
<p>Conversely, research by <a href="http://preventioncentre.org.au/">a colleague</a> shows people who do not have bottleshops within 800 metres of their home <a href="http://onlinelibrary.wiley.com/doi/10.1111/dar.12341/full">say their health is better</a> than the health of people who live closer to a bottleshop.</p>
<p>Competition between nearby outlets – and the <a href="https://academic.oup.com/alcalc/article/44/5/500/182556/Hours-and-Days-of-Sale-and-Density-of-Alcohol">extended opening hours</a>, increased visibility of outlets and <a href="http://www.sciencedirect.com/science/article/pii/S1054139X07002984">exposure to alcohol advertising</a> – that often goes with it can increase alcohol consumption.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179726/original/file-20170725-30134-qy06og.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Clusters of bottleshops often lead to extended opening hours as outlets compete.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/501889456?src=yuelOVBrP9czMKoaYMjKoA-1-42&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>The clustering of outlets can also encourage outlets to compete on price and promotions for cheaper and greater quantities of alcohol. Such promotions can lead to anti-social behaviour such as <a href="https://www.newcastle.gov.uk/sites/default/files/wwwfileroot/business/licences/statement_of_licensing_policy_2013-2018_final.pdf">alcohol-related injury and violence</a>. Researchers see this in both rich and poor areas.</p>
<p>Increasing the density of alcohol outlets <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03333.x/full">exacerbates domestic violence</a> in the postcode area, which we see across all areas, but with higher rates in areas of socioeconomic disadvantage.</p>
<p>And there’s a <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03333.x/full">stronger association</a> between outlet density and violence in general in socioeconomically disadvantaged areas compared to other areas.</p>
<p>There are also different effects depending on how the alcohol is sold. For example, a high density of alcohol outlets (which includes large and small bottleshops, clubs and pubs) is strongly related to <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2010.00251.x/full">alcohol-related chronic disease</a>. Meanwhile increases in the number of licenses for bottleshops are associated with <a>increases in rates of domestic violence</a>. We see this across the board, not just in poorer areas.</p>
<h2>How about Indigenous communities?</h2>
<p>The health consequences of alcohol availability is an issue that cuts across Indigenous and non-Indigenous populations.</p>
<p>Indigenous people are <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/ch8/#t8_3">more likely to abstain from drinking</a> than non-Indigenous people (28% versus 22%). Yet Indigenous people disproportionately experience alcohol abuse and alcohol-related harms. Alcohol use is associated with <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter756Oct+2010">7% of all deaths and 6% of the total burden of disease</a> experienced by Indigenous Australians compared with <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129555476">5% of the burden of disease</a> in the general population.</p>
<p>Our research has shown restricting alcohol in Indigenous communities, where community-led, <a href="http://bmjopen.bmj.com/content/7/3/e013932">is generally effective</a> in improving health and social outcomes including disease, injury and crime.</p>
<h2>How do new bottleshops get approval?</h2>
<p>Despite the growing evidence of the detrimental effects of increasing alcohol outlet density, particularly in disadvantaged areas, bottleshops continue to be built in communities already struggling with the harms of drinking.</p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12666/pdf">Our research shows</a> when development applications for new alcohol outlets are rejected, groups with vested interests, such as the alcohol industry, take local governments to court and win – even in cases where there have been hundreds of community submissions opposing the developments.</p>
<p>In 77% of cases we looked at from 2010 to June 2015, the alcohol industry was successful in having local planning decisions overturned in court, and the proposals went ahead.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179556/original/file-20170725-6656-1rip1u7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dan Murphy’s opened up an alcohol supermarket in Nowra, NSW, despite community opposition.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=80hSkQ4-wA5N8j4U-R-eDQ-1-0">Nils Versemann/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>This was the situation for the community of East Nowra in New South Wales. The local government, Shoalhaven City Council, community members, family support services and local police joined together to <a href="http://www.dailytelegraph.com.au/shoalhaven-council-to-ban-dan-murphys/news-story/02139737c2399a977d9c57c4bc178fce?sv=31c837c8e38ac78c683fdd6f96132212">oppose the development</a> of a 1,400 square metre Dan Murphy’s (owned by Woolworths) liquor store over fears the community’s health and social problems would be made worse by making cheap alcohol more accessible. Yet, the local government’s decision to reject the proposal <a href="http://www.southcoastregister.com.au/story/402668/dan-murphys-campaign-costs-council-500000/">was overturned in court</a> and the outlet went ahead.</p>
<p>This type of situation is possible because existing policies and legislation that control approvals for liquor licences and bottleshop development applications seldom consider the public health impacts. Rather, they focus on economic imperatives, zoning, planning requirements and amenity (how attractive or pleasant a development is likely to be).</p>
<h2>What we’d like to see</h2>
<p>To reduce the public health impacts of alcohol outlets in local communities, planning law and policy in all jurisdictions need to consider health and social impacts, as is already the case in the Australian Capital Territory, South Australia and Queensland.</p>
<p>Our results suggest this approach has resulted in fewer cases where the alcohol industry has local government decisions overturned in court.</p>
<p>These provisions would empower the courts to make decisions good for the public health of their communities. They could also help protect the authority and autonomy of local governments to reject industry proposals that do not promote the health and well-being of their constituents.</p><img src="https://counter.theconversation.com/content/80324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janani Muhunthan receives PhD Scholarship funding from The Australian Prevention Partnership Centre.</span></em></p><p class="fine-print"><em><span>Andrew Wilson is Director of the the Australian Prevention Partnership Centre which is funded by the NHMRC, the Australian Department of Health, the HCF Health and Medical Research Foundation and the NSW and ACT Ministries of Health. He is a member of the Public Health Association of Australia. </span></em></p><p class="fine-print"><em><span>Stephen Jan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s growing evidence the location and density of bottleshops influences the health and well-being of locals, particularly in disadvantaged areas.Janani Shanthosh, PhD candidate, George Institute for Global HealthAndrew Wilson, Co-Director, Menzies Centre for Health Policy, University of SydneyStephen Jan, Head of Health Economics and Process Evaluation Program, George Institute for Global HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/799872017-06-30T02:59:27Z2017-06-30T02:59:27ZYes, alcohol awareness campaigns like Dry July can work, but not for everyone<figure><img src="https://images.theconversation.com/files/175525/original/file-20170626-4483-sacrkm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Giving up alcohol for a month might help you feel better in the short term, but no-one knows if taking part in these campaigns promotes long-term healthy drinking habits.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/611435279?src=proDhzL0Q32rU7IhsjhxLg-1-8&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>July on the doorstep means many people will be taking their last drinks until August.</p>
<p>Australia’s <a href="https://www.dryjuly.com/">Dry July</a> annual campaign to raise funds for people affected by cancer is about to begin and thousands have pledged to abstain for the month. </p>
<p>Dry July and similar campaigns – <a href="http://febfast.org.au/">FebFast</a>, <a href="http://www.ocsober.com.au/">Ocsober</a>, <a href="https://www.alcoholconcern.org.uk/dry-january">Dry January</a> and <a href="http://www.onthedry.ie/">On The Dry</a> – say they raise awareness about alcohol and aim to positively influence our drinking culture, while raising money for charity. </p>
<p>Given these campaigns started when concern about <a href="https://theconversation.com/au/topics/binge-drinking-1550">binge drinking</a> was peaking around 2008, they are sometimes referred to as exercises in <a href="http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11483546">binge sobriety</a>.</p>
<p>However, do these campaigns change an individual’s drinking habit or a society’s drinking culture? Or are they just novel fundraisers?</p>
<p>The evidence is mixed. While these campaigns can provide some health benefits to you and the people around you, they don’t target binge drinking. And no-one has looked at their long-term benefits.</p>
<h2>The history of giving up alcohol</h2>
<p>Going without alcohol is now seen as a sacrifice worthy of a charitable pledge, but this <a href="https://theconversation.com/a-brief-history-of-alcohol-consumption-in-australia-10580">was not always so</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=893&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=893&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=893&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1122&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1122&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175527/original/file-20170626-28085-1mqgky5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1122&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women’s Holy War: this political cartoon from 1874 features temperance campaigners (alcohol prohibition advocates) as virtuous, armoured warriors.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?search=Temperance+league&title=Special:Search&profile=default&fulltext=1&uselang=en&searchToken=6nu7p933n72h9y4tw9ywkk5ok#/media/File:Womans-Holy-War.jpg">Currier & Ives/US Library of Congress/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Temperance leagues associated with Protestant churches <a href="https://theconversation.com/the-enemy-within-the-battle-over-alcohol-in-world-war-i-30441?sr=1">were popular</a> throughout the English-speaking world in the 19th and early 20th centuries. These groups required members to pledge lifelong sobriety and lobbied governments to restrict the sale of alcohol. </p>
<p>As these movements waned following the repeal of <a href="https://prohibition.osu.edu/">prohibition</a> in the US in 1933, the funding, research and policy focus of governments and public health officials shifted to dependent drinkers. </p>
<p>The medical community first made dependent drinkers objects of medical concern and then <a href="https://theconversation.com/curing-addiction-twelve-steps-or-fixing-the-brain-10557?sr=1">self-help groups</a> gained in prominence and argued total sobriety was the only way to manage problem drinking. </p>
<p>Once problem drinking came to be more widely accepted as an <a href="https://theconversation.com/viewpoints-is-addiction-a-disease-63113?sr=4">addiction</a>, accessing alcohol became easier as governments were satisfied problem drinking was a minority issue and the majority were responsible, moderate drinkers. </p>
<p>Only when public concern over the ubiquity of alcohol and aspects of binge drinking in Australia reached a <a href="http://www.tandfonline.com/doi/full/10.1080/10304312.2016.1231786">crisis point</a> in 2008 did total, albeit temporary, sobriety re-emerge as a solution to society’s alcohol problems.</p>
<h2>What do today’s campaigns have in common?</h2>
<p>Temporary sobriety initiatives are aimed at the <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">majority of the population</a> (roughly 80%) who drink, including those who drink at very risky levels (18%), but are not dependent on alcohol. </p>
<p>Their emphasis on health and philanthropy attracts <a href="http://www.tandfonline.com/doi/full/10.1080/10304312.2016.1231786">participants</a> who see themselves as somewhat health conscious, and are often middle to upper-middle class people in their mid-30s to late 40s.</p>
<p>Although people have been giving up alcohol for set periods of time formally and informally for many years and in many locations, Australia’s FebFast began the modern trend of philanthropic 30-day campaigns in 2008. The two other Australian initiatives (Dry July and Ocsober) were launched later the same year. <a href="http://www.tipaton.fi/">Finnish</a>, <a href="http://www.cancerresearchuk.org/support-us/find-an-event/charity-challenges/dryathlon">British</a>, <a href="http://www.onthedry.ie/">Irish</a> and <a href="http://defi28jours.com/en/">Québécois</a> versions followed.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=283&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=283&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=283&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=356&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=356&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175526/original/file-20170626-4488-1ibt92y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=356&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ireland has its ‘On the Dry’ campaign.</span>
<span class="attribution"><span class="source">On The Dry/www.onthedry.ie</span></span>
</figcaption>
</figure>
<p>Most capitalise on New Year’s resolutions, being held in January (or for those who need a second shot, in February), but <a href="https://www.gosober.org.uk/">October events</a> are also held. </p>
<p>The month-long format and philanthropic link are common, as are 24-hour passes that can be purchased to authorise drinking, for instance for a special occasion.</p>
<p><a href="https://www.hellosundaymorning.org/">Hello Sunday Morning</a>, an independent Australian initiative, promotes a longer commitment but requires neither total sobriety, nor fundraising. Instead it uses <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2014-dutton086.htm">digital communication</a>, including some paid personal coaching services, to support at-risk drinkers to be more mindful about their consumption. </p>
<p>Campaigns vary in their focus, some prioritising philanthropy, others health promotion and these differences affect how the organisations measure success: dollars raised, numbers of participants or reported behaviour change.</p>
<h2>Can you feel the health benefits?</h2>
<p>Taking a month-long break from alcohol can in the short term <a href="http://www.nature.com/nrgastro/journal/v13/n4/full/nrgastro.2016.39.html">improve your liver function</a>, help you <a href="https://www.vichealth.vic.gov.au/media-and-resources/publications/evaluation-of-the-impact-of-febfast-participation">lose weight and improve your sleep</a>. It also reduces your likelihood of drinking as much over the next <a href="http://psycnet.apa.org/journals/hea/35/3/281/">six months</a>.</p>
<p>For people who often give up alcohol for a month for health and well-being reasons, these outcomes are likely to count as success.</p>
<p><a href="http://journals.sagepub.com/doi/abs/10.1177/1363459315600772">Various</a> <a href="http://psycnet.apa.org/journals/hea/35/3/281/">studies</a> also point to short- to medium-term benefits, such as weight loss, better sleep, more energy and improved liver function. Such benefits can even extend to those around them, with a sort of <a href="http://journals.sagepub.com/doi/abs/10.1177/1363459315600772">halo effect</a> because drinking is often a social activity that relies on more than one drinker. </p>
<p>However, campaigns don’t strictly measure success in these terms. Some aim to change drinking cultures, with various success. </p>
<p>They <a href="http://www.tandfonline.com/doi/abs/10.1080/10304312.2016.1231786">do not influence the kind of problem drinkers</a>, such as young (and potentially violent) binge drinkers and <a href="https://theconversation.com/older-australians-drinking-on-the-rise-and-they-dont-know-the-risks-50660">older daily drinkers</a>, who make the headlines. </p>
<p>But they make it easier for people to choose not to drink because they have <a href="https://research-repository.griffith.edu.au/bitstream/handle/10072/49570/84395_1.pdf%3Bsequence=1">normalised the option of not drinking</a>. And the more popular these campaigns become, the more socially acceptable it is to abstain. </p>
<p>Such campaigns also allow people who usually drink without too much thought to consciously <a href="http://journals.sagepub.com/doi/abs/10.1177/1363459315600772">observe the effects of alcohol</a> on their health, productivity, mood and relationships.</p>
<h2>The recipe for a good campaign</h2>
<p>The Australian model for binge sobriety has been replicated faithfully in different countries. This suggests there are certain factors key to success, including a campaign:</p>
<ul>
<li><p>well-known enough to provide a legitimate excuse to not drink (during the month and even afterward) </p></li>
<li><p>with accountability measures (pledges contingent upon sobriety, a supportive network of participants) </p></li>
<li><p>timed for periods of relative restraint (like after the holidays) or not typically associated with events involving alcohol (summer vacations, sport grand finals)</p></li>
<li><p>with the flexibility to opt out for a special occasion, and</p></li>
<li><p>including communication strategies like text messages and even suggestive participant feedback surveys that encourage participants to see sobriety as positive.</p></li>
</ul>
<h2>How about their long-term benefits?</h2>
<p>Population level studies have yet to be done to determine if a month-long campaign of not drinking influences people’s drinking levels beyond a year. But significant numbers of <a href="http://journals.sagepub.com/doi/abs/10.1177/1363459315600772">repeat participants</a> from year to year – a boon for fundraising and participant numbers – suggest a mere month of sobriety does not lead to radical behaviour change.</p>
<p>Research that looks not just at the long-term outcomes of a month of sobriety, but also the factors that make these campaigns successful, will be the key to understanding how related campaigns can tackle <a href="http://febfast.org.au/febfast-you-pick/">other health behaviours</a>, like sugar and caffeine consumption or smoking.</p>
<hr>
<p><em>The article has been updated to say people have been giving up alcohol for set periods of time with and without formal campaigns. However, Australia’s FebFast began the modern trend of philanthropic 30-day campaigns in 2008.</em></p><img src="https://counter.theconversation.com/content/79987/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Robert does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many of us might be tempted to give up alcohol for a month as part of a highly publicised campaign, like Dry July. But how successful are these campaigns and how do you measure any long-term benefits?Julie Robert, Senior lecturer, School of International Studies, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/674542016-10-24T22:33:52Z2016-10-24T22:33:52ZWomen’s alcohol consumption catching up to men: why this matters<figure><img src="https://images.theconversation.com/files/142989/original/image-20161024-28380-wrtsvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alcohol use is traditionally higher among men than women but new evidence suggests this is changing.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Women are catching up to men in rates of alcohol consumption and this has important implications for how we think about our community response to harmful alcohol use.</p>
<p>Historically, men have been more likely to drink alcohol than women and to drink in quantities that damage their health. However, evidence points to a significant shift in the drinking landscape with <a href="http://www.sciencedirect.com/science/article/pii/S0376871607003559">rates of alcohol use appearing to converge</a> among men and women born more recently. In a bid to quantify this trend, <a href="http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2016-011827">we pooled data</a> from 68 studies in 36 countries with a total sample size of over four million men and women.</p>
<p>All of the studies we looked at reported data on both men’s and women’s drinking across at least two time periods. Some data were available from men and women born in the early 1900s, other data from men and women born in the late 1900s, but each data point represented the ratio of men’s to women’s alcohol use for those born within a specific five-year time window. Taken together we were able to map ratios across the entire period from as early as 1891 right up to the year 2000 and everything in between. </p>
<p>We grouped data according to three broad definitions: any alcohol use (in other words being a drinker or not), problematic alcohol use (binge or heavy episodic drinking) and alcohol-related harms (negative consequences as a result of drinking such as accidents or injuries or a diagnosis of an alcohol use disorder).</p>
<p>What we found was that the gap between the sexes has narrowed over time. Among cohorts born in the early 1900s men were just over two times more likely than women to drink, three times more likely to drink in ways suggesting problematic alcohol use and three-and-a-half times more likely to experience alcohol-related harms. </p>
<p>Among those born in the late 1900s these ratios had decreased to almost one. This means that by the end of the last century men’s and women’s drinking had almost reached parity.</p>
<p>We did not seek to quantify by how much alcohol use is falling among men and/or increasing among women. However, of the 42 studies that showed converging alcohol use, most reported this was driven by increases in the rates of female drinking. </p>
<p>A small proportion (5%) of the individual sex ratios was less than one, the majority of which came from cohorts born after 1981. This suggests women born after this time may, in fact, be drinking at <em>higher</em> rates and in <em>more</em> harmful ways than their male counterparts. </p>
<h2>What’s changed in the last 100 years?</h2>
<p>We don’t have a definitive answer to what has driven the rise in alcohol consumption among women but in many countries around the world we have seen substantial developments in broader social, cultural and economic factors for women and increasingly accepting societal norms around female drinking. </p>
<p>It is likely <a href="https://dx.doi.org/10.2147/SAR.S21343">sex differences in alcohol use are linked</a>, probably in complex ways, to these societal changes. Most people would argue these changes have been positive. However, increased exposure to alcohol for women also means increased exposure to the <a href="http://www.sciencedirect.com/science/article/pii/S0376871615016166">physical and mental health risks associated</a> with drinking too much.</p>
<p>Regardless of the reasons behind these changes, it’s clear alcohol use and associated problems are not problems that only affect men. </p>
<p>This matters because often the focus in the media and public debate is on young men and alcohol. It matters because universal prevention can be an effective strategy to reduce harmful alcohol use among women. It matters because, while women seek treatment for almost every other physical and mental health problem at higher rates than men, women who experience problems related to alcohol generally don’t seek treatment. </p>
<p>The sooner we structure our education campaigns as well as our prevention, early intervention and treatment programs around this notion, the better our community response to harmful alcohol use will be. </p>
<p>We need to ensure education campaigns addressing the harms of alcohol use are <a href="http://www.positivechoices.org.au">designed to appeal to both men and women</a>. We need to target adolescents before drinking patterns are entrenched and deliver high quality, evidence-based <a href="http://anp.sagepub.com/content/50/1/64.abstract">universal prevention and early intervention programs</a>. We need to reduce the structural barriers (such as cost and location) as well as negative attitudes that get in the way of women <a href="http://www.sciencedirect.com/science/article/pii/S0376871614019735">seeking treatment for alcohol problems</a>. </p>
<p>Many of the men and women who are contributing to these changing drinking patterns are only now in their 20s or 30s. We need to keep tracking population trends in drinking as these cohorts age into their 40s, 50s and beyond. We need to keep asking the question: how can we do better to prevent alcohol related harms?</p><img src="https://counter.theconversation.com/content/67454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Slade receives funding from the NHMRC, the ARC and the Australian government.</span></em></p><p class="fine-print"><em><span>Cath Chapman receives funding from the NHMRC and the Australian government.
</span></em></p><p class="fine-print"><em><span>Maree Teesson is a director of CLIMATESchools Pty Ltd. An Australian company that distributes evidence based educational materials to schools. She receives funding from the NHMRC, the Australian government and the NSW government.</span></em></p>Women are catching up to men in rates of alcohol consumption and this has important implications for how we think about our community response to harmful alcohol use.Tim Slade, Associate Professor, UNSW SydneyCath Chapman, Senior Research Fellow, UNSW SydneyMaree Teesson, Professor at the National Drug and Alcohol Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/598592016-05-31T15:22:37Z2016-05-31T15:22:37ZCutting alcohol ads in sport sends the right message to youngsters<figure><img src="https://images.theconversation.com/files/124630/original/image-20160531-1921-ab8fmf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent advert for South Africa's Castle Lager. </span> <span class="attribution"><a class="source" href="http://www.brandcouncilsa.org/case-studies/latest-case-studies/castle-lager-and-brand-union.aspx">Brandcouncil SA</a></span></figcaption></figure><p>An English barbershop owner and his son have embarked on a <a href="http://www.activeeurope.org/images/Outbid_Chang_-_When_a_local_barber_shop_stands_up_to_a_giant_beer_company_.pdf">massive David and Goliath battle</a> to outbid Thai beer Chang as the front-of-jersey sponsor of their local football team. </p>
<p>In what they call the <a href="https://www.indiegogo.com/projects/outbidchang--2#/">#OutbidChang campaign</a> they started a <a href="https://www.facebook.com/hashtag/outbidchang?source=feed_text&story_id=10154136129819898">crowd fund</a> to stop Everton Football Club in the UK from using the beer as its sponsor. Everton FC is the last soccer team in the English Premier League to be funded by an alcohol company.</p>
<p>The father and son duo argues that alcohol sponsorship fuels alcohol harm to children and that in the UK children are more familiar with alcohol brands than with brands of biscuits.</p>
<p>The campaign is being supported by <a href="http://www.bigalcohol.exposed/#campaign">BigAlcohol.Exposed</a> – a global network of non-governmental organisations dedicated to exposing the truth about the unethical business methods of the alcohol industry.</p>
<p>Whether the duo is indeed able to outbid Chang beer remains to be seen – but the cause is a valid one. </p>
<p>The reality is that in 2012, across the globe about 3.3 million deaths – or 5.9% of all deaths – were attributable to alcohol consumption. Alcohol ranks among the top five risk factors for disease, disability and death throughout the world, according to the <a href="http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1">World Health Organisation</a>. </p>
<p>It results in more than deaths than HIV/AIDS and TB, and is the causal factor in more than 60 major types of disease, including neuropsychiatric disorders like epilepsy, gastro-intestinal disorders such as liver cirrhosis, cancer, cardio-vascular diseases and diabetes. </p>
<p>There is no doubt that the abuse of alcohol is harmful. And it is clear that the harm is greater in countries where there is “harmful” or binge drinking. </p>
<p>South Africa is one of these countries. Despite the fact that 65% of adults do not drink, those who do, drink 35 <em>l</em> of absolute alcohol a year. This is among the highest <a href="http://tobaccoecon.org/wp-content/uploads/2014/03/alcohol-advertising-in-south-africa-a-trend-and-comparative-analysis.pdf">in the world</a>.</p>
<p>The expressed aim of any alcohol producing company is to make profit – and to do this the more that is sold, the better. In South Africa the spend on above-the-line advertising in 2012 was R1.8 billion (about US$114 million at current rates). And that excluded sponsorship and other marketing <a href="http://tobaccoecon.org/wp-content/uploads/2014/03/alcohol-advertising-in-south-africa-a-trend-and-comparative-analysis.pdf">opportunities</a>.</p>
<p>In the US alcohol advertisers spent $2 billion on alcohol advertising in measured media – television, radio, print, outdoor, major newspapers and Sunday supplements – <a href="http://www.camy.org/resources/fact-sheets/alcohol-advertising-and-youth/">in 2005</a>.</p>
<p>Because the adverts were placed in media the youth would likely engage with, US youth viewed 45% more beer ads and 27% more liquor ads in magazines than people of legal drinking age. They also watched an average of 2,000 television ads for alcohol per year. </p>
<p>There is <a href="http://www.aafp.org/about/policies/all/alcohol-advertising.html">extensive research</a> showing that young people who are exposed to alcohol advertising are more likely to intend to drink, start drinking at an early age and to drink more than those not exposed. </p>
<h2>Does banning advertising work?</h2>
<p>Unlike many harmful substances, alcohol is legal in most societies, and is freely advertised and promoted. This includes marketing and promoting excessive use, as seen through the creation of the six pack and 12 pack, promoting high rates of use. </p>
<p>But there is evidence that banning the advertising of a product does produce results. </p>
<p>Take tobacco advertising as an example. Cigarettes are more addictive than alcohol. And each year about <a href="http://www.who.int/mediacentre/factsheets/fs339/en/">six million people die</a> prematurely from tobacco-related illnesses. </p>
<p>A recent World Health Organisation <a href="http://apps.who.int/iris/bitstream/10665/156262/1/9789241564922_eng.pdf">report</a> found that in 2010 – seven years after the organisation introduced a tobacco monitoring framework that suggested advertising bans – there were 3.9 billion non-smokers aged 15 years and over in the organisation’s member states, or 78% of the 5.1 billion population aged over 15. This number is projected to rise to 5 billion – or 81% of the projected 6.1 billion population aged over 15 – by 2025 if the current pace of tobacco cessation continues.</p>
<p>And an analysis of advertising spend in 2001, when the tobacco advertising ban came into effect in South Africa, shows that economic growth was only 2.7% and advertising decreased by 7.4%. But by 2002 the adspend was back to the 2001 level as the industry found new ways to promote its product. It continued to grow until 2007 when it was approximately double the amount spent in 2002. </p>
<p>The lesson to learn with banning tobacco advertising is that there will always be products to jump into the breach and the industry will continue to grow.</p>
<h2>Sending the wrong message</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=345&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=345&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124634/original/image-20160531-1955-9c1lt6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=345&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A screengrab of an advert where South African cricketers AB De Villiers and Aaron Phangiso wear gear sponsored by an alcohol brand.</span>
</figcaption>
</figure>
<p>Many argue that, as alcohol is a legal substance, the industry must have the right to advertise. In recognition of the harm that the industry admits that alcohol causes, a voluntary code has been developed that the industry is supposed to adhere to.</p>
<p>This code is published on the web page of the <a href="http://www.asasa.org.za/">Advertising Standards Authority</a> of South Africa. One of the guidelines is that commercial communication may not imply that alcohol consumption is essential to business and/or social success or acceptance, or that refusal to consume is a sign of weakness.</p>
<p>What isn’t clear is how this guidance is interpreted, monitored or enforced. </p>
<p>As a result, for example, a leading beer brand in South Africa <a href="http://www.sab.co.za/sablimited/content/sab-carling-black-label">sponsors</a> several events – both in <a href="http://www.kickoff.com/news/65014/cblc-celebrates-the-voices-of-football-fans">sport</a> and entertainment – as well as many male-dominated cultural activities. One of its competitions – linked to a football event – asked participants to enter by buying a “pack” of beer. </p>
<p>Football is a major preoccupation of young boys. And although the industry argues that is it advertising to adults, all boys are encouraged to participate in and watch these sports. Information about these events is freely available to boys and girls under 18. </p>
<p>A <a href="http://www.tandfonline.com/doi/full/10.1080/10810730490271665">study</a> in the US has found that while 26% of young adults between the ages of 21 and 23 had seen an alcohol advertisement, 23% of 15- to 17-year-olds had also seen the same advert. They also found that young people who could accurately identify alcoholic products and who said they liked the ads were <a href="http://www.tandfonline.com/doi/full/10.1080/10810730490271665">more likely to try drinking</a> or to drink more.</p>
<p>In South Africa all three <a href="http://www.worldofbeer.co.za/content/page/sab-brands">predominantly male national sports</a> – football, rugby and cricket – are sponsored by alcohol.</p>
<p>Although the South African government in May 2015 gazetted a new <a href="http://www.gov.za/sites/www.gov.za/files/38808_gen446.pdf">National Liquor Policy</a> for comment recommending that alcohol advertising be restricted, and sponsorship and promotions associated with alcohol be prohibited, whether this will make it into the final legislation remains to be seen. </p>
<p>Considering South Africa’s high levels of alcohol abuse and harm, this would be a step in the right direction. Whether ordinary South Africans would take a similar stand to the English barbershop owner and his son and crowd fund an outbid campaign against liquor giants is another question.</p><img src="https://counter.theconversation.com/content/59859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Goldstein is affiliated with the Health Promotion Foundation organisation.</span></em></p>Removing alcohol brands as sponsors of sports events could help reduce the trend of young people drinking.Susan Goldstein, Honorary Senior Lecturer at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/534322016-01-20T02:34:56Z2016-01-20T02:34:56ZAlcohol companies target the 20% of Australians who drink 75% of the alcohol<figure><img src="https://images.theconversation.com/files/108667/original/image-20160120-10099-1is042h.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alcohol companies are aware some Australians drink to dangerous levels – and they target their marketing at them.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/128012202@N05/14969468914/">Traveljunction/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Researchers have known for a long time that alcohol consumption is quite concentrated in a small part of the population. They argue about the exact distribution, but there is substantial agreement that, so long as alcohol sales are not heavily restricted, consumption is distributed in a quite predictable way. That is, there are many light and moderate consumers, along with a long tail of those drinking at <a href="http://pophealthmetrics.biomedcentral.com/articles/10.1186/1478-7954-8-3">heavier levels</a>. </p>
<p>In Australia, the top 20% of the drinking-age population in 2013 consumed around three-quarters of all the alcohol consumed. The top 5% consumed <a href="http://www.fare.org.au/wp-content/uploads/research/Understanding-recent-trends-in-Australian-alcohol-consumption.pdf">more than a third</a>. </p>
<p>The concentration of alcohol consumption among the heaviest drinkers has actually increased in recent years. The top 10% of consumers accounted for 49% of the consumption in 2001, and this had increased to <a href="http://www.fare.org.au/wp-content/uploads/research/Understanding-recent-trends-in-Australian-alcohol-consumption.pdf">53% in 2013</a>.</p>
<p>The heaviest-drinking 20% of the population reported consuming a daily average equivalent to 43 grams of pure alcohol - a bit over four standard drinks. This is a substantial underestimate of their actual drinking. </p>
<p>The total amount of drinking reported in such surveys is calculated to be about <a href="http://www.ncbi.nlm.nih.gov/pubmed/25486405">55% of the alcohol sold</a> in Australia, so their actual daily average is likely to be about 7.8 drinks. This is nearly four times the low-risk limit of two standard drinks per day recommended by the <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf">National Health and Medical Research Council</a>. </p>
<h2>The dangers of alcohol</h2>
<p>If you drink enough alcohol, you get intoxicated, making you unfit for a lot of everyday activities. This includes, for instance, driving a car, most kinds of work or looking after children. Apart from these issues of injury and social functioning, alcohol also carries longer-term health risks.</p>
<p>At an average of four drinks per day, the <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf">chances of dying</a> of an alcohol-related cancer or other chronic disease are two in 100 for men and 2.5 in 100 for women. At 7.8 drinks a day, the chances are about five in 100 for men and eight in 100 for women. </p>
<p>Adding in risks of dying from alcohol-related injuries more than doubles the risk for men, and increases the risk for women by more than 50%. Just considering the risks of health and injury harms, alcohol is by far the <a href="http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0189-z">riskiest</a> commodity that a majority of us regularly consume. </p>
<p>The current guidelines “to reduce health risks from drinking alcohol” set upper limits <a href="http://www.ncbi.nlm.nih.gov/pubmed/22168584">calculated</a> on lifetime death risks from drinking. These are around four times the rate National Road Safety Strategy aims for as an upper limit of lifetime rate of deaths from traffic collisions. They contrast, for instance, with the National Health and Medical Research Council <a href="http://www.nhmrc.gov.au/guidelines-publications/eh34">(NHMRC) guidelines on water safety</a>, which aim to keep the risk of death from contaminated drinking water below one in a million. </p>
<h2>Alcohol marketing</h2>
<p>Those in the business of selling alcohol have long known about the skewed distribution of alcohol consumption in the population. In meetings among people in the industry, those at the top end of the distribution are called the “<a href="http://www.fare.org.au/2016/01/risky-business-the-alcohol-industrys-dependence-on-australias-heaviest-drinkers/">super consumers</a>”, and they are vital to maintaining or increasing sales. </p>
<p>If all the “super consumers” reduced their drinking to the two-drinks-a-day average recommended by the NHMRC as an upper limit, it has been calculated, <a href="http://www.fare.org.au/2016/01/risky-business-the-alcohol-industrys-dependence-on-australias-heaviest-drinkers/">based on self-reported consumption</a>, that alcohol sales would fall by 39%. </p>
<p>In its public face, the alcohol industry takes the line that it is only seeking to protect and promote “<a href="http://www.championsdrinkresponsibly.com/lda/">responsible drinking</a>”: how to “<a href="https://drinkwise.org.au/drinking-and-you/drinking-do-it-properly/#">drink properly</a>”, minimising risks of harm. </p>
<p>But, in its internal discussions of the need for retailers to “<a href="http://www.fare.org.au/2016/01/risky-business-the-alcohol-industrys-dependence-on-australias-heaviest-drinkers/">identify and target super consumers</a>”, the industry is acknowledging a large part of its sales are to drinkers who are taking substantial risks with their own lives and the lives of those around them. If all drinkers in Australia were to drink within the government guidelines for low-risk drinking, the alcohol market would shrink substantially. </p>
<p>If governments want to reduce alcohol-related harms, they can’t rely on the industry’s commitment to responsible drinking. It’s directly against the industry’s interests for the heaviest drinkers (who make up the majority of their sales) to drink less. </p>
<p>Given this inherent conflict, policymakers should focus on well-evaluated policies such as reduced late-night trading hours for pubs and nightclubs and smarter taxation of alcoholic products. Most importantly, governments should be sceptical of working in partnership with an industry whose interests are diametrically opposed to public health.</p>
<hr>
<p><em>Update: incorrect figures for the chances of dying of an alcohol-related cancer or other chronic disease were corrected.</em></p><img src="https://counter.theconversation.com/content/53432/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robin Room receives funding from NHMRC, ARC, Healthway (WA), VicHealth (Vic.), US National Institutes of Health, Foundation for Alcohol Research and Education (FARE).
He represents his research group on the Alcohol Policy Coalition (Victoria), and has been on the coordinating committee of the National Alliance for Action on Alcohol, a public health-oriented coalition. He is chair of the board of the Australian Rechabite Foundation, a charitable foundation which supports research and community projects relevant to reducing alcohol related harm.</span></em></p><p class="fine-print"><em><span>Michael Livingston receives funding from the Foundation for Alcohol Research and Education, the National Health and Medical Research Council, the Australian Research Council, the Victorian Health Promotion Foundation and the Sax Institute. Michael Livingston is a board member of the Australian Rechabite Foundation, a charitable foundation which supports research and community projects relevant to reducing alcohol related harm. The Centre for Alcohol Policy receives its core funding from the Foundation for Alcohol Research and Education. </span></em></p>If all the “super consumers” reduced their drinking to the recommended two-drinks-a-day average, alcohol sales would fall by 39%.Robin Room, Professor and Director, Centre for Alcohol Policy Research, La Trobe UniversityMichael Livingston, Post-Doctoral Research Fellow at The Centre for Alcohol Policy Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/510272015-12-21T20:04:38Z2015-12-21T20:04:38ZGot a hangover? Here’s what’s happening in your body<figure><img src="https://images.theconversation.com/files/106138/original/image-20151215-23182-1rkbkta.jpg?ixlib=rb-1.1.0&rect=0%2C79%2C1024%2C603&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If the only liquid you consume is alcoholic, you'll become dehydrated, especially in warmer climates.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ktoine/5341059530/">Antoine K/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>It’s that time of year when we raise a glass to celebrate Christmas, the beginning of holidays, the new year, or simply to join with our friends. Many of us will pay a price, even if it’s “just” in the form of a hangover. </p>
<p>Hangovers affect people in <a href="http://onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstract;jsessionid=8643AABEBB9949578BC8193DD89C5C51.f01t02http:/onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstract;jsessionid=8643AABEBB9949578BC8193DD89C5C51.f01t02">different ways</a>, ranging from simple discomfort to such a debilitating experience you vow to “never drink again!”. Symptoms, of course, include nausea, tiredness, dehydration and, very commonly, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00694.x/abstracthttp:/onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00694.x/abstract">a pounding head</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/106141/original/image-20151215-23172-41uvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/106141/original/image-20151215-23172-41uvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=904&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106141/original/image-20151215-23172-41uvhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=904&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106141/original/image-20151215-23172-41uvhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=904&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106141/original/image-20151215-23172-41uvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1135&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106141/original/image-20151215-23172-41uvhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1135&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106141/original/image-20151215-23172-41uvhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1135&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Never drinking again?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/brossiekoppie/1433385024/">PeterVermaercke/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Hangover headaches have multiple <a href="http://onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstracthttp:/onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstract">potential causes</a>. These include electrolyte imbalances, vasodilation (widening of blood vessels) and effects on various hormones and neurotransmitters that have been linked to the experience of a headache. </p>
<p>Why does drinking too much <a href="https:/www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf">leave you feeling</a> so rotten?</p>
<p>Alcohol has a <a href="http://onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstracthttp:/onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstract">diuretic effect</a>, which makes you need to urinate more frequently. If the only liquid you consume is alcoholic, you’ll become dehydrated, especially in warmer climates. </p>
<p>So make sure you are hydrated before you start, don’t slake your thirst with alcohol, and alternate alcoholic drinks with water. </p>
<p>But beware – water is <em>not</em> the cure for a hangover. It will help prevent dehydration, but there are other culprits for that morning-after feeling.</p>
<p>Drinking more, drinking quickly and drinking on an empty stomach will all ensure a higher blood alcohol level. That means more intoxication and a greater risk of hangover (and perhaps that dreadful question of “did I really call my ex at 4am?” or “did I really say that to my boss?”). </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/106140/original/image-20151215-23172-8l1rik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/106140/original/image-20151215-23172-8l1rik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106140/original/image-20151215-23172-8l1rik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106140/original/image-20151215-23172-8l1rik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106140/original/image-20151215-23172-8l1rik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106140/original/image-20151215-23172-8l1rik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106140/original/image-20151215-23172-8l1rik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Going drink for drink will catch up with you.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/simon_cocks/4922320119/">Simon Cocks/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Going “drink for drink” with someone bigger than you will mean you will have a higher blood alcohol level than them.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2125562/">Some researchers argue</a> peak blood alcohol level is <em>not</em> the key contributor to hangovers. Alcohol is metabolised into acetaldehyde, which is toxic (it can cause flushing, nausea and significant discomfort) and then into less harmful products that are eliminated. They <a href="http://www.mineralmed.com.pt/documentos/pdf/b2067e6f-4a87-4647-a32e-0593821831a3.pdf">conclude</a> that acetaldehyde is a <a href="http://onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstract">key suspect</a> in hangovers, even though it has largely been metabolised by the time a hangover really kicks in.</p>
<p>Heavy drinking also results in poor sleep. Alcohol is a soporific and many of us fall asleep more quickly after drinking. But we are <a href="http:/onlinelibrary.wiley.com/doi/10.1002/hup.1023/abstract">less likely</a> to get the quality rapid eye movement sleep required to wake feeling refreshed. </p>
<p>Compounding this, alcohol can affect the respiratory system, potentially contributing to snoring; the diuretic effects may mean you need to make frequent visits to the toilet; and gastric irritation from drinking too much contributes to feeling sick.</p>
<p>Some of us are more sensitive to certain beverages. This may be because of chemicals called <a href="http:/www.ncbi.nlm.nih.gov/pmc/articles/PMC3674844/">congeners</a>, which are products of the fermentation process. Congeners contribute to the taste and colour of a drink; they might also contribute to the severity of a hangover. Darker drinks, such as red wine, bourbon, brandy and whisky, are generally higher in congeners than, for example, white wine and vodka, and this might mean worse hangovers. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/106139/original/image-20151215-23210-uk8hur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/106139/original/image-20151215-23210-uk8hur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106139/original/image-20151215-23210-uk8hur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106139/original/image-20151215-23210-uk8hur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106139/original/image-20151215-23210-uk8hur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106139/original/image-20151215-23210-uk8hur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106139/original/image-20151215-23210-uk8hur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Darker drinks are generally higher in congeners.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/71284893@N00/4317577251/">boo lee/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>You might also be particularly susceptible to preservatives used in some alcoholic products. But preservative-free doesn’t mean hangover-free.</p>
<p>Common wisdom is that you shouldn’t mix your drinks. There isn’t some mysterious chemical process at play: mixing your drinks is more likely to be accompanied by simply drinking more. Another myth is that your hangover was caused by that final drink, but those preceding it made their accumulating contribution.</p>
<p>If, like me, you are no longer the youngest in the room, you might experience more <a href="http:/onlinelibrary.wiley.com/doi/10.1111/acer.12238/full">severe hangovers</a>. As you age, the proportion of water and muscle tissue in your body decreases. This can influence how long alcohol stays in your body and how it affects you: the same amount of alcohol will have more effect on you as you age. </p>
<p>You might also find sleep more easily disturbed. And some medications might be associated with particular risks. Check with your doctor and pharmacist.</p>
<p>Finally, you might not just be feeling bad – a severe hangover can leave you impaired. You might not be safe to drive or operate machinery the following day. </p>
<p>Unfortunately, despite some well-publicised claims, <a href="http://www.bmj.com/content/335/7633/1288.short">there is no “cure”</a> for hangovers. A hangover is your body’s way of saying you drank too much. Prevent it by drinking less alcohol, ensuring you’re hydrated and only drinking alcohol with or after food.</p><img src="https://counter.theconversation.com/content/51027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steve Allsop receives funding from Department of Health, Australian Government, WA Government, NHMRC, Curtin University. </span></em></p>Why does drinking too much leave you feeling so rotten?Steve Allsop, Professor and Director, National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/435672015-08-14T03:57:24Z2015-08-14T03:57:24ZWhat needs to be done to end South Africa’s status as a nation of heavy drinkers<figure><img src="https://images.theconversation.com/files/91595/original/image-20150812-18080-2joitb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africans consume more than five billion litres of alcohol each year. The Department of Trade and Industry is introducing a new alcohol policy to change the country's drinking habits.</span> <span class="attribution"><span class="source">Sara Hylton/Reuters </span></span></figcaption></figure><p>Globally, there has been an increase in the amount of alcohol being consumed. <a href="http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf">Research</a> suggests that this trend is driven by an increase in drinking in India and China. In Africa, the alcohol consumption trend has not increased since 2006. </p>
<p>South Africa, however, has some of the worst drinking habits in the world. While only 60% of South Africans drink alcohol – higher than the worldwide average of 52% – the level of alcohol consumed amounts to each citizen drinking between ten and 12.4 litres of pure alcohol a year. Worldwide consumption is, on average, <a href="http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf">6.2 litres</a>.</p>
<p>Alcohol is estimated to cost South Africa <a href="http://www.scielo.org.za/scielo.php?pid=S0256-95742014000200023&script=sci_arttext">R37.9 billion</a> annually. This includes costs around health care, crime and social welfare, alcohol treatment and prevention and road traffic accidents. And this does not include intangible costs such as premature morbidity, morality and absenteeism from work. </p>
<h2>South Africa’s new liquor laws</h2>
<p>Alcohol is a legal substance, used in a reasonably safe manner by some South Africans. It is also an industry that creates employment along the value chain. The question the country faces is: how can the harm associated with alcohol be mitigated?</p>
<p>In May, Trade and Industry Minister Rob Davies gazetted a new <a href="http://www.gov.za/sites/www.gov.za/files/38808_gen446.pdf">policy</a> for public comment. The policy recommends:</p>
<ul>
<li><p>increasing the drinking age from 18 to 21;</p></li>
<li><p>stipulating that premises selling alcohol have to be 500m away from schools, churches, recreational and rehabilitation facilities; and</p></li>
<li><p>restricting alcohol advertising as well as prohibiting sponsorship and promotions associated with alcohol.</p></li>
</ul>
<p>According to minister’s <a href="http://www.gov.za/sites/www.gov.za/files/38808_gen446.pdf">discussion paper</a> there are more than 230,000 liquor outlets across the country and South Africans consume more than five billion litres of alcohol each year. Foetal alcohol syndrome cases in South Africa increased from between 41 and 46 for ever 1000 children in 1997 to between 75 and 74 for every 1000 children in 1999. Separately, 46% of people who died in accidents had alcohol in their bloodstream, equal or above the legal drinking limit.</p>
<h2>Global interventions that work</h2>
<p>Globally, there are a basket of interventions that have shown to decrease the harmful use of alcohol. These include: </p>
<ul>
<li><p>increasing the price which particularly affects young people who are price sensitive;</p></li>
<li><p>banning advertising and sponsorship of alcohol; and </p></li>
<li><p>restricting trading by imposing limits on when and where alcohol is sold.</p></li>
</ul>
<p>According to the <a href="http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf">World Health Organisation</a>, these three intervention are considered “best buys” as they are highly cost-effective in reducing alcohol-attributable deaths and disabilities. </p>
<p>In addition, changing how alcohol is sold can also mitigate harm. For example, selling food where alcohol is sold, serving soft drinks and water in addition to alcohol and ensuring adequate lighting, space and security all decrease incidents of violence. Refusing to serve drunk people has also been found to mitigate the harm of alcohol. </p>
<h2>What would work in South Africa</h2>
<p>In South Africa, similar interventions could be beneficial on many fronts, especially as the interventions are aimed at decreasing alcohol consumption and changing drinking behaviour. </p>
<p>The challenge for South Africa is that there are both regulated and unregulated alcohol outlets on every corner, and often near every school. The drunkenness spills out into the street, with violence hovering over ordinary people’s lives. Drinking places are unsuitable for children to live near, but that is exactly where they live and go to school. </p>
<p>Many argue that given the high number of unregulated outlets it would be impossible to police safer drinking places. Raising the cost of alcohol, which is also a very effective way to decrease adolescent drinking, and earmarking that money for alcohol control could be a way this to solve this. </p>
<p>Increasing the age at which a person can legally drink is an excellent option in a country where there is such a high road accident morbidity and mortality of drivers and pedestrians. The lethal combination of getting a driver’s licence and drinking alcohol is best delayed until the brain is a bit more mature.</p>
<p>And restrictions on advertising and sponsorship would go a long way to contributing to the denormalisation of drunkenness in our society – something that has to be done to create a society in which alcohol doesn’t wreak the havoc it does in South Africa. </p>
<h2>The power of the industry</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many of the national sports teams are sponsored by alcohol brands, such as Castle Lager.</span>
<span class="attribution"><span class="source">Anthony Phelps/Reuters</span></span>
</figcaption>
</figure>
<p>The alcohol industry has a direct interest in increasing the amount of alcohol consumed. It argues that it is each person’s responsibility to decrease harm around alcohol.</p>
<p>The industry is also behind a number of campaigns aimed at reducing the harmful effects of alcohol consumption. But some are directed at the wrong problem while others are misplaced.</p>
<p>For example, its contribution to educating people around the harmful effects of alcohol takes the form of promoting the dangers of <a href="http://www.sab.co.za/sablimited/content/underage-drinking-programme">underage drinking</a>, foetal alcohol syndrome and drinking and driving. But these interventions account for less than 25% of alcohol-attributable harm in South Africa – and will not affect their <a href="https://www.thedti.gov.za/business_regulation/docs/nla/other_pdfs/dna_economics_nla_act.pdf">bottom lines</a>. </p>
<p>The industry focuses on <a href="http://www.ara.co.za/family-and-teenagers/alcohol-intake-during-pregnancy/">foetal alcohol syndrome</a> by promoting messages that pregnant women should not drink. But it is missing the point. The greatest harm that alcohol does to the foetus is in the first eight weeks of a pregnancy when most women are not aware that they are <a href="http://www.cdc.gov/ncbddd/fasd/documents/redalcohpreg.pdf">pregnant</a>. To address foetal alcohol syndrome, binge drinking among young girls and women needs to decrease. And the use of contraception should be promoted. </p>
<p>While the focus on drinking and driving will mitigate harm, the <a href="http://www.ara.co.za/projects/member-campaigns/castle-designated-driver-campaign-kicks-drunk-driving-to-the-curb/">“designated driver approach”</a> suggests that drinking too much is accepted as long as you do not get behind the wheel. Many advertisements normalise this behaviour.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/4N8pNq1Mav0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Some drunk driving adverts promote drinking as long as you have a designated driver.</span></figcaption>
</figure>
<p>Despite these campaigns, the industry pours huge amounts of money into sports <a href="http://www.worldofbeer.co.za/content/page/sab-brands">sponsorship</a> through rugby, soccer and cricket. Various teams are sponsored by South African breweries. It has also invented alcopops to persuade young people – particularly boys – that alcohol is desirable. </p>
<p>The reality is that South Africa must take steps to address alcohol-related harm. This can improve safety at the population level as well as redirect much needed resources to the fiscus.</p><img src="https://counter.theconversation.com/content/43567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Goldstein receives funding from the Department of Health, The Centre for Diseases Control and the Global Fund for HIV, AIDS, Malaria and TB Control through Soul City Institute</span></em></p>With South Africa’s consumption levels higher than the worldwide average, interventions to change the country’s drinking habits are critical.Susan Goldstein, Honorary Senior Lecturer at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.