tag:theconversation.com,2011:/us/topics/alcohol-labelling-1478/articlesAlcohol labelling – The Conversation2015-04-29T04:40:16Ztag:theconversation.com,2011:article/374032015-04-29T04:40:16Z2015-04-29T04:40:16ZThink before you drink: alcohol’s calories end up on your waistline<figure><img src="https://images.theconversation.com/files/79666/original/image-20150429-7073-ud1wsm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who drink alcohol may not be aware that they're getting a fair portion of their daily energy intake from alcohol.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/chandlercollins/9805395023">Chandler Collins/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Alcoholic drinks should all carry calorie counts according to a <a href="http://www.bmj.com/cgi/doi/10.1136/bmj.h2047">leading UK public health doctor writing in the BMJ</a> today, because of their contribution to obesity. Fiona Sim, Chair of the UK Royal Society for Public Health, writes that while adults who drink may be getting as much as 10% of their daily calories from alcohol, most people are unaware drinking contributes to their energy intake.</p>
<p>Although her data are from local surveys, Sims is absolutely right in highlighting the silent role of alcohol on weight gain. The lack of information about the energy content of alcoholic beverages is likely contributing to an underestimation of consumed energy.</p>
<p>Given the equilibrium between “energy in” and “energy out” is a constant balancing act when aiming for a healthy weight, it’s important to be aware that alcohol is worth almost as much as fat in terms of the energy it provides. And the best way to inform people of this is by highlighting the number of calories on the labels of alcoholic drinks.</p>
<h2>Digesting alcohol</h2>
<p>There are seven calories in every gram of alcohol. In comparison, a gram of carbohydrate or protein yields four calories, while one gram of fat has nine calories.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/79674/original/image-20150429-7114-1svqmc2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/79674/original/image-20150429-7114-1svqmc2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/79674/original/image-20150429-7114-1svqmc2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/79674/original/image-20150429-7114-1svqmc2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/79674/original/image-20150429-7114-1svqmc2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/79674/original/image-20150429-7114-1svqmc2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/79674/original/image-20150429-7114-1svqmc2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s important to be aware that alcohol is almost the equal of fat in terms of the energy it provides.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/suckamc/2643190902">Martin Cathrae/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>The amount of alcohol that gets stored in the body as fat rather than being used as immediate fuel depends on how <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484320/pdf/nihms-402840.pdf">much you drink</a>, the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484320/pdf/nihms-402840.pdf">availability of the vitamins and minerals needed to metabolise alcohol</a>, and how much fuel your body requires at the time. </p>
<p>About 20% of ingested alcohol is absorbed into the bloodstream from the stomach. The remaining 80% gets absorbed in the small intestine like food. This happens quite quickly as alcohol doesn’t need to be digested first.</p>
<p>Alcohol travels freely in the blood, which is why levels are tested by checking blood-alcohol concentration. It can’t be stored but spreads in body tissues and fluids - wherever water is present – until it’s metabolised. For the most part, this is done by the liver, although some alcohol metabolism occurs in the stomach too. </p>
<p><a href="http://ajcn.nutrition.org/content/62/5/1101S.full.pdf+html">Alcohol is metabolised as a priority</a> over other ingested <a href="http://ajcn.nutrition.org/content/54/6/976.full.pdf+html">energy-containing nutrients</a> because it’s a toxin. The estimated amount metabolised by the liver in an hour is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484320/pdf/nihms-402840.pdf">between seven and ten grams</a>. </p>
<h2>Calories everywhere</h2>
<p>The alcohol content of a beverage is indicated by percentage of the volume of pure alcohol contained in 100 millilitres of that drink. So a 375mL bottle of beer labelled 4.5% alcohol per volume contains 4.5mL of pure alcohol for every 100mL of beer. That’s 3.6 grams of alcohol in every 100mL and 13.5 grams in the bottle. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/79669/original/image-20150429-7069-yrhi5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/79669/original/image-20150429-7069-yrhi5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/79669/original/image-20150429-7069-yrhi5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/79669/original/image-20150429-7069-yrhi5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/79669/original/image-20150429-7069-yrhi5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/79669/original/image-20150429-7069-yrhi5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/79669/original/image-20150429-7069-yrhi5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you’re sharing a bottle of wine with your partner at dinner, you’ve had 300 calories even before you start to consider the energy content of your first bite.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/isante/5057195715">Emiliano De Laurentiis/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>The energy in an alcoholic beverage includes the calories from the alcohol itself, as well as additional non-fermented starch and sugar in beer and wine, or added sugar in mixers, such as the tonic in a gin and tonic.</p>
<p>A 150mL glass of red wine with 14% alcohol <a href="http://www.calorieking.com.au/">contains on average 120 calories</a>; a bottle, which is 750mL, contains 600. So, if you’re sharing a bottle of wine with your partner at dinner, you’ve had 300 calories even before you start to consider the energy content of your first bite. That’s the equivalent of a cup of chunky vegetable soup, a slice of wholemeal bread with a teaspoon of butter, and two slices of prosciutto.</p>
<p><a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">Mixed drinks and cocktails contain at least 30mL (one nip)</a> of spirits and liquors, which have between 30% and 90% alcohol per volume, and soft drink, juice or sugar syrup. On average, a gin and tonic has about 140 calories, while a Margarita has around 170 and a Mohito comes in at approximately 145.</p>
<p>Premixed drinks are diluted to contain similar alcohol concentration to full-strength beer, but also contain a mixer, usually a soft drink, which boosts their calorie content.</p>
<h2>What you can do</h2>
<p>Given that the average woman needs around 2,300 calories a day while men need about 2,750, having a few drinks after work can add a substantial amount of “empty” energy to your day. It’s called empty calories because you’re supposed to get all the vitamins and minerals you need for good health while getting your daily estimated energy requirements. </p>
<p>You can do that with food but alcoholic beverages are nutrient-poor, or “nutrient empty”; they provide calories but insignificant amounts of vitamins or minerals. There are claims that beer and wine contain some nutrients but the amounts are so low that their impact is negligible.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/79670/original/image-20150429-7111-r0tho0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/79670/original/image-20150429-7111-r0tho0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/79670/original/image-20150429-7111-r0tho0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/79670/original/image-20150429-7111-r0tho0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/79670/original/image-20150429-7111-r0tho0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/79670/original/image-20150429-7111-r0tho0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/79670/original/image-20150429-7111-r0tho0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One way to minimise alcohol calories is to ask for unsweetened options for mixers.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/photographingtravis/15434133461">Travis Wise/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>So what can you do while waiting for governments to actually get around to mandating caloric information on the labels of alcoholic drink?</p>
<ol>
<li><p>Inform yourself of the energy content of alcoholic beverages by volume consumed and compare this with the energy content of food items.</p></li>
<li><p>Ask for unsweetened options for mixers, refill your glass with soda water before it’s empty and be aware of “on tap” alcohol content and the volume you order.</p></li>
<li><p>If you’re planning to drink, choose alcohol with the lowest number of calories. Choose light beers, for instance, and make low-alcohol cocktails at home by halving the nip of spirit and using diet soft drinks, carrot or tomato juice or sparkling water. There’s a variety of <a href="https://theconversation.com/light-wine-good-for-your-waistline-or-just-producers-bottom-line-13713">low-alcohol and lower-calorie wines</a> to choose from.</p></li>
<li><p>If you’re planning to drink alcohol, <a href="http://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">remove other “discretionary foods”</a>, such as chocolate bars, muffins and slices, from the day to keep your energy intake balanced.</p></li>
</ol>
<p>And, of course, always drink in moderation, because alcohol is toxic to your body.</p><img src="https://counter.theconversation.com/content/37403/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Veronique Chachay 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>A gram of alcohol has almost as many calories as the equivalent weight in fat. But most people who drink aren’t aware of the extra fuel they’re getting from alcohol.Veronique Chachay, Research & Teaching Academic , The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/259122014-04-28T20:29:46Z2014-04-28T20:29:46ZPowdered alcohol, seriously? A health risk we don’t need<figure><img src="https://images.theconversation.com/files/47095/original/wg3gkxw5-1398648443.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Consumers can very quickly ingest risky levels of alcohol.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-159063899/stock-photo-spoonful-of-baking-soda-and-glass-of-water.html?src=J0yfBomBjgbPBaE22PJI6w-1-48">jordache/Flickr</a></span></figcaption></figure><p>Opening a bottle and pouring liquid into a glass isn’t exactly an arduous task but a US company hopes to release a powdered variety to make consuming alcohol that little bit easier – and more portable. </p>
<p>Earlier this month, the company <a href="http://www.palcohol.com/home.html">Palcohol</a> gained regulatory approval to market powdered alcohol in the United States. The approval was subsequently rescinded because of a labelling discrepancy, but Palcohol has corrected the labels and reapplied, <a href="http://www.abc.net.au/news/2014-04-23/powdered-alcohol-concern-as-palcohol-plans-to-sell-in-us/5407090">hoping</a> the product will be on the market by September. </p>
<p>With <a href="http://www.electronicproducts.com/Packaging_and_Hardware/Prototyping_Tools_Equipment_Services/Turn_any_beverage_alcoholic_with_Palcohol.aspx">flavours</a> such as cosmopolitan and lemon drop, the product is <a href="https://theconversation.com/powdered-alcohol-will-appeal-to-young-drinkers-despite-what-the-makers-say-25935">clearly targeted</a> towards the alcopops market. But there are a number of obvious and hidden dangers that need to be considered before a product such as this should be made available in Australia.</p>
<h2>What is powdered alcohol?</h2>
<p>Drinking alcohol, or ethanol, is a highly volatile compound that boils under normal conditions at around 78 degrees Celsius; a lower temperature than water. As such, in its natural state, it’s impossible to produce in a powdered form. A solid form can be made only by freezing at minus 114 degrees but this turns back into a liquid as soon as you raise the temperature.</p>
<p>Instead, powdered alcohol is made using <a href="http://en.wikipedia.org/wiki/Host%E2%80%93guest_chemistry">host-guest chemistry</a> and a method for its production is described in <a href="http://www.google.com/patents/US3795747">several patents</a> from the 1970s. It’s not clear what method Palcohol uses, but it’s likely to trap the alcohol inside of a circular molecule called a cyclodextrin. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/47089/original/8mmx6phj-1398640210.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/47089/original/8mmx6phj-1398640210.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=587&fit=crop&dpr=1 600w, https://images.theconversation.com/files/47089/original/8mmx6phj-1398640210.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=587&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/47089/original/8mmx6phj-1398640210.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=587&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/47089/original/8mmx6phj-1398640210.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=738&fit=crop&dpr=1 754w, https://images.theconversation.com/files/47089/original/8mmx6phj-1398640210.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=738&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/47089/original/8mmx6phj-1398640210.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=738&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The structure of alpha-cyclodextrin. The cavity in the centre of the molecule is good for storing and releasing alcohol</span>
<span class="attribution"><span class="source">Nial Wheate</span></span>
</figcaption>
</figure>
<p>Cyclodextrins have a shape similar to an ice cream cone where the bottom half has been bitten off. The cavity inside the cyclodextrin is perfect for storing small molecules.</p>
<p>Cyclodextrins are used routinely in both medical products – such as the drug <a href="https://www.pfizer.com/files/products/uspi_caverject_impulse.pdf">alprostadil</a>, which is used to treat erectile dysfunction and <a href="http://labeling.pfizer.com/ShowLabeling.aspx?id=584">ziprasidone</a>, used to treat schizophrenia and bipolar disorder – and in household items like the odour-reducing spray <a href="http://chemistry.about.com/od/cleanerchemistry/f/how-febreze-works.htm">Febreeze</a>. In the past, my research group has even examined cyclodextrins as <a href="http://dx.doi.org/10.1021/ic800467c">potential delivery vehicles for anticancer drugs</a>. </p>
<p>When the alcohol is trapped in the cyclodextrin, it doesn’t evaporate and together, they can be turned into a stable powder.</p>
<h2>Misuse</h2>
<p>The product could be used in a number of ways other than the intended just-add-water preparation, such as snorting the dry powder into the nose. Many compounds can be <a href="http://informahealthcare.com/doi/abs/10.1517/17425247.2013.790887">absorbed into the body</a> from nasal tissue, such as antihistamine sprays to treat hay fever. Snorted alcohol has the potential to deliver alcohol to the brain without it having needing to go into systemic circulation in the blood stream. </p>
<p>We don’t know what the real risk of using alcohol in this way would be, as the research hasn’t been undertaken, but as a worse-case scenario the alcohol may significantly impair judgement and motor skills at levels far below those which normally give this effect. </p>
<p>In addition, snorting of any powders into the nasal cavity can cause severe irritation of the tissue leading to inflammation and bleeding. </p>
<p>One way for the company to address the misuse of their product in this way could be the inclusion of a bulking agent so that, gram per gram, each packet contains significantly less alcohol.</p>
<h2>Overindulgence</h2>
<p>The effects of alcohol and the damage it does to the body are well known, and the Australian government still advises that <a href="http://www.alcohol.gov.au/">there is no amount of alcohol that is safe</a> for everyone. The <a href="https://www.nhmrc.gov.au/your-health/alcohol-guidelines">national guidelines</a>, however, recommend women and men generally consume no more than two standard drinks per day to reduce their risk of alcohol-related disease, and no more than four drinks on a single occasion to minimise the risk of injury.</p>
<p>Despite years of advertising, education and the <a href="http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/drinksguide-cnt">standard drinks guide</a>, many adults are still unaware of how much alcohol is in different types of drinks like beer (3-10%), wine (8-15%) and spirits (15-40%) and therefore it can be easy for a person to drink more than they intended.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/47118/original/s5fpt8y9-1398658352.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/47118/original/s5fpt8y9-1398658352.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/47118/original/s5fpt8y9-1398658352.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/47118/original/s5fpt8y9-1398658352.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/47118/original/s5fpt8y9-1398658352.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/47118/original/s5fpt8y9-1398658352.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/47118/original/s5fpt8y9-1398658352.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">
<figcaption>
<span class="caption">There’s no amount of alcohol that’s safe for everyone.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/scragz/152636264">Jason Scragz/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>Given the ease with which powdered alcohol can be consumed compared with normal drinking volumes, consumers can very quickly ingest risky levels of alcohol. From the patents, the powdered alcohols contain anywhere between 30 to 60% ethanol. A 50 gram packet (half the size of a <a href="http://www.wizzfizz.com.au/Products">sherbert Wizz Fizz</a> pack), could contain as much as 30 grams of ethanol; that’s almost twice the alcohol content in a stubby or can of beer. </p>
<h2>Safety of ingredients</h2>
<p>Cyclodextrins are approved for human use and are <a href="http://www.fda.gov/food/ingredientspackaginglabeling/gras/default.htm">generally regarded as safe</a>, although one size of the molecule, called beta-cyclodextrin, is known to cause kidney damage when it is injected into the blood stream.</p>
<p>More worrying is the possibility of powdered alcohol to be adulterated if bought over the internet. Such sellers may add prescription drugs – as was the case with <a href="http://www.tga.gov.au/safety/alerts-medicine-moska-energy-140416.htm#.U1r_VlWSx8E">this energy drink</a> – or other unlisted ingredients to give their product an extra kick. These additives may pose serious dangers such as allergic reactions and overdoses. </p>
<p>Taking all of these potential dangers into consideration, the approval of any form of powdered alcohol in Australia needs to be considered very carefully before it is allowed for sale. </p>
<p><em><strong>Further reading:</strong></em></p>
<p><em><a href="https://theconversation.com/powdered-alcohol-will-appeal-to-young-drinkers-despite-what-the-makers-say-25935">Powdered alcohol will appeal to young drinkers, despite what the makers say</a></em></p>
<p><em><a href="https://theconversation.com/powdered-alcohol-and-space-diapers-have-something-in-common-25953">Powdered alcohol and space diapers have something in common</a></em></p><img src="https://counter.theconversation.com/content/25912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate 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>Opening a bottle and pouring liquid into a glass isn’t exactly an arduous task but a US company hopes to release a powdered variety to make consuming alcohol that little bit easier – and more portable…Nial Wheate, Senior Lecturer in Pharmaceutical Chemistry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/259352014-04-25T05:19:09Z2014-04-25T05:19:09ZPowdered alcohol will appeal to young drinkers, despite what the makers say<figure><img src="https://images.theconversation.com/files/47020/original/9wkrnd3t-1398346856.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mixed reactions.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/thomashawk/202734216/sizes/l">Thomas Hawk</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>The United States is on the verge of having powdered alcohol – in packets like Kool-aid but with the punch of a rum or vodka cocktail – on sale across the country. After <a href="http://www.iflscience.com/chemistry/powdered-alcohol-coming-us">much confusion</a>, Palcohol, which has seven flavours including Cosmopolitan and “Powderita” is on hold <a href="http://www.harpers.co.uk/news/us-approval-of-powdered-alcohol-in-doubt/356673.article">over problems with its labelling</a>.</p>
<p>There is a lot we don’t know about this form of alcohol (although a version was patented <a href="http://arstechnica.com/business/2014/04/powdered-alcohol-builds-on-60s-science-portability-and-reckless-youth/">as far back as 1964</a>), but we know enough about how many young people might receive it and the troubles that are likely to come from putting this kind of product on the market. The makers of Palcohol <a href="http://www.palcohol.com/home.html">have defended claims</a> that their product could be used as a sneaky way of avoiding high drinks prices in venues and that the idea came as a neat way of avoiding carrying booze after a day of physical activities. In reality, it could be used in all sorts of ways.</p>
<p>What we do know is that powdered alcohol will probably be particularly appealing to young people, judging from their demonstrated preference for flavoured alcohol (take alcopops for example), and alcoholic jello. Many adults never imagined that alcoholic jello would take off among youth, but we know <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153984/">from recent research</a> that these are not only popular, but also most popular among the kids who drink the most. Powdered alcohol is also easily concealable, which will make it more feasible for people who are underage to get hold of, travel with and consume, in both liquid and food form.</p>
<p>Palcohol’s makers appear to <a href="http://www.independent.co.uk/life-style/food-and-drink/news/palcohol-us-government-reveals-it-has-approved-powdered-alcohol-9273019.html">have been caught off guard</a> after the Alcohol Tobacco Tax and Trade Bureau (TTB) announced approval for the product. They hastily changed marketing for their product. Their website had suggested mixing it with guacamole (for “kamikaze guacamole”), salad or other foods as part of their plans to market the product while pointing out that this does not add flavor to the dish, just alcohol.</p>
<h2>What’s an average mixed drink?</h2>
<p>The producers of Palcohol suggest adding five ounces of liquid to make “one average mixed drink”. It isn’t too big a leap to suggest that drinkers will experiment with adding less liquid and using multiple packets to strengthen the effects – something you can’t do with a regular bottle of drink.</p>
<p>When it comes to alcohol consumption in its traditional liquid form there can be a <a href="http://www.ncbi.nlm.nih.gov/pubmed/12877310%20and%20http://apt.rcpsych.org/content/14/2/139.full">narrow margin of safety</a> before brain stem functions like breathing, heartbeat rhythm and the gagging reflex begin to shut down when large amounts are consumed over a short space of time, as the <a href="http://metro.co.uk/2014/02/17/fifth-person-dies-after-carrying-out-neknomination-that-involved-downing-two-pints-of-gin-4307557/">fallout from the Neknomination</a> craze has shown. When drinking over a two-hour time period brain stem function may be impaired for average sized men and women <a href="http://www.healthstatus.com/calculate/blood-alcohol-bac-calculator">respectively</a> at approximately 13 and 10 <a href="http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/standard-drink">standard drink</a> servings of alcohol. The National Institute on Alcohol Abuse and Alcoholism defines the threshold of low risk drinking as no more than four and three drinks in any one day and 14 and seven in any one week period for men and women <a href="http://rethinkingdrinking.niaaa.nih.gov/IsYourDrinkingPatternRisky/WhatsLowRiskDrinking.asp">respectively</a>. The possibility of consuming multiple packets could be dangerous.</p>
<p>Alcohol poisoning is already on the rise: hospitalisations of 18 to 24-year-olds related to alcohol overdoses in the US increased <a href="http://www.ncbi.nlm.nih.gov/pubmed/21906505">by 67% between 1999 and 2008</a>. The <a href="http://www.nbcnewyork.com/news/local/Teens-Alcohol-Poisoning-Drinking-Wiz-Khalifa-Concert-Jones-Beach-164935596.html">hospitalisation of 26 teens</a> aged 14 to 18 after loading up with drink before a Whiz Khalifa concert in New York shows that alcohol is already too accessible without making it available in packets that are easy to slip into a coat, a classroom or a concert. And of course, what better way to maximise the high than to add Palcohol to beverage alcohol, for at least twice the effect?</p>
<h2>Stealth intoxication</h2>
<p>The manufacturers have said they only promote responsible drinking, including asking people to make sure they find out whether they can take the product into venues. But we know very little about this new vehicle of alcohol delivery: is it easily detectable when added to other drinks? Could it be used as another form of stealth intoxication in a manner similar to other drugs used to facilitate sexual assaults, for example? If the company suggest adding it to food but say it doesn’t affect taste, does this up the chances of some unsuspecting person consuming it?</p>
<p>Experience in multiple countries with alcopops has shown <a href="http://www.palgrave-journals.com/jphp/journal/v26/n3/abs/3200037a.html">this type of product</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21517708">marketing attracts</a> young people at earlier ages, putting them at higher risk for addiction and other negative consequences than those who wait until they are older to drink.</p>
<p>In the US, regulation falls between a number of entities but the Treasury Department’s Alcohol Tobacco Tax and Trade Bureau (TTB) has the most power to regulate alcohol and control decisions through labelling and alcohol taxes. It is the agency that recently gave and then within days and without public explanation <a href="http://www.iflscience.com/chemistry/powdered-alcohol-coming-us">withdrew labelling approval</a> for Palcohol to go on the market. It is also possible that the Food and Drug Administration <a href="http://www.fda.gov/forconsumers/consumerupdates/ucm190364.htm">could prevent</a> Palcohol from going to market based on claims that it could be considered a food product or food additive. Given that Palcohol has never before been consumed or sold to the US public at large, it is unlikely the FDA would have considered it to be generally regarded as safe, the FDA’s standard for food safety. </p>
<p>The new, the cool, the tongue-in-cheek all appeal to younger people. Alcoholic powder would likely attract a similarly youthful and risk-taking customer base as did alcoholic jello, and the result might just be more drinking, more addiction, injuries and other adverse consequences to the drinkers as well as the people around them. </p><img src="https://counter.theconversation.com/content/25935/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Binakonsky 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>The United States is on the verge of having powdered alcohol – in packets like Kool-aid but with the punch of a rum or vodka cocktail – on sale across the country. After much confusion, Palcohol, which…Jane Binakonsky, Postdoctoral Fellow, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/162792013-07-24T04:37:55Z2013-07-24T04:37:55ZTrans-Pacific Partnership rules could block alcohol warnings<figure><img src="https://images.theconversation.com/files/27958/original/pk4hfxj9-1374637434.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Australian government appears to be contemplating signing a version of the agreement that would restrict its power to apply strong health warnings to alcohol products.</span> <span class="attribution"><span class="source">camknows/Flickr</span></span></figcaption></figure><p>New rules for alcohol labelling were discussed in Malaysia earlier this week by countries negotiating the <a href="http://www.dfat.gov.au/fta/tpp/">Trans-Pacific Partnership</a>. The proposed rules could stymie the introduction of effective health warnings on alcohol products in all the countries involved.</p>
<p>The Trans-Pacific Partnership is a regional trade agreement being negotiated between 12 Pacific Rim countries – Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, Vietnam and the United States. </p>
<p><a href="http://www.dfat.gov.au/fta/tpp/">Australia’s</a> representatives have high hopes for the agreement, seeing it as the pathway to a free-trade area in the Asia-Pacific that could rival the European Union in value.</p>
<p>But the talks have been highly controversial, in part due to concerns about the effects the pact could have on many areas of public health, such as access to medicines and tobacco control. </p>
<p>And news that the agreement’s proposed text includes an annex on the labelling of wine and distilled spirits is raising concerns among Australian alcohol policy and public health groups because it could block effective health warnings on alcohol containers.</p>
<h2>Curbing harm</h2>
<p>A matter of months after introducing the world’s first tobacco <a href="https://theconversation.com/topics/plain-packaging">plain packaging laws</a>, the Australian government appears to be contemplating signing a version of the agreement that would restrict its power to apply strong health warnings to alcohol products. </p>
<p>This apparent blind spot may be due to perceptions that alcohol is not an intrinsically harmful product and an important export commodity. Alcohol certainly has strong <a href="https://theconversation.com/a-brief-history-of-alcohol-consumption-in-australia-10580">cultural and social significance</a> in Australian society. </p>
<p>But its harmful use is associated with large-scale health, social and economic costs for our country. Indeed, the cost of alcohol’s harm to people other than the drinker was estimated in 2010 at <a href="http://www.fare.org.au/research-development/featured-research/alcohols-harm-to-others/">$36 billion a year</a>. </p>
<p>Having warning labels on alcoholic beverage containers is considered an effective way to reduce alcohol-related harm. </p>
<p>The <a href="http://www.who.int/substance_abuse/activities/gsrhua/en/">World Health Organisation</a> has recommended alcohol warning labels. So too have several <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/nphs-overview">Australian government inquiries</a>, which have emphasised that the government should mandate such warnings, rather than leaving it to the alcohol industry to voluntarily implement warnings. </p>
<p>The industry does not have a strong track record on labelling. In June 2011, the alcohol industry-funded body, DrinkWise, <a href="http://www.drinkwise.org.au/2011/07/new-consumer-messages-on-alcohol-products/">launched a voluntary system</a> of consumer information on alcohol labels. </p>
<p>A review undertaken 12 months later by the Foundation for Alcohol Research and Education found that only <a href="http://www.fare.org.au/wp-content/uploads/2011/07/FARE-Labelling-Market-Testing-Report.pdf?9d7bd4">16% of the 250 products sampled</a> carried any DrinkWise consumer messages.</p>
<p>Of the products that featured a DrinkWise message, the information took up less than 5% of the label or face of the packaging in 98% of cases. Only one product put the warning on the front of the bottle. Brewers also placed warnings on the bottom of six-packs and cartons of beer. </p>
<p>The government announced in June 2013 that it would review industry efforts to introduce pregnancy-related health warnings on alcohol. If the results are similar to those found by FARE in June 2012, there is a compelling case for the government to legislate for mandatory warning labels.</p>
<h2>Effective warnings</h2>
<p>Any mandatory labelling scheme should consider the substantial evidence from tobacco control about what type of design is most effective and where labels are best placed on products to get the message across. </p>
<p>Based on a review of the available evidence, the Foundation for Alcohol Research and Education <a href="http://www.fare.org.au/wp-content/uploads/2011/07/AER-Policy-Paper_FINAL.pdf">has suggested</a> that text and graphic health warnings should be placed on the front of the product, be horizontal in direction, cover a large proportion of the label, and have a minimum font and label size.</p>
<p>But the Trans-Pacific Partnership rules being considered may prevent countries from mandating health warnings in line with these principles. The Technical Barriers to Trade chapter of the agreement potentially presents two obstacles with introducing effective alcohol health warnings.</p>
<p>The first problem is that the terms of this chapter may make it more difficult for governments to introduce public health policies that have not been tried before and proven to work. Under a rule like this, plain packaging for tobacco products would never have been implemented.</p>
<p>This is often a problem for countries that are first in trying an innovative public health approach. But unless there’s some leeway to try new approaches, how are advances in health to be made?</p>
<p>The second potential problem is that the text in the Trans-Pacific Partnership applying to alcohol products may be modelled on the <a href="http://ita.doc.gov/td/ocg/labeling%20agreement.htm">World Wine Trade Group Agreement</a>.</p>
<p>The World Wine Trade Group Agreement is a new international agreement signed by several wine-trading countries. Some of those negotiating the Trans-Pacific Partnership, including Australia, New Zealand, Canada and the United States are signatories.</p>
<p>The Agreement appears to almost entirely limit a country’s right to stipulate where information should be placed on a wine label. This type of provision would prevent countries from requiring health warnings to be placed in the position where they would have most impact - the front label on a bottle or can.</p>
<h2>Compromising freedom</h2>
<p>If rules such as these are included in the Trans-Pacific Partnership, they will present real risks to signatories’ ability to introduce effective health warnings for alcohol. The World Wine Trade Group Agreement only involves a small number of countries but its effects would be magnified if it is used as the basis for the Trans-Pacific Partnership. </p>
<p>Agreeing to Trans-Pacific Partnership rules that restrict health efforts would be counter to good evidence-based public health policy. It would close off a strategy, which when combined with others such as restricting availability and limiting promotion, would help reduce the rising human toll of alcohol. </p>
<p>It would also undermine the excellent track record for public health leadership that Australia has established with tobacco, in particular plain packaging. </p><img src="https://counter.theconversation.com/content/16279/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Gleeson receives funding from the Australian Research Council. She is a member of the Public Health Association of Australia and active in the People's Health Movement.</span></em></p><p class="fine-print"><em><span>Paula O'Brien 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>New rules for alcohol labelling were discussed in Malaysia earlier this week by countries negotiating the Trans-Pacific Partnership. The proposed rules could stymie the introduction of effective health…Deborah Gleeson, Lecturer in Public Health, La Trobe UniversityPaula O'Brien, Senior Lecturer in Faculty of Law, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/98132013-02-28T19:22:34Z2013-02-28T19:22:34ZAlcohol warning labels and ‘valuable label real estate’<figure><img src="https://images.theconversation.com/files/20741/original/rjyy64t5-1362013623.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The government’s discussions with the industry about voluntary labelling have not been transparent.</span> <span class="attribution"><span class="source">Jesús León</span></span></figcaption></figure><p>There’s a <a href="http://www.foodstandards.gov.au/foodstandards/userguides/labellingofalcoholic4967.cfm">legal requirement</a> in Australia for all packaged alcohol to show the alcohol content of the beverage and the number of standard drinks. But there’s no need for the label to bear any information about the <a href="http://www.nhmrc.gov.au/your-health/alcohol-guidelines/alcohol-and-health-australia">well-known health risks</a> of consuming alcohol. </p>
<p>The Commonwealth government is being urged to introduce warnings on alcoholic beverages. The alcohol industry says it’s not completely <a href="http://www.nhmrc.gov.au/your-health/alcohol-guidelines/alcohol-and-health-australia">opposed to labels</a>, but is determined to find ways to protect its “<a href="http://www.alsa.com.au/fileadmin/alsa-2009/Blewett_Review_FINAL.pdf">valuable label real estate</a>”. </p>
<h2>The case for alcohol warnings</h2>
<p>The Commonwealth government has received recommendations from its own advisory bodies that health information and warnings be mandated on alcoholic beverage containers, as part of a cohesive government strategy for reducing alcohol-related harm. </p>
<p>The first recommendation came from the <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/CCD7323311E358BECA2575FD000859E1/$File/nphs-roadmap-5.pdf">National Preventative Health Taskforce</a> in 2009. The second (in 2011), came from the <a href="http://www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/content/48c0548d80e715bcca257825001e5dc0/$file/labelling%20logic_2011.pdf">food labelling review</a>, which recommended specific warnings about drinking during pregnancy, and generic warnings about other health risks (such as alcohol is harmful to your health). </p>
<p>These calls for the Commonwealth to legislate for warnings on alcohol labels have been backed by the <a href="http://www.fare.org.au/wp-content/uploads/2011/07/AER-Policy-Paper_FINAL.pdf">Foundation for Alcohol Research and Education</a>, the <a href="http://ama.com.au/position-statement/alcohol-consumption-and-alcohol-related-harms-2012">Australian Medical Association</a> and the <a href="http://www.phaa.net.au/documents/101126Attachmenttosub-NAAAPositionStatement-Reducingharmfromalcohol-creatingahealthierAustralia.pdf">National Alliance for Action on Alcohol</a>. </p>
<p><a href="http://carbc.ca/Portals/0/PropertyAgent/558/Files/7/AlcWarningLabels.pdf">Several other countries</a>, such as the United States, South Korea and Brazil, require text-based warnings on alcohol containers. Studies of US labelling show evidence that alcohol warnings have effects on knowledge and attitudes about drinking, and “intervening variables”, such as intention to change drinking habits, willingness to discuss drinking, and being willing to intervene when seeing hazardous drinking in others.</p>
<p>There’s minimal evidence that warnings on alcoholic beverages change drinking behaviour. But if the labels are to impact behaviour, they need to be more graphic and visible than they have been in the past. Australia’s <a href="http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/tobacco-label-images">tobacco warnings</a> are an example of how successful product warnings can be.</p>
<h2>The Commonwealth’s response</h2>
<p>In December 2011, the Commonwealth government announced it was still considering whether to introduce generic warnings on alcohol, but that it was “prudent” to have warnings on alcohol about the specific risks from drinking during pregnancy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/20745/original/y67fzzg6-1362014141.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/20745/original/y67fzzg6-1362014141.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/20745/original/y67fzzg6-1362014141.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/20745/original/y67fzzg6-1362014141.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/20745/original/y67fzzg6-1362014141.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/20745/original/y67fzzg6-1362014141.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/20745/original/y67fzzg6-1362014141.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">
<figcaption>
<span class="caption">It’s safest to not drink while pregnant.</span>
<span class="attribution"><span class="source">U.S. Department of Agriculture</span></span>
</figcaption>
</figure>
<p>The <a href="http://www.nhmrc.gov.au/your-health/alcohol-guidelines">National Health and Medical Research Council</a> guidelines state that for women who are pregnant or planning a pregnancy, it is safest not to drink when pregnant or planning a pregnancy. This reflects the concern about maternal alcohol consumption and <a href="https://theconversation.com/explainer-foetal-alcohol-spectrum-disorders-9871">foetal alcohol spectrum disorders</a>.</p>
<p>At this stage, the Commonwealth could have mandated a legal standard that alcoholic beverage containers bear pregnancy warnings in a prescribed format. Admittedly, this is not an entirely straight-forward process because of a treaty between Australia and New Zealand about joint food standards (including alcohol), and the sharing of food regulation powers between the Commonwealth and the states/territories. </p>
<p>Regardless, the government hasn’t mandated warnings. Instead, it has given the alcohol industry two years – until December 2013 – to introduce these warnings on a voluntary basis. And it seems that the government will only pass a labelling law if it’s not satisfied with what the industry has done by that deadline.</p>
<h2>Self-regulation is the wrong approach</h2>
<p>Alcohol labelling is not an appropriate matter for industry self-regulation. Foetal alcohol spectrum disorders are a serious public health issue that government has the responsibility and capacity to address. The alcohol industry has no special expertise in devising solutions to such problems. And it has a vested interest in limiting the size and impact of the warnings. </p>
<p>Allowing industry to self-regulate reduces both government and industry accountability. And it prevents a proper parliamentary debate about alcohol labelling that the public can participate in. </p>
<p>Indeed, the government’s discussions with the industry about voluntary labelling haven’t even been transparent. Has the government promised not to regulate if the industry does X or Y? And does it have any criteria by which it will judge whether the alcohol industry has done a good enough job at the end of 2013?</p>
<h2>The industry’s weak voluntary efforts</h2>
<p>The alcohol industry’s efforts to get pregnancy warnings onto alcohol containers are being lead by the industry-funded organisation, <a href="http://www.drinkwise.org.au/">DrinkWise</a>. Drinkwise recommends that that one of the following warnings be used on alcoholic beverages: </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/20736/original/hxkjkhq8-1362011522.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/20736/original/hxkjkhq8-1362011522.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/20736/original/hxkjkhq8-1362011522.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/20736/original/hxkjkhq8-1362011522.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/20736/original/hxkjkhq8-1362011522.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/20736/original/hxkjkhq8-1362011522.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/20736/original/hxkjkhq8-1362011522.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>There has been <a href="http://www.fare.org.au/wp-content/uploads/2011/07/IPSOS-SRI-DRINKWISE-AUDIT-REPORT-1-AUGUST-2012.pdf">poor take-up</a> of the DrinkWise pregnancy warnings. As at June 2012, only 4% of surveyed beers and ciders carried such a message, along with only 2% of wine, spirits and ready-to-drink products.</p>
<p>The industry is also not doing well at making the warnings visible or prominent. The same <a href="http://www.fare.org.au/wp-content/uploads/2011/07/IPSOS-SRI-DRINKWISE-AUDIT-REPORT-1-AUGUST-2012.pdf">recent survey</a> found that where the surveyed alcohol products bore a DrinkWise message, in 98% of cases, the message took up less than 5% of the alcohol label or packaging. It also found that labels were “on the margins …and rarely in central or prominent positions”.</p>
<p>The Commonwealth should not waste any more time on industry self-regulation of alcohol warnings. This government is generally too reticent in its regulation of the alcohol industry. In December 2013, it should act to mandate prominent, strongly-worded, graphic alcohol warning labels, and commission a proper study on the impact of those labels. </p>
<p><em>This is the ninth part of our series looking at alcohol and the drinking culture in Australia. Click on the links below to read the other articles:</em></p>
<p><strong>Part One:</strong> <a href="https://theconversation.com/a-brief-history-of-alcohol-consumption-in-australia-10580">A brief history of alcohol consumption in Australia</a></p>
<p><strong>Part Two:</strong> <a href="https://theconversation.com/social-acceptance-of-alcohol-allows-us-to-ignore-its-harms-10045">Social acceptance of alcohol allows us to ignore its harms</a></p>
<p><strong>Part Three:</strong> <a href="https://theconversation.com/my-drinking-your-problem-alcohol-hurts-non-drinkers-too-12424">My drinking, your problem: alcohol hurts non-drinkers too</a></p>
<p><strong>Part Four:</strong> <a href="https://theconversation.com/alcohol-fuelled-violence-on-the-rise-despite-falling-consumption-9892">Alcohol-fuelled violence on the rise despite falling consumption</a></p>
<p><strong>Part Five:</strong> <a href="https://theconversation.com/as-a-matter-of-fact-ive-got-it-now-alcohol-advertising-and-sport-9909">‘As a matter of fact, I’ve got it now’: alcohol advertising and sport</a></p>
<p><strong>Part Six:</strong> <a href="https://theconversation.com/advertisings-role-in-how-young-people-interact-with-alcohol-9986">Advertising’s role in how young people interact with alcohol</a></p>
<p><strong>Part Seven:</strong> <a href="https://theconversation.com/big-alcohol-and-big-tobacco-boozem-buddies-9668">Big Alcohol and Big Tobacco – boozem buddies?</a></p>
<p><strong>Part Eight:</strong> <a href="https://theconversation.com/explainer-foetal-alcohol-spectrum-disorders-9871">Explainer: foetal alcohol spectrum disorders</a></p>
<p><strong>Part Ten:</strong> <a href="https://theconversation.com/forbidden-fruit-are-children-tricked-into-wanting-alcohol-12457">Forbidden fruit: are children tricked into wanting alcohol?</a></p><img src="https://counter.theconversation.com/content/9813/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paula O'Brien 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 a legal requirement in Australia for all packaged alcohol to show the alcohol content of the beverage and the number of standard drinks. But there’s no need for the label to bear any information…Paula O'Brien, Senior Lecturer in Faculty of Law, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/32822011-09-19T20:40:37Z2011-09-19T20:40:37ZLast drinks: regulating alcohol to prevent non-communicable diseases<figure><img src="https://images.theconversation.com/files/3696/original/3401533198_f7a75f760f_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Focussing on 'harmful' alcohol use means attention is diverted from reducing alcohol intake across the population.</span> <span class="attribution"><span class="source">Visit Greenwich</span></span></figcaption></figure><p><strong><em><a href="https://theconversation.com/topics/non-communicable-diseases">Non-communicable diseases</a> – Paula O'Brien looks at the what <a href="http://www.thelancet.com/journals/lancet/issue/current">The Lancet</a> NCD Action Group and the NCD Alliance name as one of the [priority interventions](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(\11)60393-0/fulltext) for mitigating the impact of NCDs: reduction in hazardous alcohol intake.</em></strong></p>
<p>The Australian government has taken a tough stance against the tobacco industry and its deadly products. But despite the known harms of alcohol, it’s been slow to confront the nation’s drinking habit.</p>
<p>The government has a bill before Parliament mandating plain packaging of tobacco products as the latest of a series of steps to control tobacco consumption.</p>
<p>It has taken this action because tobacco is recognised as one of the leading causes of preventable death. </p>
<h2>What about alcohol?</h2>
<p>Like tobacco, alcohol is also a key risk factor for non-communicable diseases (NCDs), such as cardiovascular disease, cancer, diabetes and chronic lung disease. </p>
<p>What’s more, alcohol is the cause of many injuries and mental disorders, as well as social costs such as absenteeism from work and property damage. </p>
<p>In Australia alone, the<a href="http://www.aerf.com.au/Harm_to_Others_Full_Report_with-errata.pdf"> total annual cost of alcohol misuse</a> is estimated at $36 billion. </p>
<p>Yet, the government has done very little to deal with alcohol as a cause of disease and injury. </p>
<p>So what should it be doing? </p>
<p>This is an important question, as Australia and other countries gather this week at the <a href="http://www.un.org/en/ga/president/65/issues/ncdiseases.shtml">United Nations in New York</a> to decide what steps they need to take to prevent and control the four non-communicable diseases. </p>
<p>Countries have been moved to make this global effort because <a href="http://www.who.int/nmh/publications/ncd_report2010/en/">68% of all deaths in 2008</a> were due to one of these four non-communicable diseases.</p>
<p>The draft declaration for the UN meeting states tackling the <a href="http://www.who.int/nmh/events/un_ncd_summit2011/en/">“harmful use of alcohol” must be a priority</a>.</p>
<p>But talking about “harmful” alcohol consumption might throw Australia off course in its efforts to address alcohol as a risk factor for non-communicable diseases. </p>
<p>First, it suggests some alcohol use is <em>not</em> harmful even though there’s evidence this isn’t correct. </p>
<p><a href="http://www.cancer.org.au/File/PolicyPublications/Position_statements/CCA_Alcohol_and_cancer_position_statement_final_May11.pdf">Cancer Council Australia maintains</a> “any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption.” </p>
<p>If we accept this assessment of alcohol’s impact, it may mean we start to take a tougher approach to regulating alcohol. </p>
<p>We might start to think about alcohol as being much more similar to tobacco – in terms of its inherent potential to cause harm – than the alcohol industry would like us to believe. </p>
<p>Second, the notion of harmful alcohol use suggests that Australia should introduce programs focussing on people who drink in a harmful way, such as binge drinkers or alcoholics. </p>
<p>Programs giving attention to these sub-groups are important, but just as important are efforts to bring down the level of alcohol consumption across the whole population. </p>
<p>This is a challenging idea for many in a country like Australia, where food and alcohol go hand-in-hand at most social gatherings. And where people who abstain or who drink very little are often seen as “wowsers”. </p>
<h2>Possible measures</h2>
<p>If the real goal is to reduce alcohol consumption, then Australia should act to better regulate alcohol in three respects: pricing, <a href="http://theconversation.com/cheers-to-health-warning-labels-for-alcoholic-drinks-2891">warnings</a>, and retailing. </p>
<p>These, and other areas for action, were identified by the <a href="http://www.preventativehealth.org.au/">National Preventative Health Taskforce</a> as the way to <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/AEC223A781D64FF0CA2575FD00075DD0/$File/nphs-overview.pdf">create “a safer drinking culture for Australia”</a>.</p>
<p>The pricing of alcohol clearly affects consumption patterns. When the <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/AEC223A781D64FF0CA2575FD00075DD0/$File/nphs-overview.pdf">Northern Territory imposed a levy on cask wine</a> in the 1990s, quarterly per capita consumption of cask wine per person aged 15 years and over fell from 0.73 litres to 0.49 litres. </p>
<p>The tax system can be used to price alcohol to change the way we drink but Australia’s current taxation regime for alcoholic products is both complicated and flawed. </p>
<p>The system needs to be reformed to include: a minimum price for all alcoholic products (to prevent bargain basement discounting by retailers) and a tax based on volume of alcohol (so that high-alcohol products like wine don’t cost substantially less than low-alcohol beers). </p>
<p><a href="http://theconversation.com/cheers-to-health-warning-labels-for-alcoholic-drinks-2891">Warnings are not currently required</a> on alcoholic beverage containers or packaging in Australia. Alcohol is also largely exempt from basic nutrition and ingredient labelling requirements that apply to other foods. </p>
<p>Text and picture warnings, tested for their impact and rotated on a regular basis so consumers don’t become immune to their messages, can shape people’s knowledge, awareness, use and perceptions about alcohol. </p>
<p>The government is considering whether to introduce this style of mandatory warning regime. It should take this step and not opt for industry self-regulation. </p>
<p>But it’s not just the Federal government that has a role to play in reducing Australians’ alcohol consumption. </p>
<p>State governments are responsible for liquor licensing laws that regulate retailers of alcohol, such as bars, pubs, and cafes. </p>
<p>There are problems with under-enforcement of these laws in some states and territories. And many licensees are not meeting their obligations under the laws, such as not to serve persons who are intoxicated, because there are no real consequences for failing to comply. </p>
<p>Another problem is that previous changes to these laws have seen a proliferation in the number of licensed venues in many states. </p>
<p>In Victoria, this change was said to promise a more sophisticated, European-style drinking culture. </p>
<p>Rather, it’s now understood that increased availability of alcohol – more venues, longer opening hours – is connected with more alcohol-related problems. </p>
<h2>Leading the way</h2>
<p>Australia should make changes to the regulation of alcohol – in pricing, labelling and retailing – as a way of tackling at least this primary risk factor for non-communicable diseases. </p>
<p>And as a wealthy country, it should also look at what it can contribute to international efforts to combat non-communicable diseases – the greatest burden of deaths from non-communicable diseases is felt in poor- and middle-income countries. </p>
<p>Providing technical and financial assistance to such countries is one way to assist. At the very least, Australia should not stand in the way of evidence-based public health measures other countries want to introduce. </p>
<p>The United Nations meeting on non-communicable diseases this week will hopefully give Australia a push to take more decisive and effective action to deal with alcohol as a major cause of non-communicable diseases and other health problems.</p>
<p><strong><em>This is the second part of our <a href="https://theconversation.com/topics/non-communicable-diseases">non-communicable diseases</a> series. To read the other instalments, follow the links here:</em></strong></p>
<ul>
<li><p><strong>Part One: Sir George Alleyne discusses <a href="http://theconversation.com/we-need-a-new-paradigm-to-stop-non-communicable-diseases-3422">why we need a new paradigm to tackle NCDs</a></strong></p></li>
<li><p><strong>Part Three: <a href="http://theconversation.com/stemming-the-obesity-epidemic-requires-courageous-population-level-action-3412">Stopping the obesity epidemic will require action on the population-level</a></strong></p></li>
<li><p><strong>Part Four: <a href="http://theconversation.com/non-communicable-diseases-come-to-the-united-nations-3480">The results of the UN High-Level Meeting on Non-Communicable Diseases on New York September 19-20</a></strong></p></li>
<li><p><strong>Part Five: <a href="http://theconversation.com/tobaccos-mad-men-threaten-public-health-3450">How plain packaging works to reduce smoking – one of the biggest causes of non-communicable diseases</a></strong></p></li>
<li><p><strong>Part Six: <a href="http://theconversation.com/blueprint-for-making-medicines-more-affordable-for-everyone-3503">Blueprint for making medicines more affordable for everyone</a></strong></p></li>
<li><p><strong>Part Seven: <a href="http://theconversation.com/action-on-salt-will-mean-longer-healthier-lives-3443">Action on salt will mean longer, healthier lives</a></strong> - </p></li>
<li><p><strong>Part Eight: <a href="http://theconversation.com/death-by-suburban-sprawl-better-urban-planning-will-combat-sedentary-lifestyles-3395">Death by suburban sprawl: better urban planning will combat sedentary lifestyles</a></strong></p></li>
<li><p><strong>Part Nine: <a href="http://theconversation.com/where-we-come-from-determines-how-we-fare-the-fetal-origins-of-adult-disease-3581">Where we come from determines how we fare – the fetal origins of adult disease</a></strong></p></li>
<li><p><strong>Part Ten: <a href="http://theconversation.com/social-inclusion-brings-respect-and-better-health-sri-lankan-elders-3414">Social inclusion brings respect and better health Sri Lankan elders</a></strong></p></li>
</ul><img src="https://counter.theconversation.com/content/3282/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paula O'Brien 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>Non-communicable diseases – Paula O'Brien looks at the what The Lancet NCD Action Group and the NCD Alliance name as one of the [priority interventions](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(\11)60393-0/fulltext…Paula O'Brien, Senior Lecturer in Faculty of Law, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.