Alcohol is widely accepted as a social lubricant in the United Kingdom. But, as with many other good things, use in moderation is clearly preferable to excess. Various public health initiatives and legislative measures of varying efficacy have been introduced to control the consumption of alcohol and thereby reduce alcohol-related harm. Alcohol sales peaked in 2008, and have slightly declined since, partly as more people make a personal choice to cut back on drinking.
Alcohol is harmful in many ways, ranging from the effects of acute intoxication, alcohol dependence, alcohol-harm disorders related to long-term use, and withdrawal syndromes in chronic heavy drinkers. Alcohol use also has negative societal impacts through being implicated in assaults, domestic violence, road traffic and workplace accidents, absenteeism and loss of employment, self injury and suicide.
The definition of a maximum safe limit is unfortunately not standardised throughout the world. Alcohol consumption is measured in units, which vary in what is actually being measured between different countries. One unit in the UK equates to 8 grams of alcohol, while a unit in the US refers to 10 grams. Unit labelling of alcoholic drinks is meant to encourage safe drinking, especially alongside inclusion of the standard UK guidelines for alcohol consumption. The wide variation in strengths of alcoholic drinks and in spirits measures, however, complicates matters and makes it difficult for consumers to monitor their intake.
A unit-based measure of consumption fails to consider the actual pattern of drinking. The rate of consumption is important, given that the liver can metabolise between 1 to 2 units per hour. Episodic binge drinking is riskier than spreading out the overall amount consumed over many days. In addition, genetic factors may influence the way the body responds to and handles alcohol. Variations, or polymorphisms, in genes for enzymes that metabolise alcohol in the liver may reduce tolerance to alcohol and reduce the risk of alcohol-related disorders.
The debate on alcohol is closely interlinked to the fact that alcohol is a multi-billion-dollar international industry. The supply chain consists of vineyards, breweries, distilleries, distributors, retail outlets including supermarkets, bars, pubs and restaurants, which together account for a large numbers of jobs and for high tax revenues. It is self-evident that any initiatives to control alcohol use will require liaison with the alcohol industry, a reality which some anti-drink campaigners continue to find to be distasteful and even unethical.
Attempts have been made to control alcohol use by restricting supply. The cost of alcoholic drinks can be increased through increased taxation and the minimum pricing of alcoholic drinks (in May 2012, for the first time in the world, Scotland introduced minimum pricing at 50 pence per unit of alcohol), by restricting trading and licensing hours, and by controlling sales to underage people. Minimum unit pricing increases the price of low-cost high-strength alcoholic drinks disproportionately, thereby discouraging purchase and consumption. Happy hours, two-for-the-price-of-one and bottomless drink promotions can, however, encourage irresponsible drinking. The supply of alcohol can be regulated by the state, as in Sweden, where Systembolaget, a state-owned chain of retail stores is the only place where alcoholic drinks can be purchased.
Control of advertising aims to reduce public exposure to alcohol- by controlling the hours of public broadcasting and by restricting advertising in public areas such as sports venues. For example, France has managed without alcohol sponsorship of sport since 1991.
The debate on alcohol can be polarising. Neither prohibition nor complete deregulation are obviously the answer. The best strategy lies somewhere in between. Alcohol policy should include better control of supply (restricted sales; licensing hours), management of demand (behavioural modification through education and controls on advertising), and better screening for, and treatment of, alcohol addiction. Various national alcohol policy initiatives provide a natural laboratory to study the effects of the resulting changes, with potential lessons that can be exported to other countries.
Ashis Banerjee (familiar with the societal effects of alcohol, having worked as an emergency doctor)