Policies to Prevent Alcohol Problems:A Research Agenda for 2010-2015

The goal of alcohol prevention research is to reduce alcohol-involved problems at the family, neighborhood, community, state, and national levels. Alcohol problems are both acute (closely connected in time to the drinking event) and chronic (resulting from long-term exposure to thanol). Acute alcohol problems include (1) traffic crashes involving injury or death to the driver or others; (2) non-traffic injuries and fatalities, such as falls, fires, poisonings, or drowning, as well as violent events resulting from domestic conflict or public assaults in which ither the perpetrator or the victim has been drinking; and (3) the consequences of unprotected sex. Regular heavy consumption can lead to dependence and can substantially increase the risk of health problems, especially liver disease and certain cancers.

This research agenda for alcohol prevention should be viewed within the context of the “prevention paradox.” This paradox suggests that while alcohol dependent persons have the highest individual risk of alcohol problems, moderate and heavy nondependent drinkers account for more total alcohol problems, especially those of an acute nature, because there are o many more such drinkers compared to dependent drinkers. Therefore, a much wider public health perspective for policy research is essential, and this identification of research priorities has focused on alcohol-involved problems or high-risk drinking where the individual drinkers have not been identified by the recovery, treatment, or health screening systems. The biggest future challenge for alcohol policy research is population-level alcohol problem prevention (a public health perspective).

It is important to define alcohol policy. For the purposes of this document, alcohol policy at any level is aimed at reducing alcohol-involved problems; that is, the policy is used to produce changes in the drinking environment or setting. In turn, changes in the environment can cause changes in drinking behavior, such as drinking before or while driving, or underage drinking. Examples of alcohol policy approaches include establishing written policies and staff training for responsible alcoholic beverage service by a retail licensed establishment, or restrictions on local density and location of alcohol outlets. See reviews and discussions of alcohol policy effectiveness in Babor et al. (2003, in press), Wagenaar and Toomey (2000), and Toomey and Wagenaar (1999). These and other research reviews confirm that there is a considerable existing body of evidence concerning the effectiveness of specific national, state, and local alcohol policies.

The following summarizes key issues that should stimulate alcohol prevention policy research from 2010 to 2015. While many priorities exist and much more needs to be understood about the effectiveness of specific alcohol policies, the alcohol policy research priorities cited here reflect new or under-developed areas of research that are judged to be highly relevant to needed policy change. They are organized into domains identifying the highest alcohol policy research priorities at the international, national, state, provincial, and community levels.

I. International Trade Agreements

II. National/State/Provincial/Community Prevention

III. Retail Price of Alcohol

IV. Physical Availability of Alcohol

V. Prevention of Intoxication and Over-Service of Alcohol

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