Alcohol Use Disorders (140) Unanswered questions (2) Strategies to reduce alcohol consumption in minors

13 March, 2024

Dear colleagues,

Neil raised a series of unanswered questions that he identified during the course of the forum. [ ]

Among them is what can be done to reduce social pressures (especially on young people) to drink large quantities of alcohol?

With this communication I want to summarize the information available in this regard.

There is no single measure – a silver bullet - that can solve this complex social problem on its own.

Alcohol consumption, especially among adolescents, is one of the most difficult behaviors to change, fundamentally because alcohol consumption is deeply rooted in social culture. (1) It is difficult for young people to change their behavior regarding alcohol if there is no change in society in general.

The classic strategy, often promoted or supported by the alcohol industry, is to prioritize education at the school level. Research on effective interventions to reduce underage drinking (particularly through school-based programs) has increased substantially over the past few decades. While there is some positive data, researchers have concluded that these programs alone are unlikely to lead to sustained reductions in underage drinking. (2)

Reducing alcohol-related problems among young people necessarily requires comprehensive interventions, including public policies, that help change the general social and cultural environment in which they live and sustainably reduce the amount of total alcohol consumed by society.

During the Sixty-third Session of the World Health Assembly in Geneva in May 2010, WHO's 193 Member States reached a historic consensus on a global strategy to reduce the harmful use of alcohol through adopted resolution WHA63. 13. The resolution adopted and the strategy endorsed provide guidance to both Member States and the WHO Secretariat on ways to reduce the harmful use of alcohol.(3)

It contains ten areas of policy options and interventions in which governments can intervene to reduce the harmful use of alcohol.(4)

1. Leadership, awareness and commitment.

2. Response of health services.

3. Community action.

4. Policies and measures against driving under the influence of alcohol.

5. Availability of alcohol.

6. Marketing of alcoholic beverages.

7. Pricing policies.

8. Mitigation of the negative consequences of alcohol consumption and alcohol intoxication.

9. Reduction of the public health impact of illicit alcohol and informally produced alcohol.

10. Monitoring and surveillance.

Sphere 1. Leadership, awareness and commitment. For actions to be sustainable, strong leadership and solid political will and commitment are needed, expressed through the adoption of comprehensive and intersectoral national policies, evidence- based, sufficiently funded and free of conflicts of interest.

Policies must be accompanied by a concrete action plan and supported by effective and sustainable implementation and evaluation mechanisms, and the timely participation of civil society.

Sphere 2. Health services response. Health services are essential to address individual-level harm among people with alcohol use disorders and other alcohol-induced health problems. These should offer prevention and treatment interventions to individuals and families who are at risk of, or already have, alcohol use disorders and associated conditions. The health service response must be strengthened and sufficiently funded to match the magnitude of the public health problems caused by the harmful use of alcohol.

Sphere 3. Community action. Governments and other stakeholders can support communities and build their capacity to use theoretical and practical knowledge to adopt effective approaches to prevent and reduce alcohol use and modify collective behavior, and then impact individual behavior.

Policy options and interventions in this area include, among others: support for rapid assessments to identify gaps and priority areas of action in community-level interventions; promoting greater recognition of alcohol-related harms at the local level and promoting appropriate effective and cost-effective responses; strengthening the capacity of local authorities to promote and coordinate concerted community actions; capacity building at the community level for regulatory enforcement; mobilization of communities to prevent the sale of alcohol to minors; provision of care and support to affected people and their families; community programs and policies for subpopulations at particular risk, such as youth and others

Sphere 4. Policies and measures against driving under the influence of alcohol. Driving under the influence of alcohol seriously affects judgment, coordination and other motor functions. This is a major public health problem that affects the drinker and, in many cases, innocent parties. Policy options and interventions in this area include, among others, implementing and enforcing an upper limit for blood alcohol concentration; increased checkpoints and random breath testing; administrative suspension of driving license; progressive permit for new drivers with zero tolerance for alcohol while driving.

Sphere 5. Alcohol availability. Public health strategies aimed at regulating the commercial or public availability of alcohol through laws, policies and programs are an important means of reducing the overall level of alcohol use, especially by vulnerable or high-risk groups. Reducing the commercial and public availability of alcohol can in turn influence the social availability of alcohol and thus contribute to changing social and cultural norms.

Policy options and interventions in this area include the implementation of an appropriate system to regulate the production, wholesale and service of alcoholic beverages and to impose limits on the distribution of alcohol and the operation of alcohol outlets, through the application of the following measures (5): introduction of a retail marketing authorization system or state monopolies aimed at public health; regulation of the number and location of alcohol point of sales , whether or not located on premises; regulation of the days and hours of operation of retail outlets; regulation of retail sales in certain locations or during special events; establishing an appropriate minimum age for purchasing or consuming alcoholic beverages; adoption of policies to prevent sales to intoxicated persons and those under the legal minimum age, and consideration of the possibility of implementing mechanisms to hold sellers and waiters accountable in accordance with national legislation; formulation of policies regarding the consumption of alcohol in public places and in official activities and functions of public bodies; adoption of policies aimed at reducing and eliminating the availability of alcoholic beverages produced, sold and distributed informally or illicitly.

Sphere 6. Marketing of alcoholic beverages. Reducing the impact of marketing, especially among young people and adolescents, is an important objective if the use of alcohol is to be reduced. Alcohol is marketed through increasingly sophisticated advertising and promotion techniques, including sponsorship of sporting and cultural events. It is very difficult to target marketing to young adult consumers without simultaneously exposing those under the legal drinking age.

Policy options and interventions in this area include:

(a) regulatory frameworks, preferably of a legislative nature, through: regulation of the content and magnitude of marketing ( direct and indirect) in all media; regulation of sponsorship activities; restriction or prohibition of promotions; regulation of new forms of alcohol marketing, such as social media;

(b) development by public bodies or independent bodies of effective monitoring systems for the marketing of alcohol products;

(c) establishment of effective administrative and deterrent regimes regarding violations of marketing restrictions.

Sphere 7. Pricing policies. Pricing policies are one of the most effective interventions to reduce the consumption of alcoholic beverages (especially by minors), and stop the progression towards the ingestion of large quantities of alcohol and/or episodes of binge drinking.

It is estimated that increasing the price of alcohol by 10% would reduce overall alcohol consumption by an average of around 7% across all types of drinks. The more the price of alcohol increases, the more alcohol consumption and related harms could potentially be reduced. (6)

The existence of a significant illicit market for alcohol can undermine these policies, so changes in taxation must be accompanied by activities aimed at subjecting illicit and informal markets to effective public control.

Increasing taxes may also encounter resistance from consumer groups and economic operators.

Policy options and interventions in this area include: a specific national tax regime on alcohol, accompanied by effective enforcement measures; periodic review of prices based on inflation and income; prohibition or restriction of any direct or indirect form of promotional prices, discount sales, prices below cost and single prices that give the right to unlimited drinking; setting minimum prices for alcohol, where applicable; reduction or interruption of subsidies for economic operators in the alcohol sector.

Sphere 8. Mitigation of the negative consequences of alcohol consumption and alcohol intoxication. It includes policy options and interventions that focus directly on reducing the harm caused by alcohol intoxication and alcohol consumption. Including:

(a) regulating the context of alcohol consumption to minimize violence and disruptive behaviors, including the use of plastic or shatterproof glass containers to serve alcohol and the management of alcohol problems at large scale public events;

(b) demand compliance with laws that prevent the serving of alcohol to the point of intoxication of the drinker and legal responsibility for the consequences of the resulting damages;

(c) adoption of management policies in relation to the responsible serving of alcoholic beverages on premises and training of staff in relevant sectors on how best to avoid situations of drunk and aggressive drinkers, and to identify and treat such persons;

(d) reduction of the alcoholic content of different types of beverages;

Sphere 9. Reducing the public health impact of illicit alcohol and informally produced alcohol

The consumption of illicitly or informally produced alcohol can hamper the ability of governments to intervene in the alcohol problem by taxing and controlling the marketing of alcohol.

To achieve this, good scientific, technical and institutional capacity must be available to plan and apply appropriate national, regional and international measures. Good knowledge of the market and a correct understanding of the composition and production of informal or illicit alcohol are also important, as well as an adequate legislative framework and measures for its effective enforcement.

The increased revenue from the alcohol tax can be, in part, used to combat illicit trade.

Sphere 10. Monitoring and surveillance. Monitoring and surveillance measures are required at the local, national, and international levels to monitor the magnitude and trends of alcohol-related harms, strengthen advocacy activities, formulate policies, and evaluate the impact of interventions.

For practical purposes of understanding and implementation, priority measures to reduce alcohol consumption and alcohol-related problems have been summarized in the SAFER Strategy: (7)

Strengthen restrictions on alcohol availability. Enacting and enforcing restrictions on commercial or public availability of alcohol through laws, policies, and programmes are important ways to reduce harmful use of alcohol. Such strategies provide essential measures to prevent easy access to alcohol by young people and other vulnerable and high-risk groups.

Advance and enforce drink driving countermeasures. Road users who are impaired by alcohol have a significantly higher risk of being involved in a crash. Enacting and enforcing strong drink-driving laws and low blood alcohol concentration limits via sobriety checkpoints and random breath testing will help to turn the tide.

Facilitate access to screening, brief interventions and treatment. Health professionals have an important role in helping people to reduce or stop their drinking to reduce health risks, and health services have to provide effective interventions for those in need of help and their families.

Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion. Bans and comprehensive restrictions on alcohol advertising, sponsorship and promotion are impactful and cost-effective measures. Enacting and enforcing bans or comprehensive restrictions on exposure to them in the digital world will bring public health benefits and help protect children, adolescents and abstainers from the pressure to start consuming alcohol.

Raise prices on alcohol through excise taxes and pricing policies

Alcohol taxation and pricing policies are among the most effective and cost-effective alcohol control measures. An increase in excise taxes on alcoholic beverages is a proven measure to reduce harmful use of alcohol and it provides governments revenue to offset the economic costs of harmful use of alcohol.

I hope this material can be useful to you.

Kind regards,










Dr. Eduardo Bianco

Director, Addiction Training Program (ATP)



HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT