Reducing Harmful Drinking - REFERENCED

7/27/2019 Reducing Harmful Drinking - REFERENCED

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REDUCING HARMFUL DRINKING: INDUSTRY CONTRIBUTIONS

Brett Bivans, International Center for Alcohol Policies (ICAP), USAi

Marjana Martini c, International Center for Alcohol Policies (ICAP), USAii

This paper was prepared on behalf of the companies sponsoring the International Center forAlcohol Policies; it is Brett Bivans and Marjana Martinics input into the WHO Global Strategyprocess on areas where industry members can contribute.iii

PRODUCERS ROLE IN REDUCING HARMFUL DRINKINGInterventions to reduce the potential harm associated with drinkingiv can be divided into two basiccategories, which are by no means mutually exclusive and may be used in tandem tocomplement and strengthen each other. One is the population-level approach, consisting ofacross-the-board measures, such as controls over price and availability. The other approachinvolves interventions that are applied in a targeted way, focusing on particular groups, behaviors,or settings where the potential for harm is elevated (1, 2). A balanced alcohol policy thereforeincludes targeted interventions, allowing for flexibility and specificity in addressing problems anddrawing on contributions from sectors beyond government, including the beverage alcoholindustry (2).

Alcohol producers recognize that theirs is one of the most highly regulated industries in the world.Part of the reason for this is the potential that exists for their products to be irresponsiblyconsumed and thus cause harm. Of course, this potential exists for other products, such asautomobiles and pharmaceuticals. Reasonable regulation is designed to protect consumers andsociety at large without imposing intolerable demands on producers or restricting individual

freedom of choice. Thus, in seeking the right balance between population-level measures andtargeted interventions, all stakeholders have to be conscious of the need and potential forpartnership (2).

There is growing international recognition of the importance of building and strengtheningrelationships between the public and private sectors (3). Such collaborations offer innovativesolutions for addressing social, economic, and environmental challenges and enhance theprovision of goods and services. Considerable efforts, however, are still required from allstakeholders to move from the abstract desirability of partnerships to putting real partnerships intopractice that enhance the delivery of a shared focus on reducing harmful drinking.

iMr. Bivans is Director of Partnership Development at ICAP, where he handles industry-related issues,

such as corporate social responsibility, self-regulation, road safety, retail, and responsible hospitality. Priorto joining ICAP, Mr. Bivans was the first manager of the Global Road Safety Partnership (GRSP).iiDr. Martini c is Vice President of Public Health at ICAP, where her work focuses on the nexus between thescientific evidence base and international alcohol policy development. She has published extensively in thefields of neuroscience and alcohol policy.iii

This paper was submitted as a contribution to the WHO public hearing on ways of reducing harmful use ofalcohol. It was then expanded into two chapters, published in the 2009 book Working Together to ReduceHarmful Drinking: Chapter 7, Making Responsible Choices, by Marjana Martinic; and Chapter 8, WorkingTogether, by Brett Bivans and J ohn Orley (see www.icap.org/Publications/WorkingTogether).iv

See ICAP Health Briefing, Drinking Patterns and Health Outcomes: An Overview (available:http://www.icap.org/PolicyTools/ICAPHealthBriefings/ ).
http://www.icap.org/Publications/WorkingTogetherhttp://www.icap.org/Publications/WorkingTogetherhttp://www.icap.org/Publications/WorkingTogetherhttp://www.icap.org/Portals/0/download/all_pdfs/Policy%20Tools/Overview%20-%20Drinking%20Patterns%20and%20Health%20Outcomes.pdfhttp://www.icap.org/PolicyTools/ICAPHealthBriefings/http://www.icap.org/PolicyTools/ICAPHealthBriefings/http://www.icap.org/Portals/0/download/all_pdfs/Policy%20Tools/Overview%20-%20Drinking%20Patterns%20and%20Health%20Outcomes.pdfhttp://www.icap.org/Publications/WorkingTogetherhttp://www.icap.org/Publications/WorkingTogetherhttp://www.icap.org/Publications/WorkingTogether


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Reducing Harmful DrinkingContribution to the WHO Public Hearing

The industry aligns with the overarching goal of reducing harmful drinking as part of its long-termbusiness interests (4). ICAP and its sponsoring companies endorse the fact that targetedinterventions implemented in partnership make a significant contribution to this goal. Initiativesexist in a range of areas in which industry members, by virtue of their involvement, resources, orexpertise, have a unique contribution to make (e.g., 1, 5, 6). Below are examples of industrypartnerships in a range of areas.

WHAT IS BEING DONE: MULTI-STAKEHOLDER PARTNERSHIPSMany targeted interventions to reduce harmful drinking are best delivered in partnership, withindustry members well positioned to play a substantial role. The broad range of possibleinterventions to target harmful drinking will necessarily involve an equally broad range ofstakeholders in their implementation. Two important areas are education and road safety.

Industry Partnerships in Consumer Education and Public AwarenessEducation may be aimed at the general population, for example, through the provision of drinkingguidelines, issued by governments and quasi-governmental organizations in many countries (7).In some countries, packaging and labeling of commercial beverages are used to provide basicinformation on alcohol content, ingredients, or allergens (8). The challenge is how to make thesefacts and recommendations accessible and relevant to the reality of how people drink. Industry

members can help educate consumers by disseminating such information on their product ordedicated websites (7).

Young peopleparticularly those under the legal drinking ageare the most frequent target ofalcohol education, including school-based programs, life skills, and mass media campaigns (9,10, 11). As parents and peers are two of the most significant influences in shaping behavioramong young people (e.g., 12), approaches have been developed to involve them in reinforcingpositive norms about drinking, changing negative norms, and reducing the potential for harm (10,13, 14, 15, 16). The Strengthening Families Program, implemented with industry support inseveral countries (e.g., Poland, Spain, and the U.K.), helps build parents skills and facilitatedialogue about drinking (17).

Educational approaches can also be aimed at professionals who deal with alcohol issues. These

include awareness raising and skills training for education, health, social, and law enforcementworkers. For example, the industrys Alcohol 101 program in the U.S. helps educators encourageresponsible choices among secondary school and college/university students (18); and Soif deVivre, a road safety education campaign in France, targets some materials at educationprofessionals (19). Support by industry members can also help integrate information aboutdrinking into training curricula for nursing, medical, and social service courses, or throughcontinuing medical education programs.

Industry Partnerships in Road SafetyAlcohol impairment, both by drivers and pedestrians, is acknowledged as an importantcontributory factor in road traffic injuries and was identified as one of the critical risk factors inthe World Bank and WHOs World Report on Road Traffic Injury Prevention (20). The alcoholindustrys involvement in road safety generally, and combating impaired driving in particular, has

been extensive, global, and long-running (1, 5, 6).

ICAP is a founding member of the Global Road Safety Partnership (GRSP); ICAP staffcontributed to the development of the Drinking and Driving: a Road Safety Manual for Decision-makers and Practitioners, produced by GRSP under the UN Global Collaboration on Road Safety(21). With its sponsors, ICAP supports the recommendations of theWorld Report and the GoodPractice Manual. Industry members are already making positive contributions that build on therecommendations of the World Report.

Industry has participated in a number of partnership initiatives in this area (1, 5, 6):

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public awareness campaignsadvertisements and messages by government, public health,and private sector organizations about the effects of alcohol on driving;

designated driver campaigns and programs; ride-share/free-taxi or taxi-call programsschemes organized in collaborations with local

government to provide alternative transport for those who have been drinking;

server training and responsible hospitality programs; support for setting of legal blood alcohol concentration limits, public awareness campaigns

about these limits, and collaboration with local authorities to improve enforcement; development of national alcohol policies and plans of action.

There is considerable scope for these programs to be improved. Industry members are keen todevelop their actions further and to explore increasing collaboration with governments, the publichealth community, and others involved in road safety.

Industry Partnerships in Other AreasA number of other areas have been conducive to partnership. The initiatives highlighted beloware examples of the myriad of interventions that beverage alcohol members are already doingand that they are willing to replicate, scale up, and help adapt to different national, religious, and

cultural contexts in partnership with other stakeholders. The ICAP Blue Book contains numerousadditional examples (1); and the European Forum for Responsible Drinking (5) and theWorldwide Brewing Alliance (6) both publish compilations of industry members partnershipinitiatives to reduce harmful drinking.

Screening and Brief InterventionsAmong the most successful targeted interventions for at-risk groups are early screening foralcohol problems and the provision of treatment or brief interventions. Evidence in support ofsuch measures is strong (e.g., 22, 23, 24, 25). While industry members themselves cannotprovide these interventions, they can partner with and support training and resources for technicalpersonnel who can. For example:

Screening and Brief Intervention by Pharmacists. In Chile, a joint project of ICAP, theUniversity of Chile, Thomas J efferson University, and Farmacias Ahumada, a majorpharmacy chain, trained pharmaciststhe main point of contact for primary health careamong lower socioeconomic groupsto identify early signs of alcohol abuse in clients, offerinterventions, and provide follow-up counseling.

Screening for alcohol problems can be coupled with other areas of prevention (23), such asworkplace alcohol programs (26), prenatal care (27), HIV screening, and vaccination and otherpreventive care to socially excluded groups and communities.

Another area for industry involvement is the development of on-line screening programs,particularly useful for giving advice to young people (24, 28). Such initiatives can be developedand made available with the involvement of educational institutions and other partners.

Responsib le Hospitality

Responsible hospitality and server training are obvious initiatives in which the beverage alcoholindustry has a clear role as a partner. These programs are often delivered and supported bypartnerships involving local government, enforcement agencies, health services, and, importantly,the retail and hospitality sectors (29). Establishing national guidelines for server training is asphere where both partnerships and delivery of programs can be enhanced. For example:

TIPSTraining for Intervention Procedures. This U.S. skills-based training program isdesigned to prevent intoxication, alcohol-impaired driving, and underage drinking. See:http://www.gettips.com/.

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Drinking and PregnancyHarm reduction approaches to alcohol policy focus on minimizing the potential harm associatedwith certain patterns of drinking. Included among these approaches are measures that addressgroups of individuals deemed to be at particular risk for harm. One area that has attractedparticular attention is alcohol consumption by pregnant women (30). For example:

Foetal Alcohol Syndrome (FAS) Campaign. Initiated in 2004 in South Africa, this campaignbrought together the Industry Association for Responsible Alcohol Use (ARA), the Foundationfor Alcohol Related Research (FARR), and the Department of Health. See:http://www.farr.org.za.

Drinking and the WorkplacePrograms concerning alcohol in the workplace are part of sound organizational practicesdesigned to support employees, families, and the community. In this regard, employersrecognize that they have a role and responsibility to enact policies and promote efforts intendedto prevent harm before it occurs through limiting the availability of alcohol, offering educationprograms about drinking and alcohol abuse, implementing individual interventions for employees

with drinking problems, and offering employee assistance programs (EAPs) and screening ofproblem drinkers (31). For example:

Heineken Cool@Work. This global program offers training on how to live by Heinekensworkplace alcohol policy and how to communicate it, both internally and externally. See:http://www.heinekeninternational.com. Other industry members have similar programs (5, 6).

HIV/AIDSPartnerships with the private sector, national governments, NGOs, and community-basedorganizations can contribute to reducing some of the effects of the HIV pandemic by supportingaffected individuals (32). Such programs often support increased community efforts to preventnew infections and the improvement of care for those already afflicted. For example:

Nile Breweries clinic support. Nile Breweries partners with the Ugandan Ministry of Health,an NGO, and a local healthcare organization to supply a fully-equipped, government-accredited clinic with drugs, a qualified doctor, and nurses. See: http://www.sabmiller.com.

EVALUATIONEffectiveness research is increasingly an important component of prevention, especially given thegrowing emphasis on evidence-based programming. Rigorous insistence on measurement,however, may not always be possible, particularly when it comes to developing countries (33).Moreover, whereas quantitative measures are certainly fairly straightforward to interpret,qualitative indicators are also important but more rarely taken into consideration. For instance, isit possible to quantify change in drinking culture? There needs to be some agreement amongthose who work in the prevention field and, particularly, those who attempt to assess various

prevention efforts that there is a place for both qualitative and quantitative measures ofeffectiveness.

The complexity of assessing interventions means that many efforts are never formally evaluated.This lack of formal evaluation is often emphasized by the critics of various targeted interventionapproaches. However, this raises an important issue: The lack of evaluation is by no meansproof that certain approaches do not work; it simply means that a program or an approach hasnot been evaluated, nothing more or less. Where possible, the industry is willing to work withothers to rigorously evaluate prevention programs.

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REFERENCES1. International Center for Alcohol Policies (ICAP). (2005ongoing). ICAP blue book: Practical

guides for alcohol policy and prevention approaches. Available:http://www.icap.org/Publication/ICAPBlueBook/tabid/148/Default.aspx.

2. Stimson, G., Grant, M., Choquet, M., & Garrison, P. (Eds.). (2007).Drinking in context:Patterns, interventions, and partnerships. New York: Routledge.

3. See, for example: Donahue, J . D., & Zeckhauser, R. (2005). The anatomy of collaborativegovernance. In Oxford Handbook of Public Policy. Oxford: Oxford University Press. Nelson,

J . (2002). Building partnership cooperation between the United Nations system and theprivate sector. New York: United Nations Global Compact Office. Nelson, J ., & Zadek, S.(2000). Partnership alchemy: New social partnerships in Europe. Copenhagen: CopenhagenCentre. Reinicke, W. (1998). Global public policy. Washington DC: Brookings Institute.Business Partners for Development. (2001). Endearing myths, enduring truths: Partnershipsbetween business, civil society organizations and governments.Washington DC:World Bank

4. Grant, M., & OConnor, J . (Eds.). (2005). Corporate social responsibility and alcohol: Theneed and potential for partnership. New York: Routledge.

5. European Forum for Responsible Drinking (EFRD). (2007). Drinks industry initiatives 2007:Voluntary initiatives by EU spirits industry. Brussels, Belgium: Author. Available:http://ec.europa.eu/health/ph_determinants/life_style/alcohol/Forum/docs/alcohol_lib14_en.pdf.

6. Worldwide Brewing Alliance. (2007). Global social responsibility initiatives. London: BritishBeer and Pub Association. Available:http://ec.europa.eu/health/ph_determinants/life_style/alcohol/Forum/docs/alcohol_lib6_en.pdf

7. For a regularly updated table on drinking guidelines internationally, see the Policy Issues:Drinking Guidelines section of the ICAP website:http://icap.org/Home/PolicyIssues/DrinkingGuidelines/tabid/125/Default.aspx. See also:International Center for Alcohol Policies (ICAP). (2003). International drinking guidelines.ICAP Report 14. Washington, DC: Author.

8. International Center for Alcohol Policies (ICAP). (2008). Informing consumers about beveragealcohol. ICAP Report 20. Washington, DC: Author. This ICAP Report is intended as acompanion document to the table reviewing the general information required for on-productlabeling in 43 nations and the European Union, available:http://icap.org/Education/EducatingthePublic/AlcoholBeverageLabeling/tabid/268/Default.aspx.

9. National Research Council & Institute of Medicine. (2004). Youth-oriented interventions. InReducing underage drinking: A collective responsibility (pp. 185215). Washington, DC:National Academies Press.

10. Gorgulho, M., & Tamendarova, D. (2008). Tackling extreme drinking in young people:Feasible interventions. In M. Martinic & F. Measham (Eds.), Swimming with Crocodiles: Theculture of extreme drinking (pp. 219259). New York: Routledge.
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11. See chapter 7, Targeting groups: Young people (pp. 139171), in Stimson, G., Grant, M.,

Choquet, M., & Garrison, P. (Eds.). (2007). Drinking in context: Patterns, interventions, andpartnerships. New York: Routledge.

12. Gleason Milgram, G. (2001). Alcohol influences: The role of family and peers. In E. Houghton

& A. Roche (Eds.), Learning about drinking (pp. 85107). See also Donovan, J . (2004).Adolescent alcohol initiation: A review of psychosocial risk factors. Journal of AdolescentHealth, 35, 529.e7529.e18. Wood, M. D. (2004). Do parents still matter? Parent and peerinfluences on alcohol involvement among recent high school graduates. Psychology of

Addictive Behavior, 18, 1930.

13. Centre for Addiction and Mental Health (CAMH). (1999).Alcohol and drug preventionprograms for youth: What works? Toronto, Canada: Author.

14. J ones, L., J ames, M., J efferson, T., Lushey, C., Morleo, M., Stokes, E., et al. (2007, April).Areview of the effectiveness and cost-effectiveness of interventions delivered in primary andsecondary schools to prevent and/or reduce alcohol use by young people under 18 years old.London: National Institute for Health and Clinical Excellence.

15. Kumpfer, K. L., Alvarado, R., & Whiteside, H. O. (2003). Family-based interventions forsubstance use and misuse prevention. Substance Use and Misuse, 38, 17591787.

16. Lederman, L. C., & Stewart, L. P. (2005). Changing the culture of college drinking: A sociallysituated communication campaign. Cresskill, NJ : Hampton Press.

17. For more information, see the Strengthening Families Program official web page:http://www.strengtheningfamiliesprogram.org/. See also Kumpfer, K. L., Pinyuchon, M.,

Teixeira de Melo, A., & Whiteside, H. O. (2008). Cultural adaptation proces for internationaldissemination of the Strengthening Families Program. Evaluation and the Health Professions,31, 226239.

18. For more information about Alcohol 101 program, see the website run by the Century Council

(a national not-for-profit organization, funded by leading U.S. distillers and dedicated tofighting alcohol-impaired driving and underage drinking and to promoting responsibledecision-making about alcohol): http://www.alcohol101plus.org/home.html. For materialsavailable to educators, see: http://www.alcohol101plus.org/main/educators.cfm.

19. For more information about Soif de Vivre (in French), seehttp://www.soifdevivre.com/.

20. Peden, M., Scurfield, R., Sleet, D., Mohan, D., Hyder, A. A., J arawan, E., et al. (2004). Worldreport on road traffic injury prevention. Geneva, Switzerland: World Health Organization.Available:http://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.html.

21. Global Road Safety Partnership (GRSP). (2007). Drinking and driving: A road safety manualfor decision-makers and practitioners. Geneva, Switzerland: Author. Available:http://www.who.int/roadsafety/projects/manuals/alcohol/en/index.html .

22. Marlatt, G. A. (Ed.). (1998). Harm reduction: Pragmatic strategies for managing high-riskbehaviors. New York: Guilford.

23. For an overview, see International Center for Alcohol Policies (ICAP). (2005ongoing).Module 18: Early identification and brief intervention. In ICAP blue book: Practical guides foralcohol policy and prevention approaches. Available:
http://www.strengtheningfamiliesprogram.org/http://www.alcohol101plus.org/home.htmlhttp://www.alcohol101plus.org/main/educators.cfmhttp://www.soifdevivre.com/http://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.htmlhttp://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.htmlhttp://www.who.int/roadsafety/projects/manuals/alcohol/en/index.htmlhttp://www.who.int/roadsafety/projects/manuals/alcohol/en/index.htmlhttp://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.htmlhttp://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.htmlhttp://www.soifdevivre.com/http://www.alcohol101plus.org/main/educators.cfmhttp://www.alcohol101plus.org/home.htmlhttp://www.strengtheningfamiliesprogram.org/


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http://www.icap.org/portals/0/download/all_pdfs/blue_book/Module_18_Early_ID_and_Brief_Intervention.pdf.

24. Larimer, M. E., & Cronce, J . M. (2007). Identification, prevention, and treatment revisited:Individual-focused college drinking prevention strategies, 1999 2006.Addictive Behaviors,

32, 24392468. On screening and brief interventions for young people, see also Task Forceof the National Advisory council on Alcohol Abuse and Alcoholism. (2002). How to reducehigh-risk college drinking: Use proven strategies, fill research gaps. Bethesda, MD: NationalInstitutes of Health.

25. Academic ED SBIRT Research Collaborative. (2007). The impact of screening, briefintervention, and referral for treatment on emergency department patients alcohol use.

Annals of Emergency Medicine, 50, 699 710.e6.

26. Anderson, B. K., & Larimer, M. E. (2002). Problem drinking and the workplace: Anindividualized approach to prevention.Psychology of Addictive Behavior, 16, 243251. Seealso: Richmond, R., Kehoe, L., Heather, N., & Wodak, A. (2000). Evaluation of a workplacebrief intervention for excessive alcohol consumption: The workscreen project. PreventiveMedicine, 30, 5163.

27. See, for example: OConnor, M. J ., Whaley, S. E. (2007). Brief intervention for alcohol use bypregnant women.American Journal of Public Health, 97, 252258. See also: Chang, G.,McNamara, T. K., Orav, E. J ., Koby, D., Lavigne, A., Ludman, B., et al. (2005). Briefintervention for prenatal alcohol use: A randomized trial. Obstetrics and Gynecology, 105,991998.

28. Whilte, H. R. (2006). Reduction of alcohol-related harm on United States campuses: The useof personal feedback interventions. International Journal of Drug Policy, 17, 310319. Seealso: Saitz, R., Palfai, T. P., Freedner, N., Winter, M. R., Macdonald, A., Lu, J ., et al. (2007).Screening and brief intervention online for college students: The iHealth study.Alcohol and

Alcoholism, 42, 2836.

29. For an overview, see: International Center for Alcohol Policies (ICAP). (2005ongoing).Module 4: Responsible hospitality. In ICAP blue book: Practical guides for alcohol policy andprevention approaches. Available:http://www.icap.org/portals/0/download/all_pdfs/blue_book/Module_04_Responsible_Hospitality.pdf. See also p. 14-4 in International Center for Alcohol Policies (ICAP). (2005ongoing).Module 14: Public order and drinking environments. In ICAP blue book: Practical guides foralcohol policy and prevention approaches. Available:http://icap.org/Portals/0/download/all_pdfs/blue_book/Module_14_Public_Order_and_Drinking_Environments.pdf.

30. For an overview, see: International Center for Alcohol Policies (ICAP). (2005ongoing).Module 10: Drinking and pregnancy. In ICAP blue book: Practical guides for alcohol policyand prevention approaches. Available:

http://icap.org/portals/0/download/all_pdfs/blue_book/Module_10_Drinking_and_Pregnancy.pdf.

31. See, for example: Cook, R., & Schlenger, W. (2002). Prevention of substance abuse in theworkplace: Review of research on the delivery of services. The Journal of PrimaryPrevention, 23, 115141. Roman, P., & Blum, T. (2002). The workplace and alcoholprevention.Alcohol Research and Health, 26, 4957. See also: Roman, P., & Blum, T.(1999). Employee assistance programs and other workplace interventions. In M. Galanter &H. Kleber (Eds.), Textbook of substance abuse treatment (2nd edition). Washington, DC:American Psychiatric Press.
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32. For an overview, see: International Center for Alcohol Policies (ICAP). (2005ongoing).

Module 24: HIV/AIDS, high-risk behavior, and drinking. In ICAP blue book: Practical guidesfor alcohol policy and prevention approaches. Available:http://www.icap.org/Portals/0/download/all_pdfs/blue_book/Module%2024%20-

%20HIV%20high-risk%20behaviors%20and%20drinking%20patterns.pdf.

33. See chapter 8, Feasible interventions for minimizing harm (pp. 173192), in Stimson, G.,Grant, M., Choquet, M., & Garrison, P. (Eds.). (2007). Drinking in context: Patterns,interventions, and partnerships. New York: Routledge.
http://www.icap.org/Portals/0/download/all_pdfs/blue_book/Module%2024%20-%20HIV%20high-risk%20behaviors%20and%20drinking%20patterns.pdfhttp://www.icap.org/Portals/0/download/all_pdfs/blue_book/Module%2024%20-%20HIV%20high-risk%20behaviors%20and%20drinking%20patterns.pdfhttp://www.icap.org/Portals/0/download/all_pdfs/blue_book/Module%2024%20-%20HIV%20high-risk%20behaviors%20and%20drinking%20patterns.pdfhttp://www.icap.org/Portals/0/download/all_pdfs/blue_book/Module%2024%20-%20HIV%20high-risk%20behaviors%20and%20drinking%20patterns.pdf

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Reducing Harmful Drinking - REFERENCED