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This chapter begins the discussion of excessive consumption and its regulation by looking at alcohol. Its story reflects many issues relevant to the regulation of excessive consumption, generally, those that are now being played out in terms of smoking, nonnutritious eating and sedentary lifestyles, drugs, and gambling. Topics covered include alcohol and public health, regulating consumption from the 19th century to Prohibition, and regulation after Prohibition into the 21st century.

This chapter considers the aims, mechanisms, and effects of alcohol taxation and pricing, two important economic strategies that have strong implications for the prevention of alcohol-related problems. It reviews economic research and other studies to evaluate how alcohol prices affect alcohol consumption and what aspects moderate the effects of price changes.

This chapter describes alcohol consumption trends and patterns of drinking in a global perspective. The typical frequency of drinking and the amount of alcohol consumed per occasion vary enormously, not only among world regions and countries, but also over time and among different population groups. It is shown that variations in these ‘patterns’ of drinking affect rates of alcohol-related problems, and have implications for the choice of alcohol policy measures.

This chapter focuses on the contributions or effects of alcohol consumption to mortality rate at the time when Estonia, former GDR, Poland, Russia, Lithuania and Latvia are at the rapid pace of transforming to market economies. It also deals with the impact on mortality rate of alcohol consumption before the transition period and its difference to the post-transition period. Alcohol consumption affects mortality rates either as the direct cause of death or as the proximate cause of death arising from accidents, traumas, suicide or homicide. A large portion of deaths due to external causes like accident are attributable to alcohol consumption. However, in the countries stated above, liberalization of the economy is not a factor in considering why alcohol consumption affects mortality rate.

This chapter describes the enormous range of alcohol-related consequences within two broad categories: alcohol's contribution to the burden of illness carried by individuals and societies; and alcohol's harmful effect on the social fabric of families, communities, and nations. It also discusses the potential health benefits of moderate alcohol use. The chapter begins with a discussion of how epidemiologists establish causal relations between drinking and its consequences. It then reviews the evidence on health consequences in three different frames: 1) the role of alcohol in the global burden of disease and disability; 2) alcohol and all-cause mortality; and 3) the relation of alcohol to specific causes of death and disease. The relation of drinking to different types of social problems is then considered. A case study of the Russian experience during the anti-alcohol campaign of 1985-7 is used to illustrate the potential changes in health and social problems that follow from reductions in alcohol consumption. The available evidence on the relative magnitude of health and social problems from drinking is also considered.

This chapter begins with a brief overview of the categories of subjective effects of alcohol, then considers the role of subjective effects from the context of prominent contemporary theories of alcohol use and misuse. Building on this conceptual foundation, it discusses important features of beverage and dose and characteristics of the setting (including the concurrent use of other psychoactive drugs) that affect the subjective experience of drinking. It then considers what is known based on the various methodological approaches used to investigate subjective effects — including survey research on alcohol expectancies and drinking motives, and ecological momentary assessment — with a particular emphasis on experimental research.

Education and persuasion strategies are among the most popular approaches to the prevention of alcohol-related problems. This chapter examines these strategies in several contexts and settings, including schools, colleges, and communities and the general population. The chapter is organized into three main sections: initiatives involving the media, school-based programmes, and college programmes.

Beer, wine, and distilled spirits are alcohol-based commodities that are bought and sold in the marketplace. And alcohol is a drug with toxic effects and other intrinsic dangers such as intoxication and dependence. This chapter examines these different aspects of alcoholic beverages, paying special attention to the contrast between alcohol's dual role as a commodity and as a drug.

This chapter provides an introduction to the current state of alcohol marketing and what is known about the way in which marketing has its impact. It assesses two different policy approaches — codes of content and restrictions to reduce exposure — for their likely impact on consumption and harm. Interventions that change exposure to advertising have often been limited, and evaluations have mixed findings. More effort has gone into the establishment of codes aimed to affect the content of the advertising. Conclusions regarding the likely effects of these approaches can be made based on theoretical understanding, and empirical evidence about the way in which marketing has its effects and its measured impacts. Conclusions may also be informed by research on tobacco advertising, where the impacts are established and widely accepted.

This chapter presents an example of the application of the scheme for critical appraisal: large population-based case-control study entitled ‘Risk of breast cancer in relation to lifetime alcohol consumption’, published in the Journal of the National Cancer Institute in 1995. This large case-control study has shown a regular positive association between recorded alcohol intake and breast cancer risk. The results are generally consistent with the results of other observational studies, most of which, however, would be open to the same limitations.

This chapter reviews existing research on alcohol and crime from the perspective of economics, first considering evidence from laboratory studies on the pharmacological effects of alcohol consumption on the brain and behavior. It then lays out several pathways by which alcohol consumption could lead to the commission of crime and also addresses the relationship between alcohol and other drugs, with respect to both consumption and regulation. Next, the chapter reviews studies on the relationship between alcohol regulations and crime, grouping them by the type of alcohol regulation examined (tax/price restrictions, age-based restrictions, spatial restrictions, temporal restrictions, and regulations not otherwise classified). It summarizes what is known about the value of each type of regulation and concludes with a discussion of economic considerations in assessing the importance of alcohol regulations as part of an effective crime-control strategy.

This chapter reviews the evidence on the consumption of alcohol and the risk of coronary heart disease (CHD) and with compares it mortality in general. The chapter has four general sections. The first section studies of ‘average’ volume of drinking and CHD. It reviews the results of the studies, the potential biases in studies of alcohol, the biological mechanisms for the cardioprotective effects of alcohol, the possibility that the effect of alcohol is modified by background cardiovascular risk, and the public health implications of the results. The second section examines the role of drinking patterns, namely the effect of binge and heavy drinking on CHD. It then reviews the evidence linking different types of alcoholic beverages with CHD risk. Finally, the effects of alcohol on all-cause mortality are summarized.

This chapter considers individual differences associated with alcohol effects. There is wide variability in subjective and other responses to alcohol. The sources of this variability include allelic variation in enzymes responsible for the metabolism of alcoholism, sensitivity (through either initial sensitivity or acquired tolerance), temperament, neurocognitive functioning, and social learning. These sources of heterogeneity in alcohol response appear to be very important not only in understanding the acute effects of alcohol on the individual but also in understanding risk processes underlying the development of alcohol use disorders.

This chapter discusses alcohol consumption and policies in the postwar world. While official attitudes toward alcohol consumption generally shifted in more liberal directions since the 1960s, there were also countervailing tendencies related to specific issues, such as drinking, driving, and binge-drinking. Some societies faced significant alcohol-related challenges and responded with tighter controls.

Along with measures designed to reduce the availability of alcohol, taxation has been the most common policy approach used by governments to control alcohol consumption and its attendant health and social problems. This has provided the means for extensive studies of its impact on alcohol consumption and related harm in a variety of societal settings. This chapter reviews this literature, broadly summarizing the relationships between alcohol prices, alcohol consumption, and alcohol problems. Studies show that consumers respond to price increases by reducing their consumption and to reductions in price by drinking more. Many critics of alcohol taxation suggest that it fails to affect problematic drinkers. This is not supported by the literature, with studies showing that both young people and heavy drinkers respond to price changes.

This chapter examines some of the factors which have shaped alcohol policy in different parts of the world and how international consensus on alcohol policy is evolving. It discusses the factors causing divergence in alcohol policy, patterns of policy implementation, attempts to create an international consensus through research, attempts to create an international consensus on policy, and prospects of concerted action on alcohol.

This chapter sets the stage for the chapters to follow by describing how research is conducted to evaluate the effects of specific alcohol policies, and to assess the impact of prevention strategies (e.g., alcohol education in schools) and other interventions (e.g., screening and brief counselling for high-risk drinkers) that precede formal alcohol policies. In some cases policies persist despite evidence that the strategy is flawed, and the outcome with regard to reducing alcohol-related problems is thus inconsequential. To understand why policies succeed or fail to accomplish their aims, the field of alcohol policy analysis has begun to consider the mechanisms that relate policies to outcomes, as demonstrated by the research discussed in this chapter.