Background
The latest edition of Alcohol: No Ordinary Commodity1,2 was published in November 2022 following on from the success of the previous two editions. The third edition provides an updated examination of alcohol-related harms globally, while also updating and critically reviewing the scientific evidence of global alcohol control policies.

Key findings
Five major issues are outlined in the book.

1. Alcohol as a leading contributor to death and disease worldwide
Alcohol continues to be a leading contributor to death and disease worldwide, linked to many health conditions and social problems, including cancer, heart disease, liver disease, self-harm, and domestic violence. Alcohol use not only impacts the person who drinks but those around them. Hence, the book outlines the substantial harm to the health burden of others, including road traffic deaths, homicides, child maltreatment deaths, and interpersonal violence. The book also outlines the growing alcohol use and related harms in low-income and middle-income countries and how policies to reduce per capita consumption have been opposed by the alcohol industry.

2. The alcohol industry: a nexus of considerable influence
The shift from multiple regional producers of alcohol products to a small number of transnational corporations has resulted in dominant corporate power of the major alcohol producers and trade associations that are hugely profitable and influence the political decisions that affect consumption and harm. This nexus of actors actively markets alcohol products to recruit more people who drink, build brand loyalty, normalise alcohol, and validate the industry’s role in the policy arena. This globalisation is facilitated by trade and investments agreements.

3. Strategies and interventions to reduce alcohol-related harm
The book rates 69 policy options as (1) best practices – those considered to be highly effective, supported in numerous studies, capable of reaching their target group, and relatively low in cost; (2) good practices – policies, strategies, and interventions considered a good investment but are less supported in the research and less effective than best practices; and (3) ineffective or potentially harmful policies and practices.

Pricing and taxation policies: The policy areas classified as best practices in the book were alcohol taxes that decrease affordability, noting that with price increases come less drinking and consequently less harms and problems. Tax increases reduce population-wide alcohol use, including among the heaviest drinkers and young people as well as providing governments with tax revenues, which in turn can be used to offset the costs of treatment, prevention, and enforcement. However, the authors note that alcohol taxes need to be substantial to be effective. One study included in the book highlights the case study of Lithuania, where substantial alcohol tax increases resulted in preventing over 1,000 deaths in 1 year alone along with economic gains. Minimum unit pricing (MUP), product-specific pricing, and special taxes targeting drinks favoured by children and young people were found to be good practices. Unsurprisingly, policies that increase the affordability are considered harmful and ineffective at reducing alcohol use and related harms.

Regulating physical availability: Limiting the hours and places of alcohol sales, alcohol monopolies that are welfare-orientated, and age restrictions to purchase alcohol are considered best practices. Less effective but rated as good practices are restricting outlet density; promoting lower-strength alcohol products; preventing alcohol use and sale at an individual level, such as a court order; and prohibiting alcohol, where supported by religious or social norms. Ineffective practices were identified as those that increase outlet density. Evidence to support the best practice of reducing hours of sale was highlighted by the example of significant homicide reductions in a Brazilian city following earlier closing times.

Restrictions on alcohol marketing: Children and young people exposed to alcohol marketing are more likely to drink and to drink early. Those with alcohol dependence are more likely to relapse and experience cravings for alcohol when exposed to such marketing. Thus, predictably, total bans on alcohol marketing (best practice) and partial bans (good practice) are favoured over industry voluntary self-regulation of marketing (ineffective and harmful).

Drink-driving countermeasures: Dissuading drink-driving through monitoring and detection measures (e.g. checkpoints, breathalysing) were noted as the most effective policies. Good practices include low blood alcohol concentration levels, graduated licensing for young or new drivers, drink-driving courts, and interlock devices. Ineffective policies include severe punishment, designated driver programmes, safe ride services, education programmes, and victim impact statements.

Other good practices addressing alcohol use and harms: Several other approaches are acknowledged in the book as being good practices but with limited evidence of their effectiveness in reducing alcohol use and related harms. These include (1) education and persuasion strategies, such as public health campaigns promoting abstaining from alcohol, low-risk drinking guidelines, health warning labels, and school-based programmes; (2) modifying the drinking environment, for example, training and licensing of security personnel and bar staff, and policing approaches; (3) treatment in the form of therapeutic approaches, some pharmacotherapies, Alcoholics Anonymous (AA); and (4) early intervention to screen and provide brief interventions for hazardous and harmful drinkers, which is a cost-effective approach compared with most treatment services.

4. The policy process: multiple stakeholders, multiple agendas
The major stakeholders involved in alcohol policy often have competing values, interests, and ideologies. There are no international-level agreements to limit alcohol-related harms, unlike other psychoactive substances. For alcohol policy to use science in the public interest, there is a need for multinational processes to address the consequences of increasing globalisation of alcohol production, trade, and marketing.

5. Alcohol policies: a consumer’s guide
According to the latest alcohol policy research, best practices and good practices are more numerous and more effective than ever. No one single approach addresses alcohol-related harms, but along with the most effective best practices (e.g. price, availability, marketing controls), there are numerous other good practices that can contribute to reducing alcohol use and related harms.

Anne Doyle of the Health Research Board with Professor Thomas Babor, lead author of Alcohol: No Ordinary Commodity

Conclusion
The welcome publication of the third edition, a hugely valuable resource book for those working or interested in the public health approach to alcohol, like its two previous editions, contributes to an extraordinary advancement in the evidence base on alcohol policy issues.

Alcohol is no ordinary commodity. It is a carcinogen causing millions of deaths globally every year and yet it continues to be sold in the marketplace like many other products. This book seeks to stop the normalisation of drinking and to publicise the dangers of its use and highlight how poorly regulated it is. Not only does the third edition do this, but it also suggests effective and cost-effective solutions to reduce alcohol use and related harms.

Book launch and lead author visit to Dublin
The book was launched in the World Health Organization Regional Office for Europe in Copenhagen on 6 December 2022, with two of the main authors presenting the findings, Professor Thomas Babor and Dr Jürgen Rehm. Two days later, on 8 December, Professor Babor visited Dublin to again present a number of key findings from the book and participate in a discussion on alcohol policy.

1    Babor TF, Casswell S, Graham K, et al. (2022) Alcohol: no ordinary commodity – research and public policy. 3rd edn. Oxford: Oxford University Press. Available as a free e-book from: https://www.drugsandalcohol.ie/37638/

2    Babor TF, Casswell S, Graham K, et al. (2022) Alcohol: no ordinary commodity – a summary of the third edition. Addiction, 117: 3024–3036. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16003?af=R