BACKGROUND & AIMS: Alcohol is a leading global risk factor for more than 200 diseases, premature death, and disability. We aimed at updating the Alcohol Preparedness Index (API) to map global and regional policy trends between 2010 and 2019.

METHODS: We compiled policy data from 141 countries from the World Health Organization Global Information System on Alcohol and Health and scored five domains: national policy frameworks; production, pricing, and taxation; marketing and availability; drink-driving countermeasures; and monitoring and surveillance. The primary endpoint was the percentage change in API between 2010 and 2019. We summarized trends by region and explored potential variables that explain these trends with an adjusted regression model.

RESULTS: By 2019, fewer than 25% of countries had a strong national alcohol plan (defined as a written national policy accompanied by a formal action plan for its implementation), whereas 40% had none. Production, pricing, and taxation showed the clearest increase (27% in 2010 and 78% in 2019). Monitoring and surveillance reached strong levels at 47.5%. The median API increased from 57.0 (39.0-82.0) in 2010 to 74.8 (58.3-83.5) in 2016, remaining above baseline in 2019 at 67.8 (51.2-83.8). Larger population size negatively correlated with API change (β = -19.1, p <0.05). Human Development Index and alcohol per capita consumption were not significantly associated with API change.

CONCLUSIONS: From 2010 to 2019, preparedness on alcohol policy increased globally, though progress remained uneven across domains and regions. These findings highlight persistent policy gaps and support the prioritization of evidence-based interventions aligned with the SAFER framework. Future efforts should focus on translating policy presence into implementation, with particular attention to domains most strongly linked to alcohol-associated liver disease outcomes.

IMPACT AND IMPLICATIONS: Despite the well-established harms of alcohol, global trends in alcohol policy preparedness remain poorly characterized. Using the validated Alcohol Preparedness Index across 141 countries, we demonstrate meaningful but uneven global progress between 2010 and 2019, with gains concentrated in taxation and monitoring domains, whereas national planning and marketing controls lagged, particularly in low-income regions. These findings are directly relevant to policymakers and public health authorities, as stronger alcohol policy environments have previously been linked to lower rates of alcohol-associated liver disease, hepatocellular carcinoma, and cardiovascular mortality. Within the limitations of an ecological study design, this work provides a practical roadmap for identifying policy gaps and prioritizing interventions aligned with the WHO SAFER framework to reduce the global burden of alcohol-related disease.