• Alcohol;
  • incentives;
  • intoxication

Alcohol is an intoxicating drug, and the more you drink the harder you [1] and those around you fall [2]. We are used to targeted alcohol policy measures such as drink-driving, whose implementation is not only cost-effective [3], but one that leads to increased public support for the measure [4]. Graham et al. [5] use the drink-driving experience to promote operationalization of reducing intoxication among bar drinkers. I can see many spin-offs from profiling and implementing this approach. Here are 12 of them.

  1. A greater need to install licensing systems for the sale of alcohol in all countries of the world, so that enforcement can be enforced. If there is no licence to lose, sanctions are difficult to enforce. The last World Health Organization (WHO) survey conducted at the end of 2008 found that 123 of 162 Member States (76%) surveyed had some form of licensing system [6].
  2. A greater realization of the risks to the drinker from intoxication, including death, that increase with both the frequency of drinking, and the amount drunk per occasion for which risks rise exponentially, but for which there is no level of risk free consumption [7]. This information should be included in added warning labels.
  3. A greater realization of the harm caused to others by alcohol in general, and by intoxication in particular, including crime, accidents, violence, homicide, domestic violence and sexual violence [2]. Factoring in the harm caused by alcohol to others nearly doubled the social costs of alcohol in Australia [8].
  4. Knock-on effects in reducing the chronic harms from heavier drinking, whose risk particularly increases from heavy drinking occasions, including heart disease [9].
  5. A move towards drunk-free bars (as there are smoke-free bars), supported by measures to design out drunkenness, as happened, for example, in the city of Carlisle in England during the First World War [10].
  6. Greater acceptance of the responsibility of sellers, which may have consequences for the responsibilities of ‘off-licence’ retail outlets not to sell to underage drinkers. A study in the Netherlands found that all 14–15-year-olds set with the task of buying alcohol were able to do so, 75% of the time at their first attempt, taking less than 10 minutes to do so [11].
  7. Greater pressure from bars, supermarkets and stores not to sell cheap alcohol. If already drunk customers are excluded from the entering the bar, there is less profit to the bar [12].
  8. Greater incentives for producers to produce new products with lower alcohol content beverages, so that more ‘drinks’ can be sold without leading to intoxication. Bars themselves could also experiment with smaller same-cost serving sizes, another way of selling more ‘drinks’ without increasing intoxication.
  9. If it becomes accepted that sellers have a responsibility to reduce harms to and caused by their customers, why not the same with producers of cars, who can design better alcohol-free cars so that they cannot be driven after consuming alcohol.
  10. Creating a social norm that drinking to intoxication is not socially acceptable, as drink driving is increasingly considered socially unacceptable. This also begins to put some added responsibility on to the individual drinker, as is also the case for drink driving.
  11. Facilitate politically acceptability of alcohol policy measures. Similar to drink driving, this is a targeted measure that particularly reduces the harm to people other than the drinker and, thus, should be politically more acceptable. As a wider range of policy measures are implemented to reduce the harm caused by alcohol, so it should become easier to implement others.
  12. Finally, greater acceptance that alcohol is a powerful drug of abuse, ranked by experts as more harmful overall to individuals and society than other drugs, yet not subject to international, legally binding regulatory frameworks [13].

Declaration of interests



  1. Top of page
  2. References
  • 1
    Taylor B., Irving H. M., Kanteres F., Room R., Borges G., Cherpitel C. et al. The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend 2010; 110: 108116.
  • 2
    Anderson P., Baumberg B. Alcohol in Europe: A Public Health Perspective. A Report for the European Commission. London: Institute of Alcohol Studies; 2006.
  • 3
    Anderson P., Chisholm D., Fuhr D. C. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet 2009; 373: 22342246.
  • 4
    Loxley W., Homel R., Berger D., Snortum J. Drinkers and their driving: compliance with drinking-driving legislation in four Australian states. J Stud Alcohol 1992; 53: 420426.
  • 5
    Graham K., Miller P., Chikritzhs T., Bellis M. A., Clapp J. D., Hughes K. et al. Reducing intoxication among bar patrons: some lessons from prevention of drinking and driving. Addiction 2014; 109: 693698.
  • 6
    World Health Organization. Global Status Report on Alcohol and Health. Geneva: World Health Organization; 2010.
  • 7
    National Health and Medical Research Council (NHMRC). Australian Guidelines to Reduce Health Risks From Drinking Alcohol. Canberra: NHMRC; 2009.
  • 8
    Laslett A.-M., Catalano P., Chikritzhs Y., Dale C., Doran C., Ferris J. et al. The Range and Magnitude of Alcohol's Harm to Others. Fitzroy, Victoria: AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Eastern Health; 2010.
  • 9
    Rehm J., Baliunas D., Borges G. L., Graham K., Irving H., Kehoe T. et al. The relation between different dimensions of alcohol consumption and burden of disease—an overview. Addiction 2010; 105: 817843.
  • 10
    Seabury O. The Carlisle State Management Schema. Carlisle: Bookcase; 2007.
  • 11
    Van Hoof J., Gosselt J. F. Underage alcohol sales—it only takes a minute: a new approach to underage alcohol availability. J Stud Alcohol Drugs 2013; 74: 423427.
  • 12
    Hughes K., Quigg Z., Bellis M. A., Calafat A., Van Hasselt N., Kosir M. Drinking behaviours and blood alcohol concentration in European nightlife users. BMC Public Health 2011; 11: 918. doi: 10.1186/1471-2458-11-918.
  • 13
    Room R. International control of alcohol: alternative paths forward. Drug Alcohol Rev 2006; 25: 581595.