Alcohol is the most widely used drug in Australia and can cause harm to individuals, families, and communities. It contributes to more than 4% of all deaths in Australia and costs billions of dollars each year in healthcare and non-healthcare costs (1-3). So it is no surprise that preventing harmful use of alcohol is a priority for government and non-government organisations.
In 2021 the Australian Government launched the National Preventive Health Strategy 2021-2030, which recognises the significant harm caused by alcohol in preventable diseases. The Strategy sets three targets to reduce this harm:
- At least a 10% reduction in harmful alcohol consumption by Australians (≥14 years) by 2025 and at least a 15% reduction by 2030.
- Less than 10% of young people (14-17-year-olds) are consuming alcohol by 2030.
- Less than 10% of pregnant women aged 14 to 49 are consuming alcohol whilst pregnant, by 2030 (4).
These reductions are to be achieved through effective prevention strategies.
What is prevention and what are prevention strategies?
Prevention focuses on reducing risk factors to prevent a disease or disorder before it arises. This includes behavioural factors, such as risky alcohol consumption. Strategies used in prevention usually fall into three categories:
- Supply reduction – these are strategies that reduce the supply of alcohol and regulate the supply of alcohol. For example: decreasing the availability of alcohol through liquor licensing regulation, minimum age purchasing requirements and alcohol-free policies and environments.
- Demand reduction – these are strategies that prevent the uptake or demand of alcohol and delay use. This can include strategies such as community engagement, education, mass media campaigns, warning labels and taxation to increase the price of alcohol.
- Harm reduction – these are strategies that reduce the harmful impacts of alcohol, for example responsible service of alcohol programs and guidelines on recommended standard drinks (5).
Effective prevention strategies have been useful and important tools in reducing risky behaviours and improving health outcomes. In Australia, we have seen smoking rates drastically decrease as result of multiple different prevention strategies over decades. This includes mass media campaigns, plain packaging, taxation, community engagement, restrictions on sales and availability, and the list goes (4).
When it comes to prevention and alcohol, we are faced with the complexity that drinking is considered a cultural norm and many people are unaware of the negative heath consequences of consuming alcohol. There is not a lot of evidence available yet to understand what works and what doesn't. We do have strong evidence that increasing the price of alcohol through taxation (demand strategy) is effective in reducing alcohol consumption, however less is known about the effectiveness of other prevention strategies to support those working in alcohol prevention (6).
To find the most effective way of moving forward in alcohol prevention, the NSW Ministry of Health and Cancer Institute NSW recently commissioned the Australian Prevention Partnership Centre and Sax Institute to complete a rapid review on the Value of Prevention to Reduce Alcohol Consumption (7).
The review found an overwhelming number of benefits to reducing harmful use of alcohol. This includes physical, social and mental health benefits for the individual as well economic and social benefits for communities. There was also strong evidence that alcohol consumption is linked to several cancers, including cancers of the mouth, pharynx, larynx, oesophagus, breast, stomach, liver, and bowel (7).
The review looked at the evidence from several different prevention strategies, including e-health, settings-based health promotion, mass media campaigns, interventions in the built environment and interventions for priority populations. When delivered alone, these interventions displayed varying degrees of success. However, most of the evidence supports interventions that involve multiple prevention strategies from across the three types of prevention strategies: demand, supply and harm reduction. As well as government agencies, non-government agencies and communities working collaboratively to reduce alcohol related harm. On a community level, effective prevention could look like a combination of health promotion and education programs in different settings, restrictions to accessing alcohol, and having strong referral systems in place for those at risk of alcohol related harm (7).
Across most interventions, it is clear from the review that more needs to be done. There is a need for robust evaluations and for multicomponent interventions to demonstrate the value of prevention in reducing alcohol consumption. Importantly there is also a need for robust economic evaluations to help make the case for more investment in prevention! (7).
So what's next for those working in alcohol prevention? Let's use the evidence we have and work together in a coordinated and multi-strategic approach to reduce risky alcohol consumption. And don't forget – evaluate and share!
You can access the full review here as well as a podcast with Dr Elly Howse, Research Manager at the Prevention Centre, and Nikki Woolley, Skin and Lifestyle Portfolio Manager at Cancer Institute NSW discussing the review.
Get help reducing alcohol intake
There are many services, including free or low-cost options, to help people reduce their alcohol consumption.
Drinks Meter is a free, user-friendly app for your phone or tablet that provides confidential, personalised feedback about your alcohol use based on advice from doctors and the Australian guidelines to reduce health related risks from alcohol.
The Get Healthy Service Alcohol Reduction Program is a free telephone-based coaching service designed to support you to make healthy lifestyle changes and reduce your alcohol consumption, available at 1300 806 258, Monday to Friday 8am – 8pm.
Your Service Hub is an online directory with alcohol support services across New South Wales.
For free and confidential advice 24/7 call the Alcohol and Drug Information Service (ADIS) on 1800 250 015. Counsellors are available to provide information, referrals, crisis counselling and support. Or start a web chat with an ADIS counsellor online Monday to Friday, 8.30am – 5pm. ADIS can also provide up-to-date information about service availability in your area during the COVID-19 pandemic.
References:
1. Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease Study 2018. Canberra, Australian Government. 2021.
2. Whetton S, Tait RJ, Gilmore W, Dey T, Agramunt S, Halim SA, et al. Examining the social and economic costs of alcohol use in Australia: 2017–18. Perth, WA: Curtin University; 2021.
3. Crosland P, Ananthapavan J, Davison J, Lambert M, Carter R. The economic cost of preventable disease in Australia: a systematic review of estimates and methods. Australian and New Zealand Journal of Public Health. 2019;43(5):484–95. doi:10.1111/1753-6405.12925
4. Department of Health. National Preventive Health Strategy. Valuing health before illness: living well for longer. Canberra: Australian Government; 2021.
5. Drug and Alcohol Office (2014). Introduction to Alcohol and Other Drug Prevention, Drug and Alcohol Office, Perth.
6.Chaloupka FJ, Powell LM, Warner KE. The Use of Excise Taxes to Reduce Tobacco, Alcohol, and Sugary Beverage Consumption. Annual Review of Public Health. 2019;40(1):187-201. doi:10.1146/annurev-publhealth-040218-043816
7. Crosland P, Howse E, Heenan M, Mohamad Asfia SKB, Dona SWA, Angeles MR,West R, Rychetnik L. 2022. The value of primary prevention to reduce alcohol consumption, an evidence check rapid review. The Australian Prevention Partnership Centre, Sydney.
