The role of national governments in prevention of social, cultural and health problems linked to substance abuse can hardly be overestimated. This is the same for both alcohol and illicit drugs. However, governments cannot act alone and in isolation. A broad spectre of stakeholders, from civil society as well as from profession groups, have to be mobilized in an integrated strategy. In such a broad strategy government’ role is two-fold; on one hand leadership and coordination and on the other hand implementation of policies and programs.

In the WHO sponsored study “Alcohol in Developing Societies; A Public Health Approach” an international group of scientists under the leadership of Robin Room concludes: “The research evidence clearly indicates that governments possess the powers and policy levers to create comprehensive and successful alcohol policies.”

The study summarizes available data on effective interventions: “Prevention measures that affect the population level of alcohol consumption are among the most effective ways of preventing alcohol-related problems. Concerning the prevention of alcohol-related problems, the politically easiest strategies are often among the least effective.”

The study stresses the importance of alcohol control policy interventions by governments:

• Evaluation studies have demonstrated that measures that restrict and channel sales and consumption of alcohol can be effective in holding down or reducing rates of alcohol-related problems, including harm to those around the drinker.
• The most effective measures include taxation to limit consumption levels, specific licensing of alcohol outlets, limits on the number of outlets and on the times and conditions of alcoholic beverage sales or service, minimum-age limits, and drinking-driving countermeasures.
• Government monopolies of all or part of the retail or wholesale market have often been effective mechanisms for implementing alcohol control measures, while ensuring equitable availability.
• Limits on advertising and promotion, and requirements for warning labels or signs, are also of importance, though it is often difficult to demonstrate their short-term effectiveness in changing drinking behaviour.

These are the same conclusions as in another WHO study; “Alcohol: No Ordinary Commodity” (Tomas Babor et al).

A comprehensive approach

National and local governments should take a comprehensive approach to the problems of substance abuse, for alcohol, as well as for illicit drugs:

• Prevention activities including control policies, directed towards the general population as well as towards more specific target groups, in order to reduce the overall use of intoxicating substances,
• Early interventions towards individuals to prevent emerging alcohol and drugs problems,
• Treatment programs for addicts, problems users and their families,
• Rehabilitation and integration back into the community after treatment,
• Harm-reduction measures towards individuals who suffer from serious problems of substance abuse. Such measures can, however, never replace the other interventions listed above.

The prevention triangle

A comprehensive national strategy, with a a combination of several interventions and activities, is necessary to give a reduction in the level of alcohol and drug related harm. The “prevention triangle” may be a good guide to such a comprehensive strategy:

1. Control policies:

Interventions by governments to reduce the availability of a substance and to guarantee - from a health and social point of view - a safest possible production and distribution system.

2. Education:

Training of professionals, education of consumers, parents, youth etc and campaigns to raise awareness, challenge and motivate the public and to create an understanding of the need for control policies.

3. Mobilization:

Make alcohol and drug prevention a part of the agenda for social and political movements, link the issue to other key policy issues and involve leadership and members of NGOs in practical activities.

Balance between elements in a strategy

The WHO study ”Alcohol in Developing Societies” concludes as follows on the balance between the various elements in such a broad strategy, after having stressed the importance of control policies:

• “Building an integrated societal alcohol policy requires both horizontal integration, of the various departments within a level of government, and vertical integration, of the functions of the various geographic levels of government.
• Well-designed alcohol education is an appropriate part of the school curriculum, but is unlikely by itself to do much to reduce rates of alcohol problems in a society.
• Likewise, a low-intensity public information and persuasion campaign may have the symbolic value of appearing to do something about alcohol problems, but will usually have little practical effect on them.
• Provision of specialized treatment is a worthy and humane initiative in a modern society, but its primary justification is in terms of the help given to drinkers and their families. In and of itself, it is unlikely to lead to a reduction in a society’s rates of alcohol problems.
• Brief interventions, however, have shown to be cost-effective and lead to public health gains, although they have not been broadly disseminated or utilized in developing societies.”

WTO agreements in conflict with health concerns?

Restrictions on the production, distribution and sale of alcohol have proved to be effective in the promotion of public health and welfare, both from a scientific point of view as presented above and from practical experience in many societies over many decades. New international trade agreements coming up under the umbrella of the World Trade Organization (WTO) may become a threat to the right of national and local governments to regulate.

See here for more information.