Alcohol advertising, again

The usual lot want to ban alcohol advertising in sport, to protect kids.

I'll excerpt from my submission to the Ministerial Forum on Alcohol Advertising and Sponsorship of a couple of years ago; the whole thing is here. They were focused on evidence since 2010 because they took the Law Commission's prior report as starting point, so that explains the 'since 2010' bits quoted below.

Nelson (2010) examines whether alcohol advertising bans affected alcohol consumption in a panel of 17 OECD countries over the years 1975-2000. His modelling is careful: he begins by controlling for the underlying factors giving rise to country-level restrictions on alcohol advertising before estimating the effects of those restrictions controlling for the underlying factors that cause advertising restrictions and controlling for the overall stringency of alcohol regulation. He finds that bans on alcohol advertising have no effect on total alcohol consumption. It is rather important to correct, as he does, for the underlying factors that predict countries’ adoption of advertising restrictions: Gallet and Andres (2011) demonstrate that countries with a greater proportion of youths, with greater life expectancy, with higher income, and with greater Muslim populations are more likely to adopt advertising restrictions. If countries that are generally healthier, as demonstrated by life expectancy, are more likely to adopt restrictions on alcohol advertising, correlations between health outcomes and advertising bans could easily be spurious. Nelson also notes that while, from the 1980s onward, most countries liberalised their restrictions on alcohol advertising the period since the 1980s has also seen reasonable declines in total alcohol consumption. Similarly, the period of liberalisation in New Zealand, from 1989 onwards, also corresponds with a period of substantial decline in per capita consumption.

Some evidence since 2010 has suggested that increased exposure to alcohol advertising is associated with increased risk of youth drinking.

Morgenstern et al (2011) finds that German students who were better able to recall the names of alcohol brands from popular advertisements had a higher risk of drinking and of binge drinking. However, they are unable to demonstrate a temporal effect: that is to say, they cannot demonstrate whether advertising recognition preceded drinking, or came subsequent to drinking. Consequently, they cannot tell us whether students most able to recall alcohol brands are 2.3 times as likely to engage in binge drinking as those least able to recall alcohol brands, or whether students who binge drink are 2.3 times as likely to remember alcohol brands. As they also measure exposure to non-alcohol advertising, it would have been interesting to see if, for example, students who take on more duties at home were better able to recall the detergent brand, whether students with mobile phones were better able to remember the T-Mobile brand, and whether students who go hiking were more able to recall the trekking-clothing ads.

Jones et al (2011) argue that youths who indicated having seen alcohol advertisements were more likely to initiate drinking and to have consumed alcohol in the past four weeks. However, their adjusted odds ratios frequently fail to achieve statistical significance. One significant effect was that having seen TV advertisements for alcohol halved the risk of having consumed alcohol in the past 12 months. But none of the odds ratios there reported should be taken particularly seriously: the substantial reduction in odds ratios after correcting for a very small number of covariates, coupled with the substantial decline in statistical significance after such correction, suggests that uncontrolled confounding could easily explain the remaining variation. Table 3 presents correlations between advertising and alcohol initiation across 32 different advertising / gender / age cohorts. They find three associations are significant at the 5% level: barely more than we would expect by sheer chance with so many separate regressions. Results in Tables 4 and 5 are rather similar: where adjusted odds ratios are significant, three show that alcohol advertising reduces the likelihood of regular or recent alcohol consumption, seven show an increased risk, and 42 show no significant relationship whatsoever. If anything, we should take this study as providing reasonably strong evidence of the absence of a relationship between having seen alcohol advertising and the initiation of alcohol consumption. Further, while some of the aggregates presented in Table 2 provide statistically significant associations between some alcohol advertising exposure and drinking, they are unable to rule out reverse causality where those who are more interested in alcohol to begin with are more likely to pay attention to and to remember alcohol advertisements. Look past their discussion of their results to what they’ve actually shown: there is scant evidence on which to hang their conclusions.

Bryden et al (2012) conduct a meta-analysis on effects of alcohol advertising. They find little evidence of harmful effects of alcohol advertising. Importantly, those studies categorised as methodologically weak were more likely to find harmful effects of alcohol advertising. See discussion at 3.2.2, p. 355.

The recent literature here surveyed suggests that even the most stringent of alcohol advertising regulation, full bans, has no effect on consumption. Individual level exposure to advertising may have small effects on consumption, but those studies showing effects do not successfully disentangle brand recognition among drinkers from effects on drinking intentions among those exposed to branded advertising.

Bryden, A., B. Roberts et al. 2012. “A systematic review of the influence on alcohol use of community level availability and marketing of alcohol.” Health & Place 18: 349-57.

Gallet, C. and A. Andres. 2011. “International evidence on the determinants of alcohol advertising restrictions.” Applied Economics Letters. 18:14, 1359-1362.

Jones, S. and C. Magee. 2011. “Exposure to alcohol advertising and alcohol consumption among  Australian adolescents.” Alcohol and Alcoholism 46:5, 630-7.

Morgenstern, M. et al. 2011. “Exposure to alcohol advertising and teen drinking.” Preventative Medicine 52: 146-151. Nelson, Jon P. 2010. “Alcohol advertising bans, consumption and control policies in seventeen OECD countries, 1975-2000.” Applied Economics 42:7, 803-23.

I couldn't see much reason to expect that advertising bans in sport would do much to reduce risky drinking. I also didn't like suggestions of bans on sponsored events, teams and venues.

Bans on alcohol industry sponsorship of sporting or other events need be based on strong evidence of net harms resulting from such sponsorship. If youths or other at-risk groups were substantially more likely to engage in harmful binge drinking instances because their favourite team or concert were sponsored by particular brands, and if those harms greatly outweighed the demonstrable benefits of sponsorship to the sponsored organisations and events, then we could have a reasonable case for restrictions or bans. That evidence, however, does not exist. While there is ample evidence of alcohol sponsorship of events and sports teams, evidence of consequent harms is lacking.

Further, it is plainly evident that attendees at sponsored events often greatly benefit from that sponsorship. The Rugby Sevens are typically taken as evidence of the awful consequences of alcohol sponsorship of sporting events. And while it’s true that the Sevens are typically associated with alcohol consumption, that hardly makes the case for a ban. Survey data from the HPA (2013) demonstrates not only broad awareness of alcohol sponsorship of the Sevens, but that alcohol’s presence at the Sevens is a critical part of the fan experience. 82% of attendees surveyed at the Sevens agreed or strongly agreed that drinking alcohol made the event more entertaining; 93% agreed or strongly agreed that they attend the Sevens because of the atmosphere; 77% agreed or strongly agreed that “drinking alcohol at this event is ‘just what you do’”. Fans attending the Sevens really seem strongly to enjoy the particular atmosphere present at the Sevens. It’s also worth noting that that same survey demonstrated that alcoholic sponsor messaging was less prominent there than at other surveyed events, like the Heineken Open or the International T20, where alcohol sponsor messaging was more prominent but where the event’s culture was rather more sober.

It is particularly worrying that the Law Commission’s report called ultimately for a ban on alcohol sponsorship (19.182), but provided only one piece of evidence suggestive of potential harms from sponsorship: that survey respondents who received free or discounted alcohol as part of their team’s sponsorship arrangement felt they should drink their sponsor’s product (19.27). On the basis of that evidence, they wished to ban all alcohol industry sponsorship of events and sports teams. Presumably they found the harms self-evident.

Meanwhile, over at the Sandpit, I have a look at another paper showing some of the social benefits of social drinking. Check it out.

UPDATE: I'd forgotten to link the Cochrane Review, that said there's not enough evidence to show anything on effects of advertising bans as yet. Curiously, none of the Science Media Centre's chosen experts seemed to have heard of that one, 'cause they didn't cite it.

Some useful context

I'm sure it's only the confines of a short radio news blurb that had Radio New Zealand miss a bit of context in this story. The full text of the RNZ bulletin:

The Government is being urged to consider whether it is time to ban alcohol advertising and sponsorship of sport.

Kerry O'Brien, a behaviour studies expert at Monash University, told an alcohol marketing conference in Wellington on Thursday, that alcohol advertising is everywhere in both New Zealand and Australia.

He said sport is a major way in which the alcohol markets its product to young people and current advertising codes aren't protecting children.

Mr O'Brien said new research shows if adults receive alcohol sponsorship in their sports club, their children may also be influenced.

Ok, an expert addressing an alcohol marketing conference wants to ban advertising. What kind of conference? Alcohol marketing. Could be some industry thing, could be an academic thing, who knows. Sounds pretty neutral and impartial though.

Here's Alcohol Action New Zealand's blurb on their conference:

THE PERILS OF ALCOHOL MARKETING - Thursday 7th March 2013 at Te Papa, Wellington

The upcoming conference titled The Perils of Alcohol Marketing is shaping up really well, with excellent keynote speakers confirmed - Professor Sally Casswell, Massey University Auckland, Professor Janet Hoek, University of Otago, Dr Kerry O'Brien, Monash University, and Associate Professor Antonia Lyons, Massey University. This will be the first conference post the Alcohol Reform Bill and focusing on this fundamental commercial issue of alcohol marketing is very apt. The draft programme is available to view and download below.

We welcome abstracts for short presentations (3-5 minutes) that illustrate the most "evil" examples of alcohol marketing. Feel free to submit an abstract that focuses on one pertinent example or, alternatively, one that skims over multiple examples. Please see the call for papers application form below.

Don't miss this critical conference on alcohol marketing - New Zealand's most socially damaging drug. Register now by completing and returning the registration form below.

So a conference, titled "The Perils of Alcohol Marketing", and hosted by Doug Sellman's Alcohol Action New Zealand, specifically went out asking people to submit abstracts illustrating "the most "evil" examples of alcohol marketing" and had a keynote speaker who thinks alcohol marketing should be banned.

Here's the conference flier:

NZ continues to be one of the most unregulated societies in the OECD for the supply and sale of alcohol. Alcohol is our most socially damaging drug yet the global alcohol industry enjoys enormous freedom to market alcohol to New Zealanders - as if it were an ordinary commercial product. 

The Conference will feature: 

Stimulating and informative keynote presentations from experts on alcohol and alcohol
marketing: Prof Jennie Connor, Prof Janet Hoek, Prof Sally Casswell, and A/Prof Antonia
Lyons. Dr Kerry O’Brien from Australia’s Monash University is a special overseas guest.
A series of short presentations illustrating the most “evil” examples of alcohol marketing.
A political panel with representatives from the main parliamentary parties outlining their
respective party policy on how to deal with “The Perils of Alcohol Marketing”, in the light of the Law Commission’s recommendation to dismantle it over a five year period. 

The draft programme included:

• Otago's Jennie Connor on Alcohol Harms
• Otago's Janet Hoek asking whether responsible alcohol marketing is a "public health oxymoron?"
• SHORE's Sally Casswell asking "Where would alcohol companies be without alcohol marketing?" 

A bit of context can sometimes be of assistance. 

Love letters

In today's NZMJ:

Marketing and supplying alcohol to young people

The posting of a video of an extremely intoxicated 9-year-old boy resulted in a media furore in recent weeks reflecting the extreme youth of the individual and a heightened focus on Internet postings; it also illustrated increased public concern over alcohol related harm and highlighted some key public health issues which require urgent action.

This case is a ‘tip of the iceberg’ illustration of what our survey data suggests is happening in New Zealand among young people (although data does not cover children as young as 9 years). As controls on sale from licensed premises have become better enforced and compliance has increased—only 9% of 16-year-old drinkers and 14% of drinkers aged 17 purchasing their own alcohol in 2012 (unpublished data, HRC funded Alcohol Policy in New Zealand [APINZ] survey)—social supply has become a major source of alcohol for those under the minimum purchase age. Much supply is from older friends or relatives and, on average, about 11 cans of ready-to-drinks (RTDs) or equivalent are supplied.1

The Sale and Supply of Alcohol Act 2012 introduced greater clarity to the law regarding supplying alcohol to minors. The Act now makes it an offence to supply without ‘express consent’ of the parent or guardian. Charges have been laid against three people in connection with this case providing an opportunity to capitalise on a public health message about the law and the likelihood of prosecution.

The supply of 8 cans of Cody RTDs and 2 shots (about 150 ml of absolute alcohol in total) illustrates the importance of RTDs. In a recent study RTDs were found to be the beverage young suppliers reported supplying most often to those under the minimum purchase age.1

Attempts overseas to introduce specific taxes on RTDs have not been successful because of substitution to alternative beverages2 or amelioration of costs by provision of multipack options3 but evidence shows affordability of alcohol is very important4 and the cost entailed in this supply (about $20.60) was obviously not sufficient to deter the generous spirit of the suppliers.

Increasing excise tax by 50% as recommended by the Law Commission in 2010, but rejected by government, would have increased the cost by only about $3 but would have been a move in the right direction. The results from the APINZ survey show heavier drinkers purchase cheaper alcohol.5 Tax increases are effective to reduce alcohol-related harm and significant tax increases, as have been applied to cigarettes in New Zealand, are urgently needed.

Equally urgent is action to reduce the exposure of young people to the marketing of all alcohol beverages including RTDs. Cody, with the third largest share of the high potency RTD market in NZ, carried out a significant television campaign in 20126 and is prominent in the bottle store displays to which children are exposed.

Then there is the question of distribution: high potency RTDs were to be subject, in the new Act, to greater controls. The original recommendation from the Minister, following the Law Commission review, was to prohibit RTDs above 5% alcohol potency.7 This was reduced to prohibiting sale from off licenses of 6% RTDs while still allowing sale from on-license premises.8 However, after government consulted the producers of RTDs these clauses were withdrawn with a promise the industry would adopt a voluntary code and government would regulate quickly if needed. It is not clear what would trigger regulation or if an organisation independent of the industry will monitor.

Which brings me to a final relevant issue in the media coverage of this story: while there were no comments from the vested interest groups, producers or retailers, one NZ Herald story did quote Dr Eric Crampton, a University of Canterbury economist, who said the video was shocking because ‘rare and sad events are shocking’. He also said ‘while several prominent anti-alcohol commentators have used this tragic case to argue for higher alcohol prices and broader restrictions on where alcohol can be sold, the overall statistics on youth drinking suggest that things are improving’.

Dr Crampton was referring a decrease in the proportion of young drinkers classified as hazardous drinkers or binge drinkers in recent surveys. The Ministry of Health (MoH) NZ Health Survey for example, reported 1 in 5 of those aged 15–17 years were hazardous drinkers (down from about 1 in 4 in 2006/7). There is no doubt there is some improvement but whether enough to argue against improved alcohol control policies is another question.

The University press release and NZ Herald story did not contextualise this ‘expert’ opinion, but in a recent news item it was announced that Dr Crampton and the University of Canterbury had accepted 3 years of funding from the Brewers Association of New Zealand.

In the words of the Director of External Relations of the Brewers Association, Jenny Cameron: “This funding ... will add to the voices in the public debate over alcohol and alcohol policy.”9

Sally Casswell

Director
SHORE and Whariki Research Centre
School of Public Health, Massey University
Auckland, New Zealand

References:

1. SHORE and Whariki. Social Supply of Alcohol to Young People in Taranaki and Mangere. Auckland: Shore and Whariki Research Centre, School of Public Health, Massey University, 2012, December.
2. Müller S, Piontek D, Pabst A, et al. Changes in alcohol consumption and beverage preference among adolescents after the introduction of the alcopops tax in Germany. Addiction. 2010;105(7):1205–13.
3. Jones S, Barrie L. RTDs in Australia: Expensive designer drinks or cheap rocket fuel? Drug Alcohol Rev. 2011;30(1):4–11.
4. Wall M, Casswell S. Affordability of alcohol as a key driver of alcohol demand in New Zealand: a cointegration analysis. Addiction. 2013;8(1):72–9.
5. Wall M, Casswell S, Huckle M, Yeh L-C. Effects of increases in alcohol excise tax: modelling based on results from the IAC survey in New Zealand. Alcohol Clin Exp Res. 2013;submitted.
6. Euromonitor. Rtds/High-Strength Premixes in New Zealand, 2012. http://www.euromonitor.com/rtds-high-strength-premixes-in-new-zealand/report
7. Office of the Minister of Justice. Alcohol Law Reform. 2010. Accessed 20 January, 2014. Available at: http://www.justice.govt.nz/policy/sale-and-supply-of-alcohol/regulation-of-alcohol/alcohol-law-reform-cabinet-paper-final.pdf
8. Ministry of Justice. Regulatory Impact Statement: Alcohol Reform Bill – Policy Amendments for inclusion in the Government Supplementary Order Paper. 2012, 6 September. Accessed Available at: http://www.justice.govt.nz/policy/sale-and-supply-of-alcohol/regulation-of-alcohol/Final%20RIS%20-%20Alcohol%20Reform%20Bill%20-%20Policy%20Amendments%20for%20Inclusion%20in%20the%20Government%20Supplementary%20Order%20Paper.pdf
9. Brewer's Association. Brewers Association to fund Alcohol Policy Research. Scoop; 2013, 6 December. Accessed 20 January, 2014. Available at: http://www.scoop.co.nz/stories/SC1312/S00025/brewers-association-to-fund-alcohol-policy-research.htm

I've just sent this letter to the NZMJ. Perhaps they'll publish it. Their standards on letters seems pretty low. [Update 14 February: it's published here.]

Dear NZMJ,

I note with interest Sally Casswell’s letter in the most recent NZMJ.[1] She writes:

“Which brings me to a final relevant issue in the media coverage of this story: while there were no comments from the vested interest groups, producers or retailers, one NZ Herald story did quote Dr Eric Crampton, a University of Canterbury economist, who said the video was shocking because ‘rare and sad events are shocking’. He also said ‘while several prominent anti-alcohol commentators have used this tragic case to argue for higher alcohol prices and broader restrictions on where alcohol can be sold, the overall statistics on youth drinking suggest that things are improving’.

Dr Crampton was referring a decrease in the proportion of young drinkers classified as hazardous drinkers or binge drinkers in recent surveys. The Ministry of Health (MoH) NZ Health Survey for example, reported 1 in 5 of those aged 15–17 years were hazardous drinkers (down from about 1 in 4 in 2006/7). There is no doubt there is some improvement but whether enough to argue against improved alcohol control policies is another question.

The University press release and NZ Herald story did not contextualise this ‘expert’ opinion, but in a recent news item it was announced that Dr Crampton and the University of Canterbury had accepted 3 years of funding from the Brewers Association of New Zealand.”

Here’s some context, if your readers would be interested.

The University of Canterbury’s media person contacted me requesting a press release on this issue. I was not inclined to comment on the case, knowing nothing of the circumstances of the 9-year-old in the video. But I was then disappointed to hear repeated instances of anti-alcohol commenters suggesting that this case served as exemplar of a worsening trend in youth drinking. I consequently wrote a release focusing on results from the most recent Ministry of Health and Auckland Youth ’12 data that show that youth drinking has been decreasing. I also insisted that the last line of the press release note what might be perceived as a conflict of interest. It reads, “Dr Crampton is a senior lecturer in economics at UC. He also advises the Brewers Association of Australia and New Zealand on alcohol economics and policy.”[2] I forwarded a copy of the release to the Brewers Association as a courtesy; it was the first time that I had talked with them about the matters discussed in the release. They did not request or initiate the release.

It is strictly incorrect for Casswell to insinuate that I was hiding any potential conflicts; they’re noted in the press release. My full disclosure statement has been up on my blog, Offsetting Behaviour[3], since the University entered into this arrangement with the Brewers to facilitate my work, and were also announced in a separate press release in December. It is also incorrect to suggest that my press release pointing to the actual statistics on youth drinking were in any way motivated by this arrangement. I just get annoyed when policy activists try to mislead the public about the underlying statistics. And I continue to be amazed by those who think tax increases are the appropriate way of dealing with those adults who think it hilarious to get 9 year olds drunk.

1. Casswell, S. Marketing and supplying alcohol to young people. New Zealand Medical Journal, 2014;127(1388).
2. The full release is archived at Scoop. http://www.scoop.co.nz/stories/AK1401/S00225/video-showing-a-drunk-nine-year-old-shocking-for-good-reason.htm
3. My disclosures statement is here: http://offsettingbehaviour.blogspot.com/2013/12/alcohol-work.html

Prohibitionist Electioneering

The usual bunch has issued a statement calling for more restrictions on alcohol. 

A four-point "call for action on alcohol", issued today, has been signed by the heads of general and specialist groups of doctors and nurses, academic researchers and the heads of the Anglican, Catholic, Methodist, Presbyterian and Salvation Army churches.

It calls on the incoming government after the September 20 election to implement Law Commission proposals from 2010 to raise alcohol taxes by 50 per cent, impose a minimum price for alcohol to stop price discounting, and phase out alcohol sponsorship and advertising except for "objective product information".

The 50 per cent tax hike would result in a 10 per cent increase in retail prices of alcoholic drinks. National Addiction Centre director Professor Doug Sellman, who organised the statement, said such a price increase would cut consumption by 5 per cent.

The Herald embeds their full statement, available here.

They open with a quote,

"If alcohol were a communicable disease, a national emergency would be declared." 

Later, they write,

The argument is often heard that policies to slow the supply of alcohol through increasing price or reducing physical availability diminish personal freedom and autonomy of "ordinary New Zealanders". It is time we moved from the self-interested and sometimes destructive "freedom to" (... drink as much as you want; supply alcohol to your children's friends; promote and sell alcohol anywhere any time) and consider the "freedom from" the harms caused by heavy drinking.

Those two together do get to the crux of things. The expansionist view of public health deems personal consumption decisions as akin to a communicable disease, puts no value on that individuals derive consumption benefits from alcohol, and largely ignores existing regulatory constraints including:

• If you're at a bar, and you're intoxicated, the bar can face pretty substantial penalties for continuing to serve you. Maybe you can drink "as much as you want" at home, but you can't do it in a licensed venue. I'm not sure what the prohibitionists will come up with to ban people from getting drunk at home, but I'd be surprised if they didn't come up with something. 
• The latest round of regulatory changes prohibited you from serving alcohol to your children's friends if they're minors unless you have a permission note from their parents. 
• You cannot promote alcohol in advertising on television outside of the watershed hours; you cannot sell alcohol outside of the permitted and constrained hours that vary from venue to venue and jurisdiction to jurisdiction. 

The market's already pretty heavily regulated. But all of those existing regulations, they never count for much. It's the next set of regulations that will make us the Shining City on the Hill. 

Back to their missive:

The 'sophisticated' alcohol culture promised twenty-five years ago by advocates of the liberalising Sale of Liquor Act 1989 has turned out to be an increasingly endemic heavy binge drinking culture in New Zealand [De Bonnaire et al 2005; Wells et al 2006]. The cost of alcohol harm is estimated to run into billions of dollars, money that would be much better spent on community benefits.

Ok. First off, here's the time path on per capita alcohol availability. Here's just how bad things have gotten since liberalisation in 1989. It's really terrible. You might want to cover your eyes and peek through the cracks in your fingers.

Can you see the huge per capita increase in alcohol consumption that came about because of liberalisation? It's there. Just squint a bit more.

Heavy drinking or binge drinking? The WHO reports [discussed here] that 5.6% of drinkers (4.5% of the population) consumed at least 6 standard drinks on at least one occasion in the last 30 days. So roughly one person in 20 had the equivalent of six 330 mL Tui, or just under two 500mL bottles of Epic's Hop Zombie Double IPA.* Even at that low a threshold, only one in twenty are drinking that much at least monthly. 

The WHO report lets us benchmark New Zealand internationally. Sure, there are other measures of everything within NZ, but the WHO figures at least run a common measure across different countries allowing for international comparisons. Why might international comparisons matter? 

Here are some of the countries lauded by Alcohol Action NZ. Quoting from them:

• Scotland’s parliament has legislated for a minimum price per standard unit of alcohol of 50p, to eliminate ultra-cheap products, although this is now being challenged in various courts by the alcohol industry.

• Finland, like other Scandinavian countries, has excise tax on alcohol about twice as high as New Zealand. [Note from Eric: the Productivity Commission noted New Zealand's particularly high alcohol prices. Yeah, the Scandanavians have high taxes, but we're hardly cheap.]

• The whole of the USA has a minimum drinking age for alcohol of 21 years.

• Ireland has off-licence trading hours of 10.30am - 10pm Monday – Saturday, 12.30 10pm on Sundays. California has a blanket closure of on-licences at 2am.

• The South African government has recently formulated legislation to ban all alcohol advertising and sponsorship, in even more stringent fashion than has existed in France for more than 20 years, although is now bracing itself for attack by the alcohol industry during the upcoming parliamentary process.

• Most countries of the world have a blood alcohol concentration (BAC) drink-driving limit of 0.05 or less, including Australia. Countries with a BAC of 0.02 or 0.03 include Sweden, Norway, Poland and Japan.

• Norway has resisted the influence of the European Union in maintaining strong regulation of alcohol in the face of trade agreements.

Ok. So Scotland, Finland, the US, Ireland, South Africa, France, Australia, Sweden, Norway, Poland and Japan are singled out as being super-awesome anti-alcohol campaigners. Let's check some outcomes.

First, let's look at age-standardised prevalence of alcohol use disorders. The WHO puts New Zealand at 3.4% prevalence, lower than all countries in the Western Pacific Region other than Brunei (1.7%), Japan (3.3%), Malaysia (2.3%), and Singapore (0.9%). See p. 320 of the appendix. Were New Zealand in Europe, we'd be much lower than average: we're lower than any European country other than Italy (1.2%), Malta (3.2%), Netherlands (1.3%), Romania (2.6%), Spain (1.4%), Tajikistan (0.8%), and Turkey (2.6%).

And how about those super-great campaigner countries? France (6.0%), Finland (7.7%), Ireland (7.3%), Sweden (9.9%), Norway (8.7%), Poland (8.7%), and Scotland (UK is 12.1%, no separate Scottish figure) all have worse rates of alcohol use disorders. Similarly, the USA (7.8%) and South Africa (5.4%) are worse than NZ. Only Japan (3.3%) is slightly below the NZ rate. If we fully replicated the experience of those countries with policies lauded by Alcohol Action NZ, we'd have worse rates of alcohol use disorders.   

Ok, maybe our problem isn't with alcohol use disorders. It's that nasty binge drinking. Let's look at at the prevalence of heavy episodic drinking in the WHO figures. The table at page 312 of the appendix puts NZ at 4.3%. Why is this lower than the 4.5% listed above? Because it's age-standardised: some differences in drinking across countries depend on demographic differences. Let's again compare NZ with our neighbours, with Europe, and with those countries whose policies are lauded by Alcohol Action NZ.

In the Western Pacific Region, Brunei (0.5%), Cambodia (1.2%), Kiribati (2.4%), Malaysia (0.3), the Philippines (1.6%), Singapore (4.2%) and Vietnam (1.3%) have lower rates; 13 countries including Australia, China, and Japan (18.4%!!) have higher rates.

In Europe, Turkey (0.2%), Tajikistan (1.0%), and Andorra (4.2%) have lower rates. Every single other country in Europe has higher rates of heavy episodic drinking. Every single one. 

Among those countries lauded by Alcohol Action, France (29.8%), Finland (35.9%), Ireland (36.5%), Sweden (24.3%), Norway (12.6%), Poland (5.4%), Scotland (UK figure of 27.1%), the USA (16.2%), South Africa (9.8%), and Japan (18.4%) ALL have higher rates of heavy episodic drinking. Every one of them. 

If we look at the WHO figures, it is utterly, utterly absurd to claim that New Zealand is some kind of binge drinking outlier. The Ministry of Health uses a different standard for potentially hazardous drinking and have higher figures; they also report that rates of hazardous drinking are declining, and especially among younger cohorts. MoH puts hazardous drinking rates at 19% of drinkers, with 80% of the population being drinkers. So 15.2% of the overall population. Even if we use that figure instead of the WHO one on heavy episodic drinking, we still get a lower rate than most of the countries lauded by Alcohol Action.

Fundamentally, how we stand relative to other countries shouldn't matter much: if a policy is cost-effective it should be implemented. But we have to define cost-effectiveness comprehensively, taking due account of the costs the policy imposes on individual consumption. And, that countries with lauded policies tend to have worse drinking outcomes than we do might just give us pause.

Previously:

• Seeing what you want to see: Minimum pricing edition
• More drinking stats
• Increasing alcohol excise is great, if you assume the right things
• On Stillman SHOREs: the effects of reducing NZ's alcohol purchase age
• Drinking time
• Drinking Ed
• More binge drinking reports
• Minimum pricing
• Minimum alcohol pricing and economic rents
• Markets hate profits: minimum pricing edition
• Petrol tax:speeding :: alcohol tax:binge drinking
• The Omniscience Constraint
• Public health and the regulatory state
• Minimum pricing
• Minimum prices and mortality risk
• Evidence and minimum pricing
• About that Canadian study...
• Alcohol minimum pricing
• A hopefully concluding note on the price elasticity of alcohol

* I only chose this one because I happened to have a bottle in my office supply.

Alcohol Healthwatch Is Making Stuff Up, Again

Here's Alcohol Healthwatch in the New Zealand Herald.

Rising economic confidence and "aggressive" marketing techniques are the driving factors behind an 8.9 million litre rise in alcohol availability last year, says one concerned health organisation.
Latest figures from Statistics New Zealand, which compared figures over the last five years, show the total volume of alcohol available in New Zealand rose to 466 million litres last year - the equivalent of 2.1 standard drinks per person aged 18 and over per day.
It represents an increase of almost 9 million litres from 2012, according to Statistics New Zealand.

The total volume of alcohol available for consumption in New Zealand did increase last year. So too did population. We usually look at per capita trends rather than total volumes.

Go to Stats NZ's Infoshare service. I cannot link directly to the data series, because StatsNZ uses session codes that won't allow it. But the series you need is ALC005AA. Copy that into the search bar that I've linked to above. Then select all years all series. This is what you get when you port it into Google Docs to get graphs.

So, what can we see here? Per capita alcohol availability dropped substantially from 1986 to 1988, levelled off, dropped substantially from 1990 through 1996 (recall that the big liberalisation came '89), then bounced around a bit with a mild rise through 2010 followed by a mild fall. The average per capita figure for those aged 15+ was 9.4 litres over the whole period, was 9.2 litres over the period since 2000, and was 9.3 litres for the period 2003-2013. The 2013 figure was 9.2 litres. Eyeballing it, we've had a slight reversion after a substantial decline in consumption, followed by a levelling-off since 2005.

The Herald's citing Alcohol Healthwatch as saying that rising economic confidence and aggressive marketing are behind a rise in alcohol availability, using "total volume of liquid containing alcohol" as the measure. The volume of pure alcohol per capita is basically flat over the last decade, but with a mild decline from 2010 to present: the period coinciding with "rising economic confidence". And if alcohol marketing has gotten more aggressive over the last year, it's had no obvious effect on consumption. If we take Rebecca Williams at her word that the marketing's gotten more aggressive, then I guess we might start worrying less about aggressive marketing.

Let's continue. Here's more from The Herald:

However, there was concern that drinkers were moving to stronger types of alcohol as further analysis of the figures showed the percentage of beer, as a proportion of total volume available, fell from 81 per cent in 1996 to 62 per cent in 2013.

Wine rose from 16 per cent to 23 per cent, and spirits and spirit-based drinks such as RTDs rose from 3 per cent to 15 per cent in the same 17-year period.

Rebecca Williams, director of Alcohol Healthwatch, said the figures appeared to confirm fears around ready-to-drink (RTDs) beverages.

"One of the worries for us has been that the RTDs ... would be exposing those young drinkers to the spirit brands and the heavier spirits, and I think that is happening," she said.

"The spirits component has increased, wine is going up on a fairly steady basis, and the worry about the wine is that it too is actually quite a larger volume of pure alcohol [per drink], so we're seeing a shift to the heavier alcohol products."

Drinks such as wine were being marketed "aggressively" in outlets like supermarkets, as well as campaigns by drinks companies, which were competing heavily with each other, she said.

The figures could show a trend back up to peak levels in 2008.

"Seeing an increase this year, seeing the economy come back on line, all of those things to me will start to signal some concerns that we could be tracking back up again," she said, saying that "when people are feeling better [financially] they spend more on booze".

Williams is right on a couple of points. Beer has taken a declining share of total alcohol over the period since 1986, but with a very recent levelling-off. The StatsNZ series ALC016AA has the total litres of alcohol available per beverage category rather than per capita, but it's still useful for assessing relative market share across the categories. When we port it over to Google Docs, and with a bit of wrangling,* we get this:
Wine seems to have levelled off at a third of total alcohol since 2006 or so, spirits have risen markedly over the last decade, and beer's dropped. So Williams is right about that. But all of that needs to be read against the broad flatlined trend in per capita total consumption. She's painting the shift to potentially higher alcohol products as representing an increase in consumption of alcohol when per capita alcohol availability hasn't changed.

Further, is Williams suggesting that the beer companies don't market aggressively against each other? Didn't we hear a lot of outrage about aggressive beer promotion at the Rugby 7s? We can't just look at a change and blame aggressive marketing for those components that get a category increase when there's pretty similar marketing for the components that get a category decrease. My weekly supermarket flyers have more pages of wine ads than of beer ads, but there are plenty of ads for sales on slabs of beer too.

Because StatsNZ changed category definitions, we can only split out low and high alcohol spirits starting in 1995. Here's category shares from 1995 onwards:
When I look at this, I see pre-mixed, lower-alcohol spirits displacing beer rather than building demand for pure spirits. And, again, per capita consumption hasn't really grown much over the period.

Summing up, where Williams comes up with marketing- and economy-based explanations for increases in total alcohol availability and for category shifts, and worries that increased consumption of low-alcohol spirits is a gateway to harder spirits, we find instead:

• No increase in per capita alcohol availability;
• No plausible story explaining why marketing has been so effective for RTDs and wine and so useless for beer;
• No plausible story explaining why improved economic conditions helped RTDs and wine but hurt beer;
• No plausible story explaining why per capita trends in total alcohol availability show a mild decline from 2010 through 2013, the period of economic recovery, when they're using economic recovery to explain changes in total alcohol availability;
• What looks like roughly constant market share for Beer + RTDs rather than RTDs being a gateway to proper whisky, though it's always possible that RTD drinkers will mature into spirits rather than shift to beer; either way, there's no increase in per capita availability. 

Let's then help the Herald out a bit by re-writing their first couple paragraphs for them.

The total volume of pure alcohol available per person in New Zealand remained constant this year. While there was an 8.9 million litre rise in the total quantity of alcoholic beverages available this past year, this increase is largely explained by a rising population combined with a shift away from spirits-based drinks, which have more alcohol per unit of total liquid, and towards medium-strength beer and wine, which have a lot more water with their alcohol. And, this category change mostly looks like noise given the longer-term trends.

While professional anti-alcohol advocacy groups, whose existence depends on shouting "Monster! Monster!" whenever a new alcohol stat comes out, blamed rising economic confidence and aggressive marketing for the increased total volume of alcoholic beverages, Statistics New Zealand noted that, "the volume of pure alcohol available per person aged 15 years and over (15+) was unchanged from 2012, at 9.2 litres per person." While anti-alcohol activists try to fuel the perception of crises by citing figures on the total amount of alcoholic beverage that's been available for consumption, it's best to look at statistics on per capita pure alcohol availability.

I wish that Monster-Shouting didn't sell papers.

Previously:

• More binge drinking reports
• Alcohol Healthwatch
• Surprise surprise surprise

Update: Thomas Lumley reached a similar conclusion.

* The period prior to 1995 uses the discontinued series on total wine; from 1996 onward, I use the revised total wine series. It doesn't make much difference but lets me have a longer time series.

Alcohol stats

I wrote this for the op-ed section of Friday's Christchurch Press. I'm currently in Oz where I'll be talking about alcohol policy for the hospitality industry association liquor retailers conference and with a few journalists. So I'm posting this Wednesday and hoping that the piece did come out in Christchurch on Friday. Anyway, enjoy. [Update: here it is!]

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It would be pretty easy for diligent Christchurch Press readers to conclude that alcohol is the worst scourge of humanity. Doug Sellman featured several times over the last fortnight warning us all of alcohol’s dangers; health reporter Georgina Stylianou wrote two articles on a new estimate of alcohol’s cost to the Canterbury health budget. And the University of Otago’s Professor Jennie Connor told us that minimum prices are remarkably effective in reducing alcohol consumption, pointing to a Canadian study “that showed a 10 per cent increase in the minimum price of alcohol reduced consumption by 16 per cent relative to other drinks.” Connor was quoted in a Mainlander feature on Doug Sellman explaining how Professor Sellman is not in fact a wowser; presumably it’s only free-spirited libertines who write op-eds in the New Zealand Herald worrying about how Woodstock commercials encourage boys “to have sex with their best mates’ mothers” and that advertisements “encouraging middle-aged women to get their teenage clothes back on and flirt with their son’s best mates” do not contribute to a healthy society.  (30 October 2009)

I do not particularly care what the jury decides on who is or is not a wowser. But I work with and care about the numbers around alcohol policy. And the impression most readers would get from the latest reporting in the Press is a bit at odds with, well, reality.

Let us begin perhaps with Jennie Connor’s citing of “a Canadian study” on the effects of minimum pricing. Can a ten percent increase in the minimum price of alcohol really reduce total alcohol consumption by sixteen percent? No. The number is so far out of line with the vast consensusof the literature that I got in touch with Chris Auld, one of the authors of what had to have been the study Connor had read, a piece in the May 2012 issue of Addiction. And my read of his study was right. If you increase the price of beer by ten percent, you could get a reduction in beer consumption of sixteen percent, but that’s because beer drinkers move over to other alcoholic drinks. Across-the-board increases in the minimum price of alcohol have far smaller effects: a ten percent price increase reduces aggregate consumption by only about 3.4 percent, as is made reasonably clear in Auld’s paper.

That the sixteen percent figure is screamingly wrong should have been obvious to anybody who is familiar with the literature. The largest estimate of the responsiveness of alcohol consumption to price measures in Wagenaar’s 2009 survey of 112 different studies suggested that a 10% price hike reduced consumption by 8.4%; Wagenaar concluded that 4.4% is the best consensus estimate. And for heavy drinkers, it was 2.8%. Auld’s 3.4% is then right where a reasonable person would have expected an estimate on the effects of minimum prices might fall. Sixteen percent – that’s right out.

The Auld study does come out in favour of minimum prices, but in conjunction with a decrease in alcohol excise taxes: it’s then a way of increasing the cost facing heavier drinkers while doing less harm to moderate drinkers if heavier drinkers drink cheaper alcohol. I worry more that the policy does disproportionate harm to moderate-drinking poorer people.

I was a bit more surprised to read of the new commissioned BERL report on the health costs of alcohol in Canterbury. Their prior work in the field, a 2009 study that included a measure of costs to the health system among other costs of alcohol, seemed to put a pretty heavy thumb on the scales in estimating the costs borne by the health system. My article in today’s issue of the New Zealand Medical Journal lists a few of those problems [note: link may only be active after lunchtime Friday, sorry]. While alcohol greatly increases the burden of disorders like liver cirrhosis, it also reduces the costs of cardiovascular disease. BERL here replicated work done in Australia by Collins and Lapsley (2008). But where Collins and Lapsley added up all the costs imposed by those disorders where alcohol makes things worse and subtracted from that total all the cost savings from those disorders where alcohol reduces costs, BERL simply erased any beneficial effects of alcohol for disorders including ischaemic heart disease, cholelithiasis, heart failure, stroke and hypertension.

As I had warned BERL against this kind of method when I served as discussant on their paper at the 2009 New Zealand Economic Association Meetings, I was curious whether they’d revised things. But, the new BERL paper wasn’t available. Two separate stories in the Christchurch Press, with lots of reaction quotes from doctors, were based on a paper that the reporter did not have and was not yet available for public critique. I received the paper Wednesday courtesy of the CDHB. And BERL, at footnote 14, reports they’ve done the same thing again: “The Collins and Lapsley fractions indicate some alcohol use may be beneficial for some conditions. We concentrate on harmful drug use, and assume zero fractions for such conditions.” So their measure of the costs of alcohol to the Canterbury health system relies on an assumption that there can be no health benefits from alcohol – an assumption that runs contrary to the weight of international evidence. Assuming one’s conclusions is hardly proper method.

Unfortunately, alcohol policy is one of those areas where a lot of people’s convictions about the right answer put a pretty strong lens on how they assess the literature. How often do you read that problem drinking among 15-24 year olds was no different in 2006/2007 than in 1996/1997 before the change in the alcohol purchase age? Or that per capita alcohol consumption is down substantially since 1991? Or that light drinkers have about a 14% reduction in their chance of dying from any cause than people who never drink,correcting for the host of other health-related behaviours that are usually given as reasons for ignoring the health benefits of moderate drinking?

Be skeptical of the moral crisis around alcohol.

Check your sources

Doug Sellman in the opinion section of today's Christchurch Press claims to have had his numbers right [not yet online]. Let's check the history here.

Here's Sellman and Connor's original press release:

Who is advising the Prime Minister on alcohol reform?

Mr Key announced today that he doesn’t believe that minimum pricing for alcohol will change the amount people drink.

“This is contrary to the scientific evidence base about alcohol pricing in general and minimum pricing in particular” said Prof Jennie Connor, medical spokeperson for Alcohol Action NZ.

“Mr Key states that what typically happens is people move down ‘the quality curve’ and still get access to alcohol. Where does this information come from? On the contrary, minimum pricing specifically targets the very cheapest alcohol options and is predicted to reduce average consumption by removing high-alcohol low-cost products from the market.”

“A recent Canadian study has shown that a 10% increase in the minimum price of alcohol reduces its consumption by 16% relative to other drinks”. [emphasis added]

“And these latest data are consistent with the scientific literature which indicates that increasing the price of alcohol has a positive impact on reducing heavy drinking”.

This is very clearly saying that there are very large price effects of increasing the cost of the lowest-priced alcohol. I had initially found the Newstalk ZB report and wondered whether she'd been misquoted, before finding the press release.

I wrote:

Connor has to have been misquoted here or the journalists left out a couple of subsequent clarifying sentences. The error is in the press release. Oh dear.

The link there is now deprecated, but the Scoop link still works.

In today's press, Sellman says that they had it right all along:

On July 3, 2012 we issued a press release recommending the government enacts a minimum price per standard drink of alcohol – to eliminate ultra-cheap drinks favoured by binge drinkers, young drinkers and heavy drinkers – and pointed to a Canadian study that showed ‘‘a 10 per cent increase in the minimum price of alcohol reduces its consumption by 16 per cent relative to other drinks’’. Our wording was based closely on the paper’s wording: “Longitudinal estimates suggest that a 10 per cent increase in the minimum price of an alcoholic beverage reduced its consumption relative to other beverages by 16.1 per cent (p0.001).”

Two days later Crampton wrote a damning critique of the press release on his personal blog, using the same arguments he later used in this Press article. However, it appears Crampton based his critique on a short Newstalk ZB news report of the press release, which quoted Jennie Connor saying, ‘‘studies show a 10 per cent increase in the minimum price of alcohol reduces consumption 16 per cent’’. Note: the reporter had cut off the words ‘‘relative to other drinks’’, which would indeed be wrong if she had said it.

Crampton’s blog piece, and his later Perspectives article, ridiculed the presumed mistake: ‘‘Can a 10 per cent increase in the minimum price of alcohol really reduce total alcohol consumption by 16 per cent?’’ he wrote. ‘‘No’’. But if he had taken the basic precaution of checking the primary source, our press release, he would have seen the words ‘‘relative to other drinks’’ and realised that we had not misquoted the Canadian study at all.

Thus Crampton’s main argument in the Press article was based on his own simple and avoidable mistake, which seems careless for a senior lecturer.

The problem isn't that the Newstalk piece left off the words "relative to other drinks" but that Sellman and Connor used that estimate as though it were relevant to average consumption and where "other drinks" would be interpreted as something other than other categories of alcoholic beverages.

Further, they might have noted that my post of 10 July quoted the press release accurately; my post of 5 July had cited the NewsTalk reporting.

If we look a bit further down the Auld paper, we see pretty clearly what Sellman and Connor had missed:

"The estimates indicate that a 10% increase in the minimum price of a given type of beverage reduced consumption of that type by about 16.1% relative to all other beverages, and a simultaneous 10% increase in the minimum prices of all types reduced total consumption by 3.4% (p<0.01 in both cases)."

Sellman and Connor were building a case in their press release that the Prime Minister was way off base in claiming that raising the minimum price would not have large effects on drinking. Whether "relative to other drinks" is included or not is irrelevant where the context suggests that "other drinks" means drinks other than alcohol.

And so I sent the letter below to the Press this morning:

Doug Sellman in Monday's Press claims to have had his numbers right all along. In his press release of 3 July, he and Jennie Connor wrote:

“Mr Key states that what typically happens is people move down ‘the quality curve’ and still get access to alcohol. Where does this information come from? On the contrary, minimum pricing specifically targets the very cheapest alcohol options and is predicted to reduce average consumption by removing high-alcohol low-cost products from the market.”

“A recent Canadian study has shown that a 10% increase in the minimum price of alcohol reduces its consumption by 16% relative to other drinks”.

The rather obvious interpretation of their release, which was highly critical of the Prime Minister's claim that minimum prices would not greatly affect consumption, was that we should expect a sixteen percent reduction in consumption of alcohol relative to other drinks were the minimum price of alcohol to rise by ten percent.

The paper on which their analysis was based does indeed have a quote that reads a lot like Sellman and Connor's. But, it refers to the effects you get if the price of one category of alcohol - like beer, wine, or spirits - rises relative to other categories of alcoholic drinks. It isn't talking about the consumption of alcohol as compared to fruit juice. This is obvious if we read the second clause of the sentence, where Auld and his coauthors write:

"The estimates indicate that a 10% increase in the minimum price of a given type of beverage reduced consumption of that type by about 16.1% relative to all other beverages, and a simultaneous 10% increase in the minimum prices of all types reduced total consumption by 3.4% (p<0.01 in both cases)."

In Monday's Press, Sellman claims not to have misquoted the Canadian study and that they had, all along, meant "relative to other drinks" to refer to other categories of alcohol. If so, it seems odd to have chosen that figure as being relevant to the argument they were building. It could be relevant if we were estimating the likely reduction in consumption of premixed "alco-pops" relative to other alcoholic beverages, but surely the total amount of alcohol consumed matters more than whether it is consumed in one type of alcoholic beverage rather than another. And, for total consumption, the 3.4% figure is the rather more relevant one.

I strongly encourage readers to read the paper on which Sellman's claims are based and to judge for themselves, rather than trusting either of us. An ungated version of it is available here: http://www.vsnews.fr/etudes/Does-Minimum-Pricing-Reduce-Alcohol-Consumption.pdf . Or, go to scholar.google.com and type "Does minimum pricing reduce alcohol consumption?" You will find that the authors there, like Sellman, favour minimum prices. I worry more about harms imposed on lower income moderate consumers of lower cost alcohol. How we weigh the tradeoff between reducing harms from heavy drinkers and reducing consumption benefits from poorer moderate drinkers is a fairly important discussion. But the case for a minimum price for alcohol ought not be based on an estimate of its effects that is roughly five times larger than that which can be supported by the evidence.

Surveying heavy drinkers

The latest NZMJ has a couple of pieces on alcohol minimum pricing.

The editorial from BC's Tim Stockwell lauds minimum pricing's successes in BC, though I think he there overstates the case - especially where some of his own work in British Columbia makes a hash of things by using regional CPI within B.C. to get differences in the real value of the province-wide minimum alcohol price. I'm pretty sure that you can't induce panel variation in your main regressor of interest by just dividing that constant by the varying regional CPI. That's probably one of those things that ,robust won't fix.

The new New Zealand evidence comes from a survey of just over a hundred heavy drinkers. The Science Media Centre asked me for comment on that part; my comments are copied below.

“Minimum alcohol pricing has the potential to mitigate harms from heavy drinking at lower cost than across-the-board excise increases. However, we need to be cautious about the potential effects.

“The Falkner et al study surveys heavy drinkers to ask them what they might do were they faced with higher alcohol prices. Thirty percent of those drinkers who have previously faced situations in which they could not afford alcohol reported having turned to illicit or prescription drugs when they could not afford alcohol; the authors note this may be an underestimate since their survey excluded drinkers who had reported co-morbid drug use. Pricing heavy alcohol users out of alcohol, for some users, will result in shifting to other substances. Net effects on harms are then less clear.

“Byrnes et al (2013), in Australian data, reported that heavy drinkers did respond to price hikes by curbing consumption, but that they did so by cutting back consumption on their lower drinking days. Heavy drinking was not affected. This will have health benefits, but smaller benefits than you might expect if you had expected that drinking on heavy drinking days would be as strongly affected. In this case, the health benefits of minimum alcohol prices may be overestimated if heavy drinkers respond to price increases by saving up to maintain binge days.

“Minimum alcohol pricing at $1 per unit would require that, for example, no standard bottle of wine be priced at less than $8 to $9 dollars. While this would affect heavier drinkers who may otherwise downshift in quality in response to excise changes, it would also affect lower income moderate drinkers. Benefits in reducing harmful drinking among harmful drinkers need be weighed against the costs imposed on moderate lower income drinkers – and especially where moderate drinkers are far more responsive to price hikes than are heavier drinkers (Wagenaar et al, 2009). We also need to note that while the survey asked heavy drinkers, who were predominantly lower income, how much they paid on average per standard drink, the survey did not ask moderate or light drinkers of lower income what they pay for their preferred product.

“While survey respondents indicated that they had not turned to informal alcohol supply, or home brewing, in response to previous instances of not being able to afford alcohol, sustained alcohol unaffordability might induce different behavioural responses. For example, one person setting up a distillation unit could easily informally supply neighbours at far less cost than either minimum prices or current alcohol cost. When alcohol prices are high enough, the investment in distillation kit, or even simpler fermentation, can become worthwhile. Were minimum pricing implemented, the government might wish to undertake better tracking of informal alcohol supply.”

“Policy in this area needs to weigh carefully the potential benefits of some drinking reduction among heavy drinkers against the harms imposed on poorer lighter drinkers.”

Declared conflicts of interest: The Initiative is a member-funded think tank. Its members include many of New Zealand’s leading corporations, including one in the alcohol industry and a retail grocery chain. While in the Department of Economics and Finance at the University of Canterbury, Dr Crampton's work was partially funded by the Brewers Association of Australia and New Zealand. He maintains his academic independence. He also is a moderate consumer of alcohol.

I might also note that if there's a case for minimum alcohol pricing, it's also a case for reducing the existing excise levy.

Previously:

• Minimum pricing
• Minimum alcohol pricing and economic rents
• Markets hate profits: minimum pricing edition
• Petrol tax:speeding :: alcohol tax:binge drinking
• Increasing excise is great, if you assume the right things
• The Omniscience Constraint
• Public health and the regulatory state
• Minimum pricing
• Minimum prices and mortality risk
• Evidence and minimum pricing
• About that Canadian study...
• Alcohol minimum pricing
• A hopefully concluding note on the price elasticity of alcohol
• Seeing what you want to see - minimum pricing edition

Causes and consequences

One thing that struck Matt and me when going through the alcohol literature was co-morbidity between heavier alcohol use and a whole pile of other bad things. We wrote:

We also worry that the aetiological fractions used may not account adequately for comorbidity between alcohol use and pre-existing mental disorders. The aetiological fractions used ascribe between twenty-five and thirty percent of male suicides to alcohol; in other words, if alcohol disappeared, the suicide rate would drop by more than a quarter for adult males over the age of twenty. As alcohol use can often be a form of self-medication among those with mental illness, whether alcohol plays that substantial a
causal role in suicides is debatable. Ross (1995) finds that more than half of those with an alcohol disorder have a lifetime comorbid psychiatric disorder. Among subcategories for which data is presented, alcohol abusers have rates of mood disorders and anxiety disorders 2.3 and 1.7 times that of non-abusers. While 9% of alcohol abusers report antisocial personality disorders, only 0.6%  of non abusers report such disorders. The Mental Illness Fellowship of Australia (2005) notes that those with bipolar disorder are eleven times more likely to engage in harmful drug or alcohol use than is the general population. Kessler et al (1997) find that those with long term alcohol abuse or dependence not only have a high probability of also exhibiting another mental disorder but also that comorbid DSM-IIIR disorders tend to predate alcohol use disorders.  

Some people with pre-existing disorders self-medicate with alcohol and consequently are better off than they would have been but worse off than average; their variance from average outcomes is counted as a cost of alcohol. Some people with pre-existing disorders self-medicate with alcohol and consequently are worse off than they otherwise would be; the total amount of their variance from average outcomes is counted as a cost of alcohol rather than only the incremental worsening from their individual baselines. This stuff isn't easy. But the direction of the bias is pretty clear.

Emma Hart at Up Front [not guaranteed safe for work] points to more work in similar vein: bisexuals are more likely to have problems with binge drinking. And it's because of underlying social pressures. She writes:

Here’s a clue, guys: it’s not the drinking, it’s the why they’re drinking. Take a lesson from gaynz.com, and maybe work out why I link to so many stories there instead of at your place: Exclusion Leading Some Bi Youth to Binge Drink. The drinking is not the problem, it’s one of the symptoms of the problem. 

She then quotes from the study's surveys of young binge-drinking bisexuals:

I drink more when I’m under high stress, when I’m stressed out, and maybe sometimes at parties when, after conversations with people, where they want to know, no one gets the bi thing. It’s really hard to explain. Quite a bit because you get people who want to know why you are not lesbian, why you are not straight, and I kind of feel that, it’s slightly easier to be one or the other, like I envy some of my friends who are gay, I’m like you know who, you know you’re there and no one questions it. But I get questioned all the time, and I find that frustrating sometimes.
...
Arahia: You kind of drink more so you can say the next day: “Oh, I was just drunk, you know. It didn’t mean anything really.” Sometimes it does, sometimes. But if you wake up the next morning with a huge hangover, you can say to the person: “Oh god, it didn’t mean anything. I was just so wasted.”

Fiona: “Didn’t mean to grope you. I was just drunk.”

Arahia: It is such a good excuse.

Fiona: And I think bi people definitely use it as more of an excuse than any other sexual orientation.

Sometimes, use of alcohol is inframarginal to whatever other behaviour we're measuring, whether crime or sex. Sometimes, alcohol use helps people to get over their inhibitions and do utility-enhancing things. And, sometimes alcohol use leads people to make mistakes. We overstate the costs of alcohol when we assume that alcohol's role is always causal and always negative, or when we assume away the positive consequences.