From: Engs, Ruth C. [Ed.], "Controversies in the Addition's Field". CHAPTER 8: Thinking About Alcohol Controls. Robin Room, Ph.D.
Robin Room, Ph.D.
The Inevitability of Alcohol Controls
By alcohol controls is meant governmental structuring of/or intervention in the market for alcohol beverages (Makela et al., 1981). This intervention can take many forms, including taxation and other interventions in the pricing of alcohol; subsidization of the production of alcoholic beverages or of their raw materials; regulation of the time, place, and manner of alcohol sales; full or partial monopolization of sales; and regulation of the contents, packaging, and advertising of alcoholic beverages. In modern industrial states, some form of alcohol controls is almost inevitable. There are only two alternatives to alcohol controls: a complete laissez-faire policy, in which the state takes no interest in the alcohol market; or total prohibition, where the state outlaws the alcohol market. Neither alternative is likely or politically palatable in the modem industrial state. The rule of the state in regulating the market is by now well accepted for foodstuffs and hazardous commodities—both of which alcohol could be considered as being. A laissez-faire policy for alcohol would thus be an anomaly. On the other hand, prohibition has proved unenforceable for a psychoactive drug as deeply entrenched and readily produced as alcohol. A strong argument for alcohol controls rather than prohibition, in fact, is that a legal industry is more amenable than anillegal one to state influence, and becomes the state's ally against illegal production and marketing.
Controls on alcohol production, marketing, and consumption have been imposed for many reasons. Government agricultural policies, providing subsidies to farmers, frequency affect the price of the alcoholic beverages made from the subsidized grapes or grain. On the other hand, alcohol taxes are an important source of state revenues; they were particularly important prior to the advent of the income tax. In hierarchical societies, alcohol controls have often functioned as sumptuary laws keeping alcohol out of the hands of those who are powerless or thought to be dangerous. Desires to maintain public order or increase productivity have lain behind such measures as restrictions on alcohol sales on election days or paydays, embargoes on serving those in working clothes before noon, and bans on serving the already intoxicated.
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Historically, public health considerations have played a relatively small role in alcohol controls. Perhaps the earliest fomms of control motivated by such considerations were regulations of beverage contents, prescribing the ingredients and forbidding adulterants. In the second half of the 19th century, an explicit ideology of alcohol control emerged, as an alternative to prohibition. At least in part, the alcohol controls proposed under this ideology—state monopoly, high license fees and taxes, alcohol rationbooks, etc.—were motivated by considerations of public health.
Though it is interesting to examine the overt rationales for alcohol controls, the motivation are often mixed, with covert rationales also at stake. In any intervention in a profitable market, someone is likely to be gaining and someone losing. Control measures often have the effect of limiting competition. creating a partial monopoly, and potentially increasing the profits for those who remain in the market. Along with such considerations as public health, public order, productivity and family protection, vested economic interests are thus often at stake in any change in alcohol controls.
Alcohol controls are thus almost inevitable in the modern industrial state, but many motivations and interests underlie the particular structuring of alcohol controls in any jurisdiction. A realistic debate about alcohol controls needs to be couched not in terms of an abstract argument for or against such controls but rather in terms of the rationale and the effects of particular changes from the existing structure of controls.
Effects of Alcohol Controls
In recent decades, a substantial literature evaluating the effects of alcohol controls has emerged. A number of reviews of this literature have appeared (e.g., Smith, 1988; Room 1984a). We may draw a number of conclusions about the effects of alcohol controls:
- Under all circumstances so far measured, raising the price of alcoholic beverages reduces the consumption, when other factors are unchanged. Since alcoholic beverages, and particularly the most popular type of beverage in a given society, are often not very price-elastic, raising the alcohol taxes will usually both add to government revenues and modestly reduce the level of consumption. It appears that the effect on heavy drinkers' consumption is at least as strong proportionately as the effect on light drinkers" consumption.
- Other alcohol control measures which limit alcohol's availability in terms of time, place, and manner of sale or in terms of the buyer's eligibility (e.g., minimum purchase age, alcohol rationing) often— though not always—affect the level of consumption. The effects seem to
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- There is little concrete evidence of an effect of controls on the advertising or presentation of alcoholic beverages (e.g. warning labels on bottles, warning signs in stores) on levels of consumption.
- From a policy perspective, the effects of alcohol controls on rates of health and social problems is arguably more important than the effects on consumption levels. The rates of various alcohol-related problems— alcohol-related traffic casualties, cirrhosis deaths, violent crime rates— are often affected by alcohol controls. The effect of price and availability controls on rates of alcohol-related problems is often stronger than the effects on consumption levels. This suggests that some alcohol controls may have an especially strong effect on vulnerable subpopulations (e.g., those at risk of death from cirrhosis) or may push consumption into less risky locales or forms (it may be that the main effect of raising the U.S. drinking age has been in partly separating teenage drinking from driving).
be stronger in situations of restricted availability than in situations of relatively free availability.
These conclusions are based on a wide-ranging and multinational literature. Rather than drawing on cross-sectional comparisons and other study designs which offer only weak evidence of casual connections, they rely on much stronger designs studying changes over time in given societies or localities, often with a comparison of changes in control societies or localities. But the limitations of the literature evaluating the effects of alcohol controls should be kept in mind:
- Most of the studies have been carried out in societies with a strong tradition of concern about alcohol problems—notably in Nordic and English-speaking countries. These are societies in which there is a long tradition of state oversight of the alcohol supply, and in which home production of alcoholic beverages is much less important than in many developing countries. There is reason to believe that the relations of alcohol controls with some alcohol problems is affected by the cultural position of alcohol and the level of concern about drinking—e.g., the relation of consumption levels with violent crime may be stronger in societies that define alcohol as a powerful and criminogenie substance.
- . The most broad-ranging segment of the literature conerns the effects of prices and taxes on consumption levels. The literature on the effects of raising and lowering drinking ages is very well-developed, but is almost entirely based on NorthAmerican experience. More generally, the literature relies heavily on "natural experiments": on studying changes in alcohol availability and controls which occur as policy
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- decisions, rather than an experimental interventions. This means that alcohol control measures are only studied when and to the extent they are politically feasible somewhere. The general trend towards liberalizing alcohol controls in the last 40 years means that, except for taxes and minimum drinking ages, there are more studies of the effects of loosening than of tightening alcohol controls. Thus, too. the literature on unpopular restrictive measures, even those, such as alcohol rationing, which seem likely to affect alcohol-problems rates, is not very developed. An exception to this are the studies of the effects of liquor-store strikes and other perturbations in the alcohol supply. But, although these studies give dramatic and important evidence of the effects on health and social problems rates of restricting alcohol supplies, they reflect special and relatively short-term situations.
- As is true more generally for evaluation studies, studies of the effects of alcohol controls provide much stronger evidence on short-term than on long-term effects. An effect which is immediate and discontinuous is more measurable than an effect which is delayed and gradual. This limitation of the technology of evaluation tends to favor measures where the postulated connection between control and consumption is immediate and mechanical over measures where the postulated connection is more distal and diffuse. Thus, for instance, we might expect the effects of a price rise or the closing of the liquor store on the comer to be inherently more detectable than the effects of a change in advertising regulations.
Competing Interests In Alcohol Controls: Symbolism, Consumer Convenience and Public Health Effects
As Gusfield's classic interpretation (1963) of the temperance movement as a "symbolic crusade" suggests, alcohol policies have long been a favored arena for symbolic policymaking. Public health interests must also be balanced against competing interests, including such considerations as the convenience of the consumer. The research evidence on the practical effects of alcohol controls is thus relevant to discussions of alcohol control policy, but is by no means determinative. This is true even in the Nordic societies, despite their commitment to an ideology of rational social experimentation. Thus the Norwegian parliament failed to make permanent a year-long experiment in closing state alcohol stores on Saturdays, despite evaluative evidence that casualty and social problems were thereby reduced.
Alcohol control policies have often been the medium of symbolic statements about social status, about norms for behavior, and about the cultural position of alcohol in American society. Thus the lowering of the
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minimum drinking age in the early 1970s was a part of a general shift in the definition of the age ofmajority, while the raising of the minimum drinking age in the 1980s can be seen as in part reflecting general societal worries and fears about youth. In the debates over restricting alcohol advertising and requiring warning labels which have been gathering steam in the U.S. and in many other countries in the last decade, it is often acknowledged that the primary issue is not the measurable effects of advertising or labels on behavior, but rather the statement which the advertising or the label makes about the cultural position of alcohol (e.g. Wallack, 1983). Is alcohol to be viewed as just another consumer product, between soap and cereal on the supermarket shelves, or it is to be set apart as a special and problematic commodity? (see Makela et al., 1981, pp. 95-96). Behind the answers to such questions often lie deep convictions about what kind of society we want.
Such symbolic concerns should not necessarily be viewed as unrelated to practical concerns about the effects of alcohol controls. Often, indeed, the immediate pragmatic concerns of public health work run up against such symbolic issues: providing birth control to prevent teenage pregnancy is seen as condoning disapproved sexuality, providing sterile needles to IV drug users is seen as condoning illicit drug use. Quite often, however, symbolic concerns can be translated into concerns about longterm effects, as opposed to the short-temm effects which are more easily measured by evaluations. In this view, the effects of alcohol advertising, for instance, are seen as played out not so much in individual impulsive choices to start drinking or to have a drink, but rather through a general "wettening" of the society, for instance through establishing the idea that drinking is an intrinsic component of glamour, romance, and having fun.
Such arguments about the symbolism of government actions are important and relevant, but we should be wary of accepting assertions about long-term effects uncritically. It can be argued, for instance, that in the long run, national Prohibition in the U.S. had a paradoxical effect. Instead of entrenching an anti-drinking ideology, as its proponents intended, it provided an attractive target for the generational revolt of the youth of the 1920s, and thus provided the foil for the eventual establishment of a "wet" ideology (Room, 1984b).
Inpresent-day industrial societies, the main resistance to applying the lessons of the alcohol control evaluations (other than from production and marketing interests) comes not from symbolic concerns but rather from a consumer convenience ethic, which demands that almost all commodities be readily accessible in unlimited quantities to the individual consumer subject only to the consumer's ability to pay. In the postwar period, the strength of this expectation has swept away Sunday "blue laws" and other
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general restrictions on shop hours, despite labor union opposition, and it is now providing some of the impetus for system change in eastern Europe. Political decisions about alcohol control measures must therefore balance the potential good effects of the measure on public health or order against the consumer inconvenience it creates. Respondents in general population surveys are noticeably more enthusiastic about alcohol controls that are seen as affecting only others than about controls that are seen as also affecting themselves (Cameron, 1981). The effect of this consumer convenience ethic can be seen in the fact that such measures as advertising restrictions and warning labels and signs are everywhere more politically feasible than new restrictions on the hours of sale or rationing of alcohol sales. Given that the consumer convenience ethic is conditioned on the customer's ability to pay, raising alcohol taxes has also proved more feasible than direct limitation of availability.
Alcohol Controls and Alcohol Policies
The idea that governments should have a coherent alcohol policy, including provision for treatment, education and other prevention measures as well as alcohol controls, has spread from Scandinavia quite widely in recent years (e.g., Moore and Gerstein, 1981; Moser, 1985). As argued above, alcohol controls are, nearly inevitably, a part of any general alcohol policy. But it would be as counterproductive to rely entirely on alcohol controls in such a policy as to ignore them completely. Like other legislative and regulatory measures, alcohol controls are only effective in a free society when they enjoy a wide measure of popular support. For many control measures—e.g., advertising restrictions and warning labels—the societal debate about the measure, and the education this entails, may well be more important in its effects than the measure itself.
Even for alcohol controls with wide popular support, there are limits to their effectiveness. As recent Soviet experience has reaffirmed, if the price of alcohol rises too high, or if the supply is sufficiently restricted, an illicit market will supply part of the shortfall, carrying with it the social costs Americans know only too well from the present-day illicit drug market.
From a governmental perspective, alcohol controls have some unique advantages. In the form of taxes and license fees, they generate rather than cost revenue (though they thereby create a governmental interest in the level of alcohol sales). In the fomm of controls on availability, they are cheaply and efficiently administered. The main target of regulation is not the consumer but the commercial producer, distributor, or seller, and the fundamental enforcement sanction is not penal but the threat to close down or seize the business. Such commercial controls are more effective and
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easily enforced than criminal laws (Room, 1983). Often, indeed, business competitors will assist in the enforcement process. On the other hand, as heavily regulated industries, the alcoholic beverage industries inevitably become heavily involved and often powerful in the political process, in an attempt to control their fate.
In the whole spectrum of alcohol policies in the modem industrial state, then, alcohol controls are destined to play a unique but not dominant role. Unlike treatment, incarceration, or other interventions, alcohol controls require no expensive establishment of service providers, and only a relatively small enforcement staff. If taxes are counted in, alcohol controls are a net source of revenue to the state. But the content and stringency of alcohol controls, even as they affect the extent and nature of alcohol problems in the society, are very much formed and constrained by the society's concerns about the attitudes to those problems.
REFERENCES
Cameron, T. (1981). Alcohol and Alcohol Problems: Public Opinion in California, 1974-1980, Alcohol Research Group: Berkeley, Report C31.
Gusfield, J. (1963). Symbolic Crusade: Status Politics and theAmerican Temperance Movement. University of Illinois Press: Urbana, IL.
Makela, K. Room, R., Single, E., Sulkunen, P., Walsh, B., with 13 others. (1981). Alcohol, Society, and the State: 1. A Comparative Study of Alcohol Control. Addiction Research Foundation: Toronto, Ont.
Moore, M. and Gerstein, D., eds. (1981). Alcohol and Public Policy: Beyond the Shadow of Prohibition. National Academy Press: Washingto4 DC.
Moser, J., ed. (1985). Alcohol Policies in National Health and Development Planning. World Health Organization: Geneva Offset Publication No. 89.
Room, R. (1983). Legislative Strategies and the Prevention of Alcohol Problems, pp.152-164 In: Grant, M. end Ritson, B., eds.,Alcohol: The Prevention Debate. Croom Helm: London.
Room, R. (1984a). Alcohol Control and Public Health. AnnualReview of Public Health, 5 293-317.
Room, R. (1984b). A "Reverence for Strong Drink": The Lost Generation and the Elevation of Alcohol in American Culture. Journal of Studies on Alcohol, 45 540-546.
Smith, D.I. (1988). Effectiveness of Restrictions on Availability as a Means of Preventing Alcohol Problems. Contemporary Drug Problems, 15 627-684.
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Wallack, L. (1983). Alcohol Advertising Reassessed: The Public Health Perspective, pp. 243-248 In: Grant, M., Plant, M., and Williams, A., eds., Economics and Alcohol: Consumption and Controls. Croom Helm and Gardner Press: London, Canberra and New York.
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