Addressing Alcohol Addiction
(Thomas Babor, Chris DeFrancesco, January 2023)
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Chris: When it comes to absurdity in our culture, look no further than beer commercials. But what may seem like harmless fun may be contributing to a societal problem. Today on the Pulse, we talk about alcoholism with someone who’s been studying it for decades.
This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful.
I am Chris DeFrancesco. Now the beer commercial is just in one example of how societal culture in the US and throughout the world has in some ways become an enabler to those who struggle with alcohol addiction. Addiction scientists have been observing cultural and environmental factors, among other things, for many years. And few have for longer than Dr. Thomas Babor, professor emeritus of public health sciences at the UConn School of Medicine and former chair of the Department of Community Medicine. Now, Dr. Babor has led an international team of addiction scientists who are out with findings from a decade of new research, and he joins us today to tell us about them.
Welcome Dr. Babor, and thank you for being here.
Dr. Babor: Hi, Chris, thanks for having me.
Chris: You are the lead author of a new edition of the book, Alcohol: No Ordinary Commodity. Why was it time for a third edition of this publication and who is the intended audience? ,
Dr. Babor: Well, let me start with the intended audience, which is global in nature. And what we’re trying to do is to reach policy makers, public health professionals, people who work in the helping professions, and there’s plenty of important messages that they need to be aware of in order to properly maintain the health of communities and populations. And alcohol plays a large part in the troubles that people present at health care settings.
Chris: Let’s talk a little bit about, and we’ll get to those examples, but let’s talk about some of the trends in global alcohol consumption that you have observed as an alcohol addiction researcher.
Dr. Babor: Right. Well, in the three additions of No Ordinary Commodity, since 2003, we’ve been tracking global alcohol consumption and the problems attributable to alcohol. And what we find is that in the high-income countries — the United States being a prime example, but Europe, Australia, and several other countries — we have a stabilization and even a decline in alcohol consumption. In contrast, in the middle- and the low-income countries particularly — the emerging economies, good examples would be India and China, Brazil is another example — huge populations consisting of mainly young people that constitute a prime market for the alcohol industry, and we start to see dramatic increases not only in alcohol consumption in those parts of the world, but also alcohol-related problems.
So the more people drink, the research suggests that at a national level, the more problems the country is going to experience, because alcohol is almost as addicting as nicotine and opioids and other drugs. There’s an addictive component to that, and regular use will produce what is called alcohol dependence.
Chris: Alright, I… I know a lot of people who drink somewhat regularly, but I don’t think I would consider them addicted. So does the fact that you have a tolerance or a predisposition to go from occasional drinker, social drinker, to addicted and problem drinker, I’m sure there are a lot of factors that go into that, including your own genetics, right?
Dr. Babor: Right. And research here at the Alcohol Research Center certainly has reinforced that finding and contributed to the conclusion that a large part of alcohol problems is due to genetics, perhaps 50%, but the other 50% is due to the environment. And the way you structure that environment makes a big contribution to either a sober society, where people are healthy and there’s less cancer in heart disease, liver cirrhosis, and so forth, or a society that, uh, is intoxicated often, which contributes to premature mortality.
Chris: You mention the Alcohol Research Center here at UConn Health, and we should acknowledge the Alcohol Research Center has earned federal funding continuously for, what is it, 45 years now? And you’ve been here for most of them. And even before you got here, you were kind of involved in establishing it. How would you say that the Alcohol Research Center either shaped or changed or influenced the way medicine looks at addiction today?
Dr. Babor: Well, a lot of it has to do with the stereotypes which our research has contradicted. One of those stereotypes is that the chronic skid row alcoholic is beyond hope and even treatment won’t provide much salvation. What we found through our research is that there are a variety of effective treatments that help people to achieve sobriety, to abstain from alcohol, and to be extremely productive members of society after they’ve become alcohol dependent. We also have. good evidence that Alcoholics Anonymous is an effective way of providing support in the community and keeping people abstinent over time. And one of the things that we’ve done within the center that has, I think, changed the way that medicine does look at alcohol problems is initiated screening, brief intervention and referral to treatment: measures based on research — which allow clinicians to gather data, and now they can gather it through online screening and even online interventions — that is sufficient to wake people up to the levels of consumption that are at risk for them and to prevent the progression of alcohol problems and get people into treatment at the same time.
Chris: You and Dr. Hesselbrock, Dr. Victor Hesselbrock, helped me a couple years ago do kind of a retrospective after you got the, I think it was the eighth five -year grant from the NIH. So I’m going to link to that in the notes of this show, if anyone listening wants to read a little bit more about that quite impressive history that the folks at the Alcohol Research Center have shaped. Now, you have been studying alcohol addiction for a very long time, since the mid 80s here at UConn Health and elsewhere before that. What is it about addiction science that caught your interest and has kept it for so long?
Dr. Babor: Well, you know, somebody once said that to know alcoholism is to know medicine. And I think it could be equally said that to know alcoholism is to know public health. Alcohol affects over 200 health conditions from liver cirrhosis, to pancreatitis, to cancer, breast cancer especially, and many other noncommunicable diseases, as well as accidents and injuries. And if you can understand how alcohol works on the body, just about every organ system is affected, and it provides you a way of learning a great deal about the human condition and about how medicine combined with public health can allow people to achieve the full measure of a healthy life.
Chris: Let’s get back to the book now, which addresses some of the public health approaches and the public policy approaches to perhaps rectifying some of the problems you described. You recommended steps people take on a policy level that could help reduce population harms. So what are a few examples of that?
Dr. Babor: Well, surprisingly, when we evaluated seven major areas where over 70 types of alcohol policies have been developed and evaluated — drinking and driving countermeasures, sobriety checkpoints or punishment for drinking and driving, or alcohol taxes, or prevention programs in the schools, or treatment — what we found was that it’s the upstream measures, the ones that apply to everyone that are much less considered, certainly within medicine, but also have tended until recently to be not paid too much attention to by public health.
Those measures are the ones that are most effective in reducing alcohol consumption in harm, and those consist of alcohol taxes increasing the price of alcohol, which decreases the availability of cheap alcohol, as well as the affordability of alcohol. So taxes, which have been with us for several hundred years, are an effective way of damping down excessive alcohol consumption.
Availability restrictions, licensing systems that control the hours of sale or the density of outlets, or the age at which kids can buy alcohol, raising the drinking age from 18 to 21, are very effective ways of preventing traffic fatalities as well as alcohol-related problems. Marketing restriction is another what is called a best practice from a public health perspective. You can prevent kids from taking an interest in alcohol, you can prevent them from starting early, progressing to binge drinking, just by controlling the exposure.
And we also consider other good practices: treatment, early intervention, drunk-driving laws, and a variety of other factors where there’s good evidence of effectiveness. But it’s the upstream measures that are going to affect most morbidity and mortality.
Chris: The beer commercial example that we started with, in a way, the ads we see on TV are kind of a microcosm of where we are as a society at that moment in time. And one of the reasons I said the beer commercials are absurd, they are absurd. I mean, a lot of them are, they’re just, to me, they just make me laugh. They’re not impacting decisions that I make as a consumer. But, in another way, from a cultural standpoint, it normalizes or creates kind of an acceptance, I guess, and if someone who’s not fully cognitively developed sees enough of those, that can impact decision making. I’m imagining that that’s part of why one of the focus areas here is responsible marketing.
Dr. Babor: Yeah, and it’s much more insidious than what you’ve just described very accurately. The industry has found that they’ve been very successful with traditional marketing: TV, billboards, radio, and movie placements, actors drinking an alcoholic beverage. They know how it works, and it works on an emotional level.
What they are now doing, and it’s continuing what they’ve done in the past, is to target young people, and they’ve concluded that the social media are the way to go. So they hire influencers to promote alcohol products. They get people onto websites that show people enjoying themselves while drinking. And the more kids are exposed to these kinds of messages, which are highly unregulated, the more they’re likely to drink.
So the alcohol industry has emerged, in our book as well as other research around the world, as one of the main obstacles to effective public health policies. It’s not just that the government has to pay attention to the research, they need to deal with an industry that is primarily driven by profits and has become concentrated to such an extent that most of the production and marketing and political influence is controlled by a small number of transnational and very powerful corporations.
Chris: And what would you say are the biggest obstacles to the recommendations that you’re presenting in your book?
Dr. Babor: Well, as I mentioned, the alcohol industry is probably the biggest obstacle. Secondly, it’s government officials, particularly elected officials, who don’t appreciate the damage that is caused by alcohol in terms of the disability that it causes and the enormous cost that the taxpayers are subsidizing the industry for. The industry takes the profits and the government pays for the harm. And the money that’s collected in taxes only accounts, in some countries ,to about one six of the total cost of the damage done by alcohol. It is one of the main four risk factors for noncommunicable diseases in the world, which account for 70% of the mortality in the world. And we’re talking about equal to or exceeding the cost of sugar-sweetened beverages and the obesity it causes, or even tobacco. And we started to get a handle on tobacco, but we now have to take cognizance of the fact that alcohol is equally serious as a cause of premature mortality.
Chris: The book is called Alcohol: No Ordinary Commodity, and what we’ll do is we’ll make sure, as far as how to get the book, we’ll put that information in the show notes too, when that becomes available, so folks can figure out how they can obtain a copy and read that. But real quickly though, that that’s going to be a free book, right?
Dr. Babor: Yeah. I’m not hawking the book. The authors volunteered their time to write it and the royalties go to a nonprofit organization to finance translations into other languages. The book will be available in soft cover, in a print version, as well as a free downloadable e-book, which can be obtained from Oxford University Press.
There’s a summary article that will be coming out simultaneously in the international journal Addiction, and we’ve started to sign contracts for translations into Portuguese, Chinese, and several other languages.
Chris: Alright, so we’ll make sure all the links to get the examples you just gave are accessible through our show file here.
Dr. Thomas Babor, you are a professor emeritus of public health science at the UConn School of Medicine, former chair of the Department of Community Medicine. You’re also affiliated with the UConn Health Alcohol Research Center and an internationally renowned addiction scientist. Thank you so much for joining us today and sharing some of your findings with us.
Dr. Babor: Thanks, Chris.
Chris: That is our time for today. For Dr. Thomas Babor, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.