What would alcohol sales look like if excessive and problem drinkers drank in moderation?

alcohol sales

The following article was recently published on the research page of the Recovery Research Institute website. It reports a novel new study focusing on the alcohol industry’s public support of moderate drinking amidst speculation that a large portion of alcohol industry profits come from alcohol sales to excessive drinkers and individuals with drinking problems. The research explored what percentage of alcohol sales are accounted for by heavy drinkers, and what the alcohol industry stands to lose financially if everyone drank in moderation (within government health guidelines).

WHAT PROBLEM DOES THIS STUDY ADDRESS?

The alcohol industry has long faced a difficult public relations dilemma. Though many individuals enjoy using alcohol with little or no consequence, for many others, alcohol causes significant emotional, physical, and interpersonal harm. At a population level, alcohol use has a prodigious, adverse social and economic impact. In order to mitigate the perception that the alcohol industry is profiting from suffering, and at times because of government pressure, in many countries major alcohol producers have voluntarily funded public awareness campaigns about the harms of excessive alcohol use. Critics, however, have argued that such voluntary measures are doomed to fail because they involve companies engaging in activities and policies aimed at reducing the harmful behaviors on which their profitability depends. In essence, these companies have a major conflict of interest. 

The alcohol industries in England and the United States have often played down the extent to which profits are driven by excessive use of their products, in spite of evidence from several countries that alcohol consumption is concentrated within a minority of heavier drinkers. The present study explored whether such findings are also true for England. Specifically, the authors asked: 1) What proportion of alcohol sales revenue is accounted for by people drinking more than government recommended guidelines for low-risk drinking (in the UK no more than 14 standard drinks per week, where a standard drink is equal to 7.9g of pure alcohol. This is considerably less than in the U.S. where a standard drink is equal to14g of pure alcohol – almost twice as much). 2) How does financial dependence on heavy drinkers vary between different sectors of the alcohol industry? 3) How would alcohol sales revenue be affected if everyone’s consumption fell to within guideline levels? 

This research has implications not just for public health policy, but for the millions of these heavy drinkers with alcohol use disorder in England, and countries like the United States.

HOW WAS THIS STUDY CONDUCTED?

This paper uses data from the UK Office for National Statistics’ Living Costs and Food Survey and the National Health Service’s Digital Health Survey for England. The Living Costs and Food Survey is distributed to households on a continuous basis throughout the year and asks each individual aged 16 years and over to keep a detailed diary of their daily expenditure over a 2-week period. For alcohol, the survey provides transaction-level data on beverage type (e.g., beer, cider, wine, spirits), price paid, and volume of product purchased. The survey also asks where the alcohol was purchased; either in a hotel, restaurant, or bar (known in the UK as on-trade sales), or from an alcohol retailer like a liquor store (referred to in the UK as off-trade sales). The authors pooled data from the 2013 and 2014 iterations of the survey, comprising a total of 9,975 households. 

The Health Survey for England is a large, nationally-representative survey of 16,872 individuals (2013 and 2014 pooled) which records self-reported ‘typical’ consumption by beverage type. Coverage of total alcohol purchases relative to estimates from more robust national accounts and sales data is approximately 60% (compared to 40% for the Living Costs and Food Survey), suggesting people markedly under-report their alcohol use. 

Drinking groups were defined according to UK government guidelines. ‘Moderate’ drinking is consumption below or equal to 14 standard drinks per week for both sexes, with a standard drink in the UK equaling 7.9g or 10ml of pure alcohol. ‘Heavy’ drinking refers to consumption above this level. Within the ‘heavy drinking’ category, the authors further distinguished ‘hazardous’ (15–35 units for women, 15–50 for men) from ‘harmful’ (36+ for women, 51+ for men) drinking, based on government guidelines.

WHAT DID THIS STUDY FIND?

The authors found that on the whole, the bulk of alcohol sales in England in 2013/14 were to individuals drinking excessively. An estimated 77% of alcohol was sold to drinkers consuming above guideline levels: 30% to harmful drinkers and 48% to hazardous drinkers. Further, alcohol consumed in excess of the guideline levels (i.e., those drinking 14 or more standard UK drinks per week) accounted for 44% of all sales.

Moderate drinkers (i.e., those drinking 14 or fewer UK standard drinks per week), who represented an estimated 59% of the population, were estimated to consume only 23% of all alcohol and accounted for only 32% of all revenue (Figure 1). The 21% of the population who were hazardous drinkers consumed an estimated 48% of all alcohol and accounted for an estimated 45% of all revenue. A relatively small group of harmful drinkers, comprising 4% of the total population, consumed almost a third (30%) of all alcohol sold in England, and accounted for nearly a quarter (23%) of all alcohol sales revenue.

Figure 1. Source: Bhattacharya et al., 2018.

Figure 1. Volume and value of alcohol sales by consumption level in England, 2013/14. The first column represents the makeup of the entire English population by drinking behaviors. The second column shows what percent of alcohol consumed in England was accounted for by each category of drinker. The third column shows the percentage of alcohol revenue accounted for by each category of drinker. As illustrated in this figure, in spite of making up only 25% of the population, hazardous and harmful drinkers accounted for 78% of alcohol consumption and 68% of alcohol revenue. 

In terms of differences between on-trade (i.e., in a hotel, restaurant or bar) and off-trade (alcohol retailors), 81% of off-trade revenue was estimated to come from those drinking above guideline levels (Figure 2). The corresponding amount was substantially lower (60%) for on-trade sales, although heavy drinkers also still accounted for the majority of sales revenue, highlighting the fact that hazardous and harmful drinkers accounted for the majority of both retail and bar/restaurant sales.

Figure 2. Source: Bhattacharya et al., 2018.

Figure 2. Proportion of revenue from harmful, hazardous and moderate drinkers by beverage types and retailer in England in 2013/14. On-trade refers to hotel, restaurant, or bar sales; off-trade refers to alcohol retailors. 77% of beer expenditure was estimated to come from drinkers consuming above guideline levels, compared to 70% for cider, 66% for wine and 50% for spirits. Hazardous and harmful drinkers accounted for the majority of on-trade and off-trade alcohol sales. 

The authors also report that should alcohol consumption be reduced to low-risk levels suggested by the UK government (i.e., 14 or less standard drinks per person, per week), the alcohol industry would stand to lose 38% of their current revenue (Figure 3). In absolute terms, this implies that the industry’s market value would fall by £13 billion (approximately US$17 billion).

Figure 3. Source: Bhattacharya et al., 2018.

Figure 3. Predicted percentage decline in alcohol revenue in England if alcohol consumption were to fall to government guideline levels for low-risk drinking (i.e., 14 or less standard drinks per person per week). Percentage declines in revenue are broken down by point of sale (on-trade versus off-trade), and alcohol category (beer, wine, etc.), as well as point of sale type crossed with alcohol category (in box, bottom right of figure). Altogether, the alcohol industry in England would stand to lose 38% of its revenue if everyone drank in accordance with government guideline levels for low-risk drinking.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Findings indicate the alcohol industry in England derives a large portion of its profit from excessive and/or problem drinkers. Given the consistency of this finding with similar research in Australia and Brazil, it seems likely that such a study conducted in the United States would find similar results. These findings raise serious questions about the conflicts of interest arising when an industry reliant on hazardous and harmful drinking is allowed to self-regulate and manages its public image with largely ineffective ‘safe drinking’ mantras (e.g., “Drink responsibly”). These findings also reinforce the need for strong alcohol sales policy, which has been shown to have real impact on problem drinking. Moreover, in so far as they suggest that a financially successful alcohol industry of its current size and form depends upon harmful drinking, the UK government’s economic support for alcohol producers, for example through tax cuts and trade negotiations, appear more problematic. These findings may also have relevance for ongoing debates about whether to restrict alcohol sales to state monopolies or open them up to commercial enterprises.

LIMITATIONS

  1. The authors’ analysis is taken from self-reported survey data, which tends to underestimate alcohol consumption. Their approach assumes implicitly that all sections of the population under-report their drinking in the same proportion. If anything, this probably underestimates the alcohol industry’s full reliance upon the heaviest drinkers, who are less likely to be represented in surveys.
  2. The analyses do not distinguish between specific companies. The degree to which any individual company benefits from sales to heavy drinkers is therefore unclear.

BOTTOM LINE

  • For individuals and families seeking recoveryHarmful and hazardous drinkers drive the bulk of English alcohol sales; a finding observed in other countries and presumed to be the same in other Western countries like the Unites States.
  • For treatment professionals and treatment systemsHarmful and hazardous drinkers drive the bulk of alcohol sales in England, and presumably other Western countries as well. Allowing the alcohol industry to design and self-monitor its own public health messaging regarding harmful/hazardous drinking represents a major conflict of interest. An industry that is financially reliant on harmful/hazardous drinking is unlikely to implement measures sufficient to curb problematic alcohol use.
  • For scientists: Harmful and hazardous drinkers drive the bulk of alcohol sales in England. The questions addressed by this research need to also be asked in the United States. Further, more research on the extent to which the alcohol industry has, in the past, mitigated volume declines by raising prices and selling more premium products would provide an indication of how sustainable such a strategy is likely to be in the long term. A further possible extension would be to explore the tax revenue generated by the government from excise duty on harmful drinkers, and the extent to which that tax revenue helps address some of the consequences of alcohol use disorder (e.g., funding publicly available treatment and recovery support services).
  • For policy makersAlcohol use and alcohol use disorder cost Western economies hundreds of billions of dollars annually and cause tremendous personal and societal harm. The alcohol industry profits directly from this problem. The alcohol industry’s conflicts of interest highlighted in this paper should be considered when creating and enforcing alcohol policy.

CITATIONS

Battacharya, A., Angus, C., Pryce, R., Holmes, J., Brennan, A., & Meier, P. S. (2018). How dependent is the alcohol industry on heavy drinking in England? Addiction, 113(12), 2225-2232. doi: 10.1111/add.14386

The Council on Recovery is the leader in providing a wide range of prevention and education resources aimed reducing alcohol use, especially among adolescents and young adults. We also offer therapeutic counseling and an intensive outpatient treatment program (IOP) for those affected by alcoholism. For more information, please call 713-942-4100 or contact us online.

How Does Spirituality Change the Brain?

The following article by Dr. Mark Gold, recently published on the Addiction Policy Forum Blog, explores the growing body of research about what regions of the brain are changed during a person’s spiritual practice. It presents compelling ideas for how fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

Spirituality can be an important component of recovery from addiction, as it can be a key way for a person seeking recovery to connect to something outside themselves – spiritual practices have long been cornerstones of mutual aid groups, such as Alcoholics Anonymous. Recently, researchers and those looking at trends have concluded that Americans are becoming less religious but at the same time identify as more spiritual. Spiritual engagement can be a way to find, as the authors in the study write, a “sense of union with something larger than oneself.” In a recent study of the brain done at Yale directed by Dr. Mark Potenza, Neural Correlates of Spiritual Experiences, scientists used functional Magnetic Resonance Imaging (fMRI) to examine exactly how spirituality activated or deactivated, certain regions of the brain, changing how people perceive and interact with the world around them.

Dr. Christina Puchalski, Director of the George Washington Institute for Spirituality and Health, defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” Importantly, the authors of the study encouraged diverse, personally-motivated definitions of spiritual experience, examples of which included participation in a religious service at a house of worship, connection with nature, mindfulness meditation, and contemplative prayer.

How do we Measure the Effect of Spirituality?

Spirituality and religious practices are a key part of many people’s lives – 81% of U.S. adults describe themselves as spiritual, religious, or both. Despite the majority of American adults engaging in some form of spiritual practice, little is known about what happens in certain parts of the brain during these spiritual experiences. Although studies have linked specific brain measures to aspects of spirituality, none have sought to directly examine spiritual experiences, particularly when using a broader, modern definition of spirituality that may be independent of religiousness. This study used a special kind of brain imaging, functional magnetic resonance imaging (fMRI), to examine neural structures and systems that are activated when we engage in spiritual practice. By detecting changes in blood flow to certain regions of the brain, the fMRI is able to detect activity in the brain when participants were asked to recall spiritual experiences.

Methodology

A potential challenge in this study is the wide variety of spiritual experiences that individuals can find personally meaningful. The authors of the study sought to address this by using a personalized guided-imagery fMRI procedure in which participants were asked to describe a situation in which they felt “a strong connection with a higher power or a spiritual presence.” Their accounts were turned into a script, which was recorded and played back to the participant during fMRI. The brain activation measured during the participant’s recall of a spiritual moment was compared to measurements taken while participants listened to narrations of their neutral and stressful experiences.

Key to this study was that the accounts were completely self-directed by the participants — which enabled the researchers to identify commonalities in brain activity among diverse spiritual experiences.

How Does Spirituality Change the Brain?

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The area highlighted in blue is the Inferior Parietal Lobe, which is associated with perceptual processing

Spiritual experiences were associated with lower levels of activity in certain parts of the brain:

  • The inferior parietal lobe (IPL), the part of the brain associated with perceptual processing, relating to the concept of self in time and space
  • The thalamus and striatum, the parts of the brain associated with emotional and sensory processing

This study furthers a growing body of research about spirituality and its connection to brain processing. These findings tell us that spiritual experiences shift perception, and can moderate the effects of stress on mental health. This study saw decreased activation in the parts of the brain responsible for stress and increased activity in the parts of the brain responsible for connection with others. A sense of union with someone or something outside of oneself and community engagement have been found to support a robust recovery from substance use disorders as well as other behavioral health issues. 

Looking to the Future

Marc Potenza, MD, PhD is an expert in Psychiatry, Behavioral Addictions, and his work at Yale in this important area is a welcome addition to the investigators working in this field. Neural Correlates of Spiritual Experiences has positive implications for instituting spiritual engagement in prevention, treatment, and recovery for substance use disorders. Importantly, participants were scanned while they recalled their own, individualized spiritual experience, but the results were consistent between participants. This means that a person does not have to participate in a certain type of spiritual practice to see the benefits, but can engage in whatever version of engagement is most compatible with their personal beliefs. This encourages treatment and recovery programs to encourage patients to pursue diverse means of spiritual engagement.

This study found a way to measure and visualize what many recovery and treatment communities have understood for years—that spirituality can reduce stress and create feelings of connectedness. By understanding what regions of the brain are changed during a person’s spiritual practice, fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

References:

  1. Smith, G., Van Capellen, P., (2018, March 7) Rising Spirituality in America [Audio Podcast]. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/articles/2018/rising-spirituality-in-america.
  2. Lipka, M., Gecewicz, C., (2017, September 6). More Americans now say they’re spiritual but not religious. Retrieved from https://www.pewresearch.org/fact-tank/2017/09/06/more-americans-now-say-theyre-spiritual-but-not-religious/

Rx Take Back Day at The Council Nets 400 Pounds of Unused & Expired Prescription Drugs

The Council’s drive-through Rx Take Back site made Rx med disposal quick & convenient
DEA agents collected over 400 lbs. of unused & expired Rx prescriptions for disposal

The Council on Recovery was a busy collection site for the DEA’s 16th National Rx Take Back Day this past Saturday. Nearly 100 people stopped by The Council’s drive-in location on Jackson Hill Street to dispose of their unused and expired prescription medications. By the end of the four-hour collection period, DEA agents had collected more than 400 pounds of Rx drugs.

This is the first time The Council has participated in the DEA’s National Take Back Day. The national initiative was launched after Congress enacted the Disposal Act in 2014, which amended the Controlled Substances Act, that gave the DEA authority to collect unused pharmaceutical controlled substances for disposal in a safe and effective manner.

The Council views unused or expired prescription medications as a public safety issue that contributes to potential accidental poisoning, misuse, and overdose. Proper disposal of unused drugs saves lives and protects the environment. As a Rx Take Back Day collection site, The Council provided a secure, convenient, and anonymous way for its constituency to clear their homes of old or unneeded Rx medications in a responsible manner.

As one of nearly 350 collection sites across the state, The Council provided an easily accessible and central location for residents in the Heights, Rice Military, Montrose, River Oaks, Midtown, and near-Downtown areas to dispose of their medications. During the last Rx Take Back Day in October, over 67,000 pounds of Rx prescriptions were collected in Texas, according to the Drug Enforcement Administration Diversion Control Division. The Council on Recovery is pleased to contribute 400 pounds to this Spring’s total haul and plans to participate in future Rx Take Back events.

If you missed Rx Take Back Day at The Council, you can still dispose of unused or expired prescriptions at DEA authorized collection sites, many of which are located within national and local pharmacies. To search the DEA’s website for a collection site near you, click here.

The Council Taking Back Unwanted Prescription Drugs Saturday, April 27

On Saturday, April 27, from 10 a.m. to 2 p.m., The Council on Recovery and the U.S. Drug Enforcement Administration will give the public its 17th opportunity in nine years to prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs.

Bring your pills for disposal to The Council at 303 Jackson Hill Street in Houston. (We cannot accept liquids or needles or sharps, only pills or patches). This drive up/drop-off service is free and anonymous, no questions asked. The Council’s drive-through covered portico will keep everyone dry in the event of rain. Additional security personnel will also assure the safety of everyone who participates in the event.

Last fall Americans turned in nearly 460 tons (more than 900,000 pounds) of prescription drugs at more than 5,800 sites operated by the DEA and almost 4,800 of its state and local law enforcement partners. Overall, in its 16 previous Take Back events, DEA and its partners have taken in almost 11 million pounds—nearly 5,500 tons—of pills.

This Take Back initiative addresses a vital public safety and public health issue. Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse. Rates of prescription drug abuse in the U.S. are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs. The Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health shows year after year that the majority of misused and abused prescription drugs are obtained from family and friends. These include someone else’s medication being stolen from the home medicine cabinet.

In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards.

For more information about the disposal of prescription drugs or about the April 27 Take Back Day event, go to www.DEATakeBack.com or call The Council at 713-942-4100 or contact us online.

When Detox Turns Deadly

Detox, also known as detoxification or withdrawal, occurs when one abruptly stops or reduces heavy, long-term use of alcohol or drugs. Detox happens when toxic substances leave the body over hours, days, or weeks, and may include a variety of non-life-threatening symptoms, such as distress or discomfort. But, sometimes detox can turn deadly.

In the case of opioids, benzodiazapines, and alcohol, detox can cause serious complications and even death. Most people are not aware of the dangers of detoxing off off these addictive substances, nor the importance of seeking medical care during the withdrawal process. Here are the facts:

Continue reading “When Detox Turns Deadly”

Do You Know the Signs & Symptoms of Substance Use Disorder?

The term “substance use disorder” is frequently used to describe misuse, dependence, and addiction to alcohol and/or legal or illegal drugs. While the substances may vary, the signs and symptoms of a substance use disorder are the same. Do you know what they are?

First a few definitions: Signs are the outwardly observable behaviors or consequences related to the use of the substance. Symptoms are the personal, subjective experiences related to the use of the substance. A substance use disorder (or SUD) is a clustering of two or more signs and symptoms related to the use of a substance.

The Recovery Research Institute recently published the signs and symptoms of SUD cited by the American Psychiatric Association. These include:

  1. Problems controlling alcohol use, drinking larger amounts, at higher frequency, or for longer than one intended.
  2. Problems controlling alcohol use despite:
    • The desire to cut-down or quit
    • The knowledge that continued alcohol use is causing problems such as:
      • Persistent or reoccurring physical or psychological problems
      • Persistent or reoccurring interpersonal problems or harm to relationships
      • The inability to carry out major obligations at home, work, or school
  3. The development of:
    • Cravings: A powerful & strong psychological desire to consume alcohol or engage in an activity; a symptom of the abnormal brain adaptions (neuroadaptations) that result from addiction. The brain becomes accustomed to the presence of a substance, which when absent, produces a manifest psychological desire to obtain and consume it.
    • Tolerance: A normal neurobiological adaptation process characterized by the brain’s attempt to accommodate abnormally high exposure to alcohol. Tolerance results in a need to increase the dosage of alcohol overtime to obtain the same original effect obtained at a lower dose. A state in which alcohol produces a diminishing biological or behavioral response (e.g. an increasingly higher dosage is needed to produce the same euphoric effect experienced initially).
    • Withdrawal symptoms: Physical, cognitive, and affective symptoms that occur after chronic use of alcohol is reduced abruptly or stopped among individuals who have developed tolerance to alcohol.
  4. Alcohol use that leads to risky or physically hazardous situations (e.g. driving under the influence)
  5. Spending large amounts of time obtaining alcohol
  6. Reducing or stopping important social/occupational/recreational activities due to alcohol use

If you or a loved have experienced the signs and symptoms of a substance use disorder, and need help, call The Council on Recovery at 713-942-4100 or contact us online.