Experts identify key measures to reduce alcohol consumption in Germany

In a recent article published in the magazine Addiction science and clinical practiceResearchers identify measures that improve alcohol health literacy (AHL) and reduce alcohol consumption in Germany.

Study: Improving alcohol health literacy and reducing alcohol consumption: Recommendations for Germany. Image credit: Oleksandra Naumenko/Shutterstock.com

Background

According to the World Health Organization (WHO), two primary determinants of alcohol consumption are the availability and affordability of alcoholic products. Theoretically, these seem easy to manage by modulating policy; however, in practice, these factors require public and political support.

Sustainable reduction of alcohol consumption requires changing an individual’s perception of risk and social norms, as well as reducing its availability and affordability. For example, raising awareness that alcohol use is a risk factor for cancer could help increase support for alcohol control policies.

With the exception of a few countries, most countries have not made significant progress in reducing alcohol consumption and, as a result, often report a high prevalence of heavy drinkers. In particular, alcohol consumption is widespread in most middle- and high-income countries.

The core attributes of AHL, which include the ability to process and understand knowledge of alcohol content, strengths, units, and harm, could become a vehicle for sustainable reduction in alcohol consumption. These characteristics are embedded in social and systemic environments called antecedents, which facilitate or limit the establishment of low-risk or abstinent drinking patterns.

About the studio

In the present study, the authors searched PubMed using keywords such as “accessibility” to derive recommendations for improving AHL. For education, health care and policy, the researchers invited five experts to review derived recommendations.

The reviewers rated the recommendations based on their likely impact on AHL and reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC).

Researchers chose Germany as a target for measures to improve AHL for several reasons. While other European countries have implemented strict alcohol control policies to reduce alcohol consumption, Germany has not.

Indeed, per capita alcohol consumption in Germany is higher than the global and European average, resulting in substantial alcohol-attributable morbidity. Despite the high financial burden on the German population, general health literacy including AHL remains low in Germany, especially among vulnerable groups.

Study results

A total of 11 recommendations for strengthening AHL and reducing alcohol consumption in Germany were found. Four of these recommendations concerned education and information measures.

‘Unplugged’, for example, is a school-based alcohol prevention program in Europe that provides knowledge and skills related to AHL in a series of 12 sessions delivered over a year. Another example of an intervention is “Klar bleiben”, which translates to “stay away” in German, which involves students committing not to consume alcohol, even occasionally, for nine weeks and discussing topics related to alcohol.

While such programs critically reflect alcohol advertising, they need to be adapted to formulate appropriate goals, such as delaying the initiation of drinking for young people. Furthermore, although these education-based measures did indeed increase individual drinking literacy, they had no effect on drinking.

Alcohol control policy measures, such as alcohol taxes, have been shown to be the most effective in reducing actual alcohol consumption; however, they have had little impact on the AHL. The reviewers made study recommendations for Germany; however, these could also apply to other nations, such as West-Central European countries with similar cultures and economies.

The current study highlighted AHL as a separate entity from alcohol consumption. To this end, programs aimed at improving AHL focus on psychological concepts, such as awareness, while evaluation of alcohol control policies focus on alcohol sales and population-level health outcomes. Since these two areas of action operate in isolation, their effectiveness is limited.

A revised study proposed the importance of increasing public awareness that alcohol is associated with various health and social risks. This educational approach could facilitate the learning of risk awareness skills that could help achieve adherence to stricter alcohol control policies.

Unfortunately, the authors failed to find empirical evidence of how these policies interact with education-based outreach measures or whether to combine these two research areas.

Conclusions

The study findings underscore the importance of integrating alcohol strategies to sustainably improve AHL and reduce alcohol consumption. Importantly, any measure aimed at reducing the social burden of alcohol should not stigmatize people who consume alcohol or have alcohol use disorders.