Creating an effective public health response to alcohol affliction

Professor Emmanuel Kuntsche commences his appointment as Director of the Centre for Alcohol Policy Research (CAPR) at La Trobe University in Melbourne this week.

A Senior Researcher and an Associate and Honorary Professor in Switzerland, the Netherlands and Hungary, Professor Kuntsche takes over from the internationally renowned Professor Robin Room.

CAPR, a joint initiative of the Foundation for Alcohol Research and Education (FARE) and La Trobe University, is a world-class research facility that contributes to the development of effective evidence-based alcohol policy on the national and global stage. In his first Drink Tank post, Professor Kuntsche says alcohol consumption is key example of the complexity of human behaviour.

Gathering insights into human behaviour is fascinating and multi-faceted. For example, we are all driven by our habits, but our behaviour can change almost instantaneously in certain circumstances – sometimes in a seemingly irrational way. Alcohol consumption is key example of the complexity of human behaviour. Some people, for example, usually drink one or two glasses of wine for dinner but may suddenly decide not to drink because they are not in the mood or choose to be the ‘designated driver’. Yet on another occasion with friends at a party or in a pub – they drink much more than usual, even if they have study, work or family obligations the next day. But there is more than individual behaviour, cognitions and emotions, events and social context influencing our habits.

Of all psychoactive substances alcohol consumption is not only the most prevalent across a person’s lifespan and around the globe, but is as old as mankind and has the longest tradition. Even some animals occasionally eat rotten fruits (containing alcohol) to get high and some scholars believe that alcohol consumption has played an important role in human evolution.

Behaviour with such a long tradition is difficult to transform, but change is sorely needed. In developed societies, alcohol consumption is among the major causes for premature death and is an avoidable health burden. And importantly, we are talking about the majority of drinkers, not just those who are alcohol dependent. There is convincing evidence that the risk for various kinds of cancers starts with relatively small amounts of alcohol consumed daily. And just a single binge drinking episode can lead to an accident with serious or even deadly consequences. Yet, a great many of drinkers, including those underage, consume much more alcohol than recommended by the Australian Guidelines to Reduce Health Risks from Drinking Alcohol.

One reason for this can be found in the millions of dollars spent each year by the alcohol industry to promote sales of alcoholic beverages. Their marketing is aimed at stimulating and increasing consumption both directly and indirectly; promoting the normality and positive aspects of drinking by sponsoring popular events such as sports and concerts.

Effective public health responses are clear, inexpensive and easy to implement. This means addressing the aggressive marketing and promotion of alcohol, together with restricting alcohol’s availability and reducing its affordability. Unfortunately, some of these policy measures can be unpopular! Drinkers don’t like to spend more, this seems to me, or travel further to get their drinks; the alcohol industry wants to maximise sales (and actually make most of its profits from those not respecting the drinking guidelines); and to be elected, politicians depend on supportive voters – most of whom drink.

So the concerns of individuals and the public health sector are ignored. It needs strong and continued advocacy to remind policy makers, drinkers and the general public that alcohol is no ordinary commodity.

As the incoming director of CAPR, I look forward to closely collaborating with the Foundation for Alcohol Research and Education in contributing to the development of effective evidence-based alcohol policy on the national and global stage.

Having worked as a European-based alcohol researcher for the last two decades, the time had come to broaden my horizons – professionally, personally, geographically. Being grateful for the opportunity to lead a world-renowned alcohol research centre, my ambition is to continue to encourage the excellent work of the team.

I am convinced about the importance of generating the best possible evidence for policy action. At CAPR, we monitor the burden resulting from alcohol consumption, and we will continue evaluating the effectiveness of existing policy measures to determine what measures should further be promoted and implemented. We will do so carefully, understanding that drinking is often an unconscious process.

We know that once alcohol is consumed, neurophysiological reward systems are activated. Together with stimulus of the social and physical environment, this instigates drinking also in moderate drinkers leading to higher amounts consume than intended or recommended. To better capture these processes, CAPR will meet the challenge of developing innovative methodologies aiming at an improved understanding of the complexity of human behaviour of which alcohol use is a key example.