The parallels between pot and alcohol regulation continue to pop, as legal recreational use spreads.

Oregon and Alaska Light Up; Liquor Control in Charge; Wet-Dry Counties Legal recreational use in Oregon launches July 1. As in neighboring Washington, the state's alcohol beverage control commission (OLCC) will enforce regulations. In Alaska, possession and growing became legal for citizens back in February, but the state is still working on market regulations. The alcohol beverage commission will also be the regulators there, Washington's liquor control director Rick Garza told the National Conference of Liquor Administrators recently during a panel discussion on pot. Like Colorado, Oregon will institute a "seed to sale" tracking system for pot, reports the East Oregonian. OLCC will also regulate the state's medical marijuana business, now loosely controlled, as it is elsewhere. In another parallel to Colorado, Washington and to alcohol regulation, individual communities in Oregon can opt-out from legalizing recreational use if "at least 55% of the electorate voted against" the ballot initiative last November, the paper reported. So just as with alcohol beverages, these states will have "wet" and "dry" areas. Indeed, about 70% of Colorado communities continue to ban recreational pot.

Pot's Health Effects Unclear; Driving Restrictions Too Just as the risks and rewards of alcohol consumption, as well as the effectiveness of sanctions to reduce misuse, continue to elicit contradictory research findings, so it's going in the early days of pot research and harm prevention. A key issue for pot has been the dearth of research, mostly barred since pot remains a Schedule 1 drug as far the federal government is concerned. That just got easier; the Dept. of Health and Human Services recently removed one significant barrier to privately-funded marijuana research. Meanwhile, what little research that has been done has been mixed.

A just-published review of 70 studies of medical marijuana, for example, concluded: "Medical marijuana is used to treat a host of indications, a few of which have evidence to support treatment with marijuana and many that do not." For "chronic pain, neuropathic pain and spasticity due to multiple sclerosis" there is "high-quality evidence" that marijuana is effective, the authors found. But evidence was weak for a number of other conditions that pot is often prescribed for, including anxiety, sleep disorders and more. And so, the authors conclude with the very familiar recommendation: more research is needed. Importantly, there is even less research on recreational use of pot.

Elsewhere, in a déjà vu of the battle over whether .08 BAC should be the per se illegal level for driving in the US, a recent analysis of the effectiveness of per se drugged driving laws found "no evidence" that they "reduce traffic fatalities." The authors looked at fatal crash data over a 20-year period in 17 states that adopted a per se drugged driving law, making it illegal to operate a vehicle with any detectable levels of illegal drugs. They reviewed the data from different angles, including time trends, adjusting for different state controls, impacts on different age groups, at different times per week and day, per 100,000 drivers, per mile driven, gender and more. Some of these views suggested decreases linked to per se laws, some suggested increases (including one that separated out men). Indeed, their "preferred specification" (including a state-specific linear time trend) indicated a "(statistically insignificant) 1.9% increase in the traffic fatality rate." But given the margin of error in this calculation and the different findings, "we cannot rule out the possibility that per se laws are effective."

Not So Credible Edibles Colorado has experienced some well-publicized problems with edible marijuana, documented in a first-person account by NY Times columnist Maureen Dowd and other reports of people accidentally (perhaps) over-consuming them. THC content varies significantly, depending on portion size and even in different parts of the edible. Then too, THC's effects take longer to take hold in edibles than smoked marijuana. (Just as peak BAC levels climb well after the last sip is swallowed.) As another speaker at NCSLA put it: "a single cookie may affect different people differently." A recent analysis of 75 edibles found that only 17% of them had accurately labeled the level of THC they contained. Sixty per cent had less than advertised, 23% had more. And the variation was as wide as 97% less than labeled. (TTB regs require beer ABV's to be within 0.3 of the labeled amount, for spirits it's 0.15 or 0.25).

A recent posting on Alternet provided "5 reasons to be wary of marijuana edibles," including: 1) a lack of knowledge about the ratio of psychoactive compounds in them compared to smoked marijuana; 2) edibles are often made from "trim" rather than buds, creating a difference likened to "the difference between a fine Scotch grown with high-quality grain and rot-gut vodka made out of cheap potatoes"; 3) lack of science about how different foods/herbs interact with marijuana. Net-net: research on edibles "has only just begun." Yet states are moving quickly to put them in the market. Compare that to the rush to ban palcohol.  

States that have more restrictive alcohol policy environments also have lower binge drinking rates among white adults and lower drinking/binge drinking rates among white and Hispanic youth. Those were the mostly predictable conclusions from a pair of studies by a group of researchers from Boston University and University of Minnesota Schools of Public Health. The principal investigator (Tim Naimi) and several of the other researchers are also well-known advocates of these same policies. The projects' "consultants" (including Jim Mosher, Frank Chaloupka, Harold Holder, etc.) are even more well-known for their advocacy of these policies.

In both studies, a group of 10 experts (coincidentally, there were 10 consultants) "rated" the efficacy of 29 different alcohol policies, from tax and availability to anti-drunk driving measures. They also determined "implementation ratings" of the policies, based on their design. These ratings could be subjective, the authors acknowledged, and a "different set of experts and a different research team might have established different ratings and a different scale." Then too, no measures of critical enforcement levels for any of these policies were available. Even so, the researchers developed a scale of alcohol policies based on these subjective ratings, and correlated them with state-by-state drinking, heavy drinking and binge drinking rates reported in federal surveys, from 2005 to 2010 for the adult study and 1999-2011 for the youth study.

Broadly, the adult study, involving 2.4 million adults over 6 years found 14% reported binge drinking (5+ drinks on at least one occasion in the past 30 days for men, 4+ for women), 3.4% reported 5+ binge episodes and 3.7% reported having 10+ drinks at least once in the past 30 days. After adjustments for gender, age, race/ethnicity, education and household income, "a 10 percentage point increase in the Alcohol Policy Scale (APS) score was associated with a lower likelihood of binge drinking, frequent binge drinking and consuming 10 or more drinks." Stricter alcohol policy environments were associated with 8% lower rates for the first two measures, 10% for the last. If you use the average rates found across the years noted above, the stricter polices were associated with a 13% binge drinking rate (instead of 14%), a 3.1% heavy binge rate (vs 3.4%) and a 3.3% rate of having 10+ drinks (vs 3.7%). These correlations occurred only among white adults. "The lack of a statistically significant association between APS and binge drinking among Blacks and Hispanics warrants future study," the authors allowed. Also, "policies that raised the price of alcohol and those that limited the availability of alcohol had significantly stronger inverse associations with binge drinking compared with other policies," suggesting those polices had "most of the impact." That's no surprise, given that policies were very likely among those considered "the most effective" by the experts in the first place.

The youth findings were similar. A 10 percentage point increase in the APS score was associated with a 7% reduction in the odds of youth drinking and 8% reduction in the odds of binge drinking. Given that about 13% of youth age 12-17 drink and about 7% binge drink, this suggests that states with stricter policies would have drinking rate closer to 12% and binge drinking rate closer to 6.5%. Another similarity: while stricter polices correlated with lower drinking rates among white and Hispanic youth, "for non-Hispanic black youth and non-Hispanic other races… there was no significant relationship between APS scores and either drinking or binge drinking."

The authors' policy prescriptions are as predictable as their results: 1) "The study strongly corroborates other evidence that alcohol policies reduce binge drinking, including frequent and high-intensity binge drinking, at the population level"; 2) "Efforts to reduce youth drinking should incorporate population-based policies to reduce drinking among adults as part of a comprehensive approach to preventing alcohol-related harms." But given the variation in drinking and heavy drinking habits found in the county study (see above) and the vagaries of local enforcement, one wonders whether these findings about state-level alcohol policy would hold up under closer scrutiny. Ref 2  

"We found huge variations in drinking patterns among [US] counties, even within a state. Indeed, state-level estimates would have masked the substantial variation between counties within states." So begins the discussion of a landmark report in the American Journal of Public Health from a group of researchers at the University of Washington's Institute for Health Metrics and Evaluation. The findings raise questions about the efficacy of state-based regulation/alcohol policy and suggest that more locally-oriented approaches may be more effective. Second, the study adds powerful evidence that the single-distribution theory favored by public health advocates is not correct and that average drinking rates do not correlate with or determine heavy drinking rates. Therefore, prevention policy should not be aimed at reducing overall consumption but rather directed at heavy/problem drinkers. The key findings, based on data from every US county in the Behavioral Risk Factor Surveillance System 2002-2012:

• Nationally, in 2012, 56% of American adults were drinkers, 8.2% were "heavy drinkers" and 18.3% were binge drinkers. This survey defines "heavy" as any drinking over the federal dietary guidelines, averaging more than 1 per day for women, 2 per day for men. But viewed by county, the overall drinking rate ranged from 11% to nearly 79%, heavy drinking rates ranged from 2.4% to 22.4% and binge drinking rates ranged from 5.9% to 36%.

• Drinking rates followed some "broad" regional patterns, but there are sizable differentials even within states: "the median gap between highest and lowest county-level prevalence within a state was 27.6, 6.3 and 9.8 percentage points for any, heavy and binge drinking respectively." Those are indeed huge swings.

• While about 15% of all drinkers are heavy drinkers and 1/3 are binge drinkers, the county data showed those proportions "varied widely between counties," from 6-67% for heavy drinking and 20-86% for binge drinking. This sharply questions any tie between average and heavier consumption.

• There was little change in overall national drinking rates from 2005-2012, but a "substantial increase," 17% in heavy drinking and +9% for binge drinking. County-by-county trends swung widely in all three measures. Indeed, for heavy drinking, trends varied from -39% to +155%.

Two key conclusions from the authors: 1) "Clearly, there is not some fixed proportion of drinkers who are binge or heavy drinkers." This variation "certainly" calls for "further investigation." Second, "as drinking patterns vary widely between and within states, county-level estimates are essential for identifying areas of greatest need and informing efforts to reduce excessive alcohol use." The study and results, the authors believe, "provide an important tool to local public health officials" to prevent harm. INSIGHTS will dig into more of the county-by-county numbers for our next issue to further explore the (lack of) relationship between overall and heavy drinking rates. Ref 1  

 Students who initiated mixed use of alcohol and energy drinks (AmED) were more likely to escalate their drinking and report negative consequences, a study out of Penn State College found. Authors of this study of 1,700 students hypothesized that 30% of the sample size "would report they consumed AmED's at any given point," but found that number to be even higher at 40% from spring semester freshmen year and follow up fall semester sophomore year. "Our rates were higher in comparison with other research," authors noted, "which may have been because these studies did not examine initiation or discontinuation of use across time." Results may also suggest AmED consumption "is more prevalent than earlier work estimated or that AmED use is on the rise."

When tracking AmED use, this study identified "four distinct groups" of AmED users, those who a) never used, b) initiated use during study period, c) discontinued AmED use during study, d) continuously used AmED between semesters. A majority of students, 60%, never mixed AmED to begin with and those students also "reported significantly lower rates of alcohol consumption and consequences" in general. Among the sample, 27.2% of students said they mixed AmED's in spring semester freshmen year and 24% said they did later in fall semester sophomore year. In sophomore year, 16% said they no longer engaged in AmED use, while 12% started using AmEDs that semester. Given that 16% of students discontinued AmED use, it suggests this mixing may be "experimental and short lived for some students," wrote the authors. In general, "an increase in drinking behaviors was observed for all groups" of students across the two semesters and "the most abrupt increase" was found among AmED initiators, "indicating a relationship between AmED use and increased alcohol consumption." While the relationship between AmED and increased alcohol consumption "cannot" be determined as causal, "it highlights the positive relationship between these patterns over time," concluded the authors. To better understand AmED use, they suggested studying a more diverse group (this study included a "large majority" of white students) and a longer longitudinal look. "Work is needed to examine additional cycles of use and how turning 21 and drinking in bars effects AmED consumption," they acknowledged. Ref 3

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References
1 OECD, "Tackling Harmful Alcohol Use, Economics and Public Health Policy," Remarks, Angel Gurría, May 12, 2015.
2 Christopher Kierkus and Brian Johnson, "Michigan DWI/Sobriety Court Ignition Interlock Evaluation," 2015 Report, May 2015.
3 Mallett, K, et al, "Longitudinal Patterns of Alcohol Mixed with Energy Drink Use Among College Students and their Associations with Risky Drinking and Problems," Journal of Studies on Alcohol and Drugs, Vol 76., No 3, May 2015, 389-396.

The Beer Institute, this time along with the Brewers Association (representing small brewers), the National Beer Wholesalers (distributors) and the Wine Institute (vintners), has engaged with the Departments of Agriculture and Health and Human Services for a third time in an attempt to make changes in the language regarding alcohol beverages in the 2015 version of the federal Dietary Guidelines. The broader coalition seeks substantially the same changes as those advised in earlier letters from Beer Institute alone, though the May 8, 2015 letter signed by the groups does not include the "Know Your Drink" graphic introduced last year by the Beer Institute (see May 2014 AII) and included in BI's fall 2014 written comments. The letter responds to the January 2015 Scientific Report of the guidelines' Advisory Committee. Recall, that committee did not advise any significant changes to the 2010 Guidelines vis à vis alcohol (see March 2 AII Update) or reflect the changes Beer Institute sought earlier. The associations argue that the current Guidelines are "fundamentally flawed" and need to be changed now in order to "provide consumers with better information about drink variability."

The new letter focuses on the same two key issues that Beer Institute had brought up previously. First, the 2015 Guidelines should drop the current "drink definition" of 0.6 oz of "fluid" (or absolute) alcohol. The associations argue the definition is a "misapplication of a reference point used for comparative dosing in scientific studies, and has no meaningful connection to the real world consumption patterns of the American consumer." That definition, which the associations say was a "last minute addition" to the 2010 Guidelines, "should have no place" in the 2015 edition. Second, the groups focus on the "real world" and insist, repeatedly over seven pages, that "especially when it comes to mixed drinks" made with "hard liquor" there is so much variation in the amount of alcohol that: 1) the guidelines should avoid attaching ABV values to "specific serving sizes that suggest beer, wine and hard liquor are always equal" and: 2) this variation needs to be explained to consumers, including the notion that depending on recipes and type of spirits used "a mixed drink may include the equivalent of several light beers or glasses of wine."

The 0.6 reference point was not developed "for purposes of educating consumers," the letter points out, noting "a dose is simply not a drink and many typical servings of alcohol beverages are NOT single dose equivalents." The associations find support for their positions in research on drink variance as well as in documents from other federal agencies, including FDA, NIAAA and TTB. While the Beer Institute's "Know Your Drink " graphic - recall it pictures dots below "customary drinks" to designate the amount of alcohol, from a single dot in a beer, to 3.5 dots in a martini - is not included in the new letter, BI will continue to use it in other forums.

Global Producers Launch New Responsible Drinking Website, Including Info on "Standard Drink" Separately, the International Alliance for Responsible Drinking (IARD), created last fall when the International Center for Alcohol Policy (ICAP) merged with the Global Alcohol Producers Group, launched its own effort to educate consumers at ResponsibleDrinking.org. The website is "intended to be a helpful health destination for current information about different forms of beverage alcohol," the health effects of drinking, its risks and responsible drinking. Several of the dozen member companies of IARD are the same brewers represented by the Beer Institute in the US: AB InBev, Heineken, SABMiller and Molson Coors. But IARD also includes the world's leading distillers.

The IARD website has a section on "How much alcohol is in my drink?" That section points out that drink strength varies depending on ABV, serving size and individual pours. Therefore, "typical" ABV levels in beer, wine and spirits "may not be accurate" for any given drink, and consumers should know how to calculate drink strength and "understand your pour," the website advises. IARD also points out that some countries have adopted "drinking guidelines" and that while 8 grams of alcohol is considered to be a "drink or unit" in the UK, in the US "a standard drink contains 14 grams" of ethanol. That's 0.6 oz of "fluid alcohol." So, in this global forum, international brewers are taking a different position than they are in the US.  

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References
1 OECD, "Tackling Harmful Alcohol Use, Economics and Public Health Policy," Remarks, Angel Gurría, May 12, 2015.
2 Christopher Kierkus and Brian Johnson, "Michigan DWI/Sobriety Court Ignition Interlock Evaluation," 2015 Report, May 2015.
3 Mallett, K, et al, "Longitudinal Patterns of Alcohol Mixed with Energy Drink Use Among College Students and their Associations with Risky Drinking and Problems," Journal of Studies on Alcohol and Drugs, Vol 76., No 3, May 2015, 389-396.

As MADD and others in highway safety increasingly turn to technology as a key prevention tool, ignition interlocks for DWI offenders are emerging as a very promising alternative to more traditional approaches. A new study prepared for the state of Michigan, based on 4 years of data, suggests that "the ignition interlock program is exhibiting significant success" and together with the state's DWI/Sobriety Courts provide "a promising method of reducing recidivism among repeat drunk drivers," the authors wrote. They compared records of about 656 drivers who were ordered to install ignition interlocks with two other similarly-sized groups that were either not assigned interlocks or went through standard "probationary" programs. The results were impressive:

• Among those ordered to install interlocks, 97.1% complied, just 0.5% removed the device and only 1.2% tampered with it.

• "Alcohol and drug use was substantially lower among Interlock Program Participants" than among the others. The participants were also more likely to improve their education, have jobs, attend more 12-step meetings, were drug tested more often (and tested negative), had fewer issues with law enforcement and "experienced a higher number of overall sobriety days."

• Nearly 90% of interlock participants graduated from the DWI/Sobriety Court after 4 years compared to 66% of non-participants. A separate analysis found that "offenders not under interlock supervision have over 3X greater odds of 'failing out' of DWI/Sobriety Court" than interlock participants.

• Interlock participants had the lowest recidivism rates for not only operating under the influence, but for all criminal offenses in the 1-3 year period following their conviction for a repeat offense or their initial offense.

"In general," the authors concluded, their analysis showed that "the presence of an ignition interlock in a DWI Court significantly reduces repeat drunk driving recidivism two years post-admission and general criminal offense one and two years post-admission." Then too, a "series of informal telephone conversations" with court personnel found that the system ran fairly smoothly, relationships remained positive among staff and the system did not "impose" significant workload issues. Ref 2  

The OECD report on "Tackling Harmful Alcohol Use" is jam-packed with data and debate points from all sides of the policy issues, and will likely be cherry-picked by one side or another. Here are some figures, facts and advocacy that got our attention.

• Overall alcohol consumption declined about 2.5% in the 34 OECD countries from 1992-2012 (the report includes some data on an additional 6 countries that are not members). But those trends include "dramatic falls" in countries like Italy, Spain and Greece and "significant" increases in Russia, China and elsewhere.

• While OECD argues that evidence is strong that rates of heavy consumption track overall consumption, clearly other measures do not align and call into question the efficacy of broad-based public health policy. For example, some of the countries with the greatest declines in overall drinking (Italy, Slovenia, Portugal and Switzerland), experienced significant increases in the proportion of 15 yr olds who have consumed alcohol. In Finland, overall consumption rose while fewer 15-yr-old were drinkers. In general, the youth drinking situation in the OECD countries seemed to have worsened, with the number of children who drink and experience drunkenness increasing "substantially in recent years," while rates of drinking and drunkenness fell among teens in the US.

• While "most alcohol is drunk by the heaviest-drinking 20% of the population," OECD found, its research also suggested that "approximately 4 in 5 drinkers in the countries examined…would reduce their risk of death from any causes if they cut their alcohol intake by one unit per week, that is the equivalent of a small glass of wine."

• While overall drinking rates rise with socio-economic status (SES) and education, "heavy drinking is polarized at the two ends of the spectrum. Less educated and lower SES men, as well as more educated and higher SES women, are more likely to indulge in risky drinking," the OECD found.

• OECD's policy recommendations to reach the 10% reduction goal (see above) were specifically derived from projections in 3 countries: Germany, Canada, and Czech Republic. But OECD did conclude that raising prices "can improve population health, and doing so in the cheaper segment of the market may be more effective in tackling harmful drinking." This supports minimum pricing policies. But it also may spur illegal production.

• On advertising restrictions, OECD is more equivocal, concluding that "regulating the promotion of alcoholic beverages may provide additional benefits." (Our emphasis.)

• One of OECD's main contributors on advertising and price policy is long-time advocate/ researcher Henry Saffer. But even Saffer's projections for the effectiveness of higher prices and ad restrictions are fairly weak. For example, he projects that a 50% decrease in advertising (a massive change unlikely to pass muster in many OECD member states) would reduce moderate drinkers' consumption by just 1.5% and heavy drinkers' consumption by 4%. And a 50% increase in tax would reduce moderate consumption by 12.5%, Saffer projects, but heavy consumption by just 3.5%.

• The report echoes Gurría's comments about an industry role in prevention: "An open dialogue and cooperation with alcohol manufacturers as well as major retailers and other related industries may be, and has already been in some countries, part of an effective policy approach in fighting the harms associated with alcohol consumption."

All in, the OECD has produced another wide-ranging, detailed international report that can be wielded by different stakeholders and policymakers in different ways. Whether it impacts policy in specific countries, especially in the US where global prescriptions appear to have little sway these days, remains to be seen.  

Add alcohol policy to the environment and education as issues that broader economic interests seek to impact. Recently, the Organization for Economic Cooperation and Development (OECD) produced a lengthy report titled "Tackling Harmful Alcohol Use." The report is the result of a 5-year effort by the international group that works with governments to "promote policies that will improve the economic and social well-being of people around the world." The focus of the report and the tone and tenor of the remarks by the OECD Secretary General Angel Gurría introducing it should be welcomed by alcohol beverage industry members, even as they'll reject some of OECD's specific guidance. The brief also includes some interesting research/ findings to inform further alcohol policy debates.

Gurría's May 12 comments in Paris are notable for two key emphases. First, he focused on "harmful consumption" not the increasingly common "alcohol consumption" adopted by some government institutions and public health advocates. Second, and naturally given OECD's charter, he fully embraced a role for the alcohol beverage industry in tackling harmful consumption, again even as some in government and many in public health reject such a role. Also, he acknowledged early in his remarks that "alcohol consumption, in moderation, brings many people pleasure, and is a source of jobs." The report itself cites research that shows moderate drinking has health benefits, including a "J-shaped curve" regarding mortality. In sum, OECD's report aims at "how to tackle heavy and binge drinking" as "harmful consumption bears a heavy cost on individuals and society."

Overall consumption has been "declining slightly" across OECD countries, Gurría pointed out. But: "Very alarming is the rise in heavy drinking, particularly binge drinking in young people and women in many countries," even in some countries where average consumption has dropped. OECD also found that in some countries 20% of the population consumed 2/3 of the alcohol, upwards of 40% of "children" have been drunk at least once and that female binge drinking rates have increased substantially. OECD links "harmful drinking" to over 200 diseases, premature death, loss in productivity and huge costs in crime and healthcare expenditures. Yet, OECD believes that the World Health Assembly's stated target of reducing harmful use by 10% over the next decade is "achievable." How? By a "comprehensive prevention strategy, combining regulation with medical intervention and price strategies." Specifically, OECD endorses: 1) more extensive medical education and patient counseling; 2) "tighter enforcement" of regulations to prevent drinking and driving and alcohol-related violence; 3) "price policies and regulation of the promotion of alcohol." All of these measures, OECD believes, are "highly cost-effective"; most pay for themselves. Indeed, for "an investment of about $5 per person per year," hundreds of thousands of injuries and "mental health conditions" can be averted, OECD calculates, though its cost-effectiveness model has already been challenged.

"Policies targeting problem drinkers are a must," Gurría stated, but they're "unlikely to cut problem drinking by more than 5%. Therefore, some "policies need to address more general alcohol-related habits," i.e. higher taxes, minimum prices or sales restrictions. These polices, he acknowledges, "affect moderate drinkers" and create a "dilemma" for governments in having to balance "the rights of the relatively safe drinker with the costs imposed by heavy and hazardous drinkers." Therefore, "each country will have to weigh the evidence of their own circumstances." Governments can't tackle this problem alone, OECD further believes. And Gurría noted that "business stakeholders have stepped up their social responsibility efforts," specifically citing the alcohol beverage producers' commitment to reduce UK consumption by one billion units by the end of this year. DISCUS quickly criticized some of OECD's methodology and use of a "flawed model" to recommend a 10% price hike via higher taxes. Yet, again, much of OECD's approach and tone compares favorably to harsher and broader competing "models," especially in the international arena. Ref 1  

 Many public health advocates, and some industry members, have criticized the supposed "deregulation" of the alcohol beverage business in the UK, beginning around 2003. They describe a drinking "epidemic" there resulting from increasing hours of sale, below-cost sales and more. Problem measures vary, but the trend in absolute alcohol consumption has gone in the opposite direction of what public health dogma would predict with looser restrictions. Indeed, per capita consumption has fallen steadily during this period, at least in Britain. Data prepared by the British Beer & Pub Association (BBPA) shows that per capita alcohol consumption fell by 18% from 2004-2014, and declined in 8 of the last 10 years. As BBPA chief executive Brigid Simmons pointed out upon release of the 2014 trend, the figures "certainly bury the myth that overall UK consumption is inexorably rising."

In Britain, beer has 36% of the alcohol, market, wine 33%, spirits 21% and cider 8%. The corresponding figures for the US are: 50.7%, 15.5%, 33.6% and less than 0.2%.

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References
1 Diaz, M et al, "The Effects of Alcohol Excise Tax Increases on Public Health and Safety in Texas," Texans Standing Tall, March 2, 2015; Christopher Ingram, "Our booze is too cheap and it's literally killing us," Wonkblog, Washington Post, April 6, 2015.
2 Wilcox, G, et al, "Beer, wine, or spirits? Advertising's impact on four decades of category sales," International Journal of Advertising, March, 2015.
3 "FDA says alcoholism meds need only eliminate heavy drinking," Alcoholism and Drug Abuse Weekly, Vol 27, No 8, February 23, 2015.
4 Robby Soave, "Now That Jackie's Story Is False, Can We Be Honest About Rape and Alcohol?" www.reason.com, April 14, 2015.

"The best way to encourage teens to drink responsibly - and safeguard themselves against campus assaults - is for Congress to repeal the National Minimum Drinking Age Act," passed in 1984. So concludes Robby Soave, a blogger for Reason.com, in finding yet another lesson from the now-discredited Rolling Stone story about an alleged gang rape at the University of Virginia. The supposed victim's claim that she was not intoxicated "struck me as unbelievable from the start," Soave claims, since alcohol abuse is so rampant on college campuses, is involved in so many sexual assaults and in fact is "almost always the real culprit" in the case of rape, he asserts. Many would no doubt question this conclusion, in no small part because it takes focus off of the rapist. And no doubt some of Soave's analysis is sketchy. (He seems oddly unaware of the widespread use of false ID to obtain alcohol, for example.) But it's hard to argue with the basic charge that illegal and over-drinking on college campuses remains a huge problem and one that has not experienced the same declines seen in other alcohol problems. Nor can the notion that a legal age of 21 complicates prevention, to say the least, be denied.

Soave relies on two key sources for claiming the mandated legal drinking age is primarily at fault for campus drinking problems. One is, predictably, Barrett Seaman, current president of Choose Responsibility, which has spearheaded efforts to lower the minimum age for several years now, aimed specifically at reducing campus drinking problems. The second is Gabrielle Glaser, the same journalist who sharply challenged Alcoholic Anonymous in The Atlantic (see above, and last issue). Glaser and Seaman provide familiar arguments against minimum age mandate of 21: that it creates a "forbidden fruit" appeal and atmosphere, forces drinking underground, encourages dangerous drinking patterns, and more. "Young people don't have moderate models," Glaser told Soave. "If you're not allowed to buy alcohol until you're 21, what are your models going to be?"

Seaman shares his experience at McGill University in Canada when the drinking age was 18 and students were "far more responsible" in their drinking habits. Soave believes that repealing the federal mandate "would allow state and local authorities to try out different policies." (He also seems unaware that "blood borders" - different minimum ages in neighboring states - in great part led to the national age limit.) Instead, these authorities are being bound by "de facto Prohibition - a policy that was correctly regarded as a failure when it applied to adults, but is for some reason still considered a success at preventing teens from drinking." Indeed, recall the debate over the minimum age in the Journal of Studies on Alcohol and Drugs last year, with two veteran researchers declaring "case closed" on the effectiveness of MDA 21. They specifically singled out Choose Responsibility for criticism and advised that "college and university leaders need to accept the fact that the age 21 law saves lives and is unlikely to be overturned."

It is possible, indeed highly likely, that MDA 21 "saves lives" and that it is responsible for creating a culture of what Soave calls "bad drinkers who put themselves in unsafe situations." That makes it yet another example of just how complex, contradictory and confounding alcohol policy can be. And why some alcohol policy debates never seem to end. Ref 4