Drinker survey and minimum alcohol price – Expert reaction

A minimum price on alcohol is unlikely to drive drinkers to criminal or dangerous behaviour, say the authors of a new study.

BottlesPrevious studies have suggested that imposing a minimum price per standard drink of alcohol could reduce harmful alcohol consumption. Last year a Ministry of Justice report explored the possibility of a minimum price of $1 to a $1.20 per standard drink in New Zealand, recommending introduction of such policies be delayed.

In a new New Zealand Medical Journal study, researchers report on a survey of 115 dependent drinkers at an Auckland clinic (subscription required), investigating how they would respond to changes in the affordability of alcohol.

Noting that the heaviest drinkers also bought the cheapest alcohol, the authors conclude that “it seems likely that a minimum pricing regime would result in an overall reduction in alcohol consumption in this group”.

They also reported there was minimal evidence drinkers would turn to non-beverage alcohol – such as methylated spirits – or criminal activity to access alcohol when it becomes unaffordable.

“Fears of such behaviours are not valid reasons for rejecting a minimum pricing regime,” write the authors.

In an accompanying editorial, Prof Tim Stockwell, Director of the Centre for Addiction Research at the University of Victoria, Canada, says the results should encourage policymakers in New Zealand to consider the introduction of minimum alcohol pricing.

“Their findings encourage the view that in contrast to the demonstrated public health and safety benefits of this policy, feared negative consequences for vulnerable populations of heavy drinkers may be minor and manageable,” he writes.

The findings come alongside another paper published in the New Zealand Medical Journal in which leading public health academics say the Government needs to take more action on policies to prevent non-communicable diseases – also known as lifestyle diseases – such as cardiovascular disease, diabetes and cancer. The authors present seven targets for decreasing levels of tobacco smoking, child overweight and obesity, salt intake, physical inactivity, alcohol consumption, saturated fat intake and improving health systems.

For curbing harmful alcohol consumption the authors recommend using price to restrict access to alcohol, among other actions.

The Science Media Centre collected the following expert commentary on the dependent drinkers survey.

Prof Jennie Connor, Chair in Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, comments:

“This study does not provide any evidence of the effectiveness of minimum pricing as a strategy to reduce harm from alcohol. There is already evidence of effectiveness of minimum pricing in the Canadian setting as described in Prof Stockwell’s editorial, and there are also modelling studies using UK data that suggest those with the most harmful patterns of drinking would receive the most health benefit from such a pricing intervention.

“Some opposition to minimum unit pricing as a policy cites hypothetical effects on dependent drinkers.  This often involves vilifying dependent drinkers and asserting that they will lie, cheat and steal to get alcohol when their drinking becomes unaffordable rather than reduce drinking or seek treatment, even though many addicted smokers do reduce or stop when prices of cigarettes go up.

“The importance of this paper is  that it consults the very people who will be most affected by minimum pricing and is reasonably reassuring that they will not be unduly harmed or turned into criminals if such a policy was introduced. The health benefits from reducing drinking in this group, and from reducing affordability of alcohol to the youngest drinkers, would be substantial.  There would also be savings to the healthcare system and other public services.

“I don’t think we need more research into minimum pricing before introducing it. When we introduce minimum pricing we need to be cognisant of the needs of dependent drinkers and provide appropriate support. We also need formally evaluate the impact of the policy change. Although existing research suggests it is likely to have a positive impact on health and save public money, we need to measure the impact to inform policy here and internationally. If the doubters are right and it is not effective in the medium term then it could be reconsidered in the light of that evidence.”

Prof Nick Wilson, Department of Public Health, University of Otago, Wellington, comments:

“This new study adds to the existing international body of scientific evidence, particularly from Canada, that minimum pricing of alcohol is likely to reduce alcohol-related harm and have minimal risks. Particular benefits of this study are that the data is New Zealand relevant and it provides information on the most dependent drinkers. Even so, the study is relatively small, involves self-reports, and does not consider the much larger group of heavy drinkers who are not as extreme in their drinking as the group studied here who used addiction treatment services.

“The advantage of minimum prices over higher alcohol tax is that it may be more politically achievable than higher alcohol taxes – given the more targeted approach towards those heaviest drinkers who are associated with the most harm to themselves and others. But from a public health perspective it might be better to just have higher alcohol taxes – so that there is greater health and social benefits gained among a much wider population of drinkers and those they harm. In this case the political acceptability could be increased by raising alcohol taxes at the same time as lowering income taxes – in a tax revenue neutral policy package.”

Dr Eric Crampton, Head of Research, the New Zealand Initiative, comments:

“Minimum alcohol pricing has the potential to mitigate harms from heavy drinking at lower cost than across-the-board excise increases. However, we need to be cautious about the potential effects.

“The Falkner et al study surveys heavy drinkers to ask them what they might do were they faced with higher alcohol prices. Thirty percent of those drinkers who have previously faced situations in which they could not afford alcohol reported having turned to illicit or prescription drugs when they could not afford alcohol; the authors note this may be an underestimate since their survey excluded drinkers who had reported co-morbid drug use. Pricing heavy alcohol users out of alcohol, for some users, will result in shifting to other substances. Net effects on harms are then less clear.

Byrnes et al (2013), in Australian data, reported that heavy drinkers did respond to price hikes by curbing consumption, but that they did so by cutting back consumption on their lower drinking days. Heavy drinking was not affected. This will have health benefits, but smaller benefits than you might expect if you had expected that drinking on heavy drinking days would be as strongly affected. In this case, the health benefits of minimum alcohol prices may be overestimated if heavy drinkers respond to price increases by saving up to maintain binge days.

“Minimum alcohol pricing at $1 per unit would require that, for example, no standard bottle of wine be priced at less than $8 to $9 dollars. While this would affect heavier drinkers who may otherwise downshift in quality in response to excise changes, it would also affect lower income moderate drinkers. Benefits in reducing harmful drinking among harmful drinkers need be weighed against the costs imposed on moderate lower income drinkers – and especially where moderate drinkers are far more responsive to price hikes than are heavier drinkers (Wagenaar et al, 2009). We also need to note that while the survey asked heavy drinkers, who were predominantly lower income, how much they paid on average per standard drink, the survey did not ask moderate or light drinkers of lower income what they pay for their preferred product.

“While survey respondents indicated that they had not turned to informal alcohol supply, or home brewing, in response to previous instances of not being able to afford alcohol, sustained alcohol unaffordability might induce different behavioural responses. For example, one person setting up a distillation unit could easily informally supply neighbours at far less cost than either minimum prices or current alcohol cost. When alcohol prices are high enough, the investment in distillation kit, or even simpler fermentation, can become worthwhile. Were minimum pricing implemented, the government might wish to undertake better tracking of informal alcohol supply.”

“Policy in this area needs to weigh carefully the potential benefits of some drinking reduction among heavy drinkers against the harms imposed on poorer lighter drinkers.”

Declared interests: The Initiative is a member-funded think tank. Its members include many of New Zealand’s leading corporations, including one in the alcohol industry and a retail grocery chain. While in the Department of Economics and Finance at the University of Canterbury, Dr Cramptonswork was partially funded by the Brewers Association of Australia and New Zealand. He maintains his academic independence. He also is a moderate consumer of alcohol.