Minimising harm from alcohol misuse: Challenges to the development of effective policy

Successive substance misuse strategies in Northern Ireland and elsewhere have <br/>been underpinned by the goal of minimising the harm accruing from the use of alcohol and other drugs. However, what it means for a person’s alcohol use to cause harm is an evolving concept. As the understanding of harm changes, the type of evidence needed to estimate the scale of harm and to evaluate the success of a given initiative changes also.<br/>This paper does three things. We first highlight a recent model by Laslett and <br/>colleagues for estimating the harm of one individual’s alcohol use to other individuals, the centrepiece of a report to the Alcohol Education and Research Foundation (AERF) in 2010. This model has been hugely influential in identifying areas where harms from alcohol use accrue and in attempting to quantify those harms (e.g. the cost of injuries inflicted during intoxication). We suggest three ways in which this model could be improved by accounting for: (a) the influence of one individual’s drinking on the drinking behaviour of their peers; (b) the level of use which triggers a given harm; and (c) the degree of time-lag in each of <br/>the domains of harm.<br/>Secondly, we explore specific challenges to developing effective policy on <br/>adolescents’ drinking behaviours, drawing on research which specifically elicits the perspectives of young people on why they drink.<br/>Thirdly, we examine the relative harms of allowing moderate levels of drinking <br/>among mid-adolescents versus promoting zero use up until late adolescence.