Harm to others from alcohol: A review & conceptual analysis of the second-hand effects of alcohol

Rationale and Goal: There is evidence that inappropriate or high-risk use of alcohol creates a substantial burden to communities, regions and countries, with negative impacts in social areas, trauma and chronic disease. In order to address these pressing issues, novel policy responses are necessary. This presentation will examine the dominant concepts, main evidence to date, and risks and challenges of drawing attention to societal level damage from alcohol.

Methods: A systematic analysis of research and commentaries was conducted, including studies based on recent general population surveys and archival data in Australia, Canada, New Zealand, the UK and US. For comparative purposes, recent literature on the impact to others related to smoking and obesity was examined.

Results: Several overlapping concepts are evident: harm to others from alcohol, second-hand effects of alcohol, collateral damage from alcohol and externalities. Of approximately 35 studies examined, there was a wide range in the prevalence of negative effects to others reported (10-73%). Heavier drinkers are more likely to experience harm from other drinkers compared to light drinkers /abstainers. Differences in reported prevalence by gender were minor but substantial differences in type of harm were present. There is evidence of increased externalities with higher drinking level of perpetrator, and variation in prevalence by beverage type.

Implications: A combination of qualitative approaches – using personal stories to illustrate harm, and quantitative methods--including economic impact analysis, is recommended. Ongoing challenges include: choosing the conceptual terminology that will facilitate clarity, and promoting an effective policy response without victimizing the drinker.