Alcohol was the world’s 7th leading cause of healthy life years lost in 2016 and is the leading cause of hospitalization in France. © adobe stock

Alcohol consumption is both directly and indirectly implicated in the onset of some 60 diseases, making it a major health risk factor. In France, around 43 million people consume alcohol. Faced with its inherent health, social and financial impacts, the country’s Health Directorate and Interdepartmental Mission to Combat Drugs and Addictive Behavior asked Inserm to take stock of the harm related to alcohol and formulate research avenues and measures to tackle it. The group of experts gathered by Inserm for the collective expert review procedure has published a report concerning the reduction of alcohol-related harm. It discusses social prevention strategies and uses data taken from the scientific literature available in the first half of the year 2020.

The collective expert review coordinated by Inserm began by making a critical analysis of the latest scientific knowledge in the field and establishing findings. The expert group then made recommendations aimed at reducing the risks and harm to health associated with alcohol consumption. Around 3,600 documents were collected from a variety of disciplines, such as clinical research, social marketing and sociology.

Alcohol consumption, leading cause of hospitalization in France

In France, high levels of consumption affect both teenagers and adults. Alcohol consumption in adolescence becomes regular (10 or more times per month) for 8% of 17-year-olds, while 40-50% report binge-drinking (5 or more drinks on one occasion) at least once a month. Among adults, the average daily intake is 27 g of pure alcohol per person (around 3 glasses).

Alcohol was the 7th leading cause of healthy life years lost worldwide in 2016 and is also the leading cause of hospitalization in France. Alcohol accounts for 11% of deaths of men and 4% of those of women from the age of 15, namely 41,000 deaths (30,000 for men and 11,000 for women according to the latest figures from 2015), making them the highest of any European country.

The expert review emphasizes that the price of alcohol, its availability and the norms relating to its consumption are associated with positive perceptions, encouraging its use. It shows that, in addition to individual factors, the marketing of alcohol (product, price, advertising, access) influences the modes and levels of consumption and plays a key role in young people’s drinking behavior. Alcohol producers are particularly present on the Internet and social media, where there is very little regulation of advertising.

The recommendations made by the experts address the issues of the law governing the sale of alcohol and the regulation of that sale, as well as communication and interventions to be considered.

For the tightening of the Évin law on the regulation of advertising and the control of the sale of alcohol

In France, the 1991 Évin law provides a framework to combat alcohol (and tobacco) related harm, but the experts note that not only is its current version not always respected, it has also been considerably modified and weakened by the lobbying of alcohol producers.

The expert group particularly recommends reducing the attractiveness of alcohol and the positive messages disseminated, and limiting its access, namely by:

• reinforcing the Évin law to prohibit advertising on the Internet, in public spaces, and to counter the effects of marketing by making health warnings more visible.
• increasing prices (taxation according to the number of grams of alcohol along the lines of the soda tax, or minimum price as in Scotland) – wine, for example, is subject to very little tax.
• better and automatic control of its access by minors.
• reducing its availability (times during which it can be sold and number of stores or licenses).

For reinforced communication by the authorities and health education for the general public

The expert group recommends the use of prevention messages aimed at the general population that are clear, specific and easy to implement and that are designed to be disseminated by digital means. These messages must also be adapted when aimed at the most vulnerable groups.

According to the collective expert review, the following must be reiterated:

• the recommended maximum intake for those wishing to drink[2],
• the need for zero alcohol, especially during pregnancy and the period before conception,
• that women are biologically more vulnerable to the damaging effects of alcohol.

The expert review highlights that a priority issue when it comes to prevention is reinforcing:

• protection factors while people are still very young. Interventions to target the prevention of consumption and strengthen users’ knowledge and “competence” should be developed, particularly through the use of digital means.
• generic protection factors such as parenting competence and psychosocial competence: such interventions are effective in schools, with parents or families, and in the workplace.
• health warnings and encouraging campaigns to stop drinking, such as “Dry January”, whose benefits (and low cost) have been proven.

For interventions to improve and adapt diagnosis and care

The experts suggest that these preventive actions should be supplemented by a strategy of systematic screening for high-risk alcohol consumption in order to enable appropriate care. The report suggests that primary care professionals should be better trained in screening strategies and effective intervention methods.

As such, the expert group recommends:

• “short interventions” by trained staff, consisting of minimal personalized counseling, aimed at people whose use puts them at risk or who are experiencing difficulties with their consumption. Such interventions are often beneficially associated with screening and have a clearly established positive cost-effectiveness ratio. They can be used on electronic media adapted for community interventions (schools, armed forces, etc.).
• strengthening the quality of the long-term follow-up of alcohol-dependent patients to avoid relapse, promoting effective therapeutic strategies (psychotherapy, medication, cognitive remediation, social rehabilitation, and the management of comorbidities).

The collective expert review concludes by stating that the major health, social and financial consequences of alcohol consumption, even at low levels, represent a burden for French society without the resources assigned to combat them being equal to the challenge. It should be possible for the measures recommended in this expert review, which are intended for the general public and public authorities, to be integrated at the heart of a policy of risk and harm reduction based on reduced consumption.

[1] By establishing a link between genetic variations associated specifically with a given biological trait and by measuring their effects on the risk of disease, Mendelian randomization makes it possible to establish a causal relationship between biological traits and risk of disease.

[2] Santé Publique France (French Public Health Agency): no more than 2 drinks per day and not every day

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