Economists are often accused of being a dour lot, whose grubby focus on molding behavior with? carrots and sticks ignores what is noble in the human spirit: higher cognition, altruism and innate goodness. Does the fight against alcohol abuse, particularly drunk driving, show that man can be reasoned with, or does economics – aka the “dismal science” — offer a better guide to human nature?
A huge number of studies from around the world have looked at the effectiveness of alcohol control measures. Peter Anderson, Dan Chisholm, and Daniela C. Fuhr have done a nice summary very recently in the medical journal The Lancet. Over the next couple of pieces, I’ll fill you in on what they report. This time, I’ll look at whether it is possible to persuade people to drink responsibly.
Strategy one: can we reach potential DUI candidates when they’re young? Unfortunately, the evidence on teaching sobriety in the classroom is not too encouraging. A large body of research has shown that the vast majority of programs have largely been ineffective. L. Jones and colleagues found that only six of 52 high-quality programs have been able to show results.
Moreover, those results tend to fade over time. For example, one of the success stories – the School Health and Harm Prevention Program – managed to reduce dangerous drinking an impressive 25.7 percent in the short haul, but only 4.2 percent 32 months later (see this from N. McBride and colleagues). Because of this, the program is not particularly cost-effective, with a cost of over $2500 for each case of hazardous drinking averted at 32 months.
If teachers can’t get the job done, can “Smart Mom?” The good news on alcohol-related parenting programs – which are designed to foster parent/child communication or otherwise improve parenting skills through discussions, videos, coaching, internet programs, etc. – is that the evidence on them is brighter. The bad news is that it’s not much brighter. Only six of 14 studies on parenting programs reviewed by J. Petrie, F. Bunn and G. Byrne come up with statistically significant evidence that they have any effect on future drinking.
As M. Stead, R. Gordon, K. Angus, and L. McDermott report, evidence on the effectiveness of social marketing campaigns (which borrow tactics from the private sector like market research and messages designed for the target audience) is also mixed; only about half of the programs they analyzed showed any effect.
Public information campaigns (e.g. advertising about the dangers of alcohol) can focus our minds on the problem but probably don’t have much effect on actual drinking, or so the limited evidence thus far indicates.
C. Wilkinson and R. Room have found that warning labels on alcohol may perhaps make us feel a little guilt, but have little if any effect on actual alcohol consumption (though they do seem to work for cigarettes).
If more persuasion to not drink isn’t too effective, what about less persuasion to drink? It seems self-evident that less alcohol advertising, sports sponsorships, etc. would lead to more sobriety, but here again the evidence is not overwhelming. The bulk of the literature,? as reviewed by C. Gallet, shows a surprisingly weak link between alcohol advertising and consumption, though some studies, particularly those that track subjects over time, have shown that less advertising does work, particularly for the young (see this from P. Anderson, A. de Bruijn, K. Angus, R. Gordon, and Gerard Hastings).
However, we are unlikely to see less advertising, particularly if we wait for the alcohol industry to take the lead; self-regulation initiatives have not led to results in the past. Ironically, responsible drinking education programs produced by the alcohol industry have been shown to sometimes have the exact opposite of the (presumably) intended effect: they actually promote positive views about alcohol and its makers.
Workplace policies like interventions have been poorly studied; though G. Webb, A. Shakeshaft, R. Sanson-Fisher and A. Havard find in their review that such techniques have “potential,” there is as yet little reliable evidence that they work.
As E.F.S. Kaner and colleagues report, one form of persuasion has proven to be effective in controlled trials: health provider intervention. In this method, doctors, nurses or psychologists screen patients and identify those who have unhealthy levels of alcohol consumption. Then the medical professionals provide information on alcohol dependence and aid in formulating a plan to cut back. The problem with this method is that it is time-consuming and costly, and does not reach, or work for, all drinkers.
It is much harder to prove that something doesn’t exist than to prove that it does exist, and it is quite possible that there are some persuasion programs out there that might be a silver bullet. Perhaps the fact that half of the programs in some of these studies had an effect is good news, not bad: we can now build on these strategies.
On the other hand, it should be noted that even in cases where statistically significant results can be shown, the actual magnitude of the effects can still be disappointingly small, as in the School Health and Harm Prevention Program cited above.
In all, we’d definitely like to see more conclusive evidence that these methods work, and thus far we don’t quite have it. My two cents is that part of the fun of drinking is knowing that you’re doing something rebellious and vaguely anti-social, and thus societal exhortations to not do it in a way only add to the perverse thrill.
Time to get the dusty old stick and carrot out of the closet? More on this next time.