Appeals and Alcohol – Can We Be Persuaded to Drink Less?

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.


Alex

Yes, what we need is more social engineering through manipulation of the free market.

/sarcasm off

Wonks Anonymous

In my experience drinking is largely self-limiting. After a few overdoses most people learn to anticipate the impact of overindulgence and limit their intake to sensible amounts.

Then there are the folks like me who never did get the knack of drinking. When we are lucky we learn to avoid it entirely and find other amusements.

If we do not, no amount of persuasion will reach us.

Coop DeVille

What of higher alcohol taxes?

Greg Macfarlane

I don't drink, so I don't really understand the pull of alcohol anyways.

That said, it seems there are two behaviors that contribute to drunk driving: being drunk and driving. Americans drink, and Americans tend to live in a way that single-occupancy vehicle driving is the only way to get from A to B. We already tried prohibition, which didn't work.

What if we spent some alcohol tax and public education money on transit services? That way drunks may still be able to get home without killing anyone.

karen

I don't believe brakes have been slammed hard enough. Drinking impairs driving severely-especially if you go way overboard.Then you have an accident-injure someone for life and who has to suffer thru it? The victims family. Is it fair to them-they didn't put that bottle in front of you. You did!!
Just remember no amount of money is going to replace the life that was lost or maimed. Everyone remembers the victims as they were,then they have to look at what you did to them for the rest of their lives. So it is not just you are in a cell- it's also the victims family and the victim. Think about it- would you want yours to suffer this way? Just remember you can get out of your cell, they can't it's a life sentence!!!

brent

". . . 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)."

". . . one form of persuasion has proven to be effective in controlled trials: health provider intervention."

The above two quotes seem to indicate that success may be tied to linking an undesired behavior to negative effects on one's own health.

The problem is that drinking to excess, and making you a danger to others, is not necessarily unhealthy. Risky certainly, and possibly life threatening; but to be unhealthful, one must drink excessively over time.

The bottom line is how does the behavior affect oneself? People consider drinking to be a lot of fun; and each drinking event to be relatively harmless to their health. Until that changes, people will continue to think of themselves first, potentially putting others in harm's way.

Read more...

Matt

The reason that none of these things work is because drinking isn't about economics. It's all about culture. Tinkering around the edges won't do any good, because as long as something as destructive as alcohol remains central to socializing in our culture, we will always pay some price. Attempts to mitigate the negative side-effects are to be commended, but I will always be skeptical about the expectations.

ak

Maybe more whining would work.

Laura

Financial incentives make me drink less. I added up what I spent in March on booze and booze-related activities and Whoa. Big money!

I really want to pay off some debt so I'm cutting into my booze allowance to do so. Hopefully I can shed a few pounds along the way.

Once I've paid off the debt I'l undoubtedly go on a bender, so maybe these results aren't actually long-term.

Morrow

Have good studies been done on the effectiveness of a punitive approach? If we cannot increase the fraction of drunk drivers apprehended, can increasing the penalties for the ones who *are* caught change behavior? I ask because Finland's rather draconian drunk-driving laws have been mentioned here and elsewhere, but not in context of whether it works better for them than for us.

Richard

Very interesting I'll read all the links. Was about to blog on this topic myself but will just tweet your post. Two things: Parents - I wonder if it is not so much the relationship but what the parents do with their own drinking - i.e. setting the benchmark! Wrong message - It's not if drunks kill/maime themselves it's the innocents whose lives and families they destroy. The problem though is how to get that through.

Shirley

Is alcoholism really a sickness or is it simply a "bad" lifestyle choice? Can one inherit it? Is it a self-destructive bent in an otherwise reasonable and very intelligent person? Where do you go from "just say no".??

Shirley

malthus

All nonsense.

In vast areas of the world, water and sex are the big killers, and if the folks there had free beer, there would be many fewer deaths from cholera and all the other serious water-borne diseases.

The prohibitionists here are not really humanitarians--they are knee-jerk fundamentalists who take great delight in forcing their silly morals on all others.

The closest thing to a solution to drunk-driving is to provide better public transportation. When we were young and drank heavily in Munich, we never even had a car for five years. We could either walk or travel efficiently by bus, streetcar, U-bahn or S-bahn for a cold beer or some wine. Kids had the right to drink beer and wine starting at age 14.

Trouble is, a drunk pedestrian's getting hit by a sober Baptist is counted by Mad Mothers (and the OP here) as an "alcohol-related" accident, and, as has been pointed out right here on Freakonomics, a drunk is safer driving home than walking!

It'll be a cold dry day in hell that I cooperate with a society that continues taking my money to build ever more roads that keep me from walking to my favorite bar. City planners here could learn a lot from Jamie Lerner of Curitiba, PR Brazil.

Read more...

Christopher Strom

There is probably some percentage of drunk drivers that could potentially be affected by further training (e.g. school-based education and public awareness campaigns). Such offenders would be non-repeat offenders, either "learning their lesson" in the classroom or as a result of a drunk driving event.

However, I think it likely that the majority of drunk driving offenses are not randomly distributed throughout the population, but are concentrated in a narrow segment of the population. Such habitual offenders are unlikely to be affected by additional training, but would be more likely to respond to individual interventions and legal enforcement.

If this is correct, then an evaluation of anti-drunk-driving programs should find little (if any) success in broad educational or awareness programs - due to the low incidence of drunk driving in the general population - and more success in programs that target known offenders.

Read more...

charlie

i recently underwent a residential treatment for alcoholism, for which the success rates (nationally in the uk) was something around 1%. (I have tried to verify this - the closest I could find was "4-26%", in a somewhat related study)

To my mind, there is an underlying issue: if people really want to drink they will.

Good luck trying to solve that through pamphlets...

Brent

I have to agree with Malthus on this. It seems that, typically, people will believe themselves to be above the norm - i.e. that while perhaps someone else might be unable to handle themselves while drunk, they will have no problems. What this means is that informing people of the negative consequences, unless they can basically be conditioned to think in a specific way (I'm thinking along the lines of Burgess' "A Clockwork Orange" here), will likely not have a substantial effect. If someone firmly believes that they will not cause any problems, then why would they be moved by hearing about the consequences that would result from such problems?

On that note, then, I agree that the most effective way to deal with drunk-driving is to eliminate the driving, rather than the drunk. Whether it be public transit, some kind of subsidized taxi program (or perhaps a taxi fee paid upon entering the bar, which may also lead to limiting drinking), etc, there need be some options available that aren't overly expensive or time consuming (which I would guess is likely why people drive, as the typical bus trip is much longer than the car trip, and taxis are quite expensive).

On a total aside, I just finished the book, and I'm glad I found this blog - it seems quite an interesting read.

Read more...

Justin James

Please spend an hour or two researching alcholism, drug addition, etc. It is clear that you know little to nothing about alcoholics and drug addicts, because if you did, you would know that no amount of persuasion can get them to stop. Sure, some of the drunk driver accidents are caused by casual drinkers. But use those powers of statistics to figure out who is more likely to get into a car accident... the 80% of the population who are casual drinkers, and might drive while over the legal limit once or twice a year (and usually, just barely over the limit), or the 10% of the population who are classified as alcoholics and may drive drunk (usually well over the legal limit) a few times a week?

Go ask an alcholic or a drug addict who got drunk or high the day they left jail or prison for an alcohol or drug related offense why they did it, and they'll have no really good answer. Ask them what would have made them not do it, and if they are honest, they'll tell you "nothing".

Until you learn about the underlying reasons why people drink and do drugs, you will never be able to discuss this topic with any kind of authority.

J.Ja

Read more...

33-year Friend of Bill W.

Several people voice some of the same opinion I have. I came to the end of my drinking at age 29. Nothing as far as I know would have changed it much, and Zeus knows I tried everything.

Three points:

1) Most people I know in 12-step programs are fine with legalizing drugs; the fact that many drugs are illegal makes the whole business an adventure. Even for alcohol, restrictions don't lead to any good outcome.

2) Sorry, but studies on the effectiveness of alcohol control or alcoholism treatment programs are at best, wild speculation. Let's see:

a) (Q) What percentage of people stay sober after first getting sober in AA? (A) Almost zero.
b) (Q) What percentage of people who get 30-days sober in AA make it to 10-years sober? (A) Less than 15%.
c) (Q) What percentage of AA members stay sober for the rest of their lives. (A) Much less than 10%
d) (Q) What kills most AA members? (A) Cigarettes.
e) (Q) Is this just guessing? (A) Yes, AA keeps no membership records or statistics, so these are just anecdotal observations.
f) (Q) What is the most successful alcoholism treatment program that has saved the lives of many millions and spawned dozens of similar programs? (A) AA of course.

AA is so good in fact, (despite the above biased stats) that many expensive "therapists" will claim that they "cured" you if they finally get you to go (for free) to AA.

3) You won't find any support for prohibition among AA members. Now, don't you find that remarkable?

(Side Economic Note: Travel expenses for going to AA meetings or donations to AA are entirely tax deductible WITHOUT receipts...!)

Read more...

LP

If you don't drive to drink, you won't drink and drive. This message is part of an ongoing campaign in Singapore to address drunk driving. It's a simple solution, I don't know how effective it's been so far and I don't know if it would work in the US, but I like it's simplicity.

Jack F

Who actually believes that serious drinking is fun?