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Background: Organising alcohol retail systems with more or less public ownership has implications for health and the economy. The aim of the present study was to estimate the economic, health, and social impacts of alcohol use in Finland in 2018 (baseline), and in two alternative scenarios in which current partial public ownership of alcohol retail sales is either increased or fully privatised. Methods: Baseline alcohol-attributable harms and costs were estimated across five categories of death, disability, and criminal justice. Two alternate alcohol retail systems were defined as privately owned stores selling: (1) only low strength alcoholic beverages (public ownership scenario, similar to Sweden); or (2) all beverages (private ownership scenario). Policy analyses were conducted to estimate changes in alcohol use per capita. Health and economic impacts were modelled using administrative data and epidemiological modelling. Results: In Finland in 2018, alcohol use was estimated to be responsible for €1.51 billion (95% Uncertainty Estimates: €1.43 billion, €1.58 billion) in social cost, 3,846 deaths, and 270,652 criminal justice events. In the public ownership scenario, it was estimated that alcohol use would decline by 15.8% (11.8%, 19.7%) and social cost by €384.3 million (€189.5 million, €559.2 million). Full privatisation was associated with an increase in alcohol use of 9.0% (6.2%, 11.8%) and an increase in social cost of €289.7 million (€140.8 million, €439.5 million). Conclusion: The outcome from applying a novel analytical approach suggests that more public ownership of the alcohol retail system may lead to significant decreases in alcohol-caused death, disability, crime, and social costs. Conversely, full privatisation of the ownership model would lead to increased harm and costs.

OBJECTIVE: Self-reported alcohol consumption in U.S. public health surveys covers only 30%–60% of per capita alcohol sales, based on tax and shipment data. To estimate alcohol-attributable harms using alcohol-attributable fractions, accurate measures of total population consumption and the distribution of this drinking are needed. This study compared methodological approaches of adjusting self-reported survey data on alcohol consumption to better reflect sales and assessed the impact of these adjustments on the distribution of average daily consumption (ADC) levels and the number of alcohol-attributable deaths. METHOD: Prevalence estimates of ADC levels (i.e., low, medium, and high) among U.S. adults who responded to the 2011–2015 Behavioral Risk Factor Surveillance System (BRFSS; N = 2,198,089) were estimated using six methods. BRFSS ADC estimates were adjusted using the National Alcohol Survey, per capita alcohol sales data (from the Alcohol Epidemiologic Data System), or both. Prevalence estimates for the six methods were used to estimate average annual alcohol-attributable deaths, using a population-attributable fraction approach. RESULTS: Self-reported ADC in the BRFSS accounted for 31.3% coverage of per capita alcohol sales without adjustments, 36.1% using indexed-BRFSS data, and 44.3% with National Alcohol Survey adjustments. Per capita sales adjustments decreased low ADC prevalence estimates and increased medium and high ADC prevalence estimates. Estimated alcohol-attributable deaths ranged from approximately 91,200 per year (BRFSS unadjusted; Method 1) to 125,200 per year (100% of per capita sales adjustment; Method 6). CONCLUSIONS: Adjusting ADC to reflect total U.S. alcohol consumption (e.g., adjusting to 73% of per capita sales) has implications for assessing the impact of excessive drinking on health outcomes, including alcohol-attributable death estimates.

ImportanceAlcohol consumption is a leading preventable cause of death in the US, and death rates from fully alcohol-attributable causes (eg, alcoholic liver disease) have increased in the past decade, including among adults aged 20 to 64 years. However, a comprehensive assessment of alcohol-attributable deaths among this population, including from partially alcohol-attributable causes, is lacking.ObjectiveTo estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults aged 20 to 64 years overall; by sex, age group, and state; and as a proportion of total deaths.Design, Setting, and ParticipantsThis population-based cross-sectional study of mean annual alcohol-attributable deaths among US residents between January 1, 2015, and December 31, 2019, used population-attributable fractions. Data were analyzed from January 6, 2021, to May 2, 2022.ExposuresMean daily alcohol consumption among the 2 089 287 respondents to the 2015-2019 Behavioral Risk Factor Surveillance System was adjusted using national per capita alcohol sales to correct for underreporting. Adjusted mean daily alcohol consumption prevalence estimates were applied to relative risks to generate alcohol-attributable fractions for chronic partially alcohol-attributable conditions. Alcohol-attributable fractions based on blood alcohol concentrations were used to assess acute partially alcohol-attributable deaths.Main Outcomes and MeasuresAlcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application. Mortality data were from the National Vital Statistics System.ResultsDuring the 2015-2019 study period, of 694 660 mean deaths per year among adults aged 20 to 64 years (men: 432 575 [66.3%]; women: 262 085 [37.7%]), an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption. This percentage was higher among men (15.0%) than women (9.4%). By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico. Among adults aged 20 to 49 years, alcohol-attributable deaths (44 981 mean annual deaths) accounted for an estimated 20.3% of total deaths.Conclusions And RelevanceThe findings of this cross-sectional study suggest that an estimated 1 in 8 total deaths among US adults aged 20 to 64 years were attributable to excessive alcohol use, including 1 in 5 deaths among adults aged 20 to 49 years. The number of premature deaths could be reduced with increased implementation of evidenced-based, population-level alcohol policies, such as increasing alcohol taxes or regulating alcohol outlet density.

Introduction Les distillateurs et les brasseurs canadiens ont affirmé que les taxes gouvernementales représentent entre 50 % et 80 % du prix des boissons alcoolisées. Ces affirmations ont été formulées dans le cadre de campagnes visant à réduire les taxes sur l’alcool. Méthodologie Nous avons examiné le bien­fondé de ces affirmations au moyen des données de Santé Canada accessibles au public ainsi que des données provinciales sur les ventes par produit et la ventilation des prix des boissons alcoolisées types dans les principaux secteurs de marché. Résultats Dans tous les cas, les taux de taxe de vente totale et de taxe d’accise se situent généralement entre 20 % et 30 % du prix de détail final, soit bien en deçà de ce qu’avancent les représentants de l’industrie.

INTRODUCTION: Alcohol is a leading contributor to liver disease, however, estimating the proportion of liver disease deaths attributable to alcohol use can be methodologically challenging. METHODS: We compared three approaches for estimating alcohol-attributable liver disease deaths (AALDD), using the U.S. as an example. One involved summing deaths from alcoholic liver disease and a proportion from unspecified cirrhosis (direct method); two used population attributable fraction (PAF) methodology, including one that adjusted for per capita alcohol sales. For PAFs, the 2011–2015 Behavioral Risk Factor Surveillance System and per capita sales from the Alcohol Epidemiologic Data System were used to derive alcohol consumption prevalence estimates at various levels (excessive alcohol use was defined by medium and high consumption levels). Prevalence estimates were used with relative risks from two meta-analyses, and PAFs were applied to the 2011–2015 average annual number of deaths from alcoholic cirrhosis and unspecified cirrhosis (using National Vital Statistics System data) to estimate AALDD. RESULTS: The number of AALDD was higher using the direct method (28,345 annually) than the PAF methods, but similar when alcohol prevalence was adjusted using per capita sales and all alcohol consumption levels were considered (e.g., 25,145 AALDD). Using the PAF method, disaggregating non-drinkers into lifetime abstainers and former drinkers to incorporate relative risks for former drinkers yielded higher AALDD estimates (e.g., 27,686) than methods with all non-drinkers combined. DISCUSSION AND CONCLUSIONS: Using PAF methods that adjust for per capita sales and model risks for former drinkers yield more complete and possibly more valid AALDD estimates.

Introduction Estimates of alcohol consumption in the Behavioral Risk Factor Surveillance System are generally lower than those in other surveys of U.S. adults. This study compares the estimates of adults’ drinking patterns and the distribution of drinks consumed by average daily alcohol consumption from 2 nationwide telephone surveys. Methods The 2014–2015 National Alcohol Survey (n=7,067) and the 2015 Behavioral Risk Factor Surveillance System (n=408,069) were used to assess alcohol consumption among adults (≥18 years), analyzed in 2019. The weighted prevalence of binge-level drinking and the distribution of drinks consumed by average daily alcohol consumption (low, medium, high) were assessed for the previous 12 months using the National Alcohol Survey and the previous 30 days using the Behavioral Risk Factor Surveillance System, stratified by respondents’ characteristics. Results The prevalence of binge-level drinking in a day was 26.1% for the National Alcohol Survey; the binge drinking prevalence was 17.4% for the Behavioral Risk Factor Surveillance System. The prevalence of high average daily alcohol consumption among current drinkers was 8.2% for the National Alcohol Survey, accounting for 51.0% of total drinks consumed, and 3.3% for the Behavioral Risk Factor Surveillance System, accounting for 27.7% of total drinks consumed. Conclusions National Alcohol Survey yearly prevalence estimates of binge-level drinking in a day and high average daily consumption were consistently greater than Behavioral Risk Factor Surveillance System monthly binge drinking and high average daily consumption prevalence estimates. When planning and evaluating prevention strategies, the impact of different survey designs and methods on estimates of excessive drinking and related harms is important to consider.

Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 93,296 alcohol-attributable deaths (255 deaths per day) and 2.7 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (54.7%) were caused by chronic conditions, and 52,361 (56.0%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.3 in New Jersey and New York to 52.3 in New Mexico. YPLL per 100,000 population ranged from 613.8 in New York to 1,651.7 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.†.

Introduction En 2017, le Canada a augmenté les taxes d’accise sur l’alcool pour la première fois depuis plus de 30 ans. Dans cet article, nous offrons un modèle permettant d’estimer les divers effets de politiques augmentant les taxes et les prix dans le but d’améliorer les résultats en matière de santé. Méthodologie Nous avons obtenu de Statistique Canada les données 2016­2017 sur les ventes de boissons alcoolisées et leur taxation dans l’ensemble des provinces et des territoires au Canada, ainsi que les données sur les ventes par produit en ColombieBritannique. Nous avons modélisé les effets de diverses politiques fiscales et d’établissement des prix ‒ taxes sans incidence sur les recettes gouvernementales, taxes corrigées en fonction de l’inflation et d’un prix unitaire minimum (PUM) ‒ sur la consommation, les revenus et les méfaits. Nous avons utilisé les élasticités de prix publiées pour estimer les effets sur la consommation et les revenus, et le modèle international en matière de méfaits et de politiques liés à l’alcool (InterMAHP) pour estimer les effets sur la mortalité et la morbidité attribuables à l’alcool. Résultats Toutes choses égales par ailleurs, les taxes volumétriques sur l’alcool (TVA) sans incidence sur les recettes gouvernementales auraient eu une influence minime sur la consommation globale d’alcool et les méfaits qui y sont liés. Les TVA corrigées en fonction de l’inflation auraient entraîné une baisse de 3,83 % de la consommation, ce qui se serait accompagné d’une réduction du nombre des décès de 329 et une diminution du nombre d’admissions à l’hôpital de 3762. En 2016, un prix unitaire minimum de 1,75 $ par verre standard (soit 17,05 ml d’éthanol) aurait permis de réduire la consommation de 8,68 %, ce qui aurait conduit à une diminution du nombre de décès de 732 et du nombre d’hospitalisations de 8 329. Indexer les taxes d’accise sur l’alcool entre 1991­ 1992 et 2016­2017 aurait fait gagner au gouvernement fédéral environ 10,97 milliards de dollars supplémentaires. Selon nos estimations, la situation aurait permis d’éviter entre 4000 et 5400 décès de plus et entre 43000 et 56000 hospitalisations supplémentaires. Conclusion L’amélioration des résultats en matière de santé publique aurait été possible grâce à (1) l’augmentation des taux de la taxe d’accise sur l’alcool pour toutes les boissons afin de compenser la non­indexation passée des taux et (2) la fixation d’un PUM d’au moins 1,75 $ par verre standard. La mise en œuvre de ces politiques permettrait aujourd’hui de réduire les méfaits dus à l’alcool tout en augmentant les recettes fédérales.

Introduction In 2017, Canada increased alcohol excise taxes for the first time in over three decades. In this article, we describe a model to estimate various effects of additional tax and price policies that are predicted to improve health outcomes. Methods We obtained alcohol sales and taxation data for 2016/17 for all Canadian jurisdictions from Statistics Canada and product-level sales data for British Columbia. We modelled effects of alternative price and tax policies - revenue-neutral taxes, inflation-adjusted taxes and minimum unit prices (MUPs) - on consumption, revenues and harms. We used published price elasticities to estimate impacts on consumption and revenue and the International Model for Alcohol Harms and Policies (InterMAHP) to estimate impacts on alcohol-attributable mortality and morbidity. Results Other things being equal, revenue-neutral alcohol volumetric taxes (AVT) would have minimal influence on overall alcohol consumption and related harms. Inflation-adjusted AVT would result in 3.83% less consumption, 329 fewer deaths and 3762 fewer hospital admissions. A MUP of $1.75 per standard drink (equal to 17.05mL ethanol) would have reduced consumption by 8.68% in 2016, which in turn would have reduced the number of deaths by 732 and the number of hospitalizations by 8329 that year. Indexing alcohol excise taxes between 1991/92 and 2016/17 would have resulted in the federal government gaining approximately $10.97 billion. We estimated this could have prevented 4000-5400 deaths and 43 000-56 000 hospitalizations. Conclusion Improved public health outcomes would be made possible by (1) increasing alcohol excise tax rates across all beverages to compensate for past failures to index rates, and (2) setting a MUP of at least $1.75 per standard drink. While reducing alcohol-caused harms, these tax policies would have the added benefit of increasing federal government revenues.

Ce numéro spécial sur les problèmes de consommation de substances paraît dans une période cruciale pour les responsables des politiques et pour les chercheurs canadiens en matière de santé. À l’heure actuelle, ce sont la crise des opioïdes et les répercussions possibles de la légalisation du cannabis qui retiennent le plus l’attention. Cependant, les substances les plus consommées et les plus nocives demeurent l’alcool et la nicotine. Les politiques visant à réduire les méfaits de ces substances ne suffisent pas : les politiques sur le contrôle de l’alcool sont progressivement abandonnées et on ne saisit pas les occasions de maximiser le potentiel de réduction des méfaits associé aux nouveaux dispositifs d’administration de nicotine plus sécuritaires. Plus généralement, il faut davantage cibler les stratégies de réduction des méfaits fondées sur l’expérience des personnes marginalisées ayant de graves problèmes de consommation de substances, de manière à ne pas aggraver les inégalités en matière de santé. Afin de mieux éclairer les interventions stratégiques, nous recommandons des approches novatrices de contrôle et de surveillance qui maximisent le recours à de multiples sources de données, comme celles utilisées dans le cadre du projet Coûts et méfaits de l’usage de substances au Canada (CEMUSC). Il faut également accorder une plus grande attention à la précision des définitions de ce qu’est une habitude de consommation à risque et un méfait, afin de favoriser l’adoption de politiques qui tiennent mieux compte des taux réels de méfaits liés à la consommation de substances dans la société canadienne et qui sont davantage capables de les contrer.

This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.Ce numéro spécial sur les problèmes de consommation de substances paraît dans une période cruciale pour les responsables des politiques et pour les chercheurs canadiens en matière de santé. À l’heure actuelle, ce sont la crise des opioïdes et les répercussions possibles de la légalisation du cannabis qui retiennent le plus l’attention. Cependant, les substances les plus consommées et les plus nocives demeurent l’alcool et la nicotine. Les politiques visant à réduire les méfaits de ces substances ne suffisent pas : les politiques sur le contrôle de l’alcool sont progressivement abandonnées et on ne saisit pas les occasions de maximiser le potentiel de réduction des méfaits associé aux nouveaux dispositifs d’administration de nicotine plus sécuritaires. Plus généralement, il faut davantage cibler les stratégies de réduction des méfaits fondées sur l’expérience des personnes marginalisées ayant de graves problèmes de consommation de substances, de manière à ne pas aggraver les inégalités en matière de santé. Afin de mieux éclairer les interventions stratégiques, nous recommandons des approches novatrices de contrôle et de surveillance qui maximisent le recours à de multiples sources de données, comme celles utilisées dans le cadre du projet Coûts et méfaits de l’usage de substances au Canada (CEMUSC). Il faut également accorder une plus grande attention à la précision des définitions de ce qu’est une habitude de consommation à risque et un méfait, afin de favoriser l’adoption de politiques qui tiennent mieux compte des taux réels de méfaits liés à la consommation de substances dans la société canadienne et qui sont davantage capables de les contrer.Substance use in Canada cost $46 billion in 2017, with the great majority of these costs resulting from the use of tobacco and alcohol. Substance use-related costs, harms and rates of use have been increasing in Canada over the past decades for both legal and illegal substances, including those for cannabis. Canadian policies to address our most harmful substances, i.e. alcohol, cannabis and tobacco, are largely failing, despite significant opportunities to improve policies on pricing, taxation and marketing of legal substances. Canada's monitoring and surveillance efforts can be improved by developing more discerning measures of risk and maximizing the use of multiple data sources.Au Canada, la consommation de substances a coûté 46 milliards de dollars en 2017, la grande majorité de ces coûts découlant du tabagisme et de la consommation d’alcool. Au Canada, les taux de consommation de substances ainsi que les coûts et les méfaits connexes ont augmenté au cours des dernières décennies, que ce soit pour les substances légales ou illégales, en particulier le cannabis. Les politiques canadiennes en matière de lutte contre la consommation des substances les plus nocives, soit l’alcool, le cannabis et le tabac, sont en grande partie inefficaces, malgré d’importantes possibilités d’amélioration en matière de tarification, de taxation et de commercialisation des substances légales. Il est possible d’améliorer les efforts de contrôle et de surveillance au Canada en élaborant des mesures de risque bien pensées et en maximisant l’utilisation de multiples sources de données.

Cet aperçu offre une comparaison entre les recettes publiques provenant de la vente et de la distribution d’alcool et les coûts pour la société associés à la consommation d’alcool, et ce, pour l’année 2014. Les données de Statistique Canada font état de recettes publiques de 10,9 milliards de dollars. Toutefois, ce montant est contrebalancé par des coûts nets pour la société de 14,6 milliards de dollars, comme le rapporte le projet Coûts et méfaits de l’usage de substances au Canada, un projet de surveillance nationale de la consommation de substances. Les coûts pour la société sont constitués des soins de santé, de la perte de productivité économique, de la justice pénale et de divers autres coûts directs. Bien que les recettes de vente d’alcool soient considérées comme un avantage pour les coffres de l’État, une comptabilisation tenant compte des coûts engagés montre que les provinces et les territoires du Canada subissent plutôt un déficit associé à l’alcool, pour un total de 3,7 milliards de dollars à l’échelle nationale.

Objective Many countries propose low-risk drinking guidelines (LRDGs) to mitigate alcohol-related harms. North American LRDGs are high by international standards. We applied the International Model of Alcohol Harms and Policies (InterMAHP) to quantify the alcohol-caused harms experienced by those drinking within and above these guidelines. We customized a recent Global Burden of Disease (GBD) analysis to inform guidelines in high-income countries. Method Record-level death and hospital stay data for Canada were accessed. Alcohol exposure data were from the Canadian Substance Use Exposure Database. InterMAHP was used to estimate alcohol-attributable deaths and hospital stays experienced by people drinking within LRDGs, people drinking above LRDGs, and former drinkers. GBD relative risk functions were acquired and weighted by the distribution of Canadian mortality. Results More men (18%) than women (7%) drank above weekly guidelines. Adherence to guidelines did not eliminate alcohol-caused harm: those drinking within guidelines nonetheless experienced 140 more deaths and 3,663 more hospital stays than if they had chosen to abstain from alcohol. A weighted relative risk analysis found that, for both women and men, the risk was lowest at a consumption level of 10 g per day. For all levels of consumption, men were found to experience a higher weighted relative risk than women. Conclusions Drinkers following weekly LRDGs are not insulated from harm. Greater than 50% of alcohol-caused cancer deaths are experienced by those drinking within weekly limits. Findings suggest that guidelines of around one drink per day may be appropriate for high-income countries.

The problem central to this document is the estimation of change in disease attributable to an epidemiological exposure variable that stems from a change in the distribution of that variable. We require that both disease and exposure are quantifiable as real numbers, and then ask how to estimate the fraction of disease attributable to exposure, producing the general attributable fraction methodology. After the mathematical framework is in place, we explore the implications of a disease that is wholly attributable to a given risk factor, demonstrate why standard applications of the attributable fractions do not extend, and present general methodological considerations for this case. Finally, we demonstrate the methodology using the example of alcoholic psychoses.

OBJECTIVE: Policy makers require evidence-based estimates of the economic costs of substance use-attributable lost productivity to set strategies aimed at reducing substance use-related harms. Building on a study by Rehm et al. (2006), we provide estimates of workplace costs using updated methods and data sources. METHODS: We estimated substance use-attributable productivity losses due to premature mortality, long-term disability, and presenteeism/absenteeism in Canada between 2007 and 2014. Lost productivity was estimated using a hybrid prevalence and incidence approach. Substance use prevalence data were drawn from three national self-report surveys. Premature mortality data were from the Canadian Vital Statistics Death Database, and long-term disability and workplace interference data were from the Canadian Community Health Survey. RESULTS: In 2014, the total cost of lost productivity due to substance use was $15.7 billion, or approximately $440 per Canadian, an increase of 8% from 2007. Substances responsible for the greatest economic costs were alcohol (38% of per capita costs), tobacco (37%), opioids (12%), other central nervous system (CNS) depressants (4%), other CNS stimulants (3%), cannabis (2%), cocaine (2%), and finally other psychoactive substances (2%). CONCLUSION: In 2014, alcohol and tobacco represent three quarters of substance use-related lost productivity costs in Canada, followed by opioids. These costs provide a valuable baseline that can be used to assess the impact of future substance use policy, practice, and other interventions, especially important given Canada’s opioid crisis and recent cannabis legalization. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.17269/s41997-019-00271-8) contains supplementary material, which is available to authorized users.

Introduction Canadian distillers and brewers have claimed that between 50% and 80% of the price of alcoholic drinks are government taxes. These claims were made in campaigns to decrease alcohol taxation. Methods We investigated these claims using publicly available Statistics Canada data and provincial-level product sales data and breakdowns of the prices of typical alcohol beverages in major market sectors. Results In all cases, the rate of total sales tax and excise taxation are mostly between 20% and 30% of final retail prices, well below the industry claims.

Objective:Alcohol use causes approximately 10% of deaths among adults ages 20–65 in the United States. Although previous research has demonstrated differential age-related risk relationships, it is...

Alcohol minimum unit pricing is a strategy capable of reducing alcohol-related harm from cheap alcoholic beverages. We used the International Model of Alcohol Harms and Policies (InterMAHP), an open-access alcohol harms estimator and policy scenario modeler, to estimate the potential health benefits of introducing minimum unit pricing in Québec, Canada.Aggregated mortality and hospitalization data were obtained from official administrative sources. Alcohol sales and pricing data were obtained from the partial government retail monopoly and Nielsen. Exposure data were from the Canadian Substance Use Exposure Database. Average price changes under two minimum-unit-pricing scenarios were estimated by applying a product-level pricing analysis. The online InterMAHP tool was used to automate the estimation of observed alcohol-attributable harm and what was projected in each policy scenario.Alcohol was estimated to cause 2,850 deaths and 24,694 hospitalizations in Québec in 2014. Introducing minimum unit pricing of CAD$1.50 was estimated to reduce consumption by 4.4%, alcohol-attributable deaths by 5.9% (95% CI [0.2%, 11.7%]), and alcohol-attributable hospital stays by 8.4% (95% CI [3.2%, 13.7%]). Higher minimum unit pricing of CAD$1.75 was estimated to reduce alcohol-attributable deaths by 11.5% (95% CI [5.9%, 17.2%]) and alcohol-attributable hospital stays by 16.3% (95% CI [11.2%, 21.4%]).The results of this policy modeling study suggest that the introduction of minimum unit pricing between CAD$1.50 and $1.75 would substantially reduce the alcohol-caused burden of disease in Québec. The quantification of alcohol-caused death and disability, and the changes in these measures under two scenarios, was significantly automated by the open-access resource, InterMAHP.

Aims Building upon an existing methodology and conceptual framework for estimating the association between the use of substances and crime, we calculated attributable fractions that estimate the proportion of crimes explained by alcohol and six other categories of psychoactive substances. Design Cross-sectional surveys. Setting Canadian federal correctional institutions. Participants Canadian men (n = 27 803) and women (n = 1335) offenders who began serving a custodial sentence in a Canadian federal correctional institution between 2006 and 2016. Measurements Offenders completed the computerized assessment of substance abuse, a self-report tool designed to assess (1) whether the offence for which they were convicted would have occurred had they not been intoxicated from alcohol or another substance, (2) whether they committed the offence to support their alcohol or other substance use and (3) whether they were dependent on alcohol (alcohol dependence scale) or another substance (drug abuse screening test). Offences were grouped into four mutually exclusive categories: violent crimes, non-violent crimes, impaired driving and substance-defined crimes. This study focused on violent and non-violent crime categories. Substances assessed were: alcohol, cannabis, opioids, other central nervous system (CNS) depressants, cocaine, other CNS stimulants and other substances. Findings According to offender self-report, 42% of all violent and non-violent crime would probably not have occurred if the perpetrator had not been under the influence of, or seeking, alcohol or other substances. Between 2006 and 2016, 20% of violent crimes and 7% of non-violent crimes in Canada were considered attributable to alcohol. In contrast, all other psychoactive substance categories combined were associated with 26% of all violent crime and 25% of non-violent crime during the same time-frame. Conclusions Attributable fraction analyses show that more than 42% of Canadian crime resulting in a custodial sentence between 2006 and 2016 would probably not have occurred if the perpetrator had not been under the influence of or seeking alcohol or other drugs. Attributable fractions for alcohol and substance-related crime are a potentially useful resource for estimating the impact of alcohol and other substances on crime.

The COVID‐19 pandemic and subsequent restrictions have resulted in additional challenges for persons with alcohol use disorders as well as for the effective operation of alcohol controls in different societies. The challenges are different in different systems and economies. Crises such as these often provide governments with opportunities to remake systems. We use the recent experience from India, which rapidly shifted between total countrywide prohibition of alcohol and unrestricted sales during this brief period, to argue against using the present crisis to bring about quick changes in alcohol policy in India. Instead, we advocate sustained, incremental pressure to develop and enforce alcohol control measures in public health delivery systems, in addition to demand reduction measures.

Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID-19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non-injury emergency room presentations. We provide some broad comparisons between alcohol-attributable and COVID-19-related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol-attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID-19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health-care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health-care services and public health more generally, it is essential that modest, evidence-based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health-care services and provide much-needed revenues for governments at this critical time.

Data regarding alcohol-caused health harms are required by policymakers for setting health priorities. However, these estimations are currently resource intensive, and estimates vary substantially by method. Thus, many countries, states, and regions do not track these harms. We address this limitation through creation of the International Model of Alcohol Harms and Policies (InterMAHP), an open-access alcohol harms estimator. InterMAHP consists of methodologies and program software designed to assist alcohol research teams in estimating alcohol-attributable mortality and morbidity, by region. It is available at www.intermahp.cisur.ca. Application is illustrated through updated estimates of alcohol-attributable mortality in Canada.Mortality counts and per capita alcohol sales were obtained from Statistics Canada. Drinking and bingeing prevalences were obtained from the Canadian Substance Use Exposure Database. InterMAHP automated the calculations of alcohol-attributable fractions (AAF) using the modern AAF formulation and a gamma distribution to specify the continuous prevalence distribution of consumption.Alcohol is a leading driver of mortality in Canada. In 2016, more than 14,800 (95% CI [12,435, 17,127]) deaths were alcohol attributable, representing 5.5% of all deaths. This burden is borne disproportionately by men (79%). Among condition categories, cancer is the leading cause of alcohol-attributable mortality in both men and women.InterMAHP has the potential to assist public health researchers globally in estimating alcohol harms. This open-access software was used to estimate alcohol-attributable mortality in Canada, which was shown to be substantial. Policies proven to reduce alcohol consumption and related harms should be considered to reduce this burden.

This summary article compares government revenue from the sale and distribution of alcohol to the societal costs caused by alcohol use for the year 2014. Statistics Canada data reported government revenue of $10.9 billion; however, this was offset by net societal costs of $14.6 billion, as reported by Canada's national substance use surveillance system, the Canadian Substance Use Costs and Harms project. The societal costs include health care, economic loss of production, criminal justice and other direct costs. Though revenue from alcohol sales has been described as a benefit to public coffers, accounting that includes costs incurred shows that all provinces and territories in Canada are running an alcohol deficit, totalling $3.7 billion nationally.Cet aperçu offre une comparaison entre les recettes publiques provenant de la vente et de la distribution d’alcool et les coûts pour la société associés à la consommation d’alcool, et ce, pour l’année 2014. Les données de Statistique Canada font état de recettes publiques de 10,9 milliards de dollars. Toutefois, ce montant est contrebalancé par des coûts nets pour la société de 14,6 milliards de dollars, comme le rapporte le projet Coûts et méfaits de l’usage de substances au Canada, un projet de surveillance nationale de la consommation de substances. Les coûts pour la société sont constitués des soins de santé, de la perte de productivité économique, de la justice pénale et de divers autres coûts directs. Bien que les recettes de vente d’alcool soient considérées comme un avantage pour les coffres de l’État, une comptabilisation tenant compte des coûts engagés montre que les provinces et les territoires du Canada subissent plutôt un déficit associé à l’alcool, pour un total de 3,7 milliards de dollars à l’échelle nationale.Canada runs an alcohol deficit of $3.7 billion per year, when accounting considers both government revenue and societal costs from established sources. Government revenue totalled $10.9 billion in 2014, but this was more than offset by societal costs of $14.6 billion, as reported by the Canadian Substance Use Costs and Harms project. Societal costs include health care, lost productivity, criminal justice and other direct costs. Among provinces and on a per capita basis, Alberta had the lowest government revenue and the highest alcohol deficit.Le Canada subit un déficit associé à l’alcool d’environ 3,7 milliards de dollars par année si on comptabilise à la fois les recettes publiques et les coûts pour la société provenant de sources établies. Les recettes publiques étaient de 10,9 milliards de dollars en 2014, mais ce montant a été plus que contrebalancé par des coûts pour la société de 14,6 milliards de dollars, comme le rapporte le projet Coûts et méfaits de l’usage de substances au Canada. Les coûts pour la société sont constitués des soins de santé, de la perte de productivité, de la justice pénale et de divers autres coûts directs. Au sein des provinces, et sur la base d’un calcul par habitant, c’est en Alberta que les recettes publiques sont les plus faibles et que le déficit associé à l’alcool a été le plus élevé.

Background Small area and regional estimates of substance use (SU) exposures are increasingly needed to support estimation of the burden of SU-attributable morbidity and mortality. There is also a need to assess SU prevalence for subgroups by place, time and sociodemographic characteristics to plan the efficient delivery of treatment and harm reduction services. However, the data available from national surveys are often insufficient to produce reliable estimates for subgroups because of small sample sizes. There are also often missing estimates for some jurisdictions and some years when no surveys were conducted. We describe new methods which utilize Canadian national survey data of SU, sales, SU attributable hospitalisations and demographic data to develop the Canadian Substance Use Exposure Database (CanSUED). Estimates from this database have been used in the study of Canadian Substance Use Costs and Harm (CSUCH). Methods Exposures were estimated for eight substance categories: alcohol, tobacco, opioids, cannabis, cocaine, other central nervous system (CNS) stimulants, other CNS depressants and other psychoactive substances. The design-based direct estimates of SU were based on the Canadian Alcohol and Drug Monitoring Survey (CADUMS) in 2008-2012, the Canadian Tobacco, Alcohol and Drug Survey (CTADS) in 2013, 2015 and 2017, per capita alcohol and tobacco sales, and rates of wholly SU-attributable hospitalisations for all Canadian jurisdictions by age and gender. Multilevel models were used to model the design-based estimates of SU to produce reliable estimates for subgroups when the coefficient of variation (CV) of the estimates were > 33.3% and to predict SU exposure in ten provinces in 2006, 2007, 2014 and 2016 and in the three territories for 2006-2017 by using empirical best linear unbiased prediction (EBLUP). Results Direct design-based estimates were based on the surveys from a total of 107,750 Canadians aged 15+. The analyses produced reliable estimates of SU prevalence by year-province-gender-age using mixed models with the EBLUP method. Correlational analyses show that the model-based estimates were significantly related to the design-based estimates produced from both the CADUMS/CTADS and Canadian Community Health Survey. The new model estimates indicate increases in binge drinking, cannabis use, other CNS depressant substance use and cocaine use between 2006 and 2017. Rates of use of opioids and tobacco showed declines. Rates of use of other substances were relatively stable or did not show overall change across the whole time period. Conclusion The mixed model-adjusted approaches produced reliable estimates for small areas and age-gender groups and help fill gaps caused by data suppression in local and national surveys. We suggest that these methods provide the most comprehensive and reliable estimates available of Canadian substance use by substance category, year, jurisdiction, age and gender. The methods could also be applied in other countries where similar data are available.

Background and aims Estimated alcohol consumption from national self-report surveys is often only 30-40% of official estimates based on sales or taxation data. Global burden of disease (GBD) estimates for alcohol adjust survey estimates up to 80% of total per capita consumption. This assumes that cohort studies needed to estimate relative risks for disease suffer less from under-reporting than typical national surveys. However, there is limited evidence on which to base that assumption. This paper aims to assess the extent of underestimation of alcohol consumption in cohort studies concerning alcohol and mortality compared with official total consumption estimates. Design Comparisons of estimated per capita consumption from a comprehensive sample of cohort studies against official estimates by country and year. Participants A total of 1 876 046 participants in 40 cohort studies from 18 countries on alcohol use and all-cause mortality identified by systematic review. Measurements Alcohol consumption data from the cohort studies were converted into usual grams of ethanol per day and then to total age 15+ per capita consumption. Matched estimates were sourced from the World Health Organization (WHO) Global Health Observatory. Findings The cohort studies had mean coverages of age 15+ per capita alcohol consumption of 61.71% (ranging from 29.19% for Russia to 96.53% for Japan), after weighting estimates by sample size for within-country estimates and by number of studies per country for the overall estimate. Regional estimates were higher for the United States (66.22%) and lower for western European countries (55.35%). Conclusions Underestimation of alcohol consumption in cohort studies is less than in typical population surveys. Because some under-coverage is caused by under-sampling heavier drinkers, the current practice of uplifting survey estimates to 80% of total population consumption in global burden of disease studies appears to be appropriate.

Introduction and Aims The province of Saskatchewan, Canada introduced minimum prices graded by alcohol strength in April 2010. As previous research found this intervention significantly decreased alcohol consumption and alcohol-attributable morbidity, we aim to test the association between the intervention and the rate of emergency department (ED) visits in four alcohol-related injury categories [motor vehicle collisions (MVC), assaults, falls and total alcohol-related injuries]. Design and Methods Data on ED visits in the city of Regina were obtained from the Saskatchewan Ministry of Health. Auto-regressive integrated moving average time series models were used to test the immediate and lagged effects of the pricing intervention on rates of alcohol-related nighttime. ED visits and controlled for daytime rates of ED visits, economic variables, linear and seasonal trends, and auto-regressive and moving average effects. Results The implementation of an alcohol minimum pricing strategy in Saskatchewan was associated with decreased MVC-related ED visits for women aged 26 and over after a 6 month lag period (−39.4%, P

Aim To establish whether the population-level pattern of cannabis use by quantity is similar to the distributions previously reported for alcohol, in which a small subset of drinkers accounts for a majority of total population alcohol consumption. Method The current study pooled Waves 1–3 of the 2018 National Cannabis Survey (n = 18,900; 2584 past-three-month cannabis users), a set of stratified, population-based surveys designed to assess cannabis consumption and related behaviors in Canada. Each survey systematically measured self-reported cannabis consumption by quantity across seven of the major cannabis-product types. In order to enable the conversion of self-reported consumption of non-flower cannabis products into a standard joint equivalent (SJE: equal to 0.5 g of dried cannabis), we created conversion metrics for physical production equivalencies across cannabis products. Results Similar to the findings in the alcohol literature, study results show that cannabis consumption is highly concentrated in a small subset of users: the upper 10% of cannabis users accounted for approximately two-thirds of all cannabis consumed in the country. Males reported consuming more cannabis by volume than females (approximately 60% versus 40%), with young males (15–34 years old) being disproportionately represented in the heaviest-using subgroups. Conclusions Most of the cannabis used in Canada is consumed by a relatively small population of very heavy cannabis users. Future research should attempt to identify the characteristics of the heaviest-using groups, as well as how population-level cannabis consumption patterns relate to the calculus of cannabis-related harms in society.

Alcohol use causes approximately 10% of deaths among adults ages 20-65 in the United States. Although previous research has demonstrated differential age-related risk relationships, it is difficult to estimate the magnitude of selection bias attributable to premature mortality based on existing cohort studies, the average age of which is greater than 50 years. The objective of our study was to assess the distribution of mortality-related harms and benefits from alcohol among adults ages 20 and older in comparison with the distribution among those older than age 50.Data from the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact software application from 2006-10 were used to determine the distribution of alcohol-attributable deaths (AADs) and the years of potential life lost (YPLLs) that was caused or prevented by alcohol for 54 conditions by 15-year age groupings (20-34, 35-49, 50-64, 65+) in the United States. We also determined the proportion of net deaths and YPLLs occurring in each age group, overall and by cause of death.Adults ages 20-49 years experienced 35.8% of the deaths and 58.4% of the YPLLs caused by alcohol, whereas the same group accrued only 4.5% of AADs and 14.2% of YPLLs gained. Overall, 46.3% of the total net deaths and 64.7% of the net YPLLs occurred among those ages 20-49; adding net deaths occurring among those ages 20-49 to those occurring after age 50 would result in an 86.3% relative increase in net deaths.Because of premature mortality, alcohol-mortality associations based on cohort studies may underestimate negative health consequences compared with those observed among the general population.

Introduction Saskatchewan's introduction in April 2010 of minimum prices graded by alcohol strength led to an average minimum price increase of 9.1% per Canadian standard drink (=13.45 g ethanol). This increase was shown to be associated with reduced consumption and switching to lower alcohol content beverages. Police also informally reported marked reductions in night-time alcohol-related crime. Objectives This study aims to assess the impacts of changes to Saskatchewan's minimum alcohol-pricing regulations between 2008 and 2012 on selected crime events often related to alcohol use. Methods Data were obtained from Canada's Uniform Crime Reporting Survey. Auto-regressive integrated moving average time series models were used to test immediate and lagged associations between minimum price increases and rates of night-time and police identified alcohol-related crimes. Controls were included for simultaneous crime rates in the neighbouring province of Alberta, economic variables, linear trend, seasonality and autoregressive and/or moving-average effects. Results The introduction of increased minimum-alcohol prices was associated with an abrupt decrease in night-time alcohol-related traffic offences for men (−8.0%, P

The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to differential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial differences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in &lsquo, no added&rsquo, risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.

Estimated alcohol consumption from national self-report surveys is often only 30-40% of official estimates based on sales or taxation data. Global burden of disease (GBD) estimates for alcohol adjust survey estimates up to 80% of total per capita consumption. This assumes that cohort studies needed to estimate relative risks for disease suffer less from under-reporting than typical national surveys. However, there is limited evidence on which to base that assumption. This paper aims to assess the extent of underestimation of alcohol consumption in cohort studies concerning alcohol and mortality compared with official total consumption estimates.Comparisons of estimated per capita consumption from a comprehensive sample of cohort studies against official estimates by country and year.A total of 1 876 046 participants in 40 cohort studies from 18 countries on alcohol use and all-cause mortality identified by systematic review.Alcohol consumption data from the cohort studies were converted into usual grams of ethanol per day and then to total age 15+ per capita consumption. Matched estimates were sourced from the World Health Organization (WHO) Global Health Observatory.The cohort studies had mean coverages of age 15+ per capita alcohol consumption of 61.71% (ranging from 29.19% for Russia to 96.53% for Japan), after weighting estimates by sample size for within-country estimates and by number of studies per country for the overall estimate. Regional estimates were higher for the United States (66.22%) and lower for western European countries (55.35%).Underestimation of alcohol consumption in cohort studies is less than in typical population surveys. Because some under-coverage is caused by under-sampling heavier drinkers, the current practice of uplifting survey estimates to 80% of total population consumption in global burden of disease studies appears to be appropriate.

The province of Saskatchewan, Canada introduced minimum prices graded by alcohol strength in April 2010. As previous research found this intervention significantly decreased alcohol consumption and alcohol-attributable morbidity, we aim to test the association between the intervention and the rate of emergency department (ED) visits in four alcohol-related injury categories [motor vehicle collisions (MVC), assaults, falls and total alcohol-related injuries].Data on ED visits in the city of Regina were obtained from the Saskatchewan Ministry of Health. Auto-regressive integrated moving average time series models were used to test the immediate and lagged effects of the pricing intervention on rates of alcohol-related nighttime. ED visits and controlled for daytime rates of ED visits, economic variables, linear and seasonal trends, and auto-regressive and moving average effects.The implementation of an alcohol minimum pricing strategy in Saskatchewan was associated with decreased MVC-related ED visits for women aged 26 and over after a 6 month lag period (-39.4%, P 0.001). There was no significant abrupt effect of this intervention on ED visits of four injury types in any of four gender-age categories; however, rates of ED visits among young males for MVCs and assaults decreased substantially during this study.The minimum pricing policy change led to a lagged decrease in motor vehicle-collision-related ED visits for women older than 25. Of note, there did not appear to be an instantaneous effect on the rate of alcohol-related injury ED visits immediately after the policy implementation nor lagged effects for other gender-age groups.

Saskatchewan's introduction in April 2010 of minimum prices graded by alcohol strength led to an average minimum price increase of 9.1% per Canadian standard drink (=13.45 g ethanol). This increase was shown to be associated with reduced consumption and switching to lower alcohol content beverages. Police also informally reported marked reductions in night-time alcohol-related crime.This study aims to assess the impacts of changes to Saskatchewan's minimum alcohol-pricing regulations between 2008 and 2012 on selected crime events often related to alcohol use.Data were obtained from Canada's Uniform Crime Reporting Survey. Auto-regressive integrated moving average time series models were used to test immediate and lagged associations between minimum price increases and rates of night-time and police identified alcohol-related crimes. Controls were included for simultaneous crime rates in the neighbouring province of Alberta, economic variables, linear trend, seasonality and autoregressive and/or moving-average effects.The introduction of increased minimum-alcohol prices was associated with an abrupt decrease in night-time alcohol-related traffic offences for men (-8.0%, P 0.001), but not women. No significant immediate changes were observed for non-alcohol-related driving offences, disorderly conduct or violence. Significant monthly lagged effects were observed for violent offences (-19.7% at month 4 to -18.2% at month 6), which broadly corresponded to lagged effects in on-premise alcohol sales.Increased minimum alcohol prices may contribute to reductions in alcohol-related traffic-related and violent crimes perpetrated by men. Observed lagged effects for violent incidents may be due to a delay in bars passing on increased prices to their customers, perhaps because of inventory stockpiling. [Stockwell T, Zhao J, Sherk A, Callaghan RC, Macdonald S, Gatley J. Assessing the impacts of Saskatchewan's minimum alcohol pricing regulations on alcohol-related crime. Drug Alcohol Rev 2017;36:492-501].

Non-local adaptation is the acquisition of general skill at a competitive task. General skill is defined as skill against a broad spectrum of opponents rather than just those an agent encountered during its training or evolution. Biological dogma suggests that evolved creatures should be adapted only to their environment and the opponents they encounter during evolution. If this dogma applies to digital evolution, then we should not observe non-local adaptation in agents trained with evolutionary computation to perform some competitive task. A number of previous studies have found non-local adaptation in prisoner's dilemma, in a model of competitive exclusion in plants, and in a virtual robotics task. This paper examines non-local adaptation in a virtual predator-prey system. One hundred distinct predator-prey lineages are evolved for 250,000 time steps, saving an intermediate population at time step 100,000. Predators and prey from distinct lineages are placed in competition. For the four possible comparisons in which the type of one competitor is held constant and the other is varied from less to more evolved, a statistically significant increase in ability to acquire food is seen in the more-evolved agents