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Trimbos warns against consequences of blurring

October 5, 2017

The Trimbos Institute is cataloging the most important findings on effective alcohol policies. This is a result of the discussion regarding the ‘blurring-pilot’ of the VNG (Association of Dutch Municipalities). The Trimbos Institute professionals are of the opinion that convincing and extensive scientific research indicating that blurring negatively affects public health, should not be ignored.

In recent weeks, discussion about this issue intensified. The VNG blurring-pilot allows 34 municipalities to experiment with allowing marketing of alcohol in locations where this is currently prohibited by the Dutch ‘Alcohol Licensing and Catering Act’ (Drank- en Horecawet). The reason for the discussion was the presentation of the final report “Pilot on Blurring Licensing and Catering Law.” The results in this report are based on experiences of the municipalities as well as the 243 businesses that participated in the blurring pilots and reported their statistics. Based on these findings, the VNG recommends national policymakers make the ‘Alcohol Licensing and Catering Act’ more flexible, in order to allow marketing and serving of alcohol in more locations. The Trimbos Institute cautions against the consequences of this policy.

Normally speaking the Trimbos Institute does not involve itself in political discussions such as this. In this case the Trimbos Institute feels urged to contribute to it. The Trimbos Institute is concerned that convincing and extensive scientific research, showing blurring negatively affects public health, is being ignored. The most important viewpoints are listed below.

Alcohol is a harmful product
Alcohol is not an ordinary consumer product, but a product that increases the risk of several types of cancer and other medical conditions. The reports limits itself to WHO statistics: 6% of deaths worldwide are related to alcohol consumption, which is also linked to over 200 medical conditions. Last year, the Netherlands National Institute for Public Health and the Environment (RIVM) calculated the costs for Dutch society of negative health effects, violence, and accidents caused by alcohol abuse. These costs amount to 2.3 – 2.9 billion euro annually. More and more studies show that there is no safe minimum limit for alcohol consumption. Based on these studies the Health Institute has been advising since 2016 to not at all consume alcohol, or certainly consume no more than one glass per day. Even though fewer Dutch people consume alcohol, 1 in 10 Dutch people is an excessive drinker and, after tobacco addiction, alcohol addiction is the largest addiction in the Netherlands. The number of clients seeking primarily help for alcohol at addiction centers (30,000 per year) is almost as high as the total number for cannabis, cocaine, MDMA, opiates, amphetamines, GHB, and other drugs combined.

More sales points, more alcohol consumption
Considering the increased knowledge about health risks, there is no reason to soften legislation. Despite this the VNG, based on its report, recommends to change the Licensing and Catering Law so that alcohol can be marketed or served in more locations. A number of scientific studies show that increasing the number of sales points leads to more alcohol consumption and therefore to more risks for public health. All of these studies emphasize rather the importance of limiting alcohol availability.

Consequences for vulnerable groups
Allowing blurring has additional consequences for vulnerable groups in our society, such as young people and addicts. In the past years a number of health organizations have advocated making alcohol less acceptable. Campaign NIX18, for instance, was launched in 2014 to prevent young people from starting to drink before the age of eighteen. Blurring, however, contributes to alcohol being consumed or sold in more and more locations that are as yet alcohol-free. Young people will be confronted with alcohol in more daily situations, such as at the barber or in a clothing store. Because alcohol is available in more situations and becomes ‘normal,’ this may have an impact on expectations and norms that children develop about alcohol; it is known that these correlate to the start of alcohol use.

For (ex)addicts the confrontation with alcohol in more and more locations presents another problem. Ex-addicts continue to have a sensitivity to the substance they were addicted so, so called cue-reactivity. Confrontation with the substance can provoke a strong physical reaction which leads to a craving for the substance. With more alcohol supplies and alcohol-cues in less clearly identified drinking environments, ex-addicts and problem drinkers can be confronted with this more often, and the risk for recurrence increases.

A step backwards
The Trimbos Institute is committed to using scientific findings for an effective alcohol policy. In past years the approach of alcohol abuse was based on a firm scientific foundation. Harmful consequences of alcohol use were reduced successfully. Young people start drinking at a later age and in general alcohol consumption is reduced. A key target in the approach was to reduce the availability of alcohol, for instance by increasing the legal minimum age for alcohol. De-normalizing alcohol in the home situation for young people also was an important pillar.

The VNG report – based on pilots in a limited number of municipalities and with a limited research question and research period – does not offer convincing arguments for an approach to increase availability and normalization of alcohol. Even though the VNG presents blurring as a step forwards, Trimbos Institute sees it as a step backwards for public health.

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Marjan  Heuving

Marjan Heuving

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