The Impact of Unrecorded Alcohol Use on Health: What Do We Know in 2020?

OBJECTIVE: About 25% of global alcohol consumption is unrecorded, that is, concerns alcohol not registered in the country where it is consumed. Unrecorded alcohol includes homemade, illicit, or surrogate alcohols. The aim of this review is to update the evidence on unrecorded alcohol and its impact on health. METHOD: A narrative review and qualitative synthesis of scientific literature (English and Russian) for the period 2016-2020 was conducted. RESULTS: A total of 100 articles were included in the synthesis. The most harm because of unrecorded alcohol seems to be caused by ethanol, although single and mass methanol poisonings constitute exceptions. Nevertheless, unrecorded consumption is associated with disproportionate harm that goes beyond toxicity, which is linked to hazardous drinking patterns of unrecorded alcohol, and its association with alcohol use disorders and social marginalization. The online sale of unrecorded alcohol, which circumvents alcohol availability regulations, is an emerging and not yet well-explored issue. CONCLUSIONS: Policy options include restricting access to methanol, increasing taxation, denaturing ethanol-containing liquids that could be used as surrogates, introducing more effective and less toxic denaturizing additives, and improving monitoring systems for fraud, tax evasion, and local sales restrictions, including raising the minimum legal drinking age. These measures should be implemented within a holistic policy framework to avoid unintended effects, such as an increase in total alcohol consumption, shifts from certain types of unrecorded products to potentially toxic alternatives, or limiting economic activity and jeopardizing the livelihoods of vulnerable populations (e.g., women comprise the majority of those making homebrew in some countries).

Spatial access to opioid treatment program and alcohol and cannabis outlets: analysis of missed doses of methadone during the first, second, and third 90 days of treatment.

Background: The burden of access to opioid treatment programs (OTPs) may change as clients become eligible for take-home privileges. Our previous study showed clients who lived more than 10-miles away from an OTP were more likely to miss methadone doses during the first 30 days of treatment. Proximity to alcohol and cannabis outlets may also negatively influence treatment adherence.Objective: To examine the association between access to this OTP, alcohol and cannabis outlets, and the number of missed methadone doses during the first, second, and third 90 days of treatment.Methods: The number of missed methadone doses was calculated for 752, 689, and 584 clients who remained in treatment, respectively, for at least 3, 6, and 9 months (50% female). Distance between client's home and the OTP, alcohol, and cannabis outlets was measured. Generalized linear models were employed.Results: Shorter distance from a client's residence to the OTP was associated with a decreased number of missed methadone doses during the first 90 days of treatment. Shorter distance to the closest cannabis retail outlet was associated with an increased number of missed methadone doses during the first and second 90 days of treatment. Shorter distance to the closest off-premise alcohol outlet was associated with an increased number of missed methadone doses during the third 90 days of treatment.Conclusions: Improving spatial accessibility of OTPs are essential to ensure treatment opportunities are available for individuals so affected. Exploring to what extent residing in areas that facilitate alcohol and cannabis availability can influence treatment adherence is warranted.

Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity.

OBJECTIVES: Potential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socio-economic status on purchasing behaviour. STUDY DESIGN: Cross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. METHODS: 639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in- and out-patient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last week's or a 'typical' weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. RESULTS: Median consumption was 184.8 (IQR = 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those <50 pence (£0.5 UK) per alcohol unit. Corresponding figures for the Scottish population are 69% and 60%. The most popular low-priced drinks were white cider, beer and vodka with the most common off-sales outlet being the corner shop, despite supermarkets offering cheaper options. Consumption levels of the cheapest drink (white cider) were similar across all quintiles apart from the least deprived. CONCLUSIONS: Heavy drinkers from all quintiles purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Non-etheless, drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary.

The implementation and development of complex alcohol control policies in indigenous communities in Queensland (Australia).

Very high rates of injury and death during the 1990s were linked with increased alcohol availability and misuse in discrete Indigenous communities in rural and remote Queensland (Australia). To address widespread concerns about a public health crisis, from 2002, the Queensland Government implemented alcohol control strategies known as 'Alcohol Management Plans' (AMPs) in 19 of these communities. Although resources for prevention and treatment were promised, AMPs became increasingly focused on local prohibition, restricted access to alcohol and punitive measures for breaching restrictions. An examination of legislation, regulations, explanatory notes, and published documents indicates this focus evolved across four phases since 2002. The first phase, from 2002 to 2004, saw 'restricted areas' with alcohol 'carriage limits' introduced, restricting the amounts and types of liquor permitted within some communities. The second phase (2002-2007) featured evaluations and reviews by the Queensland Government bringing recommendations for more stringent controls. Additionally, beyond the 'restricted areas', licenced premises situated within the 'catchments' of the targeted communities, mainly located in the nearby regional towns, became subject to 'minimising harm' provisions. These more stringent controls were implemented widely in the third phase (2008-2011) when: the operations of seven community-managed liquor outlets were terminated; the trading arrangements of two others were modified; Police powers to search and seize were increased; and 'attempting' to take liquor into a 'restricted area' also became an offence. Some communities have seen a reduction in alcohol-related harms that have been attributed to these alcohol control strategies. This commentary maps the recent regulatory history of Queensland's alcohol controls targeting discrete Indigenous communities highlighting their increasing focus on punitive measures to reduce access to alcohol. With AMPs in Queensland currently under Government review, and with community resolve for change rising, the limits to Government controls and punitive measures may have been reached.

Estimated impacts of alternative Australian alcohol taxation structures on consumption, public health and government revenues.

OBJECTIVE: To examine health and economic implications of modifying taxation of alcohol in Australia. DESIGN AND SETTING: Economic and epidemiological modelling of four scenarios for changing the current taxation of alcohol products, including: replacing the wine equalisation tax (WET) with a volumetric tax; applying an equal tax rate to all beverages equivalent to a 10% increase in the current excise applicable to spirits and ready-to-drink products; applying an excise tax rate that increases exponentially by 3% for every 1% increase in alcohol content above 3.2%; and applying a two-tiered volumetric tax. We used annual sales data and taxation rates for 2010 as the base case. MAIN OUTCOME MEASURES: Alcohol consumption, taxation revenue, disability-adjusted life-years (DALYs) averted and health care costs averted. RESULTS: In 2010, the Australian Government collected close to $8.6 billion from alcohol taxation. All four of the proposed variations to current rates of alcohol excise were shown to save money and more effectively reduce alcohol-related harm compared with the 2010 base case. Abolishing the WET and replacing it with a volumetric tax on wine would increase taxation revenue by $1.3 billion per year, reduce alcohol consumption by 1.3%, save $820 million in health care costs and avert 59 000 DALYs. The alternative scenarios would lead to even higher taxation receipts and greater reductions in alcohol use and harm. CONCLUSIONS: Our research findings suggest that any of the proposed variations to current rates of alcohol excise would be a cost-effective health care intervention; they thus reinforce the evidence that taxation is a cost-effective strategy. Of all the scenarios, perhaps the most politically feasible policy option at this point in time is to abolish the WET and replace it with a volumetric tax on wine. This analysis supports the recommendation of the National Preventative Health Taskforce and the Henry Review towards taxing alcohol according to alcohol content.

Production and characterization of distilled alcoholic beverages obtained by solid-state fermentation of black mulberry (Morus nigra L.) and black currant (Ribes nigrum L.).

The present study was conducted to appraise the potential of black mulberry and black currant to be used as fermentation substrates for producing alcoholic beverages obtained by distillation of the fruits previously fermented with Sacchromyces cerevisiae IFI83. In the two distillates obtained, the volatile compounds that can pose health hazards are within the limits of acceptability fixed by the European Council (Regulation 110/2008) for fruit spirits. However, the amount of volatile substances in the black currant distillate (121.1 g/hL absolute alcohol (aa)) was lower than the minimum limit (200 g/hL aa) fixed by the aforementioned regulation. The mean volatile composition of both distillates was different from other alcoholic beverages such as four commercial Galician orujo spirits, Portuguese bagaceiras, and two distillates obtained from fermented whey and blackberry. The results obtained showed the feasibility for obtaining distillates from fermented black mulberry and black currant, which have their own distinctive characteristics.

Solvent extraction of organic acids from stillage for its re-use in ethanol production process.

Stillage re-use in the fermentation stage in ethanol production is a technique used for the reduction of water and fermentation nutrients consumption. However, the inhibitory effect on yeast growth of the by-products and feed components that remains in stillage increases with re-use and reduces the number of possible recycles. Several methods such as ultrafiltration, electrodialysis and advanced oxidation processes have been used in stillage treatment prior its re-use in the fermentation stage. Nevertheless, few studies evaluating the effect of solvent extraction as a stillage treatment option have been performed. In this work, the inhibitory effect of serial stillage recycling over ethanol and biomass production was determined, using acetic acid as a monitoring compound during the fermentation and solvent extraction process. Raw palm oil methyl ester showed the highest acetic acid extraction from the aqueous phase, presenting a distribution coefficient of 3.10 for a 1:1 aqueous phase mixture:solvent ratio. Re-using stillage without treatment allowed up to three recycles with an ethanol production of 53.7 +/- 2.0 g L(-1), which was reduced 25% in the fifth recycle. Alternatively, treated stillage allowed up to five recycles with an ethanol final concentration of 54.7 +/- 1.3 g L(- 1). These results show that reduction of acetic acid concentration by an extraction process with raw palm oil methyl ester before re-using stillage improves the number of recycles without a major effect on ethanol production. The proposed process generates a palm oil methyl ester that contains organic acids, among other by-products, that could be used for product recovery and as an alternative fuel.

Moral transgression, disease and holistic health in the Livingstonia Mission in late nineteenth and early twentieth-century Malawi.

This article examines ideas of morality and health, and connections between moral transgression and disease in both Scottish missionary and Central African thought in the context of the Livingstonia Mission of the Presbyterian Free Church of Scotland in Malawi during the late nineteenth and early twentieth centuries. By concentrating on debates, conflicts and co-operation between missionaries and Africans over the key issues of beer drinking and sexual morality, this article explores the emergence of a new "moral hygiene" among African Christian communities in Northern Malawi.

Determination of glycyrrhizin in liqueurs by on-line coupled capillary isotachophoresis with capillary zone electrophoresis.

An on-line coupled capillary isotachophoresis-capillary zone electrophoresis method for the determination of glycyrrhizin in liqueurs is described. The optimised electrolyte system was 5 mM HCl+11 mM epsilon-aminocaproic acid+0.05% hydroxyethylcellulose+30% methanol (leading electrolyte), 5 mM caproic acid+30% methanol (terminating electrolyte) and 20 mM caproic acid+10 mM histidine+0.1% hydroxyethylcellulose+30% methanol (background electrolyte). Method characteristics, i.e., linearity (20-500 ng/ml), accuracy (recovery 99+/-4%), intra-assay repeatability (2%), intermediate repeatability (3.8%) and detection limit (8 ng/ml) were determined. Speed of analysis, low laboriousness, high sensitivity and low-running cost are the typical attributes of the capillary isotachophoresis-capillary zone electrophoresis method. Developed method was successfully applied to analysis of liqueurs with liquorice extract and some foods (sweets and food supplements) containing liquorice. Found levels of glycyrrhizin in liqueurs, sweets and food supplements varied between 1-16 mg/l, 850-1050 mg/kg and 1.6-1.8 g/kg, respectively.