BOOKS & ELECTRONIC MEDIA

Strategies to address alcohol problems

Isidore Obot

Mental Health and Substance Abuse, World Health Organization, 1211 Geneva 27, Switzerland (email: oboti@who.int)

Author: Diyanath Samaradinghe
Publisher: FORUT, 2803 Gjøvik, Norway; 2005
ISBN: 995-9193-03-1; softcover; 132 pages; price US$ 10 (available directly from the publisher)

The problems posed by alcohol consumption are attracting needed attention all over the world. This is as it should be considering the high health burden and social problems associated with alcohol use. For example, in 2000 a total of 4% of the global burden of disease and 3.2% of mortality (1.8 million deaths) were attributable to alcohol consumption. In Europe, as a whole, and in a growing number of low- and middle-income countries elsewhere, the contribution of alcohol to disease and death is even more prominent. Though the role played by alcohol in social problems affecting families and communities is difficult to quantify, there is a strong link between drinking and domestic violence, road traffic accidents and disorderly conduct. As societies grapple with ways to address these problems, any well reasoned contribution, such as this book, is a welcome development.

Strategies to address alcohol problems is a follow-up to Alcohol and poverty, by Bergljot Baklein and Diyanath Samarasinghe, also published by FORUT, a Norwegian nongovernmental organization with roots in the temperance movement. FORUT is engaged in community development work in India, Nepal, Senegal, Sierra Leone, and Sri Lanka, where it pays particular attention to consumption of alcohol and other drugs. Strategies to address alcohol problems is the result of a project funded by FORUT and led by the author, a professor of psychiatry in Sri Lanka. Temperance movements have historically played an important role in controlling alcohol at the international level. In this book, the author demonstrates his ability to use evidence and good sense to analyse and recommend strategies to address the global problem of alcohol consumption. This is a well written, easy to read book, full of what Griffith Edwards, in his foreword, describes as wisdom.

There is little disagreement that harmful consumption of alcohol is a major contributor to a wide variety of health and social problems and that these are increasing in many countries, including Sri Lanka and others in Africa, Asia and South America where consumption has been historically low. Where there is substantial disagreement is on which strategies are effective in addressing these problems in different contl texts, and this is where the book is likely to make an important contribution.

The opening chapter presents an overview of the strategy proposed by the author, which he defines as "a broad approach to understanding and dealing with the fundamental issues relating to alcohol and its consequences". This is followed by two chapters outlining what the evidence shows about the problems associated with alcohol consumption and the actions needed to address these problems. Four chapters then deal with specific strategies and actions at the community, national and global levels. Though action at these three levels is considered and discussed, the main thrust of the book is on community responses and strategies. The author is a strong believer in community action, to such an extent that it seems he has little faith in a global response by either the United Nations or WHO. This is not a limitation in itself and, indeed, he deserves commendation for propagating the view that communities have more than a peripheral role to play in addressing the alcohol-related problems that afflict individuals and families in their midst.

While few would dispute this view, there are many who think that, in order to reduce the burden imposed on society by harmful alcohol consumption, what is needed is more global action, or at least action at the national level that targets the overall population. Alcohol is a global commodity and its producers operate in an increasingly global marketplace. If the book had been written slightly later it might have taken a different stance on the potential of a global response to the increasing burden of alcohol problems in many countries. In May 2005, after more than two decades of inaction, the World Health Assembly adopted resolution WHA58.26, "Public health problems caused by harmful use of alcohol", in what many hope is the first step towards a united effort to put alcohol on the global public health agenda. This resolution effectively places a major responsibility on WHO to guide and coordinate actions and strategies to address the risks attributable to alcohol as an intoxicating and dependence-producing substance.

As WHO embarks on the challenging exercise of an objective assessment of what policies and strategies are effective and cost-effective in curbing alcohol-related problems, this book will likely serve as one of the very useful resources. It is to be hoped that it enjoys wide distribution by the publisher. While the main message of the book — that community strategies are underused but crucial in effecting change — is clear and unambiguous, readers would have benefited from more elaboration of the practical steps communities can take to improve the chance of succeeding in their actions against alcohol, and a discussion of why these actions are rarely taken by them. Despite these limitations, there is sufficient wisdom in this slim volume to go around, and actors at the national and global levels will not be disappointed by its advice and recommendations.