Alcohol – WMA – The World Medical Association

Adopted by the 66^th WMA General Assembly, Moscow, Russia, October 2015
and revised by the 68th WMA General Assembly, Chicago, United States, October 2017

PREAMBLE

1. The burden of disease and injury associated with alcohol consumption is a critical challenge to global public health and development around the world. The World Medical Association offers this declaration on alcohol as its commitment to reducing excessive alcohol consumption and as a means to support its members in promulgating harm-reduction policies and other measures.

2. There are significant health, social and economic problems associated with excessive alcohol use. Overall, there are causal relationships between alcohol consumption and more than 200 types of disease and injury including traffic fatalities. The harmful use of alcohol kills approximately 3.3 million people every year (5.9 % of all deaths worldwide), and is the third leading risk factor for poor health globally, accounting for 5.1 % of disability-adjusted life years lost. Beyond the numerous chronic and acute health effects, alcohol use is associated with widespread social, mental and emotional consequences. The problem has a special magnitude among young people and adolescents who are beginning to consume alcohol at earlier ages, and the risk to their physical, mental and social health is of concern.

3. Although alcohol consumption is deeply rooted in many societies, alcohol cannot be considered an ordinary beverage or consumer commodity. It is a substance that causes extensive medical, psychological and social harm by means of physical toxicity, intoxication and dependence.

There is increasing evidence that genetic vulnerability to alcohol dependence is a risk factor for some individuals. Foetal alcohol syndrome and foetal alcohol effects, preventable causes of intellectual disability, result from alcohol consumption during pregnancy.

Adolescence is a stage of significant vulnerability because the neurological development is not complete and alcohol has a negative impact on it. Growing scientific evidence has demonstrated the harmful effects of consumption prior to adulthood on the brains, mental, cognitive and social functioning of youth and increased likelihood of adult alcohol dependence and alcohol related problems among those who drink before full physiological maturity. Regular alcohol consumption and binge drinking in adolescents can negatively affect school performance, increase participation in crime and adversely affect sexual performance and behaviour.

4. Effective alcohol harm-reduction policies and measures will include legal and regulatory measures that target overall alcohol consumption in the population, as well as health and social policy interventions that specifically target high-risk drinkers, vulnerable groups and harms to people affected by those who consume alcohol, e.g. domestic violence.

When developing policies it should be taken into account that the majority of alcohol-related problems in a population are associated with harmful or hazardous drinking by non-dependent ‘social’ drinkers, particularly when intoxicated. This is particularly a problem of young people in many regions of the world who drink with the intent of becoming intoxicated.

5. There are many evidence-based alcohol policies and prevention programmes that are effective in reducing the health, safety and socioeconomic problems attributable to harmful use of alcohol. International public health advocacy and partnerships are needed to strengthen and support the ability of governments and civil society worldwide to commit to, and deliver on, reducing the harmful use of alcohol through effective interventions, including action on social determinants of health.

Health professionals in general and physicians in particular have an important role to play in preventing, treating and mitigating alcohol-related harm, and in using effective preventive and therapeutic interventions.

The World Medical Association encourages and supports the development and implementation of evidence-based national alcohol policies by promoting and facilitating partnerships, information exchange and health policy capacity building.

POLICY OBJECTIVES

In developing alcohol policies, the WMA recommends the following broad objectives:

6. Strengthen health systems to identify and improve a country’s capacity to develop policy and lead actions that target excessive alcohol consumption.

7. Promote the development and evaluation in all countries of national alcohol strategies which are comprehensive, evidence-based and include measures to address the supply, distribution, sale, advertising, sponsorship and promotion of alcohol. The WHO ‘best buys’ cost effective policies should be particularly promoted, such as (i) increasing alcoholic beverage taxes, (ii) regulating the availability of alcoholic beverages, (iii) restricting marketing of alcoholic beverages and (iv) drink-driving countermeasures. Strategies should be routinely reviewed and updated.

8. Through government health departments, accurately measure the health burden associated with alcohol consumption through the collection of sales data, epidemiological data, and per capita consumption figures.

9. Support and promote the role of health and medical professionals in early identification, screening and treatment of harmful alcohol use.

10. Dispel myths and dispute alcohol control strategies that are not evidence-based.

11. Reduce the impact of harmful alcohol consumption in at risk populations.

12. Foster multi-disciplinary collaboration and coordinated inter-sectoral action.

13. Raise awareness of alcohol-related harm through public education and information campaigns.

14. Promote social determinants of health approach in fighting harmful alcohol consumption.

RECOMMENDATIONS

The following priorities are suggested for WMA members, National Medical Associations and governments when developing integrated and comprehensive policy and legislative responses.

15. Regulate affordability, accessibility and availability

15.1 Pricing policies

Evidence from epidemiological and other research demonstrates a clear link between the price of alcohol and levels of consumption, especially amongst young drinkers and those who are heavy alcohol users.

Therefore, action is needed to increase alcohol prices, through volumetric taxation of products based on their alcohol strength, and other proven pricing mechanisms, to reduce alcohol consumption, particularly in heavy drinkers and high risk groups.

Setting a minimum unit price at a level that will reduce alcohol consumption is a strong public health measure, which will both reduce average alcohol consumption throughout the population and be especially effective in heavy drinkers and young drinkers.

15.2 Accessibility and availability

Regulate access to, and availability of, alcohol by limiting the hours and days of sale, the number and location of alcohol outlets and licensed premises, and the imposition of a minimum legal drinking age. Governments should tax and control the production and consumption of alcohol, with licensing that emphasises public health and safety and empowers licensing authorities to control the total availability of alcohol in their jurisdictions. Governments should also control importation and sale of illegal alcohol across borders.

Public authorities must strengthen the prohibition of selling to and by minors and must systematically request proof of age before alcohol can be purchased in shops or bars.

16. Regulation of non-commercial alcohol

The production and consumption of non-commercial forms of alcohol, such as home brewing, illicit distillation, and illegal diversion alcohol to avoid taxes, should be curtailed using appropriate taxing and pricing mechanisms.

17. Regulation of alcohol marketing

Alcohol marketing should be restricted to prevent the early adoption of drinking by young people and to minimise their alcohol consumption. Regulatory measures range from wholesale bans and restrictions on measures that promote excessive consumption, to restrictions on the placement and content of alcohol advertising and sponsorship that are attractive to young people. There is evidence that industry self-regulation and voluntary codes are ineffective at protecting vulnerable populations from exposure to alcohol marketing and promotion.

Increase public awareness of harmful alcohol consumption through mandatory product labelling that clearly states alcoholic content in units, advice on recommended drinking levels and a health warning, supported by public awareness campaigns.

In conjunction with other measures, social marketing campaigns should be implemented together with the media to educate the public about harmful alcohol use, to adopt driving while intoxicated policies, and to target the behaviour of specific populations at high risks of harm.

18. The role of health and medical services in prevention

Health, medical and social services professionals should be provided with the training, resources and support necessary to prevent harmful use of alcohol and treat people with alcohol dependence, including routinely providing brief interventions to motivate high-risk drinkers to moderate their consumption. Health professionals also play a key role in education, advocacy and research.

Specialised treatment and rehabilitation services should be available in due time and affordable for alcohol dependent individuals and their families.

Together with national and local medical societies, specialty medical organizations, concerned social, religious and economic groups (including governmental, scientific, professional, nongovernmental and voluntary bodies, the private sector, and civil society) physicians and other health and social professionals can work to:

18.1 Reduce harmful use of alcohol, especially among young people and pregnant women, in the workplace, and when driving;

18.2 Increase the likelihood that everyone will be free of pressures to consume alcohol and free from the harmful and unhealthy effects of drinking by others;

18.3 Promote evidence-based prevention strategies in schools and communities;

18.4 Assist in informing the public of alcohol related harm and demystifying the myth of health enhancing properties of alcohol.

Physicians have an important role in facilitating epidemiologic and health service data collection on the impact of alcohol with the aim of prevention and promotion of public health. Data collection must respect the confidentiality of health data of individual patients.

19. Driving while intoxicated measures

Key deterrents should be implemented for driving while intoxicated, which include a strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions.

These measures should also include active enforcement of traffic safety measures, random breath testing, and legal and medical interventions for repeat intoxicated drivers.

20. Limit the role of the alcohol industry in alcohol policy development

The commercial priorities of the alcohol industry are in direct conflict with the public health objective of reducing overall alcohol consumption. Internationally, the alcohol industry is frequently included in alcohol policy development by national authorities, but the industry is often active in opposing and weakening effective alcohol policies. Ineffective and non-evidence-based alcohol control strategies promoted by the alcohol industry and the social organisations that the industry sponsors should be countered. The role of the alcohol industry in the reduction of alcohol-related harm should be confined to their roles as producers, distributors and marketers of alcohol, and not include alcohol policy development or health promotion.

21. Convention on Alcohol Control

Promote consideration of a Framework Convention on Alcohol Control similar to that of the WHO Framework Convention on Tobacco Control.

22. Exclude alcohol from trade agreements

Furthermore, in order to protect current and future alcohol control measures, advocate for alcohol to be classified as an extra-ordinary commodity and that measures affecting the supply, distribution, sale, advertising, sponsorship, promotion of or investment in alcoholic beverages be excluded from international trade agreements.

23. Action against positive media messaging

It is important to act on the impact of media messages on beliefs, intentions, attitudes and social norms. Well-designed media campaigns can have direct effects on behavior. The media also influence the social conception of a problem, and indirectly influence political decision-making on measures for intervention on alcohol.

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012
And rescinded at the 68th WMA General Assembly, Chicago, USA, October 2017

Some states are intending to set a minimum unit price in order to reduce the medical and social effects of excessive alcohol consumption.

The WMA supports states seeking to use such innovative measures to combat the serious public and individual health effects of excessive and problem drinking.

Adopted by the 44^th World Medical Assembly, Marbella, Spain, September 1992
Revised by the 57^th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67^th WMA General Assembly, Taipei, Taiwan, October 2016
Rescinded and archived by the 76^th WMA General Assembly, Porto, Portugal, October 2025

INTRODUCTION

Deaths and injuries resulting from road crashes and collisions are a major public health problem. The World Health Organization’s 2015 Global status report on road safety indicates that the total number of road traffic deaths per year has reached 1.25 million worldwide, with the highest road traffic fatality rates in low-income countries.

Driving while under the influence of alcohol has caused a large number of the deaths and injuries resulting from road crashes. The prevalence of drinking and driving is increasing worldwide each year.

A change in the behaviour of road users with regard to alcohol consumption would appear to be the most promising approach to preventing traffic deaths and injuries. Measures forbidding driving while under the influence of alcohol will lead to a considerable improvement in road safety and an appreciable reduction in the number of dead and injured.

CONSEQUENCES OF DRINKING AND DRIVING

Driving a vehicle implies the acceptance of a certain number of risks. The careful driver will always be aware of the risks but also ensure that the level of risk never rises to an unacceptable level. Alcohol not only impairs one’s ability to drive, but it also alters a driver’s subjective assessment of risk so that he or she drives more recklessly.

Irrespective of the amount of alcohol consumed, the maximum concentration of alcohol in the body is reached:After half an hour when taken

on an empty stomach;
After an hour when taken with a meal.

On the other hand, it takes the body a long time to eliminate alcohol. An individual in good health eliminates alcohol at a rate that reduces blood alcohol concentration by 0.1 to 0.15 gram/litre/hour. Thus, one’s driving ability remains impaired long after he or she has stopped drinking.

Alcohol abuse has both short- and long-term neurological and psychiatric consequences that can endanger road safety.

Certain drugs interact negatively with alcohol, and in particular some combinations are known to reduce alertness. When drugs, whether legal or illegal, are taken with alcohol, the effect of the latter is intensified. This mixture can trigger mental dysfunctions that are extremely dangerous for road users. Physicians should be educated and informed about these pharmacological facts.

RECOMMENDATIONS

1. The WMA reaffirms its commitments to work for reducing excessive alcohol consumption and for fostering harm-reduction policies and other measures (WMA Declaration on Alcohol, October 2015.)

2. Physicians and National Medical Associations should play an active role in promoting and advocating for the development of evidence-based government policies to reduce alcohol use and driving:

Policy interventions

3. At the present time, permitted blood alcohol levels while driving vary from country to country. Even small amounts of alcohol have a direct effect on the brain, with disturbances noted at levels as low as 0.3 grams per litre. Therefore, it would be desirable to lower the maximum permissible level of blood alcohol to a minimum, but not above 0.5 grams per litre, which is low enough to allow the average driver to retain the ability to assess risk.

4. The especially high prevalence in certain countries of driving while under the influence of alcohol may justify more coercive policies, which physicians and National Medical Associations should play an active role in supporting. For example, the driver may be declared unfit to drive for a period of time sufficient to ensure he or she will no longer be a threat to road safety in the future.

5. Government officials should consider implementing restrictions on the sale or affordability of alcohol, perhaps through taxation, licensing systems, and/or limits on the days and hours of sale. Restrictions on the promotion of alcoholic beverages, including advertising and event sponsorship, should also be considered.

6. A minimum legal age for alcohol purchase and consumption should be adopted in each country. Government officials should consider implementing a separate, lower or zero blood alcohol content law for young drivers.

7. There should be strict consequences to selling alcoholic beverages to individuals under the age to purchase and consume alcohol. These laws should be properly enforced.

8. Any driver who has been in a road traffic crash must undergo a blood alcohol concentration test or a breath test.

9. The practice of random driver testing for breath alcohol levels should become more widespread, and there should be further research into other ways to test urine, breath and saliva to identify impaired drivers and prevent subsequent operation of motor vehicles.

10. Devices that prevent individuals with an unauthorised level of blood alcohol from starting the engine of or operating the vehicle should be developed and experimented with.

Educational interventions

12. Educational interventions should promote moderation and responsibility in the consumption of alcohol and seek to reduce the likelihood that someone will consume alcohol and drive afterwards.

13. The information dispensed by physicians and other health professionals should be aimed at making everyone aware of the dangers of driving under the influence of alcohol. When physicians and other health professionals issue fitness-to-drive certificates, they can use this opportunity to educate road users and pass on a message of prevention and personal responsibility.

14. In most countries, road crashes linked to alcohol consumption affect adolescents and young adults to a disproportionately high degree, and every available resource should be mobilised to reduce their consumption of alcohol. The problem of alcohol consumption in adolescents and young adults and its relation to road safety should be addressed in the school curricula so that a responsible attitude becomes the norm.

Clinical and rehabilitative interventions

15. Physicians should also be involved in reducing the likelihood of impaired driving by participating in the detoxification and rehabilitation of drunk drivers. These initiatives should be based on a detailed analysis of the problem as it manifests itself within each country or culture. Generally speaking, however, alcoholism is a medical condition with concomitant psychological or social and interpersonal difficulties that affect the family, work or social environment.

16. Alcoholic subjects should be given access to rehabilitation services. When drivers are found to have excess alcohol in their blood (or their breath), other factors linked to their excessive drinking should be examined and included in a rehabilitation programme. These rehabilitation programmes should be publicly funded.

17. Road crashes linked to the consumption of alcohol can be considered as possible predictors of other addictive and violent behaviours. This should be taken into consideration in the medical treatment of the patient.

Community interventions

18. Strategies should be developed by relevant stakeholders to ensure safe transportation home in situations where alcohol consumption occurs.

19. Eliminating alcohol from the workplace and in situations where consumers must drive should be a goal of organizational policies. The promotion of non-alcoholic drinks is an important tool to facilitate these policies.

Adopted by the 56^th WMA General Assembly, Santiago, Chile, October 2005
And rescinded at the 68th WMA General Assembly, Chicago, USA, October 2017

PREAMBLE

Alcohol use is deeply embedded in many societies. Overall, 4% of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco or hypertension. Overall, there are causal relationships between alcohol consumption and more than 60 types of disease and injury including traffic fatalities. Alcohol consumption is the leading risk factor for disease burden in low mortality developing countries and the third largest risk factor in developed countries. Beyond the numerous chronic and acute health effects, alcohol use is associated with widespread social, mental and emotional consequences. The global burden related to alcohol consumption, both in terms of morbidity and mortality, is considerable.
Alcohol-related problems are the result of a complex interplay between individual use of alcoholic beverages and the surrounding cultural, economic, physical environment, political and social contexts.
Alcohol cannot be considered an ordinary beverage or consumer commodity since it is a drug that causes substantial medical, psychological and social harm by means of physical toxicity, intoxication and dependence. There is increasing evidence that genetic vulnerability to alcohol dependence is a risk factor for some individuals. Fetal alcohol syndrome and fetal alcohol effects, preventable causes of mental retardation, may result from alcohol consumption during pregnancy. Growing scientific evidence has demonstrated the harmful effects of consumption prior to adulthood on the brains, mental, cognitive and social functioning of youth and increased likelihood of adult alcohol dependence and alcohol related problems among those who drink before full physiological maturity. Regular alcohol consumption and binge drinking in adolescents can negatively affect school performance, increase participation in crime and adversely affect sexual performance and behaviour.
Alcohol advertising and promotion is rapidly expanding throughout the world and is increasingly sophisticated and carefully targeted, including to youth. It is aimed to attract, influence, and recruit new generations of potential drinkers despite industry codes of self-regulation that are widely ignored and often not enforced.
Effective alcohol social policy can put into place measures that control the supply of alcohol and/or affect population-wide demand for alcohol beverages. Comprehensive policies address legal measures to: control supply and demand, control access to alcohol (by age, location and time), provide public education and treatment for those who need assistance, levy taxation to affect prices and to pay for problems generated by consumption, and harm-reduction strategies to limit alcohol-related problems such as impaired driving and domestic violence.
Alcohol problems are highly correlated with per capita consumption so that reductions of use can lead to decreases in alcohol problems. Because alcohol is an economic commodity, alcohol beverage sales are sensitive to prices, i.e., as prices increase, demand declines, and visa versa. Price can be influenced through taxation and effective penalties for inappropriate sales and promotion activities. Such policy measures affect even heavy drinkers, and they are particularly effective among young people.
Heavy drinkers and those with alcohol-related problems or alcohol dependence cause a significant share of the problems resulting from consumption. However, in most countries, the majority of alcohol-related problems in a population are associated with harmful or hazardous drinking by non-dependent ‘social’ drinkers, particularly when intoxicated. This is particularly a problem of young people in many regions of the world who drink with the intent of becoming intoxicated.
Although research has found some limited positive health effects of low levels of alcohol consumption in some populations, this must be weighed against potential harms from consumption in those same populations as well as in population as a whole.
Thus, population-based approaches that affect the social drinking environment and the availability of alcoholic beverages are more effective than individual approaches (such as education) for preventing alcohol related problems and illness. Alcohol policies that affect drinking patterns by limiting access and by discouraging drinking by young people through setting a minimum legal purchasing age are especially likely to reduce harms. Laws to reduce permitted blood alcohol levels for drivers and to control the number of sales outlets have been effective in lowering alcohol problems.
In recent years some constraints on the production, mass marketing and patterns of consumption of alcohol have been weakened and have resulted in increased availability and accessibility of alcoholic beverages and changes in drinking patterns across the world. This has created a global health problem that urgently requires governmental, citizen, medical and health care intervention.

RECOMMENDATIONS

The WMA urges National Medical Associations and all physicians to take the following actions to help reduce the impact of alcohol on health and society:

Advocate for comprehensive national policies that
1. incorporate measures to educate the public about the dangers of hazardous and unhealthy use of alcohol (from risky amounts through dependence), including, but not limited to, education programs targeted specifically at youth;
2. create legal interventions that focus primarily on treating or provide evidence-based legal sanctions that deter those who place themselves or others at risk, and
3. put in place regulatory and other environmental supports that promote the health of the population as a whole.
Promote national and sub-national policies that follow ‘best practices’ from the developed countries that with appropriate modification may also be effective in developing nations. These may include setting of a minimum legal purchase age, restricted sales policies, restricting hours or days of sale and the number of sales outlets, increasing alcohol taxes, and implementing effective countermeasures for alcohol impaired driving (such as lowered blood alcohol concentration limits for driving, active enforcement of traffic safety measures, random breath testing, and legal and medical interventions for repeat intoxicated drivers).
Be aware of and counter non-evidence-based alcohol control strategies promoted by the alcohol industry or their social aspect organizations.
Restrict the promotion, advertising and provision of alcohol to youth so that youth can grow up with fewer social pressures to consume alcohol. Support the creation of an independent monitoring capability that assures that alcohol advertising conforms to the content and exposure guidelines described in alcohol industry self-regulation codes.
Work collaboratively with national and local medical societies, specialty medical organizations, concerned social, religious and economic groups (including governmental, scientific, professional, nongovernmental and voluntary bodies, the private sector, and civil society) to:
1. reduce harmful use of alcohol, especially among young people and pregnant women, in the workplace, and when driving;
2. increase the likelihood that everyone will be free of pressures to consume alcohol and free from the harmful and unhealthy effects of drinking by others; and
3. promote evidence-based prevention strategies in schools.
Undertake to
1. screen patients for alcohol use disorders and at-risk drinking, or arrange to have screening conducted systematically by qualified personnel using evidence-based screening tools that can be used in clinical practice;
2. promote self-screening/mass screening with questionnaires that could then select those needing to be seen by a provider for assessment;
3. provide brief interventions to motivate high-risk drinkers to moderate their consumption; and
4. provide specialized treatment, including use of evidence-based pharmaceuticals, and rehabilitation for alcohol-dependent individuals and assistance to their families.
Encourage physicians to facilitate epidemiologic and health service data collection on the impact of alcohol.
Promote consideration of a Framework Convention on Alcohol Control similar to that of the WHO Framework Convention on Tobacco Control that took effect on February 27, 2005.
Furthermore, in order to protect current and future alcohol control measures, advocate for consideration of alcohol as an extra-ordinary commodity and that measures affecting the supply, distribution, sale, advertising, promotion or investment in alcoholic beverages be excluded from international trade agreements.