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Are the “Best Buys” for Alcohol Control Still Valid? An Update on the Comparative Cost-Effectiveness of Alcohol Control Strategies at the Global Level
Abstract
OBJECTIVE: Evidence on the comparative cost-effectiveness of alcohol control strategies is a relevant input into public policy and resource allocation. At the global level, this evidence has been used to identify so-called best buys for noncommunicable disease prevention and control. This article uses global evidence on alcohol use exposures and risk relations, as well as on intervention costs and impacts, to re-examine the comparative cost-effectiveness of a range of alcohol control strategies. METHOD: A "generalized" approach to cost-effectiveness analysis was adopted. A new modeling tool (OneHealth) was used to estimate the population-level effects of interventions. Interventions that reduce the harmful use of alcohol included brief psychosocial interventions, excise taxes, and the enactment as well as enforcement of restrictions on alcohol marketing, availability, and drink-driving laws. Costs were estimated in international dollars for the year 2010 and effects expressed in healthy life years gained. Analysis was carried out for 16 countries spanning low-, middle-, and high-income settings. RESULTS: Increasing excise taxes has a low cost (<I$0.10 per capita) and a highly favorable ratio of costs to effects (<I$100 per healthy life year gained in both low- and high-income settings). Availability and marketing restrictions are also highly cost effective (<I$100 in low-income settings and <I$500 in high-income settings). Enforcement of drink-driving laws and blood alcohol concentration limits via sobriety checkpoints had cost-effectiveness ratios in the range of I$1,500-3,000. Brief psychosocial treatments were <I$150 and
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“Legislative measures that reduce harmful behaviours such as excess alcohol consumption have been modelled as cost-effective in all WHO regions. 442”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [442]
In the citing paper
“A broad array of patient-level alcohol harm reduction interventions, such as brief interventions (for this paper, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session [7] up to 4 sessions [8], psychosocial interventions, and pharmacological treatments) have been found to be effective in high-resource settings [9,10].”
From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [10]
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“Further, the two perhaps most common and internationally applied simulation programmes do not disclose their source code to the public (for applications of the programs, see [18] and [19]), making it impossible for other researchers to apply or adapt the programme on their own.”
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The Impact of Raising Alcohol Taxes on Government Tax Revenue: Insights from Five European Countries
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“It is also recognised as one of the “best buys” by the World Health Organization (WHO) [2], as increasing taxation has proven to be an effective and cost-efficient method for reducing social and health harm associated with alcohol consumption [3, 4].”
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“Cost-effective interventions shown to reduce harmful use of alcohol consumption include restrictions on alcohol advertising, restrictions on physical availability of retailed alcohol, and increased taxes on alcohol sales [26,27].”
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Social disparities in alcohol's harm to others: evidence from 32 European countries
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Alcohol Policy Scores and Alcohol-Attributable Homicide Rates in 150 Countries
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“While a number of ‘best buy’ policies and actions to counter alcohol-related harm have been developed (Chisholm et al., 2018), initiating action to address alcohol use and related harm remains contentious globally and within New Zealand (Casswell & Rehm, 2020).”
BackgroundProbst, C., Manthey, J., Ferreira‐Borges, C., Neufeld, M., Ivo Rakovac, A., Andreasyan, D., Sturua, L., Novik, I., Hagverdiyev, G., Obreja, G., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-051874 · Cited by 11
Self-citationAlcohol Use and Cancers of the Gastrointestinal Tract. Epidemiology and Preventive Implications
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“, (12, 13): an increase in the price of alcoholic beverages via an increase in alcohol taxation (37)], and restrictions on their availability, such as a restriction on sale hours, and a ban on marketing (38).”
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“The IAC policy index was developed based on four policy domains that are the most cost-effective for alcohol control in a range of settings [25], namely availability restrictions, pricing policies, marketing restrictions and drink-driving prevention, as detailed below.”
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“Thus, the most effective ACP interventions, which led to an immediate change in both overall mortality and alcohol-attributable mortality, were the WHO’s so-called "best buys", and were mainly driven by significant increases in alcohol excise taxes [47, 48].”
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“…buys” recommended by the WHO to reduce alcohol-attributable harm (World Health Organization, 2017); “best buys” have not only been shown to be highly effective, but they are also highly cost-effective (Chisholm et al., 2018; Chisholm et al., 2004) and need relatively few resources to implement.”
Self-citationPrevalence of alcohol use by gender and HIV status in rural Uganda
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“While structural interventions, such as reducing the availability of alcohol, increasing prices through taxes, and restricting alcohol advertising have been found to be effective at reducing alcohol use in other settings [45], research is limited in sub-Saharan Africa [44].”
BackgroundThe impact of an integrated alcohol policy: The example of Lithuania
Rehm, J. T., Lange, S., Miščikienė, L., & Jiang, H. (2024) · Drug and Alcohol Review · doi:10.1111/dar.13980 · Cited by 9
“Based on a listing of all alcohol policies in Lithuania [9], we first identified WHO “ best buy ” policies [17, 18] with an a priori fixed threshold based on expert judgement: taxation increases which resulted in lowered affordability, availability restrictions affecting more than 20% of the…”
Self-citationLi, L., Zhang, Y., Leng, J., Li, S., Lei, Y., Cao, Z., Luo, Y., Xiong, H., Wu, Z.-J., Tao, R., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0327831 · Cited by 9
“%) and mortality rates from 0.18 to 0.09 per 100,000 (EAPC = −2.96%), establishing a global model for effective control [33].”
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Self-citationReducing Harm Through Evidence‐Based Alcohol Policies: Challenges and Options
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Self-citationNichol, B., Rodrigues, A., Wilson, R., & Haighton, C. (2024) · Health & Social Care in the Community · doi:10.1155/2024/6786899 · Cited by 8
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Self-citationAlcohol and Public Health: Failure and Opportunity
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Self-citationAlcohol use during pregnancy in Rakai, Uganda
Wynn, A., Nabukalu, D., Lutalo, T., Wawer, M. J., Chang, L. W., Kiene, S. M., Serwadda, D., Sewankambo, N. K., Nalugoda, F. K., Kigozi, G., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0256434 · Cited by 8
“Additionally, there is some evidence showing alcohol reduction policies and programs are cost-effective [30,31]; however, among pregnant women, the research is limited.”
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“The International Alcohol Control (IAC) study developed a policy index which used four policies established in a large body of research to be likely to be the most effective (and cost-effective) in a range of settings (Babor et al., 2022; Chisholm et al., 2018).”
BackgroundSaengow, U., Patanavanich, R., Suriyawongpaisal, P., Aekplakorn, W., Sornpaisarn, B., Jiang, H., & Rehm, J. T. (2024) · BMJ Global Health · doi:10.1136/bmjgh-2023-014428 · Cited by 8
Self-citationDo Changes to the Alcohol Retail Environment Reduce Interpersonal Violence?
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Self-citationMinimum unit pricing for alcohol in Scotland
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“36,37 This has the potential to bridge the gap in evidence to inform low-and middle-income countries regarding the impact of substance use prevention.”
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Self-citationPublic perceptions of responsibility for alcohol control actions by actor type in seven countries
Pettigrew, S., Booth, L., & Pinho‐Gomes, A. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107486 · Cited by 6
Probst, C., & Kilian, C. (2021) · Addiction · doi:10.1111/add.15466 · Cited by 6
“Unfortunately, the most cost-effective alcohol control policies, such as taxation, regulation of availability and implementation of screening and brief intervention (SBI) [6], are not well equipped per se to target low SES populations if we do not pay close attention in their implementation [7].”
BackgroundInfluentialThe estimated health impact of alcohol interventions in New Zealand: A modelling study
Chambers, T. J., Mizdrak, A., Herbert, S. E., Davies, A., & Jones, A. C. (2023) · Addiction · doi:10.1111/add.16331 · Cited by 5
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“Alcohol policies can include measures such as control of physical availability, alcohol taxes, regulation on publicity, or drink-driving countermeasures (Xuan et al., 2016; Chisholm et al., 2018).”
BackgroundGlobal Health Risk Factors: Alcohol Consumption
Rehm, J. T., Manthey, J., & Shield, K. D. (2021) · Springer eBooks · doi:10.1007/978-3-030-45009-0_37 · Cited by 6
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Self-citationA critical commentary of the paradoxical ‘success’ of Making Every Contact Count (MECC)
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“…demonstrated to be effective in targeting a variety of individual behaviours including smoking (Jepson et al., 2010; Stead et al., 2013), alcohol (chisholm et al., 2018; Jepson et al., 2010), healthy eating (Jepson et al., 2010), and physical activity (Aveyard et al., 2016; Jepson et al., 2010).…”
Increases in alcohol consumption in middle-income countries will lead to increased harms
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“…are in line with other work demonstrating a decrease in alcohol attributable harm linked to the implementation of policies in Lithuania and the effectiveness of taxation more broadly (Chisholm et al ., 2018; Rehm et al ., 2020; ˇ Stelem˙ekas et al ., 2021; Rehm et al ., 2022; Tran et al ., 2022a).”
Self-citationHodgson, A. F., Bantjes, J. R., Pirkis, J., Hawton, K. E., Basera, W., & Matzopoulos, R. (2025) · BMJ Global Health · doi:10.1136/bmjgh-2024-017171 · Cited by 4
“2 41 42 Such public health measures are, however, likely to be thwarted by powerful industry and commercial interests which continue to influence alcohol policy and legislation, 43 particularly in Africa and other LMICs.”
Company global competitive strategy and employee’s awareness
Urbański, M. (2021) · Marketing and Management of Innovations · doi:10.21272/mmi.2021.2-04 · Cited by 4
Hu, A., Zhao, X., Room, R., Hao, W., Xiang, X., & Jiang, H. (2023) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2023.2280948 · Cited by 5
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“…and dietary quality in pregnant individuals (Adam et al., 2020), the justification for MECC builds upon the effectiveness of brief interventions to address smoking (DiClemente et al., 2017), alcohol (Chisholm et al., 2018), physical activity (Vijay et al., 2016), and diet (Whatnall et al., 2018).”
Evaluation of the national alcohol control strategy (Green Paper on Alcohol Policy) of Estonia
Rehm, J. T., Reile, R., Correia, D. M., Neufeld, M., & Jiang, H. (2025) · Drug and Alcohol Review · doi:10.1111/dar.14024 · Cited by 4
“…by an integrated national alcohol control policy installing all three of the WHO ’ s ‘ best buys ’ for alcohol policy (i.e., taxation increases, marked restrictions on availability, a ban on marketing and advertising [23, 24]) within 1 year (for a listing of policies for Lithuania, see Ref.”
Self-citationA “buck a beer,” but at what cost to public health?
Shield, K. D., Probst, C., & Rehm, J. T. (2019) · Canadian Journal of Public Health · doi:10.17269/s41997-019-00184-6 · Cited by 4
“In fact, alcohol pricing policies are the most cost-effective method of reducing alcohol consumption and its consequences (Canadian Institute for Health Information 2017; Chisholm et al. 2018).”
BackgroundSelf-citationA narrative review of alcohol control policies in Latvia between 1990 and 2020
Gobiņa, I., Isajeva, L., Springe, L., Vrobļevska, E., Pelne, A., Mārtiņsone, U., & Lange, S. (2023) · Drug and Alcohol Review · doi:10.1111/dar.13647 · Cited by 4
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“If alcohol control policies reduce consumption levels across the population and especially among heavy drinkers (Chisholm et al., 2018), the proportion of heavy drinkers in the population would decrease while the proportion low-to-moderate drinkers would increase.”
BackgroundSelf-citationImpact of the COVID-19 pandemic on acute mental health admissions in Croatia
Kalanj, K., Ćurković, M., Peček, M., Orešković, S., Orbanić, A., & Marshall, R. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1231796 · Cited by 4
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“Increasing the price of alcohol, through alcohol taxation or other pricing policies, has long been recognised as an effective and cost-effective way to reduce harmful alcohol consumption and harm [1, 2] and reduce health inequalities [3].”
Correia, D. M., Manthey, J., Allebeck, P., Kraus, L., Månsson, A., & Rehm, J. T. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-094586 · Cited by 3
“For example, Chisholm and colleagues 10 employed a modelling approach relying on a single effect estimate from another study, 12 and Saffer and Dave 11 based their conclusions on findings that did not reach statistical significance at the conventional alpha level of 0.05.”
InfluentialSelf-citationCHANGING DRINKING BEHAVIOR DURING THE COVID-19 PANDEMIC
Shamsieva, S. R., & Mollaeva, N. R. (2022) · Bulletin of Medical Science · doi:10.31684/25418475-2022-4-133 · Cited by 3
Rehm, J. T., Correia, D. M., Hassan, A. S., Manthey, J., Rovira, P., Shield, K. D., Ferreira‐Borges, C., Neufeld, M., & Štelemėkas, M. (2025) · Drug and Alcohol Review · doi:10.1111/dar.70028 · Cited by 3
“…taxation on alcoholic beverages—iden-tified as a ‘best practice’ in alcohol control policy [3] or as one of three ‘best buys’ by the World Health Organization (WHO) in its list of most cost-effective policies [4, 5]—has been shown to be effective in reducing alcohol consumption and harm ([3, 6]).”
Self-citationManthey, J., Jasilionis, D., Jiang, H., Meščeriakova-Veliulienė, O., Petkevičienė, J., Radišauskas, R., Rehm, J. T., & Štelemėkas, M. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-053497 · Cited by 3
“High levels of alcohol consumption and a comparably large attributable disease burden globally [11] and particularly in Europe [13] require effective public health interventions, such as increasing the retail price of alcoholic beverages.[26, 27] The more than 100% excise tax increase for beer and wine implemented in…”
BackgroundSelf-citationEstimated Impacts of Alcohol Control Policies on NCD Premature Deaths in Thailand
Chaiyasong, S., Gao, J., & Bundhamcharoen, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159623 · Cited by 3
“, which modeled the effects, costs, and cost-effectiveness of five alcohol control strategies for upper-middle- and high-income countries, including Thailand [8].”
BackgroundMethodResultInfluentialJiang, H., Tran, A., Petkevičienė, J., Štelemėkas, M., Lange, S., & Rehm, J. T. (2022) · Drug and Alcohol Review · doi:10.1111/dar.13584 · Cited by 3
Self-citationKilian, C., Lemp, J. M., Kerr, W. C., Mulia, N., Rehm, J. T., Ye, Y., & Probst, C. (2024) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-024-01267-3 · Cited by 3
“Our Minnesota case study further adds to the existing evidence that repealing Sun-day sales bans are not only associated with alcohol consumption but are also likely to increase alcohol-attributable mortality (see also Chisholm et al., 2018).”
Self-citationCondon, L., Hargreaves, S. C., Barry, D. A., Curejova, J., Morgan, D. L., Worrall, S., Çelik, F., & Price, M. J. (2024) · Health & Social Care in the Community · doi:10.1155/2024/9020329 · Cited by 3
Studying harm from others’ illicit drug use—can stigma really be avoided?
Ramstedt, M. (2021) · Addiction · doi:10.1111/add.15332 · Cited by 3
Krnel, S. R., Kilian, C., Keršmanc, M. H., Roškar, M., & Koprivnikar, H. (2021) · Slovenian Journal of Public Health · doi:10.2478/sjph-2022-0003 · Cited by 3
“Evidence supporting this hypothesis can be derived from research on alcohol control policies and economic crises (11, 15).”
BackgroundTrapero‐Bertran, M., Gil-Doménech, D., & Vargas‐Martínez, A. M. (2021) · Adicciones · doi:10.20882/adicciones.1649 · Cited by 3
Myran, D. T., Friesen, E. L., Talarico, R., Gaudreault, A., Taljaard, M., Hobin, E. P., Smith, B. T., Schwartz, N., Giesbrecht, N., Crépault, J., et al. (2024) · Addiction · doi:10.1111/add.16566 · Cited by 2
Ejima, J. U., Kumar, P., & Subramanian, A. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.118358 · Cited by 3
“It effectively treats depression, anxiety (Barth et al., 2016; Cuijpers et al., 2016), and alcohol misuse (Chisholm et al., 2018).”
Zayar, N. N., Vichitkunakorn, P., Aekplakorn, W., Chaiyasong, S., Correia, D., Hassan, A. S., Htet, K. K. K., Nontarak, J., Patanavanich, R., Rovira, P., et al. (2026) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2026.105191 · Cited by 2
Self-citationRehm, J. T., Correia, D., Amul, G. G. H., Ang, I. Y. H., Chaiyasong, S., Chhoun, P., Chong, C. L., Chua, A. M. R., Hairi, N. N., Hanafi, E., et al. (2026) · Journal of Global Health · doi:10.7189/jogh.16.04150 · Cited by 2
“The scale was restricted to the three ‘best buy’ policies, which were initially recommended by the WHO to cost-effectively reduce the burden of non-communicable disease [ 18 , 19 ], but have been shown to have a wider impact on all-cause mortality and the burden of disease [ 20 , 21 ].”
Self-citationKöger, M., Schillok, H., Voß, S., Coenen, M., Merkel, C., Jung‐Sievers, C., & On behalf of the COSMO Study Team (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095489 · Cited by 2
“, stricter time restrictions on the sale of alcohol in retail outlets, restrictions on alcohol marketing, or higher taxes/prices on alcoholic beverages) [53,54].”
BackgroundVankov, D., Jankovszky, D., Vankov, B., Galanternik, M., & Rodriguez, C. (2024) · Global Health Journal · doi:10.1016/j.glohj.2024.02.002 · Cited by 2
Correia, D. M., Tran, A., Kokole, D., Neufeld, M., Olsen, A., Likki, T., Ferreira‐Borges, C., & Rehm, J. T. (2024) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.2016 · Cited by 2
“To reduce alcohol ‐ related harm, different policy options have been proposed, with pricing policies, availability and marketing restrictions usually considered as most effective and cost ‐ effective (Babor et al., 2022; Chisholm et al., 2018).”
BackgroundSelf-citationSurveillance of alcohol use through population surveys in the Americas from 2010 to 2019
Jaswal, H., Sohi, I., Chrystoja, B. R., Imtiaz, S., Franklin, A., Wettlaufer, A., Rehm, J. T., Monteiro, M. G., & Shield, K. D. (2024) · Addiction · doi:10.1111/add.16661 · Cited by 2
“Currently, taxation and pricing policies are the most effective interventions for lowering alcohol consumption and its associated harms [143 – 145].”
Self-citationRogerson, M., Blank, L., Clowes, M., Everson-Hock, E., & Goyder, E. (2024) · BMJ Public Health · doi:10.1136/bmjph-2024-000953 · Cited by 2
“4 48 The introduction of a minimum unit price for alcohol in Scotland has been associated with a reduction in harms, but only Wales has replicated this.”
Colom, J., & Segura, L. (2020) · PubMed Central · Cited by 2
HISTORICAL AND CONTEMPORARY CONTEXTS OF ALCOHOL CONSUMPTION IN MODERN UKRAINE
Klymanska, L. D., Klimanska, M. B., Herasym, H. Z., Savka, V. Y., Andreichuk, S., & Myshok, R. (2022) · Wiadomości Lekarskie · doi:10.36740/wlek202208116 · Cited by 1
Moskalewicz, J., & Sierosławski, J. (2023) · Alcoholism and Drug Addiction · doi:10.5114/ain.2023.130364 · Cited by 1
‘But … Would I Be Able to Toast With Friends?’ When Service Users Ask for New Care Pathways
Rocelli, M., Aquili, L., Palmieri, A., Romaioli, D., Ferrari, L., & Faccio, E. (2024) · Health Expectations · doi:10.1111/hex.14148 · Cited by 1
Sensory Discrimination Tests for Low- and High-Strength Alcohol
Franklin, A., Shield, K. D., Rehm, J. T., & Lachenmeier, D. W. (2024) · Beverages · doi:10.3390/beverages10040095 · Cited by 1
Self-citationTrends in economic indicators, alcohol use, and alcohol-attributable health indicators in India
Rehm, J. T., Hassan, A. S., Franklin, A., Patra, J., Wettlaufer, A., Jiang, H., & Shield, K. D. (2025) · Alcohol and Alcoholism · doi:10.1093/alcalc/agaf024 · Cited by 1
Self-citationZhu, Y., Kilian, C., Probst, C., Kerr, W. C., & Rehm, J. T. (2025) · Addiction · doi:10.1111/add.70168 · Cited by 1
Self-citationSymons, M., Gilmore, W., Henrickson, N., & Chikritzhs, T. N. (2025) · Australian and New Zealand Journal of Public Health · doi:10.1016/j.anzjph.2025.100256 · Cited by 1
Metadata
- Authors
- Chisholm, D., Moro, D., Bertram, M., Pretorius, C., Gmel, G., Shield, K., & Rehm, J.
- Affiliations
- World Health Organization (CH)
- University of Cagliari (IT)
- Avenir Health (US)
- Centre for Addiction and Mental Health (CA)
- Venue
- Journal of Studies on Alcohol and Drugs
- Publisher
- Alcohol Research Documentation, Inc.
- Published
- 2018-07
- Volume
- 79
- Issue
- 4
- Pages
- 514-522
- ISSN
- 1937-1888 (ISSN-L)
- 1938-4114
- OpenAlex
- W2886141074
- Cited by
- 253
- References
- 0
- Citations by year
- 2026: 12 · 2025: 25 · 2024: 32 · 2023: 36 · 2022: 39 · 2021: 56 · 2020: 32 · 2019: 17 · 2018: 4
- FWCI
- 21.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Studies on Alcohol and Drugs (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- cost-effectiveness, Best Buy, excise tax, alcohol marketing restrictions, alcohol availability restrictions, sobriety checkpoints, brief psychosocial intervention, hazardous drinking, healthy life years, non-communicable disease prevention
- MeSH terms
- Blood Alcohol Content, Alcohol Drinking, Automobile Driving, Cost-Benefit Analysis, Female, Humans, Male, Public Policy, Taxes, Global Health, Marketing
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