ALCOHOL (M FARRELL AND E STOCKINGS, SECTION EDITORS)
A Taxonomy of Alcohol Harm Countermeasures
Published online: 21 April 2018
Springer International Publishing AG, part of Springer Nature 2018
Purpose of Review The addictions field lacks a coherent framework for strategies to reduce harm arising from the consumption of
alcohol. We need to be able to clarify the mechanisms by which key strategies operate, and encompass aetiological factors that do
not involve drinking.
Recent Findings We outline population and high-risk individual strategies focused on supply- and demand-side factors and
propose a system laid out in two tables, for classifying consumption-focused and non-consumption-focused countermeasures.
Summary Some countermeasures belong in more than one cell, reflecting more than one underlying mechanism. The taxonomy
will aid the synthesis of a vast scientific literature and guide new countermeasure development, evaluation, and policy.
We define alcohol harm as diminished health due to injury or
disease caused at least in part by the consumption of alcohol.
The concept of aetiology we adopt follows that of Rothman and
colleagues , encompassing sufficient, necessary, and proba-
bilistic causation, in which consumption of alcohol increases
the likelihood of injury or disease in combination with other
variables. In other words, injury or disease may not occur even
in the presence of heavy alcohol consumption because the
combination of contributing causes is not sufficient.
This thought experiment is outcome-oriented, conducted
on the premise that alcohol consumption is of interest to the
extent that it increases (or could plausibly increase) the inci-
dence of injury or disease, and is modifiable. In this frame-
work, determinants of drinking are important as upstream fac-
tors whose modification may, through their effects on drink-
ing, reduce the incidence or severity of injury or disease.
Our motivation for writing this paper is the observation that
present understandings of alcohol harm countermeasures are
fragmented by a lack of clarity about how some policies and
interventions operate. For example, government policy re-
views often categorise alcohol taxation as a demand-side strat-
egy(e.g.,), when it is arguably supply-side, and national
policies (e.g., ) do not often encompass countermeasures
that address contributing causes other than alcohol consump-
tion, framing them as “harm reduction”,whentheyare,we
argue, better characterised as primary prevention.
These concerns are partly academic, reflecting a desire for
internal consistency, but also, we argue, practical. A new tax-
onomy will be valuable if it aids the synthesis of the vast and
rapidly growing scientific literature used to guide the formu-
lation of new alcohol harm countermeasures, their evaluation,
and their implementation as policy.
What is already known about this topic
There are systems used for classifying alcohol harm countermeasures,
distinguishing supply control, demand reduction, and harm reduction.
However, they differ in their classification of key countermeasures and
do not coherently account for approaches focussed on factors other than
What this paper adds
We clarify the conceptual underpinnings of alcohol harm aetiology and
prevention strategy, integrating public health and economic frameworks.
We present a classification system for alcohol-focused and non-alcohol-
focused countermeasures to help guide research synthesis and policy
This article is part of the Topical Collection on Alcohol
* Kypros Kypri
School of Medicine and Public Health, University of Newcastle,
Department of Preventive and Social Medicine, University of Otago,
Dunedin, New Zealand
Current Addiction Reports (2018) 5:297–302