Professor John Holmes talks to the SSA about the arguments for and against no- and low-alcohol drinks (NoLos), and what boxes NoLos would need to tick in order to be taken seriously as a public health response to alcohol-related harm.

At a general population level, we really have very little sense what impact these products are having. We only have the most basic data on how many people are actually drinking them, how big a contribution they are to overall alcohol product sales, and who’s drinking them.

John Holmes is Professor of Alcohol Policy and Director of the Sheffield Alcohol Research Group at the University of Sheffield – a multidisciplinary team of researchers and doctoral students who conduct public health, health economic, and health psychology research on alcohol. He spoke at the SSA’s 2022 Annual Conference on how to maximise the public health benefit of no- and low-alcohol products (NoLos) and minimise their potential for harm.

In this edited interview filmed at the conference, John describes evidence about the public health impact of NoLos, and what concerns or criteria would need to be satisfied for NoLos to stand shoulder-to-shoulder with an alcohol policy such as minimum unit pricing.

No- and low-alcohol products are drinks that have less than 1.2% alcohol by volume (ABV). These have the potential to reduce alcohol-related harm when people use them as substitutes for regular-strength alcoholic beverages by reducing their overall alcohol consumption. While some anecdotal evidence suggests that people are substituting regular-strength alcoholic beverages for NoLos, John explains that more data is needed to understand patterns of purchasing and consumption, and whether enough people are making the ‘switch’ (and are doing so frequently enough) to make an impact on population-level alcohol harm.

While it is certainly plausible that people would use NoLos as a replacement for regular-strength alcoholic beverages, this can’t be assumed. As other researchers such as Emily Nicholls have highlighted, NoLos could function as substitutes (i.e. used instead of what people are already drinking), but they could also function as additions (i.e. used on top of what people are already drinking).

In the interview, John talks about some potential consequences of NoLos being ‘additions’ in people’s lives. For people dependent on alcohol, NoLos could make it easier to reduce or eliminate alcohol, but on the other hand, they could trigger cravings. The fact that these products look, smell, or taste similar to alcohol is not necessarily harmless.

“While these drinks might make it easier by allowing [people] to maintain abstinence – giving them something to drink that’s a bit like alcohol – it might also trigger cravings, and just mean that alcohol is more present in the world in more situations that make it harder to maintain abstinence.”

No- and low-alcohol products could also be introduced into times and spaces where alcohol wouldn’t usually be consumed (e.g. at work, at the gym, or in the mornings), which could inadvertently normalise alcohol-type products in more settings.

Furthermore, they could be used to surreptitiously advertise alcohol brands in settings where alcohol advertising is not permitted or not appropriate. For example, John cites research from Dr Nathan Critchlow and Dr Richard Purves, which reported on alcohol advertising in Ireland during the 2021/2022 European Rugby Champions Cup and 2022 Six Nations Championship. They found that most references to alcohol brands during the tournaments were for zero-alcohol variants but used similar branding to their regular-strength counterparts.

Acknowledging that there are currently more gaps in knowledge about NoLos than dependable evidence, John says that there is a need for further research, which he hopes to contribute to through an NIHR-funded study, which will aim to provide a comprehensive evidence base about NoLo marketing, consumption, sales, purchasing, consumer trends, and health outcomes that can inform research, public health practice and policymaking.

“There is real potential for these to have a big impact on public health that goes far beyond any kind of intervention that government might normally look at. And that’s why we really need to understand what’s going on here. Is it leading down that path, or is it leading down a different path where it’s only really making a difference around the margins, and there’s some risks as well, and it’s a much more muddy story?”

In the meantime, he says that “real ‘back of the envelope’ calculations” suggest that NoLos account for about 1% of the total volume of alcohol products sold. If that got up to 10% and people were using them as substitutes for regular-strength alcoholic beverages, NoLos could lead to an impact similar in size to that projected for minimum unit pricing, which would constitute “a big impact on public health that goes far beyond any kind of intervention that government might normally look at”.

by Natalie Davies

Editor’s note: Quotes have been condensed and edited for clarity.

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