A framework convention for alcohol?

by Robin Room

Among all the psychoactive substances which humans consume, alcohol ranks very high In terms of the harms it causes. In the comparative risk analysis which was part of the recent estimates of the Global Burden of Disease for 2010, alcohol ranked second only to tobacco in harm to health.  And the GBD primarily measures harm to the health of the user.  But much of the harm from alcohol is not to the drinker, but to others – whether family, friends or strangers – and includes social as well as health harms.  The extent of this harm to others is at the same order of magnitude as the harm to the drinker – much greater than the harm to others from tobacco.  When the potential harm to others is taken into account, alcohol was recently ranked by psychopharmacologists first among psychoactive substances in its intrinsic harmfulness.

But for Europeans and Europe-derived societies, alcohol is “our drug”, intermingled for most in daily life and economically and politically in agriculture and commerce.  So Europeans have had a hard time facing up to the problems alcohol causes in a holistic way, and considering it in the same policy framing as opiates or tobacco.  The result has been that, alone among the globally used psychoactive substances, there is no international agreement and control structure for alcohol. 

There are three main reasons why alcohol should be covered by an international treaty. First, it is needed to take alcohol out of the category of being just another commodity in world trade agreements and disputes. A recent example of this is the European Union, among the parties in World Trade Organization negotiations on “technical barriers to trade”, objecting to Thailand requiring graphic warning labels on alcoholic beverages in its domestic market.  Second, it is needed to establish the principle of comity with respect to national alcohol control policies – that states will not act to undercut another nation’s domestic policies, or encourage such actions. Third, treaties like the Framework Convention on Tobacco Control or the Single Convention on Narcotic Drugs set up a system of regular international consultation and debate, building consensus and stimulating international action, as well as a continuing secretariat charged with forwarding international action. The tobacco convention is served by an international staff in the dozens and the drug treaties by staffs in the hundreds.  In comparison, the international situation for alcohol is a disgrace: there are the equivalent of maybe half a dozen fulltime positions at the World Health Organization devoted to alcohol issues.

There are two main options for putting alcohol under coverage of an international treaty. One is to begin on the process of adopting a Framework Convention on Alcohol.  While the tobacco convention would be a good model to start from, an alcohol convention would need to have some different provisions and language, reflecting the ways in which patterns of use of alcohol and the range of harms from its use differ from those for tobacco.  As the tobacco experience shows, adopting a Framework Convention will take time to accomplish.  And, as the treaty’s name implies, this is not the end of the process: there will be a continuing process thereafter of discussing and adopting protocols to implement and strengthen it.

The other option is to schedule alcohol as a controlled substance under the 1961 or 1971 drug conventions.  This process starts with a systematic review by the WHO’s Expert Committee on Drug Dependence. The report of the Committee’s meeting last June notes that at that meeting the issue of “whether ethanol (ethyl alcohol) should be considered for pre-review” by the Expert Committee was raised, and that “the Expert Committee referred this matter for consideration at a future Expert Committee meeting”.

Major issues will arise in going down this track. The most dramatic would be a need to amend the Convention under which alcohol was listed to allow the legalisation in controlled domestic markets of sale and use other than for “medical or scientific purposes”.  Sarah MacKay and I have recently completed work on what changes in the treaties would be needed to accomplish this.  However, the work was not undertaken with alcohol specifically in mind: the drug control system is presently facing circumstances, for instance regarding cannabis, which are pushing it anyway in this direction.  Presuming these issues can be solved, the provisions in the drug treaties controlling international trade and commerce in controlled drugs are a workable and serviceable system for managing international trade in hazardous commodities so that comity is maintained with respect to national alcohol control and supply systems.

Pursuing each of these options will require a long-term commitment from those interested in an international public health approach to alcohol issues.  Since it is not immediately apparent which option is more likely to succeed, I think it would make sense for the moment to pursue both.


- Nutt, D.J., King, L.A., Phillips, L.D. (2010) Drug harms in the U.K.: a multicriteria decision analysis. Lancet 376(9752):1558-1565.

- O’Brien, P. (2013) Australia’s double standard on Thailand’s alcohol warning labels.  Drug & Alcohol Review 32(1):5-10.

- Rehm, J., Borges, G., Gmel, G., Graham, K., Grant, B., Parry, C., Poznyak, V., Room, R. (2013) The Comparative Risk Assessment for alcohol as part of the Global Burden of Disease 2010 Study: what changed from the last study? International Journal of Alcohol and Drug Research 2(1):1-5. http://www.ijadr.org/index.php/ijadr/article/view/132/95

- Room, R. (2006) International control of alcohol: alternative paths forward. Drug and Alcohol Review 25:581-595.

- Room, R., Schmidt, L., Rehm, J. & Mäkelä, P. (2008) International regulation of alcohol. British Medical Journal 337 (Nov. 6):a2364.http://www.bmj.com/content/337/bmj.a2364

Room, R., ed. (2012) Roadmaps to Reforming the UN Drug Conventions. Beckley Park, Oxford, UK: Beckley Foundation. http://www.beckleyfoundation.org/wp-content/uploads/2012/12/Roadmaps_to_Reform.pdf

- Taylor, A.L., Dhillon, I.S. (2012)  An international legal strategy for alcohol control: not a framework convention – at least not yet (with commentaries and a response), Addiction 108:450-462.

- WHO Expert Committee on Drug Dependence (2012). Thirty-Fifth Report. http://apps.who.int/iris/bitstream/10665/77747/1/WHO_trs_973_eng.pdf