Zero Alcohol, but Not Zero Risk?
Literature Review Paper
Previous research – Unregulated Rapid Expansion of Zero Alcohol
Shift in consumer behavior
The market for zero-alcohol products is currently experiencing a surge. It surpasses the growth rate of traditional alcohol products. This expansion is caused by advanced production methods. These methods uplifted non-alcoholic products in terms of the taste, traditionally linked with alcohol. This trend is a noticeable shift in consumer behavior and likes.
Internationally, no- and low-alcohol beverages (NoLos) comprise a group of products containing up to 3.7% alcohol by volume (ABV). In Australia, ZAPs contain under 0.05% ABV.
A range of beer, wine and spirits products are available and are manufactured to look, smell and taste the same as alcohol-containing products. However, ZAPs are not subject to the same liquor-licencing legislations and are classified as soft drinks, which are regulated under the food standards (Australia New Zealand Food Standards, 2016). This means they are available on the shelves of supermarkets and convenience stores and may even be accessible to minors.
Shift in awareness
Contemporary society also experiences a generational transition. The shift is raising awareness among individuals regarding the quantity of alcohol they consume. As a result, there is a growing inclination towards alternatives. Nevertheless, the purpose of alternative signals a dangerous result. Going for alternatives seems to be a search of the experience of alcohol without the associated alcohol.
The World Health Organization (WHO) has drawn attention to critical issues of no- and low-alcohol beverages. These beverages are often referred to as “NoLos.”
- WHO underscored a suspicious absence of regulatory frameworks and oversight mechanisms governing NoLo.
- This regulatory gap raises concerns about the potential risks.
The Gap Being Explored by Present Research
The gap addressed by this study involves the assessment of risks linked to zero-alcohol products.
This research paper explores physiological and behavioral reactions exhibited by individuals. These individuals have alcohol use disorders. The study observes their reaction when exposed to zero-alcohol products.
ZAPs are often manufactured by the alcohol industry and are being marketed as a safer, healthier alternative to alcohol.
The study asks whether ZAPs are safe for all, including those individuals with a history of alcohol use disorder (AUD) or co-occurring mental health disorders? In addition, what are the potential risks linked with ZAPs at the individual, community and population levels?
Potential risks and benefits of NoLos
On the one hand, NoLos have lower health risks than alcohol-containing products, with only negligible amounts of alcohol content, lower calories and no interaction with psychotropic medications.
As alcohol consumption often plays a dominant role in the Australian social landscape, NoLos may provide a non-alcoholic alternative while still supporting the social connection and cultural experience that is often centered around alcohol use.
On the other hand, although ZAPs have been proposed to reduce alcohol intake by the substitution of these products to their alcohol-containing counterparts, this substitution effect has not yet been supported by research, according to the WHO.
To date, there has been no rigorous research testing the safety or efficacy of ZAPs as a substitute in high risk or dependent alcohol users, and the role of ZAPs as a measure to reduce harm needs further investigation.
The researchers have gathered information from previously conducted studies.
They have examined ten studies that include data on physiological responses, cravings for alcohol, and behavioral patterns in users of NoLo beverages.
Heightened craving for alcohol
Reviewed studies suggest that users grappling with alcohol use disorders might develop heightened need for alcohol when they use zero-alcohol products.
Moreover, their bodies respond in a manner similar to when they use alcohol. This bodily response is characterised by increased heart rate and sweating. This suggests that some users are triggered for alcohol cravings by these products.
NoLo fail to be a substitute
Substituting traditional alcoholic beverages with zero-alcohol products fails in addressing social, environmental, and cultural forces perpetuating alcohol use.
In Australia, alcohol use is wide-spread.
- The introduction of zero-alcohol alternatives inadvertently has become a facilitation to early initiation of alcohol use.
- Moreover, the excessive use of alcohol is further provoked.
Indirect promotion of alcohol use
There exists a practice called “alibi marketing”. Here zero-alcohol beverages are regulated under food, rather than liquor, licensing laws in Australia. This specialized category label attracts fewer constraints on how these products can be showcased and advertised.
Paradoxically, this regulatory framework encourages the use of alcohol in risky situations.
Few tips by the study to not be deceived by ZAPs
- Acknowledge that zero-alcohol products are triggers for those grappling with alcohol addiction and young people.
- Report advertisements that instigate alcohol-related behavior and intentions.
- Advocate for a regulatory policy framework that addresses the complexities of NoLo advertisements.
These guidelines are informed by the study. The aim is to provide evidence-based recommendations to mitigate risks linked to zero-alcohol products.
Main concerns with ZAPs
There is a need to be cognisant of the potential risks that arise from the intake of NoLos.
Risk to people with (history of) Alcohol Use Disorder (AUD)
ZAPs may be of lower risk but not zero risk – particularly concerning certain groups, such people with a history of AUD. The consumption and exposure to NoLos has been shown to increase cravings and physiological responses for alcohol for people with an AUD.
ZAPs have been shown to act as cues for alcohol use among individuals with risk factors for AUD such as depression or anxiety disorders, other substance use disorders, a history of trauma or personality vulnerabilities such as behavioural disinhibition and low emotional constraint. Exposure to and witnessing the consumption of ZAPs by others may influence vulnerable individuals to consume alcohol.
In addition, the substitution to ZAPs as an alternative to alcohol does not address factors that may strongly influence alcohol use in individuals with AUD such as the sociocultural environment and peer influences.
Public health risks of NoLos
It is also important to consider the public health risks in the context of rising availability and promotion of ZAPs. They are often packaged to look like their equivalent alcohol products, with prominently displayed branding and labelling that may appear very similar to their alcoholic counterparts. This is an example of ‘alibi marketing’.
Alibi marketing is an intentional practice by the alcohol industry aimed at promoting the brand identity of the manufacturer, extending its reach to populations and places where alcohol advertising is otherwise limited or not allowed at all.
The concern is that ZAPs increase brand familiarity and awareness of alcohol products, even among non-alcohol users, such as children and adolescents.
Concerns have also been raised that ZAPs are marketed to condone and encourage alcohol use in situations and by people where it would be considered risky, such as in pregnant women or in occupational or legal situations where abstinence is mandated.
This may lead to confusing messaging where the consumption of alcohol may appear to be endorsed or normalized and send the message that equivalent alcohol-containing products are safe and harmless.
Emerging concerns highlight that ZAPs may not be zero risk.
ZAPs carry the risk of precipitating and promoting alcohol consumption, particularly in certain vulnerable or at-risk populations.
There is a need to be vigilant about how these products are being promoted and marketed. Individuals with mental health disorders that affect cognitive functioning and judgement may be particularly vulnerable and susceptible to marketing influence.
Psychiatrists need to be aware of the undue influence on patients through the promotion of ZAPs by advertisements and marketing strategies. Psychoeducation for both patients and staff about the potential risks and limitations of ZAPs is crucial.
The content and placement of alcohol and ZAP marketing in Australia are regulated by various regulatory codes, and potential risks associated with the advertising of ZAPs among a vulnerable patient population need to be monitored, particularly if alcohol consumption is being normalized or encouraged through messaging, branding and promotion.
Education to the wider community about risks of NoLos is required.
From a public health perspective, there is a role for psychiatrists to both educate others about the wider public health risks and harms due to ZAPs and advocate for appropriate and responsible marketing.