A sobering wake-up call around alcohol marketing

Like readers before me (The Psychologist, 2017), I was shocked to find a £75 voucher for wine with my recent issue. I, like many others, have a complicated history with alcohol and have struggled with my own alcohol use. I immediately felt that old, familiar craving – I could almost taste the wine. The promise of it being available at a cheap price was music to my ears. Coming to my senses, I threw the voucher in the bin. Others may not have been able to – this is the effect that alcohol marketing has.

On raising this with The Psychologist via X/Twitter, the response was that this had been considered before with the conclusion that 'many people can drink responsibly, and advertising income is vital to our future'. However, throughout my career exploring unhealthy marketing, I know that thinking in terms of individual behaviours and responsibility does not make much sense when we are talking about an addictive substance (Clark, 2020). Shaming people about their behaviours is unlikely to change behaviour and only shifts the blame from the industry and commercial determinants of health to an individual. 

Instead, throughout this article, I want to confront some myths around alcohol and explain how this marketing causes harm. 

Alcohol use is a growing public health priority

In England in 2022 there were 10,048 deaths related to alcohol use, an increase of 33 per cent since 2019 (Office of National Statistics, 2024) – these figures are likely to be an underestimate (Colin Angus, 2024). There were 342,000 hospital admissions (Office for Health Improvement & Disparities, 2024). On top of this, there are approximately 602,391 dependent drinkers in the UK (with only 18 per cent of these receiving treatment) (Alcohol Change UK, 2024). 24 per cent of the UK population regularly drink over the recommended guidelines (Alcohol Change UK, 2024). Alcohol use harms often go unrecognised for a long time due to most drinkers at risk of harm classifying themselves as 'moderate drinkers' (Alcohol Change UK, 2015). Most drinkers with a problem do not accept, or do not know, that they have a problem.

Whilst alcohol can lead to temporary stress relief and relaxation, long-term consumption increases the risk of mental health issues such as anxiety and depression as well as a range of different diseases throughout the body as well as cancer, leading to long-term morbidity (Iranpour & Nakhaee, 2019). And there's stigma (Alcohol Change UK, 2024) and financial harm (Scottish Families Affected by Alcohol and Drugs, 2022) that can come from addiction. This is before we even consider the wider costs to friends, family, and society.

Alcohol harm comes at a cost – approximately £27.4billion each year in costs to the NHS, criminal justice system, social services, and lost productivity (Institute of Alcohol Studies, 2024).

Alcohol marketing leads to alcohol use and normalisation of use

This sounds obvious but if it didn't work, the alcohol industry would not spend money on this. There is strong, causal, evidence that exposure to alcohol imagery and commercial communications on alcohol increases subsequent experimentation and use in adolescents (Anderson et al., 2009), and adolescents who try alcohol before the age of 15 are then more likely to develop problematic use throughout their lives (The Lancet, 2018). Furthermore, a review has shown that alcohol marketing is likely to have an effect on alcohol consumption in people with, or at increased risk of, an alcohol problem – acting as a trigger (Murray et al., 2024). Indeed, Alcohol Focus Scotland have referred to alcohol marketing as a human rights violation, undermining the right to life, survival and development, and also the right to privacy (Alcohol Focus Scotland, 2022). Pushing an addictive product on a population is harmful for the population.

The alcohol industry also influences conversations around alcohol, and there is growing evidence that the alcohol industry opposes effective alcohol regulation policies and actively engages in activities that have a negative impact on public health (Babor, 2023; Fabbri & Gilmore, 2023). This affects how alcohol is perceived in society and the social norms around its use.

What about responsible drinking? 

The alcohol industry is keen to push the line that they are socially responsible and have regularly pushed the slogan 'drink responsibly' (Alcohol Change UK, 2015; Jones et al., 2017), so much so that this has become part of the conversation around drinking. It likely influenced The Psychologist editor's response to me raising this issue. The opposite line, of course, is that harms come from irresponsible drinking. 

What is responsible drinking? Is this a pint of beer a day, a few bottles of wine on the weekends? Or any drinking which does not result in getting 'wasted'? These are all responses I've had to this question asking colleagues over the past couple of days. We've already mentioned that 24 per cent of drinkers regularly consume over the recommended amount and that there is no safe level of alcohol use (World Health Organization, 2023) – there is no such thing as 'Drink responsibly'. 

Furthermore, this concept is unclear for a reason. The ambiguous nature of the messaging leaves this open to interpretation, empowering consumers to define this themselves and therefore justify their drinking (Jones et al., 2017). Consumers position themselves as unproblematic drinkers, and therefore do not see the information or warning on the label as applying to them (Davies et al., 2022). Such slogans position alcohol use as unproblematic and an appealing part of everyday life (Alcohol Change UK, 2015) and are unlikely to lead to behaviour change (Davies et al., 2022) – it's very easy to overlook the addictive and harmful effects of alcohol when you believe that your alcohol use is unproblematic. The Psychologist has justified the use of alcohol advertising in part by referring to people's ability to drink responsibly – to continue to do so would be irresponsible.

The point of all of this is not to demonise adults having a drink – they have every right to. The point is to highlight that alcohol marketing and the alcohol industry likely nudges them to do so and encourages drinking (Alcohol Focus Scotland, 2022; Murray et al., 2024). Instead of focusing on individual factors, the path to reducing harm at a population level needs to come from a change in our relationship towards and societal norms around alcohol. The World Health Organization recommends 'best buys' to reducing this by effectively regulating marketing, price, accessibility and availability, and treatment (World Health Organization, 2011), which have all been shown to be effective for reducing alcohol harm (Rehm et al., 2023). The promotion in The Psychologist appears to market cheap, available alcohol to readers – three of the four 'best buy' areas. Removing this could reduce the prompt to drink.

What about other marketing?

Take gambling. We know this is addictive and causes harm. Would we be happy to see gambling adverts in The Psychologist? This is an opportunity for The Psychologist and the BPS to get ahead of the curve. 

An argument could also be made regarding the type of alcohol shown. This was a voucher for wine, an alcohol product associated with affluence and luxury (Decanter, 2021), and therefore likely to be perceived as positive by a professional affluent audience. Would we accept the same if the vouchers were for cheap vodka or cider?

It's also informative to consider the example of tobacco. Alcohol harm isn't quite the same as tobacco harm, but it's in the same league – both substances are a group 1 carcinogen and cause cancer (International Agency for Research on Cancer, 2024). In fact, alcohol use is known to cause seven different types of cancer (Cancer Research UK, 2023), but this information is not widely known amongst the general public (Blance North East, 2024). In fact, contrary to public opinion and the widespread myth that some alcohol (read 'red wine') is good for you – spoiler alert, it's not (Wojtowicz, 2023) – the World Health Organization has declared that there is no safe level of alcohol consumption, regardless of type of alcohol (World Health Organization, 2023). 

Once upon a time, tobacco was marketed and advertised. However, over time the harm caused by tobacco was recognised, leading to a consensus that tobacco advertising should be banned through the World Health Organisations Framework Convention on Tobacco Control (World Health Organization, 2003). Whilst there is currently no international regulation to prevent alcohol marketing like there is for tobacco, there are attempts to change this as our recognition and perception of alcohol as a harmful commodity changes over time. In 2022, the World Health Organization launched the European Framework of Action on Alcohol (World Health Organization, 2022), arguing that there needs to be attempts to control and restrict alcohol marketing. By moving away from alcohol marketing, The Psychologist and The British Psychological Society could show that they are being responsible and moving ahead of the curve.

Why should we, as Psychologists, know better?

Drinking alcohol acts on the dopaminergic system leading to a reward response, which may promote further alcohol consumption (Di Chiara, 1997). In our society, alcohol use is also inherently linked with reward – think about a glass of wine at the end of a busy day or celebrating (or commiserating) when watching your favourite sports team (Alcohol Change UK, 2024). The good feeling we get from alcohol and the links to rewards has the potential to lead to dependency and addiction (Di Chiara, 1997). 

This dependency and addiction impair a person's autonomy (Levy, 2006) and in line with dual processing theories, cue-elicited urges, attentional bias, automatic approach tendencies, implicit memory associations and cognitions promote the maintenance of addictive behaviour (Heather, 2018). Stimuli associated with alcohol use, such as social celebratory gatherings and sporting events, can become conditioned cues and evoke craving or relapse, (Beck et al., 2012), and it certainly seems as though alcohol marketing works in this way (Murray et al., 2024). 

In the British Psychological Society's Code of Ethics, section 3.3 states psychologists should 'respect the welfare of humans, non-humans and the living world'. We know that alcohol marketing leads to alcohol use, and alcohol use can lead to addiction (of which marketing drives further use). We know that alcohol harm is a public health priority, with rising morbidity and mortality from alcohol-related diseases (e.g. cancer, liver disease and heart disease). We should recognise as a profession that advertising any addictive product may lead to addiction, and thus cause harm to the welfare of humans.

My welfare was certainly not respected as I was exposed to alcohol marketing on a Sunday morning whilst reading The Psychologist – a battle which I, and many others, did not ask for or want. Removing alcohol advertising from The Psychologist would not take away the audience's right to drink. It would just remove a prompt, and an implicit validation from the BPS, for them do so. It would be the ethical thing to do. 

Recognising that alcohol marketing has an impact on behaviours and population health is an important step for our profession to take. It opens the doors for further study in this area and for us to take a stance on the commercial determinants of health. And so it's time we called time on alcohol marketing in The Psychologist and pushed for greater alcohol regulation in our society Getting our own house in order would be a good first step. 

• Dr Alex Barker (Lecturer in Psychology, University of Derby); with assistance from Greg Fell  (Director of Public Health – Sheffield, President of the Association of Directors of Public Health UK) and Professor Emma Wilson (Professor of Public Health, University of Nottingham; The Institute of Alcohol Studies).

Editor's note: As Dr Barker has noted, the inclusion of advertising inserts from an alcohol company has been discussed before, both internally and with the Psychologist and Digest Editorial Advisory Committee. We did get responses in favour of continuing to accept the advertising. The discussions also led to this special issue.

You'll note from the minutes reproduced there, the Advisory Committee was 'unclear in fact whether the question of inserts was within the remit of this committee'. This has since been clarified – it is an operational decision for me and the Director of Communications and Engagement.

My personal view, which I have shared in this discussion on social media, is that I agree with pretty much everything Alex has said, except for the ethical duty for The Psychologist to be 'ahead of the curve' on this. I fully accept the harm that alcohol can cause to many; but this is also true of many other products and services that are advertised. To a greater or lesser extent, directly or indirectly, in the short or long term, most consumption within a capitalist culture has the potential to cause harm. That's why we have regulation of the advertising industry: we, and the reputable companies who advertise with us, abide by that.

Advertising income from any one advertiser is not particularly substantial, but it is significant in the current economic climate. Income helps us to sustain a print edition, and other projects such as our podcast. I'm open about that being a factor.

To address a specific, yes, I think I would be minded to accept advertising around vodka and cider (and beer, for that matter), assuming the emphasis wasn't on 'cheap' (see Dr Barker's point about the WHO and harm reduction). That hasn't cropped up as a decision to make – advertising does tend to be 'self-regulating' to an extent in terms of the match between product and audience. As Dr Barker says, these companies advertise because there is take-up of the offer amongst our readers. 

I'll admit I would look far less favourably on gambling advertising. As Dr Barker notes, that's an inconsistency. But again, it has never cropped up, presumably again because such advertisers are aware that the recognition and perception of harm amongst our readers there is on a different level.

So overall, while I do think Psychologists have a role to play in pushing for increased regulation of alcohol advertising, I am yet to be convinced that The Psychologist should take a stand above and beyond what is already in place. I'm always willing to be persuaded otherwise, at which point I would feed into decision-making. Dr Barker's article, and the conversations I've had with him around it, is an important step in that continuing conversation.

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