Alcohol Regulation in Scandinavia: Could It Work in the UK?
Over almost 100 years, the Nordic countries of Finland, Iceland, Norway, Sweden and Denmark have had restrictive alcohol policies.
Could any of these work in the UK? Let’s take a look at these policies and their effectiveness as highlighted in the book, “The Effects of Nordic Alcohol Policies – What happens to drinking and harm when alcohol controls change?”
What Did the Policies Involve?
There were four essential methods used to tackle alcohol use and abuse:
- State monopolies of alcohol sales
- Surveillance of alcohol users
- Restricted hours of alcohol access in bars and restaurants
- Heavy taxation
These policies were used as part of the countries’ wider welfare states whereas societies accepted a certain amount of heavy taxation and controls to their freedoms in return for free healthcare and excellent state infrastructure.
To some extent, the UK operates two of these policies, ironically policies that were shown in the book to be the least effective in managing harmful alcohol use. In the next four sections, we will look at the four policies and show you why.
State Monopolies of Alcohol Sales
For most of the last 70 years, Sweden, Finland, Norway and Sweden have operated state monopolies of alcohol sales. Every time there has been a change, academics have been ready to study what happened.
Between 1920 and 1955 Sweden operated a ration book system for certain sections of society, with even some adults like married women with children denied any access at all. Naturally, people with alcohol use issues were denied their ration books too.
In 1955, the country ended the rationing of alcohol. The immediate upshot was:
- Overall alcohol use grew by 25%
- Drinking offences such as drink-driving and public intoxication grew by 100%
- Delirium tremens for problem drinkers leapt by more than 400% from 160 a year to 700 a year
Between 1964 and 77, Sweden briefly allowed mid-strength beer (up to 4.7% alcohol) to be sold in grocery stores.
It is interesting to note that hospitalisations for violence, attempted suicides and accidental falls related to alcohol did not drop when restrictions were tightened.
This suggests a separation of the problem drinking cohort from the moderate drinking cohort.
In 1932, Finland introduced a state monopoly system of alcohol off-premises sales. These stores were few in number – just 132 across the country – with none in rural areas, and comparatively few restaurants were allowed to sell alcohol on their premises.
Roll on to 1968, and beer of up to 4.7% alcohol volume was allowed to be sold in 17,000 grocery stores and 2,700 cafes.
At the same time, 46% more restaurants and 22% more state monopoly stores sold alcohol. Medium strength beer became the drink of choice for younger people.
Beer consumption grew by 125% and spirits sales grew by 12%.
Between 1968 and 74 a study was conducted on alcohol harm. Alcohol psychosis admissions went up by 110%.
Pancreatitis admissions went up by 100%, alcoholism rates up 70%, cirrhosis by 20% and most sadly of all, alcohol-related deaths went up by 58%.
The response by the Swedish government to these rocketing problems with alcohol use was to implement heavy taxation policies between 1955-58.
The research showed that moderate drinkers cut their alcohol use. Those who had alcohol misuse problems found the heavy taxation less expensive than they did buy from the black market so continued to consume harmful levels of alcohol.
The upshot was that while heavy taxation drove overall alcohol use down to pre-1955 levels, the moderate drinkers drank far less and the heavy drinkers still drank heavily.
Surveillance of Alcohol Users
As part of the Finnish alcohol policy, from 1932 people were only allowed to buy a certain amount of alcohol a week and their purchases were noted in ledgers.
A number of categories of ‘abuse’ were listed under the national policy such as selling the alcohol you had bought someone who had breached the abuse rules, being intoxicated in public and so on.
Where the rules were breached a system of warnings, interrogation and temporary bans of up to a year were given.
In 1952 these rules were relaxed. Wine and strong wine was no longer included in surveillance notes.
There were two results – moderate alcohol users’ consumption did not increase but those who were prone to problem drinking consumed more. More people were admitted to hospital and psychiatric units for their alcohol use.
Extending Bar Opening Hours – Iceland
Until 1999, the police and hospitals had problems of a surge in fights and injuries at bar closing time that was set at 02:30 am on Friday and Saturday nights and 11:30 pm on weekdays and Sundays.
There was a national debate about to handle the situation. One side suggested tighter alcohol laws and the other allowing all night drinking to allow the police to deal with problems throughout the night as opposed to only at closing time.
The liberal side won and in 1999 a one-year pilot, later extended to two years, was introduced where Reykjavik bars and clubs could open all night with appropriate licensing.
A survey of those with late-night licenses showed that the average closing time for bars was 04:30 with some later and some earlier at night.
This is where policy seems to have gone against common sense!
- Drink driving arrests increased by 80%
- Fights leading to hospitalisations increased by 34%
- Slips, trips and falls by intoxicated people increased by 23%
Given that carnage, one would think that the authorities would have dialled back on the new regulations around licensing. The opposite happened – the country chose to extend the licensing laws to 05:30 am.
The police and hospital were happy with the fact that they had to deal with fewer incidents at a given moment, even as they markedly increased, so could better tackle the problems as they arose.
Overall Alcohol Use Isn’t Related to Overall Harm
One of the most interesting findings from the book is that imposing alcohol policies upon all parts of society doesn’t necessarily reduce the harm caused, from serious illness to violence.
When Sweden imposed high taxation upon alcohol after it ended its rationing system, moderate drinkers cut back their consumption but problem drinkers didn’t change their habits.
When Finland stopped monitoring individual wine and strong wine consumption, alcohol harm went through the roof, while moderate drinkers didn’t change their habits.
In the next section, we will show you that similar policies have been enacted in the UK with similar effects. Taxation doesn’t moderate problem drinkers’ consumption.
Could Such Policies Work in the UK?
The United Kingdom has had quite restrictive alcohol access policies in the past. In World War 1, the Defence of the Realm Act reduced pub opening hours from up to 19 hours a day to just 5.5 hours and closing time was 9:00 pm in some places.
Research showed that convictions for drunkenness fell by 79% in Liverpool and 89% in Portsmouth as a result. This is the opposite of what happened when Iceland relaxed its bar opening hours in 1999 – violence and drink driving exploded there.
Restricting the amount of alcohol that can be consumed, through rationing, surveillance, or premises opening hours, seems to have the best impact on alcohol harm. Finland, Iceland and Sweden saw large jumps in alcohol harm when restrictions were loosened.
This is also reflected in what happened during World War 1 in the UK. Limiting the availability of alcohol is the best way forward. It has the greatest impact on harm reduction where taxation seems not to have such a great effect.
Where it comes to taxation, The Lancet Public Health looked at the Minimum Unit Pricing of alcohol in Scotland, introduced in 2020. While overall consumption fell, the households that consumed the most alcohol in the study didn’t change their consumption.
This reflects Sweden’s experience we showed above, where taxation isn’t a deterrent to those who may have alcohol misuse problems.
The question that has to be asked is whether in a country where civil liberties are often touted as being important above all, could such policies be achieved?
Given the nature of today’s politics, can one see a crackdown on off-licenses and pub opening hours?
Can one see a ration book system being imposed upon citizens when the problem isn’t seen to be so severe in the public imagination?
Today is different to that of 1914 Britain that faced an existential threat from Germany. As such one cannot imagine that a Nordic alcohol policy model could get through Parliament.
Taxation is too readily offered as a solution but time and again, this has been shown to be ineffective in harm reduction.