Lithuania joined the European Union (EU) on May 1st 2004 and has experienced significant economic growth since then. Despite some setbacks since then (notably, the economic crisis of 2008-2010), Lithuania maintains a rapid growth rate, is a high-income country and has made significant progress in many social and economic areas. One such success story is Lithuania’s use of alcohol control policies to reduce alcohol-related harm, and particularly to improve traffic safety. In 2004, Lithuania had one of the highest tolls of traffic-related death rates in the EU, but since then has demonstrated one of the most significant improvements in the area of traffic safety. According to Eurostat, in 2004 there were 22.3 traffic deaths per 100,000 in Lithuania. By 2017, this had dropped to 6.8 (the EU averages were 9.7 and 4.9 respectively). Such an improvement may be the result of significant investment in road infrastructure and safety, social campaigns and preventive work by the government and various institutions.

 

For many years, Lithuania was also among the top alcohol consumers in Europe, leading to significant levels of alcohol-related harms (according to World Health Organization data). Lithuania has responded to the challenge by implementing a number of alcohol control policies for over a decade, some of which were also targeted at drink-driving. Such a strong policy response may be referred to as a natural experiment.

 

Jürgen Rehm and colleagues have assessed the impact of these alcohol control policies on reducing alcohol-related collisions, crashes, traffic injuries and deaths in Lithuania in an article “Alcohol control policy and changes in alcohol-related traffic harm”, published on Addiction in August 2019. An interrupted time–series analysis of routine monthly statistics from the Lithuanian Road Police Service was performed, covering a period from January 2004 to February 2019. In total 11 time points were identified when 19 different categories of alcohol control policies were implemented:

• Alcohol price and taxation:

  • Joining the EU resulted in smaller relative prices of alcohol (1 May 2004);

  • Excise tax increased by 10–20% (1 January 2008);

  • Excise tax increased by 10–15% and tax exemptions abolished for small breweries (1 January 2009);

  • Decline in affordability of alcohol due to the economic crisis (in 2009-2010);

  • Excise tax increased by 10% for beer, 14–47% for wine, 1% for ethyl alcohol (1 April 2014);

  • Excise tax increased by 15% for beer, ~10–16% for wine, 2% for ethyl alcohol (1 March 2015);

  • Excise tax increased by 8% for beer and wine, 2.5% for ethyl alcohol (1 March 2016);

  • Excise tax increased by 112% for beer, 111% for wine, 23% for ethyl alcohol (1 March 2017);

• Marketing and advertising:

  • Alcohol advertising banned on TV and radio from 6 a.m. to 11 p.m. (1 January 2008);

  • Ban on advertising alcohol (including a full ban of TV, radio and internet advertisements) with only a few exceptions, such as producer’s logo in sales areas or memorabilia like umbrellas, mugs, t-shirts etc. (came into effect 1 January 2018);

• Alcohol availability and drinking environment:

  • Retail alcohol sale time restricted from 10 p.m. to 8 a.m. with the exclusion of bars and restaurants (1 January 2009);

  • Minimum age for purchasing or consuming alcohol increased from 18 to 20 years old, (1 January 2018);

  • Off-premise alcohol sale time was limited to 10 a.m. – 8 p.m. from Mondays to Saturdays, and 10 a.m. to 3 p.m. on Sundays (exceptions: airports, ferries, train bars/shops), (1 January 2018);

  • Alcohol retailers obliged to ask for ID from consumers that look below 25 years old (1 January 2018);

• Drink-driving legislation:

  • Penalties increased to car confiscation or even imprisonment for repeat offenders, blood alcohol concentration (BAC) thresholds were reduced for young drivers to 0.2‰ (1 January 2008);

  • Ban on having alcohol in opened bottles or cans in cars (1 January 2009);

  • BAC thresholds reduced to 0‰ (zero tolerance policy) for professional drivers (taxi, buses and trucks), new drivers (under 2 years of experience) and all motorbikes (1 January 2015);

  • Alcohol sales banned in petrol stations (1 January 2016);

  • Driving with more than 1.5‰ blood alcohol concentration requalified as criminal offence (1 January 2017), amended again on 1 April 2019 to strengthen the regulation.

 

Between 2004 and 2018, the annual number of collisions/crashes and the annual number of traffic injuries decreased by more than half and the number of all-cause traffic fatalities decreased by 82% (from 508 to 93). At the same time alcohol-related traffic collisions and crashes declined by 75% (from 753 to 191, alcohol-related traffic injuries declined by 77% (from 1091 to 252) and alcohol-related traffic deaths by 85% (from 84 to 13). According to the results of time-series analysis (adjusting for secular changes, economic factors, seasonality) each implemented alcohol control policy has reduced the proportion of alcohol-attributable crashes, injuries and deaths by 0.55%, 0.60%, and 0.13% respectively.

 

When analysing the impact during the specific periods of alcohol control policy implementation (2004-2010, 2010-2014, 2014-2018), the most significant impact was observed during the latest period when alcohol sales in petrol stations were banned, excise taxation was doubled for beer and wine, and multiple availability as well as marketing restrictions came into action. The authors concluded that the overall alcohol control policies aiming to reduce population-wide alcohol consumption were related with the reduction of alcohol-related traffic crashes, injuries, and deaths.

 

The article has also received a scientific comment by Jasilionis (2019) and a response by the authors Štelemėkas et al. (2020) debating the challenges and further research of alcohol-related harms. The current study is one of the first studies planned to evaluate the effects of the natural experiment in Lithuania.

 

This text was first published in Institute of Alcohol Studies (IAS) Blog