The adverse consequences of alcohol consumption include the negative consequences of drinking on individuals other than the drinkers themselves, including both health and social problems. Several terms have been used to refer to this concept, including for instance: the secondhand effects of drinking, social harm from others’ drinking, collateral damage from alcohol, negative externalities, alcohol-related social victimization and alcohol’s harm to others. Alcohol’s harm to others (HTO) is an interactional occurrence at the level of individuals and their relationships and is determined from the perspective of those affected by the drinker rather than from the perspective of the drinker or the society. The major social relationships to drinkers involve four main sets of roles: family, friend, co-worker and stranger.

Alcohol's Harm to others (HTO) from drinking has been more widely publicized in recent years. It has been recognized as a potential focus for alcohol policy and social development. Thus, the issue of HTO was identified as one of four priority research areas (along with fetal alcohol spectrum syndrome, alcohol-related infectious disease and alcohol policy implementation in low- and middle-income countries – LMICs) at WHO Research Initiative on Alcohol, Health and Development meeting in Stockholm in 2009. Thereafter, the Global strategy to reduce harmful use of alcohol was adopted in 2010, and alcohol’s harm to others was recognized as a major category of negative outcomes of alcohol consumption, and as one of the main areas to be addressed. Children, adolescents, women of child-bearing age, pregnant and breastfeeding women are highlighted as target populations which are at high risk of alcohol-attributable harm. Many policy options are proposed in order to prevent harm to others from drinking, and it is recognized that accessible support and service systems should be provided for those who are affected by drinkers. 

The study

In 2011, WHO, the Thailand Health Promotion Foundation (ThaiHealth) and the Centre for Alcohol Policy Research (CAPR) agreed to collaborate in conducting and supporting an International research project on harm to others in LMICs, under the Memorandum of Understanding between WHO and ThaiHealth on Health Promotion (MOU).

The main goal of the study is to understand the scope and magnitude of HTO, to measure the extent of recognition and ways of addressing HTO  in  health  and  social  service  agencies, and to draw out the implications of the findings for policies and interventions to reduce the harmful use of alcohol and its consequences.

The main objective of the study is to chart and measure the many ways in which drinking may adversely  affect  others  around  the  drinker, and the diverse responses to such harms by societal response agencies, in a selection of LMICs. A second objective is to compare profiles and prevalence of HTO between societies, as well as within each society, and to develop and test hypotheses about explanations of the differences found,  with  a  view  to  improving  preventive policies and the public health response to HTO.

The Master Research Protocol Phase I and Phase II

The study is designed in two phases, using two types of “windows” to get a view of alcohol’s harm to others in the society, including (i) a general population survey: asking a cross-section of the population about their personal experience with HTO in both the private and the public spheres and (ii) agency caseload studies: the actions and records of health and social response agencies, which deal with injury, crime, child neglect and family problems. In looking at the issue through both windows, and comparing the distributions and patterns found, the study aims for a balanced approach relevant to prevention of as well as societal responses to HTO.

The WHO/ThaiHeath Master Research Protocol Phase I and Phase II were developed in the course of the MOU WHO/ThaiHealth10. The protocols were approved by the WHO Research Ethics Committee (ERC) in June 2012 and April 2018, respectively. These protocols were for application in LMICs in a collaborative project, to study HTO in each society and also to make cross-national analyses. The protocol is also expected to be more widely applied in future projects, including in developed countries.

Apart from in the nine countries in the cross-national comparative project,  this HTO survey was conducted in many countries worldwide, including the USA, six Northern European Countries (Denmark, Finland, Iceland, Norway, Sweden and Scotland), Switzerland, Scotland, Ireland, Brazil and Belize. Two main HTO global research networks are: IGSAHO – International Group for Studies of Alcohol’s Harm to Others and GENAHTO - Gender, Alcohol and Harm to Others, an international study group with US funding for comparative survey analyses on alcohol’s harm to others, 2016-2020, involving more than 40 countries.

List of publications

Laslett, A.-M., Room, R., Waleewong, O., Stanesby, O. and Callinan , S.(Eds) (2019), Harm from others’ drinking: patterns in nine societies. Geneva: Word Health  Organization.

Callinan, S. et al. (2019) Harms from a partner’s drinking: an international study on adverse effects and reduced quality of life for women. The American Journal of Drug and Alcohol Abuse, 45:2, 170-178, https://doi.org/10.1080/00952990. 2018.1540632

Room, R., Callinan, S., Greenfield, T.K., Rekve, D., Waleewong, O., Stanesby, O., Thamarangsi, T., Benegal, V., Casswell, S., Florenzano, R., Hanh, TMH, Hettige, S., Karriker-Jaffe, KJ, Obot, I., Rao, G., Siengsounthone, L., and Laslett, AM. (2019) The social location of harm from others’ drinking in ten societies. Addiction   144:3,   425-433 https://doi.org/10.1111/add.14447

Stanesby, O., Callinan, S., Graham, K., Wilson, I., Greenfield,TK., Wilsnack, S., Hettige, S., Hanh, TMH., Siengsounthone, L., Waleewong, O., & Laslett, A.-M. (2018). Harm from known others’ drinking by relationship proximity to the harmful drinker and gender: A meta-analysis across ten countries, Alcoholism: Clinical and Experimental Research. 42(9): 1693-1703 https://doi.org/10.1111/ acer.13828

Waleewong, O. et al. (2018) Seeking help for harm from others’ drinking in five Asian countries: variation between societies, by type of harm, and by source of help, Alcohol & Alcoholism, 53(6): 667-673 https://doi.org/10.1093/alcalc/agy044

Waleewong, O. et al. (2018) Harm from others' drinking-related aggression, violence and misconduct in five Asian countries and the implications. Int J Drug Policy 56: 101-07. https://doi.org/10.1016/j.drugpo.2018.03.015

Laslett, A.-M. et al. (2017) A multi-country study of harms to children because of others' drinking, Journal of Studies on Alcohol and Drugs; 78(2):195-202. doi: 10.15288/jsad.2017.78.195 10.15288/jsad.2017.78.195

Laslett, A.-M. et al. (2016) Scoping response system management of alcohol’s harm to others in lower middle- income countries, Nordic Studies on    Alcohol    and    Drugs;    33:5-6. https://www.degruyter.com/view/j/nsad.2016.33.issue-5-6/nsad-2016-0043/nsad-2016-0043.xml

Callinan, S., Laslett, A.-M., Rekve, D. et al. (2016) Alcohol’s harm to others: an international collaborative project. The International Journal of Alcohol and Drug Research, 5(2): 25-32. http://dx.doi.org/10.7895/ijadr.v5i2.218