The effect of alcohol marketing on people with, or at risk of, an alcohol problem: A rapid literature review

There is a comprehensive evidence base demonstrating the relationship between alcohol marketing and underage drinking. Far less is known about the impact of alcohol marketing on other potentially vulnerable populations, such as people with, or at risk of, an alcohol problem. For the purposes of this review, this includes people with an alcohol use disorder, in recovery from an alcohol use disorder, and
hazardous and harmful drinkers. This report presents findings from a rapid review that aimed to answer the following
research questions:
• What is the effect of alcohol marketing on drinking behaviour in adults with, or
at risk of, an alcohol problem?
• What are the psychological and neurological effects of alcohol marketing in
adults with, or at risk of, an alcohol problem?

A rapid review of primary studies was conducted with the aim of exploring the effect or potential effect of alcohol marketing on people with, or at risk of an alcohol
problem, as defined above. Studies were eligible for inclusion in this review if their populations were defined within the paper as being with, or at risk of an alcohol
problem, taking into account the possibility of different definitions in different settings. Studies were only included if results or outcomes were presented separately for at
least one of the populations of interest. Binge drinkers were not included as a population of interest in this review. Studies covering different aspects of the ‘marketing mix’ (the four Ps of promotion, place, product, and price) were included, with the exception of alcohol outlet density, labelling and non-branded alcohol cues. Children and adolescents were excluded from the review. Quantitative and qualitative study designs were eligible for inclusion. Outcomes related to alcohol use were included, as well as psychological indicators such as awareness of or noticing marketing, appeal or perception of alcohol advertisements,
alcohol craving, intentions to consume alcohol, symptoms of alcohol dependence and alcohol-related emotions and cognitions. Searches for relevant literature were conducted through three peer-reviewed electronic literature databases (from inception to November 2021), reference list
scanning and citation tracking of included studies, grey literature searching of relevant websites, and enquiries through expert networks. We undertook a narrative
synthesis of included papers, grouping studies together by population (participants with harmful or hazardous consumption levels of alcohol and those recovering from
an alcohol use disorder) and by type of study (quantitative; qualitative). The review included 11 studies, which focused on participants recovering from an alcohol use disorder (AUD, 6 studies) and those with hazardous or harmful consumption levels of alcohol (5 studies). Seven studies used a quantitative design and four used a qualitative design. Of the quantitative studies, three were crosssectional studies and four were experimental studies. A limited number of studies have investigated the effect of alcohol advertising in harmful/hazardous drinkers. In experimental studies, one included study found no effect of adverts on actual alcohol consumption, but found that alcohol advertising could influence positive alcohol-related emotions and cognitions among heavy drinkers. Another found that individuals who exhibit greater risky alcohol use are more likely to express intentions to consume alcohol upon exposure to beer than
water ads. Finally, one study found shorter reaction times in problem drinkers relative to non-problem drinkers when exposed to non-branded alcohol images in a study where participants were instructed to respond as quickly as possible to ‘go’ stimuli whilst refraining from responding to ‘no-go’ stimuli with branded and unbranded alcohol pictures as stimuli. Two cross-sectional studies highlighted the potential risks of alcohol advertising for heavy drinkers: one found that drinkers reporting symptoms of alcohol problems were more likely to notice alcohol brands in magazines and newspapers, while another found that among students, heavy drinkers perceived alcohol adverts as
more appealing; however, due to the observational designs used, neither of these studies were able to make causal inferences about the effect of alcohol advertising.
Similarly, a small number of quantitative studies have investigated the effects of advertising on drinkers in recovery. Only two studies were found, both of which
suggest a relatively small effect of alcohol advertising in this population. One crosssectional study reported that more than three quarters of participants (77%) recalled
seeing alcohol marketing in the last six months, with 24% reporting that alcohol marketing was influential. The most influential factors affecting the purchase of a
specific alcohol product included price, accessibility, the brand and alcohol percent. Using an experimental design, a further study reported increased craving after exposure to alcohol advertisements and this measure showed a positive association with the number of alcohol-dependence symptoms. In absolute terms, however, craving was relatively low.
In three interview studies, respondents indicated that alcohol advertisements triggered a desire to drink, particularly those which contained the participants’
preferred drink and even where the advertisements were perceived negatively. Some reported that they viewed advertisements as being responsible for their relapse. Television was cited as being a particularly powerful medium, with feelings that television intruded into their own home. One study further reported that music and party scenes were particularly troubling in terms of creating an association with good times. Participants in both studies reported negative emotions associated with viewing alcohol advertisements, including loss, lack of belonging, anger, sadness, guilt and exclusion from the norm. Participants in these studies reported needing to use strategies to avoid alcohol advertising, either through turning off and avoiding
adverts or recalling the negative aspects of alcohol use. The retail environment was also identified in one further qualitative study as being challenging for drinkers in
recovery. High visibility of alcohol, especially in small shops where it is harder to avoid alcohol products, and in-store advertising were identified as risks to recovery.

• Taken together, the findings of the studies included in this review suggest that an effect of alcohol marketing in people with, or at risk of, an alcohol problem
is likely.
• Several studies report effects of alcohol marketing such as influences on positive alcohol-related emotions and cognitions and alcohol craving, which may translate into effects on alcohol consumption. There is also evidence that
alcohol marketing is perceived to act as a trigger by people in recovery from alcohol problems and pose a risk to recovery.
• This review demonstrates that the impact of alcohol marketing on people with or at risk of an alcohol problem should be a concern for marketing regulators and a focus for future research.
• Future research should include longitudinal and experimental studies to determine whether alcohol advertisement has a causal effect on alcohol use in people with or at risk of an alcohol problems, including the differential effects between these groups and of different types of marketing.