Renee Quinn, University of Waterloo; Wim van Dalen, Dutch Institute for Alcohol Policy STAP & EUCAM; Utrecht, the Netherlands, May 2022
This article is reposted for technical reasons, September 2025
Introduction
Restrictions on alcohol marketing in the Netherlands, and worldwide, focus mostly on restricting exposure to vulnerable groups. In terms of preventing harm caused by alcohol marketing, the term ‘vulnerable people’ almost always implies adolescents and young people. There is increasing awareness that the definition of vulnerable groups should be expanded to include those with Alcohol Use Disorders (AUDs). Additionally, most research focuses on the impact of alcohol advertising on young people and there is very little peer reviewed research on the impact of alcohol marketing on those with AUDs.
This article explores the impact of alcohol marketing on individuals with an AUD through semi-structured interviews. Despite the limited number of studies on alcohol advertising and its effect on those with AUDs, their experiences closely mirror the findings that are available in scientific literature. Through their stories, this article intends to draw attention to the need for increased restrictions on alcohol advertising to all vulnerable groups, not just young people. Their stories are intended to inspire researchers to further explore this topic and to motivate policy makers and health experts to push for more encompassing restrictions on alcohol marketing.
How does alcohol use impact the Netherlands?
Alcohol use is extremely common in the Netherlands, with 74% of the population over 12 years of age having consumed alcohol in 2021 (CBS, 2022). In the latest figures released by the Netherlands Central Bureau of Statistics (CBS) for 2021, 7% of people in the Netherlands were classified as excessive drinkers, while 8% were classified as heavy drinkers. Excessive drinkers are defined as those over 18 years who drank more than 21 glasses a week for men, or more than 14 glasses a week for women. The CBS defines heavy drinking as adults over 18
years of age who, per week, drink more than 6 drinks in one day (men) or more than 4 drinks per day (women) (CBS, 2022). Excessive and heavy alcohol use was prevalent in all prosperity levels, with an increase in more prosperous groups (9% excessive, 10% heavy in prosperous groups versus 6% excessive and 7% heavy in groups with lower prosperity). Education level did not affect excessive and heavy alcohol use as much as prosperity, but as education and prosperity are related, higher education level was associated with an increase of alcohol use (CBS, 2022). The Dutch Health Council advises “not to drink alcohol, and if you do, no more than one glass per day”. Forty-one percent of Dutch people over 18 years state they do not drink alcohol at all, or at most one glass per day (CBS, 2020).
Alcohol use is a risk factor for over 200 health conditions, including cancer, liver disease and stroke (Alcohol Health Alliance, 2021). In 2019, alcohol was partly attributable to 8,339 deaths in the Netherlands from cancer, cardiovascular problems, liver disease, pancreatitis, diabetes, accidents, and self-harm (GBD Risk Factor Collaborators, 2019). In 2021, emergency visits caused by alcohol use were recorded in every age group, with 3,200 visits due to intoxication, and 15,300 visits due to alcohol caused accidents and violence (Veiligheid.nl, 2020). Given these statistics, it is obvious that alcohol related costs are significant. A study by the National Institute for Public Health and the Environment (RIVM) estimated that alcohol cost the Netherlands between 2.3 and 4.2 billion euros in 2013, when accounting for the cost of lower labour productivity, use of police and judiciary, and traffic accidents (National Institute for Public Health, 2019).
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013), Alcohol Use Disorders (AUDs) are “characterized by impaired control over alcohol consumption and an increasing pattern of alcohol use despite significant damage affecting global health, the lives of family members and friends, andsociety in general”. AUDs are a leading risk factor for early death and disability among 15 to 29 year old’s and are one of the most prevalent mental health issues in our society (Landreat, et al., 2020).
The NEMESIS study examined the proportion of Dutch people who ever abused alcohol and those who are alcohol dependent, as defined by the DSM-5 (see Table 1 for definitions of alcohol abuse and alcohol dependence). Using a sample of 6,646 respondents, the study found that 14.6% of Dutch people had abused alcohol in their lifetime and that 2% were considered alcohol dependent (de Graaf, ten Have, & van Dorsselaer, 2010). In 2021, the population of the Netherlands was approximately 17,606,800 people. If we use the findings from the NEMESIS study, we can estimate that there may be around 352,000 people with alcohol dependence in the Netherlands. Of course, this number may be higher due to underreporting of alcohol addiction in society. Many individual, environmental and alcohol related risk factors influence the chance of developing an AUD (Landreat, et al., 2020). These factors can include alcohol availability, the cultural meaning of alcohol in society, and alcohol marketing strategies (Landreat, et al., 2020).
Table 1. Classification of AUDs by the DSM-5
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Classification of Alcohol Use Disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) |
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Alcohol Abuse a pattern of inappropriate alcohol consumption evidenced by at least one of the following four criteria:  |
Alcohol Dependence the person meets at least three of the following criteria: |
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• Repeatedly consuming alcohol so that it is no longer possible to meet obligations at work, school or at home to a significant extent. • Drinking repeatedly in dangerous situations (e.g., driving under the influence). |
An individual: |