The “Ravages” prevention campaign on the risks of alcohol was developed following the publication in 2017 of an expert opinion on public discourse regarding alcohol (see box). This expert group produced a number of recommendations, highlighting the importance of informing the public that the health risks of alcohol consumption increase with the amount consumed, that there is no such thing as risk-free alcohol consumption, and that guidelines for lower-risk consumption exist. The 2019 campaign was the first by Santé publique France to address the long-term risks associated with alcohol and to raise awareness of the consumption guidelines.

It therefore had two main objectives:

• To improve the public’s understanding of the medium- and long-term risks associated with alcohol consumption. Three health conditions were highlighted during the campaign: cancer, hypertension, and cerebral hemorrhage.

• To publicize the new lower-risk drinking guidelines, formulated as "No more than two drinks a day, and not every day."

Ultimately, the goal was to reduce the proportion of drinkers who consume more than the recommended limit in order to reduce alcohol-related morbidity and mortality in the long term.

The first broadcast of the campaign in March–April 2019 was evaluated through a longitudinal follow-up survey of 4,002 drinkers (sample selected using the quota method). They were surveyed online before the campaign (February 22–March 18), immediately after the first broadcast (April 17–May 12), and approximately 6 months later (September 25–October 15): 2,538 people responded to all three survey waves.

The main indicators of the evaluation were: knowledge of the risks highlighted in the campaign (cancer, hypertension, cerebral hemorrhage), knowledge of the guidelines, and self-reported alcohol consumption in relation to the guidelines.

After the campaign was broadcast, a link was observed among drinkers—including those who exceed the recommended limit and are therefore at greater health risk—between exposure to the campaign and greater awareness of the “two drinks maximum a day” guideline, as well as of the risks of hypertension and cerebral hemorrhage. Another positive finding was the association between exposure to the campaign and a decrease in the proportion of high-risk drinkers across the sample. On the other hand, there was no association between exposure to the campaign and knowledge of the link between alcohol and cancer, or knowledge of the benchmark number of days without consumption.

Further analysis revealed differences based on the respondents’ profiles: the link between exposure to the campaign and a reduced proportion of high-risk drinkers was observed primarily among women, and the link with improved awareness of the risks of high blood pressure related to alcohol consumption was observed only among more affluent social groups.

The positive results nevertheless diminished over time: all favorable effects observed were insignificant after six months.

These results support the scientific literature, showing that mass media campaigns on alcohol risks can be effective in improving public knowledge about the subject and changing attitudes toward it. Evidence regarding the effect on reducing alcohol consumption is weaker. However, recent experimental studies show that campaigns combining messages on long-term risks and consumption guidelines can potentially have an impact on drinking habits. The strength of our study lies in how it demonstrates, under "real-world" conditions, that a social marketing campaign on alcohol can influence knowledge and behavior.

The fact that the campaign’s effects are no longer noticeable after a few months is consistent with the scientific literature (including for campaigns on topics other than alcohol) and supports the case for repeating large-scale campaigns. The 2019 campaign was therefore successively improved (creation of new visuals and more educational messages on risks and guidelines, adaptation of the media plan to ensure high visibility among target audiences) for six repeat broadcasts over four years.

Today, our studies show that alcohol still has a predominantly positive image among the public, that guidelines for lower-risk consumption remain insufficiently known, and that the risks associated with even small amounts of alcohol are either unknown or viewed with detachment from one’s own consumption. It therefore seems necessary to continue de-normalizing alcohol and to remind people that alcoholic beverages pose health risks, even in small doses. Changes in perception take time... and changes in behavior even more so.

To avoid the habituation effect with the “Ravages” campaign, we are developing new communication tools. The “Good health has nothing to do with alcohol” campaign, set to launch in January 2023, reminds people of the long-term risks of alcohol and invites them to reflect on the role it plays in their lives by highlighting a widespread cultural absurdity: raising a toast to “good health”… with an alcoholic drink.

January, the month for New Year’s resolutions, is a good time to reflect on our drinking habits: hence the Dry January challenge, launched in France in 2020 by a group of organizations, based on a model developed in the United Kingdom. It is a one-month alcohol-free challenge to examine one’s relationship with alcohol and observe the benefits to one’s quality of life. The evaluation conducted by the agency in 2020 highlighted the value of this initiative in helping people step back and reduce their alcohol consumption.

The Alcool Info Service website (see box) offers support in this process of reflection and reducing consumption. It also provides advice and assistance if needed. Furthermore, it offers a digital tool, the “alcohol meter,” which allows users to compare their consumption with the guidelines and to assess the health risks they are taking.

In addition to social marketing aimed at the general public and the remote assistance tools provided by Alcool Info Service, Santé publique France is carrying out other work on alcohol prevention: dissemination of measures aimed at specific groups, such as young people, with the objective of reinforcing protective behavior in a festive context (the “Amis aussi la nuit” campaign); evaluation and promotion of several programs to strengthen life skills among adolescents; advocacy for regulatory measures that support reduced consumption (e.g., restrictions on advertising for alcoholic beverages). It is the combination of these efforts that may ultimately create a favorable environment for changing the image of alcoholic beverages and lead to a decrease in drinking in France.