Blockchain Papers

Taisia Huckle, Kristen Mummert, Antonia C. Lyons, Tim McCreanor · 6 authors

INTRODUCTION: The study aims are to: (i) explore methods for identifying alcohol company marketing in metaverses; (ii) identify current types of alcohol marketing in metaverses; and (iii) identify dominant portrayals and meanings of alcohol marketing in these settings. METHODS: Our design was exploratory, employing various approaches to identify alcohol company marketing across multiple metaverses. In stage one, we systematically navigated through metaverses as an avatar, documenting and coding all instances of alcohol company marketing. In stage two, the research team collaboratively explored and discussed excerpts of this marketing. The team thematically analysed the transcribed discussion, identifying key meanings and interpretations of immersive and interactive alcohol marketing. RESULTS: Stage one: alcohol company marketing was identified in two metaverses, Decentraland and Sandbox. Within those metaverses were five alcohol company marketing experiences: Heineken Silver, Jose Cuervo Tequila, Wisher Vodka, San Matias Tequila, and Mason Martell Cognac. Marketing strategies included immersive commerce, virtual drinking, immersive branding, immersive engagement, gaming, non-fungible tokens (digital assets), education, non-player characters promoting brands and virtual event-based marketing. Stage two: themes identified were: (i) immersive branding, representing continued exposure to brands that were both foregrounded and on the edge of users' awareness; (ii) immersive engagement, including alcohol-related gaming, quests, and alcohol production; (iii) avatars simulating drinking behaviour (virtual drinking); and (iv) immersive commerce representing how metaverse alcohol marketing may drive alcohol transactions. DISCUSSION AND CONCLUSION: Alcohol companies are using novel immersive marketing techniques in metaverses. The impact on the experiences and drinking behaviours of users are unknown and require investigation.

Daihun Kang

Abstract Background The intersection of cryptocurrency, especially Bitcoin, with public health issues, particularly synthetic opioid-related deaths, presents an emerging field of study. This research explores the statistical relationship between Bitcoin market fluctuations and synthetic opioid mortalities, against the backdrop of Drug Enforcement Administration (DEA) enforcement actions. Methods Utilizing data from 2009 to 2022, this study employs Pearson correlation and linear regression models to investigate the relationship between annual Bitcoin price fluctuations and synthetic opioid-related death rates, alongside DEA domestic arrest trends. Results A pronounced positive correlation (r = 0.92) was found between Bitcoin price changes and synthetic opioid mortality rates, with the Bitcoin price accounting for approximately 84.78% of the variance in opioid-related deaths (R² = 0.8478). The analysis also notes a disparity between increasing synthetic opioid fatalities and decreasing DEA domestic arrests. Conclusions The findings reveal significant correlations between Bitcoin price fluctuations and synthetic opioid-related fatalities, highlighting potential gaps in current drug enforcement strategies. This study underscores the need for an interdisciplinary approach to address the complexities introduced by cryptocurrency in the opioid crisis and suggests the necessity of integrating financial and public health strategies to combat emerging drug abuse trends.

Taisia Huckle, Sally Casswell

Harmful product producers, such as alcohol companies, are exploring and already active in the metaverse [1]. Much in the same way as alcohol companies have used digital media platforms to embed alcohol into young people's lives [2-7] and shape behaviour through an all-encompassing marketing environment [8], alcohol company activities in the metaverse that similarly foster excessive consumption and addictive behaviour [9] may pose new and greater risks for young people and other vulnerable groups, accelerating the need for a regulatory response to alcohol marketing. The simplest way to describe the metaverse is as an immersive next-generation version of the internet using virtual or augmented reality technology [10]. The metaverse is a digital immersive reality that combines aspects of social media, online gaming, augmented reality (a digital overlay projected on the real world) [10], virtual reality (accessed using a headset to see and operate within a digital world) and cryptocurrencies [11, 12]. It is a fast-evolving collection of interactions, technologies and business models that will look very different from today's internet [13]. While the metaverse is still young, in the future there may be numerous sophisticated metaverses, providing the infrastructure, especially bandwidth, can be developed to support them [12]. The metaverse will be an observable digital universe made up of millions of digital galaxies (metaverses/platforms) [14]. Each metaverse will likely be designed based on the needs it serves, for example, Meta (previously Facebook) anticipates friends socialising [15] while others envision a place parallel to the physical world where you spend your digital life [16]. The metaverse will offer innovative and expansive economic opportunities for corporations and users alike. The ultimate vision for the metaverse is a world that has its own fully functioning economy, jobs and shopping centres [17] or, in other words, platforms for human leisure, labour and existence in general [10]. Metaverses in which alcohol companies are active will be relevant for public health. Alcohol corporations are developing innovative ways of embedding alcohol into consumers' lives in the metaverse [18]. They were early movers in previous digital technologies and similarly are engaging with the metaverse in its development. Not only will alcohol advertising be more immersive compared to social media platforms and therefore more impactful, but also young people and other vulnerable groups such as those on a path to becoming heavy drinkers will likely be targeted for advertising, much as they are now in social media digital spaces but with expanded access to and analysis of their individual data. These can include the use of biometrics such as heart rate, tracking eye movement and pupil dilation, which are required to produce the immersive experience of virtual reality but can also be used to identify a user's interests and buying preferences [19]. The metaverse can facilitate the integration of virtual and real-life consumption experiences. Like social media, the metaverse may utilise targeted advertising and consumer participation, integrating them with purchasing [20-22] and delivery in real-time to consumers. One company has already linked their virtual drinks to their real-world products where buyers are sent a six-bottle case of actual vodka [23]. These processes will likely be enhanced in the metaverse as e-commerce will evolve into i-commerce (immersive commerce) [13]. Users (as avatars) will be able to enter a virtual alcohol shop or wine retailer and interact with the store avatar. Each bottle will tell you about itself—before you make a physical decision to purchase [13], after which a rapid delivery service may deliver alcohol to your location. Rapid online alcohol delivery is already expanding in many countries and is of concern as it is under-regulated [24]. Consumers will be able to go to virtual bars and buy virtual drinks [25]. Miller Lite is opening its first virtual bar and Heineken has opened a virtual brewery in Decentraland [26, 27]. Young consumers are already interacting in virtual bars in the metaverse [23]. The metaverse can allow for enhanced engagement with alcohol marketing. Engagement with merchandise will be facilitated by branded items being created in collaboration with upcoming Non Fungible Tokens artists (Non Fungible Tokens are blockchain-based tokens that each represent a unique asset like a piece of art, digital content, media or land title) [11], as well as new ways to encourage engagement via consumer-driven and viral advertising [28]. Brands do not necessarily expect the end result to be an immediate purchase; the bigger win is the chance to build a brand pathway, develop a relationship and engage in deeper dialogue with audiences that turns users into followers, customers and, hopefully 1 day, brand evangelists [29]. The metaverse could boost the impact of techniques already used by marketers. Influencers on social media have the power to affect purchase decisions of others because of their authority and popularity [30]. The metaverse will allow influencers to interact in 3D, to hold alcohol-branded events, concerts or virtual parties. Celebrities, famous musicians and users could be invited and attend. The power of influencers, paid for by alcohol companies, is likely to be magnified in an immersive environment and the metaverse will provide new ways to ‘influence’. Manipulation exploiting psychology and our reward system could be used in the metaverse [31] given these tactics are already employed on social media [9, 32]. One example is dark advertising exploiting cognitive bias [33] or dark patterns to create a cycle that provides unpredictability, which gives consumers dopamine hits [34]. In social media these are likes and shares, or the excitement of seeing what's new in the feed. In the metaverse, there will be unpredictability in 3D [34]. Unpredictability can include attending an alcohol branded concert or alcohol sponsored party to meet celebrities. Consumers can be a part of any exciting event they choose, which can then elevate dopamine levels [34]. The ‘addiction by design’ techniques already harnessed on social media by global industries producing harmful products [9] will likely become more innovative and exacerbated in the metaverse. Behavioural scientists have raised the need to scrutinise the development of the metaverse given the enhancement of the negative aspects of social media [34] and because commercial interests have also recognised the potential impact of these concerns and responded accordingly. The social media platforms most involved in the development of the metaverse, including Facebook, now renamed Meta, have recognised the potential concerns of regulators in relation to issues such as data privacy. Facebook has established a research fund to collaborate with ‘policymakers, experts and industry partners to build the “metaverse” in a responsible manner’. This includes engaging with academic institutions on issues such as biometrics and human computer interaction and privacy models in the context of wearables such as virtual reality headsets [35]. While the metaverse is still in its early stages of development, public health needs to understand the metaverse. How will producers of harmful products target, engage and capture the attention of young people in the metaverse? What will the health impacts be? Or will young people drink less because they spend their time in the metaverse engaged in other activities, such as investing in Non Fungible Tokens or property, or socialising? Public health also needs to learn lessons from the failures to regulate alcohol on Facebook, Instagram, Twitter and social media generally. Many metaverses are being developed by private companies in the current unregulated environment, which means the problems we have regulating technology companies now could be reproduced and amplified in the metaverse [36]. Relying on self-regulation by corporations has been shown to be ineffective [37]. Prohibiting alcohol marketers from using user-generated content and distributing content that is intended to be shared by consumers, such as in Finland, does not affect marketers' ability to increase consumer engagement—the most important aspect of marketing in terms of effectiveness [38]. While some countries have bans on alcohol marketing online including social media, no good evaluations have been completed [39]. Other metaverses are user owned, where users may have the rights to sell direct ads [40] and it is not known how these could be regulated. Policy makers need to understand the metaverse and the potential challenges it poses to public health. Early research documenting developments is needed to avoid the same failure to act in time, as happened with social media [36]. While early engagement with the creators and owners of metaverses may lead to enhanced user safety, it is more likely government regulation will be needed, including a global treaty. What is certain is that we cannot let the metaverse develop unscrutinised, nor without effective strategies to protect the health and well-being of young people. Taisia Huckle: Conceptualisation; writing – original draft. Sally Casswell: Conceptualisation; writing – review and editing. Open access publishing facilitated by Massey University, as part of the Wiley - Massey University agreement via the Council of Australian University Librarians. None.

Cristian Bortes, Susanna Geidne, Charli Eriksson

BACKGROUND: In 2013, around 40 % of the schools in Sweden had structured programs to prevent tobacco and alcohol debut in compulsory school. There has unfortunately been a lack of scientific evidence to support most of the prevention methods focusing on primary prevention in schools in Sweden. The aim and purpose of the present study is to evaluate the effectiveness of the Non-Governmental Organization SMART contract-signing strategy in reducing the growth of youth substance use and other problem behaviors amongst Swedish adolescents. METHODS: Students from five schools in a medium-sized Swedish municipality were surveyed in three waves from 7(th) to 9(th) grade of compulsory school. We used General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures smoking, use of snus and alcohol, drunkenness, delinquency, and bullying significantly changed different amounts over time in groups that had participated in the SMART program for long time, a short time, sporadically- or not at all. Groups were compared on demographic background variables, and outcome measures were assessed on all measurement occasions by a one-way ANOVA. The magnitude of group differences at the end of the study was estimated according to Cohen's d. RESULTS: Number of years with a contract has an effect on the levels of self-reported youth problems in 9(th) grade. We found small to medium-sized differences in measured outcomes between students who participated in the program for the longest period of time, 5 years, and who participated for the shortest time, 0-2 years. CONCLUSION: Findings suggests that the SMART program has preventive effects on adolescent substance use.

H. Adger, Shonali Saha

Alcohol is the drug of choice among youth, with 12% of 8th-graders, 22% of 10th-graders, and 29% of 12th-graders reporting heavy episodic drinking. Although prevalence rates are at historic lows, alcohol use continues to be widespread among adolescents, and pediatricians must screen for underage and family alcohol use in health assessment visits.After completing this article, readers should be able to:National surveys make it clear that the use of alcohol among adolescents is both widespread and harmful. By the 12th grade, close to three-quarters of adolescents in high school report ever having an alcoholic drink, and more than one-quarter report having their first drink before age 13 years. Data from Monitoring the Future, an annual survey of youth in the United States, show that 71% of high school seniors reported some experience with alcohol in the past; 41% reported use in the last 30 days and, of great concern, 3% reported daily use. More than one-half (58%) of 10th-graders and more than one-third (36%) of 8th-graders report having consumed alcohol at some point in their lives, and more than one-third of 10th-graders (37%) and one of six 8th-graders (16%) report having been drunk in the past. (1) The good news is that the use of alcohol by teens, as well as the use of many of the illicit drugs, has declined over the past decade. The bad news is that, although these declines are encouraging, alcohol remains the drug of choice among youth.The pattern of alcohol use that is exhibited by many adolescents is one of drinking too much and at too early an age, thereby creating problems for themselves, for people around them, and for society as a whole. Underage drinking is a leading public health problem in this country. Underage drinkers consume, on average, four to five drinks per occasion approximately six times per month. By comparison, older adult drinkers, ages 26 and older, consume, on average, two to three drinks per occasion approximately nine times per month. A particularly worrisome trend is the high prevalence of heavy episodic or binge drinking in adolescents, which is defined often as five or more drinks in a row in a single episode. Monitoring the Future data show that 12% of 8th-graders, 22% of 10th-graders, and 29% of 12th-graders report engaging in heavy episodic drinking.Studies find that drinking alcohol often starts at very young ages. Moreover, studies indicate that the younger children and adolescents are when they begin to drink, the more likely they are to engage in behaviors that can harm themselves and others. Those who start to drink before age 13 years, for example, are nine times more likely to binge drink frequently as high school students than those who begin drinking later. Data from recent surveys show that approximately 10% of 9- to 10-year-olds have already started drinking; nearly one third of youth begin drinking before age 13, and more than one in four 14-year-olds report drinking within the past year. (2)(3)A number of studies show that the early onset of alcohol use, as well as the escalation of drinking in adolescence, are risk factors for the development of alcohol-related problems in adulthood. Initiating alcohol use earlier in adolescence or in childhood is a marker for later problems, including heavier use of alcohol and other drugs. Individuals who report initiation of alcohol use before age 15 years were four times more likely to meet criteria for alcohol dependence and two times more likely to meet criteria for alcohol abuse as those individuals who began drinking after age 21 years. (4)The consequences of underage drinking include a range of physical, academic, and social problems. Perhaps most frightening is the fact that alcohol is the leading contributor to morbidity and mortality in youth. Alcohol use is the leading contributor to death due to injuries, the primary cause of death in individuals younger than 21 years of age. Annually, 5,000 youth die of alcohol-related injuries that involve underage drinking. This includes injuries sustained in motor vehicle crashes (∼1,900), homicides (∼1,600), and suicides (∼300), as well as unintentional injuries not related to motor vehicle crashes. Among studies of adolescent trauma victims, alcohol is reported in 32% to 45% of hospital admissions. The association between alcohol use and violent behavior is well documented. Numerous studies of adolescents report that alcohol use is linked to both violent behavior and to violence-related injuries. (5)(6)Other harmful behaviors and negative consequences frequently related to excessive drinking among adolescents are high-risk sexual behaviors (unplanned and unprotected intercourse); sexual misconduct, including rape; and assaults. Having multiple sexual partners, failing to use condoms, and performing other high-risk sexual behaviors have been associated with alcohol use in adolescents. Furthermore, alcohol use by the offender, victim, or both has been linked to sexual assault, including date rape.As youth move from adolescence to young adulthood, they encounter dramatic physical, emotional, and lifestyle changes. Developmental transitions, such as puberty and increasing independence, have been associated with alcohol use. Because drinking is so widespread among adolescents, simply being an adolescent may be a key risk factor for initiation of alcohol use, as well as for drinking dangerously.Data from imaging studies show that the brain continues developing well into the twenties, during which time it continues to establish important communication connections and further refines its function. Many believe that this lengthy developmental period may help to explain some of the behaviors characteristic of adolescence, such as the propensity to seek out new and potentially dangerous situations. For some adolescents, thrill-seeking includes experimenting with alcohol use. Developmental changes also may offer a possible physiologic explanation for why teens act so impulsively, often not recognizing that their actions—such as drinking—have consequences.How adolescents view alcohol and its effects also influences their drinking behavior, including whether they begin to drink and how much. An adolescent who expects drinking to be a pleasurable experience is more likely to drink than one who does not. Beliefs about alcohol are established very early in life, even before entering elementary school. Before age 9 years, children generally view alcohol negatively and see drinking as bad and associated with adverse effects. By approximately age 13 years, however, their expectancies shift, becoming more positive. Accordingly, adolescents who drink the most also place the greatest emphasis on the positive and arousing effects of alcohol.Differences between the adult brain and the brain of the maturing adolescent may explain why many young drinkers are able to consume much larger amounts of alcohol than adults before experiencing the negative consequences of drinking, such as drowsiness, lack of coordination, and withdrawal or hangover effects. This unusual tolerance may help to explain the high rates of binge drinking among many adolescents and young adults. At the same time, adolescents appear to be particularly sensitive to the positive effects of drinking, such as feeling more at ease in social situations, and young people may drink more than adults because of these positive social experiences.Children who begin to drink at a very early age (before age 12 years) often share similar personality characteristics that may make them more likely to start drinking. Young people who are disruptive, hyperactive, and aggressive—often referred to as having conduct problems or being antisocial—as well as those who are depressed, withdrawn, or anxious, may be at greatest risk for alcohol problems. Other behavior problems associated with alcohol use include rebelliousness, difficulty avoiding harm or harmful situations, and a host of other traits seen in young people who act out without regard for rules or the feelings of others (ie, disinhibition).Some of the behavioral and physiologic factors that converge to increase or decrease a person’s risk for alcohol problems, including tolerance to alcohol’s effects, may be linked directly to genetic factors. For example, being a child of an alcoholic or having several alcoholic family members places a person at greater risk for alcohol problems. Children of alcoholics (COAs) are between 4 and 10 times more likely to become alcoholics themselves than are children who have no close relatives with alcoholism. (7) COAs also are more likely to begin drinking at a young age and to progress to drinking problems more quickly.Research shows that COAs may have subtle brain differences that could be markers for developing later alcohol problems. For example, by the use of newer brain-imaging techniques, scientists have found that COAs have a distinctive feature in one brainwave pattern (called a P300 response) that could be a marker for later alcoholism risk. (8) Some studies suggest that these brain differences may be particularly evident in people who also have certain behavioral traits, such as signs of conduct disorder, antisocial personality disorder, sensation-seeking, or poor impulse control. (9)Drinking and alcohol-related problem behavior reflect a complex interplay between inherited and social-environmental factors, the implications of which are only beginning to be explored in adolescents. And although even more is understood about the role and contribution of genetics, this knowledge still does not tell the entire story.Social and environmental factors, such as the influence of parents and peers, also play a role in alcohol use. For example, parents who drink more and who view drinking favorably may have children who drink more. Other influences, such as the impact of the media, have been examined and are felt to play an important role. Today, alcohol is widely available and aggressively promoted through television, radio, billboards, and the Internet.Although the severe health problems associated with harmful alcohol use are not as common in adolescents as they are in adults, studies show that adolescents who drink heavily may put themselves at risk for a range of health problems.Chronic heavy drinking during adolescence and into young adulthood appears to be associated with detrimental effects on brain development, brain functioning, and neuropsychological performance. Recent evidence suggests that heavy drinking during adolescence is associated with poorer neurocognitive functioning during the young adult years and is associated particularly with impairment of attention and visuospatial skills. (10)Brain imaging and studies of event-related potentials have demonstrated subtle but significant abnormalities in brain structure and function. In a recent study, researchers used magnetic resonance imaging to determine the effects of heavy drinking on the changing brain structure of teens and young adults with alcohol use disorders. Hippocampal volumes were smaller in youths with alcohol use disorders than in matched controls and correlated with the onset of alcohol use disorder and with the duration of alcohol use disorder. (11) The earlier an individual developed an alcohol use disorder and the longer the duration of the alcohol use disorder, the smaller was the volume of his or her hippocampus. (12) Other studies have looked at the effect of alcohol on the structure of white matter and have demonstrated that white matter integrity was reduced in the corpus callosum of youths with alcohol use disorders.Research studies indicate that a number of factors seem to influence how and to what extent alcohol affects the brain, including:Elevated liver enzymes, indicating some degree of liver damage, have been found in some adolescents who drink Young drinkers who are or liver enzymes, even with only of both and puberty is a period associated with including in the and in increase of other and factors, which are for alcohol during this period of and development (ie, before or during may the for development of and are the in the in of At the same time, they experience high rates of mortality and morbidity because of their behavior, including the use of many including adolescence is a time of risk and for many young people in some of that alcohol use. 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Barbara S. McCrady

The USA is entering an era of major change in the financing and delivery of health-care services, including a greater emphasis on evidence-based treatment. Mainstream US alcohol treatment is an amalgam of experience- and evidence-based approaches; the National Institute for Health and Clinical Excellence (NICE) alcohol guideline could provide a model for reform in the USA. The NICE guideline 1 on the diagnosis, assessment and management of harmful drinking and alcohol dependence should be required reading for anyone concerned about evidence-based approaches to alcohol treatment. The guideline was developed to ‘improve standards of care, diminish unacceptable variations in the provision and quality of care … and ensure that the health service is patient centred’ (p. 13). Under the UK single-payer model, once a NICE guideline is published and disseminated, local health-care groups are expected to develop a plan to implement the guideline. The guideline covers five major domains, offering a comprehensive set of recommendations that carefully distinguishes the needs of persons with harmful drinking/mild alcohol dependence from the needs of those with more severe dependence. Key recommendations focus on the therapeutic relationship; family involvement; use of standardized assessment tools; development of agreed-upon drinking goals; use of care coordination and case management; use of evidence-based treatments, such as motivational interviewing, Twelve-step facilitation, behavioral couple therapy, and pharmacotherapies; mutual help groups; treatment of comorbid psychological problems; and outcomes monitoring. This is an excellent guideline, but could it be applied in the USA? The delivery of alcohol treatment is quite different in the USA than in the UK; these differences might limit the applicability of the guideline. In the USA, alcohol and drug problems are typically treated in the same programs, and the administration of policy and services occurs through a single state authority over both alcohol and other drug issues. There are approximately 13 000 substance abuse treatment programs in the country. Treatment is provided through private programs, funded through health-care insurance, self-payment, or endowments; and public programs, funded through sources including Medicaid (for low income individuals and those with disabilities), Medicare (for older adults) and block grants from the Federal government to each state. Each of the 50 states independently governs the system of care within that state; sometimes authority is assigned at the county level (with 3033 counties or county-equivalents in the USA). The large number of programs and decentralization of authority challenge the application of any uniform standard across the country. The vast majority of US programs view alcohol problems from a disease perspective and incorporate Twelve-step principles into the treatment, but more than half also say they have adopted motivational interviewing, motivational enhancement therapy, and cognitive-behavioral approaches 2. The primary goal of treatment is typically abstinence from all psychoactive drugs. In contrast to the UK, the USA has no systematic approach to incorporating research findings into alcohol treatment, nor are there US-wide mandated standards of care. The US Preventive Task Force (USPSTF) is tasked with making evidence-based recommendations about preventive and treatment health services, leading to guidelines for clinical care that are adopted by Medicaid and Medicare. The only alcohol-related USPSTF guideline is for alcohol screening and counseling in primary care settings 3. Various other groups have developed and promulgated practice guidelines 4; some private insurance companies use such guidelines for the purposes of reimbursement. The structure and delivery of health-care services in the USA is likely to change considerably with the 2008 passage of mental health/substance abuse parity legislation, and full implementation of the 2010 Patient Protection and Affordable Care Act (ACA) (upheld by the US Supreme Court in June 2012). The ACA requires that alcohol and other substance use disorders (SUD) be part of the ‘essential health benefit’ package and prohibits insurers from denying coverage for pre-existing conditions. The ACA mandates SUD/mental health screening and referral in primary care settings. It is anticipated that expanded health-care coverage will lead to a greater number of individuals with SUDs who have insurance, resulting in a greater demand for SUD services. The guideline represents a different philosophical approach to alcohol problems than that of the current US system and there are significant differences in the systems of care, but many of the assessment and treatment recommendations are highly pertinent to the USA. Philosophically, the mainstream US treatment system takes a medical approach. A formal Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis is required, and individuals are referred to as ‘patients’ or ‘clients’ (versus ‘service users’ in the guideline) who receive ‘treatment’ (versus ‘care’). Although programs and providers aligned with the guideline perspective exist in the USA, they do not represent a majority. Views of the family also differ. The guideline recognizes family engagement and support as a central component of treatment; mainstream US programs rarely, or only superficially, include a family component in treatment. The guideline is supposed to lead directly to changes in the delivery of services; currently the USA has no similar system to enforce change. With the full implementation of the ACA, the USA will have to develop better ways to deliver evidence-based treatments and monitor/enforce their use; the UK system could provide a model. The US integration of alcohol and other substance use services within the same programs could make it more difficult to apply the guideline in the USA. However, there are sufficient similarities in the service delivery systems in terms of levels of care and differentiation of service needs based on problem severity that many of the guideline recommendations could be adopted. The guideline recommends the use of standardized measures to assess individuals seeking services. The US system also is moving to a standardized intake assessment model, with many states requiring the use of the Addiction Severity Index 5. The US system would do well to consider the more alcohol-specific measures recommended in the guideline. The selection of drinking goals continues to be more controversial in the USA than elsewhere. The guideline provides a sensible, evidence-based model for working collaboratively with clients to select treatment goals; the USA should more fully embrace that model. Finally, the guideline provides an excellent blueprint for selection of treatments based on presenting concerns and the severity of the drinking problem. The research literature that underpins the recommendations represents work of US, UK and other European scientists, suggesting a knowledge base that is generalizable across cultures. More fully adopting the assessment, goal-setting and treatments recommended by the guideline could improve outcomes and efficiency in the US system. In conclusion, the Guideline Development Group (GDG) has performed an incredible service for those affected by problematic drinking. The US system of care is in a state of change as the ACA and the attendant changes in health-care delivery are enacted across the country. Philosophical perspectives on drinking problems and approaches to treatment are evolving slowly in the USA; the perspective and recommendations of the GDG should form a blueprint for advancing efficacious treatments on both sides of the Atlantic. None.