Abstract
Southeast Asia plays a vital role in the global alcohol trade, with rapid economic growth and increasing intra-regional travel contributing to shifts in alcohol consumption. This descriptive review of publicly available data sources aims to assess the extent to which alcohol control policies in Southeast Asia align with the World Health Organization (WHO)’s SAFER framework. Data on alcohol consumption, gross domestic product (GDP) per capita, religious demographics, and life expectancy were obtained from recent publicly available sources, including the World Bank Group and the WHO. Policy data were collected from official legal documents in each country’s official language(s). Measures targeting drink-driving, alcohol availability, and alcohol advertising were most frequently implemented. All countries had some form of alcohol taxation, although levels and structures varied. Treatment services for alcohol use disorders were seldom available. The findings highlight key policy gaps and regional disparities in alcohol regulation. These insights may guide policymakers and stakeholders in developing more effective and harmonized alcohol control strategies. Limitations of the review include the lack of detailed data on policy enforcement and the exclusion of alcohol-related policies not covered by the SAFER framework.
What We Already Know
The WHO launched the SAFER initiatives in 2018 to support countries in reducing the harmful use of alcohol.
The current socioeconomic conditions in Southeast Asia create an environment conducive to increased alcohol consumption.
There are variations within the region regarding national-level alcohol control policy.
What This Article Adds
This descriptive review identified policy gaps and regional disparities in alcohol control.
Measures targeting drink-driving, alcohol availability, and alcohol advertising were most frequently implemented.
Treatment services for alcohol use disorders were seldom available.
Introduction
Southeast Asia is a dynamic and developing region that plays a key role in the global economy, including in the production, trade, and consumption of alcohol. For this article, Southeast Asia refers to the region that includes Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Viet Nam. The region’s diverse economic and cultural landscape presents both challenges and opportunities for alcohol control. Although slightly less than half of the population in Southeast Asia identifies as Muslims, among whom drinking is religiously discouraged, however, per capita alcohol consumption has steadily increased over the past decades until the onset of the COVID-19 pandemic. 1
A primary driver of this trend is economic transformation. Economic development is strongly associated with an increase in alcohol consumption, 2 likely due to the availability of disposable income. 3 Over the past 20 to 30 years, most countries in the region have shifted from low- to middle- or upper-middle-income status,4,5 characterized by economic growth, increased urbanization, higher disposable incomes, and lifestyle changes that have normalized alcohol use. 3 The region’s economies are highly interconnected, featuring extensive intra-regional trade and tourism. In tourism-driven nations like Malaysia, Singapore, and Thailand, a substantial proportion of visitors comes from the neighboring countries, further reinforcing cross-border alcohol marketing and consumption. 6 Given these interdependent economies and socioeconomic conditions, the alcohol consumption and resulting alcohol-attributable harms in Southeast Asia are expected to rise. Consequently, alcohol control should be viewed not only as a national concern but also as a shared regional goal.
The current socioeconomic conditions in Southeast Asia create an environment conducive to increased alcohol consumption, making the region a priority growth market. 7 At the same time, however, the health and social harms associated with alcohol consumption, particularly among youth and urban populations, are increasing. Alcohol consumption in Southeast Asia contributes substantially to the region’s disease burden, with alcohol-related deaths and disability-adjusted life years (DALYs) accounting for a large proportion of the total burden. 8 Tuberculosis, road injuries, liver cirrhosis, and other unintentional injuries are leading causes of the burden of alcohol-attributable deaths. 9 The region also faces challenges related to infectious diseases and mental health disorders, with alcohol use exacerbating these conditions. The burden is further compounded by weak regulatory frameworks, limited enforcement, and aggressive industry interference.1,8
Recognizing the global burden of alcohol-related harm, the World Health Organization (WHO) launched the SAFER initiative in 2018 to support countries in reducing the harmful use of alcohol. The initiative comprises five evidence-based, cost-effective strategies: (1) strengthen restrictions on alcohol availability; (2) advance and enforce drink-driving countermeasures; (3) facilitate access to screening and treatment; (4) enforce bans on alcohol advertising; and (5) raise prices through excise taxes. The SAFER aims to strengthen the implementation of the Global Strategy to Reduce the Harmful Use of Alcohol and contribute to achieving Sustainable Development Goals. 10
Country-specific assessments of alignment between national alcohol control policies and the SAFER framework were conducted in 2019 by the WHO South East Asia Regional Office (WHO SEARO). 11 However, as other Southeast Asian countries were members of the Western Pacific Regional Office (WHO WPRO), the review did not include the entire region. Other countries in Southeast Asia have adopted SAFER measures, but the implementation of the initiative has been uneven and often fragmented. While the Association of Southeast Asian Nations (ASEAN) Framework for Action on Alcohol Control exists 6 in addition to the SAFER framework, the lack of regional coordination, coupled with policy gaps and regulatory loopholes, undermines the overall effectiveness of these efforts. 1 While some nations have made notable progress, others continue to struggle with enforcement and industry interference.
In this context, there is an urgent need for a comprehensive review that provides multilateral insights, compares policy approaches, and identifies strategic gaps across the region. It also offers an opportunity to generate multilateral insights and promote policy coherence across borders. The reviews also have the potential to serve as the basis for mobilizing a regional-level Framework Convention on Alcohol Control. 12 Therefore, the objective of this descriptive review was to assess the extent to which alcohol control policies in Southeast Asia align with the framework of the WHO’s SAFER interventions.
Methods
In this article, Southeast Asia refers to the nation-states that are members of the ASEAN, which includes Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam.
Recent Developments in Socioeconomic Conditions and Alcohol Consumption in Southeast Asia
Based on common determinants of alcohol consumption identified in the literature,8,13 -15 we summarized the median age, gross domestic product (GDP) per capita, adjusted for purchasing power parity (PPP), annual GDP growth, and the proportion of the population who identified as Muslims, using the most recently available data from public sources.16 -18 As alcohol consumption is known to correlate with life expectancy, 19 we also summarized changes in life expectancy at birth among countries in Southeast Asia. We did not include sex distribution, as the sex ratios in all countries in the region were deemed to be broadly similar. 16 As investigators started conducting this review in 2024, the year 2022 was the year in which the most recent data were available for all countries in the region and reported socioeconomic conditions using data from the mentioned year.
Data on alcohol consumption included the prevalence of current adult drinkers (i.e., consuming at least one standard drink in the past year), the prevalence of heavy episodic drinkers (consuming at least 60 g or more of alcohol during one drinking occasion in the past month), and adult (15 years and older) alcohol per capita consumption (APC). The APC was calculated based on recorded consumption (based on taxation and sales data) and unrecorded consumption (alcohol consumption not captured through taxation or sales databases, such as homemade alcohol, smuggled alcohol, and surrogate alcohol). The APC was also corrected for the consumption of both inbound and outbound travelers for each country. All indicators of alcohol consumption were obtained from the WHO’s 20 Global Information System on Alcohol and Health.
Alcohol Control Policy in Southeast Asia
The authors developed a framework based on WHO’s SAFER interventions, examined their respective countries’ laws and regulations in relevant languages, and compiled the findings. The authors from each country reviewed alcohol control laws and regulations in their country and compiled the review tables. In addition, a summary of WHO 21 data on alcohol taxation was included.
Results
Socioeconomic and Demographic Characteristics
As of 2022, the ten Southeast Asian countries examined exhibited considerable diversity in their population sizes, per capita incomes, economic growth rates, religious compositions, and life expectancies (Table 1).
Characteristics of Countries in Southeast Asia (2022 Data).
Abbreviations: PPP, GDP per capita, gross domestic product per capita (adjusted for purchasing power parity, in Current International Dollars.
United Nations, 2024.
Central Intelligence Agency, 2024.
World Bank Group, 2024.
The median age varied substantially across countries, with Lao PDR having the youngest median age at 24.0 years and Thailand the oldest at 39.2 years. Life expectancy at birth in 2022 ranged from 67.3 years in Myanmar to 83.0 years in Singapore. Economic indicators exhibited a wide range of variation in 2022. The GDP per capita based on PPP (GDP-PPP) ranged from $5203 in current international dollars in Cambodia to $141 943 in Singapore. Annual economic growth rates also varied, with Malaysia experiencing the highest growth at 8.65%, while Brunei Darussalam recorded a negative growth rate of −1.63%. Religious affiliation varied greatly across these nations. The proportion of the population identifying as Muslim ranged from less than 1.00% in Vietnam to 87.00% in Indonesia.
Alcohol Consumption Patterns
Data from 2022 on alcohol consumption further highlight the diversity within the region, particularly influenced by religious demographics (Table 2). Countries with predominantly Muslim populations, such as Brunei Darussalam and Indonesia, reported very low annual APC of less than 1 L. Specifically, Brunei Darussalam had an APC of 0.5 L recorded and 0.2 L unrecorded, while Indonesia reported 0.1 L recorded and 0.02 L unrecorded. 20
Age-Standardized Prevalence of Alcohol Consumption in the Past 12 Months, Heavy Episodic Drinking in the Past 30 Days, and Alcohol Per Capita Consumption Among the Population 15 Years and Over (2022 Data).
Sources: World Health Organization. 20
Abbreviations: Current drinkers, individuals who drank alcohol within the past 12 months before data collection; APC, alcohol consumption per capita (in liters of pure alcohol); HED, heavy episodic drinking.
The percentage of current drinkers and those engaging in heavy episodic drinking (HED) varied across the non-Muslim majority countries. The prevalence of current drinkers ranged from 21.5% in Myanmar to 70.8% in Singapore (Table 2).
In several countries, particularly Cambodia, Laos, and Vietnam, unrecorded (untaxed and unregulated) alcohol consumption accounted for a considerable proportion of the total alcohol consumption. For example, in Vietnam, recorded APC was 3.7 L, while unrecorded APC was 7.9 L. In the Lao PDR, recorded APC was 7.7 L, and unrecorded APC was 3.7 L (Table 2).
Alcohol Policies and Alignment With World Health Organization’s SAFER Recommendations (2020 Data)
Of the ten countries with data available in 2016, Cambodia, Indonesia, Lao PDR, Singapore, Thailand, and Vietnam had specific national alcohol policies, with Cambodia, Thailand, and Vietnam having a national action implementation plan. Malaysia did not have a particular national alcohol policy but an action plan for implementing an alcohol policy. While the Philippines has implemented various alcohol-related policies, there was no national alcohol policy or action plan for alcohol policy implementation.
Table 3 depicts the availability of alcohol control policies in each country. All ten countries had some form of alcohol control. Muslim-majority countries were less likely to have policies regarding alcohol availability control than Muslim-minority countries.
Alignment of Alcohol Control Policies With the WHO SAFER Framework (2024 Data).
Sobriety checkpoints refer to places where roadside tests are administered to evaluate whether an individual is driving under the influence of alcohol. Blood alcohol concentration/content (BAC) refers to the percentage (%) of ethanol in the blood based on the mass of alcohol per mass of blood. Random breath testing refers to the roadside checks of randomly selected motorists by the police to take a preliminary breath test to assess blood alcohol level based on breath analysis results. Such procedures are called “compulsory breath testing” in some countries.
Abbreviations: AUD, Alcohol Use Disorder; BAC, Blood Alcohol Concentration; Bru, Brunei Darussalam; Cam, Cambodia; Ind, Indonesia; Lao, Lao PDR; Mal, Malaysia; Mya, Myanmar; Phi, The Philippines; SBI, Screening and Brief Intervention; Sin, Singapore; Tha, Thailand; UHC, Universal Health Coverage; Vie, Viet Nam.
0.05% for non-professional and 0.0 for professional and motorcycle drivers.
0.05% for general drivers and 0.02% for minors and professional drivers.
Restrictions on Alcohol Availability
Most countries in the region, including Cambodia, Lao PDR, Myanmar, the Philippines, and Vietnam, set the Minimum Legal Purchase Age (MLPA) at 18 years. In contrast, Indonesia and Malaysia had an MLPA of 21 years, while Thailand’s MLPA was 20 years. Brunei Darussalam had a unique policy: it banned alcohol for Muslims entirely and set the MLPA at 18 for non-Muslims consuming alcohol in private premises.
Regarding restricted hours or days of sale, countries including Cambodia, Indonesia, the Philippines, Singapore, and Vietnam do not have restrictions. In other countries, restrictions varied from specific dry days, such as Buddhist holidays in Thailand, to general limitations on opening hours for both on-premises and off-premises sales. Restrictions on the location of alcohol outlets existed in Indonesia, Laos, Thailand, and Vietnam. In Thailand, alcohol sales and consumption were prohibited at places of worship, educational institutions, government offices, bus and train stations, public piers, and public parks. Thailand banned online alcohol sales. None of these governments maintained a complete monopoly on alcohol sales; however, some had state-owned enterprises involved in the production or distribution of alcohol.
Drink-Driving Countermeasures
All countries had policies addressing drink-driving. Most countries set Blood Alcohol Concentration (BAC) limits for drivers. These limits varied, with some countries having a general limit (eg, 0.05% BAC) and others having lower limits for young/novice drivers or professional drivers. For instance, the Philippines and Thailand had a 0.05% BAC limit. Lao PDR and Myanmar had a BAC limit of 0.08%. Cambodia and Vietnam had a 0.00% BAC limit. Indonesia did not specify a BAC threshold but required drivers to operate vehicles reasonably with full concentration.
Random breath testing was infrequently reported in most countries; however, sobriety checkpoints were commonly implemented in several countries, indicating ongoing efforts to deter drink-driving.
Screening, Brief Interventions, and Treatment
Policies enabling access to screening, brief interventions, and treatment for alcohol use disorders were generally weak or absent across the region. Only a few countries, such as Thailand, specifically mentioned universal health coverage (UHC), including treatment for alcohol use disorders, along with policies for screening and brief interventions within primary health care settings. Some countries, like Singapore, did not specify UHC. Pharmacological treatment for relapse prevention was unavailable in most countries. In the Philippines, naltrexone was included in its Essential Medicine List (EML). 22 However, the accessibility and availability remain contingent on a physician’s prescription. Thailand included acamprosate and naltrexone in the National Medicine List in 2024, alongside disulfiram, and they were covered under UHC. 23 However, these medicines remained unavailable in the public medical service system due to their high cost. This finding reveals a significant gap in addressing alcohol-related harm through the health care system.
Bans or Comprehensive Restrictions on Alcohol Advertising, Sponsorship, and Promotion
Most countries had some form of restrictions on alcohol advertising, although the scope varied. Brunei Darussalam implemented a complete ban on alcohol sales and public consumption. Vietnam had partial restrictions across TV, radio, and social media. Thailand also imposed extensive limits, including prohibitions on both direct and indirect advertising. Singapore prohibits advertising to minors, although minors may still appear in alcohol ads. The industry’s Code of Practice was self-regulated and not legally mandated in Singapore. Similarly, the Philippines only had non-statutory and voluntary industry measures on alcohol marketing, with a limited government-issued guideline on the commercial display at point-of-sale and on the sale, promotion, and advertising of alcoholic beverages. 24
Other countries imposed partial restrictions, such as banning advertising on specific media like TV and radio or during certain times, or restricting particular marketing tactics aimed at minors. However, wide-ranging bans covering all media types, primarily digital and social media, were less consistently enforced. Restrictions on alcohol sponsorship of events and in-store promotions were less common and less comprehensive. Brand stretching or brand extension was the domain with room for expansion in most countries.
Pricing and Taxation Policies
All countries had regulations or policies regarding alcohol taxation. However, the specific tax structures and rates varied significantly.
Excise tax was utilized by all countries with alcohol sales. The structure of these taxes varied: most countries used a volume-based specific tax for beer, although some, such as Indonesia, Malaysia, and the Philippines, employed an ad valorem tax or a combination of both. For wine, an ad valorem tax was common, but some countries also used volume-based specific taxes or a combination. Spirited beverages exhibited similar diversity in tax structures, including volume-based specific tax, ad valorem tax, or mixed systems, often based on ethanol content.
Discussion
This descriptive review examined alcohol consumption patterns and the current state of alcohol control policies across ten Southeast Asian countries using the WHO’s SAFER framework. Despite the region’s socioeconomic diversity, a few consistent patterns emerged. Alcohol consumption levels tended to be lower in Muslim-majority countries, reflecting cultural and religious norms. In contrast, higher levels were observed in countries with more liberal alcohol policies and growing economies. Rapid economic growth, urbanization, and a youthful demographic, particularly in countries like Cambodia, Lao PDR, and Vietnam, have created favorable conditions for increasing alcohol use and aggressive marketing expansion.
While all ten countries had some form of alcohol regulation, the extent and enforcement varied significantly. Policies with wide coverage included measures against drink-driving, taxation, and partial restrictions on advertising. In contrast, fewer countries have developed comprehensive strategies to ensure access to treatment, regulate outlet density and sales hours, or address digital and cross-border alcohol marketing. Policies related to alcohol use disorder treatment and integration into health systems were particularly underdeveloped in the region.
Brunei Darussalam stood out as an exception. Although alcohol access and taxation were not applicable due to its prohibition model, the country enforced other SAFER-related measures effectively. This coherence, despite an outright prohibition, resembles models found in other Islamic nations, such as the Maldives. 8
Several emerging concerns span the region and require urgent policy attention. First, countries such as Cambodia, Lao PDR, and Vietnam reported high levels of unrecorded alcohol consumption, sometimes equal to or exceeding recorded consumption. This presents challenges to taxation, quality control, and harm monitoring.25,26 Second, regulation has not kept pace with digitalization; online sales and marketing, especially via social media, were often under-regulated or escape enforcement. This weakens policies designed to control access and reduce exposure among youth, making it easier for unrecorded and illegal alcohol to reach vulnerable populations. 27
Third, many countries lacked regulation on brand extensions, allowing alcohol companies to market their brands on non-alcoholic products such as clothing or energy drinks. This practice can indirectly promote alcohol use among youth and complicate efforts to reduce consumption. 28
Finally, access to treatment for alcohol use disorders remained very limited. Pharmacological treatments, such as naltrexone and acamprosate, were often unavailable or unaffordable in Southeast Asia, despite policy commitments in some countries, like Thailand,29,30 to improve access. Screening and brief intervention in health care settings have been recommended in various guidelines, including the recently updated WHO Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological, and substance use disorders.31,32 However, our findings indicate that these interventions are underutilized in the real world, highlighting a significant treatment gap.
Despite shared cultural and economic ties, as well as active intra-regional trade and tourism, the region lacks mechanisms for coordinated alcohol policy. This fragmentation allows industry actors to exploit cross-border loopholes and deploy marketing strategies that circumvent national laws. 33 A regional framework, possibly modeled after the WHO Framework Convention on Tobacco Control (FCTC), 12 could facilitate harmonization of advertising regulations, minimum purchase ages, and taxation benchmarks. It could also support the development of shared data systems and cooperative enforcement mechanisms to reduce unrecorded consumption and strengthen regulatory capacities.
Future alcohol control strategies should prioritize regulations of online and cross-border marketing, especially on digital platforms, which remain poorly regulated. Screening and treatment for alcohol use disorders should be integrated into national health systems, ideally through the UHC framework. In addition, reforms to strengthen alcohol taxation, such as adjusting for inflation and expanding to cover informal producers, would help reduce affordability and consumption. Stronger enforcement of existing laws, especially those addressing drink-driving and alcohol marketing, is also necessary. Ultimately, coordinated regional action would enhance Southeast Asia’s capacity to address the evolving challenges of alcohol-related harm.
This review benefited from multilingual research capacity, allowing access to primary legal documents in local languages. However, it was limited to the scope of the WHO SAFER framework and did not include deeper legal or political economy analyses of alcohol policy development. Future research should focus on conducting detailed country-level case studies, examining enforcement mechanisms, and evaluating the impact of policies. We did not identify policy gaps at multiple levels, which limited the scope of the study’s findings. Our description of socioeconomic condition, alcohol consumption, and policy only included more recent snapshots (after 2020) but not changes over time, which limited the understanding regarding changes in these characteristics. Future studies should consider creating timelines to address this gap. Furthermore, we used life expectancy as a measure of health status in this study, which was widely available but also subject to limitations in its interpretation (e.g., competing causes of death). Future studies should consider including alcohol-attributable morbidity and mortality to enable a more comprehensive perspective. Alcohol per capita consumption provided average alcohol consumption but did not capture variables by person, place, and time (e.g., binge-drinking during festivals in tourist areas); thus, the scope of the interpretation was limited. Similarly, using prevalence data alone provided a limited view, and future studies should also include average consumption among drinkers or other measures of alcohol consumption distribution to strengthen the interpretation.
Conclusion
This review examined the link between socioeconomic development, cultural diversity, and alcohol policies in Southeast Asia. While many countries have adopted elements of the WHO’s SAFER framework, gaps remain in areas like alcohol treatment, unrecorded alcohol regulation, digital marketing control, and integration of alcohol services into health systems. Muslim-majority nations generally had lower alcohol consumption and stricter policies, whereas middle-income, tourism-focused countries with young populations experienced rising consumption and related issues. In countries where unrecorded alcohol was significant, health and regulatory challenges were especially severe.
To effectively mitigate these risks, stronger national policies should be reinforced through regional cooperation. Harmonized regulations, cross-border enforcement, and shared data systems could help improve policy coherence and curb industry influence. As the region continues to navigate rapid economic and technological transformation, collective and timely action is essential to protect public health and advance sustainable alcohol control.
Footnotes
ORCID iDs
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.