A new analysis comes as non-alcoholic drinks soar in popularity. BMJ It warns that without strong regulation and a focus on real alternatives, these products have the potential to widen inequalities and undermine proven alcohol control measures.

study: How should public health respond to the rise in non-alcoholic and low-alcohol beverages? Image credit: Franck Legros/Shutterstock.com

Recent analysis and evidence-based policy reviews BMJa group of authors reviewed existing research and policy evidence on the health effects of low-alcohol and non-alcoholic drinks and outlined evidence-based principles to maximize potential benefits while reducing risks.

Non-alcoholic drinks are on the rise amid uncertainty about the impact on public health

Non-alcoholic or low-alcohol drinks have become one of the most popular choices in the UK (England), 20% of adults consume them at least sometimes. This reflects a broader global trend towards healthier and more moderate drinking habits.

These products are widely available in supermarkets and social gatherings, where they are promoted as safer options. These may help reduce the health risks associated with alcohol as an alternative to stronger drinks, but there remain concerns about their marketing, fairness, and potential unintended consequences.

It is very important to understand whether these drinks actually help reduce the population’s alcohol consumption or whether they primarily serve as a profit-making strategy. The authors stress that current evidence is limited and further research is needed to determine who benefits most, in what circumstances, and at what costs.

Non-alcoholic and low-alcohol drinks are becoming more popular

Non-alcoholic and low-alcohol beverages, commonly referred to as “no-alcohol and low-alcohol” (nolo) beverages, contain little or no ethanol and are designed to taste like traditional beer, wine, and spirits.

in Englandthese products do not contain more than 1.2% alcohol by volume (ABV), you can call them “low alcohol”. These are different from weaker alcoholic beverages that still contain enough alcohol to cause intoxication and long-term health effects, and non-alcoholic alternatives such as: kombucha Or botanical soft drinks.

Sales of these products are rapidly increasing in high-income countries due to improved production techniques, health trends, and consumer interest in flexible drinking patterns. Analysts expect this growth to continue across the world, primarily in Europe, North America, Asia and parts of Africa.

However, despite their growing popularity, noro drinks still make up a small proportion of total alcohol sales, highlighting the gap between consumer awareness and actual substitution at a population level. Many of these items share brands with alcohol, which can change the way people view drinking.

Public health benefits of alternatives

The main potential health benefit of non-alcoholic and low-alcohol beverages is that they can replace ethanol-rich beverages. When people choose these products over standard alcoholic beverages, their risk of alcohol-related harm may decrease. This is especially true for heavy drinkers, people with limited resources, and those who drink in high-risk situations, such as during pregnancy, adolescence, or before driving.

Research shows that some people have already started switching to non-alcoholic drinks. Still, the magnitude of this substitution appears modest and its effects may be too small to produce significant health gains at the population level. At social gatherings such as pubs and restaurants, these drinks may allow you to participate without consuming alcohol or feeling left out. They may also support attempts to reduce alcohol consumption, but evidence of their effectiveness in addiction treatment and recovery settings remains limited and should not be assumed.

Not everyone switches to non-alcoholic drinks equally. Because the prices of these products are often similar to alcoholic beverages, people from lower socio-economic classes who experience alcohol-related harms use them less. Therefore, without targeted policies, non-alcoholic beverages may worsen rather than improve health disparities.

Marketing practices and new risks

Although non-alcoholic and low-alcohol beverages may have some benefits, they also raise serious public health concerns. One of the big issues is surrogate marketing, where alcohol brands use non-alcoholic variants to circumvent advertising bans. By leveraging shared branding, lookalike packaging, and sporting event sponsorships, alcohol companies can maintain brand visibility in spaces where traditional alcohol marketing is limited, such as televised sporting events and family-friendly venues.

There are also concerns that these products and their marketing may cause cravings in people in recovery, or may signal pregnancy or attempts at abstinence. The authors stress that the evidence for these effects is limited and often outdated, but they argue that the potential risks warrant caution. Although solid evidence of a “gateway effect” has not yet been established, surrogate marketing can expose children and adolescents to these products from an early age, potentially normalizing alcohol brands before they reach legal drinking age.

Additionally, alcohol-free spaces such as gyms, family events, and workplaces help establish social norms. Allowing alcohol-branded products in these locations could weaken the boundaries that protect vulnerable populations. However, some consumers may welcome alcohol-free alternatives, especially in environments where soft drink options are limited.

Industry impacts and policy issues

Another challenge lies in the alcohol industry’s role in framing non-alcoholic and low-alcohol beverages as solutions to alcohol-related harms. By promoting these products, companies position themselves as public health partners while potentially resisting more effective measures such as price controls, advertising restrictions, and reduced availability of high-strength alcohol.

International guidance from the World Health Organization (who) stressed that substitutes should not be used to circumvent existing regulations or expand the marketing of alcohol to new audiences. Nevertheless, policy responses vary widely across countries.

While some governments have expanded regulations on the sale of alcohol to include common branded non-alcoholic products, others have allowed sponsorship and advertising under existing loopholes, resulting in uneven public health protection across regions and between more tightly regulated and more liberal alcohol markets.

Labeling practices further complicate matters. Terms such as “light” or “reduced alcohol” can mislead consumers about the actual alcohol content and undermine informed choices.

Principles of public health precautionary response

A precautionary approach to non-alcoholic and low-alcohol beverages prioritizes public health over commercial interests, without assuming greater benefit or harm in advance. Key principles include promoting authentic alternatives to high-strength alcohol, ensuring equal visibility of alcohol-free options within licensed premises, and protecting alcohol-free spaces from brand infringement.

Policies should aim to create clear regulatory definitions that distinguish between non-alcoholic beverages and low-strength alcohol or soft drinks. Price incentives, availability standards, and social marketing campaigns may help promote substitution, especially among high-risk groups. At the same time, marketing restrictions should apply equally to non-alcoholic products that share branding with alcoholic beverages. Protecting public health from industry influence requires transparent policymaking that draws on lessons from the harm reduction debate for other consumer products, such as e-cigarettes and formulated foods.

Non-alcoholic beverages are promising but not a guaranteed solution

Non-alcoholic and low-alcohol beverages represent both an opportunity and a challenge for public health. If they were completely replaced by stronger alcohol, it could potentially reduce illness, injury, and social harm. However, current evidence suggests that both benefits and risks remain uncertain and context-dependent. Without clear rules and regulations, these products can promote harmful marketing practices and undermine proven alcohol control measures.

A balanced, precautionary approach that fosters substitution, protects at-risk groups and limits commercial impact is essential. Strengthening the evidence base and aligning policy with public health priorities will determine whether non-alcoholic and low-alcohol beverages become a meaningful tool for harm reduction or a missed opportunity.

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