The Kettil Bruun Society for Social and Epidemiological
Research on Alcohol is an international organization of scientists
engaged in research on the social aspects of alcohol use and alcohol problems.
Drugs, and Violence:
Youth Risk Taking, Behaviors and Prevention
|Maria Abrahamson||Marianne Aeberhard||Allaman Allamani|
|Airi-Alina Allaste||Ellen J. Amundsen||Barbro Andersson|
|Franca Beccaria||Agnieszka Bielinska-Kwapisz||Anders Bergmark|
|Sharon Bernards||Kim Bloomfield||Alexandra Bogren|
|Ulrika Boman||Jason C. Bond||Sander Bot|
|Didra BrownTaylor||Sandra L. Bullock||Elin K. Bye|
|Cheryl J. Cherpitel||Anita Chopra|
|Aleksandra G. Davidaviciene||Deborah A. Dawson||Andrée Demers|
|Jakob Demant||Maria Dinis|
|Karen Elmeland||Rutger C. M. E. Engels||Antonina Eriksson|
|Kaye Middleton Fillmore||Ana Maria Garcia Flores||Bridget Freisthler 1|
|Bridget Freisthler 2|
|Alejandro Garduño-Lobo||Henk F.L. Garretsen||Anne George|
|Norman Giesbrecht||Gerhard Gmel||Tahra Goraya|
|Kathryn Graham||Thomas K. Greenfield||Natera Guillermina|
|Pekka Hakkarainen||Denise Herd||Kimmo Herttua|
|Siri Hettige||Ann Hope||Geoffrey Hunt|
|Akanidomo K J Ibanga 1||Akanidomo K J Ibanga 2|
|Annika Jakobsson||Jan Joosten|
|Patrik Karlsson||William C. Kerr||Dorie Klein|
|Harald Klingemann||Hervé Kuendig|
|Paul H Lemmens||Margaret K. Libby||Ifeta Ličanin|
|Robert Lipton||Jared Lobdell||E. Anne Lown|
|Scott Macdonald||Etienne Maffli||Raquel Magri|
|Pia Mäkelä||R.A Martins||Laurence Michalak|
|Zofia Mielecka-Kubien||Robert Murray|
|Louise Nadeau 1||Madhabika B. Nayak||Thor Norström|
|Katarzyna Okulicz-Kozaryn||Hilgunn Olsen||Jenny Cisneros Örnberg|
|Esa Österberg||Jeanette Østergaard|
|Jessica Palm||Jussi Perälä||Mark Pertschuk|
|Ken Pidd||Agnieszka Pisarska||Martin Plant|
|Evelien A.P. Poelen||Christiane Poulin||Jane Powell|
|William Alex Pridemore|
|Giora Rahav||Amira Redžić||Gregory Robinson|
|Ann Roche||Robin Room||Jan Ryan|
|Veronica Santarlasci||Bo Sandberg||Marianne Saint-Jacques|
|Klara Selin||H.K.Sharma||Janusz Sieroslawski|
|Fredrik Spak||Wanda Snow||Renske Spijkerman|
|Kerstin Stenius||Tim Stockwell||Jessica Storbjörk|
|Benjamin J. Taylor||Christoffer Tigerstedt||Wendy Todd|
|Jukka Törrönen||Karen Trocki||Kalle Tryggvesson|
|Adriana M Tucci|
|Kelsey C. Underwood|
|Haske van der Vorst||Daksha van Dijck||Ninive von Greiff|
|Samantha Wells||FD Wittman 1||FD Wittman 2|
|Donald W. Zeigler||Justyna Żulewska-Sak|
Young women’s and men’s different worlds of alcohol, fear and violence in focus group discussions with 18 year olds in Stockholm
The purpose of the paper is to investigate how young women and men in focus group discussions reason about alcohol, street violence and fear of assault by a stranger and to compare the different kinds of threats that young women and men present of what might happen when they are out at night and on their way home. The interviews are analysed from the point of view of the accounts the young people give for their feelings and behaviours. The young women’s accounts are dominated by their answers to an implicit question of blame for how they ensure their security and which measures they have taken. What the young women are afraid of is rarely formulated explicitly. It goes without saying. For the young women alcohol and intoxication have no excuse value in this context. On the other hand the accounts the young men are giving for their actions consist of answers to the implicit question of blame for violence they have been involved in and also of blame for fear of violence. The young men’s picture of threat is concrete and consists of other young men of the same age. By their accounts they show that, fear of violence is something that has to be given an explanation. The young men use intoxication both as an excuse for the violence they are using and as an explanation to why violence occurs.
Natural recovery from a survey perspective epidemiology of recovery without professional treatment from addiction of alcohol, legal and illegal drugs, tobacco and pathological gambling in Switzerland relation between general and addiction-specific attitudes and natural recovery
Numerous surveys and reviews show that natural recovery is the most important pathway to change in a wide range of addiction problems. Additional information about self-change is provided from community research and studies with special samples focusing on factors contributing or impeding natural recovery. Extracted factors vary study by study but many support the importance of cognitive decision making. The study is the first survey in Switzerland conducted to assess self-change rates from different addictions and to find out about cognitive factors other than cost and benefit considerations influencing natural recovery. In a representative telephone survey (N=707) life time prevalence rates of addiction problems with alcohol, hard drugs, cannabis, prescription drugs and gambling and the respective solutions to the addiction problems are assessed. Respondents who did not seek any professional help (including self-help groups) are defined as natural remitters. This group is compared with professionally treated persons with resolved addiction problems, with currently addicted respondents both treated and non-treated and with a control group (no addiction problems). Dimensions of comparison are besides socio-demographic characteristics general attitudes such as locus of control, socio-political preferences and general trust in professional and political authorities. They are used as predictors for group classification. The study allows for an international comparison with other surveys on natural remission as the normal way to quit addictive behaviour. Characteristics which discriminate between the group of natural remitters from the other groups are outlined, using general attitudes as discriminative factors.
The Florence 1 early identification and brief intervention project
Notwithstanding the dramatic decrease in the amount of wine consumption since 1970s and of the new drinking patterns that begin to be popular among youngsters, the Italian drinking pattern still sticks to tradition, i.e. daily drinking of wine (or beer) during the mean meal. However, since 1990s, increasing attention has grown among the general population and the health professionals related to the potential physical and behavioural harm that alcohol may produce. Is of interest to note how one of the first Italian known community alcohol prevention experiences, implemented within the neighbourhood of Rifredi in Florence (1992-1998), contributed to the planning of the Italian Early Identification and Brief Intervention (EIBI) Project.
The Florence 1 EIBI project is one of the 4 official projects in the WHO Europe “Phase IV” EIBI study that were eventually funded in 2004 by the Italian Ministry of Health. The project' aim is that general practitioners and primary health Care professionals identify risky drinkers and alcohol-related problems among their clients and use communication skills to educate patients at risk to reduce drinking alcohol beverages or stop drinking if necessary. In the planning process, emphasis has been given both to the customisation of the international protocol and to the alliance with general practitioners, in order that they at least partly own the project.
As a consequence, a co-operative of Florence GPs and the Florence Health Agency have formally agreed that: (a) all the approximately 50 GPs involved in the EIBI project receive an Alcohol Training (b) a random sample of 10,000 clients (18-75 years) at GPs’ offices in two different set of communities in the province of Florence will be enrolled in the study; the two communities being Scandicci and North Chianti (c) those clients who turn out to be risky drinkers enter a 12-month brief intervention program with follow up at three months as an average (d) the interaction between physicians and their patients is randomly evaluated by means of both a self-report questionnaire and a videotape study focusing on doctor-client communication (e) the quantitative evaluation relies on the changes in both intervention rates in the doctors office and in community diagnoses of alcohol-related disease, while the qualitative evaluation relies on baseline and final interviews with key people in each of the two communities.
The project is intended to end in 2006. So far, building institutional alliances, implementing alcohol training for GPs and planning the baseline qualitative evaluation were accomplished.
Risk behaviour and drug use in connection with social environment and cultural representations
Abstract: Illicit drug use is a rather new phenomenon in Estonia as compared to Western countries. Rapid growth of illicit drug use started in the 1990s, alongside with significant social change in the society in general and the value orientations of youth in particular.
Association with different users is largely affected by social background and cultural conditions. Today it is possible to separate the recreational scene influenced by international club-culture and the marginal scene which is largely connected with criminal activities.
The empirical part of the paper is based on in-depth interviews with drug users. I have investigated different type of drug users, whose initiation into the drug scene took place according to the youth culture and the marginalisation models. Health sense and risk behaviour are mostly influenced by the drug user group, its position in society and self-perception
Moderate recreational users with high sub-cultural capital have relatively good positions in the society. According to the Levi-Strauss triangle, they perceive themselves as representing the culture, and "others" are either raw (young clubbers who exaggerate with drugs) or rotten (marginalised heroin users). This distinction stresses responsible and health-sensitive behaviour and avoids the transition to problem use. Heroin users from marginalized communities lack the capacity to make choices from the health perspective. Culturally, they have partly negative, "rotten" images of themselves – they perceive addiction as stronger than their will and are of opinion that opiates rule their lives. Having low position in society and positioning themselves "under the master of heroin" makes it hard to quit or control their drug use. Drug user groups are rather distinctive and standing apart. Social background of drug users and social and cultural reasons for drug use largely influence the future of drug experimenters and the health risks they take.
Associations between intoxication and exposure to violence in the youth population of the multicultural city of Oslo
Background: The association between intoxication and exposure to violence is well documented. It is not well documented whether such associations are the same for different ethnic groups in a multicultural society. Groups with Muslim background report a much lower level of drinking than the host population. Non-western/non-Muslim youth report a level in between those in the host population and those with Muslim background. Is the association influenced by aspects of development in a multi-cultural context for youth with immigrant background?
Methods: Data from the youth part of the Oslo Health Study conducted during 2000-2001 among 15-16 year olds were used; a total of 8,361 students in 10th grade with response rate 88.3percent.
Results: (preliminary) Intoxication was highly associated with exposure to violence. Among never drinkers 17.2 percent (CI 14.6- 19.9) of the boys and 9.0 percent (CI 7.1- 11.0) of the girls had been exposed to violence. Among those who had been intoxicated twice or more 40.9 percent (CI 38.4- 43.4) of the boys and 21.7 percent (CI 19.7- 23.7) of the girls had been exposed to violence. For boys none of the associations were significantly different between those with Norwegian background, Muslim background and Non-Western/Non Muslim background. For girls there were significant differences between those with two Norwegian parents and those with Muslim background. The girls with Muslim background report a higher level of exposure to violence than the girls with two Norwegian born parents, especially by grownups.
Conclusion: Further work will be presented.
Key words: alcohol, youth, intoxication, violence exposure, immigrants, epidemiology
The ESPAD drunkenness scale
Abstract: In the 1999 and 2003 the European School Survey Project on Alcohol and Other Drugs (ESPAD), an analogue scale, marked from 1 (somewhat merry only) to 10 (heavily intoxicated to the point of being unable to stand on my feet), was included in the questionnaire to indicate the intoxication level on the last drunkenness occasion. In addition, the scale was included, from 1999 on, in the questionnaire of the Swedish annual surveys among students aged 15-16. This paper reports primarily the findings from the six Swedish surveys. Students indicating different levels of intoxication are almost normally distributed over the scale in all of the surveys, with a slight skewedness to the right. However, when controlling for annual average alcohol consumption it is obvious that the distribution changes. Among students with the smallest alcohol consumption the distribution of the drunkenness scale is sloped from the left to the right, among students with a medium high consumption the distribution is about normal and within the group with the highest consumption it is skewed to the right. The scale is significantly correlated with the average annual alcohol intake among the students (2004: Pearson .99), the higher value on the intoxication scale the higher the annual alcohol intake. Although the subjective feeling of being drunk is very much dependent on a person’s weight and length, experience of alcohol consumption and physical condition at the time of consumption, the scale seems to measure quite well the different levels of alcohol intoxication. The paper also discusses the usefulness of the scale in other ESPAD countries with different consumption pattern and different alcohol cultures.
Key words: ESPAD drunkenness scale, students, annual alcohol consumption, alcohol culture
Prevalence of drug use in three cohorts of young Swedish women
Abstract: The study presents prevalence of drug use among 1123 women aged 20 and 25 years in Göteborg, Sweden. The aim of the study was to measure prevalence of illegal and legal drug use in three cross-sectional cohorts interviewed in 1990, 1995 and 2000 as well as to describe the development of drug use within the same period. Prevalence was calculated for illicit and licit drug use in total and for three different patterns of drug use; narcotics only, medications only or a combination of the use of these substances. Also presented is the frequency of drug use. Further were analysed trends in changes of the use of nine specified drugs. Results: Both life-time and 12-months use of illicit drugs was significantly higher for 20-year-old women in 2000 (from 20.2percent to 33.4percent and from 9.5percent to 22.3percent respectively). The use of licit drugs was highest (but not significant) among 25-year-old women in 1990. Cannabis was the most prevalent drug used with a significant increase in life-time use for 20-year-old women from 17,4percent to 28,8percent. Both age-groups reported significant increases in the use of heroin, 25-year-old women in use of psychedelica and 20-year-old women in use of other drugs. Conclusions: The prevalence rates found were higher than compared to contemporary studies in Sweden. Further was found a significant trend for using both illegal and legal drugs among the youngest cohort, and a tendency for more regular use of drugs in both age-groups in 2000.
Key words: Prevalence, illegal drug use, legal drug use, young women
The Mediterranean alcohol project: changes in the consumption of alcoholic beverages in Italy: An explorative study into the causes of the decrease in consumption between 1970 - 2000
Italy is a “wet country” traditionally characterized by high alcohol consumption, although consumption has been decreasing constantly for the last thirty years. Between 1970 and 2000 pure alcohol consumption has passed from more than 13 litres to 7,5 pro capite, with a decreasing trend without interruption. In a period of a intense European discussion about the opportunity of having more homogeneous alcohol policies among member states, the Italian case is becoming more and more interesting for his specificity: in fact, this reduction occurs in a context without any specific alcohol policy.
The aim of this study is to explore some factors that may have produced this relevant alcohol consumption reduction (in particular in wine and spirits). The data we present are the results from a qualitative field study carried out in 4 Italian regions in 2004. 117 males (40-45 years old and 65-70 years old) who had reduced their alcohol consumption were interviewed. Furthermore, some individual interviews with experts were carried out as well as two focus groups. In reconstructing the drinking careers of the people interviewed we have focused our attention on the qualitative aspects of the transitions that take place during life and on different subjects’ capacity to cope.
The complex theme of the study of drinking careers has been approached using a guideline interview which combines completely standardised survey techniques (a questionnaire with multiple-choice questions) with partially standardized ones (a semi-structured interview).
Key words: alcohol consumption, reduction, alcohol culture, wet drinking culture, alcohol policy.
Alcohol prices, consumption, and traffic fatalities
JEL Classifications: Il (Health), H2 (Taxation), and C3 (Econometrics)
We examine the relationships among alcohol prices, alcohol consumption and youth traffic fatalities using data across U.S. states from 1982-2000. Some previous studies have found large, negative associations between alcohol taxes and fatalities. However, commonly-used price data suggest little or no connection between alcohol prices and fatalities. These apparently conflicting findings may result from measurement error and/or endogeneity in the price data, which biases ordinary least squares estimators toward a finding of no price effects.
Using alcohol taxes as instrumental variables, we find youth fatalities to be negatively related to prices: A ten percent increase in alcohol prices is predicted to reduce youth fatalities by 9 percent. In addition, alcohol consumption is positively related to fatalities: A 10 percent increase in per capita consumption is associated with a 12.9 percent increase in fatalities.
Increasing the drinking age by one year is estimated to reduce teen fatalities by one to three percent, with the largest estimated impact on weekend night fatalities. There is some evidence that keg registration is associated with lower teen fatalities, but not on weekend nights. A youth BAC law is not significantly related to fatalities.
All of these results rely on the assumption that alcohol taxes and other measured policies are appropriately "exogenous," i.e. that these policies affect consumption and drunk driving, but are unrelated to unmeasured attitudes that affect both consumption and policy. Further research on the determinants of policy will help to assess the validity of this assumption.
The concept of treatment for substance abuse: Context, modality and choice
The definition of basic concepts is often a source of substantial problems in most areas of science, this holds to be true also in the field of substance abuse research. In the following we intend to discuss some conceptual and practical problems that can be identified in connection with the concept of treatment. The paper sets out to discuss both the content and boundaries of the concept of treatment within the field of substance abuse. It entails a critical discussion of some existing definitions of treatment and puts forward a tentative and flexible definition that takes its point of departure in the context and the intention behind activities or interventions that are described as treatment. The paper also deals with by what means it is possible to make meaningful distinctions between different modalities of treatment and the difficulties to establish an evidence-base for best practices. Finally we try to discuss the relation between some basic theoretical mechanisms behind a number of popular treatment modalities and the relative importance of the individual’s choice of entering treatment.
Kathryn Graham2, Samantha Wells1, and Andrée Demers3
1 Centre for Addiction and Mental Health, Canada
2 Centre for Addiction and Mental Health and Department of Psychology, University of Western Ontario, Canada
3 Université de Montréal, Canada
Adapting the audit for use in a non-clinical telephone survey: Results from the GENACIS Canada survey
This paper addresses various methodological issues related to the use of the AUDIT in a non-clinical Canadian population sample including adapting the questions for drink size and pattern, and for use in a lengthy telephone interview, as well as respondent and item missingness. In addition, we compare the psychometric properties of the AUDIT and AUDIT-C. Factor analysis and scale reliability analysis are also used to examine the contribution made by the first question (drinking frequency) alone and the first three questions (frequency, quantity and frequency of binge drinking) towards total AUDIT scores. Prevalence rates and correlates of alcohol problems as measured by the AUDIT in this sample of Canadians are also presented. The analysis indicates a significant difference between gender, age, partner status and education in prevalence rates of alcohol-related problems using the AUDIT with a cut-off score of 8.
Key words: AUDIT, AUDIT-C, methodology, psychometric, telephone survey, prevalence
Kim Bloomfield1, 2,
Ulrike Grittner2, Hanna Barbara Rasmussen3
1 Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark
2 Institute for Medical Statistics, Biometry and Epidemiology, Free University Berlin, Berlin, Germany
3 Copenhagen University, Copenhagen, Denmark
Socio-demographic determinants of alcohol consumption in the Danish general population
Danes have been characterized as in a “league of their own” when comparing their drinking style to their Nordic counterparts. Denmark can also be found among the top ten highest alcohol consuming countries in Europe, and in recent international youth studies, Danish teens have ranked near the top with regard to frequency of binge drinking.
Although such facts are known about Danish drinking, little research has examined actual drinking patterns and determinants of drinking outcomes in the general population. The proposed paper intends to fill in the “landscape” of Danish drinking patterns and explores how various socio-demographic factors are related to specific drinking patterns.
The data come from a national telephone survey of the Danish general population conducted August and September 2003. The response rate for the survey was 49,6 percent with a final sample size of 2030 cases. The age of respondents ranged from 15 to 99 years with 56 percent women and 44 percent men.
Preliminary analyses indicate that 5.6 percent of the population is abstainers. About 17 percent of men and 7 percent of women are daily drinkers and 15 percent of men and 10 percent of women can be categorized as heavy drinkers. Almost 40 percent of men and 20 percent of women are heavy episodic drinkers. Among drinkers, men’s mean alcohol consumption is 19 grams per ethanol per day and women’s is 8 grams. Among both genders age is negatively correlated with heavy drinking and heavy episodic drinking, but positively correlated with daily drinking. Results from multivariate analyses as well as conclusions will be presented.
Key words: drinking patterns, Denmark, general population
‘Out-of-the-ordinary’ an exploration of the concepts of intoxication and sexuality
The purpose of this study is a sociological exploration of the concepts intoxication and sexuality and the links between these. As the cultural conceptions linking alcohol consumption, intoxication, and sexuality typically are gender based, the study will focus on the role of conceptions of gender in this equation.
Weber ( 1996), in his writings about the world religions, talks about the orgy and its links to sexual practice and in line of association he also talks about intoxication or sobriety. Maffesoli (1993) uses the metaphor of the orgy to describe contemporary group attachments, and the orgy in its original form of religious ritual practice is linked both to intoxication and sexual practices. Hence, both Weber and Maffesoli discuss the orgy and its religious roots, and they both discuss intoxication and/or sobriety, in Weber’s case metaphorically.
The first step of the exploration of the concepts is to find out what these two sociological perspectives can tell us about the points of contact between intoxication and sexuality. I discuss what can be seen as common in intoxication and certain sexual experiences and how these ways of seeing sexuality and intoxication might help us understand what these mean to people today. The second step is a discussion of what role gender plays in the relationship between intoxication and sexuality. Can these concepts of intoxication and sexuality combined with cultural conceptions of gender help us understand why women’s and men’s intoxication is viewed (and evaluated) differently?Key words: intoxication, sexuality, Max Weber, gender
Do changes in availability of alcohol affect the levels and patterns of drinking?
During recent years, two major changes have taken place that have affected availability of alcohol in the south of Sweden. The first change came about in October 2003 when Denmark lowered their taxes on spirits by 45 percent which corresponds to a reduction of the price of cheaper brands by about one fourth. The second change occurred in January 1st 2004, when travellers’ allowances were increased substantially. The implication of these two policy changes is a price reduction on alcoholic beverages for people living in the south of Sweden.
The aim of the study is to investigate weather these policy changes have had an effect on the consumption of alcohol in the south of Sweden, using northern Sweden as a control site. The study uses representative samples of the adult population from the south and the north of Sweden. Telephone interviews have been conducted both prior to and after these policy changes. In both parts of Sweden 1500 respondents were interviewed in each of the 3rd and 4th quarter in 2003 and about 70 percent of these were reinterviewed in the same period in 2004. Data has also been collected from new samples in 2004. The study will estimate the combined as well as the independent effects of the two policy changes on the level of consumption, both in terms of total consumption and beverage-specific consumption. For this purpose, a Q-F-measure of the last 30 days will be used. The study might also analyse changes in drinking patterns, e.g. binge drinking.
Key words: Alcohol consumption, taxation, price changes, longitudinal study
Jason C. Bond,
Thomas K. Greenfield, Nina Mulia, and William C. Kerr
Alcohol Research Group
Public Health Institute
Explaining ethnic differences in risk of alcohol-related problems and dependence symptoms among US drinkers
Background: Rates of social consequences and dependence symptoms associated with alcohol use have been found to be elevated among certain at-risk segments of the US population including youth, ethnic minorities, and the poor. In associating alcohol consumption and related adverse effects among ethnic subgroups, studies have traditionally assumed that risk rises proportionally with consumption which, in general, may not be the case.
Method: Using the combined 1995, 2000 US National Alcohol Surveys, yearly volume of consumption and frequency of consuming five or more drinks/day were used to predict alcohol-related problems and dependence symptoms among men and women for blacks, whites, and Hispanics separately, using Generalized Additive Modeling methods.
Results: For men, the relationship between volume and both alcohol-related problems and dependence were lowest among whites and appeared nearly linear across the range of volume. For black and Hispanic men, the relationship also appeared linear and elevated above that of whites. Similar results were found using freq 5+ drinks/day for men. Risk appeared linear for white and Hispanic women for predicting consequences from volume, but increased sharply for black women drinking above an average of two drinks/day. This sharp increase was also found for both black and Hispanic women when predicting dependence. Fewer differences were seen among female ethnic groups when using frequency of 5+ for prediction. Other variables, such as the income, age, or education level of drinkers can be incorporated in these models and may disproportionately put some groups at higher risk for adverse effects of alcohol.
Pastime in a pub: Observations of young adults’ activities and alcohol consumption
A limited number of studies have focussed on situational characteristics that may predict alcohol consumption. These studies have shown that factors like location, day of the week, group size and gender distribution are related to differences in drinking, and might explain as much variance in alcohol consumption as individual characteristics. But when young people share the same situational characteristics, it does not necessarily imply that this will lead to identical drinking behaviour. Alcohol consumption typically takes place in a time-out situation, and a time-out can be spent by engaging in several leisure time activities. In a bar, palaver is the dominant pastime, but this may take place during other activities, like watching TV or playing games. These activities might inhibit drinking because of the physical difficulties of combining drinking with other activities. Findings of an observational study on drinking in young adults in a bar lab (N = 238) will be discussed. In this study, we followed the ad-lib drinking of peer groups (7 - 9 persons) during a 1h period. The main aims were to assess 1) to what extent involvement in certain activities is related to drinking pace during that activity; 2) to what extent the differences in drinking pace between activities are related to alcohol consumption over activities, and 3) whether initial drinking level (measured by questionnaires before the pastime) predicts selection of specific activities.
Key words: Alcohol, Young Adults, Activities, Observations
The development of international PSAs and break-through messaging about under-aged drinking: An innovative partnership between academia, a college of design and a global health organization
Global public health problems associated with alcohol consumption have reached alarming proportions, and alcohol has become one of the most important risks to the global health of young people. Few prevention efforts have successfully focused on reducing the consumption and negative consequences related to under-aged drinking throughout the Americas. Typical collaborative efforts have included research teams primarily composed of multi-disciplined academicians but few approaches--if any--have combined the expertise of a college of design, a global health promotion organization and academia. In an effort to counter alcohol advertisements that appeal to under-aged drinkers throughout the Americas, the Pan American Health Organization commissioned Art Center College of Design in Pasadena, California to design and develop anti-drinking Public Service Announcements (PSAs) for international distribution. This paper addresses the research methodology, creative process, and integrated educational approach behind this innovative partnership, led by designmatters @ Art Center College of Design, a college-wide initiative dedicated to broaden the humanitarian impact designers exert on issues of societal consequence. This is an exemplary project that demonstrates how the interplay of academic research (in this case, an alcohol expert that educated students in the film and advertising disciplines about the complex scope of the problem) with multi-disciplinary design expertise at the service of a global health organization can result in a bold awareness campaign that provides a new paradigm for break-through messaging about alcohol consumption among youth.
Key words: PSAs, alcohol, under-aged drinking
The relationship between alcohol use related-related harms and drug use and harm among a Swedish university sample
Objective: This paper examines the relationship between alcohol and drug use, including frequency of use, heavy use and experiences of alcohol and drug-related harm, within a Swedish University sample.
Method: A quantitative, postal survey collected data on sociodemographic characteristics, lifestyle, school-related variables, alcohol/drug use and related attitudes. Participants were randomly selected from all students registered in levels A to D (years 1-4) in four participating universities. Students participated anonymously. A response rate of 70.0 percent resulted in 4,575 completed surveys. Analysis is largely descriptive.
Results: 96 percent of students consumed alcohol within the last year, 45 percent reported drinking 5+ drinks/occasion at least monthly. Alcohol-related harm was reported by 42.7 percent of current drinkers. Cannabis was used by 25.4 percent of respondents (lifetime), 8.9 percent reported use in the last year. Only 9.9 percent (lifetime) and 2.8 percent (last year) reported using other drugs. Drug-related harm was reported by 16.5 percent of current drug-users.
Binge drinkers, individuals scoring 8+ on the audit, daily smokers, and those experiencing alcohol harms in the last year were more likely to have used drugs, lifetime and past year (p<=0.0001). However for current drug users, the only alcohol-related variables that predicted drug-related harms were the age at which the student first experienced drunkenness and their frequency of drinking (p<0.0001).
Discussion: While heavy drinking was related to the use of illicit drugs, neither it nor the experience of alcohol-related harms was predictive of drug-related harms. In Sweden, students who experience alcohol-related harm appear to represent a different group than those experiencing drug-related harm.
Key words: drug use, alcohol, binge drinking, harm, cross-sectional postal survey
Assaults and homicide rates in Norway 1880 - 2003: Alcohol, economy and the role of social integration
Several studies have explored the relationship between alcohol consumption and different measurements of violence such as assaults and homicide on the aggregate level. However, the majority of these studies deals with bivariate relationships, e.g. one outcome is regressed onto per capita consumption (or beverage-specific consumption). A number of studies have linked aspects of social integration to suicidal behaviour, following the Durkheimian tradition, and the question is whether this may be a suitable approach for assaults and homicides as well.
The aim of this study is to make a contribution to the sparse literature regarding other factors that may explain the changes in violence rates. The main question will be to test the relationship between alcohol consumption and violence rates, and to investigate to what extent changes in variables related to economic circumstances and social integration might contribute to the explaining of the changes in violence rates. In Norway, both violence rates and alcohol consumption have increased the past 30 - 40 years. Additionally, the study will explore whether effects of some variables have changed over time. The data comprise aggregate time series for Norway during the period 1880-2003, and the data will be analysed utilizing the Box–Jenkins technique for time series analysis.
Key words: assaults, homicide, alcohol, social integration, time series.
Cheryl J. Cherpitel1,
Yu Ye1, Jacek Moskalewicz2, and Grazyna Swiatkiewicz2
1 Public Health Institute, Alcohol Research Group, Berkeley, California, USA;
2 Institute of Psychiatry and Neurology, Warsaw, Poland
Risk of injury: A case-crossover analysis of emergency service patients in Poland
Rates of heavy, problem drinking and alcohol dependence are thought to be high in Central and Eastern European countries, including Poland, where large changes in alcohol consumption and the health care system have occurred over the last 15 years, but data on risk of injury from alcohol consumption are relatively non-existent. Estimates for risk of injury from drinking within six hours prior to the event are reported in samples of emergency services patients from Warsaw (n=508) and Sosnowiec (n=432), using case-crossover analysis based on usual frequency of drinking. A four-fold risk of injury was found, and was significantly greater for those positive for alcohol use disorders compared to those negative. A 17-fold increase in risk for violence-related injury was found, and was significantly greater for males than females. Injury risk related to drinking was expected to be significantly greater in Sosnowiec, due to more traditional drinking styles of infrequent intake of large quantities of spirits, than in Warsaw, but this was only partially borne out by these data. Risk estimates for all injuries were similar to those found in other case-crossover studies in emergency departments. Given the high relative risk estimates for injury related to drinking prior to the event, especially for violence-related injury, even when chronic drinking patterns are controlled, hospital-based emergency services in Poland may be an important site for identification of those who could benefit from a brief intervention or referral for a reduction in alcohol-related injuries.
Key words: Emergency services, case-crossover, Poland, injury risk, violence
A.Chopra1, H.Sethi1, A. Dhawan1, and P
1 National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
2 Thrissur Medical College, Kerala
Drinking practices in Thrissur District, South India
Alcohol abuse and dependence are an increasing problem in India as also in South East Asia. Little is known about the alcohol drinking patterns such as hazardous or harmful use and dependence in the country. As part of a larger study to estimate prevalence of tobacco, alcohol and illicit drugs in Thrissur district (Kerala, South India) the current communication examines and identifies drinking practices in Thrissur District (Kerala, India).
Data were re-analysed from the 2002 rapid assessment survey conducted in the district collected by a stratified random sampling method (n = 12,731). Among 4,371 males, self-report of alcohol consumption (n=917) were categorized into infrequent, harmful, dependent and heavy users.
Drinkers reported consuming only beer (locally prepared brew called toddy, (16.0 percent), spirits (74.0 percent) and both (10.1 percent). Based on QF measures, 40.3 percent were infrequent, 43.9 percent hazardous 11.3 percent dependent and 4.1 percent heavy episodic (5+ more drinks) drinkers. Concomitant tobacco use was reported by 71.2 percent users. Infrequent users were in younger age group while heavy episodic were in higher age group though the associations were not significant. Alcohol dependence and heavy episodic use was characterized by weekly/ daily use whereas Infrequent and hazardous use was associated with intermittent use. Logistic regression analysis showed variables education, employment status, living in rural areas, type of alcohol (beer or spirits) and tobacco use to be associated with drinking.
Interpretations and Conclusions: A clearer understanding of these factors would be of immense benefit in planning intervention programmes for alcohol consumers in the district.
Key words : Rapid assessment , alcohol, hazardous drinking
The use of alcohol and other drugs amongst students in different regional areas in Lithuania
Objective: This paper examines the use of alcohol and other drugs amongst students in Lithuania and its different regional areas and compares the Lithuanian data with data of neighbouring countries (the other Baltic countries and Poland).
Methods: The study was conducted as school survey in 2003 (ESPAD 03). The stratified random sampling model was used. Response rates of 87,6 percent resulted in 5036 completed surveys. This paper presents the analysis of data in the capital, four other largest cities, largest towns, and centres of districts and rural areas.
Result: The study provided us with data about substance use in different areas of Lithuania: data of lifetime or daily use of cigarettes, use of alcohol (include 40 and more times) during lifetime or last year and during last 30 days, prevalence of drunkenness during lifetime or last year and during last 30 days, lifetime use of tranquillisers or sedatives without a doctor’s prescription, lifetime use of inhalants varied in different areas and had peculiar structure and gender differences. Particularly striking difference was found in prevalence of drug use in various areas of country. The highest prevalence was in Harbour City (more than twice higher compared with the country data average). The proportion of students who use drugs was lower in Capital City than in the harbour one. The lowest prevalence of drug use was in rural areas. These findings require special attention to the risky behaviour of youth. The paper also presents the comparison of Lithuanian data with data of the neighbouring counties.
Conclusion: Results of this study let us assess the trends of prevalence of substance use in the country. High level of drug use in some regional areas can grow hotbed of epidemic and provoke an increase of prevalence.
Key words: comparison, regional differences, hotbed of epidemic.
Deborah A. Dawson, Bridget F. Grant, and W. June Ruan
Laboratory of Epidemiology and Biometry
Division of Intramural Clinical and Biological Research
National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
Bethesda, Maryland, USA
The association between stress and drinking: Modifying effects of gender and vulnerability
Aims: To assess the relationship between number and type of past-year stressful experiences and alcohol consumption, with a focus on how gender, poverty and psychological vulnerability moderated this association.
Methods: Data from 26,946 U.S. past-year drinkers 18 years of age and over, interviewed in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), were used to construct multivariate linear regression models predicting six measures of drinking pattern and volume.
Results: There was a consistent positive relationship between number of past-year stressors experienced and all measures of heavy drinking. Frequency of binge drinking increased by 24 percent with each additional stressor reported by men and by 13 percent with each additional stressor reported by women. In contrast, the frequency of non-binge drinking decreased as stress levels increased. Job-related and legal sources of stress were more strongly associated with alcohol consumption than were social and health-related stress. Men showed a stronger association than women between number of stressors and most consumption measures; they also responded more strongly to the presence of any legal and job-related stress. Having an income below the poverty level intensified the effects of job-related stress, but having a mood or anxiety disorder did not affect any of the associations between stress and consumption.
Conclusions: Stress does not so much lead individuals to drink more often as to substitute larger quantities of alcohol on the days when they do drink. Treatment and brief interventions aimed at problem drinkers should address the issue of tension alleviation and the development of alternative coping mechanisms.
Key words: stress, consumption, binge drinking, gender
and Louis Gliksman3
1 Université de Montréal, Canada
2 Institut national de santé publique du Québec, Sainte-Foy, Canada
3Centre for Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
When the forest hides the trees: A setting typology of drinking contexts among Canadian undergraduates
Undergraduates’ drinking is contingent upon drinking context. However, contexts are multifaceted and it is through the combination of the various features of the drinking setting that the drinking context takes its symbolic meaning and provides a normative frame of reference for drinking. The aim of this paper is to develop a holistic typology of drinking contexts. The data are derived from the Canadian Campus Survey conducted in 1998 with a random sample of 8,864 students in 18 universities. For each student, up to five drinking occasions were investigated, resulting in 26,348 drinking occasions among 6,850 drinkers. The drinking occasions included information on alcohol intake and about why, when, where and with whom drinking occurred. Decision tree analysis was used to develop a typology of lighter to heavier drinking contexts, reflecting the complex interplay between places, relationships, time and other circumstances on alcohol intake. Such information may be useful to orient socio-environmental interventions among undergraduates.
The construction of high personal social status through risk-taking alcohol behaviour
In this paper we will present results from a focus group study conducted among 14 - 16 years olds between March 2004 and March 2005. This qualitative study is part of a large research project on Youth and Alcohol supervised by Professor Peter Gundelach and Professor Margaretha Järvinen that also includes an extensive quantitative study. The overall motivation of this research project is to contribute to an understanding of the alcohol culture among Danish youth, taking on a distinct sociological approach. The focus group study aims to explain how alcohol is used as a naturalized and normal part of hedonistic youth culture, and how the adolescents use alcohol in their construction of social identity. The participants in the focus group interviews are sampled from what we consider the most important networks for the adolescents, primarily their school classes and secondly their friendship networks outside the school. A total of 25 focus group interviews have been conducted.
This paper will focus on one case in which two girls successfully use alcohol to position themselves as highly popular and mature among the classmates. This can be interpreted from the way the girls in the interviews construct a dominant position by presenting their experiences with parties and drinking alcohol as an attractive and mature lifestyle. We anticipate that the girls are constructing maturity (social age) by using alcohol to perform a culturally recognizable identity in their social networks. Alcohol consumption thus seems to be one way to perform a mature, feminine identity that makes the girls stand out from the less self confident classmates who lack the same natural, adult way of drinking.
Key words: Drinking practice, adolescents, social constructivism, culture, social age, focus group interviews
Provider service profile: Choices for treatment of alcohol/cocaine-using clients
Objective: This study describes providers’ treatment recommendations for pregnant and non-pregnant women and men using alcohol and/or cocaine.
Method: In this study, a probability sample of 457 service providers (73 percent response rate) was drawn from alcohol/drug treatment, criminal justice, mental health, hospitals/medical services, and social welfare settings. Providers were interviewed about their service recommendations. Logistic regression was used to examine the predictors of treatment choices, focusing on provider work setting and demographics.
Results: Four dominant services emerged: hospital-based; AA; therapy; and halfway houses. Combinations of these services were usually recommended, although some providers (especially those not in the treatment field) chose just a single type of treatment (47 percent for pregnant, 36 percent for non-pregnant women and men). Providers primarily recommended hospital-based treatment for pregnant women, while AA dominated for other clients. Providers in criminal justice and mental health settings were more likely than those working in alcohol/drug treatment programs to recommend only the hospital-based service for pregnant women and less likely to adopt AA services. Male providers were less likely to recommend only the hospital-based service for pregnant women. Providers with postgraduate degrees were twice as likely as those without a college education to recommend therapy for all clients.
Conclusions: The majority of providers recommended treatment services within the four major profiles. For some providers selecting only one service, training in multi-service selection may broaden the range of treatment alternatives recommended to clients. Some work settings and demographics were predictors of providers’ treatment choices.
Key words: Service Profiles; Providers; Alcohol/Drug (cocaine-using); Pregnant Women; Survey Methods
“Meet your new family:” Danish discotheques and their methods of recruitment
This paper presents and discusses results from a subproject of the Danish contribution to a common Nordic project on restaurants.
The number of on-premise alcohol sale outlets has increased steadily for the last decades in Denmark, and especially types of restaurants, whose target groups are the very young customers. This manifests itself in the growing number of discotheques in all parts of Denmark. Danish youth has a high-level consumption of alcohol, and research indicates that a large part of their alcohol consumption occurs in public houses with licence to sell alcohol.
Well-developed internet-sites are among the methods that discotheques use to advertise and also recruit their customers. The results from a qualitative analysis of about 50 web-sites will be presented. The aim is to discuss the found values of appeal, which move in a field of tension between on the one hand emphasis on elements that create identity and confidence/safety and promises of transcendental experiences on the other.
Key words: Discotheques, methods of recruitment, web-sites, qualitative analysis, identity.
Reciprocal influences on alcohol consumption of siblings
Ample studies have established that parents as well as peers function as role models in the development of adolescents’ alcohol use. The relative importance of siblings, however, has been largely neglected. This seems remarkable because of the long-term nature of a sibling relationship. Still, the few studies that indeed concentrated on siblings and alcohol use have been primarily using twin samples or perception data of adolescents on drinking of their siblings.
The present study examined the impact of siblings on drinking behavior of adolescents using longitudinal data from 416 sibling dyads (sib 1; mean age 13.3, sib 2; mean age 15.2). Moreover, we explored which factors (gender constellation of the sibling dyad, quality of the sibling relationship, and similarity in norms about alcohol) affect reciprocal influences in alcohol use of siblings.
Descriptive analyses showed that although older siblings drink more frequently and intensively than the younger siblings, moderate associations were found between frequency and intensity of drinking in siblings. These similarities are hardly affected by age-differences. Findings of structural equation modeling showed that alcohol use of the older sibling affected drinking of the younger sibling one year later. In accordance with our expectations, older siblings do not model the drinking of their younger brother or sister. Further, the moderating role of (a) having the same or opposite gender as a sibling, (b) a low or high quality relationship, and (c) the same or different norms about alcohol, on the association between siblings’ alcohol use and adolescents’ drinking over time will be discussed.
Key words: adolescents, alcohol, siblings, longitudinal, survey
How daily newspapers portray alcohol policy measures regarding restaurants: A historical perspective
This paper is focused on how daily newspapers portray alcohol policy measures regarding restaurants in Stockholm and the county of Södermanland, in a historical perspective. It is a small part of a larger project on restaurants and alcohol, and is conducted at SoRAD, Stockholm University. The paper examines a 25-year time period, which particular emphasis upon the years 1977, 1990 and 2002. Since 1977 the number of licensed on-premise alcohol establishments has increased 284 percent (from 2,523 in 1977 to 9,690 in 2002).
Data for the project have been obtained from mostly newspaper archives and partly from official documents of local inspectors. While the archives at the Central Association on Alcohol and Drug Information in Stockholm provides rather full coverage of the press, it has been somewhat harder to assemble complete data coverage from the official authorities.
Discussion will focus on the portrayal of alcohol policy measures regarding restaurants in the newspapers and how this has changed over time. Who are the actors and what areas and problems appears in the press.
Key words: newspapers, restaurants, alcohol policy measures.
Kaye Middleton Fillmore1, William C. Kerr1, 2, Tim
Stockwell3, Tanya Chikritzhs4,
and Alan Bostrom1
1 University of California, San Francisco, USA
2 Alcohol Research Group, Berkeley, California, USA
3 Centre for Addictions Research of British Columbia, University of Victoria, Canada
4 National Drug Research Institute, Curtin University, Australia
Alcohol and mortality risk: Systematic error in prospective studies
The majority of prospective studies on alcohol use and mortality risk indicate that abstainers are at increased risk of coronary heart disease. A meta-analysis tested whether they contained a systematic error by including as ‘abstainers’ many people who had reduced or stopped drinking, a phenomenon associated with ageing and ill health. Most published studies were found to suffer from this error. The few error-free studies found no significant cardiac protection. Estimates of cardiac mortality from heavier drinking may also be higher than previously estimated. The conclusion that regular moderate drinking improves coronary health may be premature.
Domestic Violence Related To Alcohol Consumption Among The Population Seeking Assistance From State Prosecutor’s Offices And Among The General Population (Ages 18 To 29)
The main purpose of this paper is to study associated factors, such as habitual alcohol consumption, consumption on the day of the event, abuse and dependence, drug consumption and type of family violence by comparing two populations, one interviewed in a household survey, the other comprising those that sought assistance from State Prosecutors’ Offices (SPO), either because they were detained or because they filed a complaint, in Pachuca, Hidalgo, a modern city lying 100 km outside the capital of México with approximately one million inhabitants.
The samples were obtained during the same period in the second half of 1996. The household survey (Medina Mora, ME.) (n=980) was obtained through a stratified sample of the population ages 18 to 65, through face-to-face interviews. The interviews in the State Prosecutors’ Offices were conducted at the only two offices in this city. Data was obtained every 24 hours for a period of 45 days (N=471). Both surveys included similar questions and were undertaken face to face by trained professionals using standardized questionnaires. Univariate and multivariate analyses were carried out through logistical regression to determine associated characteristics to population that commits crimes or files complaints in comparison with the general population. Emphasis will be placed on the population ages 18 to 29, which was the population most at risk of ending up at a SPO (OR 2.7) compared with other ages. The type of crime involved and links with domestic violence were also compared.
Key words: Domestic violence, crime, denunciations, alcohol consumption, household survey, México
Paul J. Gruenewald2, Lillian G. Remer2, Bridgette Lery3,
1UCLA Department of Social Welfare
2Prevention Research Center, Berkeley, CA
3Center for Social Services Research, University of California, Berkeley
Examining child abuse and neglect over time and space
Using social disorganization and routine activities theories, recent studies have examined the cross-sectional relationship of alcohol outlets and neighborhood rates of child maltreatment. The current study examines how changes in alcohol outlet densities over six years affect rates of Child Protective Services referrals, substantiations, and foster care entries due to child maltreatment while controlling for demographic characteristics of the neighborhood in 579 stable zip codes in California. As such, this study begins disentangling complicated associations found in neighborhood environments that may place children at greater or lesser risk for abuse. Using random effects panel models we find that zip codes with higher concentrations of off-premise alcohol outlets, bars, and higher percentage of Black residents had higher rates of maltreatment, while greater average household size and median household income had lower child maltreatment rates. Characteristics of adjacent zip codes were also related to maltreatment rates in local neighborhoods, indicating a spatial dynamic to this relationship. The results suggest that environmental strategies to limit alcohol access through zoning and planning laws may effectively reduce child maltreatment. Relying on social disorganization theory, an intervention that increases social contacts between neighbors in high alcohol outlet density areas may facilitate and strengthen social ties and networks, thus reducing maltreatment rates. Efforts to prevent and reduce maltreatment suggested by routine activities theory include addressing behaviors related to parental monitoring and supervision as well as policies and procedures that reduce the number of alcohol outlets in neighborhood areas where large numbers of children live.
Key words: Child abuse and neglect, alcohol outlet densities, panel study, social disorganization theory, routine activities theory
Alcohol outlet density, parental monitoring, and adolescent deviance: A multilevel analysis
Lower levels of parental monitoring are associated with youth problem behaviors, including substance use and delinquency. Recently studies employing routine activities theory have hypothesized that greater densities of alcohol outlets, particularly bars, may provide parents more opportunities to social outside the home. This, in turn, may decrease a parent’s ability to effectively monitor the activities of his or her child, resulting in more deviant behaviors by the adolescent. Using hierarchical linear modeling (HLM) the current study assesses whether or not greater densities of alcohol outlets in zip code areas (n = 50) interact with levels of parental monitoring to affect levels of deviance among adolescents aged 14 to 16 (n = 1,541). The study finds that older adolescents who have higher grade point averages, and are not current drinkers report the lowest levels of deviant behaviors. Furthermore, the density of bars interacts with reports of parental monitoring such that adolescents in areas with more bars per roadway mile report lower levels of parental monitoring behaviors, which is associated with higher levels of deviance. Based on these findings, it may be that in those areas with greater densities of bars parents may be spending more time away from home, making monitoring of their adolescents more difficult or parents may be drinking more frequently, thus impairing their ability to adequately monitor their children. Regardless, policies and practices that limit the number of bars in neighborhood areas with large populations of adolescents may reduce deviant behaviors.
Key words: alcohol outlet density, parental monitoring, deviance, adolescents
Integral Prevention: A Holistic Approach In Developing Prevention Programs
Nesis Consulting Group develops a State Prevention Program “INTEGRA-T” in Sinaloa, México with the support of the government and the sponsoring of social associations.
Sinaloa is well known for agriculture development; nevertheless it has an enormous problem in production and drug traffic.
Very violent atmosphere (gangs fighting for local costumers)
A complex immigrations issues
Poor farmers hired to seed drugs
Connections with Colombian cartels
Hot weather (first beer dinking in México)
In México prevention policies and practices are inefficient or don’t exist. During 2004, we started up INTEGRA-T developing new strategies to prevent use-abuse of drugs and addictive behaviors.
is a comprehensive approach:
Including strategies taking current actions address to the cause instead to the consequences
Putting emphasis in the self development
Teaching people and organizations to identify their particular needs and satisfy them by themselves.
Promoting law enforcement
Making alliances with media and local coalitions
Presenting a co-responsible action plan in a network structure.
specific points to share:
Dynamics in families and educational processes in Sinaloa´s youth.
Protective factors in healthy persons
Resiliency builders and resiliency factor in a natural way
Experience of working with farmers, politicians, entrepreneurs, and local leaders.
Development of 60 workshops and 100 conferences
Design of a media campaign
Creation of alliances with locals
We work face to face with more of 1500 persons that embrace de Integral Prevention Approach.
Key words: Prevention, resiliency, programs, México, social response, integral prevention.
Henk F.L. Garretsen1, 2, Inge Bongers1,
2, and Ien van de Goor1, 2
1 Tilburg University, Tranzo Department, the Netherlands
2 Addiction Research Institute, Universities of Rotterdam, Maastricht, Tilburg and Nijmegen, the Netherlands
Academic centres: A solution to the gap between science and practice?
Many parts of the addiction care sector do not work evidence-based. The same is true for policy and prevention. It is desirable to bridge the gap between science and practice. In the presentation the use of academic centres (like academic hospitals but smaller) to bridge this gap is described. Main components of an academic centre are a long-term research program and a knowledge-exchange infrastructure. So-called science practitioners play an important role.
In the southern part of the Netherlands several academic centres have been developed successfully, among others centres in the field of addiction and mental health care (with an emphasis on youth and forensic care), public health and chronic care. The centres differ in important characteristics. Points of departure, conditions and experiences are described.
Key words: Evidence-based care, addiction care, addiction policy, addiction prevention, mental health care
Prenatal alcohol exposure and health care costs
Prenatal alcohol exposure can result in serious, costly consequences – for individuals, families, communities and societies. Our purpose is to examine the relationship between health care utilization and risk of alcohol exposure during pregnancy.
We used the T-ACE screening tool in a population based study in a large geographical region in British Columbia, Canada. The T-ACE (Sokol et al, 1989) was adapted from the CAGE specifically for use with pregnant women as a screening tool to determine risk. Originally, our purpose was to determine the feasibility and utility of the screening tool on a population basis. Data were collected on at-risk alcohol use and other variables for 3,659 pregnant women for a one-year period, 1990-1991.
Health service utilization was examined in the offspring of this cohort through data held by the British Columbia Health Linked Database (BCHLD). The BCHLD provides longitudinal person-specific health utilization information within a single publicly funded health care system, and its data is accessible for research purposes. We examined hospitalization rates to 12 years of age in relation to maternal prenatal T-ACE risk scores.
Children whose mothers were in the high risk category for alcohol use during pregnancy had a significantly higher number of hospital visits than children whose mothers were found to be in the low or medium risk category (F=5.76, p=.003). The results should assist with better understanding the health care implications associated with maternal risk of excess alcohol consumption during pregnancy.
Keywords: prenatal alcohol exposure; health care utililization
Alcohol policy effectiveness and public opinion: Is there support for effective policies in Ontario?
In recent years, the term “evidence-based” has often been used to describe alcohol-related programs and interventions. However, the reach of the term exceeds its grasp in that there is sometimes little evidence of a reduction in consumption and drinking-related harm resulting from the most popular interventions. This paper compares the conclusions from a WHO-sponsored project examining which alcohol policies have, to date, been shown to be effective with the public opinion of Ontarians drawn from cross-sectional surveys. The telephone surveys were conducted with representative samples of adults, aged 18+, between 1993-2003, with Ns ranging from 667 to 1,742. Not all alcohol policy items considered here were asked each year.
In Alcohol: No Ordinary Commodity, Babor et al. (2003) rate 31 alcohol policies. We examine eight of them for which Ontario survey data were available: advertising ban, a monopoly retailing system, raising the minimum legal drinking age, restricted hours/days of sale, restricted outlet density, raising taxes on alcohol, stopping service to intoxicated patrons, and warning labels on alcoholic beverage containers. Based on Babor et al., these eight policy measures were organized into high to low effectiveness. The results of twelve public opinion items were scored according to degree of public support or opposition to an alcohol policy, and then compared to the evidence-based policies. There is public support for a range of policies, including effective and less effective ones. In some cases, support for effective policies (e.g. raising taxes) is modest. The implications for research and policy are discussed.
Center, Lausanne University Hospital, Switzerland
2 Swiss Institute for the Prevention of Alcohol and Drug Problems, Lausanne, Switzerland
3 General Surgery Department, Lausanne University Hospital, Switzerland
4 Emergency Department, Lausanne University Hospital, Switzerland
Alcohol attributable risks of injury in a Swiss emergency room: The link between volume of drinking, drinking patterns and drinking in the event
Background: The association between alcohol consumption and injuries is clearly established for volume of drinking, heavy episodic drinking (HED) and consumption prior to injury. Little is known about how these three dimensions interact as regards the risk for injury, and which combination of risk factors exposes individuals at highest risk. This study explores the combination of risk factors for injury related to alcohol consumption. It expands on current literature by estimating which group of alcohol consumers contributes the most in absolute numbers to alcohol-attributable injuries.
Methods: In total, 8,736 patients of who 5,077 were injured (cases) and 3,659 non-injured (quasi-controls) enrolling in the surgical ward of the ER department of the Lausanne University Hospital, Lausanne, Switzerland between January 1, 2003 and June 30, 2004 were screened for alcohol use and provided sufficient data on all relevant questions. Eleven mutually exclusive consumer groups were constructed based on usual volume of drinking (abstinence, 7 (women)/14 (men) drinks a week), HED in the past month (never, at least once 4+ (women) / 5+ (men) on an occasion), and acute alcohol intake prior to injury (none, < 4/5 drinks; 4+/5+ drinks). Odds ratios comparing injured and non-injured were derived by means of logistic regressions, and alcohol-attributable fractions of injuries were calculated using an epidemiologic standard formula that combines odds ratios with prevalence of exposure.
Results: Risk for injury increased with volume of drinking, HED and alcohol intake prior to injury. In both men and women, highest risk was found for those with low volume intake, HED and 4 (women), 5 (men) drinks or more prior to injury. At the same level of acute intake heavy volume drinkers had lower risks for injury than low volume HED drinkers. There were marked sex differences for those who contributed most to alcohol-attributable injuries. For women the biggest share of the alcohol-attributable injuries stem from the group of low risk non-HED drinkers with low acute intake of less than 4 drinks (47.5 percent of all alcohol-attributable injuries). For men this share was only 20.4 percent. In men low volume drinkers with HED contributed most to alcohol-attributable injuries (46.9 percent compared to 23.2 percent among women).
Conclusions: Though all groups of alcohol consumers were at higher risk for injury, particularly prone are those drinkers who usually drink little but heavily on some occasions. The attenuated risk for injury among chronic heavy drinkers might be due to higher tolerance to the effects of alcohol. Preventive strategies should thus focus on heavy drinking occasions. Among women a high share of alcohol-attributable injuries was found at already relatively low levels of acute intake, and they may thus consider precautions particularly when consuming alcohol in situations where it is physically hazardous.
Key words: Emergency room, drinking pattern acute intake, alcohol-attributable injuries
Successful strategies to regulate nuisance liquor stores using community mobilization, youth, law enforcement, city council, merchants and a researcher
Presentation will discuss with participants successful environmental and public policy strategies involving youth and community in Pasadena and Altadena to remedy problems associated with nuisance liquor stores. Participants will be given tools to understand the importance of utilizing various substance abuse prevention strategies to change local policies and the importance of involving various sectors, especially youth, in the community to assist with and advocate for community-wide policy changes. Recent policy successes from the communities of Pasadena and Altadena will highlight the collaborative process by which the community mobilized resulting in several ordinances, how local law enforcement was given more authority to monitor nonconforming liquor stores, how collaborative efforts with liquor store owners helped to remove high alcohol content alcohol products from their establishments and how a community-based organization worked with local legislators to introduce statewide legislation regarding the regulation of nuisance liquor outlets.
Kathryn Graham1, D. Wayne Osgood2,
Samantha Wells1, and Tim Stockwell3
1 Centre for Addiction and Mental Health and University of Western Ontario, Canada,
2 Department of Sociology, Pennsylvania State University, University Park, USA,
3 Centre for Addictions Research of BC, University of Victoria, Canada
To what extent is intoxication associated with aggression in bars? A multilevel analysis
The association between alcohol consumption and aggression has been found across cultures using a range of different research methods, but relatively little is known about the relationship between level of intoxication and the occurrence and severity of aggression. In the present study, we used Hierarchical Linear Modeling (HLM) analysis on observational data from 1,334 nights of observation in 118 bars and clubs in Toronto, Canada to examine the relationship between level of intoxication and aggression.
The results of a 2-level HLM analysis (bar visit, bar) indicated that both level of intoxication of crowd during the visit as well as mean level of intoxication across visits within the bar significantly predicted frequency of aggression, controlling for other factors such as number of minutes at the bar (i.e., variation in the length of the observation period) and number of people in the bar. In the analysis of aggressive incidents, aggressive participants (initiators of aggression and aggressive victims/third parties) were significantly more intoxicated than nonaggressive participants (nonaggressive victims/third parties and involved bystanders). A 3-level HLM analysis (incident, visit, bar) indicated a positive association between level of intoxication of persons in the incident and severity of the aggressive incident, controlling for number of people in the incident and visit and bar level variables. These results suggest that (a) bars with more intoxicated patrons have more aggression; (b) there is more aggression on nights when patrons are more intoxicated; and (c) severity of aggression increases with intoxication level of persons involved in aggressive incidents.
Key words: alcohol and aggression, barroom, environment, observations, multi-level analysis
Risks of drinking for the treated or concerned are higher than others, for given patterns of drinking
We aimed to determine safe drinking patterns for those drinking after treatment, concerned about drinking, and others, those never treated or concerned. Data from two National Alcohol Surveys were pooled: the 1995 in-person NAS (N=4,925) and 2000 telephone NAS (N=7,612) only 12-months drinkers (n=7,447). Drinking measures were volume and rates of 5+ drinks (4+ for women), 8+ and 12+ drinks in any day. Problem measures were Alcohol Abuse (2+ of 15 Consequences items) and Alcohol Dependence (3+ on 7 DSM-IV domains). Segmentation Analysis was used to model risk relationship, yielding percentage meeting criterion for abuse or dependence (AUD) for empirically defined Volume-Pattern combinations, disaggregated by gender. Risk results for the Treated group, the Untreated but Concerned group, and “Others” (never treated or concerned) differed by gender. Treated and Concerned groups (combined ns=559 men, 261 women) were not statistically different, but both groups differed greatly from the rest of the population (ns=3,163 men, 3,175 women). Treated/Concerned, drinkers who restrict intake to very low volume (< 2 drinks total per week), and whose quantities never exceed 4 drinks (men) and 3 drinks (women), carry very low risk of concurrent dependence or abuse (under 5percent). Even at this low mean intake, those occasionally drinking 5+ (or 4+, women), have significantly higher risks (10 to 20percent) of meeting criteria for AUD. Others can safely drink up to two drinks/day if not exceeding quantity guidelines. Logistic regression models show independent volume and pattern effects for both average intake (volume) and intensity (quantity in a day).
Key words: Risk curves, drinking patterns, Alcohol dependence, alcohol abuse, safe drinking guidelines
Supported by an NIAAA Supplement to Center Grant P50 AA 05595, year 24
Domestic violence related to alcohol consumption among the population seeking assistance from state prosecutor’s offices and among the general population (ages 18 to 29)
The main purpose of this paper is to study associated factors, such as habitual alcohol consumption, consumption on the day of the event, abuse and dependence, drug consumption and type of family violence by comparing two populations, one interviewed in a household survey, the other comprising those that sought assistance from State Prosecutors’ Offices (SPO), either because they were detained or because they filed a complaint, in Pachuca, Hidalgo, a modern city lying 100 km outside the capital of México with approximately one million inhabitants.
The samples were obtained during the same period in the second half of 1996. The household survey (Medina Mora, ME.) (n=980) was obtained through a stratified sample of the population ages 18 to 65, through face-to-face interviews. The interviews in the State Prosecutors’ Offices were conducted at the only two offices in this city. Data was obtained every 24 hours for a period of 45 days (N=471)Both surveys included similar questions and were undertaken face to face by trained professionals using standardized questionnaires. Univariate and multivariate analyses were carried out through logistical regression to determine associated characteristics to population that commits crimes or files complaints in comparison with the general population. Emphasis will be placed on the population ages 18 to 29, which was the population most at risk of ending up at a SPO (OR 2.7) compared with other ages. The type of crime involved and links with domestic violence were also compared.
Key words: Domestic violence, crime, denunciations, alcohol consumption, household survey, México
Increased alcohol availability’s effect on alcohol related problems
Background: On October1st 2003 taxes on spirits decreased with 45 percent in Denmark, one of the countries from where Swedes got most of their alcohol brought in from travelling during 2003. With the additional changes in traveller allowances that were made in Sweden on January 1st 2004, making it possible to bring back almost unlimited amounts of alcohol, the availability of cheap alcohol increased in particular for the individuals living in southern Sweden.
Aims: The main purpose in this paper will be to test whether self reported alcohol related problems increased in southern Sweden as a result of these changes, using northern Sweden as a control area.
Data and method: Representative samples of the adult population in the southern and northern parts (parts closest to the Finnish border excluded) of Sweden were used in the study. Data were collected through telephone interviews both prior and after the changes in focus. In both parts of Sweden 1500 respondents were interviewed in each of the 3rd and the 4th quarter in 2003. About 70 per cent of these were reinterviewed one year later. The study was estimating the combined as well as the independent effects of the two policy changes. Analyses were focusing on the proportion of various alcohol related problems during the different time periods as well as for the different areas. Additional analyses were carried out for different population groups as sex, age, occupation, education level and alcohol consumption groups.
Key words: Alcohol related problems, tax-changes, travel allowances, alcohol consumption groups, longitudinal study, availability
Drug use as a generational phenomenon
Objectives: The objectives of the paper are to study and discuss about the concept of generation as an analytical tool for interpretation of drug trends.
Methodology: The paper describes the results of a population survey conducted in Finland in autumn 2002.
Significant findings: The increase in drug use during the 1990s has been described as the second drug wave. The analysis presented in this paper shows that the second drug wave in Finland was a generational phenomenon. The new drug users and experimenters come from age groups who were born in the 1970s and 1980s and who lived their youth in the 1990s and the early 21st century. Drug use has been enjoying a growing acceptance in contemporary youth culture. It seems that the new culture of recreation and experimenting with drugs has arrived in Finland. With the trends of internationalisation and the use of stimulants which is associated with night-life and partying, this culture has gained an increasingly firm footing among this new generation of young people.
Discussion: In the final part of the paper I will review European literature on drug trends and discuss about the usefulness and limitations of the concept of generation in the interpretation of drug use and new drug trends.
Key words: drug use, concept of generation, drug trends
Changes in drug use prevalence in rap music songs, 1979 - 1997
Aims. This paper explores the role of changing images of drug use in rap music from its beginnings in the U.S. in the late 1970’s to the late 1990’s.
Design. A sample of 341 rap music song lyrics released from 1979-1997 was selected using Billboard and Gavin rating charts. Song lyrics were coded for a variety of types of drug references including drug types, drug use behaviors and contexts, attitudes towards drugs, consequences of drug use, and music genres.
Findings. From 1979 - 1997, songs with references to drugs increased over six-fold (from 11 to 69 percent); those exhibiting positive attitudes rose from 16percent to 59percent. Songs mentioning marijuana increased from 33 percent to 82 percent while references to blunts, increased from zero in 1979 to 23 percent of drug references by 1997. Cocaine references rose dramatically in the 1980s but then decreased in the early 1990s. The percentage of references to hallucinogens decreased significantly from the early 80s to the mid 90s. In addition, there were significant increases in references to drugs to signify glamour and wealth, sociability, bragging, thuggish behavior, and as part of a song’s rhyme scheme. There was also a significance increase in using drugs with alcohol and for recreational purposes, as well as a sharp reduction in anti-drug references. The findings also showed that drug use in rap music was much more likely to result in positive, than negative consequences. The percentage of drug references indicating positive consequences of drug use nearly doubled during the period 1979-1997, while the percentage indicating negative consequences decreased during the same period.
Conclusions. The paper will explore potential explanations of the increasing focus on drug use rap music such as the rise of the drug war; changes in the drug use habits of rappers and listeners; rise of gangsta rap and other rap music genres and changing social images of drugs in American society.
Key words: illicit drugs, rap music, race and ethnicity, popular culture, content analysis
Kimmo Herttua¹, Pekka Martikainen¹, Pia Mäkelä²
¹ Population Research Unit, Department of Sociology, University of Helsinki, Finland
² National Research and Development Centre for Welfare and Health (Stakes), Helsinki, Finland
Alcohol-related mortality in Finland 1987 – 2003: A register-based follow-up study
Background. Alcohol is major determinant of premature death and population sub-group differences in mortality. The aim of this study is to assess to what extent alcohol-related mortality has changed by age, sex and education in Finland in 1987-2003, a period which saw two periods of economic growth, separated by severe depression. We further estimate the contribution of alcohol on life expectancy according to these variables.
Design. A register-based follow-up study of all over 15-year old Finnish men and women. Characteristics of the participants were measured at the time of the 1985, 1990, 1995 and 2000 censuses, and included sex, age, education and main economic activity. Follow-up for mortality was based on the individual level linkage to death records for 1987-2003. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. We separated the following main types of alcohol-related causes of death: 1) alcohol intoxication-related deaths and 2) alcohol-related diseases.
Expected results and discussion. These results confirm and quantify the important contribution of alcohol use to premature mortality and education differences in mortality. The results have relevance for attempts at achieving the Finnish health policy goals of reducing accidental and violent deaths among young men and reducing socioeconomic differences in mortality. Our results are also an important reference for further follow-up that extends to 2004, the year of substantial changes in pricing and availability of alcohol in Finland.
Key words: alcohol-related mortality, gender differences, educational differences, trends, life expectancy, register-based follow-up data
Abstinence: The influence of socio-cultural factors vs pragmatic consideration
This paper examines the relative significance of socio-cultural factors as against pragmatic considerations contributing to abstinence among the respondents in the Sri Lanka's GENACIS survey conducted in 2003 with financial support from the WHO. The survey covered 1201 interviewees, drawn from seven out of 9 Provinces in the country.
Sri Lanka is not a country with a deep-seated drinking culture. Drinking, which is mostly a male prerogative in the country, became more widespread over the last three decades with the liberalization of the alcohol economy. Yet, drinking habit is still not considered a 'normal' activity, well integrated into the socio – cultural life of the general population. Many ordinary people drink, but often ‘outside the gaze of family members'.
Given the above state of affairs, one would expect the sociocultural factors to constitute the most dominant influence on abstinence. Yet, a closer examination of the survey data shows that more pragmatic considerations such as health and financial costs are as important, if not more, as socio-cultural factors such as socialization and religion. On the other hand, gender, ethnicity and age differences are highly significant in the above regard, indicating a highly complex interplay between sociocultural and other factors influencing patterns of abstinence among the respondents. The paper examines how the influence of cultural factors is either reinforced or moderated by other factors and vice versa.
Alcohol policy in Ireland: The price of drink
Alcohol consumption increased by 41 percent in Ireland over the last decade, the highest rate of increase in Europe. Alcohol related harm also increased significantly in the same time period. The key triggers for the dramatic increases were rapid economic growth and changing lifestyle, strong alcohol marketing and poor policy choices. The establishment of a Strategic Task Force on Alcohol with a brief to recommend specific, evidence based measures to prevent and reduce alcohol related harm along with a public awareness campaign began a slow process of change. Effective policies have been implemented such as increased alcohol taxes and stronger alcohol laws, which for the first time in over sixteen years have decreased consumption and harm. However, it is a challenge to keep the process going. The process needs supportive structures, resource commitments and a political recognition that alcohol related harm is an Achilles heel for sustainable economic growth.
This paper will explore the dynamics and consequences of these changes, the strategic response and consequences of implementing policy changes and the challenges in shaping future effective policy in a national and international free market environment.
Key words: alcohol policy, alcohol related harm, case study
Youth and the meaning of risk in the electronic music dance scene
Since the end of the 19th century, societal concern about the behavior of young people has spawned an entire research industry. The overall intent of much of this research has been to regulate the activities of young people, especially those groups identified as at risk. One key area of control and regulation has been young people=s leisure activities and especially activities associated with ingested substances such as alcohol and illicit drugs. A recent arena of control has been the dance scene. One way the authorities attempt to control these activities is through the use of prevention messages which emphasize the high risk nature of the activities. These messages often assume that young peoples’ desire to use alcohol and illicit drugs and their subsequent failure to take heed of prevention messages are based on a combination of young peoples’ ignorance about the dangers, their lack of accurate information or pressures from their peers to use. Many of these assumptions are made with little or no empirical data to support them.
The purpose of this paper is to explore the world of lay knowledge about alcohol and drugs among adolescents and young adults. Using in-depth qualitative data from a sample of young dance event attendees in the San Francisco Bay Area we will analyze their perceptions of alcohol, ecstasy and other illicit drugs used at dance events. We will explore, using contemporary socio-cultural theories of risk, how young adults socially construct notions of risk and risk taking, the meanings associated with it and the extent to which young peoples’ notions of risk and danger around individual substances are influenced by social setting and social grouping.
Key words: Youth, qualitative, alcohol, drugs
Amount of alcohol considered appropriate to take in different settings
This study set out to examine the consumption of alcoholic beverages that would be considered appropriate in different settings/time. A total of 2,099 respondent 18-65 years were sampled in regards to how much alcohol was considered appropriate to take in different context. Responses were “No drink”, “1-2 drinks”, “Enough to feel the effects but not get drunk” and “To get drunk at times”. Results from this study showed that the greatest percentage of people felt that drinking was not appropriate irrespective of the setting. It was only in the context of man/woman with friends at the bar and at a party that a little under half of the people felt it was appropriate to drink. It was a man drinking with friends at a bar that the highest percent of respondents (15.7percent) considered okay to drink to the level that you could feel the effects of alcohol without necessarily getting drunk. Fewer yet comparatively large percent (8.3percent) felt that woman with friends at a bar could drink to the same level. Significant gender differences were seen only in the context of drinking with friends after work where more woman felt it was not appropriate in this setting (X2 = 3.69 p<.01). More men than women felt that it was okay for one to drink at a party to a point where he feels the effect without necessarily getting drunk (X2 = 14.28 p<.001), also that it was okay for a man to drink at the bar with friends to the point of feeling the effects but not getting drunk (X2 = 6.68 p <.01).
The results of this study are discussed in the light that abstinence appears to be the norm more than the exception and this may be the channel to focus on in prevention messages that use social marketing to in correcting believes about drinking.
Key words: alcohol consumption, setting, Nigeria.
Who is pressurizing who to drink or drink a little more than intended?
This study set out to investigate the pressures experienced by different individuals to drink or drink a little more than intended by someone who drinks or drinks more than they do. A random household survey of adults between the ages of 19 and 65 years was conducted to examine the nature of pressures that they have experience in the past 12 months and who had exerted this pressures to try to get them to drink or drink more than they intended. Chi-squared analyses of the data showed males were the most likely to be the ones attempting to influence others to drink. This influence was significantly higher for current drinkers than abstainers. These findings point to the need in prevention efforts to specifically teach people how to respond to pressures that would come from this particular group.
Key words: Drinking, social influence, significant others
Treatment-seeking for alcohol problems from a gender perspective: The start of an exit process
Aim: The aim of this paper was to elucidate treatment seeking for alcohol problems from a gender perspective. Method: A qualitative study was performed. Data was obtained from open interviews with five women and seven men within a month after their treatment entry for alcohol problems. The interviews were audio taped and transcribed verbatim. A content analysis was performed, using sex as a sorting factor. Findings: Treatment seeking processes in the women were categorized as; credibility, external pressure, the significance of alcohol, shame and guilt, moral demands and relief to acknowledge the problem, and for men; beliefs in the personal capability, shame and embarrassment, the significance of alcohol, future-orientation. Discussion: Analyzing men and women separately opened new ways of looking at treatment-seeking behavior. The findings were in concordance with the view of alcohol as a gender symbol, where drinking was associated with masculinity and sobriety with femininity. Gender related behavioural expectations were associated with given social roles. Although several differences were found between women and men, also similarities appeared. For both men and women the question of identity was important, as were the exit-processes that involved disengagement from behavior connected to the undesirable role as a person with alcohol problems. The establishment of a new identity, which also takes in account the persons former experiences, involves tension between past, present and future.
Key words: treatment-seeking, gender-perspective, alcohol-problems, exiting
Cultural variations in suggesting to drink less
There are at least two ways to explain criticisms on drinking. The first assumes that the noticeable consequences of drinking may influence a partner, children, family members, friends or colleagues to criticize the drinkers drinking. The other assumes that concerns about the possible consequences of somebody’s drinking make others caution him in order to avoid these.
Concerns about drinking vary with the culture one has been nurtured in. We wonder therefore (a) whether countries differ in the moment people start to suggest someone to drink less and (b) whether countries differ with respect to who makes these criticisms. Moreover, we will question (c) whether countries with comparable drinking patterns have also comparable patterns of criticizing.
For the first question, we will focus at what frequency and at which level of drinking people start criticizing and which negative consequences (acute physical and social) provoke criticisms. For the second we will focus on the relation to the drinker of the censor and his or her gender.
On basis of the GENACIS data we will present country and age group variations in suggesting the drinker to drink less, taking into account the drinkers’ drinking pattern and the acute physical and social consequences experienced. As men and women differ in their drinking habits and as the norms about drinking vary with gender of the drinker, all questions will be answered for men and women separately.
Key words: Criticisms on drinking, cultural variations, gender, GENACIS, descriptive statistics, multivariate analysis
Risk, drug prevention and young people
Much attention has been paid to the concept of risk during the last decades. This has also been the case in the area of drug prevention. Informed by e.g. epidemiological findings, efforts are made to address factors that increase the likelihood of drug use or abuse, so called risk factors. As drug use in itself also carries with it substantial risks, it would hardly be an exaggeration to say that the concept plays a prominent role in this area. As a part of my ongoing dissertation-work, in this paper I will discuss this proliferation of the use of the concept of risk and point out some consequences that might follow from this. A central issue that I will keep myself occupied with is the problems of uncertainty that emerge when people are exposed to risk information that is contradictory, including research reports, drug education in school and more informal messages from e.g. peers.
Key words: risk, drug use, prevention, young people, social theory
Evaluating the effects of beverage-specific drink ethanol content estimates on alcohol consumption measures, coverage of sales statistics and prediction of outcomes
Estimates of mean drink ethanol content by beverage type and demographic sub-groups derived from the 2003 - 2004 National Alcohol Survey Methodological Follow-up Survey are applied to individual responses in the 2000 National Alcohol Survey (NAS). Drink ethanol content means are found to vary by beverage, gender, age group, geographic region, ethnicity, alcohol consumption level, body weight and past year marijuana use. Beverage means are of particular importance. Based on pour size and brand information, mean reported “drink” ethanol content is 0.56 ounces for beer, 0.66 ounces for wine and 0.88 ounces for spirits. Three levels of specificity in drink ethanol means will be applied to NAS data: (a) beverage type only, (b) gender and age group by beverage, and (c) a modeled drink ethanol content for each beverage based on an individual’s demographics, drinking volume and other factors. These drink ethanol amounts will be applied to individuals’ monthly beer, wine and spirits volume measured by the Knupfer Series questions. The effects of implementing these drink ethanol content estimates will be compared to results using standard (unadjusted) drinks only. First, coverage of sales for the US as a whole and for each census region will be calculated using standard drinks and each of the three types of empirical drink alcohol estimates. Next, each set of estimates will be used in models predicting two or more alcohol related-consequences and meeting alcohol dependence criteria in order to evaluate whether greater specificity of drink alcohol content improves prediction.
Risk factor issues for youth in public alcohol and drug treatment in California
A recent survey was conducted of a targeted sample of 20 diverse California counties and their public alcohol and drug treatment for adolescents, using informant interviews and case studies. This was followed by secondary analysis of statewide data and supplemented by documentation collected over four years of involvement in youth treatment policy development.
The most common substances used by the youth include alcohol, although marijuana is often recorded as primary, probably due to the referral sources. These referrals are dominated by the juvenile justice system -- probation, courts, police – and linked agencies -- foster care group homes, “continuation” schools -- concerned with lawbreaking. Many referrals are triggered by youths’ problematic behaviors rather than substance use per se.
The risky circumstances identified in the interviews and case studies cluster in four domains: drinking and drug use in the family or community; school problems including failing performance or attendance, legal and criminal issues such as a violent or abusive milieu; and family problems reflecting the stresses of poverty, parental conflict, and criminal justice involvement. Other factors noted are sexual abuse (particularly for girls), post-traumatic stress (especially for refugee youth), transience coupled with lack of exposure to mainstream opportunities, and conditions such as depression and anxiety. Risky behaviors described include fighting and violence, sometimes with peer gang involvement (particularly for boys and in urban areas), and driving to nearby places with alcohol and drug availability (especially in rural and border areas).
Implications for prevention based on these circumstances and factors will be noted.
Key words: Adolescent substance abuse treatment, risk factors, treatment concerns, key informant survey, case studies, secondary analysis of data
Stigma and the politics of natural recovery attitudes towards self-change in a Swiss population survey
Research on recovery from problem substance use without professional help has been dominated by an individualistic perspective of clinical psychology. However, societal context factors such as availability but also the climate of opinion can make it harder or easier for individuals to change their behaviour successfully. The study is based on a representative telephone survey (n= 707) conducted in the German speaking part of Switzerland in October 2004. Using categories developed from the qualitative international SINR (Societal Images of Natural Recovery) it firstly describes how optimistic or pessimistic the Swiss population is that individuals can change from various types of addictive behaviours on their own and what barriers to change are assumed. Secondly, besides socio demographic characteristics of the respondents, the following predictors of the perceived change potential of addicts are considered: Self-reported consumption status; stigma, social distance and causal attributions; personal or professional experience with addiction problems; perceived locus of control and political interest/belief systems as well as trust in professionalism in general. Thirdly, change optimism is analysed as an independent variable, possibly influencing the willingness to provide support to addicts. The study provides insight into ‘the everyday politics of addiction’ and allows for a comparison with official drug and addiction policies. Conclusions can be drawn which enable us to match prevention campaign messages better with images on addiction prevailing in the general population. Finally the data shed light on the drug specific societal response, which individuals will encounter when they are trying to quit. The study is a starting point for a better understanding of the parameters which make up a ‘self-change friendly society’.
Family bonding, drinking families, and adolescent alcohol use
Literature has shown that excessive drinking by family members is positively related to adolescent alcohol use, whereas family bonding is negatively related. The aim of the present study was to determine if there is a weaker relation between family bonding and adolescent alcohol use among adolescents from excessive drinking families than among those without such a family characteristic. t-tests and linear structural equation models with between groups comparisons were used based on a national representative sample of 3,448 8th and 9th graders in Switzerland (mean age 14.77; SD .89). Adjusted for gender and age, the results confirm that strong family bonding was negatively related to both frequency of alcohol intake and frequency of drunkenness, whereas excessive drinking by family members was positively related. The between group comparison, however, revealed that in excessive drinking families the negative relation between bonding and adolescent alcohol use was even stronger than in families without excessive drinking. These results show that in families where excessive drinking is common establishing family bonds (e.g. by spending free time with children, by listening to their worries) is of particular importance.
Keywords: excessive drinking families, family bonding, alcohol use, drunkenness, adolescence, Switzerland.
Obstacles to early detection and intervention in alcohol problems in general practice
Although the official Dutch alcohol policy has stressed the importance of early detection of alcohol problems in primary practice, scientific results show limited success in implementation of screening and interventions. The current study focuses on the attitudes and characteristics of general practitioners in an attempt to distinguish obstacles in the assessment of problematic alcohol use, and the potentials for brief intervention in general practice. We have used an existing sample of general practitioners for which also detailed information on alcohol use of their patients was available. A detailed questionnaire was returned by 44 doctors. Questionnaire assessed attitudes, opinions, and self-reported behaviour on both prevention in general, as well as working with patients with possible alcohol problems, abuse or dependence (SAAPPQ). It also encompassed aspects available in the recently renewed guidelines for early detection and intervention for primary practitioners. First results are that personal aspects, such as doctor’s work satisfaction or motivation are important obstacles in working with patients with alcohol problems. They also suggest that specific role aspects, such as poor skills, and a generally a low task specific self-esteem are important impediments for doctors to actively engage problem drinking. When asked about potential barriers, doctors often mention structural (health care) and functional (effectivity, training) issues. When asked about their recent experiences with alcohol interventions, it becomes clear that they take action only in a limited number of cases. In the paper, we will add analyses of doctor and patient characteristics as specific factors potentially affecting attitudes toward early detection and intervention.
Key words: early detection, brief intervention, alcohol problems, general practice, physicians’ attitudes
Strength-based assessment, youth development, and school success
This paper describes the evaluation of the shift of a statewide network of alcohol, tobacco, and other drug (ATOD) prevention programs from a problem, or deficit, orientation to an approach that links effective prevention strategies with positive youth development research and “best practice.” A growing body of research indicates that programs with demonstrated effectiveness in minimizing use of ATOD and preventing other problems, as well as facilitating development of important skills and social assets, use a positive youth development framework and approach.
Youth Leadership Institute administered a 43-item survey to 848 youth participants from 91 programs throughout the state of California to evaluate the extent to which a youth development framework was successfully applied and measure participants’ experience of five youth development standards of practice: safe environment, opportunities for involvement and connection to community and school, opportunities for leadership and advocacy, opportunities to build skills, and caring and meaningful relationships with adults and other youth. These standards of practice reflect features of positive youth development settings described by Eccles and Gootman (2002) and represent critical supports, opportunities, and skills young people need to experience on a consistent and sustained basis to achieve longer–term developmental and ATOD prevention outcomes.
Survey results indicate that participants experienced the settings that research has linked to positive developmental and ATOD prevention outcomes. Results also indicate that youths’ experience of the standards of practice increased with the duration and intensity of their program involvement and were influenced by participant characteristics such as gender and ethnicity.
Key words: youth development, evaluation, ATOD prevention
Adolescent's risk behavior induced with drug abuse
Objective: Bosnia and Herzegovina is a country with postwar society, currently going through transition period. Therefore various risk factors for drug abuse can be found here, such as: economical, social and helath. Youngsters like to experiment with risky life stiles, without adequate knowledge about long-term health effects. The main objective was finding how many adolescents had risk behavior and subsequences oftener sexual intercourse and aggressive behavior.
Methods: Research has done in urban and rural areas of Sarajevo canton, involved 368 adolescents: male 170, female 198, aged 12-17 equal urban and rural distribution. In research used risk behavior questionnire Q 2004 (K.B.Kelly 2000).
Results: Out of total number of individuals in the study 25.8 percent was cigarette smokers, 39.4 percent consumed alcohol, 2.2 percent consumed marijuana. Among group who use tobacco 33.7 percent have fight twice or more in the last two years; suicidal thoughts: 36.8 percent, sexual intercourse 15.8 percent. Similar results were found among individuals who abuse alcohol: fighting 44.8 percent, sexual intercourse: 15.9 percent: suicidal thoughts 32.4 percent. Among youngsters who abuse marijuana: fighting: 87.5 percent, sexual intercourse: 62.5 percent suicidal thoughts 50.0 percent. Protected sex among adolescents who smoke: 46.7 percent; drink alcohol: 47.8 percent: marijuana: 60.0 percent. These results were compared with adolescents who don’t abuse drug.
Conclusion: Adolescents tend to abuse psychoactive substances in developing countries. The consequence is higher risk behavior such as violence and promiscuity. These results could be used to develop an appropriate prevention strategy. It is necessary to be aware of all relevant risk factors
Key words: adolescents, risk behavior, drug, abuse
Abstention and depression in the national longitudinal alcohol epidemiology survey
In this study we examine whether depression differs across drinking/abstention categories controlling for socio-demographic and lifestyle variables. The NLAES, a U.S. national stratified sampled cross-sectional dataset (N=42,862), was used for this analysis. Drinking status was divided into current drinkers, current heavy drinkers, former drinkers, and lifetime abstainers. Depression was dichotomized as ever having been depressed (using DSM-IV criteria) vs. never depressed. Logistic regression using SUDAAN (to account for complex sampling) was used to control for the effects of socio-demographic factors. Ex-drinkers, when drinking, consumed significantly higher average quantities than did current drinkers. When abstention was not stratified into lifetime abstention and ex-drinking, no difference was found in estimated risk of depression between abstainers and current drinkers. High quantity current drinkers were found to have an increased risk [OR=1.34, 95percent confidence interval (1.17, 1.54)]. When abstention was stratified into lifetime abstention and ex-drinking, ex-drinkers were found to have an increased risk of depression [OR=1.46 (1.33, 1.61)] while lifetime abstainers were found to be protected against depression (OR=0.70 (0.63, 0.78)) compared to current drinkers. High quantity current drinkers were found, similar to ex-drinkers, to have an increased risk of depression [OR=1.39 (1.20, 1.60)]. Abstention is not a homogeneous category with regard to depression. Ex-drinkers and lifetime abstainers can be considered distinct groups when conducting research in this area. The preventative effect found for lifetime abstainers, even relative to current drinkers, is an unusual finding that bears further study.
Key words: abstention, depression, moderate alcohol use
Toward a new scientific research programme for the etiology and epidemiology of youth alcohol use, abuse, and prevention
Starting with Dean (Chaos and Intoxication 1997) and Siegel (Intoxication: Life in Pursuit of Artificial Paradise 1989), and perspectives on brain building and brain development/maturation advanced by Dowling (The Great Brain Debate: Nature or Nurture? 2004), we suggest that youth alcohol use represents an attempt to seek the brain excitement of earlier years once the rearrangement and pruning of synapses is under way in adolescence. Adolescent risky behavior of all kinds is likely for excitation and comes from the fact that the last brain structure to mature is the cerebral cortex, seat of perception, memory, judgment, and reasoning, between 18 - 20.
As suggested by MacAndrew and Edgerton (Drunken Comportment 1969), particularly on youth participation (or not) in ceremonial drinking, and consonantly with Dowling, we suggest youth alcohol behavior is mostly phenotypic – apart perhaps from those cases with a genetic predisposition to alcohol abuse/dependence. (Here we look at types of alcoholisms and at human connections with alcohol over time.)
We look at the effect of our youth cultures on youth drinking and at cultures which seem to handle the matter better, perhaps recognizing the importance of the brain-building period. We examine brain redirection implicit in Alcoholics Anonymous and other conversion experiences, asking, are programs to this end useful for those under 21?
Fundamentally, we suggest the possibility that we will have a (Lakatosian) progressive research programme if we recognize that youthful alcohol use/abuse is for us a natural phenomenon and engines of adult treatment may not be relevant.
Key words: Brain building, brain maturation, alcoholisms, adolescence, treatments
Health effects from drinking; Type, severity and associated drinking patterns
Background: Survey questions assessing life areas harmed by drinking are widely used, but little is known about how respondents interpret such questions. The current study documented the type and prevalence of specific health harms reported to have been caused by drinking. Heavy episodic drinking patterns and alcohol dependence symptoms were examined in relation to health harms.
Methods: A telephone survey of the U.S. adult population (N = 635), conducted in 1994. Standard health harms questions were asked followed by open-ended and closed-ended probes including a question on the “most serious” harm. Self-reported estimates of cost and work missed were used to assess the severity of health harms.
Results: Among the 579 ever-drinkers 26 percent reported any lifetime health harm. The most frequent health harms were relatively minor; hangover 19 percent; poorer mental health 18 percent, headaches, nausea and low energy 17 percent. A substantial number of serious health effects were also noted; liver (6 percent), heart (4 percent), and injuries (4 percent). Among those reporting health harms, mental health problems were most likely to be reported as being the most serious (12.5 percent) harm. Health harms were conceptually grouped by type of health condition. Risk factors for those groups were examined separately. Participants reporting harms relating to intoxication, injuries or internal organs (heart, liver, stomach, diarrhea or blood) were significantly more likely to drink 5+ drinks in a day on a monthly basis or be current abstainers with past dependence symptoms, compared to abstainers with no past dependence symptoms. In multivariate analyses lifetime reports of an alcohol-related health condition involving internal organs was strongly associated with key lifetime alcohol dependence symptoms (adjusted odds ratios (AOR) = 12.0; 95percent CI 5.8-24.6) even when controlling for current heavy episodic drinking (AOR=2.7; 95percent CI 5.8-24.6).
Conclusions: The most severe harms were associated with the alcohol dependence symptom involving loss of control over drinking, whether current or past drinkers. Additional research is suggested to clarify the relationship between self-reported health harms, burdens associated with drinking patterns and possible interventions to reduce health-related harms.
2, Rick Csiernik2, 3, Pierre Durand4, T. Cameron
Wild1, 5, Margaret Rylett1
1 Centre for Addiction and Mental Health
2 University of Western Ontario
3 King’s University College at the University of Western Ontario
4 University of Montreal
5 University of Alberta
Factors related to the adoption of employee assistance and drug testing in Canada
This study examines factors related to the establishment of Employee Assistance Programs (EAPs) or drug testing programs. We hypothesized that EAPs are primarily an employee benefit and would therefore be more likely to be developed in more democratic worksites. For drug testing programs, we thought they would be more likely to be developed in top down worksites, with hierarchical styles of management. Further we hypothesized that drug testing programs would be more likely be established for socio-political reasons and in safety sensitive worksites. Methods: A sample of 633 Human Resources Managers at worksites with 100 or more employees across Canada completed a questionnaire on their worksite characteristics and the types of programs available (response rate = 77.8%). Results: We found supporting evidence that EAPs are a benefit and are established in more democratic worksites. Worksites with EAPs, compared to worksites without EAPs, had significantly (p<.01) fewer visible minorities, were more likely to be unionized (p<.0001) and more likely to involve lower levels of management control (p<.00001). Our hypotheses were also supported for the drug testing programs. Significant differences were found across provinces (p<.00001), for worksites with delivery of goods to the United States (p<.01) and for those in the safety sensitive work sectors (p<.00001). A multivariate logistic regression analysis was conducted to determine which constellation of variables best predicts the existence of programs. In Canada, the reasons for drug testing appear to be partially political, partially practical and partially an attempt to address safety issues.
Key words: Workplace, employee assistance programs, drug testing, social control
Treatment of substance related problems in Switzerland: Implementing a new harmonised monitoring system
In the past years, five different monitoring systems were used in the various areas of the helping system for substance related problems in Switzerland, without real coordination between them. Due to their different histories and supporting conditions, the instruments applied in the field of inpatient care (distinct ones for alcohol and drug related problems) and in the sphere of outpatient facilities (different ones for psychosocial intervention, substitution and heroin prescription programs) were indeed quite similar in their topics, but hardly comparable on the measurement level. Efforts were undertaken by federal instances in order to provide a fully standardised pool of items for all needs and to constitute a core body of items shared by the five data collecting systems. Another aim was to ensure compatibility with the Treatment Demand Indicator (TDI) adopted by the EU as standard in collecting and reporting data on the profile of drug users in contact with treatment services. This paper describes the issues of this harmonization process and presents the practical and organizational options taken by the coordination group.
Kew words: Treatment, monitoring system, instrument, standards
Hector Suarez, and Francisco Umpierrez
Legal and illegal drug consumption in recent detainees
Objectives: Estimate prevalence, incidence, consumption and dependency of legal and illegal drugs. Relate drug consumption with previous and actual arrests. Validate the survey application method through a drug marker and metabolites in urine. Contribute towards estimation of human, economic and social costs .Test methods and instruments
Study: over 18's of both sexes, arrested for any cause in law enforcement offices in Montevideo; 1,035 cases, 309 urine exams and 578 breathalyzer tests, during December 2004. Technique of immunoassay in its solid base phase was used to compare drug or metabolite in urine to establish marihuana, cocaine and cocaine paste metabolites. Result is positive when consumed in the last 48 - 72 hours.
Samples: 18 percent of the interviewees denied having consumed drugs recently, yet it was detected in their urine. Result bears a better relation to "sometime in a lifetime". The breathalyzer tests uncover immediate consumption, measuring its association with the committed felony. It’s considered a good method to directly measure relationship between substance abuse and recent occurrences.
Results: High drug consumption percentages, especially alcohol, marihuana, cocaine paste. Of those evidencing consumption, 43 percent do so with two or more substances. Cocaine paste is the drug that's most combined with other drugs (77 percent), marihuana being the most important. Approximately one in four felonies is linked to consumption of substances. More serious felonies (against property, robbery, assault), are committed by drug consumers in 70percent of the cases. In these felonies most detainees are convicted, incorporating individuals with drug problems to prisoner population arise.
Alcohol and preventive paradox: Wide-ranging harms and drinking pattern
Preventive paradox argues that although heavy drinkers are at highest risk, the majority of alcohol problems accrue to the less-heavily drinking majority of population. It has been criticised on the grounds that self-reports of the presence of problems are not sufficient evidence on the distribution of harms among drinkers and that drinking pattern as well as the frequency and severity of harms should be considered. We studied the distribution of self-reported problems, hospital admissions and alcohol-related deaths between the 10percent of population with the highest average alcohol consumption and the remaining 90percent of drinkers ("moderate drinkers"), separating these into two subgroups on the basis of whether the respondent reported consuming five or more drinks per occasion or not.
The data were based on four nationally representative cross-sectional Finnish Drinking Habits Surveys. A total of 6,726 respondents aged 15 to 69 years were available for the study of hospital admissions and deaths and 5,718 for self-reported problems.
Among men, 65 percent of the alcohol-related deaths and 64percent of the premature life-years lost before the age 65 years occurred among moderate drinkers. The respective figures for women were 85 percent and 83 percent. Similarly, the majority of hospitalizations and of self-reported problems occurred among moderate drinkers, even when the number of problems was taken into account. For men, within the category of moderate drinkers, binge drinkers made about two-thirds of the respondents but accounted for an even much larger proportion of harms. For women, binge-drinkers made about one-third of the moderate respondents and accounted for a similar proportion of harms.
Key words: Preventive paradox, prevention strategies, drinking pattern, alcohol-related mortality, hospitalizations, surveys
Alcohol use screening for high school students
Alcohol and tobacco are the most widely used drugs by teenagers. A study carried out in the largest 107 Brazilian cities suggests the prevalence of 5.2 percent of teenagers addicted to alcohol. The purpose of this study has been to identify the drinking pattern of students of two public high schools of the State of São Paulo, Brazil, and it constitutes the first part of a study testing brief intervention for heavy-drinking teenagers (heavy drinkers). Screening instrument comprised AUDIT - Alcohol Use Disorders Identification, and also investigated the socioeconomic level, religion and whether any relative had drunk to the point of causing trouble. In 2004, both schools tended a total of 1,670 students, with the same number of young men and women, of which 87 percent belonged to classes C and D, 13.5 percent informed that a relative had drunk to the point of causing trouble, and with predominance of Catholics, with 52.5 percent of participants, followed by Evangelicals, with 20.9 percent and 20.8 percent of individuals with no religion. By using an 8 cut-off point, AUDIT has identified 17.9 percent of students. These positive students are evenly distributed between both schools and 70 percent of them are male. About half of them are seniors (42.3 percent) and study during the night period (57.7 percent). As for religion, Catholics remain with the same percentage, but Evangelicals have dropped to 9.1 percent and the ones with no religion reached 29.5 percent. These results suggest the need of intervention for heavy-drinking teenagers who are not addicted to alcohol.
Key words: Screening, teenagers, alcohol use, brief intervention
Methodists and drinking in the USA
Methodists, the largest Protestant denomination in the U.S. after Baptists, were once strongly opposed to the consumption of alcoholic beverages, even in moderation. Methodists were the vanguard of the movement in the 19th and early 20th century which led to the unsuccessful social experiment in Prohibition from 1920 to 1933. Baptists, Presbyterians and Congregationalists were also prominent in this movement. Since then, there has been a softening of the positions of Methodists on alcohol. By 2000, according to the National Alcohol Survey, nearly half of U.S. Methodists said that their religion does not discourage the consumption of alcohol, and over 60 percent described themselves as current drinkers. What are Methodists’ current patterns of abstention and drinking, how have they changed in recent years, and how do they compare with national averages and the patterns of other religious groups? Have older Methodists kept the same attitudes, and are younger people more liberal about alcohol? Do Methodist men differ from women in drinking attitudes and behaviors and, if so, how? Have doctrinal changes in Methodism with respect to alcohol been led by the clergy, or are they reactions to changes in the laity? Our paper examines these and other questions about Methodist attitudes and practices with regard to alcohol, based on results of the National Alcohol Surveys from 1984 to 2000, supplemented by interviews with selected clergy.
Key words: Alcohol, religion, Methodism, surveys
Application of the distribution of alcohol consumption to estimation of the range of alcohol abuse (on the basis of GENACIS data)
One of the most important problems in alcohol research is estimation of the size of population of alcohol abusers. For this purpose Ledermann’s idea of using distribution of alcohol consumption according to the level of consumption can be applied. Assuming that a theoretical curve (most often used is log-normal curve) can be fitted to empirical data, one can evaluate in a population an approximate number of alcohol consumers drinking above certain level. The problem arises when the survey distribution of alcohol consumption is biased due to non-sampling errors. In such situation, in author’s opinion, there is need to combine survey and aggregate data. The paper presents the method of estimation of the size of population of alcohol abusers based on distribution of alcohol consumption proposed previously by the author and empirical results based on GENACIS survey data for chosen countries. There are also discussed some special problems coming up in the proposed approach of estimation of the range of alcohol abuse.
Key words: alcohol abuse, distribution of alcohol consumption, estimation
1 University of Manitoba, Canada
2 University of Minnesota, Minneapolis, USA
3Alcohol and Drug Research Group, STAKES, Helsinki, Finland
Protection from and risk of increased mortality associated with patterns of alcohol use in the multiple risk factor intervention trial (MRFIT) cohort
Usual consumption of alcohol has often been found to be protective against coronary heart disease (CHD) and all-cause mortality. Harm from alcohol consumption has also been demonstrated. Why have epidemiologic studies not demonstrated harm as clearly as health protection? The MRFIT includes baseline data gathered from a sample of 12,866 men across 6 years, merged with mortality data over 25 years. Variables include volume of usual drinking and at year 6 the usual volume on weekdays and weekend days. The current analysis examines the effects of pattern of consumption on survival.
Cox regression was used to analyze survival over an 18-year span following the 6th annual visit. Causes of death were CHD, stroke, all cardiovascular disease (CVD), and all causes. Usual alcohol consumption was protective for all outcomes except stroke. Numerous definitions of heavy episodic drinking were assessed. The consumption of 5+ drinks on one weekend day and no drinks on weekdays was associated with a hazard ratio (HR) of 1.33 (p = 0.04) for all-cause death, and a HR of 1.40 for CHD (p = 0.13). A definition where 90% or more of drinks occur on the weekend and 8+ occur on one weekend day was protective against CHD (HR = 0.38, p = 0.05), and all CVD (HR = 0.40, p = 0.02).
This inconsistent evidence on the effects of drinking pattern on survival leads us to infer that consumption questions incorporating “usual” are suboptimal for definitions of heavy episodic drinking. Additionally, population studies based on a cohort from which heavy drinkers were excluded may be unsuitable for studies of harm from the use of alcohol.
Key words: Epidemiology, alcohol, proportional hazards, usual drinking, heavy episodic drinking
Université de Montreal, Department of Psychology, Montreal, Canada
2 Douglas Hospital Research Center, Verdun, Quebec, Canada
3 McGill University, Dept. of Psychiatry, Montreal, Canada
4 Pavillon Foster Addiction Treatment Program, St. Philippe de Laprairie, Quebec, Canada
5 Concordia University, Dept. of Psychology, Montreal, Canada
DUI repeated offenders: Cloninger’s type II alcoholism features and recidivism
This study examined the potential of Cloninger’s Type II alcoholism conceptualization in clarifying the mechanisms underlying repeated driving under the influence of alcohol (DUI). 104 male participants with from 1 to 8 previous convictions, mean age 44.7 years, 36.7 percent of whom had failed to fully comply with sanctions in order to re-obtain their permits to drive were administered a six hour assessment battery including measures of sociodemographic, psychosocial, psychological, neuropsychological, biological and neurobiological functioning. Measures associated specifically with Cloninger’s Type II alcoholism characteristics, namely genetic loading (i.e., family history positive, delinquency), alcohol chronicity, age of onset of alcoholism, and comorbid features (i.e., antisocial, aggressive, impulsive behaviours) were used in cluster analysis. This resulted in a three group solution, with one group clearly showing a consistent Type II profile. Subsequent comparative analyses showed that the Type II group had significantly more past DUI convictions and blunted cortisol responses, the latter indicating the presence of an endogenous mechanism for alcohol abuse and reinforcement. These findings suggest that the Type II conceptualization of alcohol abuse may be useful in understanding the poor prognosis of some individuals exposed to current remedial measures for DUI, and may further suggest new avenues for better matching intervention to individual characteristics.
Key words: DUI, repeated offenders, Cloninger’s Type II, salivary cortisol, assessment
Alcohol and spousal violence-related injury: Does the association vary by type of violence?
We examined associations among alcohol patterns and problems and spousal violence-related injury in a rural district of Rajasthan, India. Of the 172 married men who participated, 35.5 percent reported no spousal violence in the past year. Unlike other studies that typically do not differentiate among types of spousal violence, we included type of violence in our examination of alcohol and injury. Sexual violence was the most frequently reported among the 111 men reporting spousal violence in the past year, 61percent reported sexual violence only, and 37.8 percent reported at least one behavior of both physical and of sexual violence. Men who reported both types of spousal violence were the most likely to report injury to their wives (37 percent), compared to those reporting only sexual violence (20percent) or only physical violence (8 percent).
General drinking patterns, specifically total volume of consumption, number of drinking days, days of heavy drinking (≥60g ethanol) had different associations with type of violence and injury. These measures were associated with physical violence-related injuries but not with sexual violence-related injuries. Drinking during the incident of violent behavior, however, was reported by similar proportions of men reporting physical (28 percent) and sexual (32 percent) violence. Violence-related injury was less likely to occur when men reported drinking during the incident of physical violence. We will also present data on differences in other alcohol use patterns (e.g., maximum), alcohol-related attitudes and open-ended data on men’s perceptions of the association between their alcohol use, violence and injury caused to their wives.
Key words: Alcohol use patterns, spousal violence, injury
Per capita alcohol consumption and sickness absence
Purpose. The purpose of the study was to assess the relationship between aggregate alcohol consumption and sickness absence in Sweden.
Data and methods. Two indicators of sickness absence were used, one based on sickness insurance data, the other on data from the labour force surveys. Alcohol consumption was gauged by sales of alcohol (100 percent) per inhabitant 15 years and above. Since changes in the economy may affect alcohol consumption as well as sickness absence, two macro economic indicators were included as control variables: unemployment and real wages. The study period was 1935-2002. The data were analysed through the Box-Jenkins method for time series analyses.
Findings. According to the findings a 1-litre increase in total consumption was associated with a 13 percent increase in sickness absence among men (p<0.05). The relationship was not statistically significant for women.
Conclusions. Previous research has documented that aggregate alcohol consumption is related to a large number of harm indicators, such as cirrhosis and accident mortality. Through the present findings yet another indicator has been added to this list.
Key words: alcohol consumption, sickness absence, time series analyses
Vulnerable young people experiences of alcohol (a work in progress)
Perceived changes in alcohol consumption and associated anti-social behaviour in young people is causing concern amongst the UK public and Government alike. Alcohol consumption is seen as a rite of passage and for many poses few problems. However, some young people who do drink heavily become involved in conflict and anti-social or criminal behaviour, resulting in referral to Youth Offending Teams or other targeted youth services, or sometimes leading to custodial sentences. There are, also, few alcohol services for the juvenile age group (15 -17 years) in the community, and those young people who are referred may choose not to engage with them.
This three year study involves two semi-structured interviews, several weeks apart, with young people aged 15 -17 years. They are in touch with youth services and have alcohol-related problems, or are considered to be “at risk” either environmentally, socially or in terms of their behaviour.
The study documents their experiences and attitudes towards drinking alcohol, the effects on their lives and the impact of any interventions that they may have received. They also have an opportunity to give their views on these services.
As this is still a work-in-progress only some emerging themes will be discussed. No definitive results are available at this time. Some issues of engaging with this difficult-to-access group will be included.
Key words: Vulnerable young people, experiences, alcohol, anti-social behaviour
Screen for problematic cannabis and other drug use among adolescents: Study of the tests’ validity
The purpose of the study was to examine psychometric properties of two screening tests for problematic use of (1) cannabis, (2) various drugs.
In the study participated a representative sample of Polish adolescent drug users (defined as those who used any illicit drug at least once in the past 12 months). In the sample (N=1344) 37 percent of subjects were girls, 28 percent had 13-15 years of age and 47 percent were 16-17 years old. Majority of them were reached by snowball sampling and prior to the study had no contacts with any drug-therapy facilities. The criterion standard for the tests’ validity was the results of clinical diagnostic interview conducted by trained specialists. According to their diagnosis 41 percent used drugs occasionally, 59 percent were problematic users and addicts.
“Drug-test” consists of 10 items. A score of 1 or higher is optimal for identifying problem drug use (sensitivity - 0,88, specificity - 0,79, PPV – 0,86, NPV – 0,81). A score of 2 or higher in the “cannabis-test” (8 items) indicates problematic use (in the whole sample: sensitivity - 0,81, specificity - 0,86; and among those, for whom cannabis is the main drug: sensitivity - 0,80, specificity – 0,94). Tests’ validity is not affected by age or sex.
The prognostic value of the tests as screening tools seems to be satisfactory and it permits to recommend tests use in various settings.
Key words: Screening, validity, problem drug-use, adolescents
Young peoples' risk taking as authoritarian populism
The capital of Norway, Oslo, has for many years had a problem with an open drug scene, but the summer of 2004 it was dissolved. It is the aim of this paper to highlight the aspects of the process leading up to the dissolution of the drug scene, mainly focusing on the approach taken by the police and local politicians. How did the politicians manage to sway the public their way, and in what matter was important decisions made regarding the dissolution of the drug scene? It will be argued that the process that took place in Oslo shows similarities with that of 'authoritarian populism', recognized as responses carried out by democratic states in situations of social crisis, legitimizing increasingly repressive punitive laws and sanctions. In the case of Oslo, the pull-factor, where young people were drawn towards drug use, was given much focus by politicians and police. However, following the process closely it has been clear that the pull factor can not be considered appropriate under the above mentioned circumstances. In other European cities, public nuisance has been a vital element in the decision to split up the open drug scene. This aspect received little attention in Norway, and was rejected by central politicians. Nevertheless it was present in media and discussions on a lower level. Was the pull factor argument used as a replacement for the public nuisance argument, to prevent a debate on humanity in relation to public nuisance features? As history shows, the pull factor argument was easily swallowed by the public, and impossible to disagree with.
Key words: Drug policy, authoritarian populism, open drug scene
The Europeanization of Swedish alcohol policy: The case of ECAS
This paper is a part of the project Sweden’s role in European and international alcohol policy (SWAP) in which the main focus is to study Sweden’s role in the development of alcohol policy both within EU and internationally.
The Europeanization of Swedish alcohol policy can mainly be described as a Swedish implementation of EU rules. The European Comparative Alcohol Study (ECAS) can however be a possible example of the reverse influence. The project was an initiative from the Swedish Ministry of Health and Social Affairs and was presented as a comparative study that could serve as a basis for further discussions about common measures in European alcohol policy. The application from the Swedish Public Health Institute and the Finish STAKES was approved in 1998 by the European Commission.
Previous research is indicating that scientific evidence is playing a significant role in putting alcohol control measures on the agenda (Bruun et al, 1975, Edwards et al 1994, Room 1984). Johnsson et al (2004) have analyzed how actors involved in policymaking processes in an American federal context are using scientific information. Their results indicate that research is most influential during the agenda setting and in connection with specification of policy alternatives. Principally however the research showed to play a negligible role in the process. The aim of this paper is to analyze how ECAS have been understood and used nationally and on an EU level. Data used in this analysis include archival government documents, both from the EU and Sweden, reviews of the literature in the field and key informant interviews.
Key words: Sweden, ECAS, alcohol research, EU
A 10 percent growth in alcohol consumption in Finland in 2004
January 1st, 2004 import quotas for travellers' duty free alcohol imports from other EU countries were abandoned in Finland and May 1st Estonia joined the EU. Alcoholic beverages are clearly cheaper in Estonia than in Finland.
In order to combat travellers' alcohol imports from Estonia alcohol excise duties were decreased in Finland 1st March. The decrease in alcohol excise duty rate for distilled spirits was 44 percent and 40 percent for intermediate products where the price difference between Finland and Estonia was the biggest. Excise duty rate for beer was lowered by 33 percent and for wine by 10 percent.
In 2004 off-premise retail sales of alcoholic beverages increased by 8.2 percent in Finland. On-premise sales decreased by 3.8 percent. Off-premise sales of distilled spirits increased by 27 percent. Corresponding figures for fortified wines and beer were 15 percent and 8 percent. Off-premise sales of wines decreased by 3 percent.
Despite the decreases in alcohol excise duty rates travellers' alcohol imports increased by two thirds. Imports of distilled spirits nearly doubled. Home production of alcohol beverages as well as smuggling alcohol into Finland decreased. All in all total alcohol consumption per capita increased between 2003 and 2004 from 9.4 to 10.3 litres. The increase in recorded alcohol consumption was from 7.7 to 8.2 litres and in unrecorded alcohol consumption from 1.7 till 2.1 litres.
Key words: Consumption, taxes, travellers' imports, EU
Drinking practices in a hedonistic oriented Danish youth culture
The purpose of this paper will be to present some preliminary results from two surveys conducted in January/February 2005 among 15 - 16 years olds and their parents.
The surveys are a component of a major research project on Youth and Alcohol supervised by Professor Peter Gundelach and Professor Margaretha Järvinen. The overall goal of this research project is to contribute to an understanding of the alcohol culture among Danish youths taking a distinct sociological approach. Hence the purpose of these two surveys is to investigate how alcohol consumption among Danish youth can be explained by looking at a variety of social and cultural variables such as child-rearing ideals, perceptions towards drinking and drunkenness among the adolescents and their parents, parental habits of drinking and socio-demographic patters (i.e. gender, socio-economic background, social status).
The survey of the adolescents’ alcohol consumption rests on representative sample of 2000 adolescents born in the year 1989. The adolescents were randomly selected from the unique Danish Civil Registration System and thereby their parents were identified. The survey of the parents rests on a sample of one parent selected by criteria of birth. Both surveys were conducted by enquete and at the time of writing the percentage of returned questionnaires are 68 percent from the adolescents and 66 percent from the parents.
This paper will examine the high level of alcohol consumption with a focus on drunkenness characteristic of the alcohol culture among Danish youths. The underlying notion is that consuming relatively large amounts of alcohol at a relatively young age symbolises mature social interaction in a hedonistic oriented youth culture. Hence the purpose of this paper will be to explore if a variety of social and material resources (i.e. number of friends, popularity in school class, family-income) influences age of first intoxication and risk-taking behaviour such as binge drinking.
Key words: Drinking practices, social status, risk-taking behaviour, quantitative methods, surveys
Priorities in Swedish alcohol and drug treatment: Policies, staff views and competing logics
How a society should direct its resources for treatment of alcohol and drug problems is a difficult question. The aim of this paper is to study how treatment staff thinks priorities are and should be made and whether they think that different client groups get the treatment they need. Questionnaires were sent to staff in the social and health care systems in Stockholm County. The empirical data is contrasted against official priorities and different ways of ethical reasoning.
Official priorities both in the health care and the social services are based on an egalitarian way of reasoning. The results from the staff questionnaire show that ‘misusers with children’, ‘new misusers’ and ‘youth’ are seen as being prioritised and thought of as groups that should be prioritised, whereas ‘persons who have been misusing for a long time’ and ‘heavy misusers’ are groups that few think should be prioritised. Discrepancies between how staff sees priorities being made and how they think priorities should be made were found – in most cases staff wish for more priorities than are now in place. The reasoning of staff seems to be based on clients past actions and to lesser extent on utilitarian and egalitarian reasoning.
Key words: alcohol and drug problems, ethical reasoning, priority, staff, treatment
How drug dealers try to survive in the drug dealing business
The presentation is part of the ongoing study about the Finnish drug markets. The objectives of the research are to find out how Finnish drug markets concerning mainly cannabis and amphetamine generally work. The objectives of this presentation concentrate on in one part of the study; how drug dealers avoid getting caught by the police and how they cope with other people in the same business. The methodology used in this study is ethnographic; participating and non-participating observation, interviews and conversations with the people living in the Finnish "underworld". Other methodologies used in this study are interviews with the Finnish police and customs authorities and the material collected from the trial archives of convicted drug dealers.
In the presentation there are presented the most significant results so far. What the drug dealers have to take in notion when planning importing drugs into the country. How the dealers make deals and arrangements with other people and how they have to use electronic communication equipment. How they try to avoid getting caught in different market places and how the dealers in the upper level of the markets use other people to protect themselves. There will be also presented the ambivalent relationship between the police and drug offenders as one avoidance strategy.
Key words: Drug markets, avoidance strategies, ethnography, cannabis
Solutions to community alcohol problems: A road map for leadership
Remember when smoking was allowed on airplanes? Today, the law banning smoking on airline flights not only reduces exposure to second-hand smoke but also promotes nonsmoking as a social norm. This is an example of environmental prevention—changing policies, settings and community conditions to support healthy behavior and discourage high-risk, unhealthy behavior.
This approach can help prevent alcohol problems by creating communities that encourage safer choices with regard to drinking. Environmental prevention combats alcohol problems by changing the underlying social and cultural factors that contribute to them—such as how alcohol is sold and advertised; when, where and how it is available (especially for those underage); and what types of drinking levels are considered socially acceptable and/or allowable.
For many, environmental prevention is a new way of thinking about alcohol problems. Many communities are already using this proven and science-based approach to reduce underage drinking; alcohol-impaired driving; alcohol-related disease, injury and death; and alcohol-related crime and violence.
This Road Map will help users understand environmental prevention and how to support communities in using the approach. With help from a group of national experts in the field, the Marin Institute developed this concise overview of environmental prevention—how it works, how we know it is effective, and how leaders at all levels can promote its use. This Road Map is for public health practitioners, community advocates, elected officials and foundation leaders who want to put environmental prevention strategies into action.
Key words: Environmental prevention, alcohol problems, public health
The alcohol and marijuana consumption patterns of adolescents undergoing occupational transition: The importance of workplace alcohol and other drug policy
Very little is known about the relationship between the workplace environment and the drug consumption patterns of adolescent new entrants to the workforce. In order to address this issue, an exploratory study of 300 young Australian apprentices in their first year of full-time employment was undertaken. More than 40 percent of the sample population reported overall marijuana and alcohol consumption patterns that placed them at risk of potential harm. In addition, 19 percent reported drinking alcohol and 6.7 percent reported using marijuana during work-related hours.
The existence of a workplace alcohol and other drug policy was associated with levels of alcohol availability in the workplace, while alcohol availability and workplace drug and alcohol policy were associated with alcohol and marijuana consumption patterns. Apprentices employed in workplaces with low levels of alcohol availability drank less frequently and engaged in less alcohol use during work-related hours compared to apprentices employed in workplaces with high levels of availability. Apprentices employed in workplaces with an alcohol and other drug policy reported less alcohol availability in their workplace, drank alcohol less frequently, were less likely to engage in alcohol use during work-hours, and reported lower levels of marijuana use compared to apprentices employed in workplaces with no policy.
These results indicated that workplace factors, and in particular workplace alcohol and other drug policies, are associated with alcohol and marijuana use that occurs in the context of the workplace and with alcohol and marijuana use that occurs away from the workplace. These findings indicate that the workplace has potential as a setting for prevention strategies design to minimise alcohol and other drug-related harms.
Key words: Adolescents, alcohol, marijuana, workplace, quantitative survey, non-parametric data.
Students’ perception of the school-based intervention targeting youth at risk
This presentation is based on information obtained from students during the project which was aimed at evaluation of the school-based intervention method. One of the research goals was to identify the youth’ opinions about the way the teachers cope with students who use alcohol and other drugs. Following data were collected during the focus group interviews run in 10 schools representing different levels of education and different settings. The total number of students participating in this research project was 70.
The results showed that in youth’ opinion, teachers should react immediately and consequently when they identify any symptom of drug use by students. At the same time they evaluated teachers’ intervention in such cases as non-sufficient. Participants argued that drug use at school is against the rules and decrease the level of security at school. They also suggested that: 1/ any form of intervention taken by teachers should support students rather then punish them; 2/ the intervention should be done in discreet way and should not violate the student’s rights; 3/ should be conducted in co-operation with parents.
The results of our former research indicate that teachers expected negative reactions and were afraid to intervene when they had realised that student used alcohol and other drugs. The information collected from the students did not confirm that. The opinions gathered from youth seem to support the general idea and specific techniques used in the school-based intervention method.
Key words: Drugs, students, school-based intervention method
Health Research Trust
University of the West of England
Glenside Campus, Blackberry Hill
Bar wars: Media frenzy and licensing policy under Tony Blair
During November 2005 new legislation is due to liberalise public bar and club opening hours in England and Wales. The new arrangements, in theory, permit bars to open 24 hours each day. These changes come at a time when the UK is experiencing a moral panic about “binge drinking” among young adults. This type of behaviour has been accompanied by clear evidence of increased heavy drinking, rising alcohol-related violent crime and liver disease. The new legal arrangements have been fiercely attacked from all sides. Researchers have joined with clinicians, police chiefs, politicians, the news media and even some bar owners, to oppose the extension of bar opening. This paper reviews recent events, and the forces involved, in the context of the much criticised Alcohol Harm Reduction Policy for England.
Best friend’s alcohol consumption as predictor of drinking in adolescence: The moderating role of friendship characteristics
Friends can be considered as important role models in the direct social environment of young people. Cross-sectional research suggests that friends’ alcohol use is strongly associated with adolescent drinking, but longitudinal studies indicate small to moderate effects of friends’ drinking on adolescent use over time. In contemporary research this has led to increased attention for the conditions under which adolescents are affected by their friends’ behaviors (e.g., Jaccard et al., 2005). Besides personal characteristics of adolescents, such as personality, self-esteem, and vulnerability for peer pressure, aspects of the friendship itself might moderate the association between friends’ and adolescents’ alcohol use.
The present study examined the relative impact of best friend’s alcohol use on the development of alcohol consumption during adolescence. In addition, we investigated if these effects were stronger in high quality friendships, in friends who are part of a popular peer group, and in the case adolescents and friends spend much time together. Data reported in this study are part of an ongoing longitudinal study among families including two adolescent siblings. In 2003 and 2004, data were collected among 832 13 to16 year olds. Further, in a sub sample of adolescents, information was obtained on drinking and friendship characteristics among the best friends themselves in order to establish the validity of adolescent self-reports. Findings from longitudinal structural equation modeling analyses will be discussed.
Key words: alcohol use, adolescents, and friends
Should harm minimization as an approach to adolescent substance use be embraced by junior and senior high schools? Empirical evidence from An Integrated School-and Community-based Demonstration Intervention Addressing Drug Use Among Adolescents (SCIDUA)
The objective of this study was to determine if school-based harm minimization drug education was acceptable and effective for junior and senior high school students in Nova Scotia, Canada. We conducted a 4-year quasi-experimental intervention using mixed quantitative and qualitative methodologies. The intervention was a co-operative participatory research project with various activities determined by the participants. The project involved a partnership of four schools, two school boards, two regional addiction services, the provincial department of health, and a university. The outcomes evaluation was based on a sample of 1117 and 849 students in the intervention schools, compared with 3755 and 4247 students in the rest of the province, in 1998 and 2002 respectively. The evaluation of acceptability of harm minimization drug education was based on an analysis of 491 documents generated from 1998 to 2002. The outcomes of effectiveness were: any use of alcohol, cigarettes, cannabis, LSD and non-prescribed stimulants; heavy episodic drinking; and cannabis- and alcohol- impaired driving and related behaviours, as measured in the 1998 and 2002 Nova Scotia Student Drug Use Survey.
Results: We found that harm minimization was an acceptable approach to drug education targeted to the senior high school population. There was evidence of effectiveness of harm minimization in that age group in that there was a significant decrease in the prevalence of specific risks and negative consequences of alcohol and cannabis use in the intervention schools relative to the rest of the province. In contrast, harm minimization was not an acceptable approach to drug education targeting the junior high population; furthermore, there was a failure of the experiment to demonstrate improvement in the prevalence of risks and negative consequences of substance use in that age group.
We conclude that “one size does not fit all” when it comes to harm minimization drug education for junior and senior high school students. However, the positive findings from SCIDUA open the door for a study on the efficacy of a standardized school-based harm minimization drug education program targeting senior high school students.
Key words: harm minimization, school drug education, adolescents
Linking geodemographic classifications to hospital episode statistics for England to assist prediction and prevention of alcoholic liver disease
This paper explores the use of geodemographic population classifications to identify and predict ‘hotspots’ of England prone to greater than expected alcoholic liver disease. MOSAIC geodemographic codes were overlaid onto Hospital Episode Statistics (HES) for England. The HES data included gender, mosaic type, mosaic code, postal and local authority district, month and year of birth, ethnic origin, Primary Care Trust and GP code. Analysis demonstrated that some geodemographic classifications of the population were over-represented for alcoholic liver disease episodes. These groups had low socio-economic and socio-cultural status, lived in areas of high deprivation and disadvantage. Manchester, followed by Liverpool and Hull had the highest estimated patient group size in England and Hart, Surrey Heath & Wokingham the three lowest (indicating low expected levels of alcoholic liver disease compared with average). Analysis of the same data was also carried out at post code level for Manchester indicating ‘hotspots’ for alcoholic level disease at street level. This analysis exemplifies the ways in which geodemographic data might be usefully applied to routine health service data. Service planning and delivery, allocation of scarce resources and improve targeting of information in harder to reach populations would be enhanced creating improved mapping of the population.
Key words: Geodemographic classification, hospital episode statistics, targeted prevention
Heavy drinking and suicide mortality in Russia
The level of alcohol consumption and the suicide rate in Russia are both among the highest in the world. Former Soviet secrecy and data falsification, however, meant that examination of these phenomena were nearly impossible until recently. This study took advantage of newly available mortality data to examine the cross-sectional ecological association between levels of heavy drinking and suicide mortality in the Russian regions (n=78). Using the suicide mortality rate and the mortality rate from alcohol poisoning as a proxy for heavy drinking, descriptive analysis showed that despite the very high overall rates of both, heavy drinking and suicide mortality varied widely by region. Subsequent regression analysis revealed a positive and significant association between the proxy for heavy drinking and suicide rates. This association held for overall, male, and female rates. When compared to the results from prior studies of alcohol and suicide in other countries, these findings lead to the hypothesis that a nation’s beverage preference may be as important in the sensitivity of its suicide rates to alcohol consumption as its wet/dry drinking culture.
Key words: Heavy drinking, suicide, Russia, ecological analysis
The gender ratio in drinking: A preliminary cross-national analysis
Considerable research efforts were devoted in the past two decades to the differences between men's and women's drinking. Most recently, the initial GENACIS report was published, comparing drinking patterns across countries. As an initial report to the European Union, this study focused mostly on a group of European countries. Only one of its chapters considered other countries.
The present study is an initial attempt to extend this study by including all the countries for which there are data on the gender drinking patterns. More specifically, it is an attempt to use the worldwide information on differential drinking rates of men and women. The hypothesis tested was that as women's status is higher the lower will be the differences between men's and women's drinking rates. While there is some support to this hypothesis, the picture seems to be far from clear.
Key words: Gender, drinking rates, abstention rates, cross-national.
Adolescent's deliquent behavior induced by alcohol consumption
Objective: Adolescence characterise frequent psychical crisis which are result of biological development, looking for own identity, changes in family relation and many socio-cultural influences. Many of social, economic and other enviromental factors make some changes in adolescents population.
The main objective was finding how many adolescent had risk behaviour and deliquent behavior.
Method: Research has done in urban and rural areas of Sarajevo canton, involved 368 adolescents: male 170, female 198, aged 12 - 17 equal urban and rural distribution. In research used risk behavior questionnire Q 2004 (K.B.Kelly 2000).
Results: Out of total number of individuals in the study 25.8 percent was cigarette smokers, 39.4 percent consumed alcohol, 2.2 percent consumed marijuana.
Destructive behavior among group who abuse alcohol was 19.3 percent, marijuana 25.0 percent, tobbacco 22.1 percent. Among adolescents who drink alcohol 4.1 percent, have taken money from someone more than once; among group who use marijuana 37.5 percent, and among smokers 3.2 percent. Out of total number of adolescents who smoke 6.3 percent have stolen things more than once; while among group who drink alcohol 9.0 percent and individuals who use marijuana 50.0 percent. Bad score in school had 12.6 percent individuals who smoke, and 21.5 percent are truant. Similar results were among adolescents who drink alcohol: 10.3 percent had bad school performance and truant was 17.9 percent. Among group who use marijuana: bad score 12.5 percent and truant was 87.5 percent.
Conclusion: Data suggests that major aspects of adolescents' risk behaviour are related to drug abuse and should be considered while designing prevention activities and programmes.
Key words: Adolescent, risk behaviour, alcohol, drug, abuse
Gregory Robinson1, Kathleen Staples2,
Shelley Osborn1, and Daniel Hicks1
1 Social Science Research Center, California State University, Fullerton, USA
2 Training, Applied Research, AOD Prevention Division, Ventura County Behavioral Health Department, California, USA
Circumstances of drinking prior to dui arrest among persons 18 to 25 years of age in Ventura County: Research results and policy implications
The results of Place of Last Drink (POLD) surveys administered to young adults between 18 and 25 years of age (N=1,227) attending court-mandated drinking driver programs between February 2002 and May 2004 in Ventura County are detailed. Young persons 18 to 25 years of age represent 6.9 percent of the county population 18 and older, but 25.9 percent of all Drinking Driver Program participants. Their alcohol use antecedent to DUI (especially that classified as binge drinking) is detailed. 65.1 percent were binge drinking on the day of their arrest. 19.5 percent report consuming 11 drinks or more, and 27 percent had a blood alcohol concentration (BAC) twice the legal limit or more. The circumstances and settings in which drinking occurred are examined. Most young people drink in a single setting before their DUI arrests. The younger the offender, the more likely that the Place of Last Drink is a private residence. Distinctions between bars, clubs and restaurants are not made by young drinkers. Three out of twenty underage drinkers arrested for DUI in Ventura County are being served alcohol in bars, clubs and restaurants.
The genesis and history of POLD in Ventura County is briefly detailed, and discussants including the division manager of the sponsoring county department respond to the policy implications of these data with regard to environmental prevention interventions designed to reduce binge drinking and impaired driving among young adults.
Key words: Place of last drink; impaired driving; alcohol use among young adults; data-driven environmental prevention
Young Australian women’s drinking patterns, occupational status and risk levels: An examination of national survey data
There is increasing interest in women’s alcohol consumption and also in the role of workplace culture on drinking patterns. Workplace cultural mechanisms and their impact on drinking behaviours are of particular concern especially where young women and students in particular are exposed to risky drinking cultures. This paper examines women’s patterns of alcohol consumption and associated risks (e.g., injury, tobacco use, drink-driving, physical and sexual abuse) in relation to work status (working full-time or part-time, studying full time or part time, doing home duties, unemployed, retired or on a pension). Data are reported from a secondary analysis of Australia’s 2001 National Drug Strategy Household Survey data (N=26,744) examining drinking patterns of women aged 15-60 (n=11,691). No significant differences were found for most variables between women employed full time and those engaged in full time home duties. However, full time female students were identified as at significantly greater risk on nearly all variables. Young women, in particular young women undertaking full time study, emerged as a population of concern with high rates of risky drinking and experiences of alcohol-related harms reported by this population of women. Intervention strategies for women at risk of alcohol related harms are discussed in light of risks and harms specific to different groups of women. The role of initial workplace experiences (e.g., work in the hospitality industry as bar staff and waitresses) is highlighted in terms of inherent risks to young women. Practical intervention strategies stemming from these findings are explored.
Key words: Women, alcohol consumption, workplace culture, students, tobacco use, drink-driving, injury, abuse
Alcohol and the World Health Organization
In early 2005, the WHO’s Executive Board recommended a resolution on alcohol to the May World Health Assembly, the first since 1983. The new resolution seems to signal an upsurge in WHO activity on alcohol issues, not only in Geneva but also in regional offices in Copenhagen and Washington. The paper reviews WHO’s activities in the area in the last 20 years, since an earlier review by the same author (The World Health Organization and alcohol control, British Journal of Addiction 79:85-92, 1984). Responsibility for organizing WHO’s work has fallen on a small cadre of staff, often on short-term appointments, using limited extrabudgetary funds. On the one hand, political constraints have at times hindered the work, and on the other hand, WHO’s presence in the field has often been amplified by work with international groups of scholars. The conflicting directions of current trends and influences on WHO’s work are described and discussed.
Fish where they are! Schools can be every system’s link to youth when a research-driven Student Assistance Program functions as a bridge between science and service.
In California the first draft of a report of the Governor’s Prevention Advisory Council High Rate Users Workgroup was circulated in July 29, 2004 by the Community Prevention Institute (CPI) Technical Assistance and Training Project. Each of the five reports mined the data and strategies in California for promising directions for reducing youth binge drinking and related youth risk taking behaviors and prevention. The Student Assistance Program (SAP) model is named as the school-based institutional response with the most promise. The Desert Sands Unified School District SAP located in Riverside County, California was named for its leadership role in the state. For the past 22 years, this model has evolved into an effective way to reduce alcohol and other drug incidents and attract youth and families to prepare their own individualized prevention plan prior to a school suspension. The two developers/ trainers of this model are currently consulting for Riverside County Office of Education to replicate this model in seven school districts. The evaluation focuses on an innovative component – the “Family Conference” held with the youth, family and one SAP staff member. The instrument reduces the size of the school system to one student/family at a time effectively bridging needs and services. The process repeatedly captures the hidden or withheld resources within every individual and family that most schools are not able to mobilize. Outcomes include reductions in alcohol and other drug suspensions and a significant increase in students/families who voluntarily seek assistance and support.
Key Words: Youth risk taking, School-based interventions, Student Assistance Programs, Action Research, Sustainability
Santarlasci1, Gabriele Bardazzi, Francesco Mari2, Fabio
Voller3, and Allaman Allamani1
1 Centro Alcologico, Azienda Sanitaria Fiorentina, Italy
2 S.O.D. Tossicologia Forense, Azienda Ospedaliera Careggi e Dipartimento Anatomia Istologia e Medicina Legale, Università degli Studi di Firenze, Italy
3 U.O. Epidemiologia, Azienda Sanitaria Fiorentina, Italy
Road accidents, alcohol and other drugs: an epidemiological study in Florence, Italy
Summary: This study focuses on traffic accidents and their association with alcohol and other psychoactive substances in the Florence metropolitan area. Three hundred and eighty three people admitted to three Emergency Departments in Florence due to traffic accidents were enrolled within three hours period after the accidents. Blood and urine samples were taken from each patient to determine the presence of alcohol, cannabis metabolites, opiates, cocaine, amphetamines and LSD. A subsample was administered a questionnaire regarding the intake of alcohol, tobacco, medicaments, and last year admission to hospital as well. Twenty five patients (6 percent) resulted positive for the presence of alcohol (38 percent, i.e. 12 patients, if we consider only the period 00.00-5.59 a.m.). Such data become 9 percent if at least one psychoactive substance is considered.
Even if such data appear to be considerably different from the findings of other comparable studies, nether less they demonstrate the important role played by alcohol and drugs in causing road accidents in Florence.
Key words: Road accidents, alcohol intake and other psychoactive drugs; epidemiological study.
Workplaces and primary alcohol prevention: Why prevent a problem if there is no?
A SoRAD study presented at the 2004 KBS seminar in Helsinki, focused upon the prerequisites for implementing the government’s goal concerning alcohol primary prevention in the Swedish work life, by exploring the intentions, roles and expectations within governmental agencies, employer’s organizations, labour organizations and other main actors. The study concluded that there is no coherent strategy to implement the goal of “alcohol free work life” in Sweden. We have now turned our focus from the central level, to the actual worklife.
“Mobilizing the civil society” is a new and important feature of the present national alcohol policy in Sweden. The government has invested resources in the local authorities, as a mean to compensate for the reduced possibilities for a restrictive national alcohol policy. The studies presented in this paper, focus on what is going on at workplaces. Two surveys were conducted: One questionnaire to staff managers at local authorities (n=189), one questionnaire to staff managers at various private companies (n=108).
Results verify previous research: There is no major interest for primary prevention at the workplaces. “Workplace prevention” is understood by respondents as dealing with alcohol problems. Consequently, if there is no alcohol problem, staff managers see no reason to work with alcohol prevention. “Primary prevention” seems to work as a political and academic terminology, but is misunderstood by the staff managers. They rather focus upon creating a healthy work environment, where alcohol prevention is not a specific issue, unless it is a specific problem.
Key words: Alcohol prevention, workplaces, policy, survey
and L. Nadeau3
1 Doctoral candidate, Department of Psychology, Université de Montréal, Canada
2 Director, Addiction Research Program, Douglas Hospital Research Center, McGill University, Canada
3 Professor, Department of Psychology, Université de Montréal, Canada
A qualitative analysis of the roles of substance use in female-perpetrated partner violence in female substance abusers’ couples
The available research on female alcoholics indicates that while a link exists between partner violence and substance abuse, many variables, such as contextual factors, influence this relationship. Studies of contextual factors of alcohol-related marital violence indicate that the family could be the most likely social setting for female alcohol or drug-related aggression. This study was a qualitative exploratory analysis of the perspectives of nine volunteer heterosexual couples on the links between their substance use and the immediate circumstances surrounding female perpetrated intimate violence. Participants were female substance abusers participating in addiction treatment that reported perpetrating physical partner violence and their male partners. Participants were asked to recount the most recent and violent incident. They were probed for substance use before and after each incident and for their perceptions on the role of substance use and physical violence. The most common scenario was the use of both a stimulant and alcohol by both partners preceding female perpetrated physical violence. Violent arguments tended to start when intoxication was wearing off and when the female expressed craving for drugs. Violence was most often initiated when the partner tried to prevent her from using. Overall, results indicated that substance use/misuse appeared related to violence by a combination of the physiological effects of multi-substance intoxication and withdrawal and the conflict created by substance use and craving. These findings suggest that getting partners to agree not to discuss female substance use or other hot topics during withdrawal might be important in reducing risk of substance-related female-to-male partner violence.
Key words: Female-to-male physical violence, female substance abusers, qualitative analysis
Predicting alcohol-related harm by socio-demographic background: High prevalence versus high risk
Aim: The main purpose of this study has been to examine the relationship between socio-demographic background (gender, age, household situation, socioeconomic status and region of residence) and the level of alcohol-related harm, when controlling for actual drinking habits in terms of both average volume and binge drinking frequency.
Method: The dependent variables, modelled in logistic regressions, were summary measures of four areas of harm from alcohol – impaired self-control, chronic health problems, public disorder and interpersonal problems. The data from 2002 Swedish national survey, consisting of 5469 completed telephone interviews with adults 17 years old and above, were analysed.
Results: According to the results and across all the problem areas, socio-demographic background variables seem to be rather weak overall predictors of experienced harm from drinking. The strongest effects found, besides drinking itself, were for being young in age – especially for public disorder and impaired self-control. Also the socioeconomic indicators (income and education) and marital status showed certain significant effects, but these pointed in different directions for men and women as well as for the different problem areas. Almost no regional differences could be observed, something that contradicts findings by others about more drinking and more harm in the South of Sweden.
Conclusion: Since the models are rather weak, it is argued that the results are, at least in part, in line with the so-called two-step model. According to the model, socio-demographic variables are good predictors of variation in drinking habits, while other factors, such as personality characteristics, may have a higher explanatory value for the actual harm from a given level of drinking. On the other hand, as our results indicate, certain population subgroups show enhanced risk for alcohol-related problems when drinking is controlled.
Sociological perspective of alcohol consumption among traditional folk artists
During the last few decades, alcohol consumption assumed a new dimension in Indian society, in terms of steady increase in per capita consumption, associated health and psycho-social squeals and vulnerability of certain population. One of such groups is underprivileged slum population and the present communication focuses on 700 folk artisans’ families living in squalor conditions in West Delhi, India. The tribal group although living in the capital city, still follows social norms and values of place of origin and make them vulnerable towards heavy alcohol consumption and disruptive behavior. The group was studied over a period of ten years while delivering clinical services for management of alcohol and drug dependence at community level. The qualitative data collected through key informants, focus group discussion and in-depth interviews showed that cultural values and social images associated with alcohol intake of the group, free flow of money and physical living conditions have a direct bearing on early age of initiation of alcohol, domestic and community violence and other risk taking behavior including pre and extra-marital sexual relationship. The social margin and disinhibition under the influence of alcohol during the celebration and festivity further give impetus to passive and active aggression, inter and intra group conflict and even serious injury. In the absence of role model, youth follows the group norms and equally become vulnerable. Most of the women are at receiving end as heavy consumption of alcohol in men folk not only lead to money drainage but uncertain marital life as men frequently indulge in risky sexual behavior lead to separation and remarriage. Besides treatment, effective social control measures need to be explored and implemented.
Key words: Alcohol, heavy intake, traditional artist, risky behaviour
Evaluation of drug policy in Poland
Till the mid-nineties Poland was a country where drug policy was rather liberal, oriented toward treatment and prevention. Due to rapid increase of drug problem in the early nineties and international pressure drug policy in Poland has shifted in a more repressive direction. In the same time harm reduction measures were continued and developed.
Effects of the Polish drug policy is evaluated on three dimensions: demand, supply and harm reduction basing on epidemiological indicators. The indicators are provided by results of school surveys, qualitative studies among youth and among problematic drug users, statistical data of Central Statistical Office and data from institutions involved in response to the drug problem. The analysis of time series of such indicators like prevalence of drug use, drug treatment demand, mortality, infection diseases, drug prices, drug related offences lead to conclusions on the achievements and failures on three drug policy areas.
The results of this evaluation provide some weak arguments for limited success of demand reduction policy and much stronger arguments for success of harm reduction activities. No impact of supply reduction on drug availability and consumption was detected.
Key words: Drug policy, evaluation, drug epidemiology
Khat abuse in Göteborg, Sweden: A pilot study
Khat abuse is known in Sweden mainly among male Somalian immigrants in the cities. Khat is classified as an illegal drug in Sweden since 1989, but not so in most other countries. The aim of this work was to increase the knowledge of the extent and social impact of khat abuse among Somalian immigrants. The Somalian group was chosen as it has been proposed that 90 percent of the abusers in Sweden come from this group.
Method: 30 loosely structured and self organising interviews were done with key informants representing custom, police, social welfare, NGOs and khat users. The results were interpreted in a constructivist frame.
Results: The abuse is almost exclusively reported among males, but some informants claim that it is increasing among women. Rates of 50 percent of the adult males were mentioned. It does not appear to spread among youth, and, as many informants emphasize, it does not create violence. The main effect appears to be passiveness in the male group and an increased tension between the women and men. Several factors may contribute to this effect, e.g. larger unemployment among the males, and that Somalian women have more to gain socially in the Swedish society. Virtually nothing of this abuse was seen in the health care sector. The police generally have disregarded the abuse, partially as a result of a fairly “toothless” legislation. The study has led to further studies and preventive efforts.
Key words: Khat abuse, key informant study
A look at alcohol’s effects on cardiovascular health stratified by age and gender
Background: Research has consistently demonstrated cardioprotection from regular alcohol use. When alcohol is consumed in a heavy episodic pattern, however, the cardioprotective effects of alcohol are negated. Alcohol’s physiological effects change with age, and the health effects of episodic drinking have not been evaluated in older populations.
Methods: We investigated the association between alcohol volume and pattern of consumption on the risk of coronary heart disease (CHD), hypertension (HYP), and other cardiovascular disease (CVD) in younger, middle-aged, and older subjects. Data from 1,154 participants in the Winnipeg Health and Drinking Survey, a community-based cohort sample, were analyzed. Participants were stratified by age (18-34, 35-49, 50-64 years) for each gender.
Results: In men, regular heavy consumption decreased the risk of CHD. Regular light consumption decreased the risk of HYP in women. Usual heavy consumption was protective against other CVD in older men, whereas light-to-moderate consumption decreased the risk in younger women. Heavy episodic drinking increased the risk of CHD in middle-aged men and was marginally significant in middle-age women. Risk of HYP was elevated in older episodic male drinkers. Usual consumption was generally protective for both men and women.
Conclusion: Regular alcohol use is associated with decreased risk of cardiovascular disease for both younger and older individuals. Heavy episodic drinking, however, may be particularly harmful for middle-aged and elderly men.
Keywords: alcohol, pattern, cardiovascular, epidemiology, age
The impact of peer and parental norms and behavior on adolescent drinking: The mediating role of drinker prototypes
Research on determinants of adolescents’ images or prototypes of drinking peers has demonstrated that parents and peers can influence the formation of drinker prototypes. It was also shown that drinker prototypes mediated relations between peer and parental drinking behaviors and norms, and adolescent alcohol use. The current study further examined this subject, while taking into account the reciprocal relationship between drinker prototypes and alcohol consumption. These issues were studied for adolescents with and without drinking experience. For this purpose, longitudinal data were gathered among 1956 Dutch adolescents (12-16 years). Structural modeling analyses revealed significant effects of drinker prototypes on future alcohol use in both abstaining and drinking adolescents. In drinking adolescents, the impact of peer and parental norms on adolescents’ alcohol use was mediated by drinker prototypes. In adolescents with no drinking experience, drinker prototypes also affected future alcohol use. However, these effects were less important than the direct impact of peer and parental drinking.
Key words: Adolescents, alcohol use, parents, peers, social image
Decentralisation and integration of addiction treatment: Does it make any difference?
The treatment of addiction problems in Sweden is handled both within the mental health care system (which handles detoxification and acute problems) and in the social service system. The latter has in an international perspective a large role, with more than half of the clients/patients on a given day. In locations where there are large mental health units, like in Stockholm county, we estimate that 50 percent of the patients/clients on any given day can be found within in each of the two parts of the system.
While the health care system is administered at a county level, the social services is a municipal affair. The co-operation between the two systems has thus not only professional but also administrative obstacles. It comes as no surprise that the efforts to integrate these two systems, for the benefit of the clients and/or for economic reasons, have met with difficulties.
In the mid-1990s, following a report at the political level in Stockholm county, a reform of the addiction treatment system was decided by both municipal and county politicians. The aim of the reform was to move the emphasis to local out-patient units within the health care system that would work in close co-operation with the social services. The county's addiction treatment was divided into two parts: the North and the South. The reform was well received in the North and seemed to be fairly quickly implemented. In the South, however, the resistance was open and changes slow.
In the years 2000 - 2002 a large follow-up study of the treatment system in both parts of the county, with approximately 2000 interviews with clients and patient in the North and the South and in both the health care and the social services system was conducted (Room et al. 2002). This study gives us the possibility to study the possible effects of the decentralisation and move from inpatient to out-patient treatment.
The aims of this study is to establish whether the decentralised system make any differences in A) the catchment of the treatment system; B) some outcomes of treatment and C) client/patient satisfaction?
The impact of the Northern Territory’s Living with Alcohol Program (LWA), 1992–2002: Revisiting the evaluation
Aims. To evaluate the impact of a comprehensive Australian alcohol prevention and treatment program on alcohol-caused deaths a) in combination with a 'harm reduction levy' or tax on alcoholic drinks that initially funded the program b) after the special levy was removed but the programs continued.
Design. The LWA program was in 1992 funded by a special tax (levy) on beverages with greater than 3 percent alcohol content by volume. The levy was removed in 1997 and the LWA program was funded federally until 2002. Trends in age standardised rates of acute and chronic alcohol-attributable deaths in the NT were examined during these different periods using ARIMA time series analyses. Separate estimates were made for Indigenous and non-Indigenous residents.
Findings. When combined, the levy and the LWA program were associated with significant declines in acute alcohol-attributable deaths as well as with Indigenous deaths between 1992 and 1997. A significant but delayed decline in chronic deaths was evident towards the end of the study period between 1998 and 2002.
Conclusions. The combined impact of the LWA program levy and the programs and services funded by the levy reduced the burden of alcohol-attributable injury to the NT in the short-term and may have contributed to a reduction in chronic illness in the longer term. The results support the concept of a harm reduction levy and underline the value of distinguishing between the acute and chronic effects of alcohol in population level studies.
Paths to treatment and outcome: Does self-choice in treatment entry predict good outcome?
One aim of the study of “Women and Men in Swedish Alcohol and Drug Treatment” was to study alcohol and drug misusers’ paths to addiction treatment. The representative sample includes 1,865 clients (71 percent men) interviewed face-to-face when entering inpatient and outpatient treatment facilities in Stockholm county. The structured interview included questions about psychosocial background, alcohol and drug consumption, problems related to alcohol and drugs, and paths to treatment.
Altogether, 1,222 out of 1,765 clients who were asked for permission to be contacted again for a follow-up interview were interviewed after 12 months (69 percent). This interview dealt with the respondents’ present living situation and alcohol and drug problems, the type and amount of treatment received since the initial interview and client satisfaction.
At baseline, most respondents reported that it was their own idea to come to treatment. At the same time, it was also common to report reasons for entering treatment indicating different forms of perceived informal and formal pressure. Informal pressure was found to be positively associated with the feeling of self-choice in treatment entry whereas perceptions of formal pressure were negatively related to self-choice. Importantly, pressures from others and self-choice were not mutually exclusive (88 percent of those reporting self-choice also reported formal or informal pressure as reasons for coming to treatment).
The goal in this paper is to analyse if and how the perceived pressures from others and self-choice in treatment entry is reflected in outcome: Does self-choice in treatment entry predict good treatment outcome, whereas pressure – especially formal pressure – is associated with poorer outcome?
Key words: Paths to treatment, self-choice, pressures from others, outcome, Sweden
Proposed changes in alcohol retailing in Ontario: An estimate of health outcomes under several scenarios
In Ontario, Canada, the import and sale of alcohol is currently a provincial government retail monopoly, but recently proposals for a number of different scenarios have been made to change the mode of retail distribution. The different scenarios are expected to have different impacts on both outlet density and prices. This study has two aims: to project how changes in density and price affect absolute alcohol consumption, and to project how changes in consumption affect alcohol-related mortality burden under the different scenarios.
Methods: Projected per capita sales for each scenario based on outlet density and price were modeled using a multiplicative model. Estimated changes to consumption patterns were calculated based on these changes. Based on expected changes of alcohol consumption under each scenario, projected estimates alcohol-attributable mortality were calculated.
Results: Preliminary analysis shows that the changes in retail mode would increase overall alcohol consumption, resulting in increases in mortality. Using conservative estimates, a 10 percent increase in consumption would result in a 13 percent increase in mortality burden, and a 20 percent increase in consumption would result in a 26 percent increase in mortality burden.
Conclusions: The suggested changes to alcohol retailing in Ontario would increase the burden of mortality in the province.
Key words: Outlet density, price, mortality, alcohol drinking, consumption
Comparing drinking cultures in motion
This paper deals with problems of comparison when studying drinking habits. First, we identify different strategies of doing comparisons and discuss their strengths and weaknesses. We emphasize the fruitfulness of using contrasting cases and ideal types as strategies when comparing drinking cultures in motion. In addition to traditional macro-structures and national peculiarities, the paper stresses the importance of considering micro-processes, mechanisms and contexts-bounded chains in the acts of drinking.
Second, the paper discusses typologies which have been suggested to make sense of people's relation to drinking and drinking problems in different cultures. For example, the distinction between wet and dry drinking cultures puts focus on the level of alcohol consumption. Further, taking the use-value of drinking as the principal criterion implies that the predominant role of alcohol has varied from being a nutrient to serving as an intoxicating substance. Finally, there is the widely used typology based on beverage type, singling out wine, beer and spirits cultures, respectively.
Interestingly these typologies are in conflict with post-war empirical facts: Finland and Sweden are currently "wetter" than Italy; the agrarian-nutritional role of wine in Mediterranean countries has diminished considerably, whereas "transgressive" drinking has become an object of concern; changes in beverage preferences in Europe have called into question the criterion based on beverage type. These facts speak in favour of an ongoing shift in the cultural position of drinking and drinking problems.
To illustrate our discussion on comparative strategies and their application in drinking cultures in motion, we have chosen two countries, which are most different, i.e. Finland and Italy. In addition, these countries have for several decades undergone major – and opposite – changes with regard to the level of alcohol consumption and cultural drinking habits.
Breaking the link: Preventing alcohol-related sexual assault in Marin County
Researchers are beginning to understand the role that social norms play in contributing to health problems and risk behaviors of youth. The objective of the Breaking the Link project was to pilot an action research model with a community-based coalition to address social norms related to alcohol and sexual assault among young people in Marin County. The project was designed to research student norms related to alcohol and sexual assault, develop data-driven strategies to change those norms and, ultimately, to reduce alcohol use and sexual assault among young people.
With support form Youth Leadership Institute’s Prevention and Research Department staff, the Breaking the Link task force (including high school students and representatives from the county health department and community-based organizations) developed a survey to assess student social norms. Survey results indicated a gap between respondents’ personal attitudes and behaviors and their perceptions about the attitudes and behaviors of student body as a whole. Breaking the Link relied upon the expertise of its youth members to create a social norm marketing campaign that would appeal to their peers. The messages promoted the positive attitudes and behaviors that were self-reported, aimed at creating a healthy social norm that would deter students from alcohol use and sexual assault. At the end of the school year, focus group data indicated that the social norms marketing campaign has had an impact on students, for example students are more aware of the issue and indicate a new level of confidence in making their own healthy decisions.
Key words: Youth, social norms, alcohol, sexual assault
Alcohol in young adults' pub diaries
The studies give a contradictory image of Finnish drinking habits. On the one hand, they can be interpreted as remaining traditional and intoxication-oriented, having a culturally unchanged common core. On the other hand, one can identify historical changes and shifts in this supposedly common core of drinking.
The paper studies the current state of Finnish drinking habits through the young adults' pub (literally 'restaurant' in Finnish) diaries (N=60; 38 women, 22 men). The authors of diaries are between 23 and 35-years-old. They were selected from the quickly expanding work areas of business or administration, with the assumption that the roles alcohol has in their diaries also indicate more general trends in Finnish drinking habits. The writers were asked to write each of their visits to the pub as a story describing the initial situation, the unfolding of events, and the final outcome. The diaries cover a minimum 8-week time-period.
The diary stories are analysed by examining: 1) what kinds of role/s alcohol plays in them, 2) how the role/s of alcohol change or develop in their story lines, and 3) through what kinds of viewpoints alcohol is consumed and experienced. By looking at these three points, it is possible to make inferences about the prevalent determinants of drinking in Finnish culture.
The analyses show that intoxication-oriented drinking is well represented in the diary stories. It does not, however, seems to be a homogeneous phenomenon but appears in the data in multiple versions and meanings. In addition, heavy drinking is not the only dominant frame for a pub or restaurant evening.
Key words: Pubs, drinking habits, diaries, narrative analysis
Trocki and Laurence Michalak
Alcohol Research Group
Public Health Institute
One thing led to another and it just happened: Understanding sexual “decision-making” in the age of AIDS
Introduction: \ Why do people have sex? The answer to this question seems obvious: Don’t people have sex because it feels good?...or because they are in love?..or because their partner wants to have sex?..or because of basic biological urges?
Sexual behavior carries many risks: unwanted pregnancy, AIDS/HIV and other sexually transmitted disease being among the most common. Yet, in spite of the large amount of research on sexual risk-taking, the study of the reasons why people have sex is surprisingly sparse. This question needs to be addressed before we can fully understand the processes that constrain or facilitate use of various means of sexual protection.
Methods: The data included both qualitative and quantitative sources from a sample of respondents recruited from a household probability study of the general population in the San Francisco Bay Area (n=129). The main data for this paper comes from a semi-structured critical incident question asked toward the end of the interview series in which respondents were asked to talk about the first time they had sex with their most recent sexual partner. Motivations and contextual information where coded and these data were merged with the quantitative data as well as being utilized in their original textual form.
Results: The most common reasons (an individual may have given multiple reasons) for having sex included: it just happened (28), physical attraction to the other (22), horney (21), part of the sequence toward a long term relationship (18) and love, romance, soulmate (17). Attribution of sexual encounters to having had too much to drink was relatively rare (9). The category most commonly associated with risky sex (e.g. not using a condom) was when the act was associated with a challenge or competitive motivation. Data have also been cross-tabulated with other respondent characteristics such as gender, age, number of sexual partners, etc.
The role of alcohol in the construction of a “good” victim
Objective: This paper focuses on the amount of blame which is attributed to the victim in two hypothetical male-to-male violence scenarios. There are two main questions. Does the victim’s intoxication have an effect on the blame attributed to him? Which other factors are important for the attribution of blame?
Methods: 1004 RDD quantitative telephone surveys were completed with Swedes aged 16 - 25. The response-rate was 73.8 percent. In addition to attitudes and expectancy, questions were asked about accepted norms of drunken aggression. The survey also included four vignettes involving different types of aggressive behaviour. Two of the vignettes were about male-to-male aggression, one about unprovoked aggression and one about provoked aggression. A number of factors were manipulated in each vignette, such as, the aggressor’s and the victim’s level of drunkenness. One of the dependent variables was how much blame should be attributed to the victim in the incident. The attribution of blame to the victim will be analysed using ANOVA in SPSS.
Different attitude questions and questions about socio-demographics will be used as independent variables in a regression model, in an effort to identify factors which determines the attribution of blame.
Key words: Alcohol, aggression, victim, vignette, violence
Childhood neglect and abuse in alcohol and drug dependent patients and in patients with depression: Evaluation by the Childhood Trauma Questionnaire CTQ
Abstract: The aim of this study was to compare the prevalence of childhood neglect or abuse, evaluated by "Childhood Trauma Questionnaire", in alcohol (N=85) or drug (N=70) dependent outpatients, depressed outpatients (N=70) and a control group of outpatients who did not fulfill diagnosis of alcohol/drug dependence or depression (N=70). We employed the "Addiction Severity Index" to evaluate the history of drug and alcohol use and the social-demographic data. The psychiatric diagnosis was made by the Brazilian version of Mini-International Neuropsychiatric Interview. Higher rates of emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect were found in alcohol/drug dependents and depressed patients than in the control group, being the prevalence higher in women than in men. The drug and alcohol dependent patients showed higher prevalence of emotional, physical and sexual abuse than the patients with depression, although among the latter the prevalence of such abuses was also higher than in the control group. The research of problems due to abuse and/or neglect and their relationship to drug/alcohol dependence and depression may contribute to a better understanding of the etiology of drug/alcohol dependence and depression as well as to a better treatment planning.
Key words: drug dependence, alcohol dependence, depression, childhood trauma, child abuse, child neglect.
Financial support: AFIP, FAPESP, CNPq
A life history approach to the study of women, identity, and alcohol
This paper offers a socio-cultural approach to the study of women’s social identities in relation to the meanings and uses of alcohol in their lives. It examines how women in the United States construct these identities in terms of how they talk about the history of their lives, important life decisions and relationships. Combining case study analysis and qualitative comparative analysis, this research explores the life history and in-depth interviews of 20 women who participated in a project on risk-taking at the Alcohol Research Group. The sample selected for this study represents a cross-section of female drinking patterns in the U.S. Since the majority of the women interviewed are in their twenties and early thirties, their narratives deal extensively with their youth.
Analysis of the life history and qualitative interview material indicates that people focus and select memories to interpret their experiences with alcohol as part of their ongoing process of ‘identity work.’ This study discovered not one, but a range of social identities associated with women’s interpretation of their own alcohol use at transverse developmental stages of their lives. It illustrates how women construct a ‘repertoire’ of ‘alcohol identities.’ The repertoire is variable but finite. Alcohol identities may be switched, highlighted, or downplayed, depending on the individual’s intent in different interpersonal relationships and sociocultural contexts.
Key words: Women, identity, life history, qualitative analysis
The impact of rules, norms and parental alcohol use on adolescents’ drinking behavior: A mediation model
Recent research reveals that setting rules about alcohol is an important factor in preventing adolescents’ alcohol use. However, it is still unclear how the effect of rule setting on adolescents’ drinking relates to other influential family factors, such as parental alcohol use. Therefore, the present study explores the role of setting rules about alcohol, parental norms about alcohol, and parental alcohol use in the development of adolescents’ drinking behavior. Besides examining the direct effects of these factors, we also tested a mediational model. It is assumed that norms and parental alcohol use affect the way parents set rules about alcohol, which in turn prevents the alcohol use of adolescent children.
Longitudinal data from 416 families, consisting of both parents and two adolescents (aged 13 to 16 years) were used for the analyses. Based on the reports of each family member, three different models were formulated: from the perspective of the children, the father and the mother. In general, results of structural equation modeling demonstrate that providing clear rules lower the likelihood of drinking in youth. In addition, setting rules also mediated cross-sectionally the impact of norms about alcohol and parental alcohol use on adolescents’ drinking. However, longitudinally these variables have only an indirect effect on adolescents’ alcohol use, namely via earlier drinking. Differences in outcomes between older and younger siblings, as well as differences in model findings with regard to the reports of the family members will be discussed.
Key words: Alcohol, alcohol specific parenting, adolescents
Daksha van Dijck1, Ronald A. Knibbe1, 2&
Henk F.L. Garretsen2, 3
1 Department of Medical Sociology, Maastricht University, The Netherlands
2 Addiction Research Institute, Universities of Rotterdam, Maastricht, Tilburg & Nijmegen, The Netherlands
3 TRANZO, Faculty of Social and Behavioural Sciences, Tilburg University, The Netherlands
Problem drinking in The Netherlands: A longitudinal general population study
Background. Under the authority of The Netherlands Ministry of Health, Welfare and Sport the present longitudinal study investigates problem drinking in the general Dutch population aged 16 - 69 years. This is the first national study on the prevalence, remission and chronicity of problem drinking in The Netherlands.
Aim. First, what is the remission and chronicity of problem drinking in the general Dutch population? Second, because the chronicity and remission of problem drinking varies across different socio-demographic groups, we examine the chronicity and remission of problem drinking in subpopulations as defined by several socio-demographic factors.
Methods. Data were obtained from respondents of a prevalence study on problem drinking, which was carried out in 2003, who gave permission to participate in a follow-up study. This follow-up study was carried out 12 months after the prevalence study to determine the chronicity and remission of problem drinking. All 420 problem drinkers and a non-problem drinking control group (N = 2047) matched by gender and age were approached by telephone. A maximum of seven attempts were made to contact problem drinkers and males aged under 35 years, and four attempts were made to contact controls. People, who could not be reached by telephone (N= 271), were sent a self-report questionnaire.
Results. Results will be presented.
Key words: Problem drinking, epidemiology, longitudinal study, general population study, chronicity, remission.
Addiction among young persons in special approved homes: ADAD as a tool for judgement and treatment
In Sweden young persons with grave psychosocial problems are cared for under LVU (the Care of Young Persons Act) and the inmates are placed at special approved homes (institutions) that SiS (The National Board of Institutional Care) is responsible for. In 1997 ADAD (Adolescent Drug Abuse Diagnosis) was introduced as a tool to investigate and judge clients to provide adequate treatment and also to evaluate and measure effects of treatment. The aim of this study is to compare different judgements of drug abuse among young people in special approved homes and discuss difficulties in describing problems (diagnosing) and implications for treatment. Data is collected from ADAD (1997 - 2001). Information from the social services about reason to place the youth, with special interest in those who are placed for drug abuse, are compared with the youths own estimation of their drug consumption, how they understand their abuse and their need of help and how the personnel at SiS, that accomplish the ADAD-interview, estimates the young peoples need of help.
The results show considerable differences in judgements of drug abuse. According to the social services about half of the young people in the special approved homes have problems with drug abuse. Among these about a third has estimated their use of drugs as non-existent or most marginal. At the same time we found young people that have reported severe drug abuse who are placed in an institution for other reasons. Comparisons between the young people and the interviewers show, not surprisingly that the young people did not estimate their need of help for drug abuse as high as the interviewer. However other problems were estimated as more important to require help with by the young people than by the interviewers, such as physical problems. Differences in problem descriptions between the sexes as well as differences in judgements of abuse are discussed in relation to conditions for treatment.
Key words: ADAD, drug abuse, young people
Alcohol consumption and predisposing characteristics: Are they differentially associated with three measures of aggression in a sample of young drinkers?
The primary goal of the present paper was to determine whether alcohol consumption and predisposing characteristics were differentially associated with three different measures of aggression: 1) argument or fight after drinking, 2) fight at school or work, and 3) attack or hurt someone. A secondary analysis of the U.S. National Longitudinal Survey of Youth was conducted using a composite sample of drinkers, ages 17 to 21, from the 1994, 1996, and 1998 Young Adult surveys (n=911). Twelve-month prevalence rates for the three types of aggression were 39 percent (42 percent male, 36 percent female), 24 percent (27 percent male, 20 percent female), and 17 percent (23 percent male, 10 percent female), respectively. Separate multiple logistic regression models for the three aggression measures compared with no aggression revealed that a composite measure of heavy episodic drinking, drinking frequency and volume was significantly associated with arguments/fights after drinking but was not significantly associated with fights at school/work or attack/hurt someone. However, risk taking and early behavioural problems were significantly associated with fights at school/work and attack/hurt someone but not with arguments/fights after drinking. Multinomial logit models directly comparing the three aggression groups indicated that alcohol consumption levels were significantly higher among those who reported arguments/fights after drinking than fights at school/work and attack/hurt someone. As well, attack/hurt someone versus arguments/fights after drinking was significantly more likely for males than females and for those who started drinking before age 14 compared with those who started drinking at a later age. In conclusion, type of aggression may be an important consideration in future studies on alcohol and aggression.
Key words: Aggression, youth, alcohol, predisposing characteristics
CBTS and CPOPS: Assistance to county ADPs for self-directed outcome-based prevention planning in a format that meets state and federal requirements
Capacity Building Tools (CBTs) and County Prevention Outcome Plans (CPOPs) are devices to help California county alcohol and drug programs (County ADPs) undertake evidence-based, outcome-oriented AOD prevention at the local community level. The California Department of Alcohol and Drug Programs (DADP) contracts with County ADPs to use federal Block Grant prevention funds. The federal agencies require “Five-Step Planning” requirements to be written into the county contracts. Our Prevention by Design program provides technical assistance to help county ADPs apply these Five-Step requirements. Using a “program of attraction,” we work with 58 diverse county ADPs, with widely different needs and capabilities, to help the county agencies and their community prevention providers generate local prevention initiatives that operate within a clear framework for evidence-based planning and implementation. Prevention by Design’s Regional Trainers (RTs) work with the Capacity Building Tool to use an interactive approach with county ADP prevention staff. Using the CBT, the RT and county staff prepare a county prevention outcomes plan (CPOP) that identifies current levels of capability, need, and objectives to “get to outcomes” over the next twelve. This presentation will describe the basic Five Step approach, will review initial findings regarding county ADP experience with the CBT exercise and the drafting of CPOPs, and will discuss implications for strengthening county and local community capacity to generate outcome-based prevention policies and initiatives.
Advancing California’s agenda for community environment approaches to AOD prevention planning
From about 1980 to 1995, California prevention researchers, community planners, and policy activists focused on identifying public policies and environmental methods to curtail alcohol problem environments. During this period a “local control” constituency emerged including state / county agencies with AOD prevention duties and statewide service and advocacy organizations. Initial successes, which seem to have plateaued, raise the following issues: (1) Policy development: Initial efforts at local control focused on reducing egregiously problematic settings and on advocacy for local control ordinances and state legislation. Early efforts focused on selected public health and safety problems (e.g. sales to minors) and on particular needs of ethnic, youth, affinity, and geo-defined neighborhood groups. Now it appears more attention should be paid to building institutional alliances that create and sustain long-term structural changes in local alcohol policy, and develop self-sustaining local support. Can the field move beyond coalition-based organizing and advocacy? Can California’s “prevention estates” – researchers, policy-makers, state and local agencies, formal organizations, and community groups – organize systematically to sustain continuing AOD prevention policies and initiatives at the county and municipal level? (2) Prevention practice: Can evidence-based, outcome-oriented prevention develop into constantly-improving practice through a common planning framework easily shared among all local communities? How can advances in data systems, planning models, policy and program objectives, improved environmental management tools, and monitoring / evaluation protocols, be framed for widespread use at the county / community level? This paper will review these issues and prospects for forward movement.
Yu Ye1, Thomas K. Greenfield1, Jason Bond1,
Marjorie Robertson1, and Guilherme Borges2
1 Alcohol Research Group, Public Health Institute, Berkeley, California, USA
2 National Institute of Psychiatry, México City, México
Drinking pattern of Mexican Americans: A re-visit of immigration status and acculturation
Background: Although a huge literature exists on alcohol consumption pattern of Mexican immigrants and US-born Mexican Americans, few studies examined it in the context of comparing with both US and Mexican general populations and tried to disentangle the effect of acculturation from immigration status.
Method: From combined 1995 and 2000 US National Alcohol Surveys and 1998 Mexican National Addiction Survey, a variety of drinking pattern variables were examined by multiple comparisons between Mexican Americans (n=1,375), Mexican general population (n=5,711) and non-Mexican US population (n=9,341) aged 18 to 65.
Results: For women, US-born Mexicans are more likely to drink alcohol and among drinkers, drink more frequently and heavily than immigrants. Similar effect of immigration status was showed among men, although to a lesser extent. By comparing Mexican immigrants with Mexican general population and US-born Mexican Americans with non-Mexican US population, good match was observed except consistent heavier drinking in male US-born Mexicans than non-Mexican US population (e.g. 28.3 percent vs 14.6 percent reported 5+ weekly among drinkers). In separate analysis among Mexican Americans only, multiple logistic or linear regressions were used to explore the association between drinking pattern variables and immigration status and simultaneously acculturation scale within immigration groups, which was only significantly associated with current drinking measure among women when immigration status was controlled for.
Discussion: While the study confirms the drinking pattern differences between Mexican immigrants and US-born Mexican Americans, Theory of acculturation might not be the best explanation, especially for men.
Key words: Drinking pattern, immigration, acculturation, Mexican
Threats to alcohol control policy by international trade agreements
Public health measures reduce alcohol consumption, social problems, underage drinking, violence, and related illnesses and deaths. However, under current and pending international agreements, these protections can be seen as constraints on trade and interfere with commercial priorities and profit opportunities of foreign businesses. For example state control of alcohol sales, restrictions on the number of liquor outlets in a community, limit on the alcohol content of beverages, controls on advertising, minimum age limits for the sale of alcoholic beverages can be construed as barriers to trade with severe penalties by international tribunals. Fear of reprisals will likely serve as a damper on further effective alcohol policies. Alcohol control advocates in the medical and public health communities are building awareness of but need to do more to address the conflict between international trade agreements which give priority to commercial concerns over and public health.
Key words: Alcohol, policy, trade agreements
Societal images of natural recovery in Poland, Germany, Sweden and Switzerland from a cross-cultural qualitative perspective
So far, the individual aspect of natural recovery from addiction – that is change without professional intervention or self-help groups – has been the focus of research in this area. However, individual self-change processes are also influenced by macro-societal conditions and social perceptions of addiction such as access to addictive substances and addiction stereotyping in the general population. First results from the international SINR study (Societal Images of Natural Recovery) based on a rapid ethnographic assessment approach including brief interviews with 15 key persons each from the cities of Frankfurt (Germany), Warsaw (Poland), Bern (Switzerland) and Stockholm (Sweden) will be presented. The dimensionality of perceived barriers to natural recovery, of pessimism or optimism with regard to self-change and of the evaluation of various types of addictions in people’s mind are explored. Interviewees were also asked what could be done to improve addicts’ chances for quitting on their own. More specifically, cultural differences between key-informants views on self-change in the various cities are discussed; city context policy descriptions provide background information on possibly confounding factors. The study will inform large scale representative studies and provides a comparative data base to conduct further in-depth studies on various aspects of self-change friendly environments.
Key words: Social perception, dependence, natural recovery
With thanks to these cooperating organizations