Contextual Determinants of Alcohol Consumption Changes and Preventive Alcohol Policies: A 12-Country European Study in Progress

Abstract

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

RESUME

Déterminants contextuels de la consommation d'alcool et de l’évolution des politiques de prévention alcool. Une étude européenne de 12 pays en cours.

Dans les années 50 la consommation d'alcool dans le sud de pays européens (France compris) a diminué, en particulier elle a baisse’ avec peu ou pas de mesures préventives en matière d'alcool, tandis que la consommation d'alcool a augmenté dans les pays nordiques où, historiquement, étaient en place les politiques de contrôle de l'alcool plus restrictives, même si, plus récemment, elles ont été assouplies. Au même temps, l'Europe centrale et orientale ont montré un comportement intermédiaire. Cela nous a proposé que les modifications spécifiques à chaque pays dans la consommation d'alcool entre 1960–2008 sont expliquées par une combinaison d'un certain nombre de facteurs: (a) les politiques de prévention de l'alcool, et (b) les déterminants sociaux, culturels, économiques et démographiques. Ce document décrit la méthodologie d'une étude de recherche visant à comprendre les interactions complexes, qui ont eu lieu dans toute l'Europe au cours des cinq dernières décennies. Il s'agit notamment des changements dans la consommation d'alcool, dans les habitudes de consommation et dans les méfaits liés à l'alcool, et les déterminants réels de tels changements.

RESUMEN

Determinantes contextuales de los cambios en el consumo de alcohol y políticas preventivas en el ámbito del alcohol

El consumo de alcohol en el sur de Europa ha decrecido desde la década de los 50, empezando por Francia, aunque poca o ninguna medida preventiva se hubiera implementado en dichos países. En cambio, simultáneamente el consumo de alcohol experimentó un incremento en los países nórdicos, donde existe una tradición histórica de políticas mas restrictivas, aunque recientemente hayan sido atenuadas. Al mismo tiempo, la Europa Central y del Este ha mostrado comportamientos intermedios. Proponemos que los cambios específicos experimentados por los países europeos en el periodo 1960–2008 pueden explicarse por la combinación de un conjunto de factores: (a) políticas preventivas en el ámbito del alcohol, y (b) determinantes sociales, culturales económicos y demográficos. Este artículo describe la metodología de un trabajo de investigación diseñado para entender las complejas interacciones que han ocurrido en Europa durante las últimas cinco décadas, incluyendo los cambios en las cantidades de alcohol consumidas, los patrones de consumo los trastornos relacionados con el alcohol y los determinantes de dichos cambios.

Keywords :

• alcohol consumption
• sociocultural determinants
• demographics
• alcohol policy
• time trend

THE AUTHORS

Allaman Allamani, M.D., Psychiatrist, Coordinator of Centro Alcologico, Florence Health Agency (1993–2009). He is a consultant of Region of Tuscany Health Agency and a member of the Institute of Psychosomatic Education, Florence. He has been the coordinator of some Italian alcohol community and prevention projects and has been involved in a few European alcohol prevention projects. He is also a member of the Editorial Board of Substance Use and Misuse, and author or co-author of over 170 articles and editor/co-editor of 16 books. He is a work package 3 leader of the AMPHORA project.

Fabio Voller, Ph.D., is a Sociologist at the Epidemiology Observatory of the Region of Tuscany Health Agency. He has worked on epidemiological studies of lifestyle, alcohol consumption, and psychoactive drug use in the Tuscan population. Among his publications, he is the co-author of a number of monographs about the health consequences of alcohol consumption in Italy. He is a work package 3 leader of the AMPHORA project.

Adriano Decarli, Ph.D., is a full-time Professor in medical statistics, Director of Medical Statistics and Biometry Section at the University of Milan, Head of Medical Statistics and Biometry Unit, IRCCS/INT Foundation in Milan. He is the Principal Investigator of epidemiological and methodological research projects on the role of dietary habits, hormones, and familial factors as determinants of chronic diseases in Italy and on the influence of the modifiable risk factors on the individual probability of cancer developing. He is the President of the Italian Biometric Society, Former President of SISMEC (Italian Society of Medical Statistics and Clinical Epidemiology), reviewer of several scientific journals, and author/co-author of more than 350 scientific publications (275 indexed in PubMed/Medline).

Veronica Casotto is a Researcher at the Epidemiology Observatory of the Regional Health Agency of Tuscany. She is a statistician and she has a master's degree in epidemiology. She has several years of experience in biostatistics and epidemiology, which has been applied to study planning, research design, database management, and data analysis.

Karin Pantzer, M.P.H., graduated in sociology, M.P.H. at the Pompeu Fabra University in Barcelona, and postgraduated in medical anthropology at the Milano-Bicocca University. She worked as a researcher for the Public Health Agency of Barcelona, for the Catalan Agency for Health Technology Assessment, the National Institutes of Health (NIH, USA), and for the Agenzia Regionale di Sanità (ARS, Italy).

Peter Anderson, M.D., M.P.H., Ph.D., F.R.C.P., is a Professor at the Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands, and a Visiting Professor at the Institute of Health and Society, Newcastle University, England. He coordinates several major international research and policy projects for addictions and mental health for the European Commission and the World Health Organization. He has over 120 publications in international peer-reviewed journals and is the author or editor of some 15 books. He has authored many monographs for the European Commission and the World Health Organization.

Antoni Gual is a Psychiatrist, with a long experience in alcohol research, including both the clinical and the public health fields. He conducts the alcohol unit at the Clinic Hospital of Barcelona, Spain, and also acts as an alcohol consultant at the Health Department of Catalonia. He is the coordinator of the Amphora project and is involved in several European research projects in the areas of public health and clinical trials. He is the Vice President of the International Network on Brief Interventions for Alcohol Problems (INEBRIA), research officer of the European Federation of Addiction Scientific Societies (EUFAS), and former president of the Spanish Scientific Society for the study of alcohol and alcoholism.

Silvia Matrai is a Psychologist and masters in cognitive-behavioral therapy, psychopathology, and health care management, Barcelona, Spain. She has experience as a clinical psychologist in different health settings, including medical inpatients, prepartum and postpartum psychopathology, cancer patients, and addictions, and also in clinical research. She has several publications in scientific journals and is the external advisor of Médecins Sans Frontières on mentalh-health-related issues.

Zsuzsanna Elekes, Ph.D., is a full-time Associate Professor at the Institute of Sociology and Social Policy, Corvinus University of Budapest. Her research activities mainly focus on alcohol and drug epidemiology and social policy. She has participated in several international projects in these fields.

Irmgard Eisenbach-Stangl is a Professor, a Sociologist, and a Psychotherapist, with long experiences in alcohol and drug research. She participated in several international comparative studies on alcohol consumption, alcohol policy, and alcohol prevention in European countries. She has worked for many years as a member of the advisory boards for measures against alcohol misuse and misuse of other addictive substances at the Austrian Federal Ministry of Health, for WHO Europe and WHO in Geneva and for the European Commission. Currently, she works as a senior researcher at the European Centre for Social Welfare Policy and Research in Vienna and is the lead researcher for the research area “alcohol, drugs, addiction.”

Gabriele Schmied, master of sociology (University of Vienna), acts as a Social Scientist since 1990. Since 2000, she is working at the European Centre as a researcher in the area of health and care (former health and welfare). She was involved in several national and international research projects in the field of health promotion and prevention, with a focus on HIV and alcohol and drugs research.

Ronald A. Knibbe, Ph.D., works as a Professor of the social epidemiology of alcohol and drug use at the Health Promotion Department of the Faculty of Health, Medical, and Life Sciences, Maastricht University. His main interests include adolescent and young adult's alcohol consumption, marginalized drug users, and cross-cultural comparisons of alcohol and drug use.

Sturla Nordlund, Senior Scientist, Former Director and Research Director of the Norwegian Institute for Alcohol and Drug Research (SIRUS), is a Statistician with a very long experience in social alcohol research. He has been the leader of several research projects and is now leading a work package in the Amphora project.

Øystein Skjælaaen is a Criminologist with experience in research on alcohol and illegal drugs. He works as an advisor at the Norwegian Institute for Alcohol and Drug Research, and is soon to start a Ph.D. project focusing on the cultural aspects of alcohol use in Norway.

Börje Olsson, Ph.D. in sociology, is a full-time Professor at the Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University. His primary research areas during the last 10 years are drug use and control policies in an international perspective, cultural perspectives on alcohol, drug use and prevention, public opinion, and media representations of alcohol and drug problems. Previous research areas include epidemiology and treatment research.

Jenny Cisneros Örnberg, Ph.D. in political science and a researcher and Deputy Director of SoRAD. Her research covers the policy development of public-health-related questions in Sweden and on a European Union level.

Esa Österberg, MSc, works as a Senior Researcher at the National Institute for Health and Welfare in Finland. He is a member of the Alcohol and Public Policy Group, which produced the monographs Alcohol Policy and the Public Good in 1994 and Alcohol—No Ordinary Commodity first edition in 2003 and second edition in 2010.

Thomas G. Karlsson, MSc, is a Researcher at the Department of Alcohol, Drugs and Addiction at the National Institute for Health and Welfare (THL). He has been active in the field of alcohol research since 1995 and has participated in several international research projects co-funded by the European Commission. These are, for instance, the European Comparative Alcohol Study (ECAS) as well as the SMART and AMPHORA projects. Karlsson is also a member of the Editorial Board of the scientific journal Nordic Studies of Alcohol and Drugs.

Martin Plant, Ph.D., was a Professor of addiction studies at the University of the West of England Bristol. He was engaged in a research into alcohol and other drugs since 1970. His work focused on issues related to alcohol and allied themes. He carried out a series of social and behavioral studies related to alcohol and other drugs. In addition, he conducted studies of HIV/AIDS risks in relation to the sex industry and alcohol and drug problems among anesthetists and the mental health needs of prison inmates. One of his main areas of interest was harm minimization and prevention policy. Until his death in March 2010, Martin was the Director of the UK part of a 36-country collaborative study, the European School Survey Project on Alcohol & other Drugs (ESPAD). He produced over 250 publications including a number of books. He served as a World Health Organization consultant, and an advisor to a number of UK and overseas government departments.

Moira Plant is a Professor of alcohol studies at the University of the West of England Bristol. Her work has mainly focused on issues related to alcohol and gender- and alcohol-related foetal harm. In addition, she has conducted studies of HIV/AIDS risks in relation to the sex industry, nurses and stress, and alcohol and drug problems among anesthetists and the mental health needs of prison inmates. She is the Director of the UK part of a 36-country collaborative study, Gender, Alcohol and Culture: An International Study (GENACIS). She has published a number of books; the latest written in collaboration with Professor Martin Plant is Binge Britain (2006). She has acted as a government advisor on issues such as women and alcohol and drinking in pregnancy.

Patrick Miller is a retired Senior Research Fellow at the University of the West of England, with interests in survey work on drugs, alcohol, depression, and life events.

Nikki Coghill, Ph.D., M.Sc., B.Sc., is a Senior Research Fellow in the Alcohol and Health Research Unit at the University of the West of England. She is an experienced alcohol-related researcher, with a particular interest in public health. She is involved in several national and international alcohol-related research projects.

Grażyna Świątkiewicz is a Psychologist and Sociologist with a long experience in alcohol and drug research. She is an Assistant Professor at the Institute of Psychiatry and Neurology and participant and/or coordinator in many Polish and international research projects. She has been the author of more than 100 publications in Polish and international journals and books. Publications deal mainly with sociocultural contexts of psychoactive substances consumption and related problems.

Łukasz Wieczorek is a fourth year doctoral student at the Department of Studies on Alcohol and Drug Dependence, Institute of Psychiatry and Neurology in Warsaw. His doctoral thesis concerns the barriers and facilitations of access to alcohol treatment, stigmatization of patients receiving alcohol treatment, and role of institution in treatment. His research interest focuses on epidemiology of addiction, policy on psychoactive substance, and alcohol and drug treatment system.

Gerhard Gmel, Ph.D., is associated with the Addiction Info Switzerland, Alcohol Treatment Centre, Lausanne University Hospital. Trained as a psychologist, he now works as an epidemiologist mainly in two domains. First, he is involved in many international research projects using survey data. For example, he is currently the centralized analysis and databank coordinator of one of the major research projects on gender and alcohol (GenACIS) including surveys from more than 40 counties all over the world, and participated in international youth projects such as ESPAD. He just started a cohort study with a 19-year-old man to follow-up their substance use patterns and related consequences. Second, he is doing emergency department studies and testing of the effectiveness of brief interventions in different settings. He is also a temporary advisor of the WHO with regard to alcohol epidemiology and policy and collaborated with the WHO on the estimation of the Global Burden of Disease 2000 and 2010 stemming from alcohol use, and senior editor of Addiction.

Beatrice Annaheim is a Sociologist, active in addiction research, with a main focus on cannabis use, substance use, and sports, as well as on the evaluation of prevention projects. Since 2009, she has been collaborating in the AMPHORA project on behalf of Addiction Info Switzerland.

Notes

1 With the advent of artificial science and its theoretical underpinnings (chaos, complexity, and uncertainty theories), it is now posited that much of human behavior is complex, dynamic, multidimensional, level/phase structured, nonlinear, law-driven, and bounded (culture, time, place, age, gender, ethnicity, etc.). Alcohol consumption and policies designed to effect it would be such behaviors/processes. There are two important issues to consider and that are derived from this: (1) using linear models/tools to study nonlinear processes/phenomena can and does result in misleading conclusions and can therefore also result in inappropriate intervention; and (2) the concepts of prediction and control have different meanings and dimensions than they do in the more traditional linear “cause and effect” paradigms (Editor's note).

2 This relatively new term, introduced into the intervention literature, refers to major events such as mega disasters, natural as well as man-made, famine, conflict, genocide, disparities in health, epidemics, mass migrations, economic recessions, etc., which effect adaptation, functioning, and quality-of-life of individuals as well as systems. Existential threat, instability, and chaos are major dimensions and the loss of control over one's life is experienced (Editor's note).

3 Refer to Hills's criteria for causation that were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated (Hill, 1965) (Editor's note).