The Public Health Dilemma in the Alcohol Intervention Area: Unfinished Business Between Limits and Freedom

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GLOSSARY

• Brief intervention: provides a framework for intervention to help risky drinkers to reduce or give up alcohol consumption in order to prevent harmful consequences of their drinking.

• Drinking patterns paradigm: is based on the relationship between specific ways of drinking and specific forms of alcohol-related problems. According to this paradigm alcohol policy should distinguish between low-risk, risky and harmful drinking.

• Harm reduction: describes policies that focus on reducing the harm resulting from alcohol consumption without necessarily affecting the alcohol use (i.e. improving the drinking environment and reducing the harms associated with drink-driving).

• Total consumption model or theory: shows a strong connection between total alcoholic beverage consumption in a population and mortality rate due to alcohol drinking-related pathologies.

Notes

¹ A binary, simplified delineation of the two drinking cultures being that for the Nordic alcoholic beverages are intoxicants and for the Mediterranean alcoholic drinks are foods which are part of a meal.

² The reader is referred to Hills's criteria for causation which were developed in order to assist researchers and clinicians to determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58: 295–300.). Editor's note.

³ The reader is referred to Tilly, Charles (2006). Why. Princeton Univ. Press. Princeton, NJ for a stimulating analysis about generic ‘causative’ reasons given in the West, and to Tilly, Charles (2008). Credit and Blame Princeton Univ. Press. Princeton, NJ for an important analysis about ‘blame.’ Editor's note.

⁴ Treatment can be briefly and usefully defined as a unique, planned, goal directed, temporally structured, multi-dimensional change process, of necessary quality, appropriateness and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.), associated with a range of stakeholders with agendas, and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (‘natural recovery’) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren't also used with non-substance users. Whether or not a treatment technique is indicated or contra-indicated, and what are its selection underpinnings (theory-based, empirically based, principle of faith-based, tradition-based, etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of ‘harm reduction’ and the even newer Quality of Life (QOL) and wellbeing treatment-driven models there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure as well as iatrogenic-related harms. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments. Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models; (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the ‘informed model’ in which the patient makes the decision(s). Editor's note.

Additional information

Notes on contributors

Franca Beccaria

Franca Beccaria, PhD, Italy, is a sociologist, partner in Eclectica, a research institute in Torino (Italy), contract professor at the EMDAS, European Master on Drug and Alcohol Studies, the Avogadro University (Novara) and at University of Torino (Italy). Her main research interests are alcohol and culture, drinking styles, prevention, and sociology of health. Last book edited ‘Alcohol and generation. Changes in style and changing styles in Italy and Finland’ (Carocci, 2010), and ‘Alcol e giovani. Riflettere prima dell'uso’ (Alcohol and youth. To think before using) has been published in 2013 by Giunti Editore.