Alcohol and Society 2013: A Research Report from IOGT-NTO and the Swedish Society of Medicine: Youth and Young Adults

2013·16.4 MB·English

ALCOHOL AND
SOCIETY
A RESEARCH REPORT FROM IOGT-NTO AND
THE SWEDISH SOCIETY OF MEDICINE
2013 THEME:
YOUTH AND YOUNG ADULTS
2013 © IOGT-NTO & Läkaresällskapet
Fotograf: Emelie Spjuth Svärd (Sidorna 3, 22, 32 och baksida)
Fotograf: Pernilla Förnes (Framsida, sidorna 11, 12, 14, 18 och 20)
Grafisk form: WOF factory
Tryckt hos TMG Stockholm
A RESEARCH REPORT FROM IOGT-NTO AND
THE SWEDISH SOCIETY OF MEDICINE
ALCOHOL AND
SOCIETY
Foreword | By Anna Carlstedt and Peter Friberg 5
Interview | Young people are our future 6
Main article | Alcohol-related harm among Swedish youth and
young adults: problems and possibilities 8
Retrospective | Swedish experiments with beer sales 23
Interview | Seven young people talk 30
Current research | Alcohol and complications after surgery 33
Current research | Alcohol, pregnancy and child development 35
Current research | Do restaurants opening hours matter for violence? 37
Current research | Which matters more? The risks or the benefits of alcohol? 39
Current research | Does abstinence mean you die younger? 41
The report’s authors | Presentation of the research group 42
Alcohol Research Report, 2013
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Alcohol Research Report, 2013
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Research has, throughout history, been the driving force behind development and has built the foun-
dations upon which our contemporary society rests. Where, for example, would we be without people
such as Leonardo da Vinci, Albert Einstein or Marie Curie? But research does not automatically result in
a better society. The findings and knowledge that research generates must also be accepted and used by
politicians and other power-brokers if it is to yield results – and it is here that the challenge lies.
Alcohol policy is one area in which research is very much key. Alcohol is an addictive substance and
the harm that can be linked to it costs society billions of kronor every year. And that is quite aside from
the personal tragedies that affect so many people, either directly or indirectly, as a result of the harmful
effects of alcohol. The laws and preventive measures that we use to limit alcohol-related harm are based
on research. The problems that alcohol causes are global and it is by helping each other and studying the
ways in which different countries manage the alcohol issue that we can, ourselves, become more efficient
when it comes to limiting this harm.
When we set out to produce this report, we brought together five of the world’s leading alcohol resear-
chers and assigned them a task. We asked them, based on an area that our organisations had selected as
being both important and topical, to review the latest international research in this area, to describe the
scientific basis for its findings, and to collectively reach conclusions on measures of particular relevance
for us, here in Sweden and the Nordic region. You are holding the end product of their work – which
comprises several different sections - in your hand. The researchers’ contribution to this report is the main
article on alcohol consumption among youth and young adults, but the researchers have also conducted
an overview of the remaining flora of alcohol-related research and cherry picked five pearls from the past
year’s findings. There are also two interviews which complement the results of the research: the first is
with the Chair of the research group, Harold Holder, and is where you can find out more about what
motivated him to produce the report and his views on Sweden’s alcohol policy. The second interview gives
a voice to some of the young people who are the main subject of this report. We met with several young
people who gave us their views on alcohol and on the results produced by the researchers.
We hope that you will regard this report as both a tool and a support. There are always methods or ideas
that are just that little bit better than the ones we had before. That is how society develops and that is how
we will continue to limit the harmful effects of alcohol.
Photographer: Emelie Spjuth Svärd
Anna Carlstedt: Chair, IOGT-NTO
Peter Friberg, Chair, The Swedish Society of Medicine
Alcohol Research Report, 2013
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INTERVIEW
YOUNG PEOPLE ARE
OUR FUTURE
interview with Harold Holder
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Harold Holder is one of the world’s leading quarters, and of investigating whether this policy
alcohol researchers who has led the work on could be transferred to the USA.
producing this year’s theme article on youth
drinking and prevention. He believes that re- 25 years have now passed since that first visit to
search findings should be of practical use, and Sweden and this past autumn, it was time for yet
research was the cause of his fondness for another trip. This time, a group of world-leading
Sweden, when he came here many years ago. alcohol researchers, led by Harold Holder, would
get together at Wendelsbergs Folk High School
“My friends often ask me why on earth I come where they would spend a few days compiling re-
here so often,” says Harold Holder. The Ameri- search into youth drinking and prevention.
can alcohol researcher has been visiting Sweden
an average of twice a year, every year, since 1988. “Young people are our future and what happens
And why does he keep coming back? Well, he to them during their developmental years will af-
likes Sweden. He likes the countryside and the fect them for the remainder of their lives. If we
good food, but above all, he likes Sweden’s atti- can prevent risky alcohol use by these young pe-
tude to research and the formulation of Swedish ople, and prevent the harm that alcohol causes,
alcohol policy. we can protect them and increase their potential
for living long and productive lives,” says Holder.
“You have a tradition of thinking about research
and of using it in practice, as the basis for poli- Swedish school surveys in recent years have re-
tical decision-making, for example. Plus you’re ported a fall in youth drinking, but Harold Hol-
the world leaders when it comes to using alcohol der believes that what we should really be looking
policy tools to reduce alcohol-related harm,” says at is the trend in alcohol-related harm, which is
Harold Holder. showing the opposite trend. Alcohol is current-
ly the biggest mortality and injury risk factor
Swedish alcohol policy fascinates him and he has amongst young people aged between 16 and 24.
a partnership with both Swedish researchers and “People who believe that young people drink in
decision-makers stretching back many years. His moderation are naïve. Young people don’t have
CV is a lengthy one and over the years, he has wine tasting sessions,” says Holder.
published hundreds of different peer-reviewed
articles. The EU and the Swedish Government have a sha-
red goal – to reduce alcohol consumption and the
Certain events were critical in terms of his care- ensuing injuries and illness amongst young pe-
er development, such as reading the Pink Book ople, and the hope of the research group is that
published in the 1970s. At the time, Harold Hol- this report will be disseminated across society and
der was working as a treatment researcher and it find its way into the political debate.
was thanks to the Pink Book that he came into “We’re not telling the decision-makers what they
contact with Nordic alcohol research. Alcohol should be doing about youth drinking. What we
abuse was primarily seen as an individual pro- are doing, however, is offering them suggestions
blem in the USA in those days and “Alcohol as to effective measures that we know work and
Control Policies in a Public Health Perspective” which they can use as a basis for their decision
by Kettil Bruun et al, or the Pink Book as it beca- making on a range of issues,” says Holder.
me known, not only made a deep impression on
Harold Holder, but also had a significant impact And if he, himself, were a decision-maker? One
on the international debate on alcohol policy and of the things he’d focus on is parents and other
alcohol research. adults supplying young people with alcohol. But
new assignments await Harold Holder, because he
“It changed my views on both alcohol problems has no intention of slowing down, despite having
and my career. The research presented in the reached retirement age.
book showed that alcohol policy makes a diffe-
rence and that it is possible to prevent alcohol-re- “Because now I have the time to do the things I
lated problems,” remembers Harold Holder. like doing, and I’d rather stay active in this field
than spend my time doing crosswords and jigsaw
In the late 1980s, he travelled to Sweden for the puzzles and playing bridge. I’m not a circus pony
first time with the aim of studying the history of – I only do the things that I enjoy doing,” ends
and research into Swedish alcohol policy at closer Harold Holder.
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Levels of alcohol consumption amongst Swedish teenagers and young adults are worry-
ing. Alcohol is currently the biggest mortality and injury risk factor amongst young pe-
ople aged between 16 and 24. Young people aged between 18 and 24 currently account
for 35 per cent of all alcohol-related DUI deaths, even though this group accounts for
only 7 per cent of drivers.
Extensive international research shows that young people who drink alcohol also run a
greater risk of suffering accidental injuries (e.g. falls, drowning and alcohol poisoning),
violence (e.g. murder, suicide and child abuse), and that their academic performance
and productivity declines.
Studies have also shown that binge drinking at a young age increases the risk of risky
alcohol consumption in adult years, while a Swedish study has shown that the develop-
ment of premature dementia is also linked to youth drinking.
Preventative measures have been shown to be particularly effective in reducing
young people’s alcohol consumption and the harm that ensues. Young people’s alcohol
consumption is affected by a number of different factors, such as adults’ alcohol ha-
bits, the price of alcohol, bars’ opening hours, advertising, and age restrictions on the
purchase of alcohol.
In this article, researchers have compiled suggestions for effective preventative mea-
sures aimed at young people aged between 15 and 25. The researchers propose that, in
order to reduce youth drinking and the ensuing harm, that Sweden raises the price of
alcohol and reduces young people’s access to alcohol, and that the Government could
be active in protecting its sovereignty in restricting alcohol marketing.
All of the measures proposed by the researchers are supported by international rese-
arch and are proven to be effective in reducing alcohol-related harm in young people.
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ALCOHOL-RELATED HARMS
AMONG SWEDISH YOUTH AND
YOUNG ADULTS:
PROBLEMS AND POSSIBILITIES
Youth and young adult drinking and associated youth-related outcomes including unintentional
harm for Sweden and other Nordic countries is injuries (e.g., motor vehicle crashes, falls, drow-
of special public concern. This article contains ning, alcohol poisoning), violence (homicide,
a summary of prevention strategies to reduce al- suicide, domestic violence, sexual assault, child
cohol-related harm from youth and young adults abuse and neglect), sexually transmitted infec-
covering the ages of 15 to 25 years of age. Obser- tions, unintended pregnancy, alcohol dependen-
vations and recommendations of this article are ce, poor school performance, and lost productivi-
based upon comprehensive reviews of the sci- ty.3 In addition, there is a robust body of evidence
entific literature concerning effective prevention demonstrating that drinking and binge drinking
strategies. This review does not include strate- initiation at a young age is strongly predictive of
gies with limited or no overall evidence for effec- excessive consumption and related outcomes in
tiveness in reducing population level harms, the- adulthood.4 Alcohol use in adolescence, particu-
se for instance include school based educational larly risky use, has in a Swedish study also been
programs and media awareness campaigns. In found to be associated with increased risk of fu-
addition, while a number of possible strategies ture disability pensions, both pensions at an early
have been developed and tested world-wide, this age (below 40) and at older ages.5 In another re-
article provides focus on strategies with special cent longitudinal study of nine risk factors for ear-
relevance for the Swedish and Nordic situation. ly onset dementia on Swedish conscripts alcohol
intoxication in youth was the largest risk factor
BACKGROUND: ALCOHOL CONSUMP- and led to an almost 5-fold increase in early on-
set dementia.6 Alcohol use in adolescence could
TION AND RELATED PROBLEMS therefore be considered an important marker for
future reduced work capacity.
Worldwide, excessive alcohol consumption is a
leading cause of death, hospital admissions, social
problems and economic costs. In Europe, per ca-
pita consumption is twice the world average, and
in the EU alcohol causes approximately 120 000
premature deaths annually, or 12% of all deaths
among those aged 15-64 years.1 In Sweden alone, Accordingly, protecting young people and child-
there are approximately 4 500 alcohol-attributa- ren from alcohol is one the five priority areas in
ble deaths annually.2 the 2006 EU alcohol strategy7, and the Swedish go-
As a risk factor, alcohol consumption places a vernment’s strategy for Alcohol, Narcotics, Doping
disproportionate burden on youth and young and Tobacco aims to reduce the number of young
adults, and is a leading risk factor for a variety of people that start to drink at a young age and to re-
duce harmful youth alcohol consumption.8
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APPROXIMATE NUMBER
TYPE OF PROBLEM PER CENT
OF STUDENTS
Quarrels 34,8 39 300
Lost money or valuables 25,0 28 000
Unprotected sex 22,6 25 500
Accident or injury 19,2 21 500
Problems with relations to friends 19,0 21 500
Unwanted sex 13,2 15 000
Lower achievement in school 9,8 11 000
Being robbed or stolen from 6,0 7 000
Been to hospital 4,5 5 000
Self-reported problems due to alcohol consumption, 2nd grade high school students, Sweden 201213
Although excessive alcohol consumption in common problems included accidents or inju-
Sweden is high in absolute terms and by interna- ries, unprotected or unwanted sex, and quarrels.
tional standards, it is lower than for most Nordic Despite apparent declines in the past five years,
and EU countries, in part because Sweden has youth consumption remains high. For example,
enjoyed a restrictive alcohol policy environment 2nd grade high school boys, i.e. all under legal
in comparison with most other EU nations, and drinking age, reported consuming an average
was the first country to develop an alcohol mo- of 5.7 liters of ethanol in 2012, and almost half
nopoly. However, since Sweden entered the EU (45%) reported risky drinking (>14 drinks per
in 1995, some important alcohol policies have week, or binge drinking in the past month), gi-
been weakened.9 During this period, sales from rls consumed 3.4 liters annually and 38% risk
the alcohol retail monopoly, restaurants and gro- drinking prevalence.14 Based on survey estima-
cery stores have increased by 22 per cent to 7.3 tes 17 years olds in Sweden drank more than
liters pure alcohol per capita. Total consump- 1 800 000 bottles of vodka or almost 21 million
tion, which also includes alcohol smuggled and cans of strong beer in 2012.
legally imported by travelers, is estimated to
have increased 17 per cent during the same time, EFFECTIVE POLICY INTERVENTIONS FOR
to 9.4 liters.10
Total mortality rate for those aged 16-24 years YOUTH AND YOUNG ADULTS
has increased in Sweden over the past decades,
despite decreased mortality in the Swedish ge- Alcohol policies are the most effective means by
neral population.11 Alcohol is the leading risk which to reduce excessive drinking and related
factor for death and injury among this age group. harms for both adults and youth. The most ef-
Since 1995, several important alcohol-related fective policy interventions change drinking
problems have increased, including alcohol poi- through several mechanisms, including by de-
soning deaths, violent events and single vehicle creasing the economic availability of alcohol
nighttime crash fatalities which are heavily asso- (i.e., by raising prices) or by decreasing its phy-
ciated with youth and young adults.12 sical availability. Effective environmental poli-
Beyond deaths, the prevalence of alcohol-in- cy strategies reduce consumption even among
volved problems reported by Swedish school those who drink heavily or who are alcoholic.
surveys is also of concern (see table). The most In particular, policies can reduce binge drinking
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