Alcohol and Society 2017/2018: A Survey of International and Swedish Research: Alcohol and Violence

2018·0.8 MB·English

by  Andreasson, Sven, Chikritzhs, Tanya, Dangardt, Frida, Holder, Harold, Naimi, Timothy, Stockwell, Tim

KAPITELHUVUD
Alcohol and violence
A L C O H O L A N D
S O C I E T Y 2 0 1 7 / 2 0 1 8
A SURVEY OF INTERNATIONAL AND SWEDISH RESEARCH
ALCOHOL AND VIOLENCE 1
The Swedish Society of Medicine and IOGT-
NTO are voluntary organisations independent
of commercial interests. The Swedish Society
of Medicine is the scientific organisation of the
Swedish medical profession and has a broad
range of interests across the entire field of
medicine. The importance of lifestyle to people’s
health at both individual and societal level,
is a priority issue. IOGT-NTO focuses on the
effects of alcohol and narcotics on individuals
and society, but is also engaged in broad social
and club activities. CERA is an interdisciplinary
and collaborative centre for education and
research into hazardous use, abuse and addiction
at Gothenburg University – which works to
strengthen and develop research and education
in the field of addiction, and to disseminate
scientific expertise to people working
professionally in the field of abuse and addiction,
and other interested parties.
Published by IOGT-NTO, the Swedish Society of Medicine and
CERA in cooperation with Stiftelsen Ansvar, 2017/2018
A Swedish language version of this report is also available from
www.iogt.se or www.sls.se.
© IOGT-NTO & Swedish Society of Medicine & CERA, 2017
Graphic design: Petra Handin
Illustration: Annika Carlsson
Printers: Fridholm och Partners, Hindås
ISBN: 978-91-982220-3-6
URN: urn:nbn:se:iogt-2017-aos-sv
CENTRUM FÖR UTBILDNING OCH
FORSKNING KRING RISKBRUK,
MISSBRUK OCH BEROENDE (CERA)
FORWORD
Alcohol a factor strongly
linked to acts of violence
Violence generates enormous costs for so- The Swedish Medical Association, Center for
ciety and causes great suffering for affected Addiction Research (CERA) and IOGT-NTO,
individuals, both physically and mentally. with the financial support of the Foundation
There are many factors which contribute responsible for the Future, publishes the
towards violent behavior. Alcohol’s detrimen- research report Alcohol and Society annually,
tal effect on the brain is an undisputed fact with the aim of shedding light on harmful
and this can in turn contribute to an increased effects of alcohol consumption on both indi-
risk of aggressive behavior, leading to acts of viduals and society. This year’s topic is Alcohol
violence occurring. and Violence.
Research on the subject of alcohol-related This report is presented by a group com-
violence proves difficult for ethical reasons. prising of some of the leading international
When looking at the Swedish statistics for alcohol researchers, led by Harold Holder. The
murder and violent-conduct over the past researchers collectively examine facts based
160 years, it demonstrates violent acts of on aggregated international studies with
crime rises in likelihood as alcohol consump- which to derive conclusions and measures
tion increases. Studies also show an increase focussing on Sweden and the other Nordic
in alcohol consumption of an average of countries. In previously produced studies, the
one litre per person causes a seven percent report has touched on topics such as alcohol
increase in the number of violent attacks. and its impact on young adults, the effects of
In this research report we indentify differ- low dose consumption, alcohol’s secondary
ent forms of violence, how alcohol affects injuries and alcohol-related cancer. These and
our behavior and how violence can affect earlier reports can be read on our respective
our health in both short and long term. This websites.
report presents alcohol policy and local vio- We would like to wish you good reading!
lence prevention initiatives which are aimed at We hope this report will engage you and pro-
reducing alcohol consumption and therefore vide valuable information regarding alcohol
reducing violence. research!
Claudia Fahlke Stefan Lindgren Johnny Mostacero
director, chair, chair,
CERA, University Swedish Society IOGT-NTO
of Gothenburg of Medicine
KEAXPEITCEULHTUIVVUED SUMMARY
Executive Summary
Violence is one of the great scourges of hu- reported a sexual assault. While about 80% of
manity and alcohol fuels much of it. the victims of public violence (e.g., assaults)
Alcohol is a contributing cause of many are male, more females are victims of domes-
violent incidents in Sweden that is often tic and sexual violence. Furthermore, domes-
overlooked and under-reported. Official tic violence victims, who are more likely to be
records show that the rates of homicides women and children, may be more likely to
and assaults in Sweden since the 1850s have under-report violence, and less likely to seek
closely tracked the population rate of alcohol care for violence-related injuries.
consumption (see Figure 1). In this report we A recent World Health Organization report
discuss evidence for alcohol having a direct identified many types of harm arising from
causal contribution to violence and we also violence beyond the immediate traumatic
highlight effective but under-utilised strate- injuries. Serious longer term effects impact
gies to reduce alcohol-related violence. While physical, psychological, reproductive and
the World Health Organization (WHO) identi- sexual functioning in adults and deprivation or
fies public policies on alcohol as a ‘best-buy’ neglect in children. For instance, individuals
for violence prevention, such strategies have who had experienced severe physical or sex-
been mostly overlooked in Swedish violence ual violence during their lifetime were about
prevention strategies. three times more likely to be diagnosed with
We present evidence that alcohol use con- heart disease. In general, female victims
tributes to violence affecting people across appear to be especially vulnerable to longer-
the whole life-course and in many situations, term health consequences of violence.
including: violence between family members, Reviews of international studies indicate
intimate partners, friends, acquaintances and that alcohol has been consumed prior to
strangers, child maltreatment, youth violence, assaults by between one-third and one-half
sexual violence and elder abuse. Evidence of perpetrators of violence. In Sweden, based
from different types of studies shows that on survey data for 2015, 57% of perpetrators
while alcohol does not provide a motive or of physical assault and 31% of victims were in-
excuse for violence, alcohol impairment can toxicated. With an estimate of 317 000 cases
increase the probability that there will be a of physical assault in 2015, this corresponds to
violent response to inter-personal conflict, 180 000 alcohol-related assaults in that year.
frustration or a perceived threat. Further- For all types of violence in Sweden the per-
more, people are more likely to be victims of petrator is male in 9 times of 10. The victims
aggression when they are intoxicated. of physical assaults are mostly male while the
Many violent incidents are never report- victims of sexual assaults are predominantly
ed. Furthermore, alcohol’s contribution to female.
violence tends to be invisible or ignored. In The evidence for a causal relationship
anonymous surveys, however, 2.5% of Swed- between alcohol and violence was studied
ish men and 1.5% of women reported being by triangulating the findings from three main
physically assaulted in the previous year and, research approaches: (a) human and animal
further, 0.3% of males and 1.8% of females laboratory experiments, (b) studies of alcohol
4 ALCOHOL AND VIOLENCE
EXECUTIVEKA SPUITMELMHUAVRUYD
use and violence in the general population, factor for violence is also strengthened by
and (c) studies of interventions where alcohol the consistency of the relationships observed
consumption has been affected by either across different types of violence, including
stricter or more relaxed alcohol policies. intimate partner violence, elder abuse and
Human and animal experimental studies child maltreatment.
suggest that the pharmacological effects of Alcohol policy changes related to the price
alcohol cause changes in thinking, emotions, of alcohol (e.g., taxes), trading hours (i.e.,
and physiology that increase the likelihood of hours of alcohol sales), minimum legal pur-
aggressive behaviour (e.g., feeling overcon- chase age and the number of liquor outlets
Studies shows
fident, becoming angry with relatively minor have all been found to be related to rates of
provocation) and violence victimization (e.g., violent incidents. Greater restrictions on these that alcohol
not recognizing unsafe situations, being less are associated with reductions in violence
able to defend against, of flee from, attack). while loosening of restrictions are associated impairment
Biomedical evidence also suggests that with increasing rates of violence in Sweden
can increase
alcohol counteracts the inhibitory functions of and in other countries. Government alcohol
the brain which suppress aggressive impulses. monopolies, such as Sweden’s Systembola- the probability
There is also evidence that learned beliefs get, can help resist commercial pressures to
that there will
about alcohol and aggressive behavior (e.g., increase alcohol availability and affordability.
the belief that when ones drinks it is ‘normal’ Violence can also be reduced through be a violent
to be more aggressive) can shape violent multi-component community level interven-
response to
behavior after alcohol consumption, although tions. Successful examples of such interven-
the pharmacological or physiological effects tions in Sweden include responsible beverage inter-personal
of alcohol on the brain are more powerful service (RBS), particularly when RBS training
conflict.
determinants. is combined with community mobilization
In the “real world” where experiments and stricter enforcement of licensing laws.
about violence are unethical or impractical, Examples of community interventions in Swe-
epidemiological studies of the general pop- den include the reduction of violence among
ulation demonstrate significant associations young people attending graduation parties
between alcohol consumption and violence. and policing of alcohol use in public places by
Intervention studies provide powerful tests young people.
of causal relationships by demonstrating Nearly everyone decries violence, at least
that abrupt changes in general population publicly, and yet the difficulty lies in adopting
drinking patterns predict changes in rates of meaningful interventions to actually reduce it.
violence. While many causes of violence are difficult to
The level of alcohol use in the general change (e.g. genetic, personality and cultur-
population is an important risk factor for al factors) this report finds that alcohol as a
violence. Swedish studies have found that a cause of violence stands out as being highly
1 litre increase in consumption is associated amenable to change through changes in
with a 7% increase in assaults all other factors alcohol policies.
being equal. Evidence that alcohol is a risk
ALCOHOL AND VIOLENCE 5
KAPITELHUVUD
Authors
Sven Andreasson
Karolinska Institutet,
Department of Public
Health Sciences,
Stockholm, Sweden
Tanya Chikritzhs
Curtin University,
National Drug
Research Institute,
Perth, Australia
Frida Dangart
Sahlgrenska Academy
and University
Hospital, The Queen
Silvia Children´s
Hospital – Paediatric
Clinical Physiology,
Gothenburg, Sweden
Harold Holder
Senior Scientist
Emeritus and former
Director of Prevention
Research Center,
Pacific Institute
for Research and
Evaluation, Berkely,
CA, USA
Timothy Naimi
Boston Medical
Center, Section on
General Internal
Medicine, Boston,
MA, USA
Tim Stockwell
Dept of Psychology
– Centre for
Addictions Research
of BC, University of
Victoria, BC, Canada
6 ALCOHOL AND VIOLENCE
1 INTRODUCTION
1 Alcohol-Related Violence
– Introduction
In this report we will discuss evidence from more than 50% over the following few years,
many sources that alcohol use is an impor- closely following the marked decline in alcohol
tant contributing but preventable cause of consumption. Indeed the author of this histor-
violence. A close connection between alco- ical analysis1 observe that changes in violence
hol use and violence has been documented only appeared to be associated with changes
throughout Swedish history. As shown below, in the alcohol control system and were mostly
official national records show that rates of unrelated to other major social changes and
both homicide (Figure 1) and assault (Figure world events. We will also present evidence
2) closely followed rates of per capita alco- from laboratory studies of aggressive-type
hol consumption over the years from 1851 to behaviour and from “real world” general pop-
2009. Examining the figures below shows that, ulation and intervention studies that point to a
for example, when the Bratt-system alcohol strong causal relationship between alcohol use,
rationing system was introduced in Sweden in intoxication and violence.
1917, both homicides and assault decreased by
Homicide. Number of
FIGURE 1 Close covariation between alcohol use and violence persons killed according to
vital statistics, 1851 – 2009.
Per 100,000
1.6
Registered alcohol
1.4 consumption (litre per
capita 15 years and older,
1.2 scale adjusted, divided
by 8), 1851 – 2009, 5-year
00 1.0 average*
0
100, 0.8 * Values on Y-axis (0 – 1.6) for
Per 0.6 ableceonh odli vciodnesdu mbyp 8ti oinn ohradveer
to use the same scale for
0.4
both lines. For the brown
line the value 1 means 8 litre
0.2
alcohol per person per year.
0
1851 1860 1870 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2009
From: von Hofer, H. (2011). Brott och straff i Sverige 1750 – 2010 (Crime and punishment in Sweden 1751 – 2010), 4:e uppl.
Kriminologiska institutionens rapportserie, nr 2011:3. Stockholm: Stockholms universitet.
ALCOHOL AND VIOLENCE 7
1 INTRODUCTION
Convicted
persons FIGURE 2 Assault (per 100,000) and registered alcohol consumption (litres per capita
15 years and older, 5-year average)
Alcohol *10
200
150
0
0
0
00, 100
1
er
P
50
0
1825 1850 1875 1900 1925 1950 1975 2000 2025
From: von Hofer, H. (2011). Brott och straff i Sverige 1750 – 2010 (Crime and punishment in Sweden 1751 – 2010), 4:e uppl.
Kriminologiska institutionens rapportserie, nr 2011:3. Stockholm: Stockholms universitet.
ing physical and/or sexual violence at some
1.1 Violence: an international
point in their lives, mostly committed by an
perspective
intimate partner5
In this report we focus on alcohol’s contri-
bution to interpersonal violence i.e. violence • 4 – 6% of elderly are abused in some way in
between family members, friends, acquaint- their homes2
ances and strangers, and includes child • N early one-quarter of adults worldwide
maltreatment, youth violence, intimate partner report physical abuse as a child, one-third
violence (IPV), sexual violence and elder emotional abuse and 1 of 6 physical neglect4
1 of 5 girls abuse. This report will not, however, address
• T he lifetime prevalence of childhood sexual
and 1 of 13 the important role of alcohol in self-directed abuse differs by gender – almost 1 of 5 for
violence (e.g., suicide) or collective violence
boys have girls and 1 of 13 for boys.4 Applying these
(e.g., wars, civil unrest).
figures to the population of children in Eu-
suffered from Regardless of its cause, experiencing vio-
rope suggests that 18 million children have
lence can result in many types of harm, not
childhood suffered from sexual abuse, 44 million from
only traumatic injuries but also longer term
physical abuse and 55 million from mental
sexual abuse. effects on physical, psychological, reproduc-
abuse.6
tive and sexual functioning in adults and
• I n Sweden during 2015, 2.5% of men and
deprivation or neglect in children.2 Violence
1.5% of women aged 16 – 79 were assaulted
represents a serious problem throughout the
and 3.0% of women and 0.4% of men report
world affecting males and females of all ages
being sexually assaulted.7
as illustrated by data from the World Health
Organization2 and the UNODC.3
It is estimated that 1 billion children globally
• 8 out of every 10 homicide victims are male
– over half of all children aged 2–17 years –
but women accounted for the large majority
have experienced emotional, physical or sexual
of domestic violence fatalities4
violence in the past year. Globally self-reported
• M en are mostly killed by someone they child sexual abuse has been found to be 30
don’t know, while almost half of all female times higher and physical abuse 75 times high-
victims are killed by someone close to them3 er than official reports would suggest. Perpe-
• 3 5% of women worldwide report experienc- trators of sexual violence against girls are pre-
8 ALCOHOL AND VIOLENCE
1 INTRODUCTION
dominantly males. Girls are also more likely to effects that arise from exposure to violence,
experience either sexual or physical intimate as illustrated in Figure 3. While all types of
partner violence (IPV), rape by acquaintances violence have been strongly linked to negative
or strangers and genital mutilation/cutting.8 health consequences, violence against women
Elder abuse can take many forms includ- and children contributes disproportionately to
ing physical, psychological and sexual abuse, the burden. Victims of child maltreatment and
financial as well as exploitation, neglect and women who have experienced IPV and sexual
self-neglect, medication abuse, abandonment, violence have more health problems, incur
scapegoating, and marginalisation of older significantly higher health care costs, make
people in institutions.4, 9 more visits to health providers, have more
Violence against women, against children, hospital stays, are more likely to have sexually
and elder abuse are all prone to underreport- transmitted infections and unwanted preg-
ing in official death statistics, police reports nancies, and are more likely to smoke. Women
and data on injuries treated in hospital emer- exposed to IPV are almost twice as likely to
gency departments.4 have an alcohol use disorder, twice as likely
to experience depression, and have a 4.5-fold
1.2 Health effects of violence beyond increased risk of suicide attempts compared to
physical injury women who have not been exposed to partner
The immediate consequences of violence, violence.4, 8
namely physical injuries and deaths, are only Studies from Sweden also show that victims
a small fraction of the total burden from vio- of violence are at greater risk of subsequent
lence to society. There is also a wide spectrum health problems. For example, a major survey
of longer term negative behavioural, cogni- of the Swedish population10, 11 found that vic-
tive, mental health, sexual and reproductive tims of serious violence were over-represented
health problems, chronic diseases and social among respondents who reported PTSD,
FIGURE 3 Consequences of violence
Physical Mental health and Sexual and Chronic disease
behavioural reproductive health
• Abdominal injuries • Alcohol and drug • Unintended • Arthritis and asthma
• Thoracic injuries abuse pregnancy • Cancer
• Brain injuries • Depression and anxiety • Pregnancy • Cardiovascular
• Burns/scalds • Post-traumatic stress complications disorders
• Fractures disorder • Unsafe abortions • Diabetes
• Lacerations • Eating and sleep • Gynaecological • Kidney problems
disorders disorders
• Disability • Liver disease
• Attention deficits • Complex pain
• Stroke
• Hyperactivity syndromes
• Externalizing behaviour • Chronic pelvic pain
• Smoking • HIV
• Suicidal thoughts • Other sexually
• Suicidal behaviour transmitted infections
• Unsafe sex
Källa: WHO Global status report on violence prevention, 2014
ALCOHOL AND VIOLENCE 9
1 INTRODUCTION
depression, psychosomatic symptoms, self- tested positive for alcohol and 33% were
harm behaviour, risky alcohol intake, low determined to be intoxicated using the 0.08
self-rated physical health and (among older threshold.15
respndents) heart attacks. Individuals who Other research from high-income countries
had experienced past psychological abuse were shows that alcohol consumption by either or
twice as likely to report current alcohol abuse. both victims and perpetrators of violence is
Using registry data, it was found that indi- associated with greater injury severity.16 In a
viduals who had experienced severe physical comprehensive worldwide review of studies on
or sexual violence during their lifetime were violence, alcohol was found in approximately
about three times more likely to be diagnosed 50% of both perpetrators and victims.17 The
with heart disease. review also concluded that alcohol was more
closely linked to murder, rape, and assault
1.3 Alcohol-related violence than any other mood-altering substance, and
Alcohol use is associated with significant was a contributing cause in most homicides
proportions of each of the types of violence arising from personal disputes or arguments. A
described above, and hence also with their
WHO report concluded that prior to a violent
ensuing health and social consequences. Here
incident alcohol is usually consumed by be-
we discuss evidence on the extent of the associ-
tween one-third and one-half of perpetrators.
ation between alcohol and different types of
Individual country estimates were USA 35%,
violence, both internationally and in Sweden.
South Africa 44%, England and Wales 45%
and China 50%.12
1.3.1 Association between alcohol and
Alcohol use is prevalent in different types
violence worldwide
of violence including child maltreatment, IPV,
Alcohol use by both perpetrators and victims is elder abuse and sexual violence. Estimates of
common in incidents of rape, assault, robbery alcohol-related IPV vary between countries
with injury, and family violence.12 European with the percentage of perpetrators who are
and U.S. studies find that drinking to the point impaired by alcohol ranging from 48% to
of intoxication is especially associated with 87%.18 In relation to elder abuse, many studies
violence and aggression.13, 14 A review of 71 031 have found that perpetrators misuse psy-
toxicology test results from 78 265 homicide choactive substances and are alcohol or drug
victims across 13 countries found that 48% dependent. In the United States, 44% of male
and 14% of female abusers of parents (age 60
years and over) were dependent on alcohol or
drugs, as were 7% of victims. In England, 45%
of care-givers for older people receiving respite
care admitted to committing some form of
abuse, with alcohol consumption by caregiv-
ers being the most significant risk factor for
physical abuse. In Canada, a national study of
elder abuse case files from agencies found that
drinking by the perpetrator were responsible
for 14.6% of cases.9 Finally, it is estimated
that between one-third and three-quarters of
sexual assaults involve alcohol consumption by
the perpetrator, the victim, or both.17 A study
of victims of sexual assaults in Copenhagen,
Denmark, 2001-2010, found that alcohol was
involved in 60% of the cases.19
10 ALCOHOL AND VIOLENCE