Community Prevention of Alcohol Problems

261 Pages·1997·23.828 MB·English

by  Marja Holmila, Jo Campling (eds.)

COMMUNI1Y PREVENTION OF ALCOHOL
PROBLEMS
Conununity Prevention
of Alcohol ProbleDls
Edited by
Matja Holmila
Senior ResearcMr
Social Research Institute of Alcohol Studies
He15inki
Finland
Foreword by Sally Casswell
Professor, Director of Alcohol and Public Health Research Unit
University of A uckland
Ncw Zealand
Consultant Editor: Jo Campling
in association with
Palgrave Macmillan
Editorial matter and selection © MaIja Holmila 1997
Text © Macmillan Press Ltd 1997
All rights reselVed. No reproduction, copy or transmission of
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Copyright, Designs and Patents Act 1988.
First published 1997 by
MACMILLAN PRESS LTD
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and London
Companies and representatives
throughout the world
ISBN 978-0-333-64840-7 ISBN 978-1-349-25854-3 (eBook)
DOI 10.1007/978-1-349-25854-3
A catalogue record for this book is available
from the British Library.
This book is printed on paper suitable for recycling and
made from fully managed and sustained forest sources.
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Contents
List 0/ Tables ix
List 0/ Figures x
Acknowledgements xi
Notes on the Contributors xiii
Foreword xiv
1 Introduction 1
Ma7ja Holmila
1. Hann Prevention in Transient Communities 1
2. Preventing or Promoting? 4
3. The Surface Level and the Deep Structure
of Community Life 7
4. Reflexive Problem Prevention 8
5. The Lahti Project 10
6. Research Methodologies 14
Part I Loca1 Prevention in Context 21
2 Alcohol Policy, the State and the Local
Community 23
Pekka Sulkunen and Jussi Simpura
1. Introduction 23
2. Alcohol and Consumption Risks 24
3. Alcohol Policy and the Modem Trinity of
Progress, Universalism and Nationalism 26
4. Modemity, Alcohol and the State in the
Nordic Countries 29
5. Globalization and Localization: Bifurcation of
Nation-State Politics 34
6. Alcohol-Related Issues in Globalization and
Localization 37
7. Future Perspectives 39
3 Constructing Alcohol Problems in the Community 41
Jussi Simpura
v
vi Contents
1. Introduction 41
2. The Multiple Channels of Problem
Construction 42
3. The Culture, Sodal Structure and Public
Opinion 46
4. Local Media and Alcohol Issues 48
5. Alcohol-Related Issues in Local
Administration and Politics 51
6. Local Civil Action and Alcohol Issues 53
7. Conclusion: Community Action as Problem
Construction 54
4 Alcohol and the Imperative of Health in Mass
Sodety: Images of Alcohol Policy among the
Local Elites 56
Pekka Sulkunen
1. The Public Health Predicament 56
2. Positions and Values 58
3. Control and Transgression 60
4. Three Views on Aleohol Poliey 62
5. Defending the Public Good 65
6. Cultural Intermediaries 68
7. Moral Authority 73
8. Political Ideology versus Individual Choice 74
9. Conclusion: Endotactic versus Exotactic
Value Systems 77
Appendix to Chapter 4: The Research and
Intervention Methods 81
Jukka Törrönen and Pekka Sulkunen
n
Part Reflexive Intervention 93
5 The Educational Activities 95
Maria Holmila
1. Introduction 95
2. Major Happenings 97
3. Targeted Happenings 102
4. Produced Materials 103
5. Media Advocacy 104
6. The Content of the Education 106
7. Summary 106
Contents vii
6 Brief InteIVention in Primary Health Care 108
Pelika Sillanaukee
1. Introduction 108
2. The Goals and the Process 111
3. Educating the General Practitioners and
the Nurses 113
4. Experiences from the Project 115
7 Responsible Service and Drinking Environments 123
Ma'lja Holmila and Kari Haavisto
1. The Market for Alcoholic Beverages in Lahti 123
2. Violence and Disorder 126
3. The Controversial Responsibility 129
4. SeIVer Training 132
5. Summary 134
8 The Young and Alcohol 136
Ma'lja Holmila and Kari Haavisto
1. SUITounded by Ambivalence 136
2. Playing with the Bottle: Young People's
Drinking Habits 137
3. Taking Care: the Street Service Mono 141
4. Activities with the Adolescents 143
5. What Should the Big Ones Do? 150
6. Coordinating the Activities 152
7. Conclusions 152
9 Family and Other Close Persons 154
Ma'lja Holmila
1. The Painful Contradiction 154
2. Who are the Intimate Others? 155
3. The Experiences and Actions of Intimate Others 157
4. Printing Out the Experience 164
5. Group Consultations for Family Members 165
6. The Power of Naming 167
7. Conclusions 169
Partill Assessing the Utility of the Lahti Project 171
10 Process Evaluation 173
Ma'lja Holmila
1. The Evaluative Viewpoint 173
2. The Programme Theory 175
viii Contents
3. The Partidpants' Experience and Ratings:
Prevention is Food, Love and Common Sense 176
4. Summarizing the Process 180
11 Outcome Evaluation 183
Marja Holmila and Jussi Simpura
1. Visibility of the Lahti Project in the Local
Newspapers 183
2. Reaching the Audience 186
3. Changes in Perception of Alcohol as a Sodal
Problem 188
4. Changes in Public Knowledge about Alcohol 190
5. Changes in Drinking Behaviour:
Statistics on Alcohol Consumption and
Alcohol-Related Harm 195
6. Changes in Drinking Habits: the Survey Data 200
7. Changes in Sodal Response to Alcohol
Problems 203
8. Dissemination of the Project Experience 204
9. Conc1uding the Outcome Evaluation 204
Part IV Conclusions: Local Community in
Preventive Action 207
Marja Holmila
1. The Community as the Focus of Prevention 207
2. Ideology and Opinions 208
3. Fleeting Communities and Transient Networks 210
4. The Neutral Language of Evaluation 211
5. The Relevant Surface Communities 212
6. Creative, Ritualistic and Emotional 215
Appendix 1 Unemployment Rates 217
Appendix 2 A Guidebook JOT Controlled Drinking 218
~J"enc~ 225
Index 242
List of Tables
2.1 Centra1 features of the welfare state
development and alcohol policy in Finland,
1930-95 31
5.1 The educational activities in the Lahti project 97
8.1 Frequency of drinking, 14-year-olds in Lahti 138
8.2 Frequency of drunkenness, 14-year-olds in
Lahti 138
8.3 Number of adolescents arrested for
drunkenness 144
8.4 List of youth work activities in Lahti project 144
9.1 Percentage of those who reported having one
or more elose people drinking 'too much' 156
9.2 The effects of a elose person's drinking,
respondents in Lahti 157
9.3 Harms caused by a elose person's drin king,
interviewees in Lahti 159
11.1 The content of drug- and alcohol-related
artieles in two local newspapers in Lahti,
October 1993-April 1994 184
11.2 Incidence of various alcohol-related diseases
in Lahti, 1990-94; in-patients treated in
somatic hospitals 199
11.3 Selected alcohol-related hann indicators,
Lahti and all of Finland 199
11.4 Abstainers and frequent drinkers in Lahti
and three comparison sites, 1992 and 1995 201
11.5 Frequency of heavy drinking: proportion of
those drinking six drinks or more per session,
Lahti and three comparison sites, 1992· and
1995 201
11.6 Mean values of estimated annual alcohol
consumption, Lahti and three comparison
sites, 1992 and 1995 (el 100 per cent alcohol) 202
11.7 The proportion of respondents exceeding
certain limits on the AUDIT scale, Lahti and
three control sites, 1992 and 1995 202
ix
List of Figures
1.1 Reflexive eommunity prevention 9
3.1 A sehematie presentation of the loeal and
general fields of problem eonstruetion 45
4.1 Causal strueture of argumentation on
aleohol policy 66
4.2 Aleohol policy views in Group 6 (Members
of the City Council) 75
6.1 General design of the brief intervention study 112
11.1 Do you reeall having seen or heard about the
following aetivities in the Lahti projeet? 187
11.2 Do you eonsider alcohol use to be a serious,
rather serious or not at all serious problem
in Lahti? 189
11.3 Aleohol eontent: one portion. Estimates by
frequent drinkers 191
11.4 Harmful level of consumption. Estimates by
men and women who drink frequently 193
11.5 Aggregate aleohol eonsumption, Lahti and
three comparison sites, 1990-94 198
A.1 Unemployment rates in Lahti, three
eomparison sites and all of Finland 217
x